Academic literature on the topic 'General Medical Clinic'
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Journal articles on the topic "General Medical Clinic"
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Cassidy, Irving B., Matthew R. Keith, Edward L. Coffey, and Margaret A. Noyes. "Impact of Pharmacist-Operated General Medicine Chronic Care Refill Clinics on Practitioner Time and Quality of Care." Annals of Pharmacotherapy 30, no. 7-8 (July 1996): 745–51. http://dx.doi.org/10.1177/106002809603000707.
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OBJECTIVE: To assess the impact of pharmacist-operated refill clinics on practitioner (physician/physician assistant) time. Secondary objectives included assessment of disease state control, drug acquisition costs, and human resource allocation. DESIGN: The study ran from October 1, 1993 through January 31, 1994. At one clinic the pharmacist performed chart review only and did not see the patient. At the second site the pharmacist also interviewed the patient. The pharmacist used no treatment algorithms. Practitioner and pharmacist time before and after implementation of the refill clinics was measured on 3 consecutive days of normal clinic operation. SETTING: TWO state correctional facilities. PATIENTS: The study population consisted of patients receiving chronic care who were observed during regular clinic hours. MAIN OUTCOME MEASURES: We evaluated pharmacist and practitioner time before and after pharmacist involvement. Hypertension was the only disease state yielding sufficient numbers for statistical analysis. We used a two-tailed paired t-test with the a priori level set at 0.05. We also evaluated the number of patients with disease state control before and after clinic implementation, drug acquisition costs, and human resource allocation. RESULTS: The refill clinic pharmacist reduced practitioner time commitment in both clinics. The greatest impact on practitioner time was found in the interview clinic. Quality of care was maintained equally between the two clinics, with a positive impact on human resource allocation. CONCLUSIONS: In the managed care environment, pharmacist-run refill clinics can decrease practitioner time commitment allowing reallocation of human resources while maintaining current quality of care.
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Nguyen, Quynh, Van Hieu Nguyen, Hoang Liem Luong, and Phuc Thanh Kim. "Some factors affecting the provision of medical examination and treatment services at 02 general clinics under Thu Duc District Hospital, Ho Chi Minh City from 2017-2019." Journal of Health and Development Studies 05, no. 03 (May 30, 2021): 115–24. http://dx.doi.org/10.38148/jhds.0503skpt20-065.
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Objective: To study to find out some factors affecting medical service provision of 02 general clinics under Thu Duc District Hospital. Method: Qualitative research. Data collected through 06 in-depth interviews and 02 group discussions. Results: Research results show that a number of factors affecting medical examination and treatment activities of the two clinics are positive ones: Newly built facilities, clean and airy rooms, most of the facilities The equipment is fully invested and equipped with a number of modern equipment such as Ct-san, endoscopy system. The drugs in 02 general clinics are provided by the hospital, so most of the drugs available in the hospital are available in the clinic, this helps the patient feel secure when coming to the examination, both clinics have made the master cabinet. On the financial side, this makes it easier for the clinic to have autonomy in revenue and expenditure. The staff of the clinics are always supported by the hospital. The information technology system meets all activities of the clinic.In addition to the positive factors, there are also negative factors affecting medical examination and treatment: Lack of qualified post-graduate doctors study, especially the specialties. Negative factor: The facilities of Linh Tay clinic are still narrow, lacking some equipment to serve the people. Some drugs are not on the list of drugs approved for use in the clinic or are not covered by health insurance. Due to being located far from the hospital, the network system is not stable. Security coordination between clinics and local authorities has not been effective. The burden of medical equipment depreciation costs and hospital overheads also affect the financials of the clinic. Keywords: General clinic, medical service provider, Hospital Thu Duc district.
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Mason, Julie D., and Colleen A. Colley. "Effectiveness of an Ambulatory Care Clinical Pharmacist: A Controlled Trial." Annals of Pharmacotherapy 27, no. 5 (May 1993): 555–59. http://dx.doi.org/10.1177/106002809302700503.
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OBJECTIVE: To compare two general medicine clinics to determine the effectiveness of an ambulatory care clinical pharmacist in assisting recognition of drug therapy problems for physicians and decreasing drug therapy costs. DESIGN: Controlled trial SETTING: Two general medicine ambulatory care clinics associated with a large, tertiary-care teaching hospital. PATIENTS: Those with scheduled and completed appointments in the clinics during the two-week study period. METHODS: Medication profiles of patients attending clinic A (pharmacist intervention) and clinic B (no pharmacist intervention) were reviewed by the pharmacist prior to clinic appointments. Potential drug therapy problems were identified at each clinic, but interventions were performed only at clinic A. Postappointment audits determined the number of recommendations implemented at clinic A versus the number of drug therapy problems (potential interventions) recognized and addressed by clinic B physicians independently of pharmacist intervention. Potential and actual savings were extrapolated to one year from the two-week study period. RESULTS: Implementation of interventions at clinic A was greater than at clinic B (p<0.001). Drug therapy cost savings at clinic A were annualized to yield $185 per intervention. Potential cost savings of $176 724, or four times the pharmacist salary costs, is projected. CONCLUSIONS: An ambulatory care pharmacist is effective in identifying drug therapy problems, resulting in significant cost savings to the institution.
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Kerrison, Susan, and Roslyn Corney. "Private Provision of ‘outreach’ Clinics to Fundholding General Practices in England." Journal of Health Services Research & Policy 3, no. 1 (January 1998): 20–22. http://dx.doi.org/10.1177/135581969800300106.
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Objectives: To establish the contribution of the private sector in providing outpatient ‘outreach’ clinics in general practitioner fundholding practices. Method: Postal survey of all 13 first-wave fundholders and four of the 13 second-wave fundholders in the former South East Thames Region of the National Health Service in 1995. Results: Fourteen practices responded. Ten practices had set up at least one medical specialist ‘outreach’ clinic and 12 at least one paramedical clinic since becoming fundholders. Eight practices reported their arrangements for consultant ‘outreach’ clinics and ten practices their arrangements for paramedical clinics. Forty-nine per cent of the total medical specialist hours and 46% of total paramedical hours were provided by private practitioners. The largest number of hours provided privately was in gynaecology. Conclusion: This small study identified considerable private provision of fundholders' ‘outreach’ clinics. However, there is no system in the NHS to monitor the extent of this market, the types of activities undertaken or the relative quality and cost of the services provided.
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Chong, C. K. L., J. C. N. Chan, S. Chang, Y. H. Yuen, S. C. Lee, and J. A. J. H. Critchley. "A patient compliance survey in a general medical clinic." Journal of Clinical Pharmacy and Therapeutics 22, no. 5-6 (October 1997): 323–26. http://dx.doi.org/10.1111/j.1365-2710.1997.tb00013.x.
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Aksha sharen Arul Edwin, Lakshmi T, and Karthik Ganesh Mohanraj. "Medical Emergency in Dental Clinic - An update." International Journal of Research in Pharmaceutical Sciences 11, SPL3 (September 18, 2020): 831–39. http://dx.doi.org/10.26452/ijrps.v11ispl3.3031.
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In general, one of the convincing methods to tackle an emergency is to be well-organized and prepared priory. The intention of the study is to analyze the availability of medical emergency procedures and equipment in dental clinics. Also, the aim is to determine the level of awareness, knowledge, perceptions, individual experiences and preparedness of the dental practitioners and dental students for the management of medical emergency situations in their hospitals or clinics. A cross-sectional survey based study was done from April to among 100 dental students in Chennai. The self-structured well-designed questionnaire containing the protocols and emergency procedures followed in their clinic. The questionnaire forms were circulated online through Google forms. The data from all the participants were collected and analyzed through SPSS software. In the present study, it was inferred that the majority of the population are aware about the medical emergencies in dental clinics (99%) and the remaining 1% of the population are not aware of it. The conclusion of this study is that the above statistical analysis about knowledge awareness on recent advances in the treatment of medical emergencies in dental clinics has provided an alarming situation about the capability of dentists to deal with such conditions for the betterment of patients .
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Rochow, S. B., A. D. Blackwell, and VJ Brown. "Quality of Life in Parkinson's Disease: Movement Disorders Clinic vs General Medical Clinic - A Comparative Study." Scottish Medical Journal 50, no. 1 (February 2005): 18–20. http://dx.doi.org/10.1177/003693300505000107.
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Objectives: to determine the effect of attending a movement disorders (MD) clinic on quality of life (QOL) outcomes for patients with Parkinson's disease (PD). Methods: Postal questionnaire study of forty-two patients with Parkinson's disease attending either a movement disorders clinic or more conventional general medical clinic were selected consecutively to complete the Parkinson's Disease Quality of Life Questionnaire (PDQL). All patients were diagnosed by a consultant physician with an interest in Parkinson's disease (S.B.R.) and had attended either the movement disorders clinic or the general medical clinic on at least three occasions. Questionnaires were completed independently of the examiners and returned by post. Results: Mean PDQL score was 124.1 [5.16] in the movement disorders clinic and 95.9 [5.86] in the general medical clinic. Analysis of covariance revealed that those subjects attending the MD clinic reported a significantly higher QOL than those subjects in general medical care (F(1,39)= 161.98, P<0.001). Conclusion: These data indicate that the quality of life of respondents attending the movement disorders clinic is significantly higher than those attending the general medical clinic.
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Kerry, TP, P. G. T. Cudahy, H. L. Holst, A. Ramsunder, and N. G. McGrath. "A doctor at a PHC clinic: A ‘must-have’ or ‘nice-to-have’?" South African Medical Journal 113, no. 1 (December 20, 2022): 24–30. http://dx.doi.org/10.7196/samj.2023.v113i1.16700.
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Background. Many patients have their healthcare needs met at primary healthcare (PHC) clinics in KwaZulu-Natal (KZN), without having to travel to a hospital. Doctors form part of the teams at many PHC clinics throughout KZN, offering a decentralised medical service in a PHC clinic.Objectives. To assess the benefit of having a medical doctor managing patients with more complex clinical conditions at PHC clinic level in uMgungundlovu District, KZN. Two key questions were researched: (i) were the patients whom the clinic doctors managed of sufficient clinical complexity that they warranted a doctor managing them, rather than a PHC nurse clinician? and (ii) what was the spectrum of medical conditions that the clinic doctors managed?Methods. Doctors collected data at all medical consultations in PHC clinics in uMgungundlovu during February 2020. A single-pagestandardised data tool was used to collect data at every consultation.Results. Thirty-five doctors were working in 45 PHC clinics in February 2020. Twenty-six of the clinic doctors were National HealthInsurance (NHI)-employed. The 35 doctors conducted 7 424 patient consultations in February. Staff in the PHC clinics conducted 143 421 consultations that month, mostly by PHC nurse clinicians. The doctors concluded that 6 947 (93.6%) of the 7 424 doctor consultations were of sufficient complexity as to warrant management by a doctor. The spectrum of medical conditions was as follows: (i) consultations for maternal and child health; n=761 (10.2%); (ii) consultations involving non-communicable diseases (NCDs), n=4 372 (58.9%) – the six most common NCDs were, in order: hypertension, diabetes, arthritis, epilepsy, mental illness and renal disease; (iii) consultations involving communicable diseases constituted 1 745 (23.5%) of cases; and (iv) consultations involving laboratory result interpretation 1 180 (15.9%).Conclusion. This research showed that at a PHC clinic the more complex patient consultations did indeed require the skills and knowledge of a medical doctor managing these patients. These data support the benefit of a doctor working at every PHC clinic: the doctor is a ‘musthave’ member of the PHC clinic team, offering a regular, reliable and predictable medical service.
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Francis, Maureen D., Whitney E. Zahnd, Andrew Varney, Steven L. Scaife, and Mark L. Francis. "Effect of Number of Clinics and Panel Size on Patient Continuity for Medical Residents." Journal of Graduate Medical Education 1, no. 2 (December 1, 2009): 310–15. http://dx.doi.org/10.4300/jgme-d-09-00017.1.
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Abstract Background Accreditation Council for Graduate Medical Education program requirements for internal medicine residency training include a longitudinal, continuity experience with a panel of patients. Objective To determine whether the number of resident clinics, the resident panel size, and the supervising attending physician affect patient continuity. To determine the number of clinics and the panel size necessary to maximize patient continuity. Design We used linear regression modeling to assess the effect of number of attended clinics, the panel size, and the attending physician on patient continuity. Participants Forty medicine residents in an academic medicine clinic. Measurements Percent patient continuity by the usual provider of care method. Results Unadjusted linear regression analysis showed that patient continuity increased 2.3% ± 0.7% for each additional clinic per 9 weeks or 0.4% ± 0.1% for each additional clinic per year (P = .003). Conversely, patient continuity decreased 0.7% ± 0.4% for every additional 10 patients in the panel (P = .04). When simultaneously controlling for number of clinics, panel size, and attending physician, multivariable linear regression analysis showed that patient continuity increased 3.3% ± 0.5% for each additional clinic per 9 weeks or 0.6% ± 0.1% for each additional clinic per year (P < .001). Conversely, patient continuity decreased 2.2% ± 0.4% for every additional 10 patients in the panel (P < .001). Thus, residents who actually attend at least 1 clinic per week with a panel size less than 106 patients can achieve 50% patient continuity. Interestingly, the attending physician accounted for most of the variability in patient continuity (51%). Conclusions Patient continuity for residents significantly increased with increasing numbers of clinics and decreasing panel size and was significantly influenced by the attending physician.
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Hua, Natalie T., Chia-Ding Shih, and David Tran. "Medical and Economic Impact of a Free Student-Run Podiatric Medical Clinic." Journal of the American Podiatric Medical Association 105, no. 5 (September 1, 2015): 418–23. http://dx.doi.org/10.7547/13-022.
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Background Data from the free student-run podiatric medical clinic at Clínica Tepati at the University of California, Davis, were used to analyze medical and economic impacts on health-care delivery and to extrapolate the economic impact to the national level. Clínica Tepati also provides an excellent teaching environment and services to the uninsured Hispanic population in the Greater Sacramento area. Methods In this analysis, we retrospectively reviewed patient medical records for podiatric medical encounters during 15 clinic days between November 2010 and February 2012. The economic impact was evaluated by matching diagnoses and treatments with Medicare reimbursement rates using International Classification of Diseases codes, Current Procedural Terminology codes, and the prevailing Medicare reimbursement rates. Results Sixty-three podiatric medical patients made 101 visits during this period. Twenty patients returned to the clinic for at least one follow-up visit or for a new medical concern. Thirty-nine different diagnoses were identified, and treatments were provided for all 101 patient encounters/visits. Treatments were limited to those within the clinic's resources. This analysis estimates that $17,332.13 worth of services were rendered during this period. Conclusions These results suggest that the free student-run podiatric medical clinic at Clínica Tepati had a significant medical and economic impact on the delivery of health care at the regional level, and when extrapolated, nationally as well. These student-run clinics also play an important role in medical education settings.
Dissertations / Theses on the topic "General Medical Clinic"
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Deitcher, Rebecca Ulman. "Health locus of control and HIV : a study of beliefs, attitudes, and high-risk behaviours among homosexual men attending a general medical clinic." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=39806.
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Acquired immunodeficiency syndrome (AIDS) remains an epidemic illness with no known cure. Survival time after infection with the human immunodeficiency virus (HIV), has been lengthened considerably. Rates of new infection among the at-risk male homosexual populations have decreased. Prevention is possible through effective, targeted interventions. This study is an exploration of the role or health locus of control, an individual difference construct from the area of social learning theory, in the maintenance of health-oriented behaviours, co-risk indicative behaviours, and high-risk behaviours in a population of adult male homosexuals attending a general medical clinic. The findings result in distinctly different past histories and present patterns of homosexual behaviours among the two serostatus subpopulations. Low internal expectancy of control over health repeatedly relates in distinctive patterns with the areas of level of happiness, condom usage, and hish-risk sexual behaviours. High internal expectancy of control relates significantly to knowledge-related variables. The physician plays a pivotal role as the source of useful information in this at-risk population. The study population as a whole reports accurate knowledge about HIV and AIDS. The men have reduced high-risk behaviours, increased safer sexual behaviours, and implemented the changes advocated. Serostatus differentiates for many high-risk behavioural patterns. There remains a small core of men among the study participants who continue to participate in high-risk sexual behaviours.
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Boyle, Brian William. "Evaluation of the Extent to Which Massachusetts General Hospital Emergency Department Triage of Transient Ischemic Attack Patients Aligns With Virtual TIA Clinic Protocol: A Pilot Cross-Sectional Medical Record-Review to Inform Care Redesign Efforts." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:17295888.
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The Virtual TIA Clinic Protocol was developed as part of the Partners Care Redesign
effort to reduce costs and increase quality in the care of patients presenting with symptoms of
transient ischemic attack, through risk stratification, triage, and follow-up based on factors
including the ABCD2 score. The work presented here is a small N, pilot cross-sectional study
which compares actual practice in the MGH ED to what the protocol would suggest, in an effort
both to validate the components of the protocol and to better understand further opportunities to
create value in the care of this patient population. It was found that actual practice resulted in
triage patterns similar to what would have been dictated by the protocol in question. This
suggests that full implementation of the protocol – with the costs associated – may not be
justified. Further work could involve refinement of the protocol to achieve the desired effect on
triage, with future, similar studies made more effective by a code to designate patients in whom
TIA is possible but who do not ultimately receive the code for such under the current
documentation system.
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Pearson, David John. "Exploration of clinical learning in general medical practice : a case study." Thesis, University of Edinburgh, 2010. http://hdl.handle.net/1842/6303.
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This thesis tells a story of a single year in the life of a primary care teaching practice from the multiple perspectives of clinical learners and those supporting learning. This story involves many people from junior medical students to nurses and doctors with twenty years of experience. It explores how they learn as clinicians. The research takes the form of a single descriptive case study based within a purposefully chosen GP teaching practice in West Yorkshire, England. The case study comprises interview, observational and documentary data collected over a single academic year in 2008/9. Interview data from 33 subjects were transcribed and analysed using thematic analysis within a modified grounded theory approach. The evidence from interview data was strengthened through direct and indirect observation and from documents relating to learning and teaching. I present a theory of how clinical learning occurs within the chosen practice, and on the nature of being a teaching practice. The findings are presented in the context of the existing literature of learning in this setting and within a theoretical framework of literature on social learning and communities of practice. Clinical learning appears to occur through engagement and opportunity. Engagement in learning is made up of four elements; recognition, respect, relevance and emotion. The elements are remarkably consistent across learner groups. Opportunity includes the availability, authenticity and immediacy of patient encounters; and the opportunity to learn with and from peers and professional colleagues. The research findings are consistent with existing work on social learning from other settings, but add to the literature. Engagement appears possible through recognition, relevance and respect and in the absence of meaningful participation, belonging or a clear trajectory of learning. Meaningful opportunities for clinical learning include those where patient encounters are made powerful through the authenticity that arises from the social and personal context of illness, and from the immediacy of hearing patient narratives de novo. The teaching practice studied in the case study is not dissimilar to others described in the literature of primary care learning, but this case study offers a far more detailed exploration of the elements which contribute to learning in the practice. These elements include strong whole practice support for learning, a skilled and committed clinical and educational workforce and a more indefinable additional element which is best summarised as a passion for education.
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Lucas, D. Pulane. "Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital." VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2996.
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Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.
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Saunders, Robert Edward. "Pharmacists in general medical practice : a case study of clinical commissioning groups." Thesis, Keele University, 2018. http://eprints.keele.ac.uk/5106/.
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Pharmacists have been identified to address the increasing workload in United Kingdom (UK) general practice. A pilot has been commissioned by National Health Service England (NHSE) to upskill pharmacists for this purpose. Evaluation is underway and early reports indicate that there have been integration issues. The value of pharmacists working in general practice and the level of training required for the role are not fully understood. The research reported in this thesis was started before the NHSE pilot. It was conducted to understand the background of Clinical Commissioning Group (CCG) practice pharmacists (PPs), and their interactions with stakeholders. The rationale was to provide an insight into their working relationships and to generate recommendations to support the integration of pharmacists into general practice. The project was conducted in four CCGs in the West Midlands in 2014 using an interpretive/collective case study approach incorporating mixed methods for data collection. Quantitative data was collected on the background, employment and activities of PPs. Qualitative data was collected on stakeholders’ views of the CCG PP role from commissioners, general practitioners (GPs), and patients. Different commissioning models for PPs were studied to provide a deeper understanding of PPs’ interactions. The workload problems in general practice subsequently modified the focus of this thesis to determine the value of PPs to general practice, the level of training required and to propose a model for the integration of pharmacists into UK general practice. The thesis study identified some determinants of integration found in previously published studies but also discovered new areas specific to the integration of pharmacists into UK general practice. These areas can be grouped into three elements - the pharmacist’s skills and attributes, practice level facilitation and national level support. They are presented as a unique Model for the Successful Integration of Pharmacists into General Practice Teams.
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Osborne, Thomas. "The doctor's view : clinical and governmental rationalities in twentieth-century general medical practice." Thesis, Brunel University, 1991. http://bura.brunel.ac.uk/handle/2438/5312.
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This thesis traces endeavours in the twentieth century to provide the 'intellectual' foundations for general medical practice as an independent, autonomous clinical discipline. The empirical focus of the study is upon the application of psychological and 'person-centred' approaches to general practice; above all, in the work of Michael Balint, and the Royal College of General Practitioners in the post-war period. The thesis is guided by two predominant theoretical concerns. First, to highlight the complex strategies and the wide range of means and resources that have been required to give substance to the claim that general practice is 'by nature' a person-centred endeavour. Second, to consider - and to question certain influential approaches to medical power in general, and to the social consequences of 'emancipator' - person-centred - forms of medicine in particular. Specifically, the 'power/knowledge' approach to medical sociology is contested both with regard to its empirical findings and in relation to its basis in the work of Michel Foucault (of whose writings on clinical medicine an alternative evaluation is offered).
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Campbell, Natasha. "Placebos in medicine: from conceptualizations in medical school to integration in clinical practice." Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=107754.
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Placebo effects constitute context-dependent medical phenomena, and exemplify the link between psychosocial factors and physiological processes. By surveying medical students (Study 1) and practicing physicians (Study 2), the present thesis explores the knowledge and attitudes towards the role of placebos, and their related effects, in the clinic. In addition, this thesis addresses the ethics of deception in clinical practice (Commentary Response 1). Findings from Study 1 demonstrate that medical students are unaware of many non-drug effects that influence response to treatment, and yet, approximately 40% reported that they would prescribe a placebo in clinical practice. Such placebo science knowledge is critical, moreover, considering recent reports documenting the widespread use of placebos in clinical practice. These findings may foster informed discussions regarding the inclusion of placebo science in medical curricula. Study 2 reveals substantive differences among subspecialties of medicine, specifically between psychiatrists and non-psychiatrists, on the issue of placebos. Moreover, approximately 20% of physicians in Canada reported that they have prescribed or administered a placebo in the course of routine clinical practice. Such findings have implications for formal policy regarding the use of placebos in the clinic. Altogether, these findings underscore the crucial role placebos and non-drug effects have within the medical community, and emphasize the value of further exploration into the intricacies of placebo knowledge, patterns of use, and efficacies within various practices.Les effets du placebo constituent un phénomène médical lié au contexte et illustrent le lien entre les facteurs psychosociaux et les processus physiologiques. Suite à un sondage mené auprès d'étudiants en médecine (Étude 1) et auprès de praticiens (Étude 2), cette thèse explore les connaissances et les attitudes vis-à-vis du rôle des placebos et de leurs effets dans le cadre clinique. De plus, la présente étude aborde les questions éthiques qui reposent sur la tromperie en clinique (Réponse au Commentaire 1). Les résultats de l'étude 1 démontrent que les étudiants en médecine ignorent l'influence de divers éléments non médicamenteux sur la réaction aux traitements, pourtant, 40% d'entre eux ont déclaré qu'ils prescriraient un placebo lors de leur pratique clinique. Être au fait des dernières recherches sur le placebo est critique, tout particulièrement lorsque l'on considère les derniers rapports sur l'utilisation du placebo dans le cadre clinique. Ces recherches peuvent mener à des discussions éclairées sur l'ajout de cette science aux études médicales. L'étude 2 révèle qu'il existe à ce sujet des différences substantielles au sein des spécialisations, tout particulièrement entre les psychiatres et les non-psychiatres. Par ailleurs, environ 20% des médecins au Canada ont signalé qu'ils avaient prescrit ou administré un placebo au cours de leur routine clinique. De tels chiffres ont des conséquences sur la réglementation qui entoure l'usage des placebos lors de routines cliniques. En somme, ces résultats soulignent le rôle crucial joué par les placebos et les effets non médicamenteux au sein de la communauté de médecins et l'importance d'explorer davantage les connaissances liées au placebo, son usage et son efficacité dans le cadre de diverses pratiques.
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Gavin, Michael John. "Crisis of legitimacy? : the clinical role, intellectual status and career motivations of general medical practitioners." Thesis, University of Manchester, 2004. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.638049.
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Kalogeropoulos, Dimitris. "An intelligent clinical information management support system for the critical care medical environment." Thesis, City University London, 1999. http://openaccess.city.ac.uk/7714/.
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Significant advances have been achieved in the fields of medical informatics and artificial intelligence in medicine in the past three decades and, having demonstrated an ability to support clinical decisions, knowledge-based systems are becoming increasingly ubiquitous in various clinical settings. Nonetheless, few systems have so far been successful in entering routine use. On the one hand, primarily due to methodological difficulties and with very few exceptions, developers have failed to show that pertinent systems are effective in improving patient care. On the other hand, support systems have not been sufficiently well integrated into the routine information processing activity of the clinical users. As a consequence, their clinical utility is disputed and constructive assessmenist further hindered. This thesis describes the development of an intelligent clinical information management support system designed to overcome these obstacles through the adoption of an integrated approach, geared toward the solution of the problems encountered in the acquisition, organisation, review and interpretation of the clinical decision supporting information utilised in the process of monitoring intensive care unit patients with acid-base balance disorders. The system was developed to support this activity incrementally, using the methods of object-oriented analysis, design and implementation, with the active participation of a clinical advisor who assessed the functional and ergonomic compatibility of the system with the supported activity and the integration of a previously validated prototype knowledge-based data interpretation system, which could not evaluated in the clinical setting for the reasons described above.
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Mahboob, Usman. "How do medical students and clinical faculty members from two different cultures perceive professionalism." Thesis, University of Glasgow, 2014. http://theses.gla.ac.uk/8913/.
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Background: Professionalism is contextual and varies with culture. It has multiple dimensions including individual, inter-personal, organizational, and societal components. The aim of this study was to add some new perspectives to understand professionalism. Professionalism was explored in the context of two different cultures, Scotland and Pakistan, to identify similarities and differences in perceptions of clinical faculty members and medical students. Methodology: The method used was qualitative multiple case studies in a constructivist approach. Cultural Historical Activity Theory (CHAT) was used as a theoretical framework to enhance understanding of the study. Faculty members from three Scottish and three Pakistani medical schools were interviewed. Focus group discussions were arranged with groups of 7-10 medical students from each of the six medical schools. The data was analysed using a thematic analysis to identify reasons for cultural similarities and differences across two countries. Results: The results were divided into nine themes, that is, the nature of the healthcare system, models and process of professionalism, attributes of professional doctors, approach of doctors towards their patients and other healthcare professionals, working in teams, self-regulation, the role of doctors in society and within families, dealing with ethical dilemmas and legally difficult situations, and resolving conflict situations in the work place. Discussion The variance of professionalism found in this study was mainly due to the health professionals working in two different healthcare systems. The cultural differences between the two countries were reflected in these systems and the activity of professionalism included conflicts and dilemmas, self-regulation, and professional attributes. Medical professionals were found to adopt different institutional models of professionalism when they perform their daily activities. Conclusions: This study showed that doctors and medical students from both countries have mostly similar perceptions about professionalism with some dissimilarities resulting from differences in the culture, history, institutional ethos, daily activities and the role of religion. There is a lack of training in professionalism and a need to include it in the formal curriculum in Pakistan. A training programme could be organized and incorporated into the curriculum using the themes, models and process of professionalism with attention to culturally sensitive situations to prepare medical students for their early professional years in both countries. A focus needs to be on the preparation of communication skills in different contexts and the improvement of the internal environment, which is within the control of every individual. A faculty development programme, with similar objectives, needs to be introduced for medical staff to enhance their understanding of professionalism.
Books on the topic "General Medical Clinic"
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1945-, Harris Tom, ed. The voice clinic handbook. London: Whurr Publishers Ltd., 1998.
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Mayo Foundation for Medical Education and Research, ed. Mayo Clinic family health book: The Ultimate Illustrated Home Medical Reference. 2nd ed. New York: William Morrow and Company, Inc, 1996.
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L, Longworth David, and Cleveland Clinic Foundation, eds. The Cleveland Clinic internal medicine case reviews. Philadelphia: Lippincott Williams & Wilkins, 2003.
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Berry, Leonard L. Management Lessons from Mayo Clinic. New York: McGraw-Hill, 2008.
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Lennon, Robert L. Mayo Clinic analgesic pathway: Peripheral nerve blockade for major orthopedic surgery. Rochester, MN: Mayo Clinic Scientific Press, 2005.
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Lennon, Robert L. Mayo Clinic analgesic pathway: Peripheral nerve blockade for major orthopedic surgery. Rochester, MN: Mayo Clinic Scientific Press, 2006.
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Polin, Bonnie Sanders. Cleveland Clinic Healthy Heart Lifestyle Guide and Cookbook. New York: Broadway Books, 2008.
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Polin, Bonnie Sanders. Cleveland clinic healthy heart lifestyle guide and cookbook. New York: Broadway Books, 2007.
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D, Seltman Kent, ed. Management lessons from Mayo Clinic: Inside one of the world's most admired service organizations. New York: McGraw-Hill, 2008.
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Katorkin, Sergey, Mihail Mel'nikov, Pavel Myshencev, Sergey Sushkov, and Sergey Sushkov. Lymphedema of the lower extremities: modern aspects of complex treatment: textbook. allowance. ru: INFRA-M Academic Publishing LLC., 2017. http://dx.doi.org/10.12737/25282.
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The training manual sets forth modern views on the etiology, pathogenesis, clinic and principles of complex treatment of lymphedema of the lower extremities.
Individual tactics based on the use of clinico-functional and biomechanical methods in diagnosis and treatment are substantiated.
The authors described methods of conservative treatment, the technique of classical operations and modern innovative technologies. It meets the requirements of the Federal State Educational Standard of Higher Education of the latest generation.
The manual is intended for students of medical higher educational institutions, clinical residents, surgeons, angio-surgeons and general practitioners
Book chapters on the topic "General Medical Clinic"
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Bernabei, Antonio, Vincenzo Currò, Alessandro D’Atri, and Giovanna La Cava. "A distributed system for the integrated management of general and subspecialist pediatric outpatient clinic." In Medical Informatics Europe 1991, 101–5. Berlin, Heidelberg: Springer Berlin Heidelberg, 1991. http://dx.doi.org/10.1007/978-3-642-93503-9_17.
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Lotsberg, Maria Lie, and Stacey Ann D’mello Peters. "Publication Bias in Precision Oncology and Cancer Biomarker Research; Challenges and Possible Implications." In Human Perspectives in Health Sciences and Technology, 155–74. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-92612-0_10.
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AbstractPublication bias and lack of information sharing are major obstacles in scientific research. Indeed, a lot of time, money and effort might be misspent on research that has already been undertaken, but not published. Over time, this causes a bias in the scientific literature that has implications for researchers designing new research projects or interpreting results. It also affects society and decision-making processes as important scientific knowledge is not shared, used, and critically discussed. In the specific context of medical research, publication bias can have a great impact on patients’ lives, as they could potentially have received a more adequate treatment or avoided harmful side-effects. The issue of publication bias seems even more stringent for precision oncology and biomarker research, as aiming for perfection or ‘hyper precision’ will leave even less space for ‘negative’ results than in medical research in general. Indeed, although a lot of resources are spent on cancer biomarker research, still only a few biomarkers end up in the clinic, and even for those that “succeed” in this process, there are still challenges with defining cut-offs for biomarker positive and negative subgroups as well as deciding how to treat the biomarker defined subgroups in a most optimal way. The aim of this chapter is to explore the extent of publication bias in the context of precision oncology and cancer biomarker research: its implications on researchers, patients, and society, as well as to reflect on the deeper roots of the problem.
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Ghosh, Sumanta, Dipesh Shah, Namdev More, Mounika Choppadandi, Deepak Ranglani, and Govinda Kapusetti. "Clinical Validation of the Medical Devices: A General Prospective." In BioSensing, Theranostics, and Medical Devices, 265–97. Singapore: Springer Singapore, 2021. http://dx.doi.org/10.1007/978-981-16-2782-8_11.
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Spencer, J. A., A. L. Robinson, A. Corradine, and D. D. Smith. "Evaluation of the Impact of Clinical Skills Teaching on General Practice." In Advances in Medical Education, 299–301. Dordrecht: Springer Netherlands, 1997. http://dx.doi.org/10.1007/978-94-011-4886-3_91.
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Mejri, Nesrine, Haifa Rachdi, Lotfi Kochbati, and Hamouda Boussen. "General Oncology Care in Tunisia." In Cancer in the Arab World, 285–99. Singapore: Springer Singapore, 2022. http://dx.doi.org/10.1007/978-981-16-7945-2_18.
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AbstractTunisia is the smallest country in the Maghreb region, in terms of square and the third in terms of population. It has homogeneous health coverage and an efficient primary care structure. Medical oncology, surgical oncology, radiotherapy, pediatric oncology, and Bone Marrow Transplantation are provided to all geographic regions and practiced according to the national (scientific societies of medical oncology, radiotherapy, and surgical oncology) and international guidelines. Clinical trials and translational research are encouraged despite limited resources. The quality of care provided in public and private oncology structures involves not only nationals, but also Libyan and African citizens. Continuous medical education is sustained by authorities and scientific societies, as well as scientific publications and translational research.
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Pedapenki, Ravi Mohan, and Ali Madan. "General Oncology Care in Bahrain." In Cancer in the Arab World, 31–40. Singapore: Springer Singapore, 2022. http://dx.doi.org/10.1007/978-981-16-7945-2_3.
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AbstractThe Kingdom of Bahrain is a small island nation with the highest health care and life expectancy comparable in the Gulf Cooperation Council (GCC), has a small population, but a higher incidence rate of cancers in GCC countries. Two public (government) oncological facilities are available in Bahrain for cancer patients, mostly for Bahraini citizens. The majority of the consultants in medical and radiation oncology are expatriates and there is a need for locals to get trained in these faculties. With changing lifestyles, obesity, and the genetic factors peculiar to this ethnic population, the incidence of cancer is bound to rise over the years to come. Health-related policy decisions to join the international organizations for clinical trials will bring in more research and better cancer care, apart from increasing more facilities for palliative care. The scope of this chapter is to provide an overview of the current information about the cancer status in Bahrain, including epidemiology, statistics, and facilities of care.
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Benarroch, Eduardo E., Jeremy K. Cutsforth-Gregory, and Kelly D. Flemming. "Sensory System." In Mayo Clinic Medical Neurosciences, edited by Eduardo E. Benarroch, Jeremy K. Cutsforth-Gregory, and Kelly D. Flemming, 209–48. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190209407.003.0007.
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The sensory system provides information to the central nervous system about the external world (exteroceptive) and the internal environment (interoceptive). Impulses traveling toward the central nervous system are called afferent impulses. Afferent information may be transmitted as conscious data that are perceived by the organism and then used to modify behavior; as unconscious data that, although used to modify behavior, remain unperceived by the organism; or as both conscious and unconscious data. Afferent impulses are functionally subdivided into 4 categories: general somatic afferent impulses (from skin, striated muscles, and joints), general visceral afferent impulses (largely unconscious, from serosal and mucosal surfaces, smooth muscle of the viscera, and baroreceptors), special somatic afferent impulses (relating to vision, hearing, and equilibrium), and special visceral afferent impulses (relating to taste and smell).
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Gruneisen, Roger. "General Questions to Help Understand a Clinic or Medical Practice." In Medical Clinics and Practices, 11–20. Productivity Press, 2019. http://dx.doi.org/10.4324/9780429440151-3.
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Benarroch, Eduardo E., Jeremy K. Cutsforth-Gregory, and Kelly D. Flemming. "Posterior Fossa Level: Brainstem and Cranial Nerve Nuclei." In Mayo Clinic Medical Neurosciences, edited by Eduardo E. Benarroch, Jeremy K. Cutsforth-Gregory, and Kelly D. Flemming, 561–94. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190209407.003.0016.
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The posterior fossa level contains all the structures located within the skull below the tentorium cerebelli and above the foramen magnum. These structures are derivatives of the embryonic mesencephalon, metencephalon, and myelencephalon and include portions of all the systems discussed in other chapters. The major structures of this level are the brainstem, cerebellum, and segments of cranial nerves III-XII before their emergence from the skull. The brainstem, the core of the posterior fossa level, is a specialized rostral extension of the embryonic neural tube that preserves, even in the mature state, many of the longitudinal features of the spinal cord and provides for segmental functions of the head. This chapter describes the general anatomy of the posterior fossa, the anatomy and functions of cranial nerves III-XII, and the internal anatomy of the medulla, pons, and midbrain.
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Martin, Kari A. "Miscellaneous Psychiatric Disorders." In Mayo Clinic Neurology Board Review, edited by Kelly D. Flemming, 343–47. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780197512166.003.0043.
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In a number of psychiatric disorders, patients present with medical and psychological symptoms that are not well explained by a medical condition or substance use. The prevalence of somatic symptom disorder in the general US adult population may be about 5% to 7%. Associated demographic characteristics include female sex, older age, fewer years of education, lower socioeconomic status, unemployment, and a history of childhood adversity, comorbid psychiatric illness, social stress, and reinforcing illness benefits. A high level of medical care utilization rarely alleviates the patient’s concerns.
Conference papers on the topic "General Medical Clinic"
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Maula, Diah Ayu Rahmawati, Sendhi Tristanti Puspitasari, and Sapto Adi. "The Overview of Health Care Service Management at Malang Class 1 Prison General Medical Clinic." In The 1st International Scientific Meeting on Public Health and Sports (ISMOPHS 2019). Paris, France: Atlantis Press, 2020. http://dx.doi.org/10.2991/ahsr.k.201203.037.
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Rebegea, Laura, Camelia Tarlungianu, Rodica Anghel, Dorel Firescu, Nadejda Corobcean, and Laurentia Gales. "BURNOUT RISK EVALUATION IN MEDICAL ONCOLOGY – RADIOTHERAPY PERSONNEL." In The European Conference of Psychiatry and Mental Health "Galatia". Archiv Euromedica, 2023. http://dx.doi.org/10.35630/2022/12/psy.ro.5.
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Europäische Wissenschaftliche Gesellschaft Home About the Journal Peer Review Editorial Board For Authors Reviewer Recognition Archiv Kontakt Impressum EWG e.V. indexing in the Clarivate Analytics indexing in the Emerging Sources Citation Index Crossref Member Badge Erfolgreich durch internationale Zusammenarbeit PUBLIC HEALTH DOI 10.35630/2022/12/psy.ro.5 Received 14 December 2022; Published 6 January 2023 BURNOUT RISK EVALUATION IN MEDICAL ONCOLOGY – RADIOTHERAPY PERSONNEL Laura Rebegea1,2 orcid id logo, Camelia Tarlungianu1 , Rodica Anghel3 orcid id logo , Dorel Firescu4,5, Nadejda Corobcean1,6, Laurentia Gales3 orcid id logo 1 Department of Medical Oncology - Radiotherapy, „Sf. Ap. Andrei” Emergency Clinical Hospital, Galati, Romania 2 Medical Clinical Department, Faculty of Medicine, „Dunarea de Jos” University of Galati, Romania 3 „Carol Davila” University of Medicine and Pharmacy”, Bucharest, Romania 4 IInd Clinic of Surgery, „Sf. Apostol Andrei” Emergency Clinical Hospital, Galati, Romania 5 Surgical Clinical Department, „Dunarea de Jos” University, Faculty of Medicine and Pharmacy, Galati, Romania 6 „Nicolae Testemitanu”State University of Medicine and Pharmacy. Chisinau, Moldova download article (pdf) laura_rebegea@yahoo.com, tarlungianucamelia@yahoo.com ABSTRACT Introduction: Even if, all studies evidenced that Burnout syndrome affects medical personnel from all medical specialties, the highest prevalence is in surgical, oncological and emergency medical specialties. Scope: Burnout syndrome evaluation in Medical Oncology and Radiotherapy personnel. Method and material: This study has involved 50 persons employee in Medical Oncology and Radiotherapy Department, from all categories: 11 superiors personal (medical doctors, physicists, psychologist), 31 nurses, and 8 auxiliary personnel (stretcher-bearer). The following questionnaires were used: professional exhaustion level questionnaire (with 25 items), questionnaire for attitude and adaptation in stressed and difficulties situations, BRIEF COPE and SES scale. Results: After professional exhaustion level questionnaire for superior personnel, emotional exhaustion prevalence, followed by reduced personal achievement and an accentuated increasing of affecting grade after first year of activity, with a pick around 10 years of activity were revealed. For nurses, share of depersonalization is relative homogenous, in moderate - low limits. The results revealed that 56% of personnel from this study have risk for burnout syndrome developing, without any prevention methods and 12% has already burnout syndrome. Conclusions: In general, this syndrome is under-evaluated and under-diagnosed, and its incidence can be diminishing by using the techniques of stress resistance, psychological counseling, cresting a friendly and tolerant professional climate.
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Meinert, David. "Resistance to Electronic Medical Records (EMRs): A Barrier to Improved Quality of Care." In InSITE 2005: Informing Science + IT Education Conference. Informing Science Institute, 2005. http://dx.doi.org/10.28945/2896.
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While most industries have aggressively leveraged information technology (IT) to improve quality and reduce costs the healthcare sector has lagged behind. Electronic Medical Records (EMRs) hold great promise for improving quality of care yet widespread adoption is lacking. Physician acceptance is critical to widespread adoption of ambulatory EMRs, yet there is little independent research on physician perceptions. This paper attempts to address this void by reporting the results of a study of physician perceptions related to EMRs in a large, multi-specialty clinic. Physician perceptions of select EMR functions and general attitudes and beliefs are reported. While the importance and anticipated utilization of EMR functions varied, nearly 80 percent of the respondents felt an EMR should be implemented. The findings have implications for both vendors attempting to design and market EMR systems and physician executives and practice managers seeking to solicit support for EMR adoption and/or develop a successful implementation strategy.
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Santoso, Dian Budi, Nuryati, and Nur Rokhman. "Experience of Electronic Medical Records Adoption in Primary Health Care in Indonesia." In The 2nd International Conference on Technology for Sustainable Development. Switzerland: Trans Tech Publications Ltd, 2022. http://dx.doi.org/10.4028/p-j260sd.
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Along with the development of information technology, health care facilities in Indonesia have begun to adopt the use of electronic medical records (EMR). This adoption process needs to be documented as a best practice model for health care facilities in the transition process from paper-based medical records to electronic ones. This paper discusses specifically the adoption process of EMR in primary health care facilities. Focus group discussion, interviews, and documentation studies were carried out in one community health center and one general practitioner clinic in a Special Region of Yogyakarta, Indonesia, which is in the process of transitioning medical record management from paper-based to electronic-based. The transition process begins with the appointment of a key people leader, socialization related to EMR, comparative studies to other health facilities that have implemented EMR, determining the projected impact of EMR implementation, conducting needs analysis and design, starting the implementation of EMR, and conducting periodic evaluations. The transition process went through well by the two primary health care facilities which were the subjects of this study. There are several obstacles from the human resources and the technical side but they can be overcome in line with periodic evaluation and improvement.
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Cazzolato, Mirela T., Lucas S. Rodrigues, Lucas C. Scabora, Guilherme F. Zaboti, Guilherme Q. Vasconcelos, Daniel Y. T. Chino, Ana E. S. Jorge, Robson L. F. Cordeiro, Caetano Traina-Jr, and Agma J. M. Traina. "A DBMS-Based Framework for Content-Based Retrieval and Analysis of Skin Ulcer Images in Medical Practice." In XXXIV Simpósio Brasileiro de Banco de Dados. Sociedade Brasileira de Computação - SBC, 2019. http://dx.doi.org/10.5753/sbbd.2019.8812.
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Bedridden patients with skin lesions (ulcers) often do not have access to specialized clinic equipment. It is important to allow healthcare practitioners to use their smartphones to leverage information regarding the proper treatment to be carried. Existing applications require special equipment, such as heat sensors, or focus only on general information. To fulfill this gap, we propose ULEARn, a DBMS-based framework for the processing of ulcer images, providing tools to store and retrieve similar images of past cases. The proposed mobile application ULEARn-App allows healthcare practitioners to send a photo from a patient to ULEARn, and obtain a timely feedback that allows the improvement of procedures on therapeutic interventions. Experimental results of ULEARn and ULEARn-App using a real-world dataset showed that our tool can quickly respond to the required analysis and retrieval tasks, being up to 4.6 times faster than the specialist’ expected execution time.
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Toshimitsu, Akihiro, Nobuo Okazaki, Hiroyuki Kura, Eitaro Nishihara, and Shinichi Tsubura. "Toshiba General Hospital PACS for routine in- and outpatient clinics." In Medical Imaging 1996, edited by R. Gilbert Jost and Samuel J. Dwyer III. SPIE, 1996. http://dx.doi.org/10.1117/12.239281.
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Gashenko, Olga Viacheslavovna. "Health preparation of the elderly population by the special complex." In All-Russian Scientific Conference with International Participation. Publishing house Sreda, 2020. http://dx.doi.org/10.31483/r-75821.
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The article discusses the state of health and ways ofhealing the elderly, medical and social problems faced by this category of citizens. A study was conducted to identify the incidence rate and to determine the effectiveness of the introduction of a special complex for the elderly, statistics were collected together with general practitioners and general practitioners of clinics in Vladivostok. Conclusions were drawn that a special set of exercises has no contraindications and is generally available to the elderly.
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Huda, Walter, Ernest M. Scalzetti, Marsha L. Roskopf, and Robert Geiger. "Clinical performance of a prototype flat-panel digital detector for general radiography." In Medical Imaging 2001, edited by Eliot L. Siegel and H. K. Huang. SPIE, 2001. http://dx.doi.org/10.1117/12.435506.
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Edmonds, E. W., D. M. Hynes, J. A. Rowlands, B. D. Toth, and A. J. Porter. "Clinical Application Of High Resolution Digital Image Storage For General Radiography." In 1985 Medical Imaging Conferences, edited by Samuel J. Dwyer III and Roger H. Schneider. SPIE, 1985. http://dx.doi.org/10.1117/12.947299.
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Martinelli, Jose, Jessica Ivanovs, and Marcos Martinelli. "GERIATRIC EVALUATION IN 27 CASES OF MUSICAL HALLUCINATION." In XIII Meeting of Researchers on Alzheimer's Disease and Related Disorders. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1980-5764.rpda073.
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Background: Musical hallucination (AM) is a type of complex auditory hallucination described as hearing musical tones, rhythms, harmonies, and melodies without the corresponding external auditory stimulus. This type of hallucination is relatively rare and is seen less often than other types of hallucination. Such hallucinations can be continuous or intermittent and are usually accompanied by a clear and critical awareness on the part of the patient. AM are found mainly in elderly women with progressive hearing loss, usually due to ear diseases or lesions. They also occur in neurological disorders, neuropsychological disorders (eg dementia) and psychiatric disorders, especially depression. Objective: To evaluate clinical and neuropsychological issues of the elderly with Musical Hallucinations Methods: Twenty-seven outpatient patients clinic of Geriatrics and Gerontology at FMJ from January 2010 to October 2019 were selected Results: Of the 27 patients, 20 were women. The average age was 83.47 years. The most prevalent diseases were systemic arterial hypertension, osteoporosis, diabetes mellitus, hypothyroidism, osteoporosis, chronic obstructive pulmonary disease and dementia syndrome. With the exception of one patient, all had hearing loss. The songs were the most varied from Gregorian chant to lullaby. Many had this picture for months and continuously (day and night). 40% of them had no insight into AM. We emphasize that all these patients sought medical care with the main complaint of musical hallucination. Conclusion: In general, AM has an uninterrupted, fragmentary and repetitive character. They are involuntary, intrusive and have an apparent exteriority. They differ from the simple mental image of auditory sensation in that they appear to come from outside the individual as if they actually hear an external device playing music. Currently, it is estimated that about 2% of elderly people with hearing loss also have AM. The neuropsychological basis of AM is not fully established. The phenomenological study, especially the perception of complex sequences and consistency with previous auditory experience strongly suggest the involvement of central auditory processing mechanisms. Normal musical auditory processing involves several interrelated brain levels and subsystems. While the recognition of elementary sounds is done in the primary auditory cortex, the recognition of musical characteristics such as notes, melody and metric rhythm occur in a secondary and tertiary association center, which in turn, are greatly influenced by regions linked to memory and emotion.
Reports on the topic "General Medical Clinic"
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Gall, Daniel W. Coding Accuracy of the Ambulatory Data System: A Study of Coding Accuracy Within the General Internal Medicine Clinic, Walter Reed Army Medical Center. Fort Belvoir, VA: Defense Technical Information Center, April 1998. http://dx.doi.org/10.21236/ada372083.
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MacFarlane, Andrew. 2021 medical student essay prize winner - A case of grief. Society for Academic Primary Care, July 2021. http://dx.doi.org/10.37361/medstudessay.2021.1.1.
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As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.
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Woods, Rachel, Alison Zhong, and Madelyn Vincent. Factors Associated with Influenza & Tdap Vaccine Uptake in Pregnant Patients at the UT Family Medicine Clinic in Memphis. University of Tennessee Health Science Center, 2021. http://dx.doi.org/10.21007/com.lsp.2020.0003.
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INTRODUCTION: Given the increased risk for infections among pregnant patients and newborns, vaccination against influenza (>50,000,000 annual US cases affecting all ages) and pertussis (>15,000 annual US cases disproportionately affecting newborns) are recommended among pregnant patients in order to protect them and their babies via passive immunity to cover a newborn’s window of vaccine ineligibility. Though flu and Tdap vaccination rates among pregnant patients have been trending upwards nationally, there is still room for improvement to achieve optimal rates. OBJECTIVES: The primary objectives were to study factors that affect the vaccination rates at the University of Tennessee Family Medicine Clinic at Memphis (UTFMC-M), compare those rates with national pregnancy flu/Tdap vaccination rates, and to generate recommendations based off observed factors associated with vaccine uptake to improve flu/Tdap vaccination rates in UTFMC-M pregnant patients. METHODS: This was a retrospective chart review of UTFMC-M patients who were pregnant from September 1, 2019-April 24, 2020 (included 2019-2020 flu season) (n=465). Variables studied included demographic data (race, age, insurance), immunization history (vaccine status, history of physician encouragement), and prenatal history (parity, number of prenatal visits, trimester at first visit, high risk clinic (HRC) admittance status). Vaccination status was based on ACIP recommendations (Flu shot eligible = any gestational age; Tdap eligible = ≥27 weeks). Positive HRC admittance was noted for patients with ≥2 visits to the UTFMC-M HRC, a clinic that specializes in high risk pregnant patient care. RESULTS: The patient sample was predominantly black (84.3%) and insured by Medicaid programs (88%). Among eligible UTFMC-M pregnant patients, 50.1% were flu-vaccinated (n=465); 73.8% were Tdap-vaccinated (n=317); and 52.1% were Flu+Tdap-vaccinated (n=317). No significant associations were found between vaccine uptake and HRC status, parity, and age. However, statistically significant relationships were found between vaccine uptake and physician encouragement (positive relationship with flu shot: X2(1, N = 465) =131, p < 0.001, Tdap: X2 (6, N = 465) =476, p < 0.001), number of prenatal visits (flu shot group median 8 visits, Tdap group median 9 visits vs. unvaccinated group median 4 visits; p < 0.001), and early trimester age at first prenatal visit (X2(6, N = 465) =47.635 , p CONCLUSION: 2019-2020 UTFMC-M vaccination rates were on par with 2018-2019 US flu vaccine rates and higher than 2018-2019 US Tdap and Flu+Tdap rates. There were statistically significant relationships between vaccine uptake at UTFMC-M and physician encouragement, number of prenatal visits, and early trimester age at first prenatal visit but no significant relationships with UTFMC-M HRC admittance, parity, or age. Recommendations following from our observations to address further vaccine rate improvement include: continue vaccine encouragement, continue booking multiple visits (8 for flu, 9 for Tdap), prioritize Tdap vaccine higher for late trimester intake patients, and focus on flu vaccine encouragement and education.
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Osadchyi, Viacheslav V., Hanna B. Varina, Kateryna P. Osadcha, Olesia O. Prokofieva, Olha V. Kovalova, and Arnold E. Kiv. Features of implementation of modern AR technologies in the process of psychological and pedagogical support of children with autism spectrum disorders. [б. в.], November 2020. http://dx.doi.org/10.31812/123456789/4413.
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The article deals with the actual issue of the specificity and algorithm of the introduction of innovative AR technologies in the process of psychological and pedagogical support of children with autism spectrum disorders (ASD). An innovative element of theoretical and methodological analysis of the problem and empirical research is the detection of vectors of a constructive combination of traditional psycho-correctional and psycho-diagnostic approaches with modern AR technologies. The analysis of publications on the role and possibilities of using AR technologies in the process of support children with ASD (autism spectrum disorder) and inclusive environment was generally conducted by surfing on the Internet platforms containing the theoretical bases for data publications of scientific journals and patents. The article also analyzes the priorities and potential outcomes of using AR technologies in psycho-correction and educational work with autistic children. According to the results of the analysis of scientific researches, Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) medical care and medical rehabilitation “Autism spectrum disorders (disorders of general development)”, approaches for correction, development and education of children with ASD, AR technologies were selected for further implementation in a comprehensive program of psychological and pedagogical support for children with ASD. The purpose of the empirical study is the search, analysis and implementation of multifunctional AR technologies in the psycho-correctional construct of psychological and pedagogical support of children with ASD. According to the results of the pilot study, the priorities and effectiveness of using AR technologies in the development of communicative, cognitive, emotional-volitional, mnemonic abilities of children and actualization of adaptive potential and adaptive, socially accepted behaviors are made. The possibilities and perspectives of using AR technologies as an element of inclusive environment, with regard to nosology and phenomenology, need further investigation.
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Fatehifar, Mohsen, Josef Schlittenlacher, David Wong, and Kevin Munro. Applications Of Automatic Speech Recognition And Text-To-Speech Models To Detect Hearing Loss: A Scoping Review Protocol. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, January 2023. http://dx.doi.org/10.37766/inplasy2023.1.0029.
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Review question / Objective: This scoping review aims to identify published methods that have used automatic speech recognition or text-to-speech recognition technologies to detect hearing loss and report on their accuracy and limitations. Condition being studied: Hearing enables us to communicate with the surrounding world. According to reports by the World Health Organization, 1.5 billion suffer from some degree of hearing loss of which 430 million require medical attention. It is estimated that by 2050, 1 in every 4 people will experience some sort of hearing disability. Hearing loss can significantly impact people’s ability to communicate and makes social interactions a challenge. In addition, it can result in anxiety, isolation, depression, hindrance of learning, and a decrease in general quality of life. A hearing assessment is usually done in hospitals and clinics with special equipment and trained staff. However, these services are not always available in less developed countries. Even in developed countries, like the UK, access to these facilities can be a challenge in rural areas. Moreover, during a crisis like the Covid-19 pandemic, accessing the required healthcare can become dangerous and challenging even in large cities.
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Rada, Maria Patricia, Alexandra Caseriu, Roxana Crainic, and Stergios K. Doumouchtsis. A critical appraisal and systematic review of clinical practice guidelines on hormone replacement therapy for menopause: assessment using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Instrument. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, December 2022. http://dx.doi.org/10.37766/inplasy2022.12.0089.
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Review question / Objective: To assess the quality of clinical practice guidelines (CPC) on hormone replacement therapy for menopause using the AGREE II instrument and to provide a summary of recommendations. Information sources: Literature searches using MEDLINE, Embase, Scopus, Geneva Foundation for Medical Education and Research from inception to date will be searched. The search terms include guidelines / guidance / recommendation and hormone replacement therapy related keywords and MeSH terms. National and international organizations websites will be searched individually. Additional searches on the references of the primary included items may help identify any guidelines missed on the primary searches. In the case of more than one published guideline from the same national or international association, only the latest version of the guidelines will be included and evaluated. Any disagreements on inclusion criteria will be addressed through discussion and consensus meeting within the research team. Guidelines published in languages other than English will be considered on an individual basis. Guidelines must be publicly available on a website or in a peer-reviewed publication.
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Tipton, Kelley, Brian F. Leas, Nikhil K. Mull, Shazia M. Siddique, S. Ryan Greysen, Meghan B. Lane-Fall, and Amy Y. Tsou. Interventions To Decrease Hospital Length of Stay. Agency for Healthcare Research and Quality (AHRQ), September 2021. http://dx.doi.org/10.23970/ahrqepctb40.
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Background. Timely discharge of hospitalized patients can prevent patient harm, improve patient satisfaction and quality of life, and reduce costs. Numerous strategies have been tested to improve the efficiency and safety of patient recovery and discharge, but hospitals continue to face challenges. Purpose. This Technical Brief aimed to identify and synthesize current knowledge and emerging concepts regarding systematic strategies that hospitals and health systems can implement to reduce length of stay (LOS), with emphasis on medically complex or vulnerable patients at high risk for prolonged LOS due to clinical, social, or economic barriers to timely discharge. Methods. We conducted a structured search for published and unpublished studies and conducted interviews with Key Informants representing vulnerable patients, hospitals, health systems, and clinicians. The interviews provided guidance on our research protocol, search strategy, and analysis. Due to the large and diverse evidence base, we limited our evaluation to systematic reviews of interventions to decrease hospital LOS for patients at potentially higher risk for delayed discharge; primary research studies were not included, and searches were restricted to reviews published since 2010. We cataloged the characteristics of relevant interventions and assessed evidence of their effectiveness. Findings. Our searches yielded 4,364 potential studies. After screening, we included 19 systematic reviews reported in 20 articles. The reviews described eight strategies for reducing LOS: discharge planning; geriatric assessment or consultation; medication management; clinical pathways; inter- or multidisciplinary care; case management; hospitalist services; and telehealth. All reviews included adult patients, and two reviews also included children. Interventions were frequently designed for older (often frail) patients or patients with chronic illness. One review included pregnant women at high risk for premature delivery. No reviews focused on factors linking patient vulnerability with social determinants of health. The reviews reported few details about hospital setting, context, or resources associated with the interventions studied. Evidence for effectiveness of interventions was generally not robust and often inconsistent—for example, we identified six reviews of discharge planning; three found no effect on LOS, two found LOS decreased, and one reported an increase. Many reviews also reported patient readmission rates and mortality but with similarly inconsistent results. Conclusions. A broad range of strategies have been employed to reduce LOS, but rigorous systematic reviews have not consistently demonstrated effectiveness within medically complex, high-risk, and vulnerable populations. Health system leaders, researchers, and policymakers must collaborate to address these needs.
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Apiyo, Eric, Zita Ekeocha, Stephen Robert Byrn, and Kari L. Clase. Improving Pharmacovigilliance Quality Management System in the Pharmacy and Poisions Board of Kenya. Purdue University, December 2021. http://dx.doi.org/10.5703/1288284317444.
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The purpose of this study was to explore ways of improving the pharmacovigilance quality system employed by the Pharmacy and Poisons Board of Kenya. The Pharmacy and Poisons Board of Kenya employs a hybrid system of pharmacovigilance that utilizes an online system of reporting pharmacovigilance incidences and a physical system, where a yellow book is physically filled by the healthcare worker and sent to the Pharmacy and Poisons Board for onward processing. This system, even though it has been relatively effective compared to other systems employed in Africa, has one major flaw. It is a slow and delayed system that captures the data much later after the fact and the agency will always be behind the curve in controlling the adverse incidents and events. This means that the incidences might continue to arise or go out of control. This project attempts to develop a system that would be more proactive in the collection of pharmacovigilance data and more predictive of pharmacovigilance incidences. The pharmacovigilance system should have the capacity to detect and analyze subtle changes in reporting frequencies and in patterns of clinical symptoms and signs that are reported as suspected adverse drug reactions. The method involved carrying out a thorough literature review of the latest trends in pharmacovigilance employed by different regulatory agencies across the world, especially the more stringent regulatory authorities. A review of the system employed by the Pharmacy and Poisons Board of Kenya was also done. Pharmacovigilance data, both primary and secondary, were collected and reviewed. Media reports on adverse drug reactions and poor-quality medicines over the period were also collected and reviewed. An appropriate predictive pharmacovigilance tool was also researched and identified. It was found that the Pharmacy and Poisons Board had a robust system of collecting historical pharmacovigilance data both from the healthcare workers and the general public. However, a more responsive data collection and evaluation system is proposed that will help the agency achieve its pharmacovigilance objectives. On analysis of the data it was found that just above half of all the product complaints, about 55%, involved poor quality medicines; 15% poor performance, 13% presentation, 8% adverse drug reactions, 7% market authorization, 2% expired drugs and 1% adulteration complaints. A regulatory pharmacovigilance prioritization tool was identified, employing a risk impact analysis was proposed for regulatory action.
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Raymond, Kara, Laura Palacios, Cheryl McIntyre, and Evan Gwilliam. Status of climate and water resources at Saguaro National Park: Water year 2019. Edited by Alice Wondrak Biel. National Park Service, December 2021. http://dx.doi.org/10.36967/nrr-2288717.
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Climate and hydrology are major drivers of ecosystems. They dramatically shape ecosystem structure and function, particularly in arid and semi-arid ecosystems. Understanding changes in climate, groundwater, and water quality and quantity is central to assessing the condition of park biota and key cultural resources. The Sonoran Desert Network collects data on climate, groundwater, and surface water at 11 National Park Service units in south-ern Arizona and New Mexico. This report provides an integrated look at climate, groundwater, and springs conditions at Saguaro National Park (NP) during water year 2019 (October 2018–September 2019). Annual rainfall in the Rincon Mountain District was 27.36" (69.49 cm) at the Mica Mountain RAWS station and 12.89" (32.74 cm) at the Desert Research Learning Center Davis station. February was the wettest month, accounting for nearly one-quarter of the annual rainfall at both stations. Each station recorded extreme precipitation events (>1") on three days. Mean monthly maximum and minimum air temperatures were 25.6°F (-3.6°C) and 78.1°F (25.6°C), respectively, at the Mica Mountain station, and 37.7°F (3.2°C) and 102.3°F (39.1°C), respectively, at the Desert Research Learning Center station. Overall temperatures in WY2019 were cooler than the mean for the entire record. The reconnaissance drought index for the Mica Mountain station indicated wetter conditions than average in WY2019. Both of the park’s NOAA COOP stations (one in each district) had large data gaps, partially due to the 35-day federal government shutdown in December and January. For this reason, climate conditions for the Tucson Mountain District are not reported. The mean groundwater level at well WSW-1 in WY2019 was higher than the mean for WY2018. The water level has generally been increasing since 2005, reflecting the continued aquifer recovery since the Central Avra Valley Storage and Recovery Project came online, recharging Central Arizona Project water. Water levels at the Red Hills well generally de-clined starting in fall WY2019, continuing through spring. Monsoon storms led to rapid water level increases. Peak water level occurred on September 18. The Madrona Pack Base well water level in WY2019 remained above 10 feet (3.05 m) below measuring point (bmp) in the fall and winter, followed by a steep decline starting in May and continuing until the end of September, when the water level rebounded following a three-day rain event. The high-est water level was recorded on February 15. Median water levels in the wells in the middle reach of Rincon Creek in WY2019 were higher than the medians for WY2018 (+0.18–0.68 ft/0.05–0.21 m), but still generally lower than 6.6 feet (2 m) bgs, the mean depth-to-water required to sustain juvenile cottonwood and willow trees. RC-7 was dry in June–September, and RC-4 was dry in only September. RC-5, RC-6 and Well 633106 did not go dry, and varied approximately 3–4 feet (1 m). Eleven springs were monitored in the Rincon Mountain District in WY2019. Most springs had relatively few indications of anthropogenic or natural disturbance. Anthropogenic disturbance included spring boxes or other modifications to flow. Examples of natural disturbance included game trails and scat. In addition, several sites exhibited slight disturbance from fires (e.g., burned woody debris and adjacent fire-scarred trees) and evidence of high-flow events. Crews observed 1–7 taxa of facultative/obligate wetland plants and 0–3 invasive non-native species at each spring. Across the springs, crews observed four non-native plant species: rose natal grass (Melinis repens), Kentucky bluegrass (Poa pratensis), crimson fountaingrass (Cenchrus setaceus), and red brome (Bromus rubens). Baseline data on water quality and chemistry were collected at all springs. It is likely that that all springs had surface water for at least some part of WY2019. However, temperature sensors to estimate surface water persistence failed...
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Rankin, Nicole, Deborah McGregor, Candice Donnelly, Bethany Van Dort, Richard De Abreu Lourenco, Anne Cust, and Emily Stone. Lung cancer screening using low-dose computed tomography for high risk populations: Investigating effectiveness and screening program implementation considerations: An Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the Cancer Institute NSW. The Sax Institute, October 2019. http://dx.doi.org/10.57022/clzt5093.
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Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.