Message from the Director Institute of Health Care

Fifteen years have passed since the Institute of Health Care was founded within the University of Malta. In line with advances in health care professional education worldwide, and indeed with advances in medical knowledge, technology, health service delivery and care, the University of Malta forged ahead and raised the professional education of nurses, midwives and professions allied to medicine onto an academic platform. The Institute was set up to develop diploma, degree and post-graduate courses in Communication Therapy, Dental Technology, Environmental Health Science, Medical Laboratory Science, Midwifery, Nursing, Occupational Therapy, 2002, Physiotherapy, Podiatry, and Radiography. Furthermore, the Institute earned a sound academic standing in the interdisciplinary Master and Post Qualification Diploma in Health Services Management that has attracted medical and pharmacy graduates in addition to our own health care graduates. It is with great satisfaction to report that fifteen years down the road, the Institute of Health Care has steadily grown in esteem and recognition both within our University as well as Swith our counterparts internationally.peer-reviewe

Journal of Mind and Medical Sciences: translational and integrative mission

Initiated four years ago, Journal of Mind and Medical Sciences (J Mind Med Sci.) established the mission to publish papers on mental and medical topics in distinct but closely interrelated domains. The editorial policy especially encourages interdisciplinary and integrative perspectives, being equally focused on basic research and clinical investigations and short reports. The journal adheres to the philosophy that high quality, original ideas and information should be readily accessible and freely shared within and amongst the scientific community. Accordingly, J Mind Med Sci. is an online, open access, non-for-profit journal which, because of individual/ private support, has levied no charges for submission, review, and publication of articles. All published articles may be freely downloaded and used by anyone from anywhere for scientific purposes. Journal of Mind and Medical Sciences is published by ValpoScholar/ Valparaiso University using the leading institutional repository platform of Digital Commons (powered by Bepress and under the local management of Jon Bull, Library Services, Valparaiso University), which combines submission management, editorial, and peer-review tools into a unique and flexible publishing software system. These editorial and publishing norms have facilitated the journal’s evolution, now indexed and abstracted in several international respected databases. Journal visibility is wide among international academic institutions and readers, as documented by the number of downloaded articles cited in respected journals, some indexed by Thomson Reuters and having high impact factors. In addition, published authors in J Mind Med Sci. periodically receive a statistical report about views / downloads of their articles. It is a pleasure and honor to thank all those who have thus far supported the journal activity (authors, reviewers, editorial board and assistance, publishing support), and to further invite and encourage scientists to contribute to the general progress of knowledge, and in particular to the development of mental and medical disciplines, using our academic platform, available at http://scholar.valpo.edu/jmms/

Knowledge of Asthma and the Utilization of Certified Asthma Educators in a Health Law Partnership Legal Services Clinic and a Metropolitan Children’s Hospital , A Needs Assessment

ABSTRACT BACKGROUND: The Health Law Partnership (HeLP) Legal Services clinic is part of the Health Law Partnership in the School of Law at Georgia State University. HeLP clinic law students learn alongside residents and medical students while working on cases involving childhood asthma, housing conditions, education, and access to healthcare for clients who are low income residents of the metro Atlanta area. PURPOSE: The purpose of the study was three-fold. One evaluation described the knowledge of asthma amongst the residents, medical students, and law students who practice at the HeLP clinic. The second evaluation determined the use and/or the need of certified asthma educators (AE-C) within the HeLP clinic and at Children’s Healthcare of Atlanta. Thirdly, what were the gaps found in inpatient and outpatient asthma education at Children’s Healthcare of Atlanta, and where can the use of AE-C’s be helpful in providing effective asthma education using evidence-based practice? METHODS: Following IRB approval, medical students, law students and pediatric residents were invited to participate in a two-part survey to assess the perception and utilization of AE-C’s and the knowledge of asthma using the National Asthma Education Prevention Program (NAEPP) guidelines. Data obtained was analyzed using SPSS, version 23. Descriptive analysis and t-tests of significance were utilized. De-identified patient data was obtained for gaps in asthma education. RESULTS: Thirty-one HeLP clinic members responded, 44% medical students and residents, and 32% law students completed the survey. Approximately 64% of the HeLP clinic members have 1 year or less than 1 year of experience serving in the clinic. Current data suggests that 85% of HeLP clinic members, law students and medical residents would utilize the resources of an AE-C if available within the clinic. There was no significant difference of the knowledge of asthma management between law students and medical residents (p = 0.008). However, when reviewing individual answers of the asthma self-management guidelines, law students answered more correctly than pediatric residents. Data reported from the HeLP clinic revealed that legal aid was provided for 112 children with a diagnosis of asthma. CHOA treated 7,482 children with asthma in the Emergency Department across 2 campuses, of which 64% did not receive asthma education upon discharge. CONCLUSION: This study was to determine the knowledge of asthma and the use of AE-C’s within the HeLP clinic and CHOA amongst law students and medical residents. No known studies have compared the knowledge of asthma and the use of an AE-C’s within a health law partnership collaboration that is unique to HeLP. Further education and needs awareness is needed for physicians and those who advocate for individuals with this incurable, yet, manageable pulmonary disease. The utilization as well as awareness of AE-C’s within HeLP and CHOA is strongly suggested

Clinical experience : an ethnography of medical education

This thesis reports an ethnographic study of undergraduate nodical students at Edinburgh University, in their first year of clinical studies. It explores various aspects of their 'clinical experience' in the course of that year. The thesis is organized in four parts. Part I provides the context for the research. The conduct of the study is reported, and the methods used (participant observation, interviews and self-administered questionnaire) are discussed. The medical school, the undergraduate curriculum and the work of the fourth (first clinical) year are also outlined. Part II examines two major concepts - 'student culture' and 'professional segmentation'. The variety of medical and educational experiences that students encounter, and the students' understandings of segmentation within the medical school are examined. This part of the thesis also explores how students use their understanding of such diversity in organizing their own careers in the medical school. The argument is also illustrated with case studies of individual clinical attachments. Part III is focused on the social Interaction of clinical teaching - between doctors, students and patients. The management of clinical information in such encounters is discussed. The argument proceeds with a consideration of theconditions for the successful accomplishment of bedside teaching, and of contingencies which can undermine such accomplishment. Part IV develops the analysis begun in Parts II and III. The management of medical knowledge is analysed further: the 'classic case', 'clinical experience' and clinicians' appeals to indeterminate knowledge are documented. These topics are linked with the theme of Part II, as it is argued that divergencies in personal knowledge are grounded in processes of segmentation in the medical profession and the medical school. Thus the themes of 'professional segmentation' and 'clinical experience' are reunited in the concluding section of the thesis

PHYSICIAN AS A MANAGER: PERSONAL AND MANAGERIAL CHARCTERISTICS, SAUDI ARABIA

BACKGROUND: The emergence of physicians' roles in key adminstrative positions within many King Saudi Arabia health care organizations has represented a major change in the medical profession over the last two decades. This have created a need for physicians who are willing to assume a high level of responsibility for managing evovling health care organizations. The study explores the perception of physician managers regarding their work, personal and managerial characteristics. METHODS: The data for this study were obtained from a sample of 200 physicians working in management positions in different health care organizations in Riyadh. Physicians were selected at random with probability proportional to size from a list containing managers in all health care organization to participate in the study RESULTS: Our results indicated that physician managers lack admistration skills. No formal training in medical adminstration and management because management principles are not integrated in the medical context and the majority were experienced in management for less than four years.  Very few possess the technical comptencies such as strategic planning, financial and economics knowledge. Boredom with medical practice, improvement of personal position and encouragement from others are related to being older, having more years in medicine and interest in medicine is reduced. The finding also supported the notion that physician manager can maintain stable levels of loyality to professional interest and organization. This dual commitment is related to work-relate characteristics involving sharing his time favorably to management job and to patient care. Recommendation: To improve their management skills physicians can benefit from mamagement education programs such as those offered by King Saud University

An Investigation into Ghanaian Primary Care Physicians’ Beliefs and Their Influence on Clinical Knowledge Translation

ABSTRACT AN INVESTIGATION INTO GHANAIAN PRIMARY CARE PHYSICIANS’ BELIEFS AND THEIR INFLUENCE ON CLINICAL KNOWLEDGE TRANSLATION by Linda D. Caples The University of Wisconsin-Milwaukee, 2019 Under the Supervision of Professor Barbara Daley, PhD There is a disconnect between the use of evidence-based clinical practice guidelines and the medical practice of Ghanaian primary care physicians in the care of hypertensive patients. This study sought to answer the question of how the formal and informal beliefs of Ghanaian primary care physicians influence clinical knowledge translation in the management of hypertension in adults. The process of clinical knowledge translation helps physicians construct knowledge along with interactions with other healthcare professionals, their patients, and the communities they serve. These interactions help inform a physician’s salient beliefs. Thus, the use of the Theory of Planned Behavior (TPB) facilitated research into how background factors influenced behavioral, normative, and control beliefs and in turn, how those beliefs influenced intentions and ultimately, physician behavior. Findings in the form of six themes illustrate the importance of culture and context in shaping the beliefs of how primary care physicians saw their patients and how they translated clinical knowledge into medical practice. The background factors such as a physician’s gender, medical school training, clinical setting, health sector, specialty, and years in practice had some influence on beliefs. However, the patient population significantly influenced their beliefs particularly their interactions with patients within the culture and context of Ghana. Additionally, clinical knowledge translation is supported using continuing medication education (CME) as a primary channel of knowledge translation and as a means to educate physicians and other health care professionals about clinical practice guidelines. Incorporating culture and context into the development of CME content is important for effective clinical knowledge translation and improved patient care. This is particularly important in medically pluralistic societies such as Ghana, where primary care physicians are few and traditional medical practitioners are prevalent. Implications of this research may shape policy, future CME content development, and CME research

'If it's a medical issue I would have covered it by now': learning about fibromyalgia through the hidden curriculum: a qualitative study

BACKGROUND: Fibromyalgia syndrome (FMS) is a long-term condition that affects between 1 and 5% of the general population and lies within the spectrum of medically unexplained symptoms (MUS). FMS can be difficult to diagnose and is usually done so as a diagnosis of exclusion. There is continuing debate regarding its legitimacy excluding other causes of symptoms. It is known that the diagnosis and management of MUS, including FMS, receives little attention in medical curricula and attitudes towards patients with FMS amongst medical professionals and trainees can be negative. The purpose of this study was to investigate how attitudes and perspectives of undergraduate medical students towards FMS are acquired during their training. METHODS: Qualitative interviews with 21 medical students were conducted to explore their views on FMS, encounters with patients with FMS, and where learning about FMS occurs. Participants were recruited from two English medical schools and the study was approved by two University Ethics committees. Interviews were digitally recorded with consent and data analysed thematically, using principles of constant comparison. RESULTS: The data were organised within three themes: i) FMS is a complex, poorly understood condition; ii) multiple sources for learning about FMS; and iii) consequences of negative attitudes for patients with FMS. CONCLUSION: Undergraduate medical students have limited understanding of, and are sceptical over the existence of FMS. These attitudes are influenced by the 'hidden curriculum' and witnessing attitudes and actions of their clinical teachers. Students interpret a lack of formal curriculum teaching around FMS to mean that it is not serious and hence a low priority. Encountering a patient, friend or family member with FMS can increase knowledge and lead to altered perceptions of the condition. Teaching and learning about FMS needs to be consistent to improve knowledge and attitudes of clinicians. Undergraduate students should be exposed to patients with FMS so that they better understand patients with FMS

Domestic violence management in Malaysia: A survey on the primary health care providers

<p>Abstract</p> <p>Aim</p> <p>To assess the knowledge, attitudes and practices of primary health care providers regarding the identification and management of domestic violence in a hospital based primary health care setting.</p> <p>Method</p> <p>A survey of all clinicians and nursing staff of the outpatient, casualty and antenatal clinics in University Malaya Medical Centre using a self-administered questionnaire.</p> <p>Results</p> <p>Hundred and eight out of 188 available staff participated. Sixty-two percent of the clinicians and 66.9% of the nursing staff perceived the prevalence of domestic violence within their patients to be very rare or rare. Majority of the clinicians (68.9%) reported asking their patients regarding domestic violence 'at times' but 26.2% had never asked at all. Time factor, concern about offending the patient and unsure of how to ask were reported as barriers in asking for domestic violence by 66%, 52.5% and 32.8% of the clinicians respectively. Clinicians have different practices and levels of confidence within the management of domestic violence. Victim-blaming attitude exists in 28% of the clinicians and 51.1% of the nursing staff. Less than a third of the participants reported knowing of any written protocol for domestic violence management. Only 20% of the clinicians and 6.8% of the nursing staff had ever attended any educational program related to domestic violence.</p> <p>Conclusion</p> <p>Lack of positive attitude and positive practices among the staff towards domestic violence identification and management might be related to inadequate knowledge and inappropriate personal values regarding domestic violence.</p

Pancreatic Cysts Identification Using Unstructured Information Management Architecture

poster abstractPancreatic cancer is one of the deadliest cancers, mostly diagnosed at late stages. Patients with pancreatic cysts are at higher risk of developing cancer and surveillance of these patients can help with early diagnosis. Much information about pancreatic cysts can be found in free text format in various medical narratives. In this retrospective study, a corpus of 1064 records from 44 patients at Indiana University Hospital from 1990 to 2012 was collected. A natural language processing system was developed and used to identify patients with pancreatic cysts. The input goes through series of tasks within the Unstructured Information Management Architecture (UIMA) framework consisting of report separation, metadata detection, sentence detection, concept annotation and writing into the database. Metadata such as medical record number (MRN), report id, report name, report date, report body were extracted from each report. Sentences were detected and concepts within each sentence were extracted using regular expression. Regular expression is a pattern of characters matching specific string of text. Our medical team assembled concepts that are used to identify pancreatic cysts in medical reports and additional keywords were added by searching through literature and Unified Medical Language System (UMLS) knowledge base. The Negex Algorithm was used to find out negation status of concepts. The 1064 reports were divided into sets of train and test sets. Two pancreatic-cyst surgeons created the gold standard data (Inter annotator agreement K=88%). The training set was analyzed to modify the regular expression. The concept identification using the NegEx algorithm resulted in precision and recall of 98.9% and 89% respectively. In order to improve the performance of negation detection, Stanford Dependency parser (SDP) was used. SDP finds out how words are related to each other in a sentence. SDP based negation algorithm improved the recall to 95.7%