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Medical & Health Profession Education - Science topic

Medical & Health Profession Education is a created for Medical & Allied Health Educators
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Kaplan books, text books, first asid?
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Many students report great pace and success rate with Boards and Beyond + Pathoma + Sketchy + First Aid + UWorld for Step 1, while most of them reserve Kaplan for Step 2 CK.
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suggest some indexed journals with low publication charges that publish medical education related research projects
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List of journals
1.Journal of Education and Health Promotion
2.Journal of Medical Education and Curricular Development
3.Perspectives on Medical Education
4.International Journal of Medical Research & Health Sciences
5.Advances in Medical education and practice journal
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CoVID-19 has affected teaching and migration to an online platform is inevitable. What are the ways to do so and what makes it a smooth transition?
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Jasvinder Kaur Bhatia that is an excellent question and one which I am afraid has no quick and easy answer (although Anton Vrdoljak , I love screen cast o matic). The Journal of Literacy and Technology has just published a rapid response journal on this very subject. I will be the first to admit that some of the findings are not the perfect answer that everyone is looking for but they do speak to Heena Chawda 's excellent point that whether we like it or not, chalkboard or no, the educational world has fundamentally changed. This scholarship within the journal was created by people in the pandemic, for people in the pandemic. If preferred technology is what you are looking for (LMS, video sub-systems, and the like) this is probably too in depth for your needs. If you want a more expansive look at the issues it might be helpful as an expose on first findings in suddenly online research.
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Are there any specific laws that dictate the format of a medical prescription? Is using abbrevation such as bd, t.i.d, o.d, a legal requirement?
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Any one can tell what are the ethics of prescription
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I'm currently looking for a tool to do a quantitative study that measures the relationship between the entrepreneur's characteristics and medical education. The tool might be on the teacher perspective or student perspective. I'm looking for a validated tool that I could use (preferably free) in this study.
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Rizqy Rahmatyah Good topic. Want to know about it.
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Various models like Apprenticeship model, BID model, Koen's Model, One Minute Preceptor (OMP), 4C/ID model etc have been previously utilized for surgical resident's training. Dynamics of student learning and resident learning, however, in operating room are significantly different. Which models of learning are appropriate for medical student's learning in Operating Room and why?
We are trying to establish the role of structured learning process of a medical graduate in Operating Room (OR) setting and trying to analyze the potential role of various models being currently used for surgical resident training in OR-based learning of a medical student.
You can also record your response in this survey below:
This can take your time but eventually it would be productive one.
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We are trying to bring about some curricular changes to improve medical education.
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I'd start by embedding the simplification in every aspect of the institution's fabric, then the rest falls in place.
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How to apply test of significance of differences of percentages? There are some online calculators available, but are they reliable?
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McNemar test used for pre post in SPSS.
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I just learnt that some people are already Professors without having the highest degree which is PhD. How possible for someone to become a Prof without obtaining a PhD degree ? What are the criteria for such appointment if possible? Can someone become a Professor with a Master's or Bachelor's Degree ? Kindly give an instance if possible . Thanks
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Sounds strange in practice, but in theory i don't think the amount of research one has carried out will merely qualify such a person for Professorship without any Ph.D. Maybe Honorary Professorship which is also rare. Because i know honorary degrees are usually awarded based on your highest qualification.
For instance, if i have a Masters in say - Law, any university granting me an honorary degree will award me a Ph.D. If i was First degree holder, then i will be awarded a Masters degree. To award me a Prof. from just first degree or Masters sounds strange.
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Interprofessional education is important for healthcare system as it is a team work. Looking for ideas / methods which are effective in improving interprofessional skills in healthcare education.
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This is a wonderful question. I typically use focused mentoring within an inter professional team. The interprofessional team research provides a setting where students, fellows, and other trainees gain first hand experience in needed skills such as building and engaging team members, holding colleagues accountable for promised work, negotiating roles and responsibilities on a project, presentation, or paper, and handling disciplinary differences in academic support for team science, culture and communication patterns, and measures of success, .
As challenges emerge, I try to provide opportunities for discussion of both the rewards and challenges of interprofessional team work. More recently, I have been interested in developing resources for trainees in the most important skills needed for interprofessional teams.
Looking for suggestions on resouces for interprofessional training, including any curriculum development on training in interprofessional team research and any program that involve explicit training in the important knowledge and skill domains needed for interprofessional team research.
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Chronic pain is difficult to treat
Acetaminophen is usually inadequate
Non-steroidal agents have long term toxicities- renal and cardiac and annual bleeding risks
Opioids are available in all countries [Oxycontin, Vicodin, Tramadol, Tramacet, etc] and prescribing at low doses invariably lead to higher doses/more powerful opioids and then addiction.
So the BIG question is: how to treat chronic pain conditions effectively, without causing addiction?
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So the BIG question is: how to treat chronic pain conditions effectively, without causing addiction?
Dear Fazleh,
Chronic pain is a very broad term where it could be malignant chronic pain(related to cancer and AIDS) and non-malignant chronic pain(which can be neuropathic, inflammatory, nociceptive..etc). Hence, pain management plan varies widely based on the pain type; e.g: neuropathic pain is more likely to benefit from gabapentin or pregabalin but not opioids.
Concerns about addiction could be minimized through different strategies as recommended by the guidelines (for example: opioid rotation, relying more on sustained release formulation rather than the immediate release, as well as continuous follow up). Fear of addiction should not lead to improper pain control in this population. Moreover, there are some tools that can assist the physician to predict those patients who have higher risks.
you may have a look at:
Opioid Treatment Guidelines
Clinical Guidelines for the Use of Chronic Opioid Therapy
in Chronic Noncancer Pain
Regards.
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The software would for example model the effects of changes in blood pressure, heart rate and rhythm, skin colour change, in response to various interventions such a drug administration, change in posture, blood loss etc...
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We have a great software solution that has been integrated into both software and hardware at https://pulse.kitware.com/
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Universities usually put a premium on research outputs[PhD frenzy], but seem to give little emphasis to teachers and teaching.
Students are also the bread and butter of any institution, so this does seem odd.
There should be more standardized courses for the teachers/tutors [ train the trainer courses], more testing and validation of teachers and more incentives for teachers.
How many universities have standardized validation and evaluation of their teachers?
Are we disrespecting our teachers? How do we better value them and retain them?
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Dear Fazleh,
This is a million dollar question. It is indeed a disturbingly interesting problem that teachers and universities are facing across the world. Just this morning, a lecturer posed this question when we were having a course in University pedagogy. The problem, however, had started in the US even some decades before1920s when Universities shifted their commitment from centers of advanced learning to research Universities. They did this by turning themselves into “‘corporations of the education industry’ to gather a lion’s share of social resources available to higher education ……and also to focus on educational products for the most important national markets.” What is noteworthy is that across the Atlantic and elsewhere, private financing and philanthropic sources have historically turned the University’s other institutional mandates (advanced learning and teaching) into research focus and issues that mattered to certain policy makers with economic and political clout.
But it seems that at least across the Scandinavia there is a better grasp of the problem; Universities provide courses for lecturers, researchers and PhD students so that they can develop their teaching skills in order to engage students better. Thus, teachers are respected and valued very much in the Nordics.
Elsewhere however, the problem is a little different and precious little is being done to solve it. This is because
1) There are so many adjuncts to do the teaching at a lower cost (most will never get tenure).
2) This also frees the main professors to engage in research and become more popular - this is good for the University’s brand but at the researchers’ cost: limited time, pressure and lessened incentives.
3) Research is also the main criteria for showcasing the intellectual power of universities in their quest to brand themselves. Hence, it remains the priority.
4) Apart from basic research, so many other forms of research have become mostly innovation-focused in collaboration with industry. Once the financial incentive structures are established, the researchers and the Universities see this as a path worth pursuing. Of course, that makes economic sense but at the expense of teaching.
“Why is teaching not valued by Universities?” Clearly, the research-focus has meant that teaching is sometimes undervalued and in some cases teachers are undermined and disrespected. In the short term it would be possible to gloss over such a problem, but the long-term effects can be very detrimental for teaching and learning.
What to do?
-Make teaching as important as research, in such a way that we incentivize both.
-Give more training to teachers/lecturers to develop their skills (as in Finland).
-Make teaching count as much as research during evaluation. Of course, sometimes universities need to adjust both, based on individual aptitude. Some people are more research oriented while others are more teaching oriented. Universities can figure out where and how to allocate who in order to get the optimal results-taking into consideration their areas of strength.
Please see: Roger L Geiger. To advance knowledge: The growth of American research universities, 1900-1940. Oxford University Press. Acknowledgements to colleagues from my pedagogy course.
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During clinical consultation doctors and nurses interview patients about their medical history. But, patients are usually not prepared for the clinical consultation. In theory, if patients administer their medical history on a computer/tablet before their appointment with the doctor or nurse, then they should be prompted and prepared for the medical history interview. This is one of the hypothetical advantages of patient-administered computerized history taking systems/automated medical history taking systems. What quantitative and/or qualitative factors measures exist that would assess if patients are prepared for the medical history interview?
I'm actually interested in identifying doctor-patient communication and non-communication measures that would determine if a group of patients who took an electronic medical history questionnaire were more prepared for a clinical consultation compared to a group that didn't take the electronic history questionnaire.
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There isnt any
I am just authoring
How to get the best from your GP practice to try to fill this gap!
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In many universities, teachers are also expected to be involved in research as a result of which teaching suffers. I have tried looking for evidence but would also like to know what others feel about this widely debated issue.
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It depends on the person. If a researcher is a good teacher then he/she can contribute the society in a high level.
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sometime it becomes very confusing to manage the scenario in which student found to be sleeping in the middle of the class; and he/she has the reason for it but not actually to be valid to consider for his deed, like viewing TV shows for late night or viewing foot ball for late night. should i take disciplinary action against him/her or let him sleep there or send him to his room to sleep?
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I see this differently. Human brains are changing, affected by technology, exposure to voluminous screen time, multiple inputs. I hate to be the one to say it to this group, but the talking head is dead. Even highly educated adults, in voluntary situations, cannot stand to sit for hours on end anymore. Class should be more focused on the higher end of the learning pyramid: towards analysis, synthesis, and this often the best use of class time, not lecturing on what can be read outside of class. The world needs the skills of collaborative thinking, design thinking, not ability to rehash and regurgitate. Tolerance for this is long gone, and I fear many of us have failed to retool. Rethink, retool, reboot our schools (or class)!
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a. Allow them to transfer into DR.
b. Make them finish their IR residency commitment first.
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Ask them what about IR is less appealing to them; what has deflated their interest in IR; many times a particular instructor or professor can be harder than the IR resident anticipated. Getting to the basis of their thought process regarding seeing themselves in IR often will be a key to helping them in their decision making.
Dennis
Dennis Mazur
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IR residency will be challenged by being one of the most specialized residencies in the NRMP match and yet not having a required clerkship in the medical school curriculum. How do you plan on ensuring that students have adequate exposure to IR prior to making their career decisions?
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A good lecture session for half a day or one day should be informative.
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a. Heavily. We will likely recruit at least one resident per year on the Independent Pathway.
b. Sporadically. We will likely use it only to fill in gaps every few years.
c. Seldomly. We will likely never use that pathway to recruit.
d. We haven’t thought about this.
e. We won’t have an IR residency.
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e. We won’t have an IR residency.
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Do you currently participate in any of the following activities to improve medical student exposure to IR:
a. IR Student Interest Group
b. IR Sub-Internship
c. IR Electives
d. Participation in an IR Medical Student Symposium
e. IR faculty teaching in the M1-M3 medical school curriculum
f. Encourage student engagement in the SIR RFS
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A medical or surgical rotation should include students on rounds with the team to see all radiographs (interventional or non-interventional) taken on each day of the medical student rotation on any service where radiographs are taken.
The radiologist should begin questioning of the interpretation of the radiographs with the medical student going first.
Dennis
Dennis Mazur
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I am looking for opportunities as a research fellow in institutions doing research in
1.clinical areas eg  evidence based medicine,  reproductive health,  population control,  infectious disease (HIV/AIDS, malaria,  tuberculosis etc) , noncommunicable diseases
2.public health ( health economics, health equity)  especially in developing countries 
3.Medical education ( quality and satisfaction measurements and improvements) 
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Public health activities in developing countries are mostly government supported.I think you should think about join in Nigerian Govt. Public Health wing first.
You can also follow the below link:
 Wish your success!!
Regards,
Dr.Munzur-E-Murshid
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I'm researching the observer role in simulation training for healthcare professionals, part of this includes analysing approaches expert faculty have used but that haven't been published.
We're interested in how you developed these approaches, and what you learnt. Full information about the study can be found at the attached link.
If you think you can help contribute, please complete get in touch!
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I think well structured debriefing is so far the best
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What is the appropriate formula for determining sample size in comparing three groups of study population.
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The PASS 15 program has a Multiple Comparisons of Proportions for Treatments vs. a Control. If you have a control group you could try this. 
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my project considers collection and analysis of administrative quality and patient safety data from particular hospital to identify trends in quality and safety and to identify evidence of missed nursing care and its association with nurse staffing and skill mix. 
please any one has suggestions on the  data that should be collected for this purpose from the hospital and the way of analysing it.    
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Care left undone during nursing shifts: Associations with workload and perceived quality of care
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Health promotion in theory and in practice is two different notions, theoretical knowledge can be extracted from the may standard textbooks for the same, but that would be different approaches that can be utilized for imparting practical knowledge?
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I agree Sudeep. But it also pays to think outside the box. Sometimes doing something as simple as getting the person a cup of coffee or a meal can open the door to impart information or getting other services like Social services involved. Our Social Workers are an amazing group of people with outstanding resources. I encourage those that work in any field to look at the other services available and utilize them. You might be surprised at what they can achieve. 
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Dental research is of paramount importance in order to improve mankind's ability to preserve and conserve humanity's oral health.India being a nation of more than a billion people has both the challenge to keep dentistry affordable and reachable and the opportunity to contribute immensely to global research in a meaningful manner.
The number of colleges that our country has along with the thousands of postgraduate students actively doing their dissertations makes it a fertile ground for us to translate this into a research powerhouse. But is that it, Why is dental research still not getting its due importance here and what can be done to bring it out from the shadows into the limelight.
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Acknowledging the factors mentioned in the earlier comments, I would also add another factor here that is collaborative research. I say this because I was personally conducting research on dental implants at the Material Testing Laboratory, Departments of Material Science, IIT Bombay, a few years ago. The aim of the research among other things was to improve the mechanical strength of the dental implants to lend them longevity as well as making them cheaper by using newer materials. We were fortunate to be partnered by the local dental colleges in and around Mumbai; although, we had to struggle with a lot of dentists due to their inertia to participate in such research. They were not really enthused about the project primarily due to lack of mental bandwidth that a practising doctor can offer and also because research in India is unstructured. 
I would, therefore, say that more structured collaborative research is required which would not only enrich the field but ultimately benefit the patients too. 
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There is a wealth of research and information in relation to waste medication in primary care but appears to be limited when related to secondary care (hospitals). I am interested in how health professionals view medication waste and the impact this has upon health services. Additionally I wish to look at the root causes of medication waste within secondary care.
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Dear Karen Stone
Adequate knowledge about the health hazard of hospital waste, proper technique and methods of handling the waste, and practice of safety measures can go a long way toward the safe disposal of hazardous hospital waste and protect the community from various adverse effects of the hazardous waste. With this background, you must consider the levels of healthcare professions in you study and you must prepare appropriate questionnaire for each of them...
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For example, medication errors in surgery alone should be done or DUE along with medication errors can be done? please suggest alone or a combination is better?
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Greattopic - medication wrrors. But can you b more specific on this plese?
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What do you think about the definition of e-health? Is it clearly presented in health profession? or it is a future thing to come? Are there regulations to observe/control this concept in different countries? 
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With the contributions of all the RG colleagues on our question early this year 2016 on e-health, we were able to produce the attached paper on the concept maturity of e-health. Hope this paper give a better understanding for the current status of this concept.
Regards to all
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I have the HWQ questionnaire but I cannot find the scoring - has anyone had experience of this? 
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Now, The role of evidence-based medicine in the medical sciences is growing. I'm interested to know how can write an excellent Systematic Review. I want to know:
1. What steps is a systematic review?
2. What is the standard of a good systematic review?
3. What steps must be followed at each stage?
Please introduce to me articles, books and related sites that can answer my questions.
Thanks a lot and wish all the best for you
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Dear Sajjad,
I found the following two papers containing a very helpful step by step guide to conducting a systematic review.
1.       Khan, K.S., Kunz, R., Kleijnen, J. & Antes, G. (2003) Five steps to conducting a systematic review. Journal of the Royal Society of Medicine. 96 (3), 118–121.
2.       Wright, R.W., Brand, R.A., Dunn, W. & Spindler, K.P. (2007) How to Write a Systematic Review: Clinical Orthopaedics and Related Research. [Online] 45523–29. Available from: doi:10.1097/BLO.0b013e31802c9098.
Make sure you stick to the PRISMA guide when reporting (especially if you are planning to publish your paper), and for quality assessment I found Jadad score been heavily used to assess the quality of RCT included.
There will be some variations if you plan to encompass other design than a RCT. The book titled “doing a systematic review: A student guide” is useful as well (reference below).
3.       Angela Boland, M. Gemma Cherry, & Rumona Dickson (eds.) (2013) Doing a Systematic Review: A Student’s Guide. 1 edition. London ; Thousand Oakes, California, SAGE Publications Ltd.
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In the on call duty, a patient presented to the ER. Retrospectively there was suspected major medical negligence and near miss, who is legally responsible; the attendant physician was a junior resident in hospital. The on call rota includes a resident + a specialist and a consultant. In the case of legal complaint who is responsible if the specialist and the consultant were not informed about the case and if they were informed and have not seen the patient.
second question; who should be responsible for admission of cases; junior resident, senior resident, specialist or consultant?
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Dr. Sersar,
The answer to your question is decided by the judicial system where the medical negligence exists.  You are in Saudi Arabia and I can't speak to the rules regarding medical jurisprudence in your country.   
In the USA there are 4 elements to malpractice.
Duty – A duty must have been owed to a patient by a healthcare practitioner charged with that patient’s care. The doctor-patient relationship is a common example of a situation where that duty would exist.
Breach of Duty –The healthcare practitioner who had the duty of care for that patient must have failed in his/her duty by not exercising the degree of care or medical skill that another healthcare professional in the same specialty would have used in an equal situation. (This is when an expert is often called in to testify as to what an appropriate standard of care would be.)
Damage – The patient must have suffered emotional or physical injury while in the care of the healthcare practitioner. The injury can be a new one, or an aggravation of an existing injury.
Cause – There must be solid proof that the breach of duty by the healthcare practitioner caused the patient’s injury.
A successful medical malpractice suit will have proven that all four of these factors exist. If the defendant or healthcare practitioner being sued can prove that one or more of the elements does not exist, then the plaintiff would not prevail.
Each individual involved in medical negligence can be found at fault. Not just the attending physician.   Negligence cases can target multiple individuals.
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We would like to implement SBAR communication in a German Hospital. We are thankful for all advices, hints or literature tips: What are the main obstacles? What structures do we need for successful implementation? How should a SBAR training look like? How should we evaluate the effects of SBAR? etc.
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I have found recently, that it's just as important to train the physicians as the nurses.  Doctor's will know what specific infomation nurses will provide and not be overwhelmed by what is coming at them over the phone. Nurses have a tool to give doctors quick, pertinent information so that doctors can make a quick, informed decision about care. I've used it and feel it saves time for both the physician AND the nurse. SO, when training for its use....include doctors.
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We want to conduct a research to access medical students' knowledge about patients' rights.
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Thanks Anjali
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Literature, names of experts, special interest for instruments that have been validated / evaluated
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you can use the ICAST tool
it is the ISPCAN Child Abuse and Neglect tool, it is available in the website of ISPCAN and we translate it to Arabic
you can contact the national family safety program to send you the arabic tool
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I need it for my masters research and couldnt find a validated one.Does anyone know about questionnaires to identify faculty perception about roles and expectations from the medical education department?
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Hello Saima,
I would advise you to conduct qualitative research design. I performed a study interviewing doctors, nurses, students and parents to gather information about the current status of our "hidden curriculum" of our pediatric department.
The paper will be published soon. Referring to our results surprisingly it is more about the people in your department and the attitude of the actual working environment that influences  expectations on medical educations. I would start to collect these information and develop your strategy afterwards.
Best regards
Eric
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There are a number of non profit organizations in developing countries seeking to bring solutions for problems in health care These organizations often come with well trained practitioners with specialized skills and knowledge. With sustainability and longevity in mind, how do the local health care practitioners interact with their visiting colleagues? Does a transfer of knowledge occur? Are local practitioners often inspired to seek to acquire more knowledge in these specializations or perhaps alter their current methods of diagnosis andtreatment? Or do the benefits of the visiting practitioner's skills and knowledge lost, or abandoned when the visitors leave?
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The outcomes obviously vary depending on the work settings, rules, personnels, & prior experiences. It can go either ways. Some well-organised institutions have already formulated interaction code for physicians` interactions.
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My classmates and I researching the knowledge, skills, and disposition required to open a private practice as an occupational therapist. Our research team is investigating many different health professions who have opened a private practice to find gaps in education to allow new graduates to feel more confidant about opening a private practice. 
We would appreciate any advice or article you might deem helpful because this is our first research project. 
Thank you!
Sam 
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Your clinical skills are as well as the softer skills are important to maintain an evidence-informed, patient-centered system of care.  The following business skills may also be helpful:
Organizational behavior and human resources: Staffing issues such as hiring and firing, and management issues such as leadership and motivation.
Strategic management: The process by which an organization determines its long-run direction, sets goals and objectives.
Finance: The process of acquiring, investing, and managing resources such as offices and equipment.
Marketing: Defining target markets, selecting market positions, and managing product, pricing, communications, and channel decisions.
Legal and ethical Issues: Tort liability, contracts, labor law, agency and organizational law, and ethical decision-making.
Accounting: The process of managing the recording, reporting, and analysis of financial transactions of a business.
Managerial decision making: The use of research design and statistical tools to improve decision-making.
Operations and systems management: Managing the processes that produce and distribute products and services.
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How can you provide dental treatment to the patients with severe gag reflex. Specially recording the impressions become a serious problem for such patients .... how do we deal with this.
Please share your experience ?
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First start with the ABCs of dealing with this issue: The choice of trays that don't extend excessively; the choice of impression materials that don't easily flow backwards; and the choice of the right amount of this material so you dont end up with excess flowing backwards.
Then we move to the tricks that could be used, and I could mention a couple here: EITHER have the patient suck a candy made with the medical topical anesthetic tetracaine 1% until it begins to coat both the hard and soft palates, OR have the patient massage their hands with a chemical ice bag. The idea here is to keep the hypothalamus distracted and busy. As you know, the hypothalamus is the part of the brain that, besides other things, controls the gag reflex. So if you can keep this part busy with those "other things", then it will temporarily "forget" about the gag reflex.
Morning appointments are typically given for those anxious patients. To minimize the gag reflex, patients anxiety needs to be at a minimum. So anything that can be done to decrease the anxiety should be tried. Having a chair with heat and vibrating modes that the patient can control during the procedure also helps, since it provides a pleasing vibration meanwhile.
Nitrous oxide is a good way to calm the patient and their reactions to sensations during dental procedures.And finally, antianxiety elixir could be used.
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Constant change in health environment impact nursing practice and education and creates gap. Change demands Graduate education to adapt and innovate to bridge the gap to maintain the balance between education and industry and promote quality health care.
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Grants, scholarships, tuition vouchers, and loan reimbursements, designed to lower the cost of a nursing education, have also tended to depress starting wages. This is because nursing graduates who receive subsidized education through these programs are willing to, or in some cases are required to, work for lower starting wages than they would without the subsidies.As a result all nursing graduates are lower, including for those who did not receive a subsidy for their education through the government programs.
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In a study published in 2011 by the Journal of Royal Society of Medicine (JRSM) entitled "The answer is 17 years, what is the question: understanding time lags in translational research"; the authors estimated that we need up to 17 years to transfer the outcome of many studies into clinical guidelines and clinical practice?
First; do you agree that we are already wasting a lot of time in this process of transfer? Second, do you suggest effective strategies to tackle this issue?
Best Regards
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Some people distinguish translation from implementation.  For them, the former is development of practical clinical applications from basic research; whereas the latter involves the widespread adoption of clinical applications.  It is usually the latter to which the "17 years" is said to apply.  
But, that certainly is not the case.  Some innovations in health care are implemented very quickly.  An example is the spread of laparoscopic cholecystectomy beginning in the mid-1980s or various forms of fiberoptic endoscopy.  Those made economic sense to the potential adopters.  They involved less physician time (laparoscopic cholecystectomy) or were enough less traumatic that more patients would accept them (virtually all endoscopy and endoscopic procedures).  That made a "business case" for adoption, one way to accelerate spread.
Another way is to tie the "innovation" to a system that makes it easy to adopt/use.  For example, it is easier to adopt clinical guidelines based on evidence that can be built into electronic decision-support systems.  If, the clinician has to look up the guideline instead of having it presented in a usable form, it is less likely to be adopted.
Without going into detail, it is worth reading the summary material in Everett Rogers' seminal book on diffusion of innovation published in 1962 and, I believe, still in print.  It gives a number of principles that lead to more rapid adoption.
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Our School district has an opportunity to establish a new model for School Nursing/Health Services. Historically we have had a RN Administrator; for the past 1.5 yrs we have had a non-nurse Administrator and we recently added a Lead Nurse position (.4 FTE). There is discussion around the need for a return to a Nurse Administrator for the department.
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I am sorry, I haven't come across any comparison between nurse administrators and non-nurse administrators specifically for for school nurses. 
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What is the eligibility conditions and registration fee? Is it really important for admission to a Specialty program in USA?
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Hello Armin, 
I work for a school of medicine that trains MD physicians in the United States in a 4-year program.  At this school, the first two years of medical school are called "pre-clinical" because the student is mostly busy attending lectures and skills classes and laboratory classes.  The third year of medical school is called the clinical clerkship, where the student participates in on-site learning at a teaching hospital, rotating through many disciplines such as pediatrics, internal medicine, emergency medicine, etc.  Students  must complete the first two years at our medical school in order to join the clerkships, they must pass a knowledge test before beginning the clerkship rotations, and they cannot graduate from our school without having this year-long experience and receiving acceptable marks for their participation from their preceptors.  Then there is a final  year of medical school where students prepare themselves for graduating and being matched to a suitable residency program, and of course there is a series of formal licensing examinations required in the United States.  So it would not be possible to transfer into our school to participate only in the 3rd year course of study.  
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Literature reviews indicate that expert clinical RNs who transition from acute care settings are not educated to teach in the clinical setting.
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Well this is somewhat tricky question to be answered . as there are various factors affecting the teaching in clinical settings. There are changes in Medical education. The Medical education is changed to student need based. You require mentors for this. The mentors definitely are giving factual directions for actual student needs. The quality of the mentors given is important here. This affects the performance.
I feel that we learn by imitating someone which is natural procedure. Every person learns by seeing something right from the parents.So your Mentor is  important for the role.
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Teaching undergraduate dental students.
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I haven't taught Dental Ethics, but are you already familiar with the book by David T. Ozar,  Dental Ethics at Chairside? If not, it would be an excellent place to start.
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I am planning to study the mosquitoes of Chennai city and need to know what will be the ideal month and ideal place for keeping the traps.
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Depends on the target mosquito type. If you dealing with all mosquito types, then it is prudent to liaise with the appropriate city department. Remember to rehearse the breeding sites then the dept. staff will direct you where to locate your sites 
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I want to know the relation of severity with the specific clinical findings of crepitus sound.
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An interesting question. Years back I started my career with this question.  We tried to record the sound from the joint using a microphone attached to the knee - an experiment not entirely successful. 
Crepitus apparently has no direct relationship to knee OA. It frequently decreases when a knee becomes inflamed or has fluid in the joint, a common occupancy as knee OA becomes more severe. 
Best best in can be an early sign of OA if it is present. 
Siddharth Das 
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I am interested in why some students can score better on MCQ exams than other forms of assessment while others underperform. It seems to me that a think-aloud protocol (cognitive lab) might cast some light on the test-taking strategies. 
There seems to be a lot of work around reading comprehension, but I'm having trouble finding anything in health professions education, which is my are of interest.
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I'd be interested to know of these myself - I can't think of one that examines that specifically offhand.  There are some papers using think aloud to look at other aspects, certainly.  Schuwirth et al (2001) looked at context-free vs case-based MCQs,   Vorstenbosch et al (2013) looked at altering response/answer formats (images vs text).
For cueing effects in MCQs, Schuwirth's 1996 paper is often cited, but it didn't use a think-aloud protocol. 
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In the UK and some universities in the US and Canada, palliative care was not included as a subject in the medical curricula undergraduate courses. Now more and more schools of medicine are incorporating it. A specific tool, validated or not, could be useful to me and others.
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Thanks for the answer, Koshila. I am really interested in to study longitudinally the influence of to learn (or not to learn!, as "William" would say) in the vision of the medicine of the professional. I knew the work of Mason but the Merril'one is new to me. Any thought would be welcome!
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I'm working on a research proposal, dealing with labor migration in the health and care sector. Interested in the situation in Japan, because it should be hit hard by the effects of demographic change. Any recommendations on literature?
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There is some interesting work about trafficking that focus on sex labor migration from Latin America to Japan. 
Piper, N. (1999). Labor migration trafficking and international marriage: female cross-border movements into Japan. Asian Journal of Womens Studies, 5(2), 13.
Leheny, D., & Warren, K. (Eds.). (2009). Japanese aid and the construction of global development: inescapable solutions. Routledge.
Blanchette, T. G., & da Silva, A. P. (2012). On bullshit and the trafficking of women: Moral entrepreneurs and the invention of trafficking of persons in Brazil. Dialectical anthropology, 1-19.
I also attended this session at the recent AAAs titled "PRODUCING ANTHROPOLOGY IN/OF THE "NEW GLOBE": TRANSNATIONAL HUMAN AND CULTURAL MOBILITY IN JAPAN AND BEYOND". Probably some of the participants would be interesting for you.
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For teaching, lecture, small group teaching, clinical demonstrations and laboratory exercises are used very effectively. Theory exam consisting of essay type questions, various type of MCQs are good tools for assessment. For practical exams, OSPE, OSCE Viva and practical performance are tools used for the purpose.
But for skills like communication, interpersonal skills, leadership qualities, research interest, working as team member etc, no significant emphasis is given and no tool is available to judge such abilities in a graduating student.   
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Thanks for prompt reply. 
No doubt, formative and summative  evaluation is very effective and gives good results. But patient counselling is one aspect to be assessed. What about other skills like  research abilities,leadership qualities, punctuality, confidence, motivation,self-reliance etc. How can we evaluate them in formative evaluation.  
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New experience in our college.
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We use the MOSLER in Newcastle Medical School. It tests more than an OSCE in that it allows assessment of integrated clinical skills as in a long case but in a more reliable way. A good review comparing OSCE and long case reliability was done in 1999 by Wass and we have published on MOSLERs, particularly about validity and acceptability.
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Patients are reporting issues such as poor access to care, availability of socio-economic resources and time; knowledge; and emotional and physical energy. (Bee et al. 2014)
The work patients must do to care for their health; problem-focused strategies and tools to facilitate the work of self-care; and factors that exacerbate the burden felt (Eton et al 2014)
Capacity, responsibility, and motivation: a critical qualitative evaluation of patient and practitioner views about barriers to self-management in people with multimorbidity. BMC Health Services Research (Impact Factor: 1.77). 11/2014; 14::536. DOI: 10.1186/s12913-014-0536-y
Building a measurement framework of burden of treatment in complex patients with chronic conditions: a qualitative study. Patient Related Outcome Measures 2012:3 39–49 http://dx.doi.org/10.2147/PROM.S34681
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Have you considered the first tool within the Flinders Program - Chronic Condition Care Planning? You'll find details about it at:  http://www.flinders.edu.au/medicine/sites/fhbhru/self-management.cfm
It's called the 'Partners in Health Scale' and it's a 12 item measure that the person self-rates re their knowledge, relationship with health professionals, access, monitoring and responding, physical, social and emotional impacts, lifestyle, etc. The tool has been validated and used in many research trials and in practice as either a standalone to measure change over time, determine client groupings, determine for services which clients would benefit from care planning, etc.
It has been adapted into other languages and used in the US, NZ, Australia, Hong Kong and some other countries.
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The impact factor is an important issue and just to know more on this.
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Thanks Michael Krichbaum , for your valuable suggestion and i incorporated the topics.
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As I read over the articles and general makeup of this website's literature, I am finding an inordinate number of typos througout. Although I enjoy the articles and sharing of information, I do have one concern.
Over the years, I have found that one of the quickest ways to lose all credibility as a writer and/or publisher is to send out the final product with even one typo within the body of literature. I would ask that greater time and effort be spent in looking into this issue.
P.S. I sure hope you don't find any typos in this critique. :)
Thank you,
Larry Johannessen, Ph.D., LCSW, MSW, MDiv
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I agree that one of the ways in which a professional highlights his or her own competence is through attention to detail, such as spelling and grammar.  My hypothesis would be that the myth of multi-tasking contributes to the downfall of detail.  When we go back-and-forth between tasks, concentration is diminished and more than precise speech is lost.  I have also found that assistance such as 'spell-check' can contribute to the wrong word appearing in a variety of output, from thesis publication to texting.
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I think we can't use general self-efficacy scale for measuring the effect of a specific Intervention on self efficacy. For example I doubt on the accuracy of following article because they measured general self-efficacy by GES 10:
"The Effect of Teaching through Demonstration on Midwifery Student's Self-efficacy in Delivery Management".
Any suggestions are welcome.
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Just to concur that there is a literature on General Self-efficacy that correlates with Self-esteem and a number of other general psychology traits. My bias is showing because while these traits are sometimes interesting and have some predictive power for other general psychological states, they have little value when studying specific behaviors. 
The Bandura approach and/or Ajzen's Perceived Behavioral Control (specifically its Internal Control component) together offer something like 18,000 articles involving a vast array of different and very specific subject areas.  Bandura's own work tends to assume that the behavior involved is desirable (an easy assumption when so much of it is over-coming psychological problems), and a more complete model is found in the Social Cognitive Career Theory found in the career development literature.
I find the literature on Entrepreneurial Intention Model (e.g. in the Entrepreneurship Theory and Practice, or  Journal of Business Venturing) to be particularly interesting because it involves a 20 year evolution of a causal model where Bandua's and Ajzen's construct are used in competing studies.
A couple of people have tried to used one of the General Self-efficacy scales for the study of entrepreneurship, with some success.  But the problem is that in the context of the a entrepreneurship classroom, it seems likely that the questions are interpreted by the students as specific to the entrepreneurship domain.
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(Glasgow et al, 2002; Whitlock et al, 2002)
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Dear Mr Almeira Pino-Oliveira,
I enclose the article of my colleague Dr Sonja van Dillen in which the 5A framework is used (van Dillen SM, Noordman J, van Dulmen S, Hiddink GJ (2014). Quality of weight-loss counseling by Dutch practice nurses in primary care: an observational study. Eur J Clin Nutr. 2014 Jul 2. doi: 10.1038/ejcn.2014.129. [Epub ahead of print]
Best regards,
Gerrit J Hiddink
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I am searching for an instrument to be used to track possible improvements in quality of life for participants in an Alzheimer day program - a therapeutic garden intervention compared to activities as usual. Ideally, the instrument would measure QoL before, during, immediately after, and 6 months out from the intervention (the garden), to see if quality of life (however measured) is improved, and sustained over time.
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Comparison of QoL-AD and DQoL in elderly with Alzheimer's disease   Aurore Wolak-Thierry, Jean-Luc Novella,Coralie Barbe, Isabella Morrone, Rachid Mahmoudi and Damien Jolly a Faculty of Medicine, University of Reims Champagne-Ardenne, Reims Cedex France
Hi Arthur, here is the publication info:
 
b Clinical Research Coordination Unit, University Hospitals of Reims, Reims, France
c Department of Geriatrics and Internal Medicine, University Hospitals of Reims, Reims Cedex, France
Aging & Mental Health Published online: 20 Jun 2014 DOI: 10.1080/13607863.2014.927822
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Could anyone point me towards any papers investigating research/audit capacity in resource poor settings (low and middle income countries)?
I'm interested in looking at work being undertaken in this area, but it seems to be rather neglected and I haven't turned up much on PubMed or Google Scholar. Audit in particular is an essential component of local quality improvement, yet from my recent experience of working in the Republic of Congo and Rwanda, this is an area in need of considerable development.
Many thanks!
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For anyone following this thread, you might be interested to know the the Journal of the Royal Society of Medicine have just published a WHO sponsored supplement entirely devoted to "Narrowing the knowledge gap in sub-Saharan Africa".
The link is provided below.
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The study of health sciences is often compartmentalized: human diseases, live-stock diseases, wild animal diseases. Some of us grew up thinking that doctors were responsible for human health, and vets for animal health.
But for the past decade, we have had severe diseases that involve both human and animal hosts. In Malaysia, we had the fear of H1N1 or swine flu.
What is being done in your country or institution concerning this compartmentalization of health science studies? What innovative collaborations are being put in place to control diseases that involve human and animal hosts?
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Thanks @ Marcel. I get your point. On the link, it is stated that at this moment, we have:
''International bodies such as the World Health Organization and the World Bank have adopted the One World-One Health approach in their collaborative efforts to control avian and pandemic influenza and other diseases of global concern'. And...
'The resulting programs bring together experts ranging from biologists and sociologists to economists and natural-resource managers. The rapid partnering of animal- and human-influenza specialists on the current H1N1 outbreak is an example of how a more comprehensive approach can speed the response to a potential pandemic.'
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When we say PhD do we understand each other? Is anyone, with some expert experience, interested in working on such standards. In 2004 in Zagreb, Croatia we held one meeting on harmonisation of PhD programs in Europe. As a consequence, we made organisation called ORPHEUS which today has over 88 institutions as a members. In collaboration with Association of Medical School in EUROPE (AMSE) and World Federation of Medical Education we developed European standards. Please visit our web site http://orpheus-med.org/index.php
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Thank you Ratan. I hope we are not alone with such a view.
Look in Europe in my field of medicine: in Russian Federation they have two PhDs: aspiratura and doctorate of science, in Germany PhD in clinical medicine practically does not exist (MD title is somethimes based on good but usually small research project. Habilitation is something completly different.
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Seawater can have different effects on skin/ human body as compared to normal water bath. How better/adverse that can prove to be?
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Sea bathing has become one of the most popular hobbies these days. William Buchan wrote in 1701, in his book 'Domestic Medicine', that he advocated the practice of sea bathing as it was thought to have medicinal benefits. The ocean contains all the vital elements, vitamins, mineral salts, trace elements, and amino acids (which is, by the way, a really good reason for using sea salt in our diet, as opposed to 'table' salt). Sea water is bacteriostatic and the cleansing and healing properties of saline have been recognized for many years. Naturopaths believe that bathing in sea water acts directly on chronic health disorders. They believe that cool sea water calms down overwrought nerves, tranquillizing the whole body. By the same token, they believe that warm sea water, during the summer months improves circulation and relaxes muscles. The high salt content also provides natural buoyancy, which also helps with relaxation. It is also considered that the magnesium content of sea water is sufficiently strong to have a nutritional and calming effect on our nerves, which would explain why we find sea water bathing so relaxing. It is easy to see why it would be thought that the motion of the waves in the sea help to massage the body and assist in the removal of toxins.
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What is the pharmacological and structural difference between teophylline and theobromine?
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I'm not sure that I am able to give any good up to date peer-reviewed literature on this, since most of what I know about these chemicals I know from medical and chemistry textbooks.
First, both theophylline and theobromine belong to a class of agents called methylxanthines (along with caffeine). A methylxanthine is a derivative of xanthine. For some pictures of Xanthine, I recommend Wikipedia: http://en.wikipedia.org/wiki/Xanthine to get a picture of a xanthine.
Both theophylline and theobromine have a methylgroup hanging off of one of the Nitrogens in the double ring Xanthine structure, the difference is which Nitrogen the methyl group is attached to. (see wikipedia page for a nice picture of what I don't think is well explainable in words)
Pharmacologically, methyl-xanthines have two important mechanisms:
1. They are phosphodiesterase inhibitors (if you recall phosphodiesterase breaks down cAMP, which is a second messenger in many cell receptors), so they actually have many different pharmacologic effects - this is responsible for many adrenergic effects in the cardiovascular and pulmonary system. (though effect 2 below probably also affects heart rate)
2. They are inhibitors of adenosine receptors - this is largely responsible for neurostimulant effects (though effect 1 is probably also important).
Now to leave the basic science, clinically what are they good for -
Theophylline is particular useful for the treatment of pulmonary function. It is a bronchodilator and also has some anti-inflammatory effects. For this reason it is used in the treatment of asthma (but because of its side effects and the need for close monitoring is usually a 3rd or 4th line agent). It is also used in the treatment of spinal cord-injured patients, especially those who continue to rely on a tracheostomy for either respiration or for maintenance of the respiratory tract (or if they are having difficulty weaning form a ventilator).
Theobromine as far as I know is not routinely being used clinically (at least not in the US), but the most practical clinical use that I know of it is as a cough suppressant.
Not sure if this is what you were looking for, but I hope that this gets you off to a start in the right direction.
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Evidence is mounting that sugar is the primary factor causing not just obesity, but also Non-communicable disease.
There is no doubt that excess sugar can be toxic to your body, and it's only a matter of time before it will be commonly accepted as a causative factor of most cancers, in the same way as we accept that smoking and alcohol abuse are direct causes of lung cancer and cirrhosis of the liver.
I quote from Dr Mercola " Fructose elevates uric acid, which decreases nitric oxide, raises angiotensin, and causes your smooth muscle cells to contract, thereby raising your blood pressure and potentially damaging your kidneys. Increased uric acid also leads to chronic, low-level inflammation, which has far-reaching consequences for your health. For example, chronically inflamed blood vessels lead to heart attacks and strokes; also, a good deal of evidence exists that some cancers are caused by chronic inflammation".
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Sugar is not the direct cause of these problems such as hypertension and other chronic diseases. Sugar releases glucose on digestion, which if massive causes a large insulin response. Regular intake of large amount sugar may cause hyperinsulinemia .
Exogenous administration of Insulin and endogenous hyper-insulinemia elevate blood pressure in several ways. They cause sodium retention by directly increasing the activity of the epithelial sodium channel (ENaC), the sodium phosphate co-transporter, sodium hydrogen exchanger type III and Na-K-ATPase. (Tiwari et al., 2007). Insulin also induces oxidative stress, which causes impairment of the vascular endothelium, decreased availability of nitric oxide, and therefore atherosclerosis and hypertension (Virdis et al., 2013)
Insulin causes excitation of the sympathetic nervous system via a central action on the hypothalamus, where it is believed to act on the anteroventral third ventricle hypothalamic region (Muntzel et al., 1995) Other researchers have found that hyperinsulinemia in normotensive humans increases sympathetic nerve activity but not arterial pressure since it also causes skeletal muscle vasodilatation. However, in the presence of insulin resistance and/or hypertension, insulin may cause exaggerated sympathetic activation or impaired vasodilatation and thus elevate arterial pressure. (Anderson et al., 1992)
Hyperinsulinemia also causes obesity by converting glucose into fat in the dispose tissue. However, whether glucose is converted into fat or glycogen depends on timing of food intake. When sugar is consumed soon after exercise, glucose is converted to glycogen but when sugar is ingested by a sedentary person, the glucose is converted into fat.
It has also suggested that a large insulin response following a large glucose intake tends to block the action of leptin on the feeding center in the hypothalamus thereby preventing satiety.(Lustig, 2010) This leads to demand for more glucose producing food and eventually a state of obesity and its sequelae of metabolic syndrome, hypertension, type 2 diabetes mellitus, and other chronic diseases.
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As the field of medicine becomes more competitive some people may feel that research is becoming a compulsory component of their training and it may become a 'tick-box' on the CV. Many are of the opinion that certain people who want to do research should be focused on doing high-quality original research and others should focus on other areas of their career which they wish to specialise in. Should everyone do research in their career at some stage or should it be left up to those who wish to pursue academia only; should academia be left only to the academics?
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All really interesting responses....I think the general consensus is that not everyone should do research and certainly not for CV purposes but for the progression of medical knowledge and improvement in patient care. However all clinicians should be aware of the several facets of research inclusive of research governance and critical appraisal of existing research. Do correct me if I am wrong
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Please limit your answers to books written in English language.
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There are reasons to believe that interprofessional education may be cost effective but I am interested to know if there is any hard evidence to back this up.
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hi;
I haven't looked for evidence related to cost-effectiveness of interprofessional education but agree with Dean. The opportunity to offer courses to groups of health science students makes sense for a number of reasons, one of which is cost, the other is to build those relationships early in the health care providers socialization into the health care environment. Those courses should be the ones that all students pursuing health care careers need in order to practice. The discipline specific education needs to be provided to the students by those of their profession who understand that disciplines theorys, models and unique contribution to health and wellness of constituents.
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There is a high bar for introducing a new intervention (social/behavioral, drug, device, etc). However, I suspect that many interventions, treatments, and decisions in medicine do not have a high level of evidence base (i.e. no formal trials, decisions are based on experience, practice, etc). Have there been studies that estimate what proportion of medicine is evidence-based?
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My own review suggests there are large areas of clinical practice that are in poor compliance with evidence-based guidance, and that even in cases of compliance, the underlying clinical practice guidelines often exhibit low methodological quality, thus robbing even wider swatches of medical practice with a much needed strong evidence-based foundation.
COMPROMISED COMPLIANCE WITH EVIDENCE-BASED GUIDELINES
In cardiology, a critical review of evidence-based guidelines in hypertension [1] found that despite the widespread availability of evidence-based guidelines for treating hypertension, recent evidence suggests that physicians may not be prescribing first-line drugs for their patients with high blood pressure, and for patients with high blood pressure alone, only 38 percent being on a diuretic, and less than a third prescribed a beta-blockert (he JNC VI recommended first-line antihypertensives for essential hypertension), while approximately half of individuals with high blood pressure and certain comorbidities received non-first-line interventions.
It's been independently shown that GPs are in poor compliance with evidence-based hypertension guidelines and are undertreating hypertension [2] and, despite being aware of the risks of hypertension in the elderly and the benefits of its treatment, with fewer than half complying with the broad recommendations of even the most conservative evidence-based guidelines [3,4], a problem widespread among GPs in the UK and elsewhere [5].
In OBGYN, another UK review [6] examined the practice of induction of labour (IOL) to determine whether induction was performed as per the Royal College of Obstetricians and Gynaecologists/National Institute for Clinical Excellence (RCOG/NICE) guidelines, finding only 60 – 70% compliance with guidelines.
If we turn to the domain of emergency medicine, in particular Emergency Oxygen Guidelines in emergency departments, another British study [7] found that as many as 46% of patients were inappropriately receiving excess oxygen, and as many as 40% were inappropriately not receiving oxygen, so it is clear that uptake of authoritative evidence-based guidelines has been poor as in the inpatient setting.
Another recent (2012) retrospective analysis of compliance with evidence based protocols in cases admitted to the ICU [8] found that in 45% of the severe pre‐eclampsia patients and in 46% of sepsis cases, the guidelines were not followed and there was exceedingly poor adherence - a mere 10.8% - to guidelines of massive hemorrhage cases.
Within trauma medicine, another recent (2014) review of compliance with evidence-based guidelines in patients with traumatic brain injuries [9], it was found that the overall compliance rate was 73%, with only 3 out of 11 Level I trauma centers achieving a compliance rate exceeding 80%, despite the fact that multivariate analysis showed that increased adoption of EBM was associated with a reduced mortality rate. This cross-confirms the previous observation [10] of patients admitted to Level I trauma center (2006–2008) with moderate to severe injuries, where little over half of evidence-based recommended care was delivered to trauma patients with moderate to severe injuries, just 17% for neurosurgical interventions, and alarmingly, with those patients with increasing severity of traumatic brain injuries being the least likely to receive optimal evidence-based care.
In oncology, another recent (2014) review of melanoma treatment in Australia and New Zealand [11] evaluated both the extent of evidence-based support for clinical practice guideline recommendations concerning cutaneous melanoma follow up and the methodological quality of these guidelines; the review found that melanoma follow-up recommendations concerning frequency of physical examinations, duration of follow-up appointments and use of imaging or diagnostic tests are based mostly on low-level evidence or consensus expert opinion; in addition, recommendations were often inconsistent between different guidelines, and to this day, there is no international evidence-based consensus regarding what constitutes best practice for follow up of melanoma survivors.
CONCLUSIONS - AND ANOTER PROBLEM: COMPROMISED GUIDELINES
These and over a hundred other studies I reviewed across the spectrum of medical specialties collectively and strongly suggest that large proportions of medical clinical practice demonstrate low to at most modest compliance with evidence-based recommendations and practice guidelines. Aggravating this problem is the related - and underlying - problem, of clinical practice being informed by putative evidence-based clinical practice guidelines that themselves are of significantly compromised methodological quality. Thus, a Canadian study [12,13] evaluated the strength of the evidence underlying therapy recommendations (n=338) in evidence-based clinical practice guidelines in three domains (diabetes, dyslipidemia, and hypertension), finding that overall, less than one-third of treatment recommendations (and less than half of those citing RCTs in support of the advocated treatment) were based on high-quality evidence.
And although evidence-based medicine regards RCTs as the strongest form of evidence for clinical decision making, a recent intensive review [14] found that overall, at least 20.2% of all published medical research has significant methodological flaws, and perhaps alarmingly, prospective studies appear to have as many methodological limitations as nonprospective studies, and RCTs have as many limitations as non-RCTs, with as much as 38.7% of published RCTs receiving detailed review found to have methodological issues.
Similarly, among 100 orthopedic articles analyzed for compliance with CONSORT and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines [15], 96% failed to report trial registration, 63% failed to discuss study limitations, 59% failed to report the source of funding, 48% failed to report details of the research setting, 38% failed to report adverse events and unintended effects, 37% inadequately reported the number of patients enrolled, and 23% reported no measurement of error for the primary outcome.
And again: up to 30% of articles in the thoracic surgery literature have been reported to have limitations, with the most frequently cited problem being inappropriate use of statistical tests or violation of principles of research design, and the experimental design of many surgical investigations often do not adequately account for bias or type II error [16]. Statistical tests were used or reported incorrectly in 27% of articles evaluated in the surgical literature and were not used at all in an additional 10% of articles [17].
The data I have presented above, which can be extended by dozens and dozens of additional studies, collectively suggests that substantial portions of clinical practice have decidedly questionable foundations in robust evidentiary medicine, with low compliance and low study methodology aggravating the evidence-based foundations of modern medicine. We need to do better as a profession.
REFERENCES
1. Holmes JS, Shevrin M, Goldman B, Share D. Translating research into practice: are physicians following evidence-based guidelines in the treatment of hypertension? Med Care Res Rev 2004; 61(4):453-73.
2. Cranney M, Barton S, Walley T. The management of hypertension in the elderly by general practitioners in Merseyside: the rule of halves revisited. Br J Gen Pract 1998; 48: 1146–1150.
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Your study is just the kind that I was looking for. Only yesterday we were discussing the matter of challenges presented to frontline health providers when different organizations or initiatives introduce quality improvement with different names. We did not discuss it from the perspective of conflict of interest, rather one of confusion, but now I am thinking that in the confusion conflict of interest can arise. Kenya is in process of developing a quality improvement policy supported by development partners with passionate interest in improving health service delivery and are convinced that one strategy for addressing confusion is harmonization or standardization. It is just as well to start thinking about conflict of interest as well. It would be useful to read some more work dealing with conflict of interest as well as misunderstandings. This will facilitate the design of appropriate continuing education, support and mentorship.
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We identified via literature review, 7 common contextual factors key to implementation of the QI programme Productive Ward http://onlinelibrary.wiley.com/doi/10.1111/jonm.12069/abstract A larger review of Lean Healthcare including PW citations we identified 3 main components cited as common impacts... Leadership, empowerment & engagement http://www.emeraldinsight.com/journals.htm?articleid=17102117 The most indepth study of all is from Mary Dixon-Woods http://qualitysafety.bmj.com/content/early/2012/04/27/bmjqs-2011-000760
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I found HCG has role in Angiogenesis but mainly in cancer. I want to know if this is true for a normal Angiogenesis relationship.
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Sir that's true, agree.
But I want to know whether it's having some role to maternal angiogenesis during pregnancy.
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I've argued for over a decade now that it is 'essential' that the terms health promotion and health education are delineated and separated out. Many health practitioners use the terms interchangeably to mean the same thing. Many of those practitioners might view the 'difference' between them as semantics; as not important - especially those working in healthcare and health service-based settings. I, however, have suggested that the only way that health professionals can be seen to be credible with the wider health promotion community, is if we all fully use the exact language and context of health promotion and health education and apply this to clinical practice and other health arenas. Do you agree - or have a differing view?
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Gulay I am afraid I disagree with you, and see health education as being one small component of health promotion. Most health care professionals seem to believe that they are providing health education, when in reality all they are doing is providing health information. Particularly in clinical settings professional seem to think that by providing an individual with a pamphlet on a health topic that this is health promotion! In my view, health information is a minor aspect of health education, for many consumers it may be awareness raising, for a few it may be educational.
To really engage in health education, information needs to be accompanied with a change of perspective and insight into how actions or beliefs need to change. However for health education to result in health promotion, action on this information needs to occur.
Telling an obese person that they need to loose weight and giving them information of health consequences such as diabetes or heart disease is not health promotion. Health promotion occurs when you look beyond an individuals behaviours. While it might be necessary for the obese person to learn cooking skills to improve their diet, it may also be necessary that healthier food options are available for them to buy when they do their grocery shopping. These food options also need to be affordable. This individual may also need a safe neighbourhood to feel comfortable to walk to the shop to get this food, or to undertake the physical activity we all know needs to occur along with a healthy diet to maintain a healthy weight. A number of factors may impact on if actions are adopted to make a change in this individuals life, having a friend to walk with or a neighbourhood walking group, may make the difference between participating in physical activity or not, etc, etc. Health promotion involves working towards creating all of the supports which facilitate adopting or maintaining better health actions.
Sorry to be so long winded, this is a topic I am extremely passionate about :-)
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In the clinical training courses, dental students are supposed to treat their first patients under supervision of the clinical assistants (teachers). How do you give feedback on the students' performance? Do you observe every step the student undertakes during treatment, including communication and hygiene?
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In some cases, I ask the student to write down 3 things that went well (and why they went well) and 3 things that need improvement (and why they need improving). This practice helps them reflect upon their practice and figure out ways to improve further practice.
Furthermore, every surgical procedure receives a written evaluation from the supervisor, which helps in assessing student level for end term evaluations.
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The first two years of undergraduate teaching in Nepal involves basic concepts related to health and disease. How ethical is it not to train them equally in the area of basic sciences? Is there a need to harmonize or not?
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I agree with you Dean. The entry level criteria for undergraduates is similar so the basic concepts could be harmonized. As you said, along with being cost effective it will be a very effective model for developing countries like mine where there is scarcity of academicians. There would be no need for separate content and teaching methodologies and different evaluation systems. But as Nelson said common sense should prevail!!!
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The quantitative analysis is basically descriptive in nature of a database which has been built from patient records having a specific illness.
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In your specific case, "existing patient records" randomization is not a real issue. Make sure that in your work you describe, with detail, how you gained access to the data. Another key issue is how you formulate the problem, make sure that yours is clearly stated.
Randomization would be central if you were studying health people. as I understand you are studying a diseased population.
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Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. When health providers disagree with their patients, colleagues, or regulatory professional bodies about the suitability of specific types of care, there are conflicting views on whether such health providers should be forced to violate their conscience, or punished if they refuse to do so.
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The general ethical and legal consensus in the U.S.A. is that it depends on two things. First, it depends on the seriousness of the action that a practitioner believes immoral. More serious actions, such as physician assisted suicide, are ones where we tend to allows practitioners to refuse to participate. Second, it depends on the broader costs of allowing practitioners to refuse to participate. For example, in cases such as pharmacists refusing to fill prescriptions for birth control or the morning after pill, there are more significant concerns about the costs of allowing such refusals (particularly in rural areas). So we tend to not allow refusals to participate when broader costs become higher.
It's hard to be much more specific, and certainly the laws in the U.S.A. have significant variation amongst states and vary based on the particular issue.
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To improve nurse and field health professional relational skills we have run a specific educational intervention that used performing art and theatre (experiential laboratories).
Has anyone been involved in such experiences before? We are testing different evaluation methodologies but we are still far from understanding what is happening during and after the intervention.
A focus group, specifically observing greed and individual diary of the experience was conducted and analyzed. In one case, we have also used a controlled observation in a quasy-experimental setting since randomization was not possible.
Any suggestions, indications or reference suggestions are well-accepted.
Thanks a lot for the help
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