Background: Discharged against medical advice (DAMA) is defined as any instance when a patient wants to leave the hospital against the managing physician’s decision. This study aimed to identify factors that influenc...Background: Discharged against medical advice (DAMA) is defined as any instance when a patient wants to leave the hospital against the managing physician’s decision. This study aimed to identify factors that influence patients to decide to be DAMA. Methods: A descriptive, cross-sectional study. The study was conducted in the emergency department (ED) of King Fahad Medical City (KFMC)-Saudi Arabia-Riyadh city. A questionnaire in both Arabic and English was distributed to all participants to fill in either English or Arabic. Results: Between 1 March and 30 April 2021, 510 responses were collected. Most of the study participants (31.4%) were over the age of 54. Our findings showed that 12.5% of our participants had taken discharge against medical advice in the past. Results Regarding Factors That Influence Patients to Decide on DAMA Showed: Regarding Inappropriate behavior and disrespect of the physician or staff to the patient and his relatives, 262 (51.4%) participants, 85 (16.7%) participants, and 163 (32%) participants agreed, neutral, and disagreed, respectively. Regarding the Lack of physicians’ and nurses’ attention to the patient and his relatives (emotionally), our result showed that 278 (54.5%) participants, 95 (18.6%) participants, and 137 (26.9%) participants agreed, neutral, and disagree, respectively. Regarding failure to inform the patient or his relatives of his condition, it showed that 257 (50.4%) participants, 95 (18.6%) participants, and 158 (31%) participants agreed, neutral, and disagreed, respectively. Regarding feeling better from DAMA, our result showed 226 (44.3%) participants, 119 (23.3%) participants, and 165 (32.4%) participants agreed, neutral, and disagreed, respectively. Regarding patients’ or their relative’s tiredness of hospital stay, the result showed that 166 (32.5%) participants, 104 (20.4%) participants, and 240 (47.1%) participants agreed, neutral, and disagreed, respectively. Conclusion: The long wait time to be seen by a physician was the major factor that forced patients to leave the emergency department against medical advice.展开更多
This study investigates advice-giving in peer-to-peer comment sections on Chinese social networking sites. The results show that advice, explanation, experience, and assessment are the four most frequent discursive mo...This study investigates advice-giving in peer-to-peer comment sections on Chinese social networking sites. The results show that advice, explanation, experience, and assessment are the four most frequent discursive moves in Chinese advice given by peers on social networking sites. Involvement, mitigation, and face-threatening strategies are also utilized frequently by those peers to give directives and express empathy and solidarity on Chinese online sites, thereby building supportive relationships among them in online communities. The online peer advice-giving in this study is influenced by multiple aspects of the platform, participants, and language use, presenting distinctive characteristics that differ from other studies.展开更多
In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a n...In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.展开更多
Our individual metabolic phenotype is the result of the interaction between nutrients and DNA to modify gene expression. This is a combination of epigenetic interactions whereby nutrients modify the structure of DNA t...Our individual metabolic phenotype is the result of the interaction between nutrients and DNA to modify gene expression. This is a combination of epigenetic interactions whereby nutrients modify the structure of DNA to affect gene expression as well as individual genetic variation that alters our response to diet. Our metabolic phenotype is influenced by developmental plasticity, imprinting in early life and interactions with environmental factors over time. Unlike the human genome which is relatively fixed and stable throughout the body, the human metabolic phenotype is far more complex and dynamic, varying over time and among cells and varying greatly from person to person. Dietary recommendations are often generalized and intended to avert chronic illnesses such as diabetes and cardiovascular disease. In a climate where we are striving for personalisation of healthcare maybe we need a simpler approach;one that embraces genetic variation yet focuses on the optimum nutritional benefit of dietary components.展开更多
We published rapid advice guidelines and updated guidelines for coronavirus disease 2019(COVID-19)management on February 6,2020,and September 4,2020,respectively.These two guidelines vary widely in their developmental...We published rapid advice guidelines and updated guidelines for coronavirus disease 2019(COVID-19)management on February 6,2020,and September 4,2020,respectively.These two guidelines vary widely in their developmental background,type of evidence,grade of recommendation and so on.We shared our experience for the development of these two guidelines to help clinical practitioners better understand and implement guidelines and to help guideline developers facilitate communication and discussion for guideline development during the pandemic.展开更多
Adequate care of type 2 diabetes is reflected by the individual’s adherence to dietary guidance;yet, few patients are engaged in diabetes self-care at the recommended level, regardless of race/ethnicity. Few studies ...Adequate care of type 2 diabetes is reflected by the individual’s adherence to dietary guidance;yet, few patients are engaged in diabetes self-care at the recommended level, regardless of race/ethnicity. Few studies on the effect of dietary medical advice on diabetes self-management (DSM) and glycemic control have been conducted on Haitian and African American adults with type 2 diabetes. These relationships were assessed in total of 254 Blacks with type 2 diabetes (Haitian Americans = 129;African Americans = 125) recruited from Miami-Dade and Broward Counties, Florida by community outreach methods. Although dietary advice received was not significantly different between the two Black ethnicities, given advice “to follow a diet” as a predictor of “using food groups” was significant for Haitian Americans, but not for African Americans. Haitian Americans who were advised to follow a diet were approximately 3 times more likely to sometimes or often use food groups (or exchange lists) in planning meals. Less than optimal glycemic control (A1C > 7.2) was inversely related to DSM for African Americans;but the relationship was not significant for Haitian Americans. A one unit increase in DSM score decreased the odds ratio point estimate of having less than optimal glycemic control (A1C > 7.2%) by a factor of 0.94 in African Americans. These results suggest that medical advice for diet plans may not be communicated effectively for DSM for some races/ethnicities. Research aimed at uncovering the enablers and barriers of diet management specific to Black ethnicities with type 2 diabetes is recommended.展开更多
This paper focuses on parents’ use and experiences of general practitioner (GP) out-of-hours (OOHs) services in Ireland. The progress in the establishment of GP OOHs services is considered by the Health Service Execu...This paper focuses on parents’ use and experiences of general practitioner (GP) out-of-hours (OOHs) services in Ireland. The progress in the establishment of GP OOHs services is considered by the Health Service Executive (HSE) to be a highly significant quality initiative for patient care, and the health service as a whole. Outside of normal GP surgery hours, parents of children can call a dedicated telephone number, to have their urgent health concerns assessed and to be advised about the appropriate level of care. Experienced nurses, who are often based in a GP OOHs centre, assess the call over the telephone and provide advice to the callers. The spur for conducting this study arose from my personal and professional experience which, I believe, underscores the need for exploring and understanding parents’ views of GP OOHs services, in order to bring about change in nurses’ practice of delivering advice over the telephone. The overall aim of the study is to explore and understand the views of parents of children, aged two years and under, following telephone advice received from nurses in the context of a GP out-of-hours service. A qualitative, exploratory, and descriptive design was used to examine the views and experiences of parents of children aged two years and under, who used a GP out-of-hours service provider in Ireland. Nine parents who had received phone advice from a nurse were purposively sampled to take part in the study. Data were collected using semi-structured interviews by telephone. Data were transcribed and analysed thematically. Themes included parents’ perceptions of illness in children with the need to be heard, parents’ views about accessibility to GP OOHs, parents’ expectations that the service would offer guidance and reassurance, parents’ satisfaction with the nurse’s advice, and parents’ experiences of hospital emergency departments (EDs). Suggestions for improving the GP OOHs service were made across these themes. The suggestions include: higher staffing levels, wanting a quicker call back, preference for face-to-face assessment over telephone advice and a preference for a children’s area in the GP OOHs. The study revealed that parents are satisfied with the GP OOHs service and the parental decision-making model has the potential to provide an opportunity to continue the progress of the establishment of GP OOHs services in Ireland.展开更多
The doctor looked at his patient’stongue,felt of his pulse(脉搏),knocked onhis chest,and began:“Same old story,myfriend.Too much confinement(闭门不出).Don’t deny it.What you need is plenty ofoutdoor exercise.Walk,w...The doctor looked at his patient’stongue,felt of his pulse(脉搏),knocked onhis chest,and began:“Same old story,myfriend.Too much confinement(闭门不出).Don’t deny it.What you need is plenty ofoutdoor exercise.Walk,walk,walk.”“But,doctor—”“Don’t argue with me.I am the doctor.Take my advice.Walk ten times as much展开更多
Background: Type 2 diabetes mellitus (T2DM) is a chronic disease that has become a major health care concern, especially in developing countries like Pakistan. Lifestyle modification and appropriate pharmacotherapy ar...Background: Type 2 diabetes mellitus (T2DM) is a chronic disease that has become a major health care concern, especially in developing countries like Pakistan. Lifestyle modification and appropriate pharmacotherapy are shown to improve blood glucose levels, lipid abnormalities and blood pressure. It is not known how many patients adhere to advice and drugs prescribed. This study aimed to determine adherence to lifestyle and therapeutic advice. Methods: A cross sectional hospital based study was conducted among patients attending the diabetic clinic at the Aga Khan University Hospital, using a structured questionnaire. Adult patients with T2DM and with at least one year duration of diabetes were included in the study. Results: Participants were aged between 32 and 92 years old with a mean age of 55.7 years old (SD ± 10.7). Mean duration of diabetes was 10.7 years old (SD ± 7.7). Majority (94%) of the patients were literate. Around half (47.3%) of the patients have had achieved glycemic target (HbA1c < 7%). Above target glycemic control was more common among patients with ischemic heart disease (68.1%), neuropathy (64.8%) and those on insulin (62.5%). Self-reported non-adherence for blood sugar monitoring (9.5%), physical activity (61.7%), tobacco use (43.4%) and foot care (43.9%) were noted. About 25% of the participants were not fully adherent to dietary advice. None of the patients from our study reported non-adherence to medications. Good adherence to physical activity was found in males with college degree. The highest percentage of tobacco use (33.3%) was reported among businessmen. Conclusion: We noted low adherence to advice for physical activity, tobacco use and SMBG, but a high adherence to prescribed medications and insulin. This was a selected group visiting a teaching hospital. This will need to be studied further in the community and efforts are required to motivate patients.展开更多
<b><span style="font-family:Verdana;">Introduction:</span></b><span><span><span style="font-family:;" "=""><span style="font-family:...<b><span style="font-family:Verdana;">Introduction:</span></b><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> Binding retains an important place in Africa. Leaving a health facility to see a bonesetter is common there, but a source of complications. The purpose of this work was to analyze the results obtained by bonesetter </span><span><span style="font-family:Verdana;">after discharge against medical advice. </span><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"> Analytical cross-sectional</span></span><span style="font-family:Verdana;"> study over a period of one year, including all patients admitted for limb fracture, discharged against medical advice for treatment with a bonesetter. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Thirty-nine patients were selected. The average age was 36.9 years, and the sex ratio was 5.50. The fractures were open in 35.9%. At a mean follow-up of 19 months, the course was marked by pain in 34.4% and inequality in limb length in 62.5%. Thirteen fractures (40.6%) were consolidated with axis defect, and 11 were without axis defect (34.4%). There were eight non-union (25%), and eleven patients (34.4%) presented with stiffness in one or more joints. Seven patients had died. </span><b><span style="font-family:Verdana;">Discussion:</span></b><span style="font-family:Verdana;"> The problem of discharge against medical advice is found in all hospitals but is particularly marked for fractures in our context. The absence of an X-ray and ignorance of the rules of asepsis lead to complications. Only the fractures of the two bones of the leg had progressed well (5/8 good results). The rate of vicious calluses (40.6%) and non-union (25%) is high. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Although a few cases have progressed favorably, the results of patients traditionally treated after discharge against medical advice are generally poor.</span></span></span></span>展开更多
A group of CAS members andexperts noted for their pharmaceu-tical knowledge and expertuse tookpart in an exhaustive consultingand lecture program in Hong KongSAR, Shenzhen and Guangzhoufrom Apri 5 to 13, focusing on n...A group of CAS members andexperts noted for their pharmaceu-tical knowledge and expertuse tookpart in an exhaustive consultingand lecture program in Hong KongSAR, Shenzhen and Guangzhoufrom Apri 5 to 13, focusing on newresearch approachs to drug com-pounds involved in Chihese tradu-tional medicine.展开更多
Ⅰ. MAIN TRAFFIC PROBLEMS IN THE MEGACITIES IN CHINA (1) Road capacity is far from enough The road space per capita in China’s megacities has long been very limited and it is only recently did it began to increase fr...Ⅰ. MAIN TRAFFIC PROBLEMS IN THE MEGACITIES IN CHINA (1) Road capacity is far from enough The road space per capita in China’s megacities has long been very limited and it is only recently did it began to increase from 2.8 to 6.6 square meters.But, fast as it is, this change still cannot meet the demand of the growing urban traffic volume with an average annual rate of 20 percent. At present,among the 34 cities populated over one million people each in China, 27 are being suffered by展开更多
词数:539阅读难度:建议阅读时间:6分钟I taught my first class at Columbia University’s M.F.A.program this month,and even though I’ve been teaching college writing since 1993,I initially felt a little frightened by the ...词数:539阅读难度:建议阅读时间:6分钟I taught my first class at Columbia University’s M.F.A.program this month,and even though I’ve been teaching college writing since 1993,I initially felt a little frightened by the school’s marvelous campus.That,and regretful.I enjoyed going to college at the展开更多
In general, if you’re dealingWith either a well-publicizedinternet supplier or with anestablished company with both"brick and mortar" stores and aneCommerce website, you shouldhave no trouble getting the go...In general, if you’re dealingWith either a well-publicizedinternet supplier or with anestablished company with both"brick and mortar" stores and aneCommerce website, you shouldhave no trouble getting the goodsyou ordered at the price youordered them, roughly whenpromised. And think about all thetime you’re saving! Here are fourfactors to bear in mind:展开更多
The indispensability of information in agricultural development led to the setting up of Farmers’Information and Advice Centres(FIACs)by the government of Bangladesh all over the country.The FIACs mainly provide info...The indispensability of information in agricultural development led to the setting up of Farmers’Information and Advice Centres(FIACs)by the government of Bangladesh all over the country.The FIACs mainly provide information related to different agriculture subsectors like crop,fisheries and livestock with the overall aim of improving farmers’livelihood.Hence,the effectiveness along with problems and suggestions for improvement of the FIACs’services were examined in this study by surveying two FIACs of Dinajpur sadar upazila.The effectiveness of FIAC was determined on some selected farm(crop,fisheries and livestock)information based on three dimensions viz.information received,its understanding and application.Data were collected using interview schedule from a sample of 96 farmers selected by proportionate random sampling method.Descriptive statistics and Pearson’s Product Moment Correlation Coefficient(r)were used in the analysis.In terms of crop production sub-sector,all the respondents(100%)received,understood and applied‘tomato seed production technology’information,followed by‘rice seed production and preservation technology’(96.9%).Also,as for the livestock sub-sector,all the respondents(100%)received,understood and applied‘beef fattening through UMS method’information,followed by‘livestock rearing’(89.5%).Similarly,in case of fisheries sub-sector,all the respondents(100%)receive,understand and apply‘Pangas(Pangasius pangasius)culture method’information,followed by‘preparation of an ideal pond’(92.3%).In essence,the FIACs are quiet effective in their service delivery.Among the seven selected characteristics of the respondents,educational qualification,family income and perception on the service delivery efficiency of FIACs showed positive significant association with the effectiveness of the FIAC.However,the foremost problems mentioned by the respondents were FIACs staff inefficiency(83.33%)and lack of effective long term training program for both farmers and staff(73.84%).To address the identified problems,the respondents suggested recruitment of more staff(78.13%)and organizing more training programs for both staff and farmers(67.71 percent).展开更多
文摘Background: Discharged against medical advice (DAMA) is defined as any instance when a patient wants to leave the hospital against the managing physician’s decision. This study aimed to identify factors that influence patients to decide to be DAMA. Methods: A descriptive, cross-sectional study. The study was conducted in the emergency department (ED) of King Fahad Medical City (KFMC)-Saudi Arabia-Riyadh city. A questionnaire in both Arabic and English was distributed to all participants to fill in either English or Arabic. Results: Between 1 March and 30 April 2021, 510 responses were collected. Most of the study participants (31.4%) were over the age of 54. Our findings showed that 12.5% of our participants had taken discharge against medical advice in the past. Results Regarding Factors That Influence Patients to Decide on DAMA Showed: Regarding Inappropriate behavior and disrespect of the physician or staff to the patient and his relatives, 262 (51.4%) participants, 85 (16.7%) participants, and 163 (32%) participants agreed, neutral, and disagreed, respectively. Regarding the Lack of physicians’ and nurses’ attention to the patient and his relatives (emotionally), our result showed that 278 (54.5%) participants, 95 (18.6%) participants, and 137 (26.9%) participants agreed, neutral, and disagree, respectively. Regarding failure to inform the patient or his relatives of his condition, it showed that 257 (50.4%) participants, 95 (18.6%) participants, and 158 (31%) participants agreed, neutral, and disagreed, respectively. Regarding feeling better from DAMA, our result showed 226 (44.3%) participants, 119 (23.3%) participants, and 165 (32.4%) participants agreed, neutral, and disagreed, respectively. Regarding patients’ or their relative’s tiredness of hospital stay, the result showed that 166 (32.5%) participants, 104 (20.4%) participants, and 240 (47.1%) participants agreed, neutral, and disagreed, respectively. Conclusion: The long wait time to be seen by a physician was the major factor that forced patients to leave the emergency department against medical advice.
文摘This study investigates advice-giving in peer-to-peer comment sections on Chinese social networking sites. The results show that advice, explanation, experience, and assessment are the four most frequent discursive moves in Chinese advice given by peers on social networking sites. Involvement, mitigation, and face-threatening strategies are also utilized frequently by those peers to give directives and express empathy and solidarity on Chinese online sites, thereby building supportive relationships among them in online communities. The online peer advice-giving in this study is influenced by multiple aspects of the platform, participants, and language use, presenting distinctive characteristics that differ from other studies.
基金supported(in part)by the Entrusted Project of National Center for Medical Service Administration,National Health and Family Planning Commission China(No.[2019]099)the First Level Funding of the Second Medical Leading Talent Project in Hubei Provincethe Special Project for Emergency of the Ministry of Science and Technology(2020YFC0841300)。
文摘In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
文摘Our individual metabolic phenotype is the result of the interaction between nutrients and DNA to modify gene expression. This is a combination of epigenetic interactions whereby nutrients modify the structure of DNA to affect gene expression as well as individual genetic variation that alters our response to diet. Our metabolic phenotype is influenced by developmental plasticity, imprinting in early life and interactions with environmental factors over time. Unlike the human genome which is relatively fixed and stable throughout the body, the human metabolic phenotype is far more complex and dynamic, varying over time and among cells and varying greatly from person to person. Dietary recommendations are often generalized and intended to avert chronic illnesses such as diabetes and cardiovascular disease. In a climate where we are striving for personalisation of healthcare maybe we need a simpler approach;one that embraces genetic variation yet focuses on the optimum nutritional benefit of dietary components.
基金the Entrusted Project of National Center for Medical Service Administration,National Health and Family Planning Commission China(No.[2019]099)the Emergency Special Project for COVID-19 of Wuhan Municipal Health Commission(EG20A02).
文摘We published rapid advice guidelines and updated guidelines for coronavirus disease 2019(COVID-19)management on February 6,2020,and September 4,2020,respectively.These two guidelines vary widely in their developmental background,type of evidence,grade of recommendation and so on.We shared our experience for the development of these two guidelines to help clinical practitioners better understand and implement guidelines and to help guideline developers facilitate communication and discussion for guideline development during the pandemic.
文摘Adequate care of type 2 diabetes is reflected by the individual’s adherence to dietary guidance;yet, few patients are engaged in diabetes self-care at the recommended level, regardless of race/ethnicity. Few studies on the effect of dietary medical advice on diabetes self-management (DSM) and glycemic control have been conducted on Haitian and African American adults with type 2 diabetes. These relationships were assessed in total of 254 Blacks with type 2 diabetes (Haitian Americans = 129;African Americans = 125) recruited from Miami-Dade and Broward Counties, Florida by community outreach methods. Although dietary advice received was not significantly different between the two Black ethnicities, given advice “to follow a diet” as a predictor of “using food groups” was significant for Haitian Americans, but not for African Americans. Haitian Americans who were advised to follow a diet were approximately 3 times more likely to sometimes or often use food groups (or exchange lists) in planning meals. Less than optimal glycemic control (A1C > 7.2) was inversely related to DSM for African Americans;but the relationship was not significant for Haitian Americans. A one unit increase in DSM score decreased the odds ratio point estimate of having less than optimal glycemic control (A1C > 7.2%) by a factor of 0.94 in African Americans. These results suggest that medical advice for diet plans may not be communicated effectively for DSM for some races/ethnicities. Research aimed at uncovering the enablers and barriers of diet management specific to Black ethnicities with type 2 diabetes is recommended.
文摘This paper focuses on parents’ use and experiences of general practitioner (GP) out-of-hours (OOHs) services in Ireland. The progress in the establishment of GP OOHs services is considered by the Health Service Executive (HSE) to be a highly significant quality initiative for patient care, and the health service as a whole. Outside of normal GP surgery hours, parents of children can call a dedicated telephone number, to have their urgent health concerns assessed and to be advised about the appropriate level of care. Experienced nurses, who are often based in a GP OOHs centre, assess the call over the telephone and provide advice to the callers. The spur for conducting this study arose from my personal and professional experience which, I believe, underscores the need for exploring and understanding parents’ views of GP OOHs services, in order to bring about change in nurses’ practice of delivering advice over the telephone. The overall aim of the study is to explore and understand the views of parents of children, aged two years and under, following telephone advice received from nurses in the context of a GP out-of-hours service. A qualitative, exploratory, and descriptive design was used to examine the views and experiences of parents of children aged two years and under, who used a GP out-of-hours service provider in Ireland. Nine parents who had received phone advice from a nurse were purposively sampled to take part in the study. Data were collected using semi-structured interviews by telephone. Data were transcribed and analysed thematically. Themes included parents’ perceptions of illness in children with the need to be heard, parents’ views about accessibility to GP OOHs, parents’ expectations that the service would offer guidance and reassurance, parents’ satisfaction with the nurse’s advice, and parents’ experiences of hospital emergency departments (EDs). Suggestions for improving the GP OOHs service were made across these themes. The suggestions include: higher staffing levels, wanting a quicker call back, preference for face-to-face assessment over telephone advice and a preference for a children’s area in the GP OOHs. The study revealed that parents are satisfied with the GP OOHs service and the parental decision-making model has the potential to provide an opportunity to continue the progress of the establishment of GP OOHs services in Ireland.
文摘The doctor looked at his patient’stongue,felt of his pulse(脉搏),knocked onhis chest,and began:“Same old story,myfriend.Too much confinement(闭门不出).Don’t deny it.What you need is plenty ofoutdoor exercise.Walk,walk,walk.”“But,doctor—”“Don’t argue with me.I am the doctor.Take my advice.Walk ten times as much
文摘Background: Type 2 diabetes mellitus (T2DM) is a chronic disease that has become a major health care concern, especially in developing countries like Pakistan. Lifestyle modification and appropriate pharmacotherapy are shown to improve blood glucose levels, lipid abnormalities and blood pressure. It is not known how many patients adhere to advice and drugs prescribed. This study aimed to determine adherence to lifestyle and therapeutic advice. Methods: A cross sectional hospital based study was conducted among patients attending the diabetic clinic at the Aga Khan University Hospital, using a structured questionnaire. Adult patients with T2DM and with at least one year duration of diabetes were included in the study. Results: Participants were aged between 32 and 92 years old with a mean age of 55.7 years old (SD ± 10.7). Mean duration of diabetes was 10.7 years old (SD ± 7.7). Majority (94%) of the patients were literate. Around half (47.3%) of the patients have had achieved glycemic target (HbA1c < 7%). Above target glycemic control was more common among patients with ischemic heart disease (68.1%), neuropathy (64.8%) and those on insulin (62.5%). Self-reported non-adherence for blood sugar monitoring (9.5%), physical activity (61.7%), tobacco use (43.4%) and foot care (43.9%) were noted. About 25% of the participants were not fully adherent to dietary advice. None of the patients from our study reported non-adherence to medications. Good adherence to physical activity was found in males with college degree. The highest percentage of tobacco use (33.3%) was reported among businessmen. Conclusion: We noted low adherence to advice for physical activity, tobacco use and SMBG, but a high adherence to prescribed medications and insulin. This was a selected group visiting a teaching hospital. This will need to be studied further in the community and efforts are required to motivate patients.
文摘<b><span style="font-family:Verdana;">Introduction:</span></b><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> Binding retains an important place in Africa. Leaving a health facility to see a bonesetter is common there, but a source of complications. The purpose of this work was to analyze the results obtained by bonesetter </span><span><span style="font-family:Verdana;">after discharge against medical advice. </span><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"> Analytical cross-sectional</span></span><span style="font-family:Verdana;"> study over a period of one year, including all patients admitted for limb fracture, discharged against medical advice for treatment with a bonesetter. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Thirty-nine patients were selected. The average age was 36.9 years, and the sex ratio was 5.50. The fractures were open in 35.9%. At a mean follow-up of 19 months, the course was marked by pain in 34.4% and inequality in limb length in 62.5%. Thirteen fractures (40.6%) were consolidated with axis defect, and 11 were without axis defect (34.4%). There were eight non-union (25%), and eleven patients (34.4%) presented with stiffness in one or more joints. Seven patients had died. </span><b><span style="font-family:Verdana;">Discussion:</span></b><span style="font-family:Verdana;"> The problem of discharge against medical advice is found in all hospitals but is particularly marked for fractures in our context. The absence of an X-ray and ignorance of the rules of asepsis lead to complications. Only the fractures of the two bones of the leg had progressed well (5/8 good results). The rate of vicious calluses (40.6%) and non-union (25%) is high. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Although a few cases have progressed favorably, the results of patients traditionally treated after discharge against medical advice are generally poor.</span></span></span></span>
文摘A group of CAS members andexperts noted for their pharmaceu-tical knowledge and expertuse tookpart in an exhaustive consultingand lecture program in Hong KongSAR, Shenzhen and Guangzhoufrom Apri 5 to 13, focusing on newresearch approachs to drug com-pounds involved in Chihese tradu-tional medicine.
文摘Ⅰ. MAIN TRAFFIC PROBLEMS IN THE MEGACITIES IN CHINA (1) Road capacity is far from enough The road space per capita in China’s megacities has long been very limited and it is only recently did it began to increase from 2.8 to 6.6 square meters.But, fast as it is, this change still cannot meet the demand of the growing urban traffic volume with an average annual rate of 20 percent. At present,among the 34 cities populated over one million people each in China, 27 are being suffered by
文摘词数:539阅读难度:建议阅读时间:6分钟I taught my first class at Columbia University’s M.F.A.program this month,and even though I’ve been teaching college writing since 1993,I initially felt a little frightened by the school’s marvelous campus.That,and regretful.I enjoyed going to college at the
文摘In general, if you’re dealingWith either a well-publicizedinternet supplier or with anestablished company with both"brick and mortar" stores and aneCommerce website, you shouldhave no trouble getting the goodsyou ordered at the price youordered them, roughly whenpromised. And think about all thetime you’re saving! Here are fourfactors to bear in mind:
文摘The indispensability of information in agricultural development led to the setting up of Farmers’Information and Advice Centres(FIACs)by the government of Bangladesh all over the country.The FIACs mainly provide information related to different agriculture subsectors like crop,fisheries and livestock with the overall aim of improving farmers’livelihood.Hence,the effectiveness along with problems and suggestions for improvement of the FIACs’services were examined in this study by surveying two FIACs of Dinajpur sadar upazila.The effectiveness of FIAC was determined on some selected farm(crop,fisheries and livestock)information based on three dimensions viz.information received,its understanding and application.Data were collected using interview schedule from a sample of 96 farmers selected by proportionate random sampling method.Descriptive statistics and Pearson’s Product Moment Correlation Coefficient(r)were used in the analysis.In terms of crop production sub-sector,all the respondents(100%)received,understood and applied‘tomato seed production technology’information,followed by‘rice seed production and preservation technology’(96.9%).Also,as for the livestock sub-sector,all the respondents(100%)received,understood and applied‘beef fattening through UMS method’information,followed by‘livestock rearing’(89.5%).Similarly,in case of fisheries sub-sector,all the respondents(100%)receive,understand and apply‘Pangas(Pangasius pangasius)culture method’information,followed by‘preparation of an ideal pond’(92.3%).In essence,the FIACs are quiet effective in their service delivery.Among the seven selected characteristics of the respondents,educational qualification,family income and perception on the service delivery efficiency of FIACs showed positive significant association with the effectiveness of the FIAC.However,the foremost problems mentioned by the respondents were FIACs staff inefficiency(83.33%)and lack of effective long term training program for both farmers and staff(73.84%).To address the identified problems,the respondents suggested recruitment of more staff(78.13%)and organizing more training programs for both staff and farmers(67.71 percent).
