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An Exploration of the Experiences of Migrant Women: Implications for Policy Development of Effective User Driven Health Care Delivery Systems 移民妇女经验的探索:对有效的用户驱动的卫生保健提供系统的政策发展的影响
Pub Date : 2012-07-01 DOI: 10.4018/IJUDH.2012070102
J. Fitzpatrick
Women across the world migrate for a wide range of reasons. Some gravitate to urban centres in their own countries seeking safety, education, health care, and employment opportunities. Others travel across national boundaries seeking reprieve from the atrocities of war and extreme poverty. Migration within countries is on the rise, as people move in response to adverse conditions such as lack of resources, services and education, and employment opportunities. In addition they may want to escape from violence or natural disasters. This movement of people from rural to urban areas has resulted in an explosive growth of cities around the globe. This paper draws on a research case study undertaken with the Kewapi language group in Port Moresby and the Batri Villages of the Southern Highlands in Papua New Guinea. It seeks to highlight the perspectives of women traveling vast distances from their home communities in order to seek education and health care. It explores the implications for developing effective service user focused health care systems designed to meet the needs of mobile and vulnerable women. The study suggests that if women and their families from remote rural communities are encouraged and facilitated in participating in health promoting initiatives they can dramatically improve their life and health experiences and that of their community.
世界各地的妇女由于各种各样的原因迁移。有些人被吸引到自己国家的城市中心寻求安全、教育、保健和就业机会。其他人则跨越国界,寻求从战争暴行和极端贫困中解脱出来。由于缺乏资源、服务、教育和就业机会等不利条件,人们为应对这些不利条件而迁移,因此国内的移徙人数正在上升。此外,他们可能想要逃离暴力或自然灾害。这种人口从农村向城市的流动导致了全球城市的爆炸式增长。本文借鉴了对巴布亚新几内亚莫尔兹比港的克瓦皮语群体和南部高地的巴特里村进行的研究案例。它力求突出从家乡远道而来寻求教育和保健的妇女的观点。它探讨了发展有效的以服务用户为重点的保健系统的影响,旨在满足流动和弱势妇女的需要。这项研究表明,如果鼓励和便利来自偏远农村社区的妇女及其家庭参与促进健康的倡议,她们就能大大改善自己及其社区的生活和健康状况。
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引用次数: 3
Practical Skills Evaluation of Medical Students with a Mini-Objective Structured Practical Examination (OSPE) for Nosocomial Infections 用小目标结构化实践考试评价医学生医院感染的实践技能
Pub Date : 2012-07-01 DOI: 10.4018/IJUDH.2012070103
C. Pai, T. Jaggi, S. Gore, Harapriya Kar
Evaluation is the driving force promoting learning in medical students who are mostly ‘exam oriented.’ Doctors play an important role in spreading nosocomial infections due to noncompliance with preventive measures. This could stem from lacunae in the traditional system of education wherein certain practical skills aren’t evaluated. In this study, an innovative mini OSPE (Objective Structured Practical Examination) for nosocomial infections was designed and implemented for post teaching evaluation of practical skills such as hand washing and safe hospital waste disposal. Seventy eight students, divided into two cohorts were evaluated after they underwent the traditional method of lecturing or hands on small group teaching. The mini OSPE demonstrated a significant increase in acquisition of practical skills in the cohort which underwent small group teaching as compared to the one which underwent traditional teaching. Within the small group teaching cohort, the scores improved in the late phase as compared to the early phase, the difference being statistically significant. Innovative techniques such as mini OSPE are valuable tools of evaluation and should be incorporated in the curriculum of para clinical subjects. When applied to important topics such as Nosocomial infections, this can help enhance learning and retention of practical skills with better application to future clinical practice.
评价是医学生学习的动力,医学生多以考试为导向。由于不遵守预防措施,医生在传播医院感染方面发挥着重要作用。这可能源于传统教育体系的缺陷,其中某些实用技能没有得到评估。在本研究中,设计并实施了一种创新的小型医院感染目标结构化实践考试(OSPE),用于教学后对洗手和医院废物安全处理等实践技能的评估。78名学生被分成两组,在接受了传统的讲课方法或动手小组教学后进行了评估。与接受传统教学的学生相比,接受小组教学的学生在学习实用技能方面取得了显著的进步。在小组教学队列中,与早期阶段相比,后期阶段的分数有所提高,差异具有统计学意义。创新的技术,如迷你的OSPE是有价值的评估工具,应纳入准临床科目的课程。当应用于医院感染等重要课题时,这有助于加强实践技能的学习和保留,更好地应用于未来的临床实践。
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引用次数: 3
Barriers, Challenges and Possible Solutions in Establishing Diabetes Self-Management Education (DSME) in India: A Policy Perspective 在印度建立糖尿病自我管理教育(DSME)的障碍、挑战和可能的解决方案:政策视角
Pub Date : 2012-07-01 DOI: 10.4018/IJUDH.2012070101
T. Sathyanarayana, G. Babu, Shridhar M. Kadam
The number of diabetic people in India is increasing. A vast gap of health service need and provision exists. However, the proposed agenda of promotion and recognition of diabetes educators may translate into diabetes effective management at individual level to the maximum possibility. Managing diabetes is a unique and on-going process. As such, self-management of the disease is crucial. Diabetes patients should receive support to help them to manage diabetic condition as effectively as possible. This study proposes conceptual approach to diabetes self-management education. This framework further articulates the short term and long term outcomes. DSME promotion through educational intervention in a sustained manner has long-term benefits. DSME in an Indian context as optimally trained, effective, efficient, viable health human resource allocation across different levels is not a feasible solution in a low resource setting. This study proposes that a need exists for further research in an Indian context about the scientific credibility of DSME, financial feasibility, cultural acceptability and operation stability of the policy initiative.
印度的糖尿病患者数量正在增加。在卫生服务需求和提供方面存在巨大差距。然而,糖尿病教育工作者提出的促进和认可议程可能会最大限度地转化为个人层面的糖尿病有效管理。管理糖尿病是一个独特而持续的过程。因此,疾病的自我管理至关重要。糖尿病患者应得到支持,以帮助他们尽可能有效地管理糖尿病病情。本研究提出糖尿病自我管理教育的概念方法。该框架进一步阐明了短期和长期成果。通过持续的教育干预促进DSME具有长期效益。在印度情况下,DSME作为经过最佳培训、有效、高效、可行的各级卫生人力资源分配,在资源匮乏的情况下不是一个可行的解决办法。本研究提出,有必要在印度背景下进一步研究DSME的科学可信度、财政可行性、文化可接受性和政策举措的运行稳定性。
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引用次数: 3
A Cross-Sectional Evaluation of Illness Perception About Asthma Among Asthma Patients at a Referral Tertiary Care Public Chest Hospital in Delhi, India 在转诊三级保健公立胸科医院哮喘患者对哮喘的疾病认知的横断面评估,印度德里
Pub Date : 2012-07-01 DOI: 10.4018/IJUDH.2012070104
S. Shendge, Barnali Deka, A. Kotwani
Adult patients visiting emergency room (March 2009-December 2009) of the public chest hospital for asthma exacerbation completed interviewer-administered questionnaires on sociodemographics, clinical history, disease beliefs, use of inhaled corticosteroids (ICS), and self-management of asthma after stabilization of their condition. Overall 87% patients believed that they had asthma when they are having symptoms, which is called as no symptoms, no asthma belief. No association was found between no symptoms, no asthma belief with gender, income, family history of asthma, and co-morbidity. Younger patients in the age group 18-29 years had four to five-fold greater odds and patients with education above 10th grade had three to four-fold greater odds of having the no symptoms, no asthma belief or the acute episodic belief. Acute episodic belief was negatively associated with beliefs about always having asthma, asthma being a serious condition, having lung inflammation, or the importance of using ICS, and was positively associated with expecting to be cured. All patients irrespective of their belief of acute or chronic nature of asthma had poor adherence to the treatment and other self-management behaviors.
2009年3月至2009年12月至公立胸科医院急诊室就诊的哮喘加重成年患者完成了由访谈者填写的社会人口统计学、临床病史、疾病信念、吸入性皮质类固醇(ICS)使用情况以及病情稳定后哮喘自我管理等问卷。总体而言,87%的患者认为他们有症状时患有哮喘,这被称为无症状,无哮喘信念。无症状、无哮喘信念与性别、收入、哮喘家族史和合并症之间没有关联。年龄在18-29岁之间的年轻患者有4到5倍的几率,而受教育程度在10年级以上的患者有3到4倍的几率没有症状,没有哮喘信念或急性发作信念。急性发作性信念与总是患有哮喘、哮喘是一种严重疾病、患有肺部炎症或使用ICS的重要性的信念呈负相关,与期望被治愈呈正相关。所有患者,无论其认为是急性还是慢性哮喘,对治疗的依从性和其他自我管理行为都很差。
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引用次数: 0
Disability Studies in Medical Education 医学教育中的残疾研究
Pub Date : 2012-04-01 DOI: 10.4018/IJUDH.2012040105
A. Khetarpal, Satendra Singh
Uncompassionate attitudes of doctors can have adverse impact on the already shattered emotional health of a person with disability. The medical conditions or disabilities are seen in isolation from their daily lives. The quality health care is thus compromised. Disability Studies can increase the understanding of the disabled population. The curriculum offered to medical students has an impact on their learning potential. Medical practice influences social conditions and is also influenced by society. The social background of diseases and their causation must be understood within a holistic framework. Disability studies can bring together various disciplines dealing with human pain, pathology treatment, rehabilitation, and coping skills. Medical students must have comprehensive training about complex human behaviour, ethics, and social justice. They must learn the relationships among disease, distress, and disability. Co-existence of disability studies with medicine can transform medical practice, leading to high quality healthcare. Including Disability Studies in medical curriculum would bring Medical Humanities into classrooms.
医生的无情态度会对残疾人已经支离破碎的情感健康产生不利影响。医疗状况或残疾是与他们的日常生活分开看待的。卫生保健的质量因此受到损害。残疾研究可以增加对残疾人群的了解。提供给医学生的课程对他们的学习潜力有影响。医疗实践影响着社会状况,也受到社会的影响。必须在整体框架内了解疾病的社会背景及其原因。残疾研究可以将人类疼痛、病理治疗、康复和应对技能等不同学科结合起来。医学生必须接受有关复杂的人类行为、道德和社会正义的全面训练。他们必须了解疾病、痛苦和残疾之间的关系。残疾研究与医学的共存可以改变医疗实践,从而带来高质量的医疗保健。将残疾研究纳入医学课程将使医学人文学科进入课堂。
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引用次数: 2
Recovery of a Triple Whiplash Accident 三重鞭伤事故的恢复
Pub Date : 2012-04-01 DOI: 10.4018/IJUDH.2012040107
Anna Christine Doehring
Five years ago, the author survived a nasty car accident which brought her to the place of offering healing for others. This paper demonstrates how ‘patient users’ in web space may document a lot of their health details on their own in the form of narratives, as well as meticulously prepared lists that can be shared in ‘user driven health care’ forums and commented on by health professionals who genuinely want to help them. The author’s connection with non-mainstream healing is strong. This author shares that even after getting an MRI by a neuro-radiologist, the testing was not followed up by competent care. It was not carefully explained to her so she understood the implications of the lesions for further activities of daily living by the neuro-radiologist but rather it was left to the chiropractor to explain even though he may be ill-equipped to provide post injury brain care and life skills management. Finally, the narrative points toward the fine balance between finding effective treatment options and the responsibility of providing financially for oneself and family after a debilitating injury.
五年前,作者在一场严重的车祸中幸存下来,这使她来到了为他人提供治疗的地方。本文演示了网络空间中的“患者用户”如何以叙述的形式记录自己的许多健康细节,以及精心准备的列表,这些列表可以在“用户驱动的医疗保健”论坛中共享,并由真正想要帮助他们的卫生专业人员进行评论。作者与非主流治疗有很强的联系。这位作者分享说,即使在接受了神经放射科医生的核磁共振检查后,测试也没有得到合格的护理。没有仔细向她解释,所以她理解了神经放射学家对进一步日常生活活动的损害的影响,而是留给脊椎指压治疗师来解释,即使他可能没有能力提供损伤后的大脑护理和生活技能管理。最后,故事指出了在寻找有效的治疗方案和为自己和家人提供经济上的责任之间的微妙平衡。
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引用次数: 3
Helping Patients Help Themselves: The Added Benefits of Remote Patient Monitoring to Home Health Care 帮助病人自助:远程病人监控对家庭医疗保健的额外好处
Pub Date : 2012-04-01 DOI: 10.4018/IJUDH.2012040106
Maria Angela M. Saquibal, Melissa Lantz-Garnish
The Johns Hopkins Home Care Group (JHHCG) developed standard protocols for management of patients with chronic heart failure (CHF) and chronic obstructive pulmonary disorder (COPD) in an effort to improve patient outcomes and reduce preventable hospital readmissions. JHHCG implemented Remote Patient Monitoring (RPM), a telemonitoring program customized for the CHF/COPD patient that provides real-time, daily reporting of qualitative and quantitative data as well as patient education/reinforcement. Patient data is trended on a web-based program and overseen by the Disease Management Nurse. Emerging trends are easily identified, allowing for early and appropriate intervention. This program sets itself apart because of the constant communication and aggressive management of the patient as a team (patient, RPM disease manager, field nurse, and physician). Key to the success of home care and RPM is access to and collaboration with a responsive, managing physician that oversees the patient based on their plan of care.
约翰霍普金斯家庭护理小组(JHHCG)制定了慢性心力衰竭(CHF)和慢性阻塞性肺疾病(COPD)患者管理的标准方案,以改善患者的预后并减少可预防的住院再入院。JHHCG实施了远程患者监测(RPM),这是一项为慢性阻塞性肺病/慢性阻塞性肺病患者定制的远程监测计划,提供实时、每日定性和定量数据报告以及患者教育/强化。患者数据在一个基于网络的程序上进行趋势分析,并由疾病管理护士监督。新出现的趋势很容易识别,从而可以进行早期和适当的干预。这个项目与众不同,因为它作为一个团队(患者、RPM疾病管理人员、现场护士和医生)对患者进行了持续的沟通和积极的管理。家庭护理和RPM成功的关键是与一位反应迅速、善于管理的医生合作,根据他们的护理计划对患者进行监督。
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引用次数: 1
Conversational Learning in Medical Education: Clinical Problem Solving Around Chronic Persistent Headache 医学教育中的会话学习:慢性持续性头痛的临床问题解决
Pub Date : 2012-04-01 DOI: 10.4018/IJUDH.2012040103
Tamoghna Biswas, A. Price, Shivika Chandra, A. Datta, R. Biswas
Traumatic Brain Injury (TBI) survivors frequently experience headaches, often labeled as a psycho-social aftermath of poor adjustment to the reality of decreased brain function, but they may be the result of actual physical sequelae of the TBI. This article illustrates an active experiential learning exercise set in a in a user-driven learning environment using a web interface. Using a conversational learning approach, the discussion was centered around a neurological problem on the topic of chronic persistent headache, which generates a considerable amount of diagnostic uncertainty and interventional dilemma among physicians. The physician members of an online forum shared their viewpoints and insights regarding the topic. By utilizing a blend of experiential and empirical evidence, they collaboratively reached a solution. User-driven learning can serve as a potential learning tool in continuing medical education and also as a valuable educational resource to medical students, helping them develop empathy and real-life problem solving skills. Also, when such conversations involve multiple stakeholders (patients and their relatives, physicians and other health-care providers, medical students, etc.) it can foster a collaborative interface which is the essence of user-driven healthcare.
创伤性脑损伤(TBI)幸存者经常经历头痛,通常被认为是对大脑功能下降的现实适应不良的心理-社会后果,但它们可能是TBI的实际生理后遗症的结果。本文演示了一个使用web界面在用户驱动的学习环境中进行的主动体验式学习练习。使用会话学习方法,讨论集中在慢性持续性头痛的神经问题上,这在医生中产生了相当多的诊断不确定性和介入困境。在线论坛的医生成员分享了他们对这个话题的观点和见解。通过综合利用经验和实证证据,他们共同达成了一个解决方案。用户驱动的学习可以作为继续医学教育的潜在学习工具,也可以作为医学生的宝贵教育资源,帮助他们培养同理心和解决现实问题的技能。此外,当这样的对话涉及多个利益相关者(患者及其亲属、医生和其他医疗保健提供者、医学生等)时,它可以促进协作界面,这是用户驱动医疗保健的本质。
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引用次数: 3
Cognitive Rehabilitation Computer Brain Solutions: Prevention Powerhouse or a Warm Fuzzy Wannabe? A Perspective in Neuroplasticity and Practicality 认知康复计算机大脑解决方案:预防发电站还是温暖模糊的崇拜者?神经可塑性与实用性展望
Pub Date : 2012-04-01 DOI: 10.4018/IJUDH.2012040111
A. Price
Mild traumatic brain injury (MTBI) survivors claim advantage in retraining their brains with neuroplasticity based cognitive training after trauma. Significant growth in computer based cognitive rehabilitation is spurred on by positive research findings on neuroplasticity and advances in accessible computer technology. Drawbacks include limitations on the part of both patient and therapist in regards to time expenditure, cost of therapy, ease of use/learning curve, and the availability of long-term studies in regards to near and far transfer of training. MTBI patients may have sustained motor, visual, auditory, and chronic pain difficulties that complicate computer use. Benefits and barriers as perceived by patients and psychologists who are using the interventions for patient rehabilitation are critical. MTBI patient and therapist feedback concerning efficacy, usability accessibility, and satisfaction are needed to realize this form of rehabilitation.
轻度创伤性脑损伤(MTBI)幸存者声称在创伤后用基于神经可塑性的认知训练再训练他们的大脑有优势。基于计算机的认知康复的显著增长是由于神经可塑性的积极研究成果和计算机技术的进步。缺点包括患者和治疗师在时间支出、治疗成本、易用性/学习曲线以及关于远近转移培训的长期研究的可用性方面的限制。MTBI患者可能有持续的运动、视觉、听觉和慢性疼痛困难,使计算机使用复杂化。患者和使用干预措施进行患者康复的心理学家所认识到的益处和障碍至关重要。实现这种形式的康复需要MTBI患者和治疗师对疗效、可用性、可及性和满意度的反馈。
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引用次数: 6
There is a Human Being Inside Every Patient 每个病人的内心都有一个人
Pub Date : 2012-04-01 DOI: 10.4018/IJUDH.2012040113
J. Garrison
In this paper, the author recounts her experience in dealing with recovery from a traumatic brain injury. She shares her insights on the dubious practice of patient labeling. The author also affirms her belief in the role a positive outlook plays in recovery.
在本文中,作者叙述了她在处理从创伤性脑损伤恢复的经验。她分享了她对病人标签这种可疑做法的见解。作者还肯定了她的信念,积极的态度在康复中起着重要作用。
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引用次数: 2
期刊
International Journal of User-Driven Healthcare
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