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Forensic Science International. Synergy 2022This article discusses the gap between the Inquest Legislation of Tanzania and the medical practitioner's teaching curriculum which also covers the medico-legal field....
This article discusses the gap between the Inquest Legislation of Tanzania and the medical practitioner's teaching curriculum which also covers the medico-legal field. The Tanzanian law clearly states that 'any Government medical practitioner' may be given the responsibility of exhumation, provision of post mortem order and then examination of the corpse where there are ample circumstances requiring an inquest to assist police investigation and the Judiciary in determining whether the cause of death was natural. However, the medical training curriculum in Tanzania for many years did not offer any courses of forensic exhumation and identification of human skeletal remains. Therefore, there has been a gap between the legal entities and the curriculum organization of medical practitioner: a condition that leads to medical practitioners failing to fully support the criminal investigation departments and the judicial system. The article highlights the existing gap and its challenges, shortage of experts in the field of forensic science services and provides some suggestions on how to address these challenges where the proposed methods can be applied to both short- and long-term plans.
PubMed: 35958940
DOI: 10.1016/j.fsisyn.2022.100276 -
Quintessence International (Berlin,... Jul 2021Few studies have examined pain levels for the injection of local anesthesia in children, though it is a routine technique in pediatric dentistry. The objective of the...
OBJECTIVE
Few studies have examined pain levels for the injection of local anesthesia in children, though it is a routine technique in pediatric dentistry. The objective of the study was to evaluate the difference in the assessment of procedural pain by the child, parent, dental practitioner, and independent observers during injection of local anesthesia for dental treatment in pediatric dentistry.
METHOD AND MATERIALS
In total, 27 male and 22 female children (5 to 17 years of age, mean ± SD 9.8 ± 4.0 years) received local anesthesia (LA) via infiltration or mandibular alveolar blocks according to a standard protocol. After the dental treatment, the children assessed the pain levels for the procedures on a visual analog scale (VAS), while their parents and the dental practitioner used a numeric rating scale (0 to 10). Independent observers also assessed pain via video tape for an evaluation after blinding. The heart rate was monitored continuously during the procedure. The Bland-Altman method was used to quantify the comparison between pain ratings.
RESULTS
The assessed level of pain by dental practitioner, parent, and child during injection of LA differed clearly (child: 3.94 ± 2.71; parent: 3.31 ± 2.60; dental practitioner: 3.02 ± 1.98; video observer 1: 1.76 ± 2.56; video observer 2: 1.89 ± 2.55). In 42.9% of cases the dental practitioner's rating and the self--reported pain by the child during injection of LA differed by ≥ 2 on the numeric rating scale, which is clinically a highly different and relevant assessment.
CONCLUSION
As pain perception in children during the injection of local anesthetic and its assessment varies considerably depending on the assessing person and the treated child, dental practitioners and researchers should be cautious in interpreting the patient's pain perception.
Topics: Anesthesia, Dental; Anesthesia, Local; Anesthetics, Local; Child; Dentists; Female; Humans; Male; Pain Perception; Pediatric Dentistry; Professional Role
PubMed: 34076376
DOI: 10.3290/j.qi.b1492035 -
Bulletin Du Cancer 2019An effective health system is based on effective primary care, at the center of which is family medicine. Cancer prevention and screening are integral aspects of general... (Review)
Review
An effective health system is based on effective primary care, at the center of which is family medicine. Cancer prevention and screening are integral aspects of general practitioners skills. Prevention is linked with the notion of risk. The relationship between the general practitioner and his or her patient reinforces the prevention of the development of preventable risk factors. It also strengthens information on intrinsic risk factors for patients. The protective factors highlighted by the general practitioner can thus reduce the risk a little more. Screening strategies differs across cancers and countries. In France, general practitioner's involvement is important for colorectal cancer screening. The active participation of their general practitioner, strengths patient's adherence and participation. Their role is to inform and collect data for breast cancer screening. Recently organized cervical cancer screening requires greater involvement of general practitioners who can act as both actors and informants. Family medicine is at the heart of cancer prevention and screening. It is a central hub for improving the health of patients in our healthcare system. The general practitioner knows the patient, which gives him an important advantage to accompany him in the prevention and screening of his risk factors.
Topics: Adult; Aged; Early Detection of Cancer; Female; France; Harm Reduction; Humans; Male; Middle Aged; Neoplasms; Patient Participation; Physician's Role; Physician-Patient Relations; Physicians, Primary Care; Primary Health Care; Risk Factors; Smoking Prevention
PubMed: 30661748
DOI: 10.1016/j.bulcan.2018.11.015 -
Praxis Nov 2017
PubMed: 29137536
DOI: 10.1024/1661-8157/a002821 -
Journal of the Advanced Practitioner in... Apr 2023The advent of precision medicine targeting oncogenic mutations and other alterations has led to a paradigm shift in the treatment of many solid tumors and hematologic... (Review)
Review
The advent of precision medicine targeting oncogenic mutations and other alterations has led to a paradigm shift in the treatment of many solid tumors and hematologic malignancies. For many of these agents, predictive biomarker testing is necessary to determine the presence of such alterations in order to select patients who are most likely to respond, and to avoid the use of ineffective and potentially harmful alternative therapy. Recent technological advances such as next-generation sequencing have facilitated the identification of targetable biomarkers in patients with cancer and thus help inform treatment decisions. Moreover, new molecular-guided therapies and associated predictive biomarkers continue to be discovered. For some cancer therapeutics, regulatory approval requires the use of a companion diagnostic to ensure proper patient selection. Advanced practitioners therefore need to be aware of current biomarker testing guidelines regarding who should be tested, how and when to test, and how these results can guide treatment decisions using molecular-based therapies. They should also recognize and address potential barriers and disparities in biomarker testing to ensure equitable care for all patients, and assist in educating patients and colleagues alike on the importance of testing and integration into clinical practice to enhance outcomes.
PubMed: 37206903
DOI: 10.6004/jadpro.2023.14.3.18 -
International Journal of Nursing... Apr 2018The role of nurse practitioners in primary healthcare has been validated over the years and is now being considered as a key solution in various primary healthcare... (Review)
Review
The role of nurse practitioners in primary healthcare has been validated over the years and is now being considered as a key solution in various primary healthcare settings to the provision of comprehensive care. The context in which the role has been established positions nurse practitioners' practice within medical and nursing paradigms. As the healthcare system evolves, nurse practitioners must define their identity to advocate for roles that reflect their professional values. A historical overview highlighting the context in which the NP role expanded will guide a philosophical discussion regarding role identity. After exposing tensions between the nursing and medicine disciplines, Abbots' theory of profession will be utilized to understand the foundations leading to initial research on nurse practitioner integration within the healthcare system. Feminist philosopher bell hooks' discourse on marginality will serve as a platform to reflect on the nurse practitioner identity within the current social context. Foucault's notions of governmentality, parrhesia and care of the self will then guide reflections regarding ways for nurse practitioners to locate themselves as a profession.
PubMed: 31406811
DOI: 10.1016/j.ijnss.2018.03.001 -
Annals of Medicine Dec 2023Widespread cannabis consumption and recreational cannabis legalization is thought to have led to an increase in motor vehicle accidents, although there currently lacks... (Review)
Review
Widespread cannabis consumption and recreational cannabis legalization is thought to have led to an increase in motor vehicle accidents, although there currently lacks ethical guidance for primary care practitioners on cannabis-impaired driving. The aim was to develop an ethical framework for primary care providers on cannabis-impaired driving. An ethical analysis in the form of a critical interpretive review was undertaken, using a systematic approach to determine the appropriate action to a given situation with evidence to substantiate its claims. The search strategy was designed to answer the research question: What are some ethical concerns for primary care providers to consider when cannabis-impaired driving is suspected? Four databases were searched in December 2021 using keywords related to cannabis, impaired driving, ethics, and primary care. The resulting evidence was synthesized as recommendations for primary care practice. The ethical approach for primary care practitioners in addressing cannabis-impaired driving can be summarized as the duty to always inform, provide care through prevention and harm reduction strategies, and report when necessary. The prevention of cannabis-impaired driving should not fall on the sole responsibility of primary care practitioners. As this review offers a high-level discussion of the ethical considerations in cannabis-impaired driving, specific recommendations will depend upon the legal and policy designations of individual jurisdictions. Ultimately, the practitioner should manage cannabis-impaired driving in a way that fosters the therapeutic relationship in patient-centered care, through motivational discussions, collaboration with specialists, skills for self-management, patient empowerment, and support. KEY MESSAGES • For patients who report driving frequently and using cannabis, the frequency of use, dosage, form of cannabis, tolerance levels, and withdrawal symptoms should be discussed, while informing the patient of the risks, harms, and legal consequences associated with cannabis-impaired driving. • The practitioner's primary responsibility in the cannabis-impaired driving context is to provide care to patients who drive and consume cannabis, which may include referring patients to mental health care to manage addictive or problematic behaviors associated with cannabis use. • Practitioners may have a duty to report cannabis-impaired driving to legal authorities (such as law enforcement) when the user engages in harmful behavior to themselves or others.
Topics: Humans; Cannabis; Databases, Factual; Mental Health; Primary Health Care
PubMed: 36444881
DOI: 10.1080/07853890.2022.2151716 -
Sociology of Health & Illness Jun 2023Research on why people use complementary and alternative medicine (CAM) shows clients value the CAM consultation, where they feel listened to and empowered to control...
Research on why people use complementary and alternative medicine (CAM) shows clients value the CAM consultation, where they feel listened to and empowered to control their own health. Such 'empowerment' through CAM use is often theorised as reflecting wider neoliberal imperatives of self-responsibility. CAM users' perspectives are well studied, but there has been little sociological analysis of interactions within the CAM consultation. Specifically, it is unclear how user empowerment/self-knowledge relates to the CAM practitioner's power and expert knowledge. We address this using audio-recorded consultations and interviews with CAM practitioners to explore knowledge use in client-practitioner interactions and its meaning for practitioners. Based on our analysis and drawing on Foucault (1973), The Birth of the Clinic: an archaeology of medical perception and Antonovsky (1979), Health, Stress and Coping, we theorise the operation of power/knowledge in the CAM practitioner-client dyad by introducing the concept of the 'salutogenic gaze'. This gaze operates in the CAM consultation with disciplining and productive effects that are oriented towards health promotion. Practitioners listen to and value clients' stories, but their gaze also incorporates surveillance and normalisation, aided by technologies that may or may not be shared with clients. Because the salutogenic gaze is ultimately transferred from practitioner to client, it empowers CAM users while simultaneously reinforcing the practitioner's power as a health expert.
Topics: Humans; Complementary Therapies; Self Concept; Referral and Consultation
PubMed: 36915224
DOI: 10.1111/1467-9566.13629 -
Applied Neuropsychology. Child 2016This article provides a review of working memory and its application to educational settings. A discussion of the varying definitions of working memory is presented.... (Review)
Review
This article provides a review of working memory and its application to educational settings. A discussion of the varying definitions of working memory is presented. Special attention is given to the various multidisciplinary professionals who work with students with working memory deficits, and their unique understanding of the construct. Definitions and theories of working memory are briefly summarized and provide the foundation for understanding practical applications of working memory to assessment and intervention. Although definitions and models of working memory abound, there is limited consensus regarding universally accepted definitions and models. Current research indicates that developing new models of working memory may be an appropriate paradigm shift at this time. The integration of individual practitioner's knowledge regarding academic achievement, working memory and processing speed could provide a foundation for the future development of new working memory models. Future directions for research should aim to explain how tasks and behaviors are supported by the substrates of the cortico-striatal and the cerebro-cerebellar systems. Translation of neurobiological information into educational contexts will be helpful to inform all practitioners' knowledge of working memory constructs. It will also allow for universally accepted definitions and models of working memory to arise and facilitate more effective collaboration between disciplines working in educational setting.
Topics: Attention; Executive Function; Humans; Memory Disorders; Memory, Short-Term; Schools; Students
PubMed: 27191215
DOI: 10.1080/21622965.2016.1167493 -
BMJ Open Mar 2022To examine the use and out-of-pocket expenses resulting from consultations, products and practices across conventional, self-care, and complementary medicine (CM)...
OBJECTIVE
To examine the use and out-of-pocket expenses resulting from consultations, products and practices across conventional, self-care, and complementary medicine (CM) treatments for osteoarthritis (OA) among Australian women.
DESIGN, SETTING AND PARTICIPANTS
A cross-sectional survey of 800 women from the 45 and Up Study who had reported a clinical diagnosis of OA.
OUTCOME MEASURES
Women's use of conventional, CM and self-prescribed treatments for OA and the associated out-of-pocket cost.
RESULTS
Completed questionnaires were returned by 403 women (50.4%). Their average time since the first diagnosis of OA was 15.4 years, and self-rated severity of OA was 5.1 (out of 10) over the past 12 months. During the previous year, 67.0% of the women consulted a doctor, 39.2% consulted an allied health practitioner and 34.7% consulted a CM practitioner for their OA. Some women (19%) consulted with practitioner(s) from all three practitioner groups, 27% consulted with practitioner(s) from two of the three practitioner groups, while 6% consulted with a CM practitioner only. Women with a greater time since diagnosis had more consultations, as did women who rated their OA as more severe. Women's average combined out-of-pocket expenditure for OA-related healthcare consultations, prescription medications, products, and practices was $673 per annum. Extrapolated to all Australian women with OA, aged 50 years and over, the total out-of-pocket expenditure for this condition is estimated to be $873 million per annum.
CONCLUSIONS
Australian women with OA use a range of conventional and CM consultations, self-care, products and practices to manage their condition, incurring significant out-of-pocket expenses. Given the high individual and societal burden of OA, there is a need for further research into the concurrent use of different healthcare resources with a view to providing safe, cost-effective management of OA across the healthcare system and the wider community.
Topics: Aged; Australia; Cross-Sectional Studies; Delivery of Health Care; Female; Health Expenditures; Humans; Male; Middle Aged; Osteoarthritis; Patient Acceptance of Health Care
PubMed: 35264358
DOI: 10.1136/bmjopen-2021-055468