106 research outputs found

    Impacts and determinants of clinical knowledge transfer to patients: the case of Koa

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    JEL Classification: I11, I18, M53, D83Surveys show that China is gradually stepping into an aged society in the 21st century, with middle-aged and elderly people increasing with years. Most elderly people are living with more than one chronic disease, which requires long-term and large amount of healthcare budget to cover their medical expenses. In order to meet the growing need for elderly healthcare spending, the Chinese government has increased investment year by year, putting a huge strain on the social security funds. Therefore, how to effectively use the elderly medical expenditure has become a key to relieve the government’s financial burden, which demands joint efforts and close collaborations of the whole society, including all departments of the government, especially the health and family planning commissions, hospitals, community health service centers, and nursing homes. Among the common elderly chronic diseases, Knee Osteoarthritis (KOA) occurs in high frequencies. The pain, causing the loss of ability to walk and sleep normally, has greatly affected the patients’ qualities of life. Patients living with the KOA always suffer from long treatment cycles, recurrent symptoms and high treatment expenses. If left untreated, the worsening disease is very likely to cause physical disability, and often needs surgical treatments. However, the medical expenses for surgery and rehabilitation treatment are astoundingly high. Therefore, how to effectively prevent the disease from further worsening through early prevention, diagnosis and treatment has attracted growing attentions from medical community. Meanwhile, as the breadth and the depth of people’s medical knowledge increases across China, people become increasingly concerned about their own health. However, as things stand, most elderly people know little or nothing about their diseases, let alone to know about preventive measures like early self-massage skills. The failure to pay attention to the early symptoms always costs them to miss the best timing of treatments. In severe cases, when joints become severely deformed, joint replacement is the only effective therapeutic means. Generally, early KOA patients should get basic and effective treatments in community health service centers. In China’s case, however, patients often have no confidence in the medical expertise and capabilities of community health service centers and therefore they would go directly to the large hospitals for treatments. The hierarchical medical system advocated by the government fails to play an effective role as expected. The GPs in community health service centers indeed lack of knowledge about KOA and experience and therefore their treatment effects are often unsatisfactory. In order to solve this problem, it is necessary for specialist physicians to train and transfer professional knowledge to the GPs. Knowledge transfer is a concept in knowledge management science, which will be applied to the medical field in this study. Specifically, it refers to the process in which the specialists transfer KOA diagnosis method and standard techniques of early self-massage to GPs in community health service centers through theoretical training, step by step demonstrations, group practices and video reviews. Meanwhile, it also includes knowledge transfer from GPs to patients in the process of KOA treatment in the community health service centers. This study will address the following questions: what effects will knowledge transfer from GPs to patients have on patients’ treatment results and satisfaction level as well as the improvement of doctor-patient relations? (2) What effects will the knowledge transfer from specialists to GPs have on GPs’ satisfaction level and the improvement of doctor-patient relations? (3) To what extent do the patients have the intension to apply what they learned from GP? (4) To what extent do the GPs have the intension to apply what they learned from the specialists? (5) Whether the new treatment model proposed in this study applies to the current medical environment and whether it can, if applicable, further improve the patients’ satisfaction and doctor-patient relationship? A combination of qualitative and quantitative research methods was used in this study, including reviewing on the extent literatures, reviewing theory of planned behavior (TPB) and its applications, soliciting opinions from experts, physicians and patients, and developing questionnaires for data collection. The research data obtained from questionnaire surveys and patient pain measuring rulers and joint range of motion measurement were analyzed using statistical analysis software SPSS20.0 for descriptive analyses, measurement validations and model testing. The study concludes that through knowledge transfer, the satisfaction levels of patients and GPs have been significantly improved; the KOA treatment has achieved satisfactory therapeutic effect; and the doctor-patient relationship has been noticeably improved. Therefore, in the current healthcare context, the government should energetically promote the medical reform and vigorously encourage the knowledge transfer between specialists and GPs, and between GPs and patients, which can, to a certain extent, enhance curative effect, improve the satisfaction of physicians and patients, and effectively improve doctor-patient relationships. It is a useful and effective innovative method that deserves to be further explored and popularized.Investigações desenvolvidas na China demonstram que no século 21 a China se está a deparar gradualmente com um aumento do número de pessoas de meia idade e idosas. Observa-se que a maioria das pessoas idosas vivem com pelo menos uma doença crónica, o que leva a que o orçamento governamental no domínio da saúde seja cada vez mais elevado. Desta forma, existe uma necessidade por parte do governo chinês de reduzir estas despesas, o que passa pela colaboração de toda a sociedade, incluindo as comissões de planeamento familiar, os hospitais e os centros de saúde. Uma das doenças idosas crónicas é a osteoartrite do joelho (OJ). A OJ tem como sintomas uma forte dor que leva a dificuldades ou mesmo incapacidades de andar associada a problema a dormir. Tal faz com que a vida dos doentes se torne bastante limitada. Estes pacientes sofrem períodos de longos tratamentos, o que passa inevitavelmente por grandes despesas nos seus tratamentos. Sucede mesmo que quando a doença não é tratada, os sintomas vão piorando e como último recurso existe a necessidade de uma intervenção cirúrgica. Obviamente, que os custos associados à cirurgia e ao período pós-operatório são extremamente elevados. Desta forma, a possibilidade de prevenir, diagnosticar e tratar a doença OJ tem suscitado extrema atenção e interesse por parte da comunidade médica. Sucede que na China as pessoas idosas têm pouca consciência da OJ, o que não lhes permite prevenir as doenças com as terapias de auto massagens. Esta falta de consciência por parte das pessoas faz com que se desperdice o tempo mais adequado para se fazerem os tratamentos e resolver o problema. De facto, nos casos muito severos a única solução é mesma efetuar cirurgias para a substituição das articulações. Em contrapartida, caso se comece o tratamento logo no aparecimento dos primeiros sintomas, os doentes de OJ vão os centros de saúde da sua zona e poderiam ser efetuados tratamentos muito básicos e extremamente eficazes. Na China, sucede que as pessoas não confiam no profissionalismo e capacidade dos médicos dos centros de saúde e, portanto, recorrem aos grandes hospitais. Assim, parece que o sistema governamental a nível médico não consegue ser tão efetivo como seria desejável. Verifica-se que os médicos de família que estão nos centros de saúde não têm grandes conhecimentos sobre o OJ, o que leva a que os tratamentos não tenham os resultados possíveis. Para resolver este problema é necessários que médicos especialistas neste domínio deem formação, de modo a transferirem os seus conhecimentos para os médicos de família. Esta dissertação irá debruçar-se sobre a gestão do conhecimento em específico sobre a transferência do conhecimento. De facto, a transferência do conhecimento proposta neste estudo incide sobre os especialistas ensinarem métodos de diagnóstico de OJ e técnicas de auto massagem aos médicos de família a partir de demonstrações, de práticas de grupo e vídeos. Posteriormente, os médicos de família transferem esses conhecimentos aos pacientes que acedem aos centros de saúde. Este estudo tenta responder às seguintes questões: (1) Que efeitos terá a transferência de conhecimento dos médicos de família para os pacientes quer em termos dos resultados do tratamento, quer do nível de satisfação, quer da melhoria das próprias relações médico-paciente? (2) Qual o efeito que a transferência de conhecimento de especialistas para médicos de família terá sobre o nível de satisfação dos médicos de família? (3) Em que medida é que os pacientes irão aplicar o que aprenderam sobre OJ com médicos de família? (4) Em que medida é que os médicos de família irão aplicar o que eles aprenderam dos especialistas? (5) Se este estudo se aplicar pode melhorar a satisfação dos pacientes e a relação médico-paciente? Na parte empírica deste estudo, será realizada uma investigação qualitativa e outra quantitativa baseando-se numa extensa revisão de literatura, em específico na Teoria do Comportamento Planeado (TCP). Nesta parte, foi pedido a opinião de peritos, médicos e pacientes. Os dados quantitativos foram analisados recorrendo o software de analise estatística SPSS20.0. Tal permitiu efetuar uma análise descritiva, uma validação e teste do modelo desenvolvido ao longo desta tese. A análise do estudo empírico permite verificar que através da transferência do conhecimento conforme foi proposto neste estudo, existe um maior nível de satisfação entre os pacientes e os médicos de família. Também se verifica que o tratamento da OJ tem um efeito terapêutico bastante satisfatório e que a relação entre médico e paciente melhora significativamente. Como conclusão, considera-se que o governo chinês deve promover profundamente uma reforma médica que promova a transferência de conhecimento entre os especialistas e os médicos de família, e entre os médicos de família e os pacientes. Tal permite aumentar a eficácia e eficiência dos tratamentos, melhorar a satisfação dos médicos e dos pacientes e melhorar a relação entre os médicos e os pacientes. Assim, esta nova abordagem parece ser muito útil e eficaz o que merece ser mais explorada e divulgada

    Pulse diagnosis using signal processing and machine learning techniques

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    Capstone Project submitted to the Department of Engineering, Ashesi University in partial fulfillment of the requirements for the award of Bachelor of Science degree in Electrical and Electronic Engineering, May 2021For many centuries, pulse diagnosis has been a technique studied and applied in determining the state of health of the human body. However, its subjective nature puts it at a disadvantage in presenting an accurate diagnosis of the human body. In this project, practical research is done to standardize pulse diagnosis by acquiring body signals and applying signal processing and machine learning techniques for analysis. A prototype acquisition system is designed to obtain the body signals such as the pressure pulse waves from arteries and ECG signals. The system's efficiency was verified using cross-correlation analysis between the data acquired from the system and the standard data from Lei Zhang’s database and MIT physio net database. For the diagnostic system for the signal analysis, the time domain, frequency domain, and time-frequency domain of the signal processing techniques are adopted to extract features such as the power spectral density to be further used for classification and distinction between different signal groups. Applying the different techniques showed a distinction between the different groups of signals that aided the Support Vector Machine and K-Nearest Neighbour classification models to achieve above 90% and 80% accuracy. The experimental process and results provided insight into ways pulse diagnosis could be standardized for healthcare services.Ashesi Universit

    Dyspnea: Effect of Auricular Acupressure in End Stage Lung Cancer Patients, a Pilot Feasibility Study

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    Introduction: Dyspnea is a debilitating symptom, common in advanced lung cancer patients, and poorly controlled. The National Institutes of Health has promoted the need for research regarding end of life care symptom control. Purpose: Conduct a feasibility study evaluating auricular acupressure effects on dyspnea in hospice lung cancer patients. Theoretical framework: The UCSF School of Nursing Symptom Management Faculty Group\u27s Model for Symptom Management was used for the conceptual framework. The model includes three dimensions: symptom experience, symptom management strategies, and symptom outcomes. The Human Energy Field Theory provided context for using auricular acupressure. Aim: Conduct a pilot study evaluating feasibility and effects of auricular acupressure on dyspnea. Hypotheses: auricular-acupressure seed adhesive use on appropriate points plus standard care (SC) would be more effective than usual care or usual care plus placebo in (1) reducing dyspnea and (2) increasing oxygen saturation. Methods: Both quantitative and qualitative methods. Sample - 11 hospice patients with lung cancer and dyspnea. Procedure - 8 times (Day 1 baseline and post intervention, Days 2 early-late, 3 early-late, 4 early-late follow-ups) dyspnea was measured by the Cancer Dyspnea Scale and oxygen saturation was measured by pulse-oximeter. Qualitative questions were asked on Days 1 and 4. A trained professional administered the acupressure intervention after baseline assessments. Design -The experimental design included 3 conditions with eight measurement points in time. Patients were randomly assigned to one of three treatment conditions: (1) Standard Care; (2) Standard Care with seed adhesive on inappropriate points (placebo); (3) Standard Care with seed adhesive Auricular acupressure on appropriate points. The results were analyzed using analysis of variance (ANOVA). Results: Both quantitative and qualitative analyses supported the presence of acupressure effects with medium to large effects and a significant effect for dyspnea effort. Conclusions: Although difficult to recruit patients to a trial of alternative therapy in advanced disease, it is possible to test such treatments that potentially can improve symptoms in palliative care. Auricular acupressure may help ameliorate dyspnea. There is a continued need for symptom control at end of the life. The role of nursing is central to end of life care

    Front-Line Physicians' Satisfaction with Information Systems in Hospitals

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    Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

    A systems approach to sub-typing of rheumatoid arthritis

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    The current health care system is severely challenged by for instance rising costs, fewer new blockbuster drugs and increasing numbers of hospitalizations due to side effects. Especially in the area of chronic diseases the current disease fighting strategy is failing and a more personalized medicine approach is needed. In this thesis new sub-types of rheumatoid arthritis are characterized with metabolomics analysis and symptoms patterns. The sub-types are based on diagnostic knowledge from Chinese medicine. The two sub-types of RA patients were found to have differences in apoptosis regulation of T-cells and differences in urine acylcarnitine levels. A questionnaire was designed to distinguish the two sub-types and to evaluate symptom patterns of arthritis patients. In the future the response to treatment of these sub-types of patients can be studied and specific treatment can be targeted to these sub-types.LEI Universiteit LeidenArtrose & Reuma StichtingAnalyse en stochastie
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