Готові списки джерел за темами / Rural medicine

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Добірка наукової літератури з теми "Rural medicine"

Автор: Grafiati

Опубліковано: 4 червня 2021

Оновлено: 9 червня 2025

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Статті в журналах з теми "Rural medicine"

Norris, Merideth. "Rural medicine." Osteopathic Family Physician 3, no. 4 (July 2011): 133. http://dx.doi.org/10.1016/j.osfp.2011.05.003.

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Cao, Sissi, and Han Yan. "Championing rural medicine." University of Western Ontario Medical Journal 83, no. 1 (December 23, 2014): 51–52. http://dx.doi.org/10.5206/uwomj.v83i1.4515.

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Dr Ken Milne is an emergency department physician, Chief of Emergency and Chief of Staff at South Huron Hospital Association in Exeter, Ontario. He has been an advocate for advancing the practice of rural medicine throughout his career. Originally from a farm just outside of London, Dr Milne completed both his undergraduate and graduate degrees at Western University before attending medical school in Calgary. He returned to Western in 1997 for family medicine training and began his medical career in Goderich, where he currently resides with his wife and 3 children. In addition to being a clinician, Dr Milne has been conducting research on rural medicine for the last 17 years and helped establish what is now Discovery Week, an integral part of the Schulich School of Medicine’s first-year curriculum. He is also the creator of the knowledge translation project “The Skeptic’s Guide to Emergency Medicine” (SGEM), which disseminates evidence-based information online so patients can receive the best care. We met with Dr Milne over Google Hangouts to talk about his colourful career, the unique aspects of rural medicine and the challenges he faces working in a remote location.

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Curran, Shane. "Rural emergency medicine." Emergency Medicine 13, no. 3 (September 2001): 390. http://dx.doi.org/10.1046/j.1035-6851.2001.00248.x-i2.

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MacPherson, Melissa J. "Rural and remote medicine." University of Western Ontario Medical Journal 83, no. 1 (December 23, 2014): 4. http://dx.doi.org/10.5206/uwomj.v83i1.4467.

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WAKATSUKI, Toshikazu. "Future of Rural Medicine." JOURNAL OF THE JAPANESE ASSOCIATION OF RURAL MEDICINE 40, no. 6 (1992): 1106–12. http://dx.doi.org/10.2185/jjrm.40.1106.

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Kramlinger, Anne Marie. "Textbook of Rural Medicine." Mayo Clinic Proceedings 77, no. 3 (March 2002): 300. http://dx.doi.org/10.4065/77.3.300.

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Evans, Kayte. "Textbook of Rural Medicine." Australian Journal of Rural Health 10, no. 1 (February 2002): 75–76. http://dx.doi.org/10.1046/j.1440-1584.2002.t01-2-00431.x.

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Pfaff, Colin. "Rural medicine in Nepal." South African Family Practice 46, no. 3 (April 2004): 33–34. http://dx.doi.org/10.1080/20786204.2004.10873058.

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Lanphear, J. H. "Rural medicine/urban responsibilities." JAMA: The Journal of the American Medical Association 256, no. 18 (November 14, 1986): 2567–68. http://dx.doi.org/10.1001/jama.256.18.2567.

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Lanphear, Joel H. "Rural Medicine/Urban Responsibilities." JAMA: The Journal of the American Medical Association 256, no. 18 (November 14, 1986): 2567. http://dx.doi.org/10.1001/jama.1986.03380180129037.

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Дисертації з теми "Rural medicine"

Jensen, Samantha, and Amanda Stoltz. "Assessing Resident Physician Knowledge about Breastfeeding Medicine in a Rural Family Medicine Clinic." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/asrf/2021/presentations/51.

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Title: Assessing Resident Physician Knowledge about Breastfeeding Medicine in a Rural Family Medicine Clinic Authors: Samantha Jensen, MD and Amanda Stoltz, MD, Bristol Family Medicine Residency Program, Department of Family Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN Introduction: Many residents and faculty encourage the long-term goal of breastfeeding, and our residency program provides extensive training in obstetrics and newborn nursery. However, there is little structure and direct guidance for breastfeeding medicine already built in to the family medicine residency training. We aimed to develop a dedicated breastfeeding medicine longitudinal curriculum to improve the effectiveness of family medicine physician residents as teachers and advocates by improving residents’ fund of knowledge, provide structure for encouraging breastfeeding at prenatal visits, and incorporate breastfeeding into our family medicine practice by improving the on-site locations for breastfeeding and pumping. Method: The method of research was pre-lecture and post-lecture surveys comprised of 15 questions, including knowledge-based questions, assessment of confidence level, and a question on perceived barriers to breastfeeding. Participants attending two educational sessions during the study, and additional educational sessions have continued after study conclusion. The post-lecture survey was completed 12 weeks after first lecture. Lecture topics included an overview of breastfeeding medicine, how to encourage breastfeeding at prenatal appointments, contraindications, maternal nutritional supplements, formula supplementation, galatogogues, and the storage of breastmilk. Results: Results were compiled from the responses of 20 pretests and 9 posttest surveys. Results showed an increase in correct responses to the knowledge portion 61.15% pretest versus 77.69% posttest (t(28) 3.41, p<0.01). Resident physician confidence also increased by the conclusion of the study (t=28, p<.01). Conclusions: It can be concluded that educational lectures increase knowledge and confidence in resident physicians with regards to breastfeeding medicine. Areas for future study include specific research focusing on methods to increase access to resources for breastfeeding mothers.

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Beebe, Michele Morgen. "Use of complementary and alternative medicine among rural Montanans." Thesis, Montana State University, 2004. http://etd.lib.montana.edu/etd/2004/beebe/BeebeM0805.pdf.

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Pal, Deb Kumar. "Control of childhood epilepsy in rural India." Thesis, University College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.298246.

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Meyers, Emily Breanne. "Rural Health and Radiology: Health and Ethical Implications for Rural Citizens." NEOMED College of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ne2gs1619525106309102.

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Hagemeier, Nicholas E., Sarah Blevins, Kyle Hagen, Emily Sorah, Richa Shah, and Kelly Ferris. "Integration of Rural Community Pharmacies into a Rural Family Medicine Practice-Based Research Network: A Descriptive Analysis." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/1476.

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Purpose: Practice-based research networks (PBRN) seek to shorten the gap between research and application in primary patient care settings. Inclusion of community pharmacies in primary care PBRNs is relatively unexplored. Such a PBRN model could improve care coordination and community-based research, especially in rural and underserved areas. The objectives of this study were to: 1) evaluate rural Appalachian community pharmacy key informants’ perceptions of PBRNs and practice-based research; 2) explore key informants’ perceptions of perceived applicability of practice-based research domains; and 3) explore pharmacy key informant interest in PBRN participation. Methods: The sample consisted of community pharmacies within city limits of all Appalachian Research Network (AppNET) PBRN communities in South Central Appalachia. A descriptive, cross-sectional, questionnaire-based study was conducted from November 2013 to February 2014. Bivariate and multivariate analyses were conducted to examine associations between key informant and practice characteristics, and PBRN interest and perceptions. Findings: A 47.8% response rate was obtained. Most key informants (88%) were very or somewhat interested in participating in AppNET. Enrichment of patient care (82.8%), improved relationships with providers in the community (75.9%), and professional development opportunities (69.0%) were perceived by more than two-thirds of respondents to be very beneficial outcomes of PBRN participation. Respondents ranked time constraints (63%) and workflow disruptions (20%) as the biggest barriers to PBRN participation. Conclusion: Key informants in rural Appalachian community pharmacies indicated interest in PBRN participation. Integration of community pharmacies into existing rural PBRNs could advance community level care coordination and promote improved health outcomes in rural and underserved areas. Type: Original Research

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Shirely, Kaitlyn, Margaret Smith, Kacie Denton, Blair Brandt, Ivy A. Click, and Joseph Gravel. "Social Determinants of Health in Rural Tennessee Clinics." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6383.

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Click, Ivy A., Jeri Ann Basden, Joy L. Bohannon, Heather Anderson, and Fred Tudiver. "Opioid Prescribing in Rural Family Practices: A Qualitative Study." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6366.

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Background: Rural Tennessee, especially rural East Tennessee has seen a dramatic increase in rates of controlled drug prescriptions and controlled drug overdose deaths in recent years. However, little is known about the individual decisions to prescribe or continue prescriptions with relation to addiction concerns. Objectives: The purpose of this study was to learn more about what factors lead to physicians’ prescribing control drugs for non-cancer pain through the use of focus groups. Methods: A qualitative study, using focus groups, in five family medicine clinics in East Tennessee and Southwest Virginia. The investigators used a semi-structured interview guide designed to facilitate group discussions about prescription drug abuse and misuse. Results: There were four main themes identified by the focus groups: (1) prescribers’ changing prescribing patterns over time; (2) factors that influence controlled drug prescribing; (3) use and barriers to using state prescription drug monitoring programs (PDMPs); (4) prescribing controlled drugs to women of childbearing age. Each theme had several subthemes. Conclusions: The balance between treating the patient's symptoms and causing potential harm is a challenge. The patient's pain cannot be ignored, but the potential harm of opioid therapy is not taken lightly. As the public health concern of prescription drug abuse in rural Appalachia continues to spread, prescribers are aware of their connection to the problem, and ultimately the solution.

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Lawrenson, Ross Alexander. "Screening for undiagnosed diabetes in rural New Zealand." Thesis, Imperial College London, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263224.

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Kennedy, Craig. "Impact of telemedicine in a rural community /." St. Lucia, Qld, 2001. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16114.pdf.

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Harris, Kimberly D. "Acceptance of computer-based telemedicine in three rural Missouri counties /." free to MU campus, to others for purchase, 1999. http://wwwlib.umi.com/cr/mo/fullcit?p9945181.

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Книги з теми "Rural medicine"

Paco and Julián, eds. Un médico rural. Logroño (La Rioja, Spain): Pepitas de Calabaza, 2021.

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Georgina, Velázquez Díaz, Flores Alvarado Angel, and Programa IMSS-COPLAMAR, eds. La medicina tradicional en México: Experiencia del Programa IMSS-COPLAMAR. México, D.F: Instituto Mexicano del Seguro Social, 1988.

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Rohde, Jon E. The rural private practitioner. Delhi: Oxford University Press, 1995.

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Aguilar, Salvador. Veinte años de medicina rural. [Oaxaca, México]: Instituto Oaxaqueño de las Culturas, 1994.

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Wichmann, Matthias. Rural Surgery: Challenges and Solutions for the Rural Surgeon. Berlin, Heidelberg: Springer-Verlag Berlin Heidelberg, 2011.

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Barbara, Yawn, Bushy Angeline, and Yawn Roy A, eds. Exploring rural medicine: Current issues and concepts. Thousand Oaks, Calif: Sage Publications, 1994.

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1962-, Wilkinson David, ed. The handbook of rural medicine in Australia. South Melbourne, Vic., Australia: Oxford University Press, 2004.

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Clifford, Robert. An arrow full of quivers: A collection of short stories, anecdotes, deep thoughts, fables and bits of fun. London: Warner Books, 1996.

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Hutten-Czapski, P. Manual of rural practice. Shawville, Québec: Society of Rural Physicians of Canada, 2006.

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Arnedo, Cruz Felipe. Anecdotario de un médico rural. [Buenos Aires]: C.F. Arnedo, 1991.

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Частини книг з теми "Rural medicine"

Hu, Yi. "Abolishment of Traditional Chinese Medicine." In Rural Health Care Delivery, 51–62. Berlin, Heidelberg: Springer Berlin Heidelberg, 2013. http://dx.doi.org/10.1007/978-3-642-39982-4_6.

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Sankaran, Sujatha. "The Rural-Urban Divide." In Health Equity in Hospital Medicine, 79–81. Cham: Springer International Publishing, 2023. http://dx.doi.org/10.1007/978-3-031-44999-4_14.

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Smith, Bev. "AIDS: Religion and Medicine in Rural Kenya." In AIDS Education, 239–49. Boston, MA: Springer US, 1996. http://dx.doi.org/10.1007/978-1-4757-9122-8_34.

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Teoh, Eng Soon. "Medicinal Orchid Usage in Rural Africa." In Orchids as Aphrodisiac, Medicine or Food, 305–62. Cham: Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-18255-7_17.

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Benefice, E. "Growth and Motor Performances of Rural Senegalese Children." In Medicine and Sport Science, 117–31. Basel: KARGER, 1998. http://dx.doi.org/10.1159/000061750.

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Boeras, Debrah I., Blanche C. Collins, and Rosanna W. Peeling. "The Use of Drones in the Delivery of Rural Healthcare." In Revolutionizing Tropical Medicine, 615–32. Hoboken, NJ, USA: John Wiley & Sons, Inc., 2019. http://dx.doi.org/10.1002/9781119282686.ch35.

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Hill, Carole E. "Popular Medicine, Health Beliefs, and Cultural Models." In Community Health Systems in the Rural American South, 112–42. New York: Routledge, 2021. http://dx.doi.org/10.4324/9780429044250-5.

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Fatehi, Farhad, Monica Taylor, Liam J. Caffery, and Anthony C. Smith. "Telemedicine for Clinical Management of Adults in Remote and Rural Areas." In Revolutionizing Tropical Medicine, 439–61. Hoboken, NJ, USA: John Wiley & Sons, Inc., 2019. http://dx.doi.org/10.1002/9781119282686.ch26.

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Cohen, Steven A., Mary L. Greaney, Elizabeth Erdman, and Elena N. Naumova. "Geospatial Tools for Social Medicine: Understanding Rural-Urban Divide." In Geospatial Technology for Human Well-Being and Health, 185–201. Cham: Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-030-71377-5_10.

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Matthew, John, William Fink, and Lauri Snetsinger. "Seven Years in a Young Man’s Life: Collaborative Care in Rural Vermont." In Collaborative Medicine Case Studies, 341–50. New York, NY: Springer New York, 2008. http://dx.doi.org/10.1007/978-0-387-76894-6_28.

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Тези доповідей конференцій з теми "Rural medicine"

Medida, Jayapal, Naresh Tangudu, B. Pruthviraj Goud, Ramarao Tandu, Kalangi Praveen Kumar, and Tns Padma. "AI Assisted Tele-Medicine Kisok for Rural India." In 2024 International Conference on Computational Intelligence for Green and Sustainable Technologies (ICCIGST), 1–5. IEEE, 2024. http://dx.doi.org/10.1109/iccigst60741.2024.10717519.

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Fredrickson, Erin. "Delivering Rural Obstetric Training for Family Medicine Residents." In NAPCRG 50th Annual Meeting — Abstracts of Completed Research 2022. American Academy of Family Physicians, 2023. http://dx.doi.org/10.1370/afm.21.s1.4136.

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PÕDER, Anne. "ENTREPRENEURSHIP ACTIVITIES AND ENTREPRENEURSHIP COMPETENCIES OF ESTONIAN UNIVERSITY GRADUATES FROM BIO-ECONOMY FIELDS." In RURAL DEVELOPMENT. Aleksandras Stulginskis University, 2018. http://dx.doi.org/10.15544/rd.2017.219.

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Constant and rapid global economic and social developments and environmental processes create considerable new challenges, but also new opportunities for bio-economy. Entrepreneurs have a crucial role harnessing the new opportunities and addressing the challenges through innovation. The aim of the present paper is to study the entrepreneurship activities and entrepreneurial competencies of Estonian university graduates in the fields connected with bio-economy. The paper studies the data from a survey of three Estonian universities carried out in 2016 in the program “Systemic Development of Entrepreneurship education throughout all educational levels”. The analysis focuses on the share of entrepreneurs, assessments of the entrepreneurship competencies among the alumni, who graduated university in the fields of agriculture, forestry, fisheries; life-sciences, and veterinary medicine, and on their comparison with alumni of the other curricula. Chi-square test, ANOVA are used the compare the entrepreneurship activities, competencies of alumni of different curricula. The results show that the graduates’ field of study had significant impact on their entrepreneurship activities after the graduation, and on the attainment of entrepreneurship competencies. A quarter of the agriculture, forestry and fisheries, and a fifth of veterinary alumni were entrepreneurs, although a significantly smaller share of them in comparison with graduates of other fields had received entrepreneurship education during their studies. The share of entrepreneurs was lowest among all the fields of study in case of life-sciences alumni. The study demonstrates the need to integrate entrepreneurship education into the agricultural and life-sciences education and to address the attainment of key competencies in university’s curricula.

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Edoh, Thierry. "Smart medicine transportation and medication monitoring system in EPharmacyNet." In 2017 International Rural and Elderly Health Informatics Conference (IREHI). IEEE, 2017. http://dx.doi.org/10.1109/ireehi.2017.8350381.

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Isechi, A., C. Oda, R. Shinkura, S. Akiba, H. Fujikawa, and K. Yamazaki. "Experiment of Internet-based tele-medicine in Amami rural islands." In 2004 International Symposium on Applications and the Internet Workshops. 2004 Workshops. IEEE, 2004. http://dx.doi.org/10.1109/saintw.2004.1268589.

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Singh, Aagya, Aditya Waingade, Sahil Vishwakarma, Devesh Zope, Vaibhav Yavalkar, and Apeksha Mohite. "Rural India healthcare revolution: Graminchain blockchain-based medicine supply chain." In 2ND INTERNATIONAL CONFERENCE ON TRENDS IN MATERIAL SCIENCE AND MANUFACTURING ENGINEERING (ICTMSME2024), 020036. AIP Publishing, 2024. http://dx.doi.org/10.1063/5.0239273.

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Husain, Fadly, and Baiq Farhatul Wahidah. "Identification of Medicinal Animals in Traditional Medicine in Rural Central Java (A Preliminary Result of Ethno-Zootherapeutical Study)." In Proceedings of the International Conference on Rural Studies in Asia (ICoRSIA 2018). Paris, France: Atlantis Press, 2019. http://dx.doi.org/10.2991/icorsia-18.2019.29.

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Mwang’onda, Arthur Nathaniel, Teleza Kanthonga, and Chiedza Hwata. "Enhancing Medicine Supply Chain Efficiency in Rural African Healthcare through IoT-Enabled Smart Mobile Medicine Storage." In 2023 First International Conference on the Advancements of Artificial Intelligence in African Context (AAIAC). IEEE, 2023. http://dx.doi.org/10.1109/aaiac60008.2023.10465549.

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Guha, Sujoy K. "Biomedical equipment systems for rural health care." In 1992 14th Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE, 1992. http://dx.doi.org/10.1109/iembs.1992.5761735.

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Zhao, Zhongwei. "The Study on Chinese Rural-urban Income Gap Forecast." In 2015 International Conference on Education, Management, Information and Medicine. Paris, France: Atlantis Press, 2015. http://dx.doi.org/10.2991/emim-15.2015.47.

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Звіти організацій з теми "Rural medicine"

Andreae, Lynn J., Susan J. Andreae, Andrea L. Cherrington, Joshua S. Richman, and Monika M. Safford. Testing a Coaching Program to Help Adults with Diabetes Living in Rural Alabama Take Their Medicine as Directed. Patient-Centered Outcomes Research Institute (PCORI), November 2020. http://dx.doi.org/10.25302/11.2020.ad.130603565ic.

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Carnahan, Ryan, Grant Brown, Marianne Smith, Elena Letuchy, Linda Rubenstein, Bryan Gryzlak, Susan Schultz, et al. Evaluating a Training Program for Rural Doctors and Nursing Home Staff on Safe Medicine Use for Patients with Dementia and Nursing Home Residents. Patient-Centered Outcomes Research Institute (PCORI), June 2020. http://dx.doi.org/10.25302/06.2020.cer.1131.

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Juarez, Jessica. Development of a curriculum for use with a bovine dystocia simulator to educate and engage learners about animal agriculture and rural veterinary medicine. Ames (Iowa): Iowa State University, January 2020. http://dx.doi.org/10.31274/cc-20240624-539.

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Basagoitia, Andrea. Do home- or community-based programmes for treating malaria improve health outcomes? SUPPORT, 2017. http://dx.doi.org/10.30846/170313.

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Prompt access to diagnosis and treatment with effective antimalarial drugs is a central component of malaria control. Home- or community-based programmes for managing malaria are one strategy that has been proposed to overcome the geographical barrier to malaria treatment. In these programmes people living in rural settings, such as mothers, volunteers, or community health workers, are trained to recognise fever and provide antimalarial medicines at a low cost or for free.

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Gowrisankaran, Gautam, Claudio Lucarelli, Philip Schmidt-Dengler, and Robert Town. Can Amputation Save the Hospital? The Impact of the Medicare Rural Flexibility Program on Demand and Welfare. Cambridge, MA: National Bureau of Economic Research, March 2013. http://dx.doi.org/10.3386/w18894.

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Puig Gabarró, Pau, Raúl Katz, Hernán Galperin, Fernando Callorda, Enrique Iglesias Rodriguez, Antonio García Zaballos, Marcos Robles, and Ramiro Valencia. Medición del impacto socioeconómico del desarrollo de infraestructura de última milla en América Latina y el Caribe. Banco Interamericano de Desarrollo, June 2022. http://dx.doi.org/10.18235/0004326.

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El objetivo del presente estudio es estimar el impacto socioeconómico del despliegue de infraestructura digital de última milla en América Latina y el Caribe. Para medir el impacto económico y social de este tipo de infraestructura, el análisis diferencia según el contexto geográfico (urbano y rural), el género y el nivel educativo, y detalla los efectos y los canales de transmisión que vinculan el despliegue de infraestructura de última milla con algunos beneficios socioeconómicos. En particular, los resultados de este estudio demuestran que la banda ancha mejora la creación de empleo, el pasaje a la formalidad y el nivel salarial para toda la población. En tanto, los hallazgos indican que la diferencia entre la población con mayor calificación y aquella con menos habilidades se plantea en términos del nivel de impacto. Los resultados también revelan que el despliegue de banda ancha puede generar un aumento de la desigualdad entre géneros, entre población urbana y población rural, y entre individuos con más años de educación formal e individuos con menos años de educación formal si no se encuentra acompañado de políticas públicas que permitan acceder a un aprovechamiento igualitario de dicha tecnología. Esta evidencia concuerda con la hallada en estudios precedentes que destacan la complementariedad entre banda ancha y nivel de calificación y habilidades en la estimación de beneficios. Por ello, la contribución de las políticas públicas debe ser considerada como un mecanismo compensatorio para contrarrestar los efectos no esperados. El conjunto de resultados constituye una rica base empírica que podría ayudar a los gobiernos de la región a tomar decisiones de políticas públicas teniendo en cuenta la importancia de extender el despliegue de última milla al contexto rural.

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Gillen, Emily, Nicole M. Coomer, Christopher Beadles, and Amy Mills. Constructing a Measure of Anesthesia Intensity Using Cross-Sectional Claims Data. RTI Press, October 2019. http://dx.doi.org/10.3768/rtipress.2019.mr.0040.1910.

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With intensifying emphasis on episodes of care and bundled payments for surgical admissions, anesthesia expenditures are increasingly important in assessing variation in expenditures for surgical episodes. When comparing anesthesia expenditures across surgical settings, adjustment for anesthesia case complexity and duration of anesthesia services, also known as anesthesia service intensity, is desirable. A single anesthesia intensity measure allows researchers to make more direct comparisons between anesthesia outcomes across settings and services. We describe a process for creating a claims-based anesthesia intensity measure using Medicare claims. We create the measure using two fields: base units associated with American Medical Association Current Procedural Terminology codes on the anesthesia claim and time units associated with the service. We rescaled the time component of the anesthesia intensity measure to equally represent base units and time units. For illustration, we applied the measure to Medicare anesthesia expenditures stratified by rural/urban location. We found that adjustments for intensity were greater in urban settings because the level of intensity is greater. Compared with rural settings, unadjusted expenditures in urban settings are roughly 26 percent higher, whereas adjusted expenditures in urban settings are only 20 percent higher. Even absent longitudinal data, researchers can adjust anesthesia outcomes for intensity using our cross-sectional claims-based intensity method.

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Gillen, Emily, Olivia Berzin, Adam Vincent, and Doug Johnston. Certified Electronic Health Record Technology Under the Quality Payment Program. RTI Press, January 2018. http://dx.doi.org/10.3768/rtipress.2018.pb.0014.1801.

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The 2016 Quality Payment Program (QPP) is a Medicare reimbursement reform designed to incentivize value-based care over volume-based care. A core tenet of the QPP is integrated utilization of certified electronic health record technology (CEHRT). Adopting and implementing CEHRT is a resource-intensive process, requiring both financial capital and human capital (in the form of knowledge and time). Adoption can be especially challenging for small or rural practices that may not have access to such capital. In this issue brief, we discuss the role of CEHRT in the QPP and offer policy recommendations to help small and rural practices improve their health information technology (IT) capabilities with regards to participation in value-based care. The QPP requires practices to have health IT capabilities, both as a requirement for a complete performance score and to facilitate reporting. Practices that are unable to implement CEHRT will have difficulty complying with the new reimbursement system, and will likely incur financial losses. We recommend monetary support and staff training to small and rural practices for the adoption of CEHRT, and we recommend assistance to help practices comply with the requirements of the QPP and coordinate with other small and rural practices for reporting purposes.

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Puig Gabarró, Pau, Raúl Katz, Hernán Galperin, Fernando Callorda, Enrique Iglesias Rodriguez, Antonio García Zaballos, Marcos Robles, and Ramiro Valencia. Medición del impacto socioeconómico del desarrollo de infraestructura de última milla en El Salvador. Inter-American Development Bank, April 2022. http://dx.doi.org/10.18235/0004197.

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Este documento busca adentrarse en la medición del impacto económico y social del desarrollo de infraestructura de última milla en El Salvador, diferenciando el análisis por contexto geográfico (urbano y rural), género y años de educación formal, detallando los efectos y los canales de transmisión que vinculan el despliegue de banda ancha con los beneficios socioeconómicos. Acceder a esta información puede ayudar al gobierno de El Salvador a tomar decisiones de políticas públicas sobre la conveniencia de extender el despliegue de última milla. Los resultados demuestran la importancia de acompañar el despliegue de banda ancha con políticas públicas que promuevan un beneficio equitativo de la tecnología. En primer lugar, se destaca la necesidad de realizar acciones de alfabetización digital en áreas rurales a fin de apoyar el aprovechamiento de la banda ancha en el tejido productivo. Del mismo modo, resalta la trascendencia de implementar iniciativas específicas para reducir la brecha por nivel educativo en el uso de Internet, en particular, mediante el impulso de la alfabetización digital en la población con menos años de escolarización formal.

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MacFarlane, Andrew. 2021 medical student essay prize winner - A case of grief. Society for Academic Primary Care, July 2021. http://dx.doi.org/10.37361/medstudessay.2021.1.1.

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As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.

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