There is a significant unmet need for palliative care globally: of the 58 million people dying annually, it was estimated that at least 60% will have the prolonged advanced illness and dying and would benefit from pal...There is a significant unmet need for palliative care globally: of the 58 million people dying annually, it was estimated that at least 60% will have the prolonged advanced illness and dying and would benefit from palliative care. Zambia has a total population of 15,066,266 people. About 1,150,400 people are living with HIV and 18,900 people were reported to have died of HIV in 2014 alone. The most recent palliative care situational analysis in Zambia highlighted that palliative care remained “an essential absent factor” and revealed that there were gaps in the type of care given in various home based care (HBC) programs. Therefore, this study aimed at exploring the experiences of trained palliative care specialists in implementing palliative care in Lusaka, Zambia. This study was an exploratory qualitative research. The population comprised of the trained palliative care specialists in either degree or diploma in palliative care, working in Lusaka. Purposive sampling was used and the sample totaled 6 (n-6). The data collection was done using a semi-structured interview guide, through face-to-face in-depth interviews. The interviews lasted for an average of 20 minutes. Prompts and probes were used to increase detailed analysis explorations. Eleven themes broadly classified as facilitators or challenges emerged from the study. Among the facilitators: training influence;higher level support;effective team work and delivery models;and personal development and motivation to serve. challenges included: lack of PC knowledge;lack of essential medication for PC;work burden;lack of financial resources;lack of acceptance of PC;lack of PC guidelines;and legal restrictions on the use of opioids. The study provided evidence of the challenges and facilitators that influence palliative care that specialists experience while implementing PC. It is therefore, recommended that more research, education, effective teamwork is promoted as the study revealed that participants needed support for effective implementation of palliative care.展开更多
Background: Most countries have a shortage of Primary Care (PC) physicians. Japan has mitigated this problem by specialists making a mid-career change to PC when they go into private practice. This study examines the ...Background: Most countries have a shortage of Primary Care (PC) physicians. Japan has mitigated this problem by specialists making a mid-career change to PC when they go into private practice. This study examines the circumstances under which specialists shift to PC. Methods: Since the division between specialists and PC physicians is blurred in Japan, we focus on Physicians Providing Home Visits (PPHV). The list of PPHV was obtained from the local medical associations in two neighboring medical planning areas in Japan. The methods used were a questionnaire and in-depth interviews. Results: Of the 46 listed as PPHV, 38 responded to the questionnaires. Physicians mainly acquired their knowledge and skills in primary care from post-graduate clinical training and on the job training after becoming PPHV. The specialists who had moved to PC were equally knowledgeable regarding PC as those had taken the PC accreditation exam. The in-depth interviews revealed that the higher income earned in clinics and being able to retain their identity as a specialist were also important factors. Conclusions: The factors that contributed to physicians making a mid-career change from specialists to PC were their experiences after being certified, the higher income in clinics and the ability to retain their professional identity as specialists. These enabling factors might also be applicable for increasing the ratio of PC physicians at the global level although further studies are required.展开更多
Background: Although inflammatory bowel disease (IBD) patients have been increasing and new thera-peutic options for IBD have been developed, there are relatively few clinicians who specialize in IBD. Patients treated...Background: Although inflammatory bowel disease (IBD) patients have been increasing and new thera-peutic options for IBD have been developed, there are relatively few clinicians who specialize in IBD. Patients treated by a non-specialist of IBD may not receive appropriate treatment. This study aimed to compare disease and medication status between IBD patients treated by a specialist and those treated by a non-specialist. Methods: Medical charts of ambulating IBD patients in two hospitals were examined. All patients in one hospital were treated by one of the IBD specialists, while in the other hospital, patients were treated by one of the gastroenterologists who was a non-specialist of IBD. Results: The numbers of IBD patients were 255 (hospital with specialists) and 74 (hospital without specialists), respectively. Disease activity of the patients was not well-controlled in the hospital without specialists compared to in the hospi- tal with specialists (ulcerative colitis (UC): p = 0.0006 and Crohn’s disease: p = 0.012, respectively). The proportion of UC patients who received an insufficient dose of mesalazine (Pentasa < 3 g/day or Asacol < 3.6 g/day) was higher in the hospital without specialists (47% vs. 15%, p < 0.0001). In the hospital without specialists, more patients received long-term corticosteroids (UC: 23% vs. 5%, p < 0.0001), while fewer patients received immunomodulators (UC: 8% vs. 46%, p < 0.0001). Conclusions: IBD patients of the hospital without specialists were not well-controlled and were not prescribed appropriately with thera-peutic drugs. Fostering and placement of the specialist of IBD is an urgent problem.展开更多
Worries ＂I had not known that my kid had a nearsightedness of 800 degrees. Consequences would have been unthinkable if eye specialists from the city had not treated him,＂ said Yun Za, father of a student attending ...Worries ＂I had not known that my kid had a nearsightedness of 800 degrees. Consequences would have been unthinkable if eye specialists from the city had not treated him,＂ said Yun Za, father of a student attending the No.5 Middle School of Jarud Banner （county） in Tongliao Municipality, Inner Mongolia. He is all gratitude tor doctors of the Tongliao Prevention and Treatment Center for Students＇ Eye Diseases （Tongliao Eye Center）.展开更多
呼吸与危重症医学科(pulmonary and critical care medicine,PCCM)专科医师培训是培养高素质、高水平PCCM专科人才的重要途径。PCCM是一门涵盖范围广,疾病分类复杂的实践性学科。典型教学病例库是现代医学教育模式下的一种全新教学方式...呼吸与危重症医学科(pulmonary and critical care medicine,PCCM)专科医师培训是培养高素质、高水平PCCM专科人才的重要途径。PCCM是一门涵盖范围广,疾病分类复杂的实践性学科。典型教学病例库是现代医学教育模式下的一种全新教学方式。该院通过典型案例的教学,能够激发专培医师的主动性和积极性,提高其临床思维、临床实践、临床科研和团队协作能力。展开更多
背景应对当前健康挑战需要为患者提供整合和连续性服务,初级卫生保健人员与全科医生外其他专科医务人员协作是最常见的实现途径,不同学科人员之间协作的模式及效果直接影响整合服务的提供质量,并对患者的健康结局改善至关重要。目的采...背景应对当前健康挑战需要为患者提供整合和连续性服务,初级卫生保健人员与全科医生外其他专科医务人员协作是最常见的实现途径,不同学科人员之间协作的模式及效果直接影响整合服务的提供质量,并对患者的健康结局改善至关重要。目的采用概况性评价的方法,对初级卫生保健人员与专科医务人员协作模式相关研究特征、协作模式内容、作者报告的协作模式效果进行系统梳理。方法于2022-09-03,系统检索PubMed、EmBase、Web of Science、中国知网、万方数据知识服务平台中与初级卫生保健人员和专科医务人员协作相关的文献,检索时限设定为建库至检索当日。提取纳入文献的基本特征、协作模式特征及效果。基于Mulave齿轮模型对团队协作模式进行元素分解,结合内容分析法对文献中的协作模式内容进行整合和展示。结果最终纳入与主题相关的文献420篇,其中214篇(51.0%)的研究目的为评价协作模式效果,但仅82篇(19.5%)能够提取出具体的协作方式内容。提取有限的协作模式细节信息发现,初级卫生保健人员和专科医务人员协作模式的突出特点是共同工作方式明确且正规、协作服务内容有循证指南/规范支持、在两类人员协作中有信息系统和专职协调人员的支持。82篇文献中,54篇(65.9%)文献报告了明确的效果指标,其中90.7%(49/54)的结论为协作对服务提供过程、服务利用和健康结果相关指标的改善有影响,但较高比例(90.7%,49/54)的研究报告正面效果不能排除发表偏倚的存在。结论整合型服务使用初级卫生保健人员和专科医务人员协作模式时,需要确保两类人员合作方式、工作内容的明确化,同时注重信息和协调人员的支持作用;卫生体系与政策相关干预研究应重视对干预设计细节和执行过程的描述,未来有必要对该主题研究开展方法学质量评价和Meta分析。展开更多
文摘There is a significant unmet need for palliative care globally: of the 58 million people dying annually, it was estimated that at least 60% will have the prolonged advanced illness and dying and would benefit from palliative care. Zambia has a total population of 15,066,266 people. About 1,150,400 people are living with HIV and 18,900 people were reported to have died of HIV in 2014 alone. The most recent palliative care situational analysis in Zambia highlighted that palliative care remained “an essential absent factor” and revealed that there were gaps in the type of care given in various home based care (HBC) programs. Therefore, this study aimed at exploring the experiences of trained palliative care specialists in implementing palliative care in Lusaka, Zambia. This study was an exploratory qualitative research. The population comprised of the trained palliative care specialists in either degree or diploma in palliative care, working in Lusaka. Purposive sampling was used and the sample totaled 6 (n-6). The data collection was done using a semi-structured interview guide, through face-to-face in-depth interviews. The interviews lasted for an average of 20 minutes. Prompts and probes were used to increase detailed analysis explorations. Eleven themes broadly classified as facilitators or challenges emerged from the study. Among the facilitators: training influence;higher level support;effective team work and delivery models;and personal development and motivation to serve. challenges included: lack of PC knowledge;lack of essential medication for PC;work burden;lack of financial resources;lack of acceptance of PC;lack of PC guidelines;and legal restrictions on the use of opioids. The study provided evidence of the challenges and facilitators that influence palliative care that specialists experience while implementing PC. It is therefore, recommended that more research, education, effective teamwork is promoted as the study revealed that participants needed support for effective implementation of palliative care.
文摘Background: Most countries have a shortage of Primary Care (PC) physicians. Japan has mitigated this problem by specialists making a mid-career change to PC when they go into private practice. This study examines the circumstances under which specialists shift to PC. Methods: Since the division between specialists and PC physicians is blurred in Japan, we focus on Physicians Providing Home Visits (PPHV). The list of PPHV was obtained from the local medical associations in two neighboring medical planning areas in Japan. The methods used were a questionnaire and in-depth interviews. Results: Of the 46 listed as PPHV, 38 responded to the questionnaires. Physicians mainly acquired their knowledge and skills in primary care from post-graduate clinical training and on the job training after becoming PPHV. The specialists who had moved to PC were equally knowledgeable regarding PC as those had taken the PC accreditation exam. The in-depth interviews revealed that the higher income earned in clinics and being able to retain their identity as a specialist were also important factors. Conclusions: The factors that contributed to physicians making a mid-career change from specialists to PC were their experiences after being certified, the higher income in clinics and the ability to retain their professional identity as specialists. These enabling factors might also be applicable for increasing the ratio of PC physicians at the global level although further studies are required.
文摘Background: Although inflammatory bowel disease (IBD) patients have been increasing and new thera-peutic options for IBD have been developed, there are relatively few clinicians who specialize in IBD. Patients treated by a non-specialist of IBD may not receive appropriate treatment. This study aimed to compare disease and medication status between IBD patients treated by a specialist and those treated by a non-specialist. Methods: Medical charts of ambulating IBD patients in two hospitals were examined. All patients in one hospital were treated by one of the IBD specialists, while in the other hospital, patients were treated by one of the gastroenterologists who was a non-specialist of IBD. Results: The numbers of IBD patients were 255 (hospital with specialists) and 74 (hospital without specialists), respectively. Disease activity of the patients was not well-controlled in the hospital without specialists compared to in the hospi- tal with specialists (ulcerative colitis (UC): p = 0.0006 and Crohn’s disease: p = 0.012, respectively). The proportion of UC patients who received an insufficient dose of mesalazine (Pentasa < 3 g/day or Asacol < 3.6 g/day) was higher in the hospital without specialists (47% vs. 15%, p < 0.0001). In the hospital without specialists, more patients received long-term corticosteroids (UC: 23% vs. 5%, p < 0.0001), while fewer patients received immunomodulators (UC: 8% vs. 46%, p < 0.0001). Conclusions: IBD patients of the hospital without specialists were not well-controlled and were not prescribed appropriately with thera-peutic drugs. Fostering and placement of the specialist of IBD is an urgent problem.
文摘Worries ＂I had not known that my kid had a nearsightedness of 800 degrees. Consequences would have been unthinkable if eye specialists from the city had not treated him,＂ said Yun Za, father of a student attending the No.5 Middle School of Jarud Banner （county） in Tongliao Municipality, Inner Mongolia. He is all gratitude tor doctors of the Tongliao Prevention and Treatment Center for Students＇ Eye Diseases （Tongliao Eye Center）.
文摘呼吸与危重症医学科(pulmonary and critical care medicine,PCCM)专科医师培训是培养高素质、高水平PCCM专科人才的重要途径。PCCM是一门涵盖范围广,疾病分类复杂的实践性学科。典型教学病例库是现代医学教育模式下的一种全新教学方式。该院通过典型案例的教学,能够激发专培医师的主动性和积极性,提高其临床思维、临床实践、临床科研和团队协作能力。
文摘背景应对当前健康挑战需要为患者提供整合和连续性服务,初级卫生保健人员与全科医生外其他专科医务人员协作是最常见的实现途径,不同学科人员之间协作的模式及效果直接影响整合服务的提供质量,并对患者的健康结局改善至关重要。目的采用概况性评价的方法,对初级卫生保健人员与专科医务人员协作模式相关研究特征、协作模式内容、作者报告的协作模式效果进行系统梳理。方法于2022-09-03,系统检索PubMed、EmBase、Web of Science、中国知网、万方数据知识服务平台中与初级卫生保健人员和专科医务人员协作相关的文献,检索时限设定为建库至检索当日。提取纳入文献的基本特征、协作模式特征及效果。基于Mulave齿轮模型对团队协作模式进行元素分解,结合内容分析法对文献中的协作模式内容进行整合和展示。结果最终纳入与主题相关的文献420篇,其中214篇(51.0%)的研究目的为评价协作模式效果,但仅82篇(19.5%)能够提取出具体的协作方式内容。提取有限的协作模式细节信息发现,初级卫生保健人员和专科医务人员协作模式的突出特点是共同工作方式明确且正规、协作服务内容有循证指南/规范支持、在两类人员协作中有信息系统和专职协调人员的支持。82篇文献中,54篇(65.9%)文献报告了明确的效果指标,其中90.7%(49/54)的结论为协作对服务提供过程、服务利用和健康结果相关指标的改善有影响,但较高比例(90.7%,49/54)的研究报告正面效果不能排除发表偏倚的存在。结论整合型服务使用初级卫生保健人员和专科医务人员协作模式时,需要确保两类人员合作方式、工作内容的明确化,同时注重信息和协调人员的支持作用;卫生体系与政策相关干预研究应重视对干预设计细节和执行过程的描述,未来有必要对该主题研究开展方法学质量评价和Meta分析。
