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1.
Objectives
Modernising Medical Careers (MMC) emerged in response to acknowledged problems in training in the Senior House Officer grade. The objective of this study was to assess the effect of the Foundation Year 2 (F2) training programme on career orientation in the Northern Ireland Deanery.Methods
A prospective survey-based study was conducted for all F2 doctors participating in the Northern Ireland Foundation Programme. Career orientation was investigated using the Specialty Choice Inventory 45 (SCI45) at the start (Q1) and end (Q2) of the F2 year. Specialty choice was collated after the outcome of specialty recruitment in 2008.Results
There were 231 F2 doctors in programme during the first F2 year in 2006–2007. 147 (M=65, F=82) and 106 (M=55, F=51) completed questionnaires at Q1 and Q2. Male F2 doctors scored significantly higher in the action orientation (54.0 vs. 50.0, p<0.001) and need for assertiveness (53.0 vs. 48.0, p=0.005) subscales at both time points as well as Q1 detail is crucial (57.0 vs. 51.0, p=0.014) and Q2 independent specialty (53.0 vs. 46.0, p=0.016). Female F2 doctors scored significantly higher in the educating patients subscale at both time-points (44.0 vs. 46.0, p=0.009 and 46.0 vs. 47.0, p=0.03). Analysis of SCI45 subscale scores suggested that males tended to favour the surgical specialties while females favoured the care of the elderly and paediatric specialties. Overall only 29% of doctors were successfully appointed to a specialty in which they had expressed an interest at Q1 whilst 47.8% were selected to specialist training for their declared specialty interest at Q2.Conclusions
Despite introducing MMC with a coordinated UK wide specialty application process (MTAS), a detrimental effect on their career orientation was not evident. Pragmatic career choices based on lifestyle may be the reason why female doctors expressed a preference for care of the elderly and paediatrics while their male colleagues favoured acute, more surgically biased specialties. 相似文献2.
K Srivastava MSVK Raju D Saldanha S Chaudhury D Basannar AA Pawar VSSR Ryali SM Kundeyawala 《Medical Journal Armed Forces India》2007,63(2):137-140
Background
Training in medicine is emotionally demanding. Psychological well being of medical students is a matter of concern. There is lack of Indian studies in this area.Methods
A total of 105 medical student of one batch were assessed utilizing psychophysiological state inventory, Institute for personality and ability testing (IPAT) anxiety and depression scale, achievement motivation scale, scale for locus of control and 16 PF in three phases at one-year intervals.Result
Majority of the students had average achievement, motivation and adaptability. Anxiety and depression scores fell within normal limits. In personality profile factor ‘B’, ‘M’ and ‘Q41’ had changed significantly. Achievement motivation showed significant decreases and CSS1 and PO1 scores showed significant increase during the years of medical education.Conclusion
The results demonstrate that over satisfaction and relaxed attitude may have poor academic outcome.Key Words: Psychological well-being, Anxiety, Depression, Achievement motivation 相似文献3.
D Saldanha S Chaudhury AA Pawar VSSR Ryali K Srivastava M Sood HK Bedi 《Medical Journal Armed Forces India》2007,63(2):160-162
Background
The Army Order 3&11/2001 was introduced to curb alcoholism and to weed out habitual alcoholics. Hence a study was carried out in a zonal referral hospital from 01 Jan 2001 to 30 Jun 2003 to assess its effectiveness.Methods
The subjects consisted of officers, junior commisioned officers and other ranks who satisfied the International Classification of Diseases (ICD) 10 criteria for alcohol dependence.Result
Out of 1023 consecutive admissions, alcohol dependent cases numbered 245 (23.95%). They were disposed as under: 57/ 245 (23.6%) in S1 (fit for all duties), 67/245 (27.35%) in S2 (fit for duties with few restrictions), 72/245 (29.39%) in S3 (fit for duties with more restrictions), and 32/245 (13.06%) in S5 (unfit for further service.)Conclusion
The data showed that the percentage of cases disposed under fit for all duties had risen four times (23.80 vs 5.86), those invalided out increased by two times (12.70 vs 6.64) and those retained in S2 had reduced (26.46 vs 41.21) after the new policy.Key Words: AO 3 &11/2001, DGAFMS memorandum 111/99, AFMSF 10, Alcohol dependence syndrome 相似文献4.
Yan Xu Yining Wang Tianren Liu Junichi Tsujii Eric I-Chao Chang 《J Am Med Inform Assoc》2013,20(5):849-858
Objective
To create an end-to-end system to identify temporal relation in discharge summaries for the 2012 i2b2 challenge. The challenge includes event extraction, timex extraction, and temporal relation identification.Design
An end-to-end temporal relation system was developed. It includes three subsystems: an event extraction system (conditional random fields (CRF) name entity extraction and their corresponding attribute classifiers), a temporal extraction system (CRF name entity extraction, their corresponding attribute classifiers, and context-free grammar based normalization system), and a temporal relation system (10 multi-support vector machine (SVM) classifiers and a Markov logic networks inference system) using labeled sequential pattern mining, syntactic structures based on parse trees, and results from a coordination classifier. Micro-averaged precision (P), recall (R), averaged P&R (P&R), and F measure (F) were used to evaluate results.Results
For event extraction, the system achieved 0.9415 (P), 0.8930 (R), 0.9166 (P&R), and 0.9166 (F). The accuracies of their type, polarity, and modality were 0.8574, 0.8585, and 0.8560, respectively. For timex extraction, the system achieved 0.8818, 0.9489, 0.9141, and 0.9141, respectively. The accuracies of their type, value, and modifier were 0.8929, 0.7170, and 0.8907, respectively. For temporal relation, the system achieved 0.6589, 0.7129, 0.6767, and 0.6849, respectively. For end-to-end temporal relation, it achieved 0.5904, 0.5944, 0.5921, and 0.5924, respectively. With the F measure used for evaluation, we were ranked first out of 14 competing teams (event extraction), first out of 14 teams (timex extraction), third out of 12 teams (temporal relation), and second out of seven teams (end-to-end temporal relation).Conclusions
The system achieved encouraging results, demonstrating the feasibility of the tasks defined by the i2b2 organizers. The experiment result demonstrates that both global and local information is useful in the 2012 challenge. 相似文献5.
R Augier S Jenkins S Bortolusso Ali I Tennant J Williams-Johnson M Reid 《The West Indian medical journal》2014,63(3):252-257
Objectives:
The aim of this survey was to establish the pain management approaches to acute painful crisis (APC) in sickle cell patients at two healthcare facilities and to compare with available guidelines.Methods:
A multi-centre observational survey of the management of APC in sickle cell patients was conducted. Data were collected at the Sickle Cell Unit (SCU), Tropical Medicine Research Institute (TMRI) and Accident and Emergency Department (A&E), University Hospital of the West Indies.Results:
One hundred episodes of uncomplicated APC involving 81 patients managed at the SCU clinic and 64 episodes at the A&E in a total of 28 patients were included in the data set. Drugs used at the SCU included oral morphine, codeine and paracetamol and intramuscular diclofenac. At the A&E, parenteral morphine and pethidine were most commonly used. At the SCU, the mean time to initiation of analgesics was 38 minutes (IQR 25 to 50 minutes); at the A&E, this was 111 minutes (IQR 50 to 150 minutes). At the SCU, the mean duration of stay (DOS) was 2.9 hours (IQR 1.9 to 3.8 hours) with 94% of the patients being discharged home. At the A&E, the mean DOS was 13.0 hours (IQR 8.3 to 16.9 hours) with 93% of the patients being discharged home. The A&E patient group contained multiple high frequency presenters. Documentation of pain severity scores was inconsistent.Conclusion
The findings of the survey indicate that the management of APC at the two centres is substantially different. Further study is required to investigate patient satisfaction, centre preference and analgesic therapy efficacy. 相似文献6.
MM Harjai N Chandrashekhar Uma Raju SS Jog P Arora 《Medical Journal Armed Forces India》2005,61(4):330-332
Background
Terrorist attacks, armed conflict and all forms of catastrophe, tax our ability to cope, understand and respond to the situation. Children are more vulnerable.Material & Method
16 children, victims of a terrorist attack in an army residential camp were managed for their physical injuries and evaluated for psychological trauma.Results
All patients recovered from physical injuries, except one baby of two months, who died due to severe chest trauma. 5 children presented with Acute Stress Reaction. 3 recovered well and two, showed persistent poor scholastic performance even after one year.Conclusion
A terrorist attack, not only results in physiscal scars but also causes psychological trauma, which requires emotional support and needs to be followed up on a long term basis.Key Words: Terrorism, Trauma, Children, Gunshot injuries, Acute Stress Reaction 相似文献7.
Objective
To examine the effect of interruptions and task complexity on error rates when prescribing with computerized provider order entry (CPOE) systems, and to categorize the types of prescribing errors.Design
Two within-subject factors: task complexity (complex vs simple) and interruption (interruption vs no interruption). Thirty-two hospital doctors used a CPOE system in a computer laboratory to complete four prescribing tasks, half of which were interrupted using a counterbalanced design.Measurements
Types of prescribing errors, error rate, resumption lag, and task completion time.Results
Errors in creating and updating electronic medication charts that were measured included failure to enter allergy information; selection of incorrect medication, dose, route, formulation, or frequency of administration from lists and drop-down menus presented by the CPOE system; incorrect entry or omission in entering administration times, start date, and free-text qualifiers; and omissions in prescribing and ceasing medications. When errors occurred, the error rates across the four prescribing tasks ranged from 0.5% (1 incorrect medication selected out of 192 chances for selecting a medication or error opportunities) to 16% (5 failures to enter allergy information out of 32 error opportunities). Any impact of interruptions on prescribing error rates and task completion times was not detected in our experiment. However, complex tasks took significantly longer to complete (F(1, 27)=137.9; p<0.001) and when execution was interrupted they required almost three times longer to resume compared to simple tasks (resumption lag complex=9.6 seconds, SD=5.6; resumption lag simple=3.4 seconds, SD=1.7; t(28)=6.186; p<0.001).Conclusion
Most electronic prescribing errors found in this study could be described as slips in using the CPOE system to create and update electronic medication charts. Cues available within the user interface may have aided resumption of interrupted tasks making CPOE systems robust to some interruption effects. Further experiments are required to rule out any effect interruption might have on CPOE error rates. 相似文献8.
Background
The successful conduct of fiberoptic aided intubation is dependent upon effective local anaesthesia. The aim of the study was to compare three different methods of anaesthetizing the airway.Methods
60 adult patients (American Society of Anaesthesiologists status I-III and Mallampati class III & IV), scheduled for elective surgery, received sedation followed by spraying of the nares and posterior pharyngeal wall with 4% lignocaine. Thereafter the patients received 4 ml of 4% lignocaine either by transtracheal injection (n=20, group A), via intubating fiberscope (Pentax F1-10P2) using ‘spray as you go’ technique (n=20, group B) or by nebulizer (Devilbiss 5610W) 20 min before intubation, (n=20, group C). Patients were asked to score the procedure using visual analog scale (VAS) and severity scores. Episodes of coughing, choking, stridor, extra / total local anaesthetic used and intubation times were recorded. Patients were monitored continuously for vital parameters.Results
Group B patients showed better VAS scores with shorter intubation times and had a lower incidence of coughing and choking. The endoscopists’ VAS scores also showed a preference for group B.Conclusion
In conclusion the ‘spray as you go’ technique was safe, provided effective local anaesthesia and was preferred by both patients and endoscopists.Key Words: Awake intubation, Difficult airway, Fiberoptic intubation 相似文献9.
Objective
To develop a system to extract follow-up information from radiology reports. The method may be used as a component in a system which automatically generates follow-up information in a timely fashion.Methods
A novel method of combining an LSP (labeled sequential pattern) classifier with a CRF (conditional random field) recognizer was devised. The LSP classifier filters out irrelevant sentences, while the CRF recognizer extracts follow-up and time phrases from candidate sentences presented by the LSP classifier.Measurements
The standard performance metrics of precision (P), recall (R), and F measure (F) in the exact and inexact matching settings were used for evaluation.Results
Four experiments conducted using 20 000 radiology reports showed that the CRF recognizer achieved high performance without time-consuming feature engineering and that the LSP classifier further improved the performance of the CRF recognizer. The performance of the current system is P=0.90, R=0.86, F=0.88 in the exact matching setting and P=0.98, R=0.93, F=0.95 in the inexact matching setting.Conclusion
The experiments demonstrate that the system performs far better than a baseline rule-based system and is worth considering for deployment trials in an alert generation system. The LSP classifier successfully compensated for the inherent weakness of CRF, that is, its inability to use global information. 相似文献10.
Background
Teledermatology is the science of telemedicine applied to the field of dermatology, with an aim to avoid travelling to nearest specialist facility.Methods
Patients from Air Force Stations Jaisalmer, Naliya, 5 Air Force Hospital, Jorhat and 9 Air Force Hospital, Halwara were consulted by the dermatologist at Command Hospital (Air Force) Bangalore through the telemedicine network provided by ISRO, Bangalore from March 06 to May 08.Result
115 patients underwent teledermatology consultation using virtual teleconference (VTC) and this was compared with Store and Forward (S and F) consultation at all four stations as well as Face to Face (FTF) consultation at 5 Air Force Hospital Jorhat. Diagnosis concordance was 52.5% and 53% for Jorhat and Halwara for VTC vs S and F, while it was 75% and 25% for Jaisalmer and Naliya. For VTC vs FTF, the concordance improved to 60.66% and for S and F vs FTF it improved to 91.8%. Concordance was better for localized lesions than for generalized lesions especially of the papulosquamous group of disorders. Another reason for the discordance with VTC was poor resolution of cameras at the peripheral units.Conclusion
Teledermatology is useful for patient care in the absence of local specialist cover and the patients have to travel long distances resulting in loss of manhours. However, better camera resolution at peripheral centres will result in greater concordance.Key Words: Teledermatology, Virtual teleconference, Store and forward, Face to face 相似文献11.
Adam Wright Allison B McCoy Stanislav Henkin Abhivyakti Kale Dean F Sittig 《J Am Med Inform Assoc》2013,20(5):887-890
Background
Electronic health record (EHR) users must regularly review large amounts of data in order to make informed clinical decisions, and such review is time-consuming and often overwhelming. Technologies like automated summarization tools, EHR search engines and natural language processing have been shown to help clinicians manage this information.Objective
To develop a support vector machine (SVM)-based system for identifying EHR progress notes pertaining to diabetes, and to validate it at two institutions.Materials and methods
We retrieved 2000 EHR progress notes from patients with diabetes at the Brigham and Women''s Hospital (1000 for training and 1000 for testing) and another 1000 notes from the University of Texas Physicians (for validation). We manually annotated all notes and trained a SVM using a bag of words approach. We then used the SVM on the testing and validation sets and evaluated its performance with the area under the curve (AUC) and F statistics.Results
The model accurately identified diabetes-related notes in both the Brigham and Women''s Hospital testing set (AUC=0.956, F=0.934) and the external University of Texas Faculty Physicians validation set (AUC=0.947, F=0.935).Discussion
Overall, the model we developed was quite accurate. Furthermore, it generalized, without loss of accuracy, to another institution with a different EHR and a distinct patient and provider population.Conclusions
It is possible to use a SVM-based classifier to identify EHR progress notes pertaining to diabetes, and the model generalizes well. 相似文献12.
Background
Topical life long anti glaucoma medication forms the mainstay of treatment of primary open angle glaucoma. Their long term usage can cause changes in conjunctival epithelium.Methods
Hundred cases of primary open angle glaucoma were divided into four groups of 25 patients each. Each group was put on Timolol, Pilocarpine, Brimonidine and Latanoprost respectively. Ocular surface changes were monitored using Schirmer''s test, tear film break up time (BUT) and conjunctival impression cytology.Result
Altered Schirmer''s test value was seen in 40% of patients and reduced tear film BUT values in 26%, at the end of one year. These changes were more in patients treated with timolol. Changes in conjunctival cytology such as decrease in goblet cell density, squamous metaplasia and presence of inflammatory cells were seen in significant number of patients at the end of one year treatment. There was direct relation of duration of treatment to various ocular surface changes.Conclusion
Ocular surface changes are seen in significant number of patients of primary open angle glaucoma at the end of one year follow up with topical anti glaucoma therapy. Conjunctival impression cytology is a non invasive technique to monitor these changes.Key Words: Primary open angle glaucoma, Ocular surface changes, Goblet cell density, Squamous metaplasia 相似文献13.
Objective
Negation is a linguistic phenomenon that marks the absence of an entity or event. Negated events are frequently reported in both biological literature and clinical notes. Text mining applications benefit from the detection of negation and its scope. However, due to the complexity of language, identifying the scope of negation in a sentence is not a trivial task.Design
Conditional random fields (CRF), a supervised machine-learning algorithm, were used to train models to detect negation cue phrases and their scope in both biological literature and clinical notes. The models were trained on the publicly available BioScope corpus.Measurement
The performance of the CRF models was evaluated on identifying the negation cue phrases and their scope by calculating recall, precision and F1-score. The models were compared with four competitive baseline systems.Results
The best CRF-based model performed statistically better than all baseline systems and NegEx, achieving an F1-score of 98% and 95% on detecting negation cue phrases and their scope in clinical notes, and an F1-score of 97% and 85% on detecting negation cue phrases and their scope in biological literature.Conclusions
This approach is robust, as it can identify negation scope in both biological and clinical text. To benefit text mining applications, the system is publicly available as a Java API and as an online application at http://negscope.askhermes.org. 相似文献14.
Johanna I Westbrook Ling Li Andrew Georgiou Richard Paoloni John Cullen 《J Am Med Inform Assoc》2013,20(6):1150-1158
Objective
To quantify and compare the time doctors and nurses spent on direct patient care, medication-related tasks, and interactions before and after electronic medication management system (eMMS) introduction.Methods
Controlled pre–post, time and motion study of 129 doctors and nurses for 633.2 h on four wards in a 400-bed hospital in Sydney, Australia. We measured changes in proportions of time on tasks and interactions by period, intervention/control group, and profession.Results
eMMS was associated with no significant change in proportions of time spent on direct care or medication-related tasks relative to control wards. In the post-period control ward, doctors spent 19.7% (2 h/10 h shift) of their time on direct care and 7.4% (44.4 min/10 h shift) on medication tasks, compared to intervention ward doctors (25.7% (2.6 h/shift; p=0.08) and 8.5% (51 min/shift; p=0.40), respectively). Control ward nurses in the post-period spent 22.1% (1.9 h/8.5 h shift) of their time on direct care and 23.7% on medication tasks compared to intervention ward nurses (26.1% (2.2 h/shift; p=0.23) and 22.6% (1.9 h/shift; p=0.28), respectively). We found intervention ward doctors spent less time alone (p=0.0003) and more time with other doctors (p=0.003) and patients (p=0.009). Nurses on the intervention wards spent less time with doctors following eMMS introduction (p=0.0001).Conclusions
eMMS introduction did not result in redistribution of time away from direct care or towards medication tasks. Work patterns observed on these intervention wards were associated with previously reported significant reductions in prescribing error rates relative to the control wards. 相似文献15.
Diva Reddy A.S. Kushwaha Atul Kotwal D.R. Basannar Ajoy Mahen 《Medical Journal Armed Forces India》2012,68(3):222-225
Background
High blood pressure in childhood is a major risk factor for heart disease and stroke in adulthood. There is enough evidence to suggest that the roots of essential hypertension in adults extend into childhood. There is a paucity of literature on the blood pressure measurements amongst children. This study was done to study blood pressure profile of school children in rural area of Maharashtra.Aim & objectives
This cross sectional study was carried out to determine the prevalence of hypertension in children 6–15 years and to study the association between selected variables and blood pressure.Material & methods
This study was done using a predesigned questionnaire and making measurements of height, BMI and Blood pressure using standardized physical instruments following standard guidelines. The data was collected and analyzed using appropriate statistical tests.Results
The prevalence of hypertension in the study was found to be 4.4% with 3.5% in females and 5.1% in males.Conclusion
In the study, hypertension in students was found to be significantly associated with higher BMI and with family history of hypertension. Age, height and BMI were found to correlate positively with Blood pressure levels in this study. 相似文献16.
Robert C Wu Vivian Lo Dante Morra Brian M Wong Robert Sargeant Ken Locke Rodrigo Cavalcanti Sherman D Quan Peter Rossos Kim Tran Mark Cheung 《J Am Med Inform Assoc》2013,20(4):766-777
Background
Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness.Objectives
To describe the effects of different communication interventions and their problems.Design
Prospective observational case study using a mixed methods approach of quantitative and qualitative methods.Setting
General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals.Participants
Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards.Methods
Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010.Results
We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories.Conclusions
Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems. 相似文献17.
Tamblyn R Eguale T Buckeridge DL Huang A Hanley J Reidel K Shi S Winslade N 《J Am Med Inform Assoc》2012,19(4):635-643
Context
Computerized drug alerts for psychotropic drugs are expected to reduce fall-related injuries in older adults. However, physicians over-ride most alerts because they believe the benefit of the drugs exceeds the risk.Objective
To determine whether computerized prescribing decision support with patient-specific risk estimates would increase physician response to psychotropic drug alerts and reduce injury risk in older people.Design
Cluster randomized controlled trial of 81 family physicians and 5628 of their patients aged 65 and older who were prescribed psychotropic medication.Intervention
Intervention physicians received information about patient-specific risk of injury computed at the time of each visit using statistical models of non-modifiable risk factors and psychotropic drug doses. Risk thermometers presented changes in absolute and relative risk with each change in drug treatment. Control physicians received commercial drug alerts.Main outcome measures
Injury risk at the end of follow-up based on psychotropic drug doses and non-modifiable risk factors. Electronic health records and provincial insurance administrative data were used to measure outcomes.Results
Mean patient age was 75.2 years. Baseline risk of injury was 3.94 per 100 patients per year. Intermediate-acting benzodiazepines (56.2%) were the most common psychotropic drug. Intervention physicians reviewed therapy in 83.3% of visits and modified therapy in 24.6%. The intervention reduced the risk of injury by 1.7 injuries per 1000 patients (95% CI 0.2/1000 to 3.2/1000; p=0.02). The effect of the intervention was greater for patients with higher baseline risks of injury (p<0.03).Conclusion
Patient-specific risk estimates provide an effective method of reducing the risk of injury for high-risk older people.Trial registration number
clinicaltrials.gov Identifier: NCT00818285. 相似文献18.
K Srivastava D Saldanha S Chaudhury VSSR Ryali S Goyal D Bhattacharyya D Basannar 《Medical Journal Armed Forces India》2010,66(4):367-373
Background
Amputation of a limb affects almost all aspects of an individual''s life. Psychological aspects are important factors for adjustment with the disability.Methods
The present study was carried out on 50 consecutive male patients admitted to the Artificial Limb Centre. Base line and post therapy psychological assessment was carried out on Hospital Anxiety and Depression Scale (HADS). Trauma Symptom Inventory (TSI) was administered along with Millon Index of personality styles (MIPS). Psychological intervention was given to them on a therapy module proposed by authors. Data was analyzed with the help of SPSS.Result
Findings revealed significant differences in scores on HADS, before and after therapy (p<0.05). On Trauma symptom Inventory defensive avoidance and depression were noted to be above cut off level of (>65). Predominant personality styles were self indulgence and internally focused in motivating styles (mean prevalence score <50) and thought guided in thinking styles, dominating and controlling in behaving styles. The analysis of prevalence score of above 50 and less than 50 indicated Confident/Asserting (9B), Submissive / Yielding (11A), having significant change after therapy on score of anxiety (P<0.05). The personality dimension of dutiful and conforming had shown significant influence after therapy (P<0.05) on score of depression.Conclusion
The findings indicated psychological assessment and intervention is to be included as a part of the management after amputation.Key Words: Amputation, Psychological correlates, Personality 相似文献19.
Rohit Sharma 《Medical Journal Armed Forces India》2012,68(3):231-235