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Patient Autonomy in Medical Education: Navigating Ethical Challenges in the Age of Artificial Intelligence 医学教育中的患者自主权:驾驭人工智能时代的伦理挑战
IF 1.7 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-18 DOI: 10.1177/00469580241266364
Hui Lu, Ahmad Alhaskawi, Yanzhao Dong, Xiaodi Zou, Haiying Zhou, Sohaib Hasan Abdullah Ezzi, Vishnu Goutham Kota, Mohamed Hasan Abdulla Hasan Abdulla, Sahar Ahmed Abdalbary
The increasing integration of Artificial Intelligence (AI) in the medical domain signifies a transformative era in healthcare, with promises of improved diagnostics, treatment, and patient outcomes. However, this rapid technological progress brings a concomitant surge in ethical challenges permeating medical education. This paper explores the crucial role of medical educators in adapting to these changes, ensuring that ethical education remains a central and adaptable component of medical curricula. Medical educators must evolve alongside AI’s advancements, becoming stewards of ethical consciousness in an era where algorithms and data-driven decision-making play pivotal roles in patient care. The traditional paradigm of medical education, rooted in foundational ethical principles, must adapt to incorporate the complex ethical considerations introduced by AI. This pedagogical approach fosters dynamic engagement, cultivating a profound ethical awareness among students. It empowers them to critically assess the ethical implications of AI applications in healthcare, including issues related to data privacy, informed consent, algorithmic biases, and technology-mediated patient care. Moreover, the interdisciplinary nature of AI’s ethical challenges necessitates collaboration with fields such as computer science, data ethics, law, and social sciences to provide a holistic understanding of the ethical landscape.
人工智能(AI)越来越多地融入医疗领域,标志着医疗保健进入了一个变革时代,有望改善诊断、治疗和患者预后。然而,这种快速的技术进步同时也带来了渗透到医学教育中的伦理挑战。本文探讨了医学教育者在适应这些变化中的关键作用,确保伦理教育仍然是医学课程的核心和可适应的组成部分。医学教育工作者必须与人工智能的进步同步发展,在算法和数据驱动决策在患者护理中发挥关键作用的时代,成为伦理意识的管理者。根植于基本伦理原则的传统医学教育范式必须进行调整,以纳入人工智能带来的复杂伦理考量。这种教学方法促进了学生的动态参与,培养了他们深刻的伦理意识。它使学生有能力批判性地评估人工智能在医疗保健领域应用的伦理影响,包括与数据隐私、知情同意、算法偏见和以技术为媒介的患者护理相关的问题。此外,人工智能伦理挑战的跨学科性质要求与计算机科学、数据伦理、法律和社会科学等领域合作,以提供对伦理环境的整体理解。
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引用次数: 0
Social Determinants Influencing the Non-Adoption of Norms Favorable to the Prevention and Control of Type 2 Diabetes: Qualitative Research 影响不采纳有利于预防和控制 2 型糖尿病的规范的社会决定因素:定性研究
IF 1.7 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-17 DOI: 10.1177/00469580241282051
Gisèle Mandiangu Ntanda, Drissa Sia, Eric Nguemeleu Tchouaket, Léonel Philibert
Diet, physical activity, and body shape play an essential role in the development of type 2 diabetes (T2D) and are the social dimensions most targeted by health professionals in their practices or intervention aimed at preventing and controlling T2D. However, several interventions focus more on individual factors and less on social determinants likely to influence the adoption of dietary, body, and physical activity standards favorable to the prevention and control of T2D. This study aims to explore the social determinants influencing the rejection or adoption of dietary, bodily, and physical activity norms favorable to the prevention and control of T2D among migrants from sub-Saharan Africa. A qualitative exploratory design guided data collection and analysis. Semi-structured qualitative interviews and focus groups were conducted between October 2022 and March 2023 in Montreal and Quebec Cities. The cost of food, the difficulty of accessing certain foods, a reliable level of income, work schedules, the gazes of relatives or communities, migration policies, disappointment and stressful situations linked to migratory status, racial microaggressions, and the lack of food guides adapted to the realities of MASS were the main determinants identified by the participants. These determinants can influence the adoption of public health recommendations on diet for the prevention and control of T2D. People living with T2D obviously have an important role to play, but much of the work lies outside their control. Therefore, Preventive, clinical, or awareness-raising interventions should more consider the life and structural contexts in which these people navigate without ignoring their pre-migratory rules of dietary, body, and physical activity norms.
饮食、体育锻炼和体型在 2 型糖尿病(T2D)的发病过程中起着至关重要的作用,也是卫生专业人员在预防和控制 T2D 的实践或干预中最关注的社会因素。然而,一些干预措施更多地关注个人因素,而较少关注可能影响采用有利于预防和控制 T2D 的饮食、身体和体育锻炼标准的社会决定因素。本研究旨在探讨影响撒哈拉以南非洲移民拒绝或采用有利于预防和控制 T2D 的饮食、身体和体育锻炼规范的社会决定因素。数据收集和分析以定性探索设计为指导。2022 年 10 月至 2023 年 3 月期间,在蒙特利尔和魁北克市进行了半结构化定性访谈和焦点小组讨论。参与者指出的主要决定因素包括:食品成本、难以获得某些食品、可靠的收入水平、工作时间安排、亲戚或社区的目光、移民政策、与移民身份相关的失望和压力状况、种族微观歧视以及缺乏适应 MASS 实际情况的食品指南。这些决定性因素可能会影响采用有关饮食的公共卫生建议来预防和控制终末期糖尿病。终末期糖尿病患者显然可以发挥重要作用,但他们无法控制大部分工作。因此,预防、临床或提高认识的干预措施应更多地考虑这些人所处的生活和结构环境,而不忽视他们迁移前的饮食、身体和体育活动规范规则。
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引用次数: 0
Adverse Drug Reactions Resulting From the Use of Chiral Medicines Amoxicillin, Amoxicillin-Clavulanic Acid, and Ceftriaxone: A Mixed Prospective-Retrospective Cohort Study 使用手性药物阿莫西林、阿莫西林-克拉维酸和头孢曲松导致的药物不良反应:前瞻性-回顾性混合队列研究
IF 1.7 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-17 DOI: 10.1177/00469580241273323
Kissa W. Mwamwitwa, Elias M. Bukundi, Betty A. Maganda, Castory Munishi, Adam M. Fimbo, Deus Buma, Eva P. Muro, Wilber Sabiiti, Danstan H. Shewiyo, Morven C. Shearer, Andrew D. Smith, Eliangiringa A. Kaale
The use of chiral medicines (possessing center(s) of asymmetric carbon) may cause adverse drug reactions (ADRs). The safety assurance of these medicines is critical. We aimed to evaluate registered and commonly used anti-infective chiral medicines circulating in the Tanzanian market to establish their safety profile to protect public health. A mixed prospective-retrospective cohort study was conducted to assess the safety profile of amoxicillin, amoxicillin-clavulanic acid and ceftriaxone injection. ADRs causality assessment was conducted by using World Health Organization (WHO)-Algorithm criteria. Data were collected from 7 tertiary hospitals: Muhimbili National Hospital (MNH), Kilimanjaro Christian Medical Centre (KCMC), Bugando Medical Centre (BMC), Ligula Referral-Regional Hospital (LRRH), Kitete Referral-Regional Hospital (KRRH), Dodoma Referral-Regional Hospital (DRRH), and Mbeya Zonal-Referral Hospital (MZRH). Data were supplemented by those recorded in the WHO-Vigiflow/VigiLyze database within the same monitoring period. Data were analyzed using STATA version-15. The results were considered statistically significant when P < .05. A total of 2522 patients were enrolled in hospitals: MNH (499), KCMC (407), BMC (396), LRRH (387), KRRH (345), DRRH (249), and MZRH (239). Among those, 1197 (47.5%) were treated with ceftriaxone, 585 (23.2%) amoxicillin and 740(29.3%) amoxicillin-clavulanic acid. Out of those, 102 (4.5%) experienced adverse events (AEs), 49 (48%) were due to ceftriaxone, 37 (36.3%) amoxicillin-clavulanic acid and 16 (15.7%) amoxicillin ( P-value .012). A total of 443 participants from the enrolled and WHO-Vigiflow/VigiLyze database were experienced with ADRs. The ADRs affected mainly gastro-intestinal system 234 (53%), skin and subcutaneous tissue 85 (19%), nervous system 49 (11%), respiratory thoracic 22 (5%), and general disorders 18(4%). In this study, approximately 90% of reported AEs were ADRs possible-related to the monitored medicines, with few plausible and certain. Ceftriaxone injection caused more ADRs. Amoxicillin-clavulanic acid was associated with more ADRs than amoxicillin alone. The safety profile of these medicines is still maintained; however, comprehensive monitoring of ADRs is recommended to improve patient safety and enhance overall treatment outcomes.
使用手性药物(具有不对称碳中心)可能会导致药物不良反应(ADR)。确保这些药物的安全性至关重要。我们旨在对坦桑尼亚市场上流通的注册和常用抗感染手性药物进行评估,以确定其安全性,从而保护公众健康。我们开展了一项前瞻性和回顾性混合队列研究,以评估阿莫西林、阿莫西林-克拉维酸和头孢曲松注射液的安全性。ADRs 因果关系评估采用世界卫生组织(WHO)算法标准。数据从 7 家三级医院收集:这些医院包括:穆欣比里国立医院(MNH)、乞力马扎罗基督教医疗中心(KCMC)、布甘多医疗中心(BMC)、利古拉地区转诊医院(LRRH)、基特特地区转诊医院(KRRH)、多多马地区转诊医院(DRRH)和姆贝亚地区转诊医院(MZRH)。在同一监测期内,WHO-Vigiflow/VigiLyze 数据库中记录的数据对数据进行了补充。数据使用 STATA 15 版进行分析。当 P < .05 时,结果具有统计学意义。共有 2522 名患者在医院登记:MNH(499 人)、KCMC(407 人)、BMC(396 人)、LRRH(387 人)、KRRH(345 人)、DRRH(249 人)和 MZRH(239 人)。其中,1197 人(47.5%)接受了头孢曲松治疗,585 人(23.2%)接受了阿莫西林治疗,740 人(29.3%)接受了阿莫西林-克拉维酸治疗。其中,102 人(4.5%)出现了不良反应(AEs),49 人(48%)是头孢曲松引起的,37 人(36.3%)是阿莫西林-克拉维酸引起的,16 人(15.7%)是阿莫西林引起的(P 值为 0.012)。共有 443 名参试者在注册和世界卫生组织-Vigiflow/VigiLyze 数据库中出现 ADR。ADR 主要影响胃肠道系统 234 例(53%)、皮肤和皮下组织 85 例(19%)、神经系统 49 例(11%)、呼吸胸腔 22 例(5%)和全身疾病 18 例(4%)。在本研究中,约 90% 报告的不良反应可能与监测药物有关,只有少数似是而非的不良反应。头孢曲松注射液引起的不良反应较多。与单用阿莫西林相比,阿莫西林-克拉维酸引起的不良反应更多。这些药物的安全性仍然保持良好,但建议对不良反应进行全面监测,以改善患者安全,提高整体治疗效果。
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引用次数: 0
Developing the First Digital Occupational Therapy Dictionary Worldwide: A Promising Mobile Application Model for Occupational Therapy Service Providers and Recipients 开发全球首部数字职业治疗词典:为职业疗法服务提供者和接受者提供前景广阔的移动应用模式
IF 1.7 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-17 DOI: 10.1177/00469580241282060
Hassan Izzeddin Sarsak
The purpose of this study was to develop the first English-Arabic occupational therapy dictionary mobile application that could be used by occupational therapy service providers and recipients and help fill the gap in understanding and communicating occupational therapy services. Google Play Store and App Store application stores were searched first to identify any current electronic occupational therapy dictionary. While developing the dictionary concept and structure, end users’ needs, language, and culture were taken into consideration applying a user-friendly design, functionalities, and an easy-to-understand language with illustrative visual representations. Our search for currently available electronic occupational therapy dictionaries did not identify any mobile application on the official application stores for iPhone and Android. As a result, a conceptual model was created to develop a mobile application aiming to develop a comprehensive and user-friendly mobile electronic dictionary with over 2400 scientific terms translated and annotated from English to Arabic, more than 350 illustrative pictures, and special features to assist occupational therapy professionals and occupational therapy services recipients in looking up and understanding terminology used in rehabilitation and occupational therapy in the most convenient, fastest, and easiest way possible. The occupational therapy dictionary mobile application has helped create a unified terminology and a common language of shared understanding, proved to be a helpful tool of communicating important messages between Arab occupational therapy professionals and community members through providing an easy access to up-to-date comprehensive English-Arabic lexicography in occupational therapy. It has become the first digital occupational therapy dictionary worldwide and has been made available for everyone to download from Google Play and App Store on their smartphones, computers, or tablets free of charge. Further research is urgently needed for quality improvement and to further enrich Arabic content in occupational therapy through developing evidence-based mobile tools to be used in occupational therapy practice by Arabic-speaking population.
本研究的目的是开发第一款英语-阿拉伯语职业治疗词典移动应用程序,供职业治疗服务提供者和接受者使用,帮助填补理解和交流职业治疗服务方面的空白。首先搜索了 Google Play 商店和 App Store 应用程序商店,以确定目前是否有任何电子职业治疗词典。在开发字典概念和结构时,我们考虑了最终用户的需求、语言和文化,采用了用户友好型设计、功能和通俗易懂的语言,并配有图文并茂的视觉演示。我们对目前可用的电子职业治疗词典进行了搜索,但在 iPhone 和 Android 的官方应用商店中没有找到任何移动应用程序。因此,我们创建了一个开发移动应用程序的概念模型,旨在开发一款全面、用户友好的移动电子词典,其中包含从英语到阿拉伯语的 2400 多个科学术语翻译和注释、350 多张插图和特殊功能,以协助职业治疗专业人员和职业治疗服务接受者以最方便、最快捷、最简单的方式查找和理解康复和职业治疗中使用的术语。职业疗法词典移动应用程序帮助创建了统一的术语和共同理解的共同语言,通过提供最新的全面的职业疗法英语-阿拉伯语词典,被证明是阿拉伯职业疗法专业人员和社区成员之间沟通重要信息的有用工具。它已成为全球第一部数字职业治疗词典,每个人都可以从 Google Play 和 App Store 免费下载到自己的智能手机、电脑或平板电脑上。为了提高质量,进一步丰富职业疗法中的阿拉伯语内容,我们亟需开展进一步的研究,开发以证据为基础的移动工具,供讲阿拉伯语的人群在职业疗法实践中使用。
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引用次数: 0
Highlighting the Neuropsychological Consequences of COVID-19: Evidence From a Narrative Review 突出 COVID-19 的神经心理学后果:叙事回顾中的证据
IF 1.7 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-17 DOI: 10.1177/00469580241262442
Kalliopi Megari, Evanthia Thomaidou, Electra Chatzidimitriou
The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2, although largely affecting the respiratory system, commonly presents with numerous clinical symptoms from other systems. COVID-19 has been associated with both acute and persistent neurological abnormalities in a substantial proportion of patients. Notably, post-COVID-19 neuropsychological abnormalities have garnered attention, highlighting a high prevalence of neurocognitive issues in affected individuals. This narrative review synthesizes current knowledge on the neuropsychological impact of COVID-19, drawing insights from an extensive online search of published literature conducted in the PubMed (MEDLINE) and Scopus databases. The findings underscore significant neuropsychological effects of COVID-19 observed at both individual and societal levels during the ongoing pandemic. Neuropsychological deficits such as memory difficulties, attention problems, and executive dysfunction, alongside physical symptoms like headaches and fatigue were commonly reported. Additionally, psychological challenges, including fear, anxiety, and depression, emerged as prevalent issues arising from the uncertainties surrounding the situation, social isolation, and employment insecurities. The identified neuropsychological manifestations of COVID-19 can significantly impede normal cognitive and emotional functioning, potentially resulting in decreased productivity and an overall decline in mental health and quality of life. Early identification of signs indicative of neurological or psychological decline becomes imperative, offering a crucial opportunity to mitigate the risk of long-term neuropsychological dysfunction through the development of targeted interventions.
由严重急性呼吸系统综合征冠状病毒-2 引起的冠状病毒病 2019(COVID-19)虽然主要影响呼吸系统,但通常会出现其他系统的许多临床症状。在相当一部分患者中,COVID-19 与急性和持续性神经系统异常有关。值得注意的是,COVID-19 后的神经心理异常引起了人们的关注,凸显了受影响个体中神经认知问题的高患病率。这篇叙述性综述综合了目前有关 COVID-19 对神经心理学影响的知识,并从 PubMed (MEDLINE) 和 Scopus 数据库中对已发表文献的广泛在线搜索中汲取了见解。研究结果强调了 COVID-19 在大流行期间对个人和社会层面产生的重大神经心理学影响。除头痛和疲劳等躯体症状外,记忆障碍、注意力问题和执行功能障碍等神经心理学缺陷也被普遍报道。此外,恐惧、焦虑和抑郁等心理挑战也是普遍存在的问题,这些问题源于局势的不确定性、社会隔离和就业不安全感。已发现的 COVID-19 神经心理学表现会严重阻碍正常的认知和情绪功能,可能导致工作效率下降、心理健康和生活质量整体下降。当务之急是及早发现神经或心理衰退的迹象,通过制定有针对性的干预措施来降低长期神经心理功能障碍的风险。
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引用次数: 0
Validity and Reproducibility of a Culture-Specific Electronic Food Frequency Questionnaire: A Trinidad and Tobago Diet Assessment Study 特定文化电子食物频率问卷的有效性和可重复性:特立尼达和多巴哥饮食评估研究
IF 1.7 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-14 DOI: 10.1177/00469580241273247
Lesley Ann Foster-Nicholas, David Shavlik, Celine Heskey, Patricia Dyett, Gina Segovia-Siapco
Nutritional epidemiologists use culture-specific food frequency questionnaires (FFQs) to assess the dietary intake of groups based on country, region or ethnic groups. This study aimed to validate a culture-specific semi-quantitative electronic Food Frequency Questionnaire (e-FFQ) to estimate food group intake in the adult population of Trinidad and Tobago. A 139-item semi-quantitative e-FFQ containing local dishes and street food was administered twice to adults 18 years and older and compared against four 1-day food records (FRs) using digital photographs, which served as the reference method. The validity and reproducibility of the e-FFQ food group intake estimates were determined using paired t-tests, bivariate correlations, and cross-classifications. Reproducibility correlations between the reported food group intakes in the first and repeat administration of the e-FFQ ranged from moderate ( r = .44, P ≤ .0001) for sweetened beverages to high ( r = .91 P ≤ .0001) for alcohol. The cross-classification agreements ranged from 70% (street food) to 92% (alcohol). Energy-adjusted deattenuated validity correlations between the e-FFQ and FR ranged from ( r = .08) for water to ( r = .81) for food from animal sources, with a mean validity correlation of .36. An average of 68% of the e-FFQ estimates was correctly classified within the ±1 quintile of the exact agreement with the FRs. Agreements between the e-FFQ and FRs ranged from 55% for street foods to 95% for water, all significant at P ≤ .0001. This study shows that the culture-specific e-FFQ is a valid tool for assessing and ranking food category intake estimates of the adult population living in Trinidad and Tobago.
营养流行病学家使用特定文化的食物频率问卷(FFQ)来评估基于国家、地区或种族群体的膳食摄入量。本研究旨在验证针对特定文化的半定量电子食物频率问卷(e-FFQ),以估算特立尼达和多巴哥成年人群的食物摄入量。该研究对 18 岁及以上的成年人进行了两次半定量电子食物频率问卷调查,共 139 项,内容包括当地菜肴和街头食品,并将其与作为参考方法的四份使用数码照片的 1 天食物记录(FRs)进行了比较。采用配对 t 检验、双变量相关性和交叉分类确定了电子食物调查表食物组别摄入量估计值的有效性和再现性。在首次和再次使用电子食物调查表时,所报告的食物类别摄入量之间的再现性相关性从甜饮料的中度相关性(r = .44,P ≤ .0001)到酒精的高度相关性(r = .91,P ≤ .0001)不等。交叉分类的一致性从 70%(街头食品)到 92%(酒精)不等。经能量调整后,e-FFQ 和 FR 之间的去衰减效度相关性从水的 ( r = 0.08) 到动物源性食物的 ( r = 0.81) 不等,平均效度相关性为 0.36。平均有 68% 的电子食物频率估计值被正确归类到与食物来源标准完全一致的 ±1 五分位数范围内。e-FFQ 与食物来源标准的一致性从街头食品的 55% 到水的 95% 不等,均有显著性意义(P ≤ .0001)。这项研究表明,特立尼达和多巴哥成年人的食物类别摄入量估计值中,针对特定文化的电子食物调查表是一种有效的评估和排序工具。
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引用次数: 0
Strengthening Clinician-Researchers’ Communication and Knowledge Translation Skills: An Innovative Game Model From the Breathe Well Group 加强临床研究人员的沟通和知识转化技能:来自 "好好呼吸 "小组的创新游戏模式
IF 1.7 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-14 DOI: 10.1177/00469580241273178
Siân Williams, Genevie Fernandes, Peymané Adab, Rachel Adams, Jaime Correia de Sousa, Chunhua Chi, Andrew P. Dickens, Alexandra Enocson, Amanda Farley, Mariam Maglakelidze, Tamaz Maglakelidze, Sonia Martins, Alice Sitch, Aleksandra Stamenova, Katarina Stavrikj, Rafael Stelmach, Alice Turner, Zihan Pan, Hui Pang, Jianxin Zhang, Rachel E. Jordan
Communication is a core component of a clinician’s role; however, when clinicians conduct research, communicating the emerging findings and recommendations to different types of stakeholders can be unfamiliar territory. Communicating research to advocate for change can be even more challenging. Clinician researchers seeking to be agents for change need to conceive and craft specific, evidence-based messages and communicate these effectively to different stakeholders to negotiate action. As part of a global health research program, we developed and tested a novel game-based model to strengthen the communication skills of clinician researchers, from 4 countries, for improving services for chronic obstructive pulmonary disease. This model focused on communication with 3 key stakeholder groups for knowledge translation: Patients/carers, healthcare providers and policy makers/healthcare managers. Delivered through a series of facilitated, online meetings, this model consisted of 2 parts: developing and rehearsing advocacy messages with coaching support, and then testing them with a panel of 3 representative stakeholders, and an audience of fellow researchers. All the country teams reported increased confidence in crafting advocacy messages for specific stakeholders and have applied lessons learned from the model. Delivering this model within a global health research program requires mentoring, time, commitment, resources and translation support to address language barriers. It offers an exemplar to build the communication skills of clinician and non-clinician researchers so that they can go beyond dissemination toward translation of evidence into policy and practice.
沟通是临床医生角色的核心组成部分;然而,当临床医生开展研究时,向不同类型的利益相关者传达新的研究结果和建议可能是一个陌生的领域。通过交流研究成果来倡导变革可能更具挑战性。希望成为变革推动者的临床研究人员需要构思和设计具体的、以证据为基础的信息,并将这些信息有效地传达给不同的利益相关者,以协商行动。作为全球健康研究计划的一部分,我们开发并测试了一种基于游戏的新模式,以加强来自 4 个国家的临床研究人员的沟通技能,从而改善慢性阻塞性肺病的服务。该模式重点关注与 3 个关键利益相关群体的沟通,以促进知识转化:患者/护理人员、医疗保健提供者和政策制定者/医疗保健管理者。该模式通过一系列在线会议进行,由两部分组成:在辅导支持下制定和演练宣传信息,然后与 3 个具有代表性的利益相关者小组和研究人员听众进行测试。所有国家团队都报告说,他们在为特定利益相关者制定宣传信息方面增强了信心,并从该模式中吸取了经验教训。在全球健康研究计划中实施这一模式需要指导、时间、承诺、资源和翻译支持,以解决语言障碍问题。它为培养临床医生和非临床医生研究人员的沟通技能提供了一个范例,使他们能够超越传播,将证据转化为政策和实践。
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引用次数: 0
Characteristics of Medical Quality in Tertiary Traditional Chinese Medicine Hospitals by TOPSIS and RSR Methods 用TOPSIS法和RSR法分析三级中医医院的医疗质量特点
IF 1.7 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-14 DOI: 10.1177/00469580241275324
Lijiao Ma, Yuanyuan Li, Jianlan Xue, Lin Xu, Xianwen Li, Xuhong Chang
Performance evaluation is important for improving medical quality and services. But, there is a lack of research for medical quality in traditional Chinese medicine (TCM) hospitals. This study examines the medical quality and various indicators of tertiary public traditional Chinese medicine hospitals in Gansu Province, to establish a foundation for improving the medical and management standards of these hospitals. This study collected performance assessment data from 10 tertiary TCM hospitals in Gansu Province from 2019 to 2022. Thirteen indicators with TCM characteristics were selected and categorized into 3 aspects: control of medical costs, internal operational dimensions, and comprehensive management. The level of medical quality in different hospitals and in different years were determined using the TOPSIS method for ranking and the RSR method for grading. Firstly, in terms of TCM characteristic indicators, hospital H had the highest control of medical costs and comprehensive management among different hospitals, with 45.87% and 24.20% respectively. The highest values for control of medical costs and comprehensive management were observed in 2020, with 40.65% and 18.69% respectively among different years. When evaluating the medical quality of different hospitals using the TOPSIS method, it was found that hospital H had the highest ranking from 2020 to 2022, with C<jats:sub>i</jats:sub> values of 0.725, 0.778, and 0.667 respectively. Additionally, the RSR method indicated that hospital H had a high level of grading from 2020 to 2022, with P<jats:sub>i</jats:sub> values of 0.687, 0.690, and 0.723 respectively. These findings suggest that the medical quality of hospital H is at a high and stable level of development. Based on the TOPSIS method to evaluate the performance appraisal results and ranking of different hospitals from 2019 to 2022. The results showed that the highest ranking was hospital B(C<jats:sub>i</jats:sub> = 0.913) in 2019. The highest ranking was hospital C(C<jats:sub>i</jats:sub> = 0.809)in 2020. The highest ranking was hospital D(C<jats:sub>i</jats:sub> = 0.689) in 2021. The highest ranking was hospital J(C<jats:sub>i</jats:sub> = 0.865) in 2022. The RSR method indicated that high grading level were hospitals B(P<jats:sub>i</jats:sub> = 0.899),F(P<jats:sub>i</jats:sub> = 0.795) in 2019. The highest grading level was hospital C(P<jats:sub>i</jats:sub> = 0.809) in 2020. The highest grading level were hospitals A(P<jats:sub>i</jats:sub> = 0.868), D(P<jats:sub>i</jats:sub> = 0.813), E(P<jats:sub>i</jats:sub> = 0.689), G(P<jats:sub>i</jats:sub> = 0.873), J(P<jats:sub>i</jats:sub> = 0.813), K(P<jats:sub>i</jats:sub> = 0.842) in 2022. Based on the above results indicate that there is a large variation in the medical quality profile of different hospitals from 2019 to 2022. By comparing the results of TOPSIS and RSR method from 2019 to 2022, we found that the hospitals with identical ranking were D and J, and the hospitals with ≤2
绩效评估对于提高医疗质量和服务非常重要。但目前对中医医院医疗质量的研究还比较缺乏。本研究考察了甘肃省三级公立中医医院的医疗质量和各项指标,为提高这些医院的医疗和管理水平奠定基础。本研究收集了甘肃省 10 家三级中医医院 2019 年至 2022 年的绩效考核数据。选取了13项具有中医特色的指标,分为医疗费用控制、内部运行维度、综合管理3个方面。采用TOPSIS法排序和RSR法分级确定不同医院、不同年份的医疗质量水平。首先,在中医特色指标方面,H 医院的医疗费用控制和综合管理水平在不同医院中最高,分别为 45.87%和 24.20%。医疗费用控制和综合管理的最高值出现在 2020 年,在不同年份中分别为 40.65%和 18.69%。在使用 TOPSIS 方法评价不同医院的医疗质量时,发现 H 医院在 2020 年至 2022 年的排名最高,Ci 值分别为 0.725、0.778 和 0.667。此外,RSR 方法表明,2020 年至 2022 年,H 医院的分级水平较高,Pi 值分别为 0.687、0.690 和 0.723。这些结果表明,H 医院的医疗质量处于较高且稳定的发展水平。基于 TOPSIS 法评价 2019 年至 2022 年不同医院绩效考核结果及排名。结果显示,2019 年排名最高的是医院 B(Ci = 0.913)。排名最高的是 2020 年的 C 医院(Ci = 0.809)。排名最高的是 2021 年的 D 医院(Ci = 0.689)。排名最高的是 2022 年的 J 医院(Ci = 0.865)。RSR 方法显示,2019 年分级水平较高的是医院 B(Pi = 0.899)、F(Pi = 0.795)。分级水平最高的是 2020 年的 C 医院(Pi = 0.809)。分级水平最高的是 2022 年的医院 A(Pi=0.868)、D(Pi=0.813)、E(Pi=0.689)、G(Pi=0.873)、J(Pi=0.813)、K(Pi=0.842)。根据上述结果表明,从 2019 年到 2022 年,不同医院的医疗质量状况存在较大差异。通过比较2019~2022年TOPSIS法和RSR法的排序结果,发现2019年排序相同的医院为D、J,排序相差≤2的医院为A、B、C、E,2020年排序>2的医院为A、F,2021年排序>2的医院为C、G,2022年排序结果相同的医院为B、D、E、G、J。对比TOPSIS法和RSR法的排名结果,发现2019年至2022年排名相同的医院分别为B、F。排名结果相差≤2的医院有A、C、D、E、G、H、J、K,说明TOPSIS和RSR方法的一致性较高,结果可信。研究结果表明,不同年份的医疗质量波动较大,而不同医院的医疗质量总体水平相对稳定。建议中医医院注重提高管理效率,优化医院运营,提高医疗资源利用率,促进医院高效发展。
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引用次数: 0
Basal Metabolic Rate Versus Dietary Vitamin D and Calcium Intakes and the Association With Body Composition and Bone Health After Chronic Spinal Cord Injury 基础代谢率与膳食维生素 D 和钙摄入量以及与慢性脊髓损伤后身体成分和骨骼健康的关系
IF 1.7 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-14 DOI: 10.1177/00469580241278018
Ifon E. Dora, Refka E. Khalil, Robert A. Adler, Ashraf S. Gorgey
We examined the association among basal metabolic rate (BMR) as well as dietary intakes of vitamin D (Vit D) and calcium on body composition and bone mineral density (BMD) after spinal cord injury (SCI). Cross-sectional design. Veterans Affairs Medical Center, Richmond, VA. About 33 individuals with chronic SCI who recorded their food consumption 3 days per week for 2 weeks. BMR was measured after 10 to 12 h of overnight fast. Average daily vit D and calcium intakes, and total caloric intake were recorded and analyzed using the Nutrition Data System for Research (NDSR) software. Fasting blood analysis for 25-hydroxyvitamin D (25[OH]D) status and Triiodothyronine (T3) status was performed (n = 10). Total and regional BMD, % fat mass (FM), and % lean mass (LM) were measured by dual X-ray absorptiometry scans. Participants consumed less than the Institute of Medicine (IOM) recommended daily allowances (RDA) for vit D (600-800 IU) and calcium (1000-1200 mg) for adults. BMR was positively related to total-lean mass ( r = .62, P = .0001; n = 32) and leg-lean mass ( r = .51, P = .003; n = 32). Adjusted BMR was negatively related to BMD of the left (r = −.38, P = .047; n = 28) and the right (r = −.41, P = .032; n = 28) proximal tibia. Vit D intake was negatively related to percentage total-FM ( r = −.33, P = .07; n = 29) and legs-%FM ( r = −.37, P = .047; n = 29). Multivariate regression models indicated that adjusted BMR explained the variance in leg fat mass (34%; P = .002) and percentage fat mass (44%; P < .0001). Persons with SCI are likely to consume less than the RDAs for vit D and calcium. BMR may explain the changes in body composition and bone metabolism. Dietary vit D should be considered as a prophylactic intervention in maintenance of bone health after SCI.
我们研究了脊髓损伤(SCI)后基础代谢率(BMR)以及膳食中维生素 D(Vit D)和钙摄入量与身体组成和骨矿物质密度(BMD)之间的关系。横断面设计。弗吉尼亚州里士满退伍军人事务医疗中心。约 33 名慢性脊髓损伤患者在两周内每周记录 3 天的食物摄入量。隔夜禁食 10 到 12 小时后测量 BMR。使用研究营养数据系统(NDSR)软件记录和分析每日维生素 D 和钙的平均摄入量以及总热量摄入量。对空腹血液中 25- 羟基维生素 D(25[OH]D)和三碘甲状腺原氨酸(T3)的状况进行了分析(n = 10)。通过双 X 射线吸收扫描测量了总 BMD 和区域 BMD、脂肪量百分比 (FM) 和瘦肉量百分比 (LM)。参与者的维生素D摄入量(600-800 IU)和钙摄入量(1000-1200 mg)均低于美国医学研究所(IOM)推荐的成人每日允许摄入量(RDA)。基础代谢率与总瘦体重(r = .62,P = .0001;n = 32)和腿瘦体重(r = .51,P = .003;n = 32)呈正相关。调整后的基础代谢率与左侧(r = -.38,P = .047;n = 28)和右侧(r = -.41,P = .032;n = 28)胫骨近端的 BMD 呈负相关。维生素 D 摄入量与总 FM 百分比(r = -.33, P = .07; n = 29)和腿部 FM 百分比(r = -.37, P = .047; n = 29)呈负相关。多变量回归模型表明,调整后的血液容积可以解释腿部脂肪量(34%;P = .002)和脂肪量百分比(44%;P < .0001)的差异。SCI 患者的维生素 D 和钙摄入量很可能低于 RDA 标准。基础代谢率可以解释身体成分和骨代谢的变化。膳食中的维生素 D 应被视为维持 SCI 后骨骼健康的预防性干预措施。
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引用次数: 0
The “New-Old” Dimensions of Caring in Humanitarian Response: The Opportunity for Public Health Palliative Care to Advance the Humanitarian-Development Nexus, Decoloniality, and Localization Thought 人道主义响应中关怀的 "新 "维度:公共卫生姑息关怀促进人道主义与发展关系、非殖民主义和本土化思想的机遇
IF 1.7 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-09-14 DOI: 10.1177/00469580241277443
Rachel Coghlan, Nazanin Zadeh-Cummings, Mila Petrova, PhD, Paul Spiegel
How can palliative care framings advance humanitarian discourse? The imperative for palliative care in humanitarian settings is increasingly urgent. Recent efforts by health and humanitarian organizations demonstrate increasing attention to the issue. Yet palliative care is still not adequately formally considered or enacted by humanitarian agencies in rhetoric, policy, research, or practice. Even where it is considered in humanitarian action, palliative care is often assumed to be a novel intervention, rather than a caring practice that has existed from time immemorial, including in humanitarian situations. The generation of ideas in this paper has followed a dynamic, iterative, and reflexive process through engagement with key literature, critical thinking, conversations with colleagues across both sectors, primary data, and debate amongst the authors. The paper argues that the current dominant frame of a new, specialized, professionalized, and medicalized palliative care in the humanitarian sector would perpetuate existing challenges. It contends that viewing both fields through a “new-old” lens, where historical and traditional caring practices intertwine with progressive discourse for a more just and appropriate public health response, can further humanitarianism. It posits that the humanitarian-development nexus, decoloniality, and localization thought can benefit from palliative care practice through critical interaction with a broad range of literature.
姑息关怀的框架如何推动人道主义话语?在人道主义环境中开展姑息关怀的必要性日益迫切。卫生和人道主义组织最近所做的努力表明,人们越来越关注这一问题。然而,在人道主义机构的言论、政策、研究或实践中,姑息关怀仍未得到充分的正式考虑或实施。即使在人道主义行动中考虑到了姑息关怀,姑息关怀也往往被认为是一种新的干预措施,而不是一种自古以来就存在的关怀实践,包括在人道主义局势中。本文观点的产生经历了一个动态的、反复的和反思的过程,其间作者们参阅了主要文献、进行了批判性思考、与这两个部门的同事进行了交谈、收集了原始数据并展开了辩论。本文认为,目前在人道主义领域中新的、专业化、职业化和医疗化姑息关怀的主导框架将使现有的挑战永久化。论文认为,从 "新-旧 "的视角来看待这两个领域,将历史和传统的关怀实践与进步的话语交织在一起,以采取更加公正和适当的公共卫生应对措施,可以促进人道主义事业的发展。报告认为,通过与广泛的文献进行批判性互动,人道主义与发展的关系、非殖民主义和本土化思想可以从姑息关怀实践中受益。
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Inquiry-The Journal of Health Care Organization Provision and Financing
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