Are They Thinking Differently? The Perceptions and Differences in Medical Disputes between Veterinarians and Clients.

Medical disputes in veterinary practices are widespread; yet, a limited amount of research has been conducted to investigate the factors contributing to medical disputes. This study examined veterinarians' and clients' perceptions regarding risk factors and possible solutions to medical disputes. A total of 245 respondents from Taiwan, including 125 veterinarians and 120 clients, completed an electronic self-administered, semi-structured questionnaire in 2022. The questionnaire covered six dimensions: medical skills, complaint management, the attitudes of stakeholders during interactions, medical expenses, clients' perspectives, and communication modes. The results highlighted significant differences in the perceptions of risk factors for inducing medical disputes and possible solutions between clients and veterinarians in veterinary practice. First, young veterinarians and clients perceived medical skills as the highest risk factor for inducing medical disputes, while experienced veterinarians disagreed (p < 0.001). In addition, veterinarians with medical dispute experience identified stakeholders' attitudes during interactions as the top contributing factor. Second, regarding possible solutions, all veterinarians preferred offering clients cost estimates and cultivating empathy and compassion towards them. On the other hand, clients underscored the importance of obtaining informed consent for treatments and expenses and suggested that veterinarians should supply comprehensive written information to facilitate this process. This study underlies the importance of understanding stakeholders' perceptions to mitigate medical disputes and advocates for improved communication education and training for young veterinarians. These findings provide valuable insights for veterinarians and clients, contributing to preventing and managing medical disputes in veterinary practices.

Perceptions of Veterinarians and Veterinary Students on What Risk Factors Constitute Medical Disputes and Comparisons between 2014 and 2022.

This study compared the risk perceptions of medical disputes among veterinarians and veterinary students in Taiwan between 2014 and 2022. Online validity-tested questionnaires were used to collect data, with 106 (73 veterinarians and 33 students) and 157 (126 veterinarians and 31 students) surveys collected in 2014 and 2022, respectively. Respondents would be asked to rate their perceptions on how likely each risk factor constitutes a medical dispute according to their past experiences on a five-point Likert scale from 1 to 5: "Very unlikely, unlikely, neutral, likely, very likely." The results showed that overall risk perceptions increased significantly in 2022 compared to 2014, with the top risk factors being attitudes during interactions and complaint management among experienced veterinarians. In contrast, students considered medical skills and clients' perspectives as the top two risk factors, with complaints management ranking as the least significant factor. The findings suggest that effective communication and complaint management are crucial in preventing medical disputes, highlighting the importance of developing these skills in young veterinarians and veterinary students to reduce medical disputes. The study also recommends increasing practical experiences of medical disputes and complaint management in veterinary education to bridge the gap between the perceptions of experienced veterinarians and students.

Insight into global research on health literacy and heart diseases: A bibliometric analysis.

Background: Health literacy (HL) has shown its important role on reducing the burden of heart diseases. However, no study has provided a comprehensive worldwide view of the data regarding HL and heart diseases. The study aimed to provide insight into: (1) the intellectual structure, (2) research trends, and (3) research gaps on HL and heart diseases; and (4) to explore HL scales commonly utilized in heart studies. Materials and methods: Studies related to HL and heart diseases were retrieved from Web of Science, Scopus, and PubMed. All publications published between 2000 and 2021 were included after conducting keyword searches on "heart diseases" in general or on specific types of heart diseases (e.g., "heart failure") and "health literacy". Bibliometric analyses were carried out using the Bibliometrix R package and VOSviewer 1.6.14. Findings: A total of 388 original research articles and reviews on HL and heart diseases were included in our study. The studies were primarily conducted in the United States and developed countries. A total of 337 studies (86.9%) focused on heart failure (200 studies, 51.5%) and ischemic heart diseases (137 studies, 35.3%). Sixty-two studies (16.0%) focused on other heart diseases (e.g., valvular diseases and rheumatic heart diseases). The number of interventional studies was limited (52 studies, 13.4%) and fluctuated from 2000 to 2021. The most common questionnaires measuring health literacy among patients with heart diseases were the Test of Functional Health Literacy in Adults (TOFHLA), Short Test of Functional Health Literacy in Adults (STOFHLA), and Brief Health Literacy Screen (BHLS). Use of the eHealth Literacy Scale (eHEALS) has become the latest trend among patients with heart diseases. Conclusion: Health literacy and heart diseases were most often studied in the United States and developed countries. Several HL tools were used; eHEALS has been lately used in this field. These findings suggest the need to conduct more empirical studies on HL and heart diseases in different settings (e.g., developing or poor countries) and with different types of heart diseases (e.g., valvular and rheumatic disorders). Additionally, it is necessary to develop heart disease-specified HL scales for research and practice.

Bibliometric Analysis of Veterinary Communication Education Research over the Last Two Decades: Rare Yet Essential.

Research of veterinary communication education is a relatively rare but important field, and its importance has been increasingly noticed recently. This study aims to describe the existing veterinary education research literature by adopting the systematic bibliometric approach. We conducted a comprehensive literature exploration on worldwide veterinary education and veterinary communication education publications in the Web of Science Core Collection database from 1 January 2000 to 31 December 2021. VOSviewer and EXCEL were used to identify trends and patterns in characteristics of the publications, including author affiliations and countries, and the publishing journals. Based on our search criteria, in the past 22 years, there have been 6006 veterinary education publications with 101 publications in 2000, 684 publications in 2021 (577% increase), and 677 communication-related publications with 9 publications in 2000, 107 publications in 2021 (1189% increase). The VOSviewer results indicate that both the United States and England were the most vigorous countries with close collaboration. Our results show the publication quantity has been increasing at a sharp slope rate over the past twenty years, which indicates the importance and growth of veterinary education and the veterinary communication education research field, and identifies the international collaborations among countries and institutions.

Medical undergraduates' self-evaluation: before and after curriculum reform.

BACKGROUND: In 2013, Taiwan launched a curriculum reform-the 7-year undergraduate medical education program was shortened to 6 years. This study explored the evaluation results from students regarding the curriculum reform and investigated graduates' perceptions regarding the curriculum organization of the two academic training programs affected by this curricular reform. METHODS: A cross-sectional survey was conducted from May 14 to June 12, 2019. The 315 graduates from both the 7-year and 6-year curriculum programs in the same medical school in Taipei were invited to participate in this study. In total, 197 completed questionnaires were received, representing a response rate of 62.5%. The results of the principal component analysis confirmed the validity of the constructs employed in this self-administered questionnaire. RESULTS: The t-test results yielded two main findings. First, the graduates from the 6-year program had significantly lower scores for preparedness for the upcoming postgraduate-year residency training than did their 7-year program counterparts. Additionally, the male graduates had significantly higher scores in terms of perceptions regarding curriculum organization and preparedness for postgraduate-year residency training than the female graduates. The results of stepwise regression also indicated that the sex difference was significantly correlated with graduates' readiness for their postgraduate-year residency training. CONCLUSION: To avoid sex disparities in career development, a further investigation of female medical students' learning environment and conditions is necessary. In addition to the cross-sectional study of students' perceptions, further repeated measurements of the objective academic or clinical performance of graduates in clinical settings are desirable.

Assessment of knowledge, attitudes, and practices towards Zika virus among healthcare workers in St. Kitts.

BACKGROUND: Healthcare workers are usually the first responders during outbreaks and are instrumental in educating the populace about the prevention of different diseases and illnesses. The aim of this study was to assess the association between healthcare workers' characteristics and knowledge, attitudes and practices toward Zika virus. METHODS: This was a cross-sectional study that collected data from healthcare workers at 3 medical facilities using a validated self-administered questionnaire between July 2017 - September 2017. Logistic regression models were used to examine the association between sociodemographic and knowledge, attitudes, and practices. RESULTS: A total of 190 healthcare workers were analyzed. Of these, 60, 72.6 and 64.7% had good knowledge, positive attitudes, and good practices toward Zika virus, respectively. Healthcare workers without a formal degree were less likely to have good knowledge of Zika virus (adjusted odds ratio (AOR) = 0:49; 95% confidence interval (CI) = 0.24-0.99) compared to those with a formal degree. Reduced odds for positive attitude towards Zika virus were observed in healthcare workers with low income as compared to those with high income (AOR = 0.31; 95% CI =0.13-0.75). Being younger than 40 years old was associated with poor Zika virus practices (AOR = 0:34; 95% CI = 0.15-0.79). CONCLUSIONS: Significant association between healthcare workers' sociodemographic characteristics and Zika virus knowledge, attitudes and practices were observed. Public health interventions that seek to increase Zika virus awareness should aim to train healthcare workers who are younger, without formal degree and those earning low income.

Case study: international healthcare service quality, building a model for cultivating cultural sensitivity.

QUALITY PROBLEM OR ISSUE: In the context of medical tourism, cultural differences and language barriers are unneglectable factors, which compromise the shared decision-making between doctor and patients. INITIAL ASSESSMENT: This study constructs a cultural sensitivity cultivation (CSC) model that could be used to train medical professionals in the sector of medical tourism. CHOICE OF SOLUTION: Since 2016, there have been explorations in new strategies to offer better services. A critical step added is to include clients' perspectives in the re-examining process as a way to cultivate cultural sensitivity among the service providers. This practice expands to the sector of medical tourism. In our case study, we are able to conclude a new model that could yield quality international healthcare services. IMPLEMENTATION: The steps of our CSC model include (i) 'Promote Awareness' for shifting mindset, (ii) 'Share Scenarios' for developing empathy and compassion, (iii) 'Review Process' for collecting detail feedback, (iv) 'Identify Gaps' for targeting areas for improvement and (v) 'Improve Systems,' for changing standard operation procedures (SOPs) based on the strategies through Assmann's theory with a cultural-anthropological approach. EVALUATION: After Kuang Tien General Hospital (KTGH) implemented the new model for 1 year, the number of international patients has increased by 64%. More research could be done in the future to cover all the important aspects of providing international medical services and could apply the CSC model to different healthcare settings. LESSONS LEARNED: To optimize the shared decision-making between the doctor and medical traveler patients, healthcare providers should not only overcome language and cultural barriers but also should avoid unnecessary gestures in terms of status respect. Inviting patients to be co-investigator for quality improvement is a viable solution.

Use of mobile applications to improve nutrition behaviour: A systematic review.

BACKGROUND AND OBJECTIVE: Mobile applications could be effectively used for dietary intake assessment, physical activity monitoring, behavior improvement, and nutrition education. The aim of this review is to determine the effectiveness of mobile applications in improving nutrition behaviors through a systematic review of literature. METHODS: The review protocol was registered with PROSPERO: registration number CRD42018118809, and followed PRISMA guidelines. We involved original articles including mobile electronic devices for improving dietary intake, physical activity, and weight management in adult populations in this review. Data were retrieved from January 2010 to December 2018 with PubMed, Web of Science, Excerpta Medica Database (Embase), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) as data sources. Authors individually screened the titles and abstracts, then full articles in order to obtain papers that met inclusion criteria. RESULTS: The database search yielded 2962 records. After removing the duplicates and analyzing the full text papers a total of 8 original articles were reviewed. Two articles showed obvious bias and were not included in our results or discussion. The remaining six articles with low to moderate bias risk were included in this systematic review. Three selected studies were randomized control trials (RCTs) with over 180 participants each. The other three studies were a nested trial, a case-control trial, and a pilot RCT with 36, 162, and 24 participants respectively. All larger RCTs and the small case control trail showed significant improvements in some nutritional-health objectives measured. The other two trials showed insignificant improvements in outcomes measured between groups. CONCLUSION: This study highlights the potential significant health benefits acquirable through mobile health application-assisted nutrition interventions. Some of these studies required significant financial and time input from providers for the application's utilization. Further studies, perhaps with multiple intervention arms, are required to compare across programs the elements that are essential for health benefits observed.

Perceived Impact of Taiwan's National Health Insurance Allocation Strategy: Health Professionals' Perspective.

Studies on health care demand have indicated high levels of public satisfaction with Taiwan's National Health Insurance (NHI). However, the global budget allocation mechanism (GBAM) used by NHI has led to various adjustments in the providers' way of practice, quality of care, utilization of care, and health expenditure. Studies focusing on the satisfaction of providers with health care supply, however, remain limited. We therefore explored the provider's perceived impact of the NHI allocation plan. A cross-sectional data of 299 health professionals was collected at Taipei Medical University Hospitals in April 2012. Perceptions and attitudes were assessed using a validated 5-point Likert-type questionnaire before using a structural equation modeling technique to explore the complex interrelationships of the NHI's perceived impact. The causal path relationships between the latent variables 'characteristics of NHI's allocation plan' and 'perceived positive effect' (ß = 0.39), 'perceived positive effect' and 'satisfaction of health professionals' (ß = 0.53), and between 'characteristics of NHI's allocation plan' and 'satisfaction of health professionals' (ß = 0.30) were positively associated; while the path relationships between the latent variables 'perceived negative effect' and 'satisfaction of health professionals' (ß = -0.27) and 'characteristics of NHI's allocation plan' and 'attitude toward allocation criteria' (ß = -0.22) were negatively associated. These results indicate that providers perceived a positive impact of the NHI allocation strategy. The NHI allocation plan is an important decision-making tool among policy makers since it helps optimize outcomes. Research based on its impact at both horizontal and vertical levels on the supply side may be useful towards understanding Taiwan's GBAM. Policy-makers should therefore consider understanding the impact of GBAM at both the demand and supply side in adjusting allocation criteria.

A positive legacy of trauma? A study on the impact of natural disasters on medical utilization.

OBJECTIVE: The impact of natural disasters on medical utilization is largely unknown and often overlooked how it affects bereaving and non-bereaving survivors. The aim of this study is to determine the medical utilization between both survivor groups and long-term effects. STUDY DESIGN: A 10-year 1999-2009 population-based retrospective study by using the National Health Insurance claim database and the Household Registration database from the Department of Health, Executive Yuan, Taiwan. SETTINGS: Taiwan 1999 Chi-Chi earthquake-affected areas. PARTICIPANTS: A total of 49 834 individuals which included 1183 bereaving survivors and 48 651 non-bereaving earthquake survivors. INTERVENTION(S): None. MAIN OUTCOME MEASURES: Medical utilization of bereaving and non-bereaving survivors. RESULTS: The results showed that bereaving survivors had significantly more outpatient visits before the earthquake, within 3-month period and 1 year after earthquake (odds ratio (OR) = 1.11, 1.16 and 1.08). However, after 1 year after earthquake their outpatient visits were not significantly different from non-bereaving, and even significantly less in some years. Inpatient visits of bereaving survivors had similar trend to outpatient visits, i.e. visits were more both before earthquake and within 3-month period after earthquake (OR = 1.59 and 1.89), however, they were not significantly higher than non-bereaving survivors for the following years of the study. CONCLUSION: Our study reveals that compared to non-bereaving survivors, bereaving survivors slightly had higher medical utilization in the beginning stage of earthquake, i.e. for the first 3-month period or 1 year after earthquake. However, there were no differences between these two groups in medical utilization including outpatient and inpatient visits in long run.

The impact of different surgical procedures on hypoparathyroidism after thyroidectomy: A population-based study.

The main objective of this study is to investigate the outcome between surgical procedures and the risk of development of hypoparathyroidism followed by surgical procedure in patients with thyroid disorders.We analyzed the data acquired from Taiwan's Bureau of National Health Insurance (BNHI) research database from 1998 to 2011 and found 9316 patients with thyroid surgery. Cox regression model was used to calculate the hazard ratio (HR).A count of 314 cases (3.4%) of hypoparathyroidism was identified. The 9 years cumulated incidence of hypoparathyroidism was the highest in patient undergone bilateral total thyroidectomy (13.5%) and the lowest in the patient with unilateral subtotal thyroidectomy (1.2%). However, in the patients who had undergone unilateral subtotal, the risk was the highest in bilateral total (HR: 11.86), followed by radical thyroidectomy with unilateral neck lymph node dissection (HR: 8.56), unilateral total (HR, 4.39), and one side total and another side subtotal (HR: 2.80).The extent of thyroid resection determined the risk of development of hypoparathyroidism. It is suggested that the association of these factors is investigated in future studies.

Relationship between women's characteristics and continuum of care for maternal health in Kenya: Complex survey analysis using structural equation modeling.

The objective of this study was to understand and estimate the complex relationships in the continuum of care for maternal health to provide information to improve maternal and newborn health outcomes. Women (n = 4,082) aged 15-49 years in the 2008/2009 Kenya Demographic and Health Survey data were used to explore the complex relationships in the continuum of care for maternal health (i.e., before, during, and after delivery) using structural equation modeling. Results showed that the use of antenatal care was significantly positively related to the use of delivery care (ß = 0.06; adjusted odds ratio [AOR] = 1.06; 95% confidence interval [CI]: 1.02-1.10) but not postnatal care, while delivery care was associated with postnatal care (ß = 0.68; AOR = 1.97; 95% CI: 1.75-2.22). Socioeconomic status was significantly related to all elements in the continuum of care for maternal health; barriers to delivery of care and personal characteristics were only associated with the use of delivery care (ß = 0.34; AOR = 1.40; 95% CI: 1.30-1.52) and postnatal care (ß = 0.03; AOR = 1.03; 95% CI: 1.01-1.05), respectively. The three periods of maternal health care were related to each other. Developing a referral system of continuity of care is critical in the Sustainable Development Goals era.

Highly Diverse Efficacy of Salvage Treatment Regimens for Relapsed or Refractory Peripheral T-Cell Lymphoma: A Systematic Review.

BACKGROUND: The goal of this study was to perform a systematic review to examine the efficacy and safety of various salvage therapy regimens on patients with relapsed/refractory PTCL. METHOD: The electronic searches were performed using PubMed, Cochrane Library, EMBASE, and Web of Science from inception through June 2015, with search terms related to relapsed/refractory PTCL, salvage chemotherapy regimens, and clinical trials. An eligible study met the following inclusion criteria: (1) Patients had refractory or relapsed PTCL; (2) drug regimens were used for salvage therapy; (3) the study was a clinical trial; (4) the study reported on a series of at least 10 patients of PTCL. RESULTS: Of 35 records identified, a total of 14 studies were eligible for systematic reviews, and 12 different salvage regimens were investigated. A total of 618 relapsed/refractory PTCL patients were identified. The ORRs ranged from 22% for those treated with lenalidomide to 86% for those with brentuximab vedotin. By the three most frequent subtypes, the ORRs ranged from 14.2% to 71.5% for patients with the PTCL-NOS subtype, 8% to 54% for AITL subtypes, and 24% to 86% for the ALCL subtype. The medians of DOR, PFS, and OS ranged from 2.5 to 16.6 months, 2.6 to 13.3 months, and 3.6 to 14.5 months, respectively. The most frequently reported grade 3 or 4 adverse events (AEs) were hematological AEs, such as neutropenia and thrombocytopenia. CONCLUSION: The efficacy of salvage therapy regimens is highly diverse for patients with relapsed/refractory PTCL; this heterogeneity in therapeutic effects might be due to the diversity in mechanisms, PTCL subtype distribution, and/or numbers/profiles of prior therapy. Comparative studies with matched pair analysis are warranted for more evidence of the salvage treatment effect on relapsed or heavily pretreated patients with PTCL.