Brazilian medical publications: citation patterns for Brazilian-edited and non-Brazilian literature

Today, the quality of a scientific article depends on the periodical in which it is published and on the number of times the article is cited in the literature. In Brazil, the criteria for the evaluation of this scientific production are improving. However, there is still some resistance, with authors arguing that Brazilian publications must be preferentially addressed to the national readers and, therefore, they should ideally be written in Portuguese. In order to determine the kind of scientific journals cited in the reference lists of articles published in medical periodicals edited in Brazil, in the present study we determine the rate of Portuguese/English citations. Three issues of 43 periodicals (19 indexed in SciELO, 10 in PubMed, 10 in LILACS, and 4 in the ISI-Thompson base) of different medical specialties were analyzed, and the number of both Portuguese and English citations in the reference list of each article was recorded. The results showed that in Brazilian-edited journals the mean number of citations/article was 20.9 ± 6.9 and the percentage of citations of international non-Brazilian periodicals was 86.0 ± 11.2%. Of the latter, 94.4 ± 7.0 are indexed by ISI-Thompson. Therefore, we conclude that Brazilian medical scientists cite the international non-Brazilian periodicals more than the national journals, and most of the cited papers are indexed by ISI-Thompson.

Exploring business models for medical games: Key components and challenges

The costs of health care are going up in many countries. In order to provide affordable and effective health care solutions, new technologies and approaches are constantly being developed. In this research, video games are presented as a possible solution to the problem. Video games are fun, and nowadays most people like to spend time on them. In addition, recent studies have pointed out that video games can have notable health benefits. Health games have already been developed, used in practice, and researched. However, the bulk of health game studies have been concerned with the design or the effectiveness of the games; no actual business studies have been conducted on the subject, even though health games often lack commercial success despite their health benefits. This thesis seeks to fill this gap. The specific aim of this thesis is to develop a conceptual business model framework and empirically use it in explorative medical game business model research. In the first stage of this research, a literature review was conducted and the existing literature analyzed and synthesized into a conceptual business model framework consisting of six dimensions. The motivation behind the synthesis is the ongoing ambiguity around the business model concept. In the second stage, 22 semi-structured interviews were conducted with different professionals within the value network for medical games. The business model framework was present in all stages of the empirical research: First, in the data collection stage, the framework acted as a guiding instrument, focusing the interview process. Then, the interviews were coded and analyzed using the framework as a structure. The results were then reported following the structure of the framework. In the results, the interviewees highlighted several important considerations and issues for medical games concerning the six dimensions of the business model framework. Based on the key findings of this research, several key components of business models for medical games were identified and illustrated in a single figure. Furthermore, five notable challenges for business models for medical games were presented, and possible solutions for the challenges were postulated. Theoretically, these findings provide pioneering information on the untouched subject of business models for medical games. Moreover, the conceptual business model framework and its use in the novel context of medical games provide a contribution to the business model literature. Regarding practice, this thesis further accentuates that medical games can offer notable benefits to several stakeholder groups and offers advice to companies seeking to commercialize these games.

Biomarkers, medical treatment and fetal intrapartum surveillance in intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific disorder characterized by maternal pruritus and elevated liver enzymes. It usually begins in the third trimester of pregnancy and resolves spontaneously after delivery. ICP is considered benign for the pregnant woman, but it is associated with an increased risk for unexplained term stillbirth and preterm delivery. There are no specific laboratory markers to diagnose ICP. The diagnosis is currently based on the presence of maternal pruritus and elevated values of alanine aminotransaminases (ALT) and serum bile acids (BA). Recently, ursodeoxycholic acid (UDCA) has been used for treatment. Mechanisms leading to intrauterine fetal death (IUFD) may be multifactorial and are unknown at present. For this thesis, 415 pregnant women with ICP were studied. The aim was to evaluate the value of the liver enzyme glutathione S-transferase alpha (GSTA) as a specific marker of ICP and to assess the effect of maternal UDCA therapy on maternal laboratory values and fetal outcome. The specific markers predisposing the fetus to heart arrhythmia were studied by comparing waveform analysis of fetal electrocardiograms (FECG) during labor in pregnancies complicated by ICP with controls. The levels of maternal GSTA were high and the values correlated with the value of ALT in patients with ICP. UDCA therapy reduced the values of the liver enzymes and alleviated maternal pruritus, but it did not influence maternal hormonal values. Although the newborns experienced an uneventful perinatal outcome, severe ICP was still associated with preterm birth and admission to the neonatal intensive care unit (NICU). There were no significant differences in intrapartum FECG findings between fetuses born to ICP women and controls.

Critical elements underpinning the emergence of the medical game ecosystem: gamifying traumatic brain injury rehabilitation in Finland

The healthcare sector is currently in the verge of a reform and thus, the medical game research provide an interesting area of research. The aim of this study is to explore the critical elements underpinning the emergence of the medical game ecosystem with three sub-objectives: (1) to seek who are the key actors involved in the medical game ecosystem and identify their needs, (2) to scrutinise what types of resources are required in medical game development and what types of relationships are needed to secure those resources, and (3) to identify the existing institutions (‘the rules of the game’) affecting the emergence of the medical game ecosystem. The theoretical background consists of service ecosystems literature. The empirical study conducted is based on the semi-structured theme interviews of 25 experts in three relevant fields: games and technology, health and funding. The data was analysed through a theoretical framework that was designed based upon service ecosystems literature. The study proposes that the key actors are divided into five groups: medical game companies, customers, funders, regulatory parties and complementors. Their needs are linked to improving patient motivation and enhancing the healthcare processes resulting in lower costs. Several types of resources, especially skills and knowledge, are required to create a medical game. To gain access to those resources, medical game companies need to build complex networks of relationships. Proficiency in managing those value networks is crucial. In addition, the company should take into account the underlying institutions in the healthcare sector affecting the medical game ecosystem. Three crucial institutions were identified: validation, lack of innovation supporting structures in healthcare and the rising consumerisation. Based on the findings, medical games cannot be made in isolation. A developmental trajectory model of the emerging medical game ecosystem was created based on the empirical data. The relevancy of relationships and resources is dependent on the trajectory that the medical game company at that time resides. Furthermore, creating an official and documented database for clinically valdated medical games was proposed to establish the medical game market and ensure an adequate status for the effective medical games. Finally, ecosystems approach provides interesting future opportunities for research on medical game ecosystems.

Critical elements underpinning the emergence of the medical game ecosystem:gamifying traumatic brain injury rehabilitation in Finland

The healthcare sector is currently in the verge of a reform and thus, the medical game research provide an interesting area of research. The aim of this study is to explore the critical elements underpinning the emergence of the medical game ecosystem with three sub-objectives: (1) to seek who are the key actors involved in the medical game ecosystem and identify their needs, (2) to scrutinise what types of resources are required in medical game development and what types of relationships are needed to secure those resources, and (3) to identify the existing institutions (‘the rules of the game’) affecting the emergence of the medical game ecosystem. The theoretical background consists of service ecosystems literature. The empirical study conducted is based on the semi-structured theme interviews of 25 experts in three relevant fields: games and technology, health and funding. The data was analysed through a theoretical framework that was designed based upon service ecosystems literature. The study proposes that the key actors are divided into five groups: medical game companies, customers, funders, regulatory parties and complementors. Their needs are linked to improving patient motivation and enhancing the healthcare processes resulting in lower costs. Several types of resources, especially skills and knowledge, are required to create a medical game. To gain access to those resources, medical game companies need to build complex networks of relationships. Proficiency in managing those value networks is crucial. In addition, the company should take into account the underlying institutions in the healthcare sector affecting the medical game ecosystem. Three crucial institutions were identified: validation, lack of innovation supporting structures in healthcare and the rising consumerisation. Based on the findings, medical games cannot be made in isolation. A developmental trajectory model of the emerging medical game ecosystem was created based on the empirical data. The relevancy of relationships and resources is dependent on the trajectory that the medical game company at that time resides. Furthermore, creating an official and documented database for clinically validated medical games was proposed to establish the medical game market and ensure an adequate status for the effective medical games. Finally, ecosystems approach provides interesting future opportunities for research on medical game ecosystems

Earning logics of a portal solution for a medical device manufacturer

The need behind this thesis was in the development of a more modern earning logic for a pelvic floor muscle home training device to which a portal solution is going to be introduced as a part of new upgraded version of the device. The goal is to offer useful guidelines and recommendations for the medical device manufacturer to use in the process of creating the new business model around the new product version. In the theoretical part of this thesis, the used theoretical frameworks for business model generation and pricing models are presented. The special characteristics of healthcare technology industry are also introduced as initial data for the empirical part. The empirical data is collected via interviews and meetings from both inside and outside of the company to gain a comprehensive picture of the issue at hand. The needed changes in the business model as well as possible pricing options are gone through in the empirical chapters with the main focus being on the incoming revenue streams and pricing. As results of the thesis recommendations are presented for the changes that are needed in the business model after the introduction of the portal solution. The results of this thesis can be used for finishing the development process of the new version of the device and especially the earning logic of it.

Healthcare Information System Selection Model for Medical Clinics

The issue of selecting an appropriate healthcare information system is a very essential one. If implemented healthcare information system doesn’t fit particular healthcare institution, for example there are unnecessary functions; healthcare institution wastes its resources and its efficiency decreases. The purpose of this research is to develop a healthcare information system selection model to assist the decision-making process of choosing healthcare information system. Appropriate healthcare information system helps healthcare institutions to become more effective and efficient and keep up with the times. The research is based on comparison analysis of 50 healthcare information systems and 6 interviews with experts from St-Petersburg healthcare institutions that already have experience in healthcare information system utilization. 13 characteristics of healthcare information systems: 5 key and 7 additional features are identified and considered in the selection model development. Variables are used in the selection model in order to narrow the decision algorithm and to avoid duplication of brunches. The questions in the healthcare information systems selection model are designed to be easy-to-understand for common a decision-maker in healthcare institution without permanent establishment.

The implications of being an international medical graduate (IMG) in Canadian society : a qualitative study of foreign-trained physicians' resettlement, sense of identity and health status

This qualitative research study used grounded theory methodology to explore the settlement experiences and changes in professional identity, self esteem and health status of foreign-trained physicians (FTPs) who resettled in Canada and were not able to practice their profession. Seventeen foreign-trained physicians completed a pre-survey and rated their health status, quality of life, self esteem and stress before and after coming to Canada. They also rated changes in their experiences of violence and trauma, inclusion and belonging, and racism and discrimination. Eight FTPs from the survey sample were interviewed in semi-structured qualitative interviews to explore their experiences with the loss of their professional medical identities and attempts to regain them during resettlement. This study found that without their medical license and identity, this group of FTPs could not fully restore their professional, social, and economic status and this affected their self esteem and health status. The core theme of the loss of professional identity and attempts to regain it while being underemployed were connected with the multifaceted challenges of resettlement which created experiences of lowered selfesteem, and increased stress, anxiety and depression. They identified the re-licensing process (cost, time, energy, few residency positions, and low success rate) as the major barrier to a full and successful settlement and re-establishment of their identities. Grounded research was used to develop General Resettlement Process Model and a Physician Re-licensing Model outlining the tasks and steps for the successfiil general resettlement of all newcomers to Canada with additional process steps to be accomplished by foreign-trained physicians. Maslow's Theory of Needs was expanded to include the re-establishment of professional identity for this group to re-establish levels of safety, security, belonging, self-esteem and self-actualization. Foreign-trained physicians had established prior professional medical identities, self-esteem, recognition, social status, purpose and meaning and bring needed human capital and skills to Canada. However, without identifying and addressing the barriers to their full inclusion in Canadian society, the health of this population may deteriorate and the health system of the host country may miss out on their needed contributions.

Opioid poisoning and availability of specialized medical care in Ontario, 2002-2006

The prescription of opioid analgesics has risen sharply in North America over the past two decades. This increase has been accompanied by a rise in overdoses. The present study draws on administrative data collected from emergency department contacts to describe the epidemiology of opioid overdose in Ontario b~tween 2002 and 2006 and to examine the role of regional variation in availability of specialist care. The number of poisonings increased from 1250 (10.9 per 100,000) in FY2002 to 1816 (15.2 per 100,000) in FY2005. Local concentration of specialist physicians was significantly associated with the incidence of opioid overdose, inversely at most levels of availability, but positively at very high levels. Regional variation in incidence was also associated with demographics, median family income, and the rate of other drug poisonings. Policy options for limiting opioid-related harms are limited, but improvements in monitoring and clinical management may prove valuable.