COMMUNICATION | doi:10.20944/preprints202211.0338.v1
Subject: Social Sciences, Education Keywords: normative grading; criterion-based grading; clinic evaluations; clinic interns
Online: 17 November 2022 (11:29:06 CET)
Background: Grades in clinical courses matter. They are often used to determine clinical academic awards, scholarships, and—most importantly—interns’ suitability for graduate medical education opportunities. Aware of these stakes, clinic preceptors may feel pressure to grade too leniently or uniformly. A fair method of adjusting for differences in preceptor bias is then needed. Approach: The authors propose a technique that employs the advantages of both criterion- and normative-based grading to adjust for differences in both grader leniency and uniformity. Evaluation: The technique produces fair adjustments to any raw assign grades, and the authors demonstrate how easily this process can be administered in any clinical setting where multiple preceptors are evaluating interns. Implications: This work provides a grading framework that is transparent to all stakeholders but places responsibilities at the appropriate level. That is, clinic performance evaluations are left to clinic preceptors but grading to clinic academic managers.
REVIEW | doi:10.20944/preprints202111.0163.v1
Subject: Engineering, Industrial And Manufacturing Engineering Keywords: virtual reality; automotive industry; marketing research; immersive car clinic
Online: 9 November 2021 (11:01:16 CET)
Virtual reality (VR) can play a key role in automotive marketing research, lowering costs and shortening the time it takes to bring a new product to market. However, there are still few VR applications that support automotive customers' experiences during the early stages of product development. Through a systematic review of literature and patents, this study aims to identify the challenges and opportunities for the application of virtual reality in car clinics, and to categorize them into attributes. We searched through the knowledge databases of PatentScout, ScienceDirect, Springer, and IEEEXplore. We found 72 patents with a high concentration in a few inventors. The United States of America presented the greatest number of records and the most common applications related to the apparatus for automatically reading respondents' reactions in a virtual environment. In terms of articles, we found 19 research papers that discussed sixteen categories identified as challenges and opportunities for automotive marketing research: 1) cost, 2) location to customers, 3) flexibility in interactions, 4) model transportation, 5) depth perception, 6) haptic perception, 7) motion, 8) movement perception/ physical collision, 9) color and texture, 10) sound feedback, 11) product interaction/manipulation, 12) visual-spatial, 13) graphic quality, 14) intuitiveness, 15) cybersecurity and 16) cybersickness. We conclude that the automotive industry can employ virtual reality for marketing research, but relevant elements such as hardware and software definition, stimulus quality, and research objectives, among others, must be considered.
ARTICLE | doi:10.20944/preprints202105.0318.v1
Subject: Medicine And Pharmacology, Immunology And Allergy Keywords: Treatment adherence; child; adolescent; trend; outpatient clinic; new patient
Online: 14 May 2021 (08:48:07 CEST)
This study analysed trends of first-time patients visiting the paediatric psychiatry clinic in a university hospital. The medical records from 2009 to 2016 of first-time patients visiting the Kyung Hee university hospital were reviewed, focusing on children in grades 1–12. We analysed the prevalence rate of psychiatric disorders per 100,000 general populations by gender and grade, and the characteristics of patients who sought outpatient care more than three times. The study included 1,467 participants, of which 931 were males (63.5%). The number of male patients per 100,000 populations significantly decreased from 4.14 in 2009 to 2.03 in 2016. While hyperkinetic disorders had the highest prevalence in males, neurotic disorders were most frequent in females. Prevalence of disruptive behaviour disorders in males and mental retardations in females decreased significantly during the study period. The factors affecting continuity were being female, studying in grades 7–12, and diagnosis of depressive, hyperkinetic, and tic disorders. Physicians should consider the new paediatric patients’ gender, grade, and expected diagnosis from their first visit to improve treatment compliance.
REVIEW | doi:10.20944/preprints202109.0145.v1
Subject: Social Sciences, Education Keywords: Role-play; medical roleplay; teddy bear hospital; teddy bear clinic
Online: 8 September 2021 (11:54:09 CEST)
Background: Role-playing is often used as a pedagogical method for learning communication in medical education. Therefore, medical play using the Teddy Bear Hospital (TBH) is a concept that can quickly familiarize children with health care and help them develop positive experiences in these areas. This review aims to assess the strengths of TBH, as a form of directed medical role play, in improving health outcomes and well-being in children, along with implanting an awareness of preventive health care in young children.Methods: For this scoping review, we examined the list of recommendations, including 11 studies from two databases, PubMed and Google Scholar. We incorporated pre/post quasi-experimental studies, ANOVA, qualitative research studies, systematic reviews, and control group studies that deliberately utilize the teddy bear hospital as an intervention.Results: The results of individual studies were further categorized into three sections. The first being upon the analysis of 11 studies, the Teddy Bear Hospital was mainly conducted in Europe and Asia. It is evident that regardless of the different approaches and strategies used to implement the Teddy Bear Hospital, they all ultimately share the same intent: to raise health care awareness and alleviate young children's anxiety over medical treatment while focusing on the promotion of positive healthy lifestyle. All studies portray the teddy bear hospital as an intervention of medical roleplay which analyzed the children's feelings, behaviors, and health awareness after visiting the Teddy Bear Hospital.Conclusion: The application of the teddy bear hospital has overwhelmingly positive results, with lower levels of anxiety and improved health knowledge. Its reported efficacy calls for future studies on aspects that lead to its efficacy and potential effectiveness.
ARTICLE | doi:10.20944/preprints202105.0392.v1
Subject: Medicine And Pharmacology, Medicine And Pharmacology Keywords: Age; adherence; anti-hypertensive; Controlled hypertension; clinic; hypertension; Prevalence; Systemic
Online: 17 May 2021 (15:57:01 CEST)
Objectives: To determine the prevalence of controlled systemic hypertension and its associated risk factors among the hypertensive patients who attended the clinic at Mbeya Zonal Referral Hospital in Tanzania. Methods: A descriptive cross-sectional quantitative study was used determine the prevalence of co to 252 hypertensive patients were recruited during clinic visit from September to November 2020 and participant was randomly selected interviews using structured self-administered questionnaires. Data was analyzed using chi square test to find the risk factors associated with controlled hypertension. Results: Among 252 participants, 94(39.7%) individuals with controlled hypertension giving the prevalence of controlled hypertension. The proportion of females with controlled hypertension was slightly higher than male (49 females to 45 males). The prevalence of uncontrolled hypertension was 152(60.3%) participants. The prevalence of controlled hypertension was higher among patients who have regular clinic visit (p< .05) and have daily adherence to their anti-hypertensive medication. A similar trend was observed among participants without financial challenges to attend clinic, short duration of illness, higher level of education and there was no association between age, sex, marital status, smoking, alcohol consumption, having health insurance and having chronic illness. Conclusion: Prevalence of controlled hypertension is higher among patients who have regular clinic visit and have daily adherence to their anti-hypertensive medication. Also, it is higher among participants without financial challenges to attend clinic so they can have regular clinic visit and checkup. Reinforcement on regular drug intake and clinic visit, good nutrition and reduced salt intake and modifying lifestyles of patient with hypertension is important.
ARTICLE | doi:10.20944/preprints202304.0930.v3
Subject: Medicine And Pharmacology, Endocrinology And Metabolism Keywords: Multidisciplinary pain clinic; Diabetic foot; Amputation; Foot ulcer; Diabetes Mellitus; Economic evaluation; Cost Benefit Analysis
Online: 27 September 2023 (08:18:15 CEST)
Aims: Multidisciplinary diabetic foot clinics have been shown to be an effective therapeutic model for reducing major amputations and mortality rates. The aim of this article is to assess the economic impact of the implementation of a multidisciplinary diabetic foot clinic in a hospital in Barcelona, Spain. Methods: Observational cost-benefit study of all subjects with diabetes admitted with the diagnosis of a major amputation due to diabetic foot from 2010 to 2020. Direct and indirect costs were compared before and after the introduction of the multidisciplinary diabetic foot clinic. Results: The individual cost per patient with diabetic foot was €14,768 before the implementation of the unit. After the implementation of the clinic, the expected cost was reduced to €5,985 due to a 40% reduction in the probability of hospitalization. Overall, the implementation of the clinic resulted in cost savings per patient valued at €8,783, of which, €7,165 are related to hospital benefits. Conclusion: The results of this analysis contributes to the evidence suggesting that multidisciplinary diabetic foot clinics are cost-effective, by demonstrating that they have a positive impact on patient health while also reducing the utilization of healthcare resources.
ARTICLE | doi:10.20944/preprints202112.0306.v2
Subject: Medicine And Pharmacology, Oncology And Oncogenics Keywords: learning health system; ambulatory clinic; block schedule; disease site teams; interdisciplinary care; cancer operations; oncology value stream
Online: 26 April 2022 (04:37:15 CEST)
Abstract: Ambulatory cancer centers face fluctuating patient demand and deploy specialized personnel who have variable availability. This undermines operational stability through misa-lignment of resources to patient needs, resulting in overscheduled clinics, budget deficits, and wait times exceeding provincial targets. We describe deployment of a Learning Health System framework for operational improvements within the entire ambulatory center. Known methods of value stream mapping, operations research and statistical process control were applied to achieve organizational high performance that is data-informed, agile and adaptive. We transitioned from a fixed template model by individual physician to a caseload management by disease site model that is realigned quarterly. We adapted a block schedule model for the ambulatory oncology clinic to align the regional demand for specialized services with optimized human and physical resources. We demonstrated improved utilization of clinical space, increased weekly consistency and im-proved distribution of activity across the workweek. Increased value, represented as the ratio of monthly encounters per nursing worked hours, and increased percentage of services delivered by full-time nurses were benefits realized in our cancer system. The creation of a data-informed demand capacity model enables application of predictive analytics and business intelligence tools that will further enhance clinical responsiveness..
ARTICLE | doi:10.20944/preprints202010.0392.v1
Subject: Medicine And Pharmacology, Immunology And Allergy Keywords: antimicrobial stewardship; detection of bacteria in chronic wounds, chronic wounds, clinical decision support; diagnostic pathway; joint commission; fluorescence imaging; wound clinic
Online: 19 October 2020 (15:35:25 CEST)
Background: In 2014 the World Health Organization (WHO) warned of an emerging world-wide crisis of antibiotic resistant microorganisms. In response, government and professional organizations recommended that health care systems adopt antimicrobial stewardship programs (ASPs). In the United States, the Centers for Medicare Services (CMS) mandated antimicrobial stewardship in the hospital inpatient setting. Effective January 1, 2020, the Joint Commission required ambulatory centers that prescribe antibiotics, such as wound centers, to institute an ASP. Chronic wounds often remain open for months, during which time patients may receive multiple courses of antibiotics and numerous antimicrobial topical treatments. The wound clinician plays an integral role in reducing antimicrobial resistance in the outpatient setting: antibiotics prescribed for skin and soft tissue infections are among the most common in an outpatient setting. One of the most challenging aspects of antimicrobial stewardship in treating chronic wounds is the inaccuracy of bacterial and infection diagnosis. Methods: Joint Commission lists five elements of performance (EP): (1) Identifying an antimicrobial stewardship leader, (2) establishing an annual antimicrobial stewardship goal, (3) implementing evidence-based practice guidelines related to the antimicrobial stewardship goal, (4) providing clinical staff with educational resources related to the antimicrobial stewardship goal, and (5) collecting, analyzing, and reporting data related to the antimicrobial stewardship goal. This article focuses on choosing and implementing an evidence-based ASP goal for 2020. Discussion: Clinical trials have demonstrated the ability of fluorescence imaging (MLiX) to detect clinically significant levels of bacteria in chronic wounds. Combined with clinical examination of signs and symptoms of infection, the MLiX procedure improves the clinician’s ability to diagnose infection and can guide antimicrobial use. In order to satisfy the elements of performance, the MLiX procedure was incorporated into the annual ASP goal for several wound care centers. Clinicians were educated on the fluorescence imaging device and guidelines were instituted. Collection of antimicrobial utilization data is underway.
REVIEW | doi:10.20944/preprints201810.0324.v1
Subject: Medicine And Pharmacology, Gastroenterology And Hepatology Keywords: celiac disease; gluten-free diet; effectiveness; adherence; nutritionists; clinic; serology; duodenal biopsies; structured questionnaires; peptides derived from gluten in feces and urine.
Online: 15 October 2018 (16:27:32 CEST)
Celiac disease (CD) is a genetically conditioned autoimmune process that appears in susceptible people. It can affect people of any age, and slightly predominates in females. It has a fairly homogenous global distribution, with an average prevalence of 1-2%, the frequency having increased in recent decades. The only effective treatment is a strict and permanent gluten-free diet (GFD), although the level of compliance with it is poor, at about 50% of cases. To monitor the effectiveness of the GFD, several procedures involving various approaches are employed: a) periodic interviews by nutritionists; b) clinical follow-up; c) serological controls of specific antibodies; d) endoscopies with collection of duodenal biopsies; e) structured questionnaires; f) determination of gluten peptides derived from gluten in feces and/or urine. All of these procedures are useful when applied, alone or in combination, depending on the cases. Some patients will only need to consult to their doctors, while others will require a multidisciplinary approach to assess their compliance with the GFD. In children, normalization of duodenal mucosa was achieved in 95% of cases within 2 years, while it is more delayed in adults, whose mucosa take longer to heal completely.