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91.
《Archives of physical medicine and rehabilitation》2019,100(11):2032-2038
ObjectiveTo explore attitudes and practices of physicians relating to accessible medical diagnostic equipment in serving patients with mobility disability.DesignOpen-ended individual telephone interviews, which reached data saturation. Interview recordings were transcribed verbatim for qualitative conventional content analysis.SettingMassachusetts, the United States, October 2017-January 2018.ParticipantsPracticing physicians from 5 clinical specialties (N=20).InterventionsNot applicable.Main Outcome MeasuresCommon themes concerning physical accessibility.ResultsMean ± SD time in practice was 27.5±12.5 years; 14 practices had height-adjustable examination tables; and 7 had wheelchair-accessible weight scales. The analysis identified 6 broad themes: height-adjustable examination tables have advantages; height-adjustable examination tables have drawbacks; transferring patients onto examination tables is challenging; rationale for examining patients in their wheelchairs; perceptions of wheelchair-accessible weight scales; and barriers and facilitators to improving physical accessibility. Major barriers identified by participants included costs of equipment, limited space, and inadequate payment for extra time required to care for persons with disability. Even physicians with accessible examination tables sometimes examined patients seated in their wheelchairs.ConclusionsEven if physicians have accessible equipment, they do not always use it in examining patients with disability. Future efforts will need to consider ways to eliminate these access barriers in clinical practice. Given small sample size, results are not generalizable to physicians nationwide and globally. 相似文献
92.
Purpose
The objectives of the study were to identify the incidence and pattern of dry eye after phacoemulsification and manual small incision cataract surgeries.Methods
The study consisted of two groups of patients - Group 1 underwent manual small incision cataract surgery (SICS) and Group 2 underwent phacoemulsification. The dry eye-related data was collected preoperatively and at 1?week, 1?month and 3?months postoperatively. Ocular Surface Disease Index questionnaire, tear break-up time (TBUT) and Schirmer test – 1 were used to record the type of dry eye.Results
One hundred eyes of 96 patients, including 35 (36.5%) men and 61 (63.5%) women with the mean age of 63.1 (±8.3) years were studied. Dry eyes were found in 42% eyes (p?<?0.001) of patients at 1?week follow-up. Fifteen percent and 9% of the eyes were dry at 1?month and 3?months after surgery, respectively. There were 34 (53.1%) and 8 (22.2%) dry eyes in SICS and phacoemulsification groups, respectively at one week postoperative follow-up which was a statistically significant difference.Majority of eyes (27/42, 64.3%) had mild dryness. There were significant differences in TBUT at 1?week, 1?month and 3?months postoperatively. At 1?week review, the SICS group had mean TUBT of 10.0 (±0.55) sec as compared to 13.9 (±0.70) sec in phacoemulsification group (p?<?0.001).Conclusion
Incidence of dry eye is higher in SICS than phacoemulsification due to tear film instability. The clinicians should be conscious about dry eye symptoms and signs in an otherwise healthy eye after cataract surgery. 相似文献93.
Sabine Fuchs Britta Olberg Matthias Perleth Reinhard Busse Dimitra Panteli 《Health policy (Amsterdam, Netherlands)》2019,123(2):173-181
Objective
Medical devices (MDs) encompass a broad and heterogeneous range of technologies. While practices vary considerably across countries, MDs often find application in patient care with little or no evaluation of their effectiveness and safety following market approval. A recently proposed taxonomy of MDs considered devices from the viewpoint of Health Technology Assessment (HTA). The aim of the work presented here was to test its plausibility and applicability by considering real-world HTA practices.Methods
HTA reports on MDs from European institutions were collected in a systematic manner and the evaluated devices and/or related procedures were matched to a position on the taxonomy. Following this, representatives from 16 European HTA institutions were asked about the usefulness of the taxonomy in semi-structured interviews.Results
1237 HTA reports (2004–2015) from 33 European institutions were included in the sample. The majority of reports was on technologies from the taxonomic positions initially estimated as having high relevance. Most of the experts interviewed stated that they found the taxonomy useful, particularly regarding its potential to aid in selecting technologies for assessment and to highlight potential methodological particularities per taxonomic position.Conclusions
Overall, the distribution of identified reports on the matrix confirmed that the initial estimation of the relevance and necessity of HTA provided in the taxonomic model is plausible. In addition, interviews with representatives of European HTA institutions showed that the taxonomy could be useful. 相似文献94.
95.
96.
《Journal of Medical Imaging and Radiation Sciences》2019,50(3):365-368
There is no shortage of discussion surrounding the importance of achieving a highly engaged workforce in health care institutions. Despite the abundance of idealisms surrounding the importance of providing patient-centered care, some medical radiation technologists may consider this to be a contradiction, when they themselves do not feel valued or empowered by their employer. In addition, overwhelming evidence points to the fact that high employee engagement is directly linked to positive patient experiences and outcomes. Logically, it then follows that much attention should be paid to fully engaging health care teams. Highly engaged medical radiation technologists are more likely to provide personalized patient-centered care. Health care leaders can help to engage their teams by using effective behavioral and leadership styles that will be received favourably by most staff. With the evolution of the generations occupying the workplace, managers must adapt and vary their leadership styles, if they hope to effectively engage their teams and provide world-class patient-centered care. 相似文献
97.
Sakti Chakrabarti Jaskanwal Sara Ronstan Lobo Rachel Eiring Heidi Finnes Jessica Mitchell Mindy Hartgers Akiko Okano Thorvardur Halfdanarson Axel Grothey 《Clinical colorectal cancer》2019,18(1):52-57
Introduction
Coronary vasospasm associated with fluoropyrimidine (FP)-based chemotherapy is a potentially serious complication and reported to occur more often with infusional 5-fluorouracil (5-FU) or capecitabine than with bolus 5-FU. Given the additional benefit of oxaliplatin over FP alone in the management of colorectal cancer, retaining oxaliplatin in the treatment regimen is desirable, but the safety of combining bolus 5-FU with oxaliplatin in patients with FP-induced vasospasm is not well established. We performed a retrospective review to explore the safety of substituting FLOX (bolus 5-FU, oxaliplatin, leucovorin) for FOLFOX (infusional 5-FU, oxaliplatin, leucovorin) and CAPOX (capecitabine, oxaliplatin) in patients who had FP-induced coronary vasospasm.Patients and Methods
The pharmacy database of Mayo Clinic was queried to identify patients who developed coronary vasospasm associated with FOLFOX or CAPOX between January 2011 and January 2018 and were subsequently treated with FLOX. Detailed information was obtained on these patients by retrospective electronic chart review.Results
A total of 10 patients (median age, 56.5 years; range, 36-77 years) were identified, 9 with FOLFOX and 1 with CAPOX. Among the patients treated with FOLFOX, 8 patients had chest pain as the presenting complaint that had started within 48 hours of beginning of the 5-FU infusion. In 9 of 10 patients, coronary vasospasm occurred with the first cycle of therapy. All patients made full recovery after discontinuation of infusional 5-FU or capecitabine. All patients subsequently received FLOX with 7 median bolus 5-FU doses (range, 2-22 doses) and 7 median oxaliplatin doses (range, 2-12 doses) at 7 days to 18 months after the event, with 7 patients treated within 4 weeks of the event. FLOX did not cause any cardiovascular adverse events in any of the 10 patients.Conclusion
Bolus 5-FU in combination with oxaliplatin is safe in patients who have experienced coronary vasospasm with infusional 5-FU or capecitabine. 相似文献98.
《Research in social & administrative pharmacy》2020,16(11):1542-1549
BackgroundDiabetes is a growing concern in low-and middle-income countries. Medical missions play a role in increasing access to care and medicines, but often ignore non-communicable disease prevention and advanced management. Increased knowledge of local community needs and resources can lead to the development and implementation of pharmacist-supported interventions to improve diabetes management in rural areas.ObjectivesThe purpose of this study was to 1) understand the availability of monitoring for diabetes locally; and 2) describe knowledge and health beliefs regarding diabetes management for those with diabetes, and prevention among those at high risk of developing diabetes.MethodsThis qualitative evaluation used semi-structured interviews with key informants in a community in rural Honduras. Participants included those with diabetes, those at-risk for developing diabetes, and community leaders. Data was analyzed using thematic content analysis through an iterative process of coding and theme development.ResultsA total of 35 interviews were conducted with five resulting themes: 1) participants identified multiple barriers to diabetes management including access to monitoring, access to certain medications, and access to advanced levels of care; 2) participants acknowledge the relationship between lifestyle choices and diabetes control, but struggled with adherence to a healthy lifestyle; 3) participants identify that they have limited knowledge of diabetes pathophysiology, diabetes management, and strategies to prevent diabetes; 4) participants felt that opportunities existed within the community to support diabetes education and prevention, and 5) providers should integrate culture, societal norms, and religion in diabetes management.ConclusionThis research identifies challenges and resulting opportunities for managing diabetes in rural Honduras. Health care providers including pharmacy personnel should consider strategies to engage communities around self-care and diabetes education. Further, strategies are needed to enhance access to resources and essential medicines for diabetes management. These themes can guide clinicians in supporting communities to enhance diabetes care. 相似文献
99.
基于国家深化高等院校课程建设的新时代视域,提升课程质量成为高校教育教学发展的重要任务。地方医学院校作为基层卫生人才的培养摇篮,构建科学合理的课程质量监控体系愈发迫切。本文分析了我国高等院校课程质量监控体系存在的问题,结合地方医学院校办学特点和广州医科大学工作实践,探索构建了集“多样化监控方法、全维度监控指标、闭环式反馈机制、多层级文化建设”为一体的课程质量监控体系,为同类院校提供实际参考。 相似文献
100.
Kristin Canavera 《Patient education and counseling》2021,104(5):996-997
Lack of trust is a major problem in our current health care system and is increasingly becoming a focus in the literature and in national discussions on how to better understand, address, and resolve. In this narrative essay, I share how I wrestled with rebuilding trust after my own adverse experiences with medical error, surgery complications, and communication challenges. This perspective highlights the critical importance of physician communication and trust in the patient-physician relationship. 相似文献