Developing Multimedia-based Learning on Avoiding Imprecise COVID-19 Patients

Since the Covid-19 pandemic, many doctors are not only facing challenging extra works and longer time in the hospitals, but they also encountering obscured patients who would conceal their experience or even telling lies about what they feel and what they have been doing before coming to the hospitals. This paper is intended to describe a proposed design a mobile multimedia-based learning on avoiding those imprecise Covid-19 patients. This tutorial is as a campaign how to make patients and their families not to be afraid to become stigmatized by the community, and rather chose to be risking the illness. This tutorial is created using ADDIE instructional development method, and during the developing stage, it is conducted using Multimedia Development Life Cycle according to Luther. Subjects of the research are experts in education, medical, communication science and information technology in the preliminary testing. This research is still on going and the researchers would like to present the design of the system. Research findings show that this multimedia-based learning is the most feasible model to be implemented

Mammography screening: views from women and primary care physicians in Crete

Background: Breast cancer is the most commonly diagnosed cancer among women and a leading cause of death from cancer in women in Europe. Although breast cancer incidence is on the rise worldwide, breast cancer mortality over the past 25 years has been stable or decreasing in some countries and a fall in breast cancer mortality rates in most European countries in the 1990s was reported by several studies, in contrast, in Greece have not reported these favourable trends. In Greece, the age-standardised incidence and mortality rate for breast cancer per 100.000 in 2006 was 81,8 and 21,7 and although it is lower than most other countries in Europe, the fall in breast cancer mortality that observed has not been as great as in other European countries. There is no national strategy for screening in this country. This study reports on the use of mammography among middleaged women in rural Crete and investigates barriers to mammography screening encountered by women and their primary care physicians. Methods: Design: Semi-structured individual interviews. Setting and participants: Thirty women between 45–65 years of age, with a mean age of 54,6 years, and standard deviation 6,8 from rural areas of Crete and 28 qualified primary care physicians, with a mean age of 44,7 years and standard deviation 7,0 serving this rural population. Main outcome measure: Qualitative thematic analysis. Results: Most women identified several reasons for not using mammography. These included poor knowledge of the benefits and indications for mammography screening, fear of pain during the procedure, fear of a serious diagnosis, embarrassment, stress while anticipating the results, cost and lack of physician recommendation. Physicians identified difficulties in scheduling an appointment as one reason women did not use mammography and both women and physicians identified distance from the screening site, transportation problems and the absence of symptoms as reasons for non-use. Conclusion: Women are inhibited from participating in mammography screening in rural Crete. The provision of more accessible screening services may improve this. However physician recommendation is important in overcoming women's inhibitions. Primary care physicians serving rural areas need to be aware of barriers preventing women from attending mammography screening and provide women with information and advice in a sensitive way so women can make informed decisions regarding breast caner screening

Self-reported perceptions of factors influencing error reporting in one Nigerian hospital: a descriptive cross-sectional study

Background: Over the past decade the concern about patient safety due to the occurrence of medical errors has become a priority in healthcare. Medical errors occur from virtually all processes in the delivery of healthcare and while most have little risk for patient harm, some do result in injury, increased health care cost, lost income, decreased productivity, disability, morbidity and mortality. Under-reporting of medical errors is a global issue endangering patient safety and compromising health outcomes. Awareness and use of a hospital's error reporting system is an initial step towards improved reporting rates. Aim: The aim of the study was to describe doctors' and nurses' self-reported perceptions of factors influencing error reporting in a Nigerian hospital by survey questionnaire. Methods: This study employed a descriptive cross-sectional design to survey a random sample of 230 health professionals (n=90 doctors, n=130 nurses) working in all the units and departments of a Nigerian tertiary health institution. A theoretical model of a health information technology framework with implications for patient safety served as a guide for the literature review and interpretation of study findings. A 47-item self-administered survey questionnaire served as the data collection instrument. The questionnaire was developed following the review of available published literature and validated by four experts (n=2 doctors, 2 nurses), who determined the index of content validity. Inter-rater reliability of the instrument was subsequently measured by test-retest reliability of data from a pilot study of 30 raters (n=13 doctors, n=17 nurses). The validated questionnaire was used to determine doctors' and nurses' awareness and use of an error reporting system, frequency of reporting various types of errors, perceived barriers to error reporting and factors that facilitate an error reporting culture. Data collection took place for four weeks in February 2017. Data were analyzed in SPSS using descriptive and inferential statistics. Results: The median age of the respondents was 36 years (range of 25-59). The typical nurse respondent was female having a diploma in nursing and no Master's degree or PhD, in contrast to the doctors, most of whom were male and a few had a postgraduate qualification. The gender difference between the two groups was statistically significant (P<0.001). The majority of the respondents had 6-10 years of work experience and were in full-time employment and the difference in current work status (P=0.001) and years of work experience (P<0.001) between the two groups was statistically significant. Awareness of error reporting system: most respondents disagreed that the hospital had a system in place for reporting errors but more nurses (56/140, 40.0%) than doctors (16/90, 17.8%) were aware of such a system and the difference in responses between the two groups achieved statistical significance (X²(4, n=230) = 13.302, P<0.010); knew where and when to report errors (nurses 48.6%, n=68/140; doctors 20.0%, n=18/90) (X²(n=230) = 23.843, P<0.001); how to locate an incident form (nurses n=60/139, 43.2%; doctors n=28/89, 31.5%) (X²(4, n=228) = 9.842, P=0.043); and who to report an incident or error to (nurses n=72/140, 51.4%; doctors n=33/90, 36.7%) (X²(4, n=230) = 11.845, P=0.019). Results for type and frequency of errors reported and factors facilitating an error reporting culture did not achieve statistical significance. Perceptions of barriers to error reporting: lack of confidentiality (nurses n=62/140, 44.3%; doctors n=27/87, 31.0%) (X²(n=227) = 11.697, P=0.019). Most respondents were unsure if error reporting forms were easy to complete (nurses n=49/137, 35.8%; doctors n=26/88, 29.5%), (X²(4, n=225) = 9.926, P=0.042). Factors not perceived as barriers: positive feedback when reporting errors (nurses n=61/140, 43.6%; doctors n=24/90, 26.7%), (X²(n=230) = 10.939, P=0.026); reporting an error that did not cause harm (doctors n=40/90, 44.4%; nurses n=50/139, 36.0%), (X²(4, n=229) = 9.618, P=0.047); time involved in reporting (nurses n=76/138, 55.1%; doctors n=26/89, 29.2%), (X²(4, n=227) = 17.327); and learning from the error (doctors n=42/90, 46.7%; nurses n=40/138, 29.0%), (X²(4, n=228) = 20.777, P<0.001) Conclusion: Doctors and nurses were mostly unaware of the hospital's error reporting system which can be concluded to be an organizational factor. Respondents would be willing to report incidents if perceived barriers are removed. There is an urgent need for an effective error reporting system to be implemented in the local setting and for appropriate awareness training and educational interventions to improve doctors' and nurses' knowledge and use of medical error reporting. Relevance to clinical practice. Effective error reporting systems in the Nigerian healthcare sector that improve awareness and use of these systems should enhance a reporting culture and thereby improve patient safety

Evaluation of the competence and attitudes of primary care physicians towards information technology

The aim of this project was to produce some principles that would assist software developers (SD's) in the design of software for South African general medical practitioners (GP's). The author wanted to give SD's a cognitive model of general medical practice in the hope that this will improve the relevancy of future medical software. This cognitive model is in the form of a set of principles that SD's can keep in mind when developing software for GP's. An evaluation was done of the attitudes and competence of GP's towards information technology. This was done via detailed telephonic interviews, which were analyzed in order to deduce these principles

The stigmatisation of people with chronic back pain

This study responded to the need for better theoretical understanding of experiences that shape the beliefs, attitudes and needs of chronic back patients attending pain clinics. The aim was explore and conceptualise the experiences of people of working age who seek help from pain clinics for chronic back pain. Methods. This was a qualitative study, based on an interpretative phenomenological approach (IPA). During in-depth interviews in their homes, participants were invited to 'tell their story' from the time their pain began. Participants were twelve male and six female patients, aged between 28 and 62 years, diagnosed as having chronic benign back pain. All had recently attended one of two pain clinics as new referrals. The interview transcripts were analysed thematically. Findings. Stigmatisation emerged as a key theme from the narrative accounts of participants. The findings expose subtle as well as overt stigmatising responses by family, friends, health professionals and the general public which appeared to have a profound effect on the perceptions, self esteem and behaviours of those interviewed. Conclusions. The findings suggest that patients with chronic back pain feel stigmatised by the time they attend pain clinics and this may affect their attitudes and behaviours towards those offering professional help. Theories of chronic pain need to accommodate these responses, while pain management programmes need to address the realities and practicalities of dealing with stigma in everyday life

The adoption of AI in clinical practice : exploring neuroradiologists’ perceptions and perspectives

As the world population ages, the prevalence of chronic health conditions increases, and healthcare faces an ever-growing demand for services with progressively higher costs. This is particularly concerning for non-communicable diseases such as neurological disorders, which are a known burden of mortality, morbidity and disability. In neuroradiology, as in other medical fields, Artificial Intelligence (AI) has the potential to unlock cost reduction while simultaneously improving the efficacy of health services. However, despite the existence of numerous AI applications in healthcare, its adoption by healthcare institutions is still in its infancy and heavily dependent on health professionals’ acceptance and expectations towards AI. In this dissertation, the perceptions and perspectives of neuroradiologists towards the adoption of AI in clinical practice are explored. An online survey conducted collected responses from 184 neuroradiologists and showed that the use of AI is still low and that AI-specific knowledge is limited. Despite showing an overall positive attitude towards the use of AI, neuroradiologists are primarily concerned about technological malfunctions and lack of regulation. Results show a positive association between AI knowledge and a positive attitude towards its use. On the other hand, a negative association was found between AI knowledge and fear towards it. No significant relationship was found between age and AI use. Reassurance through providing explanation and validation of new technologies, suitable working conditions, and the creation of a robust legal framework are possibilities in the making to raise trust, provide encouragement, and establish AI readiness.Com o envelhecimento populacional, as doenças crónicas aumentam e a saúde enfrenta uma procura cada vez maior pelos seus serviços, com custos progressivamente mais elevados. Isto é particularmente preocupante nas doenças não infeciosas, como as doenças neurológicas, que contribuem decisivamente para a mortalidade, morbilidade e incapacidade. Na neurorradiologia, como em outras áreas médicas, a Inteligência Artificial (IA) tem o potencial de reduzir custos e melhorar a eficácia dos serviços de saúde. Contudo, apesar das inúmeras aplicações de IA, a sua adoção pelas instituições de saúde é baixa e depende fortemente da aceitação e expectativas dos profissionais de saúde. Nesta dissertação, exploramos as perceções e perspetivas dos neurorradiologistas em relação à adoção de IA na prática clínica. Um questionário online realizado a 184 neurorradiologistas mostrou que o uso de IA é baixo e que o conhecimento de IA é limitado. Apesar de haver uma atitude geral positiva em relação ao uso de IA, os neurorradiologistas estão preocupados com problemas tecnológicos e a falta de regulamentação, entre outros. Os resultados indicam uma associação positiva entre o conhecimento de IA e uma atitude positiva em relação ao seu uso. Por outro lado, foi encontrada uma associação negativa entre o conhecimento de IA e o medo de IA. Nenhuma relação significativa foi encontrada entre a idade e o uso de IA. Assegurar a explicação e validação de novas tecnologias, criar condições de trabalho adequadas e desenvolver uma estrutura legal robusta são requisitos em desenvolvimento para assegurar a diligência no uso de IA

Ethnographies of new clinical encounters: immigrant’s emotional struggles and transcultural psychiatry in Portugal

Based upon two years of fieldwork in a mental health service for migrants in Lisbon, this article underlines how the psychiatric interpretation of the emotional experience of displacement, homelessness and (non) belonging in migrants can be influenced by colonial legacies. These legacies – incorporated, despite the best of intentions, as a constitutive element of diagnosis and treatment into the therapeutic practices of psychiatric counselling – pathologize experiences and behaviours of marginalized people of non-Western origins, reproducing discriminative attitudes and institutional racism. You came to me, Hippocrates, to give me the hellebore, giving credit to foolish men by whom my job is considered madness. I was writing about the harmony of the cosmos, the description of the pole and about the stars […] If you, convinced that I was insane, had made me drink this medicine, my wisdom would have become madness and your art would have been blamed as responsible of creating folly [Letter of Democritus to Hippocrates].Fundamentando-se em dois anos de trabalho de campo num serviço de saúde mental para imigrantes em Lisboa, o artigo sublinha como a interpretação psiquiátrica da experiência emocional do desenraizamento, da carência de casa e da (não) pertença por parte dos migrantes pode ser influenciada por legados coloniais. Esses legados – incorporados, apesar da melhor das intenções, como elementos constitutivos do diagnóstico e tratamento nas práticas terapêuticas do acompanhamento psiquiátrico – fazem com que as experiências e comportamentos de pessoas marginalizadas vindas do mundo não ocidental sejam tratados como patologias, reproduzindo atitudes discriminatórias e racismo institucional

Motivation, money and respect: a mixed-method study of Tanzanian non-physician clinicians.

Poor quality of care is a major concern in low-income countries, and is in part attributed to low motivation of healthcare workers. Non-physician clinicians (mid-level cadre healthworkers) are central to healthcare delivery in half of the countries in Africa, but while much is expected from these clinicians, little is known about their expectations and motivation to perform well. Understanding what motivates these healthworkers in their work is essential to provide an empirical base for policy decisions to improve quality of healthcare. In 2006-2007, we conducted a mixed-method study to evaluate factors affecting motivation, including reasons for varying levels of motivation, amongst these clinicians in Tanzania. Using a conceptual framework of 'internal' and 'environmental' domains known to influence healthworker motivation in low-income countries, developed from existing literature, we observed over 2000 hospital consultations, interviewed clinicians to evaluate job satisfaction and morale, then designed and implemented a survey instrument to measure work motivation in clinical settings. Thematic analysis (34 interviews, one focus group) identified social status expectations as fundamental to dissatisfaction with financial remuneration, working environments and relationships between different clinical cadres. The survey included all clinicians working in routine patient care at 13 hospitals in the area; 150 returned sufficiently complete data for psychometric analysis. In regression, higher salary was associated with 'internal' motivation; amongst higher earners, motivation was also associated with higher qualification and salary enhancements. Salary was thus a clear prerequisite for motivation. Our results are consistent with the hypothesis that non-salary motivators will only have an effect where salary requirements are satisfied. As well as improvements to organisational management, we put forward the case for the professionalization of non-physician clinicians

Ariel - Volume 4 Number 6

Editors David A. Jacoby Eugenia Miller Tom Williams Associate Editors Paul Bialas Terry Burt Michael Leo Gail Tenikat Editor Emeritus and Business Manager Richard J. Bonnano Movie Editor Robert Breckenridge Staff Richard Blutstein Mary F. Buechler J.D. Kanofsky Rocket Weber David Maye