In manpower planning, as in all other kinds of planning, an important choice is the level of aggregation. The proper level of aggregation depends on the flexibility (mobility) of the personnel. This dependency is investigated in this paper. The manpower system considered is characterized by two dimensions, level and function group. Conditions are derived for aggregate long-term planning (aggregation over function group) combined with one-period disaggregation being optimal.
The present exercise is not as such a "manpower plan" but a purely budgetary comparison of known plus requested resources with the known commitments over the period 2007-2012. From a purely budgetary point of view, AB will have the capacity to maintain all those recently hired staff who fulfill the criteria for long term employment at CERN. Following this budgetary exercise, AB proposes to perform a CERN-wide staff work plan so as to compare the manpower available to the quantity of work to be done in the totality of the work-packages. If there is a significant mismatch between these two quantities then we propose the following measures which would create personnel economies and allow us to redress the mismatch by increased recruitment: a new job severance scheme; CERN restructuring; use of the new CERN-ITER agreement; more flexibility in transfers from Materials to Personnel budgets. Failing this a re-examination of possible closure of lower priority facilities may be needed.
The demands of a nuclear technology programme on the manpower resources of a developing country are very onerous. Unlike other industries, as well as the planning and operating staff, nuclear technology requires an additional administrative infrastructure to regulate the various activities. To minimize the effect of manpower shortage, the planning and development of manpower resources need to be carried out on a national scale. To introduce a nuclear programme, a special preparatory phase is required. During this phase the special conditions appertaining to the country are first considered, as are the evaluation and then the promotional aspects of the programme. In a second phase, all the partners involved in the implementation are considered, with reference to their roles and interrelationships. Their various tasks and obligations are fully assessed. This is a wide-ranging study covering, in addition to the construction of a nuclear power plant, the industrial collaboration and licensing agreements, and the utility operational training schemes. Finally, the third phase considers the different and necessary educational requirements, and the existent and developed level of the manpower, with respect to the scope and content of the know-how transfer. When all the relevant aspects have been considered, the expansion of the universities and educational establishments must be carried out. This whole phase needs to be started as early as possible because it involves a period of some years. (author)
Ramarao, D.; Agrawal, Rashmi; Rao, B. V. L. N.; Nanda, S. K.; Joshi, Girish P.
Purpose: Developing countries need to plan growth or expansion of education so as to provide required trained manpower for different occupational sectors. The paper assesses supply and demand of professional manpower in Indian agriculture and the demands are translated in to educational requirements. Methodology: The supply is assessed from the…
Texas State Dept. of Water Resources, Austin.
This document presents the material developed in conjunction with a project directed to test a methodology that a state water pollution control agency can use in determining its manpower and training needs. Included is a compilation of the manpower planning criteria used to relate numbers and types of personnel with deferred workloads. It also…
Makes observations about progress in the field of manpower planning in highly industrialized and developed countries. Discusses the internal and external labor market, the state of the art of manpower planning at the micro level, and an economic framework. (CT)
Davies, J. Kenneth; And Others
This document discusses the components necessary in the development of a forecasting process by which manpower needs can be determined and the development of action programs by which the projected needs may be satisfied. The primary focus of this manual is directed at that person in a state agency who has the responsibility for planning the…
Whiteside, Daniel F.; And Others
The health manpower planning experiences of four countries reported here were presented in a traveling seminar held for member countries of the Pan American Health Organization. Focus was on what should be carried out in any country to coordinate the training of health workers with the operation of health services. Following the introduction, the…
Stewart, Lawrence G.
The report is designed to make a beginning in broadening the scope of the comprehensive manpower information system for energy research, development, and demonstration, so that it could cover all manpower related to energy. It develops a plan for this extension, including determining which taxonomies require change, specifying the subsequent stages involved in expanding CEMIS to all energy manpower, and providing the basis for cost estimates for this work. The report is organized as follows: The analytical rationale is described in Chapter II. Chapter III reviews the status of manpower data in a number of energy sectors, notes limitations and gaps in the data, and discusses improvements and additions that should be made. The scope and structure of CEMIS are laid out in Chapter IV, with particular reference to the development of analytical processes, and of analytical linking functions between bodies of data, and a description of their application in anticipating the employment impact of energy changes. The appropriate steps recommended for the further development of CEMIS are described in Chapter V.
This volume is the proceedings of the conference entitled "Manpower Planning and Organization Design" which was held in Stresa, Italy, 20-24 June 1977. The Conference was sponsored by the NATO Scientific Affairs Division and organized jointly through the Special Programs Panels on Human Factors and on Systems Science. Two Conference Directors were appointed with overall responsibilities for the programme and for policy, and they were assisted in their tasks by a small advisory panel consisting of Professor A. Charnes (University of Texas), Professor W.W. Cooper (Carnegie Mellon University, now at Harvard University) and Dr. F.A. Heller (TavistQck Institute of Human Relations). Professor R. Florio of Bergamo kindly agreed to become Administrative Director and, as such, was responsible for all the local arrangements. The Conference Directors were further assisted by "national points of contact" appointed from each of the member countries of NATO. These national representatives played a substantial part in the s...
Full Text Available The development of human resources recruitment and training strategies in a dynamic environment poses a challenge to many policy makers in various organisations. The goal of every human resource manager is to recruit, train and deploy the right personnel at the right place and at the right time in order to meet organizational requirements. We develop a system dynamics simulation model that captures the dynamic behaviour of a typical corporate manpower system. Three major strategies are indentified and simulated under different manpower demand scenarios. Based on a set of performance indices, the impact of the strategies is simulated under assumed demand scenarios including steady increasing, fluctuating, and s-shaped demand. Useful managerial insights are derived from the study. The model is a decision support tool for developing reliable dynamic manpower policies in terms of recruitment, training capacity, available skills, and attrition. This approach can assist organizations to design effective manpower strategies.
YONGJIAN LI; JIAN CHEN; XIAOQIANG CAI; BENGSHENG TU
In this paper, we investigate a manpower planning problem with single employee type over a long planning horizon. The dynamic demand for manpower must be fulfilled by allocating enough number of employees and each employee has a minimal employment period. A cost objective is concerned where the costs for every employee include salary, recruitment and dismissal costs, in particular, setup cost when recruitment activity occurs in one period. In this paper we first formulate the problem as a dyn...
Development Academy of the Philippines
This study provides basic information on the status of Philippine health professionals that will serve as input for health manpower planning and for the preparation of health care financing scheme. An inventory of the existing manpower personnel is provided. In addition, factors affecting manpower supply and demand in the health sector is analyzed. This is in the hope of helping policy makers in providing market incentives for an efficient health care financing system in the future.
Dohn, Anders Høeg; Larsen, Jesper; Clausen, Jens
In a modern society, manpower can be both a scarce and an expensive resource. Skilled personnel is usually in high demand and accounts for a significant part of total expenses in many companies. When the work is divided in shifts, a roster is compiled to allocate these to the employees. The rostering process is non-trivial and especially when service is required around the clock, rostering may involve considerable effort from a designated planner. Therefore, in order to minimize costs and ove...
Van Adams, Arvil; And Others
Labor market planning techniques must take into account the dynamic nature of economies. A better approach than labor needs forecasting is use of labor market signals developed by monitoring wage and employment changes and evaluating training programs. (SK)
Cohen, S I
ILO pub-WEP pub. Working paper on the use of econometric models in human resources planning - discusses short term economic analysis of labour markets, medium term simulation of labour supply, and evaluation of training and educational expenditure; considers sample survey data collecting for national accounting. Graphs, references, statistical tables.
This Guidebook provides policy-makers and managers of nuclear power programmes with information and guidance on the role, requirements, planning and implementation of manpower development programmes. It presents and discusses the manpower requirements associated with the activities of a nuclear power programme, the technical qualifications of this manpower and the manpower development corresponding to these requirements and qualifications. The Guidebook also discusses the purpose and conditions of national participation in the activities of a nuclear power programme
... put on a breathing machine. Organ and tissue donation allows organs or body parts from a generally healthy person ... to your driver’s license. Some people also include organ donation in their advance care planning documents. At the ...
Manpower Planning for the Wastewater Treatment Workforce of Texas: An Emerging Function. Presented at the Annual Meeting of the Texas Water Utilities Association (58th, College Station, Texas, March, 1976).
This paper, presented at the 58th annual meeting of the Texas Water Utilities Association, attempts to point out the need for manpower planning for the wastewater treatment workforce of Texas. As reasons for manpower planning, this document discloses estimates of 1400-1500 new jobs, 1300 of which will be in wastewater treatment facilities of 1 MGD…
Amir, Ofra; Grosz, Barbara J.; Law, Edith Lok Man; Stern, Roni
This paper envisions a multi-agent system that assists patients and their health care providers. This system would support a diverse, evolving team in formulating, monitoring and revising a shared "care plan" that operates on multiple time scales in uncertain environments. It would also enhance communication of health information within this planning framework. The coordination of care for children with complex conditions (CCC), which is a compelling societal need, is presented as a model env...
Since the early stages of decision making, manpower availability has been recognized to be a key factor for the implementation of Brazil's nuclear power programme. Though care has been given to securing an industrial base and financial resources, the consequences of a lack of sufficient qualified manpower could be critical for the success of the whole programme. The broad scope of the Brazilian nuclear power programme which, as a main concept, aimed at establishing in the country a complete fuel cycle industry together with the construction of nuclear power plants, added another burden to the already complex task of providing appropriate human resources when advanced technologies are introduced in a developing country. Thus, not only the work-force required for nuclear power plant operation but also that needed for plant design, component manufacture, fuel cycle plant design and operation, had to be made available in number and qualification in accordance with the standards of the nuclear industry. The feasibility of the Brazilian programme depended on a complete transfer of technology, essentially achieved through personnel training. Again, the process of manpower preparation for an efficient know-how transfer required careful planning, and the great difficulty in its implementation was the lack of reliable experience at the time. (author)
The overview based on country studies included in this volume investigates the extent to which it has been possible to integrate human resource development and give priority to this important goal within the overall planning process. While it is clear that the development of human resources has to compete with other pressing demands for limited resources available for development, the key question still remains whether overall socioeconomic development undertaken has incorporated the preferre...
Hydal, Anne-Marthe Bering
Bakgrunn: Advance care planning (ACP) er en kommunikativ prosess, som utforsker pasienters preferanser for fremtidig medisinsk behandling og pleie ved livets slutt. Flere land har tatt i bruk ACP, men i Norge finnes få føringer for nedtegnelse av pasientpreferanser. Hensikt: Undersøke hvilke ACP programmer som er implementert i sykehjem utenfor Norge, og hva de ulike programmene inneholder. Videre å undersøke hvilke implementeringsstrategier som er tatt i bruk, og hvilke erfaringer som beskri...
The nuclear-power industry must attract and train 57,000 employees during the next decade, according to a survey which found a high rate of personnel turnover, 8790 unfilled positions, and 75 new plants scheduled to come on line. The Institute of Nuclear Power Operators (INPO) and the industry need to address personnel planning to find out how to meet these needs. Studies indicate a history of on-site staffing and training deficiencies. Regulatory requirements also contribute to manpower shortages. This article examines manpower problems and suggests initiatives the industry can take to support educational programs, expand training, provide employee incentives, and pool technical resources. 7 tables
Santosh K Chaturvedi
Full Text Available Research in palliative care has its challenges. However, research in different aspects of palliative care is important. This paper gives simple methods of planning and conducting a research in the area of palliative care in India.
The nuclear manpower development project has concentrated on the systemisation and specialization of education and training programs and has actively carried out diverse activities to create new nuclear courses based on the experience of the Nuclear Training and Education Center (NTC) accumulated over the past years. As the demand of education program for training nuclear manpower is increasing due to the remarkable growth of nuclear industry, NTC developed customized education programs making the most use of nuclear experiment equipment and providing practical exercise with research reactor. For improving organizational performance and the development of skilled manpower, KAERI-ACE 2.0 system offered diverse programs addressing the type of occupation and position based on individual competency. Also education on IT was carried out to improve public relations on nuclear and field trips were arranged to encourage local residents' better understanding of the nuclear industry. As a continuous effort, In 2011, NTC specially conducted a survey of employees who are attached to small and medium sized business, and analyzed the present business situations and education requirements for the development of a Pre/under job education program. Prior to this, a briefing session took place for mutual exchange of opinions of industry and academia, based on which a test operation on 'Basic Radiation Education' was carried out. This program has a significance that it was first step toward connection between the nuclear industry and academia as well as an opportunity to educate the employee involved in nuclear engineering field. In 2012, this program is planned to be expanded. With reference to the in-house training, NTC established an 'e-HRD system' providing available resources concerned with education program for cultivating talented personnel. All the education programs are based on individual competency. The e-HRD system will be test operated in 2012 and applied to the
Dellefield, Mary Ellen
Purpose: This article is a critical review of the history, research evidence, and state-of-the-art technology in interdisciplinary care planning and the written plan of care in American nursing homes. Design and Methods: We reviewed educational and empirical literature. Results: Interdisciplinary care planning and the written care plan are…
Jeanny Engels; Marjolein Rebel; Doortje Boshuizen
Purpose Implementation and evaluation of a personalized care plan for approximately 350 people with (an increased risk of) cardiovascular disease in ten general practices in the Netherlands. Context The ‘Healthy Vessels’ (‘Vitale Vaten’) care standard of 2009 describes the optimum care for people with (an increased risk of) cardiovascular disease and is based on the Chronic Care Model. New: working with a personalized care plan, with detailed attention for the promotion of self-management and...
... a Pediatrician Family Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting Involved in Your Community Healthy Children > Family Life > Medical Home > Health Insurance > Managed Care Plans: Getting Good Care for Your Child Family ...
U.S. Department of Health & Human Services — The study evaluates the performance of Medicare managed care, Medicare Advantage, Plans in comparison to Medicare fee-for-service Plans in three states with...
The manpower forecasting approach (MFA) was one of the first attempts in educational planning purposes. Manpower planners attempted: 1) to calculate the demand for manpower classified by occupation; 2) to convert this classification of demand by occupation into demand by educational attainment; 3) to devise plans and policies aimed at equating projected demands and probable supplies. The paper recalls the basic principles of the MFA from the perspective of the history of the economic thought ...
VA Health Care and Health Manpower Training Legislation. Hearing before the Subcommittee on Health and Hospitals of the Committee on Veterans' Affairs; United States Senate, Ninety-second Congress. First Session on S.2219, S.2354, S.2355, S.1924, S.2304, S.1635, S.2340, H. J. Res. 748, H. R. 481, and Related Bills.
Congress of the U.S., Washington, DC. Senate Committee on Veteran's Affairs.
Ten legislative bills related to VA health manpower training and education and to veterans' health care were considered at this hearing. The bills concerned the following: (1) establishment of new public nonprofit medical, health profession, and allied health schools and the expansion and improvement of health manpower training programs in VA…
Burt, J.; J. Rick; Blakeman, T; Protheroe, J; Roland, M; Bower, P.
The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority for chronic disease management in a number of health care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between ‘care planni...
Cargill, B. F.
The fruit and vegetable industry is on the road to total mechanization. The scientific and social communities need to collaborate as technological innovations influence manpower development and utilization. An awareness of the implications of technological advancement and manpower problems is required so that the U. S. fruit and vegetable grower…
Population increase, rural-to-urban migration, excessive population concentration side by side with scattered rural populations, and the economic crisis provide the primary framework for this analysis of health manpower in Mexico. The secondary frame of reference is the primary causes of mortality (in 1981): the leading cause, accidents and violence; the second, heart disease; the third, influenza and pneumonia; and the fourth, enteric diseases and diarrheas. Data are supplied on the number of new physicians graduating (this number rose from 2,493 in 1976 to 14,099 in 1983), and on the number of nurses (about 98,000, of which 40% are professionals). The growth pattern of the contingent of dentists is the same as that of physicians, namely, disproportionate and inefficient. The Federal Government is now trying to set up a National Health System that will fulfill the constitutional right of all Mexican citizens to health protection. On the basis of the disequilibrium apparent in every part of the health sector, the author recommends that educational and health institutions plan and coordinate the training of physicians so that the number of graduates may meet the country's needs, and the quality of their education may be improved. PMID:3780502
Crosley, Joan M.
This paper presents a brief description of the beginning phase of a long term project introducing computerized nursing care planning utilizing nursing diagnoses within one nursing department. Areas for future study are proposed.
Maria Ángeles Carrasco García
Full Text Available Introduction: Puerperal mastitis or mastitis Breastfeeding is a postpartum condition that represents one of the main reasons for abandoning breastfeeding. Mainly usually occurs between weeks 2 and 3 ª postpartum. The scientific evidence confirms that the stop breastfeeding before an attack of mastitis is not conducive to recovery and that of exclusive breastfeeding and no restrictions are effective measures to prevent milk stasis and the spread of infection.Objective: The main objective is to unify criteria for the care and integrated health care levels of care through continuity of care to promote breast-specific care to prevent the emergence of this disease.Methodology: Development of a standardized care plan to enable effective communication between professionals and implementation of quality care.Conclusions: The midwife and the nurse plays an important role in identifying those women with early-onset symptoms of postpartum mastitis in the middle, both in the maternity ward and in the primary care clinic.
Gravette, M. C.; King, W. L.
System of programs capable of building and maintaining data bank provides all levels of management with regular manpower evaluation reports and data source for special management exercises on manpower.
The article summarizes the 1975 Manpower Report chapters on: the employment and unemployment record; achievements and open issues of public service employment; changing role of women; CETA Progress report; Program responses to manpower needs; manpower impact of government policy and procedure; and Report of the Secretary of Health, Education, and…
Klerman, Lorraine V.
Family planning services are necessary for the widespread adoption of preconception care for two reasons. First, preconception care is more likely if pregnancies are planned, and family planning services encourage pregnancy planning. Second, family planning services usually include counseling, and counseling provides an opportunity to discuss the advantages of preconception care. However, the potential of family planning services to promote preconception care is limited by underutilization of...
Prue, Christine E; Daniel, Katherine Lyon
Social marketing approaches can help to shape the formation of and to create demand for preconception care services. This article describes four components of social marketing, often referred to as the 4 P's, that should be carefully researched and set in place before a national effort to launch and sustain preconception care services is pursued. First, the product or package of services must be defined and adapted using the latest in scientific and health care standards and must be based on consumer needs and desires. Second, the pricing of the services in financial or opportunity costs must be acceptable to the consumer, insurers, and health care service providers. Third, the promotion of benefits must be carefully crafted to reach and appeal to both consumers and providers. Fourth, the placement and availability of services in the marketplace must be researched and planned. With the application of market research practices that incorporate health behavior theories in their exploration of each component, consumer demand for preconception care can be generated, and providers can take preconception care to the market with confidence. PMID:16755400
Implicações de custo financeiro e recursos humanos em assistência odontológica no Brasil segundo o modelo escandinavo Implications in terms of costs and manpower of using the Scandinavian dental care model in Brazil
Jefferson L. Traebert
Full Text Available Objetivou-se detectar e analisar as implicações em custos e recursos humanos em odontologia de uma hipotética aplicação dos conceitos escandinavos de atenção odontológica no Brasil. Duas sociedades foram escolhidas para serem estudadas: Suécia, país da Escandinávia, e Santa Catarina, Estado da região Sul do Brasil. A análise teórica dessas implicações foi realizada a partir da determinação das necessidades de recursos humanos em odontologia, considerando-se os altos índices de doenças bucais no Estado brasileiro. Utilizou-se o programa de software "Health Through Oral Health" da Organização Mundial da Saúde-Federação Dentária Internacional (1989. Os resultados mostraram alto custo financeiro e a necessidade de se aumentar em até 85% o recurso humano disponível para atuar em saúde bucal no Estado de Santa Catarina. Concluiu-se que os princípios de alta provisão de recursos humanos e financeiros, característicos do modelo escandinavo, não serviriam para serem adotados por Santa Catarina e, extensivamente, pelo Brasil.The implications in terms of dental manpower and costs of applying the Scandinavian system of dental care in Brazil are specified and analysed. Two societies were chosen for study: those of Sweden, in Scandinavia and Santa Catarina, State in southern Brazil. The theoretical analysis of the implications was undertaken on the basis of an estimate of dental and auxiliary manpower required to deal with the high levels of oral disease and needs (caries, teeth needing extraction, periodontal diseases and the need for full dentures in Santa Catarina. This estimate was undertaken by means of the World Health Organization-Fédération Dentaire Internationale (WHO-FDI Model "Health Through Oral Health" (1989. The implications in costs, taking the total Swedish expenditure per dentist as a basis, were calculated and applied to the manpower calles for by the WHO-FDI model. The high costs resulting showed that the
... Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases § 441.103 Alternate plans of... otherwise need care in an institution for mental diseases. (b) These alternate plans of care must— (1)...
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Plan of Care § 456.180 Individual written plan of care. (a) Before admission to a mental hospital...
Warren, Jim; Gu, Yulong; Humphrey, Gayl
We examined the content of electronically mediated communications in a trial of shared care planning (SCP) for long-term condition management. Software supports SCP by sharing patient records and care plans among members of the multidisciplinary care team (with patient access). Our analysis focuses on a three-month period with 73 enrolled patients, 149 provider-assigned tasks, 64 clinical notes and 48 care plans with 162 plan elements. Results show that content of notes entries is often relat...
Hans, Erwin W.; Houdenhoven, van, M.; Hulshof, Peter J.H.
Rising expenditures spur health care organizations to organize their processes more efficiently and effectively. Unfortunately, health care planning and control lags far behind manufacturing planning and control. Successful manufacturing planning and control concepts can not be directly copied, because of the unique nature of health care delivery. We analyze existing planning and control concepts or frameworks for health care operations management, and find that they do not properly address v...
... library Find a dermatologist How to create an anti-aging skin care plan Skin care in your 40s ... Years of research supports each of these recommendations. Anti-aging skin care tips Protect your skin from the ...
Full Text Available Forecasting manpower requirements has been useful for economic planners, policy makers and training providers in order to avoid the imbalance of skills in the labour market. Although reviews of the manpower planning models have been conducted previously, with the accumulated experience and the booming of advanced statistical techniques and computer programs, the study of forecasting practices has undrgone considerable changes and achieved maturity during the past decade. This paper assesses the latest employment and manpower dmand estimating methods by examining their rationale, strength and constraints. It aims to identify enhancements for further development of manpower forecasting model for the construction industry and compare the reliability and capacity of different forecasting metodologies. It is cocluded that the top-down forecasting approach is the dominant methodology to forecast occupational manpower demand. It precedes other methodologies by its dynamic nature and sensitivity to aa variety of factors affecting the level and structure of employment. Given the improvement of the data available, advanced modelling techniques and computer programs, manpower planning is likely to be more accessible with improved accuracy at every level of the society.
Hwang, I. A.; Lee, T. J.; Lee, K. B.; and others
The nuclear manpower development project has concentrated on the systemization and specialization of education and training programs and has actively carried out diverse activities to create new nuclear courses based on the experience of the Nuclear Training and Education Center (NTC) accumulated over the past years. NTC has developed customized education programs on 'Nuclear Introduction' to educate new employees of the Korea Electric Power Corporation (KEPCO) and on 'Technical education for criticality and shielding analysis of the spent fuel' for employees of the Doosan Heavy Industries and Construction. NTC has also developed specialized education programs for the students of nuclear engineering departments and sciences and engineering departments in universities making the most use of experimental equipment at KAERI and providing practical exercise with the research reactor, HANARO. For improving organizational performance and the development of skilled manpower, KAERI-ACE system has offered diverse programs addressing individual competency of industry personnel in terms of type of occupation and position. Also education on IT has been carried out to improve public relations on nuclear and field trips have been arranged to encourage local residents' better understanding of the nuclear industry. As the final outcome, NTC has developed 6 new education programs for employees in industry and students in academia, and offered 64 courses to 9,630 persons (273 domestic nuclear personnel, 509 university students, 8,075 KAERI staff, 773 local resident). Especially, in 2012, NTC is honored to won 'Presidential Awards of National Quality Management Awards'. This present that KAERI-ACE system has performed well through a improvement in recent years.
As part of a broad effort intended to mitigate the consequences of radiation accidents, the United States Atomic Energy Commission has developed a program to train physicians and to orient hospital staffs in the treatment of accident victims. Seminars have been conducted to date for approximately 120 physicians on medical planning and care in radiation accidents. This paper presents the scope and specific topics covered in the seminars, together with an analysis of. experience gained during development and presentation of the seminars. More recently the program has been expanded to encompass orientation of hospital administrators and other para-medical personnel on the handling and admittance of victims of radiation accidents. The latter problem is the subject of a new color film premiered at the Symposium. (author)
Shogo Kato; Satoko Tsuru; Yoshinori Iizuka
The establishment of a system for providing appropriate long-term care services for older people is a national issue in Japan, and it will likely become a worldwide issue in the years to come. Under Japanese Long-term Care Insurance System, long-term care is provided based on long-term care programs, which were designed by care providers on the basis of long-term care service plans, which were designed by care managers. However, defined methodology for designing long-term care service plans a...
Full Text Available Abstract Background Chronic disease management requires input from multiple health professionals, both specialist and primary care providers. This study sought to assess the impact of co-ordinated multidisciplinary care in primary care, represented by the delivery of formal care planning by primary care teams or shared across primary-secondary teams, on outcomes in stroke, relative to usual care. Methods A Systematic review of Medline, EMBASE, CINAHL (all 1990–2006, Cochrane Library (Issue 1 2006, and grey literature from web based searching of web sites listed in the CCOHA Health Technology Assessment List Analysis used narrative analysis of findings of randomised and non-randomised trials, and observational and qualitative studies of patients with completed stroke in the primary care setting where care planning was undertaken by 1 a multi-disciplinary primary care team or 2 through shared care by primary and secondary providers. Results One thousand and forty-five citations were retrieved. Eighteen papers were included for analysis. Most care planning took part in the context of multidisciplinary team care based in hospitals with outreach to community patients. Mortality rates are not impacted by multidisciplinary care planning. Functional outcomes of the studies were inconsistent. It is uncertain whether the active engagement of GPs and other primary care professionals in the multidisciplinary care planning contributed to the outcomes in the studies showing a positive effect. There may be process benefits from multidisciplinary care planning that includes primary care professionals and GPs. Few studies actually described the tasks and roles GPs fulfilled and whether this matched what was presumed to be provided. Conclusion While multidisciplinary care planning may not unequivocally improve the care of patients with completed stroke, there may be process benefits such as improved task allocation between providers. Further study on the impact
Nuclear Training Center (NTC) has concentrated its efforts on the systemization and specialization of education and training programs and has actively carried out diverse activities to create new nuclear courses based on its experience accumulated over the past years. The systematic and comprehensive education systems have been set up by streamlining the education systems for internal employees conducted sporadically over the past years. For the development of efficient education courses, expansion and diversification of education and training programs have been carried out based on the study of the Systematic Approach to Training (SAT) methodology and a survey of manpower development in on-site industry. Furthermore, despite the decrease in the number of potential trainees due to various government-enforced regulations and the increase in the number of other nuclear education institutions, the consistent efforts to develop new courses and to improve previous programs based on evaluations from the trainees have led to an upgrade in the level of education and the efficiency of the operation compared to previous years. In terms of development, 7 education programs were improved accordingly and 10 new courses were created. The year 2008 was especially considered a landmark, as NTC was authenticated as one of the best Human Resource Development (HRD) institutions for providing various kinds of education in the field of nuclear energy. Today, it is recognized as the leading HRD center in Korea
Nuclear Training Center (NTC) has concentrated its efforts on the systemisation and specialization of education and training and has actively carried out diverse activities to create new education courses based on the experience accumulated so far. The systematic and comprehensive education system(KAERI-ACE) has been set up by streamlining the education systems for internal employees conducted sporadically over the past year and expansion and diversification of education and training has been built through a study on Systematic Approach Training (SAT) methodology for the development of efficient education courses and a survey of manpower development in on-site industry. The 6 education programs have been developed and 18 courses were newly developed and improved. Especially to be noted in relation to education program development is that NTC has compiled and published a book titled 'Practical Research Ethics'. NTC has played a leading role in providing a research ethics education, in helping to promote the importance of research ethics by publishing a research ethics book and distributing them to government, research institutes, universities, etc. The total number of people who receive education for the year of 2007 was 2,998 and a total of 65 training courses were established and 106 times operated. The number of industry courses was 31, 56 times operated, and 1,309 persons participated and that nuclear R and D personnel education areas (internal employees' education) was 34 courses, 50 times operated, 2,689 persons participated
Nuclear Training Center (NTC) has concentrated its efforts on the systemisation and specialization of education and training and has actively carried out diverse activities to create new education courses based on the experience accumulated so far. The systematic and comprehensive education systems have been set up by streamlining the education systems for internal employees conducted sporadically over the past years and expansion and diversification of education and training has been built through a study on Systematic Approach to Training (SAT) methodology for the development of efficient education courses and a survey of manpower development in on-site industry. The 6 education programs have been developed and 15 courses were newly developed and improved. Especially to be noted in relation to education program development is that NTC has compiled and published a book titled 'current status of research ethics of science and technology and cases' and has also conducted a survey targeted at the 30 electric power/electricity industries related to nuclear power. The total number of people who receive education for the year of 2006 was 4,186 and a total of 130 training courses were established and 125 times operated. Among them, the number of collective education was 64 courses, 104 times operated and 3,190 persons participated while as for cyber education(on-line language education), 39 courses in 3 foreign language areas established, 21 times operated and 996 persons participated
The Abbreviated Pandemic Influenza Plan Template for Primary Care Provider Offices is intended to assist primary care providers and office managers with preparing their offices for quickly putting a plan in place to handle an increase in patient calls and visits, whether during the 2009-2010 influenza season or future influenza seasons.
Westman, Bodil; Cornelius, Birgitta
The Swedish National Cancerplan states that patients should be offered an Individual Care Plan (ICP) for the treatment and survivorship care and rehabilitation planning. As there is no web-solution for ICP available, the project aim is to develop a non-commercial web-solution based on communication between the contact nurse and the patient. PMID:27332410
Kwon, Sung Ae; Kolomer, Stacey
As ethical issues arise concerning the continuation of futile medical treatment for dying patients in Korean society, advance directive planning initiatives have been put into place to guide practice. This article describes the awareness and attitudes of social workers in Korea regarding advance care planning and related factors. A total of 246 gerontological/geriatric social workers completed a mailed or in-person survey regarding awareness and attitudes toward advance care planning. Seventy-three percent (n = 180) of the participants reported no knowledge of advance directives. Social workers who emphasized self-determination as a professional value, professed a preference for hospice care, and who were comfortable discussing death were more likely to have a positive attitudes toward advance care planning. This study reinforces the need for the infusion of advance care planning and end-of-life training in social work education in Korea. PMID:27428654
E. Prue, Christine; Daniel, Katherine Lyon
Social marketing approaches can help to shape the formation of and to create demand for preconception care services. This article describes four components of social marketing, often referred to as the 4 P’s, that should be carefully researched and set in place before a national effort to launch and sustain preconception care services is pursued. First, the product or package of services must be defined and adapted using the latest in scientific and health care standards and must be based on ...
Silvester, William; Parslow, Ruth A; Lewis, Virginia J; Fullam, Rachael S; Sjanta, Rebekah; Jackson, Lynne; White, Vanessa; Hudson, Rosalie
Objectives To report on the quality of advance care planning (ACP) documents in use in residential aged care facilities (RACF) in areas of Victoria Australia prior to a systematic intervention; to report on the development and performance of an aged care specific Advance Care Plan template used during the intervention. Design An audit of the quality of pre-existing documentation used to record resident treatment preferences and end-of-life wishes at participating RACFs; development and pilot ...
Full Text Available In this paper, the optimal planning of manpower training programmes in a manpower system with two grades is discussed. The planning of manpower training within a given organization involves a trade-off between training costs and expected return. These planning problems are examined through models that reflect the random nature of manpower movement in two grades. To be specific, the system consists of two grades, grade 1 and grade 2. Any number of persons in grade 2 can be sent for training and after the completion of training, they will stay in grade 2 and will be given promotion as and when vacancies arise in grade 1. Vacancies arise in grade 1 only by wastage. A person in grade 1 can leave the system with probability p. Vacancies are filled with persons in grade 2 who have completed the training. It is assumed that there is a perfect passing rate and that the sizes of both grades are fixed. Assuming that the planning horizon is finite and is T, the underlying stochastic process is identified as a finite state Markov chain and using dynamic programming, a policy is evolved to determine how many persons should be sent for training at any time k so as to minimize the total expected cost for the entire planning period T.
The Brazilian nuclear programme will require, by 1990, the installation of at least 10 000 MWe of nuclear power capacity, the implementation of the entire fuel cycle complex, and the creation of a reactor heavy components manufacturing industry and of a nuclear power plant engineering capability. It has been estimated that such a programme will have to employ until 1985, some 7000 to 8000 people at the engineering and technician levels. As a consequence, planning the manpower preparation and qualification, involving such large numbers, required not only thorough analyses of sectoral requirements but also careful consideration of depletion rates and losses during the training process. Taking this into account, the Universities and Technical Schools will need to graduate, in average, 450 - 550 additional engineers and technicians respectively per year during the next 10 years. For this purpose, the maximum possible use of the existing educational system in the country will refrain from excessive reliance upon external sources and strengthen the local infrastructure. Crash specialization courses have been developed, in conjunction with the Universities, to specifically comply with the requirements of the nuclear programme. Only in the case where no industrial experience can be provided in the country, on-the-job training in foreign firms is being considered. Training of nuclear power plant operators is also to be a local activity. An Operators Training Center, by using a plant simulator, is under implementation with a scheduled operational date in the early eighties. For the implementation of the nuclear manpower programme, Comissao Nacional de Energia Nuclear (CNEN) has been given the task of promoting and coordinating the nuclear academic education, whereas Empresas Nucleares Brasileiras S.A. (NUCLEBRAS) has the responsibility for the specialization and training of personnel in the nuclear technological fields
The Brazilian nuclear programme will require by 1990 the installation of at least 10000MW(e) of nuclear power capacity, the implementation of the entire fuel cycle complex, and the creation of a reactor heavy-components manufacturing industry and of a nuclear power plant engineering capability. It has been estimated that such a programme will have to employ, up to 1985, some 7000-8000 people at the engineering and technician levels. The paper summarizes the consequent planning for preparation and qualification of manpower, which, as it involved such large numbers, required not only thorough analyses of sectoral requirements but also careful consideration of depletion rates and losses during the training process. Taking this into account, the Universities and Technical Schools will need to graduate, on average, 450 additional engineers and 550 additional technicians per year during the next ten years. For this purpose, the maximum use of the existing educational system in Brazil will avoid excessive reliance on external sources and will strengthen the local infrastructure. Crash specialization courses have been developed, in conjunction with the Universities, to comply specifically with the requirements of the nuclear programme. Only when no industrial experience can be provided in the country is on-the-job training in foreign firms considered. Training of nuclear power plant operators is also to be a local activity. An Operators Training Centre, by using a plant simulator, is being implemented with a scheduled operational date in the early 1980s. To implement the nuclear manpower programme, the Comissao Nacional de Energia Nuclear has been given the task of promoting and co-ordinating the nuclear academic education, while Empresas Nucleares Brasileiras SA is responsible for specialization and training of personnel in nuclear technology. (author)
... cancer or end stage chronic illness accompanied by anorexia (lack of appetite) and cachexia (muscles wasting away ... care and administrative program support. Share this: Twitter Facebook Google Search for: Choosing a Hospice: 16 Questions ...
American Vocational Journal, 1977
The Manpower Division at the American Vocational Association (AVA) convention in Houston was concerned about youth unemployment and about the Comprehensive Employment and Training Act (CETA)--its problems and possibilities. The panel discussion reported here reveals some differing perspectives and a general consensus--that to improve their role in…
Heller, Kathryn Wolff; Avant, Mary Jane Thompson
Teachers need to maintain a safe, healthy environment for all their students in order to promote learning. However, there are additional considerations when students require health care procedures, such as tube feeding or clean intermittent catheterization. Teachers must effectively monitor their students and understand their roles and…
Moye, Jennifer; Langdon, Maura; Jones, Janice M.; Haggstrom, David; Naik, Aanand D.
Many patients and health care providers lack awareness of both the existence of, and treatments for, lingering distress and disability after treatment. A cancer survivorship wellness plan can help ensure that any referral needs for psychosocial and other restorative care after cancer treatment are identified.
Call Mañosa, S; Pujol Garcia, A; Chacón Jordan, E; Martí Hereu, L; Pérez Tejero, G; Gómez Simón, V; Estruga Asbert, A; Gallardo Herrera, L; Vaquer Araujo, S; de Haro López, C
An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy. PMID:27137415
Zhen-ming XIE; Hong-yan LIU
Objective To sum up the theory of quality care according to the experience of F.P. program in China.Methods The author summarized the QOC theory and draw on its experiences and strength in family planning program in China.Results The theory facilitated the earnest program of the population and family planning program during the tenth five-year plan period, benefited the realization of the innovation of system and mechanism in population and family planning work, and the creation of a nice population environment for the healthy social and economic development in China.Conclusion The development of QOC has displayed a conspicuous theory in China's family planning program.
Mary E. McNally
Full Text Available Research focusing on the introduction of daily mouth care programs for dependent older adults in long-term care has met with limited success. There is a need for greater awareness about the importance of oral health, more education for those providing oral care, and organizational structures that provide policy and administrative support for daily mouth care. The purpose of this paper is to describe the establishment of an oral care action plan for long-term care using an interdisciplinary collaborative approach. Methods. Elements of a program planning cycle that includes assessment, planning, implementation, and evaluation guided this work and are described in this paper. Findings associated with assessment and planning are detailed. Assessment involved exploration of internal and external factors influencing oral care in long-term care and included document review, focus groups and one-on-one interviews with end-users. The planning phase brought care providers, stakeholders, and researchers together to design a set of actions to integrate oral care into the organizational policy and practice of the research settings. Findings. The establishment of a meaningful and productive collaboration was beneficial for developing realistic goals, understanding context and institutional culture, creating actions suitable and applicable for end-users, and laying a foundation for broader networking with relevant stakeholders and health policy makers.
Malhotra, Chetna; Sim, David Kheng Leng; Jaufeerally, Fazlur; Vikas, Nivedita Nadkarni; Sim, Genevieve Wong Cheng; Tan, Boon Cheng; Ng, Clarice Shu Hwa; Tho, Pei Leng; Lim, Jingfen; Chuang, Claire Ya-Ting; Fong, Florence Hui Mei; Liu, Joy; Finkelstein, Eric A.
Background Despite the promise and popularity of advance care planning, there is insufficient evidence that advance care planning helps patients to meet their end-of-life care preferences, especially in Asian settings. Thus, the proposed study aims to assess whether patients with advanced heart failure who are receiving advance care planning have a greater likelihood of receiving end-of-life care consistent with their preferences compared to patients receiving usual care. Secondary objectives...
Hasan Salih Suliman Al-Qudah
Full Text Available United Nations Principles for Older Persons acknowledge five rights to elderly or older persons, these rights are the right of "independence, care, self, fulfillment, dignity, participation.The demographic Indication witnessed increasing trends in population pyramid at developed countries on aging rates world wide, especially in most of developing countries. So in order to address this growing dilemma at our civilized world its proved at statistics surveys, on current research work as it will try to expose to efforts the plans made by many Jordanian Civil &Governmental initiatives for facing this category for the purpose of providing high standards services at both health and social care services for elderly people and to help them reaching a self-realization, and to encourage them in developing their potential through resources available in different aspects of the community educationally, culturally, spiritually and even through recreational activities.The present study aims to identify current capabilities that available in serving elderly people at two main Nursing Home Centers in Jordan located in Amman. Its limitation to only two most serving accommodated numbers of elder's Nursing Home centers the first is: White Beds Society and the second is: Centre for Princess Muna older women Nursing homes / Orthodox Charity as both are largest and oldest of Nursing homes centers serving elderly.The research concluded many numerous results most important are: There shall specialized cooperation bodies in charge of deals with other institutions working in the field of aging society, as of governmental organizations, hospitals, accredited qualified manpower to deal with this deer category of our society.secondly. Assist homes for elderly in budgetary provisions of adequate budget to them.
Steinberg, Allen T
Changes to the U.S. health care system are here. As we think about how individuals will pay for health care--while actively employed and while retired--our experiences with 401(k) plans provide some valuable lessons. In order to support employees in this new health care world--a challenge arguably more daunting than the 401(k) challenge we faced 20 years ago--some very different types of support are needed. Employers should consider providing their employees with the resources to manage health care changes. PMID:26666089
Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J
People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population. PMID:27053406
Ellen D. Hoadley
Full Text Available Turbulent market conditions have forced the health care sector to re-examine its business and operational practices. Health care has become increasingly complex as decisions and planning are reframed in light of the current lagging economy, an increased demand for services, new global competition, and impending legislation reform. The stress is felt most keenly within the nation’s hospitals and consortia of health care facilities. Facility planning decisions are no exception. Hospital administrators are abandoning the once commonplace rules governing aging infrastructure renovations. Instead, administrators are basing decisions within their respective strategic context and are attempting to align buildings, services, personnel, and technology to an overall plan that looks at markets, operations, and finances as resources for competitive advantage. This paper reviews the strategic facilities planning literature and applies those best practices which support this organizational alignment for health care. An application in the mid-Atlantic demonstrates that hospital facilities, by design, need to support the current and future needs of health care delivery systems, while dated structures impede industry advances. Health care infrastructure improvements must proactively address technological, regulatory, and financial changes facing the sector.
Sockolow, Paulina; Bass, Ellen J; Eberle, Carl L; Bowles, Kathryn H
The re-hospitalization rate of homecare patients within 60 days of hospital discharge is 30%. Enhanced care planning based on better information may reduce this rate. However, very little is known about the homecare admission and care planning processes. The research team collected data during observations of three nursing visits to admit homecare patients in Camden NJ, and conducted thematic content analysis on these data. Human factors methods helped to identify nurse decision-making related to selection of the plan of care problems, non-nursing resources, and the nursing visit pattern. They identified how the electronic health record (EHR) assisted the nurse in visit pattern frequency decisions. Major themes that emerged included reduced efficiency due to use of redundant intra-team communication methods to augment EHR documentation, redundant documentation, and workarounds and reorganization of clinical workflow. PMID:27332156
Child Day Care Planning Project, Cleveland, OH.
This report describes the Child Day Care Planning Project, which was developed by private and public representatives to meet the needs for child care in Cuyahoga County, Ohio. The project consisted of five major components. The first component, the Data Project, documented the needs and resources of the community. The second component, the Quality…
Birken, Sarah A.; Mayer, Deborah K.; Weiner, Bryan J.
Survivorship care plans (SCPs) are intended to educate survivors and providers about survivors’ transition from cancer treatment to follow-up care. Using a survey of 23 cancer programs in the South Atlantic United States, we (1) describe the prevalence and barriers to SCP use and (2) assess relationships between SCP use and (a) barriers and (b) cancer program characteristics. Most cancer programs (86%) reported some SCP use; however, less than a quarter of cancer programs’ providers had ever ...
Collins, Sandra K; Collins, Kevin S
Health care organizations continue to be plagued by labor shortage issues. Further complicating the already existing workforce challenges is an aging population poised to retire en masse within the next few years. With fewer cohorts in the age group of 25 to 44 years (Vital Speeches Day. 2004:71:23-27), a more mobile workforce (Grow Your Own Leaders: How to Identify, Develop, and Retain Leadership Talent, 2002), and an overall reduction in the number of individuals seeking employment in the health care field (J Healthc Manag. 2003:48:6-11), the industry could be faced with an unmanageable number of vacant positions throughout the organization. Bracing for the potential impact of these issues is crucial to the ongoing business continuity of health care organization. Many health care organizations have embraced succession planning to combat the potential labor famine. However, the health care industry as a whole seems to lag behind other industries in terms of succession planning efforts (Healthc Financ Manage. 2005;59:64-67). This article seeks to provide health care managers with a framework for improving the systematic preparation of the next generation of managers by analyzing the succession planning process. The proposition of these models is to initiate and simplify the gap reduction between theoretical concepts and future organizational application. PMID:17992105
Full Text Available Abstract Background The Medical Home model recommends that Children with Special Health Care Needs (CSHCN receive a medical care plan, outlining the child’s major medical issues and care needs to assist with care coordination. While care plans are a primary component of effective care coordination, the creation and maintenance of care plans is time, labor, and cost intensive, and the desired content of the care plan has not been studied. The purpose of this qualitative study was to understand the usefulness and desired content of comprehensive care plans by exploring the perceptions of parents and health care providers (HCPs of children with medical complexity (CMC. Methods This qualitative study utilized in-depth semi-structured interviews and focus groups. HCPs (n = 15 and parents (n = 15 of CMC who had all used a comprehensive care plan were recruited from a tertiary pediatric academic health sciences center. Themes were identified through grounded theory analysis of interview and focus group data. Results A multi-dimensional model of perceived care plan usefulness emerged. The model highlights three integral aspects of the care plan: care plan characteristics, activating factors and perceived outcomes of using a care plan. Care plans were perceived as a useful tool that centralized and focused the care of the child. Care plans were reported to flatten the hierarchical relationship between HCPs and parents, resulting in enhanced reciprocal information exchange and strengthened relationships. Participants expressed that a standardized template that is family-centered and includes content relevant to both the medical and social needs of the child is beneficial when integrated into overall care planning and delivery for CMC. Conclusions Care plans are perceived to be a useful tool to both health care providers and parents of CMC. These findings inform the utility and development of a comprehensive care plan template as well as a model of how
Schubart, Jane R.; Levi, Benjamin H.; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J.
Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demon...
An examination is made of training programmes in the Federal Fisheries School, Lagos, detailing training objectives, manpower requirement and training strategies, indicating also areas for improvement and development
Auslander, Gail K.; Soskolne, Varda; Stanger, Varda; Ben-Shahar, Ilana; Kaplan, Giora
This study aimed to examine the implementation, adequacy, and outcomes of discharge planning. The authors carried out a prospective study of 1,426 adult patients discharged from 11 acute care hospitals in Israel. Social workers provided detailed discharge plans on each patient. Telephone interviews were conducted two weeks post-discharge. Findings…
Need for excellence in human performance in all activities involved in nuclear power - The challenge of providing qualified manpower when required - Planning and preparing nuclear power programmes and projects - Design, construction and commissioning of nuclear power plants - Operation and maintenance, plant performance - Safe, reliable and economic operation - the national manpower development effort - Role of foreign assistance and of the IAEA - The Agency's comprehensive programme, objectives, means - Experience - Training courses, guidebooks, standards - Current trends - Examples. (orig.)
... skilled nursing, physical therapy, speech-language pathology services, or occupational therapy visit in a... 42 Public Health 2 2010-10-01 2010-10-01 false Plan of care requirements. 409.43 Section 409.43 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...
LaCrosse, Lisa M.; Heermann, Judith; Azevedo, Karen; Sorrentino, Catherine; Straub, Dawn; O'Dowd, Gloria
The process for developing the nursing care planning (NCP) function for integration into a clinical information system (CIS) will be described. This NCP system uses evidence based order sets or interventions that are specific to a problem with associated patient focused goals or outcomes. The problem, order set, goal framework will eventually be used by all disciplines in the patient focused record.
Broyles, Ila H; Sperber, Nina R; Voils, Corrine I; Konetzka, R Tamara; Coe, Norma B; Van Houtven, Courtney Harold
Evolving family structure and economic conditions may affect individuals' ability and willingness to plan for future long-term care (LTC) needs. We applied life course constructs to analyze focus group data from a study of family decision making about LTC insurance. Participants described how past exposure to caregiving motivated them to engage in LTC planning; in contrast, child rearing discouraged LTC planning. Perceived institutional and economic instability drove individuals to regard financial LTC planning as either a wise precaution or another risk. Perceived economic instability also shaped opinions that adult children are ill-equipped to support parents' LTC. Despite concerns about viability of social insurance programs, some participants described strategies to maximize gains from them. Changing norms around aging and family roles also affected expectations of an active older age, innovative LTC options, and limitations to adult children's involvement. Understanding life course context can inform policy efforts to encourage LTC planning. PMID:26553887
Stevens, Lindsay M
A major health care goal in the United States is increasing the proportion of pregnancies that are planned. While many studies examine family planning from the perspective of individual women or couples, few investigate the perceptions and practices of health care providers, who are gatekeepers to medicalized fertility control. In this paper, I draw on 24 in-depth interviews with providers to investigate how they interpret and enact the objective to "plan parenthood" and analyze their perspectives in the context of broader discourses about reproduction, family planning, and motherhood. Interviews reveal two central discourses: one defines pregnancy planning as an individual choice, that is as patients setting their own pregnancy intentions; the second incorporates normative expectations about what it means to be ready to have a baby that exclude poor, single, and young women. In the latter discourse, planning is a broader process of achieving middle-class life markers like a long-term relationship, a good job, and financial stability, before having children. Especially illuminating are cases where a patient's pregnancy intention and the normative expectations of "readiness" do not align. With these, I demonstrate that providers may prioritize normative notions of readiness over a patient's own intentions. I argue that these negotiations of intention and readiness reflect broader tensions in family planning and demonstrate that at times the seemingly neutral notion of "planned parenthood" can mask a source of stratification in reproductive health care. PMID:26151389
Kubota, Gordon H.; Tsukahara, Theodore, Jr.
The objective of this study was to develop an economic approach to the forecasting of allied health manpower in markets in the State of California. The health manpower categories considered included: (1) Medical technology, (2) occupational therapy, (3) dietetic and nutritional services, (4) physical therapy, (5) health administration, (6)…
Association du personnel
The CERN staff turned out in force on Thursday to sign the Staff Association petition. The staff showed in a responsible manner its desire to keep staff numbers at a vital level to guarantee the future of the Organization.
The shared medication treatment plan is a key element for supporting the continuity of care. Indeed a substantial amount of emergency hospitalization is linked to medication - 5% to 10% according to some studies. Methods and tools helping all healthcare providers to have a better knowledge of the complete medication plan are therefore required in order to limit side effects linked to an insufficient knowledge of what the patient is taking. The workshop intends to present various initiatives and open the discussion about the limits, pros and cons of various initiatives. PMID:27332315
XudongLi; FengshengTu; YongjianLi; XiaoqiangCai
We consider a manpower planning problem with single employee type over a long planning horizon and analyze the optimal recruitment and dismissal polices. Dynamic demands for manpower must be fulfilled by allocating enough number of employees. Costs for every employee include salary, recruitment and dismissal costs, in particular, setup costs when recruitment/dismissal activities occur. We formulate the problem as a multi-period decision model. Then we analyze properties of the problem and give an improved dynamic programming algorithm to minimize the total cost over the entire planning horizon. We report computational results to illustrate the effectiveness of the approach.
Er-sheng GAO; Wei YUAN; Ning LIU
Objective To evaluate and overview the experience of quality care of family planning of China.Methods The framework of quality care of China was summarized and analyzed, that was clients, technology and management triangle program system.Results The 8 fundamental elements of quality care in China were presented:1) policy environment of QoC, 2) comprehensive services, 3) choice of method, 4) IEC to policy-makers and providers, 5) technical competence, 6) interpersonal communications, 7) institutional guideline and regulation, 8) appropriate constellation of service.Conclusion FP sectors should prepare different constellations of service to meet their individual reproductive health need for different clients and develop institutional guideline and regulation for FP service to follow up in practice. QoC should be a kind of standardized service process.
This paper discuses the social research and health care planning systems of South Asia. Also, the Author attempts to indicate the scope and nature of this work done in this territory to identity elements relevant to health care planning.
Kimberly Ramsbottom; Mary Lou Kelley
Long term care (LTC) homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP) important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descript...
In front-line practice, joint working between different professionals in health/social care and rehabilitation is regarded as a means to reach a comprehensive assessment of the needs of the older care recipients, leading to decisions on appropriate care and services. The aim of this study was to examine professional collaboration and professional boundaries in interprofessional care planning teams. Two different care planning teams were studied, one performing care planning in the homes of older individuals and the other performing care planning for older people in hospital wards. The empirical data consisted of audio-recorded care planning meetings and interviews with the professionals in the teams. The integration between the professionals involved was most noticeable in the investigation and assessment phase, while it was lower in the planning phase and almost non-existent in decision-making. The home care planning team tended to work in a more integrated manner than the discharge planning team. The importance of clarifying the roles of all professions concerned with needs assessment and care planning for older people became evident in this study. PMID:23343434
Sudore, Rebecca L.; Stewart, Anita L.; Knight, Sara J.; McMahan, Ryan D.; Feuz, Mariko; Miao, Yinghui; Barnes, Deborah E.
Introduction Advance directives have traditionally been considered the gold standard for advance care planning. However, recent evidence suggests that advance care planning involves a series of multiple discrete behaviors for which people are in varying stages of behavior change. The goal of our study was to develop and validate a survey to measure the full advance care planning process. Methods The Advance Care Planning Engagement Survey assesses “Process Measures” of factors known from Beha...
Determination of the manpower required for implementation of a nuclear programme is a very important factor from the national viewpoint, as it is drawn from many sectors of industry. The author provides a case-study of manpower requirements in France. He is in favour of the establishment of a manpower programme within the educational system, involving schools and universities since technicians and engineers have an important role to play throughout the different stages of a nuclear programme. In this context, he describes the IAEA contribution to acquisition of know-how by means of training courses for developing countries. (NEA)
The development of SMPRs could make it possible for countries with small electrical grids to use nuclear power. SMPRs are still in the developing stages and none of them have the capability of good plant performance. Most of the SMPRs are in the 300 MWe range and a grid capacity of at least 2000 MWe would be required before such a power plant can be connected to the grid. There is a possibility that SMPRs could generate electricity cheaper coal plants requiring desulphurization. An unexpected increase in coal price and adverse environmental effects could make it necessary to use nuclear power in the future. Qualified manpower is required to plan, build and properly operate a nuclear power plant; and the availability of qualified manpower is a pre-condition for deciding to use nuclear power. There is a possibility that Sri Lanka would be able to use nuclear power in the next 15-20 years and a total dependence upon foreign expertise is neither possible nor desirable. Therefore pre-project activities should be considering such things as teaching nuclear science and engineering in the universities and retraining existing professionals, say from the coal power industry. Adequate emphasis must be given to manpower development and to the need to scheduling this development
Whittaker, William; Birch, Stephen; MacKenzie, Adrian; Murphy, Gail Tomblin
The sustainability of publicly funded health care systems is an issue for governments around the world. The economic climate limits governments' fiscal capacity to continue to devote an increasing share of public funds to health care. Meanwhile the demands for health care within populations continue to increase. Planning the future requirements for health care is typically based on applying current levels of health service use by age to demographic projections of the population. But changes in age-specific levels of health over time would undermine this 'constant use by age' assumption. We use representative Canadian survey data (Canadian Community Health Survey) covering the period 2001-2012, to identify the separate trends in demography (population ageing) and epidemiology (population health) on self-reported health. We propose an approach to estimating future health care requirements that incorporates cohort trends in health. Overall health care requirements for the population increase as the size and mean age of the population increase, but these effects are mitigated by cohort trends in health-we find the estimated need for health care is lower when models account for cohort effects in addition to age effects. PMID:26586614
Siegrist, R B; Blish, C S
Advantages and pharmacy applications of computerized hospital management-control and planning systems are described. Hospitals must define their product lines; patient cases, not tests or procedures, are the end product. Management involves operational control, management control, and strategic planning. Operational control deals with day-to-day management on the task level. Management control involves ensuring that managers use resources effectively and efficiently to accomplish the organization's objectives. Management control includes both control of unit costs of intermediate products, which are procedures and services used to treat patients and are managed by hospital department heads, and control of intermediate product use per case (managed by the clinician). Information from the operation and management levels feeds into the strategic plan; conversely, the management level controls the plan and the operational level carries it out. In the system developed at New England Medical Center, Boston, Massachusetts, the intermediate product-management system enables managers to identify intermediate products, develop standard costs, simulate changes in departmental costs, and perform variance analysis. The end-product management system creates a patient-level data-base, identifies end products (patient-care groupings), develops standard resource protocols, models alternative assumptions, performs variance analysis, and provides concurrent reporting. Examples are given of pharmacy managers' use of such systems to answer questions in the areas of product costing, product pricing, variance analysis, productivity monitoring, flexible budgeting, modeling and planning, and comparative analysis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3284338
Promotion of a health care provider's services is essential for communication with its customers and consumers. It is relevant to an organization's marketing strategy and is an element of what is described as the marketing mix. This paper considers the relationship of promotion to the marketing of services and proposes a plan for the promotion of the organization as a whole which can also be applied to an individual service or specialty. Whilst specific reference is made to an National Health Service (NHS) Trust it is also relevant to a Directly Managed Unit. PMID:7952707
At the start of the Agency's technical co-operation activities in 1958, many of its developing Member States were just embarking on nuclear activities. To make basic nuclear training available for these countries became the first concern of the Agency and initially fellowships constituted more than 80% of the assistance provided. During the 1960s, while the programmes' expert and equipment components grew steadily, fellowships still represented more than 50% of the assistance provided to individual Member States. As counterpart institutions slowly build up small cadres of qualified staff, the share of training in the Agency's programme of technical co-operation became less dominant and, by 1986, only 22% of the funds spent on country programmes were devoted to fellowships. In the Africa region, where the share of fellowship training provided to individual Member States had dropped even below the 20% mark, and where the participation in group training events was the lowest of any region, this was having serious consequences on manpower development, as was pointed out in two separate evaluations. At least some opportunities exist in about 60% of the countries in the region for training in selected areas of nuclear science and technology, but only 20% of the countries provide training up to the MSc/PhD level. The number of trainees in nuclear science and technology graduating each year from national institutions is very small and cannot be considered adequate to satisfy existing manpower needs of the country concerned and of the region as a whole. Very few - if any - opportunities for nuclear training abroad are available for candidates from the region other than those funded by the Agency. There is very little awareness at the national level as to the actual training needs in the nuclear field in most countries of the region, underlining the importance of the role of the Agency, not only as a provider of training, but also as an adviser on assessing training needs at
Ackermann, Richard J
Advance directives are legal documents that give instructions about how to provide care when patients develop life-threatening illnesses and can no longer communicate their wishes. Two types of documents are widely used-a living will and a durable power of attorney for health care. Most states also authorize physician orders for life-sustaining treatment. Physicians should encourage patients, particularly those with severe chronic or terminal conditions, to prepare advance directives. Medicare now reimburses billing codes for advance care consultations. Directions regarding cardiopulmonary resuscitation and artificial ventilation often are included in advance care plans, and use of artificial nutrition and hydration (ANH) also should be addressed, particularly for patients with advanced dementia. Evidence shows that in such patients, ANH does not prolong survival, increase comfort, or improve quality of life. Given the lack of benefit, physicians should recommend against use of ANH for patients with dementia. Finally, physicians should encourage use of hospice services by patients whose life expectancy is 6 months or less. Although Medicare and most other health care insurers cover hospice care, and despite evidence that patient and family satisfaction increase when hospice services are used, many patients do not use these services. PMID:27490070
Peters, Rosalind M.; Templin, Thomas N
The theory of planned behavior (TPB) was integrated within the theory of self-care (SCT) to explore the predictive value of extending TPB to measure attitudes and beliefs regarding a behavioral goal, and determine the ability of goal beliefs to predict engagement in the combined, multiple behaviors necessary to control BP. The hypothesized model was evaluated in a sample of 306 community-dwelling African Americans between 21 and 65 years of age. Scales developed for the study achieved accepta...
A methodology is described for planning the training capability required during nuclear power plant operation to meet future manpower needs. The methodology involves the identification of the appropriate initial training programs and requalification training programs for each job position, and the computation of student throughput rates for each program. Application of the methodology to a subset of all job positions in a typical utility organization shows that minimum training costs may be achieved when the utility's training investment is minimized by using outside assistance from qualified training sources for certain training functions
Allen, Rebecca S.; DeLaine, Shermetra R.; Chaplin, William F.; Marson, Daniel C.; Bourgeois, Michelle S.; Dijkstra, Katinka; Burgio, Louis D.
Purpose: The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. Design…
The present paper deals with the need for trained manpower and special features of nuclear power affecting manpower requirements and gives a manpower loading schedule for the different nuclear power activities and programmes for manpower development. (orig./RW)
Abortion coverage under various health care reform proposals has dominated the political reproductive rights debate, while poor women's access to abortion under Medicaid presents a current practical concern. Under the Clinton administration's proposed Health Security Act, abortion would be covered under "services for pregnant women," and Medicaid would eventually be incorporated into the national health plan. A final version is a long way off. For now, the Hyde amendment, limiting Medicaid coverage of abortion, controls the issue. Congress has made only negligible progress in freeing federal funds for Medicaid abortions: only in situations of life endangerment, rape, or incest. States are required to cover abortions that are medically necessary under the new guidelines, which now include pregnancy arising from rape and incest. The federal policy defers to state law on the definition of rape and incest, allowing for reasonable reporting or documentation requirements, while disallowing unduly burdensome regulations by allowing the treating physician reimbursement when the physician certifies that the patient was unable for physical or psychological reasons to comply with the requirement. States disagreeing with the new abortion policy immediately registered their opposition. Utah's health department, which has a "life only" law, has pledged not to implement the new federal policy until there is further clarification. The Health Care Financing Administrator responded by writing that "the decision to implement this policy nationwide was not discretionary." Congress chose not to add statutory language deferring to the states, and under U.S. Constitutional law, where state law or policy conflicts with federal law, federal law takes precedence. The next battle will certainly center on attempts to amend the Hyde amendment itself as well as health care legislation along the "states' option" lines. PMID:12345518
Dixon, Josie; Matosevic, Tihana; Knapp, Martin
Background: Advance care planning (ACP), a process of discussion and review concerning future care in the event of losing capacity. Aimed at improving the appropriateness and quality of care, it is also often considered a means of controlling health spending at the end of life. Aim: To review and summarise economic evidence on advance care planning. Design: A systematic review of academic literature. Data sources: We searched for English language peer-reviewed journal articles, 1990 to 201...
Schubart, Jane R; Levi, Benjamin H; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J
Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83-0.95, and 0.86-0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time. PMID:22512830
Levi, Benjamin H.; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J
Abstract Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83–0.95, and 0.86–0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time. PMID:22512830
As technology transfer is one of the main objectives of the Brazilian Nuclear Program, the principal aim of manpower training has been to provide the conditions for absorbing this technology. The strategy used for such a program required a quantitative and qualitative planning of manpower needs, through medium-range and long-term forecasts, with the condition of maximum utilization of the existing educational infra-structure. On-the-job training which is considered one of the most important means for technology transfer, was given highest priority. Also, management development was considered very important for the implementation of the Nuclear Program. This paper shows the results achieved from 1973 up to now by the manpower training and development programs. (Author)
Nauta, N.J.; Perenboom, R.J.M.; Galindo Garre, F.
Since the devolution of capacity planning for care for the elderly in the Netherlands in 1998, no innovations on assessing health needs and on forecasting were made for planning health care services for the elderly. The introduction of Horizon in 2006, which uses needs and deficiencies instead of linear demographic planning has been warmly welcomed. The innovation is to step away from planning on the basis of policies and to forecast demands of services on the basis of actual deficiencies and...
Lum, Hillary D; Sudore, Rebecca L
This article provides an approach to advance care planning (ACP) and goals of care communication in older adults with cardiovascular disease and multi-morbidity. The goal of ACP is to ensure that the medical care patients receive is aligned with their values and preferences. In this article, the authors outline common benefits and challenges to ACP for older adults with cardiovascular disease and multimorbidity. Recognizing that these patients experience diverse disease trajectories and receive care in multiple health care settings, the authors provide practical steps for multidisciplinary teams to integrate ACP into brief clinic encounters. PMID:27113144
Adams, Forrest H., Ed.; Mendenhall, Robert C., Ed.
Begun in June, 1971 and completed in October 1973, the study had the following specific goals: to define the cardiologist's role; to determine cardiology training program objectives; to determine manpower needs for cardiologists; and to determine the educational needs of cardiologists. The major information was sought from all active cardiologists…
Amberson, Max L.; And Others
A final segment of the Montana research effort on agri-business manpower, this report summarizes the methods involved in and the conclusions and recommendations resulting from a study to develop an economical, efficient, and effective method of assessing current and anticipated agri-business employment opportunities and educational needs in…
Callen, John; And Others
The profile is a concise description of the demographic and economic characteristics, existing health manpower employed, and health education programs for the Yellowstone County area of Montana, one of seven surveyed in the Mountain States region (Idaho, Montana, Wyoming, and Nevada). The first section of the profile provides general population…
"India is supplying critical scientific manpower and high-tech components needed for building a Large Hadron Collider (LHC) - an accelerator used in particle physics research - a mega scientific project of the European Organisation for Nuclear Research (CERN) worth billions of dollars" (1/2 page).
Mann, J; Gat, E; Lubliner, D; Malowanczyk, C; Shwatz, C; Zusman, S; Ela, K
In the 1980s three studies were conducted in Israel utilising different methods of dental manpower evaluations. All identified a large future surplus of dentists. The current study re-evaluates the manpower supply and discusses possible solutions. A random sample of 800 dentists was approached by three mailings and a telephone call follow-up with a response of 49.7 per cent. Almost 90 per cent of dentists reported an undersupply of patients, with a mean working load of 26.3 hours/week, but being willing to add up to 3.4 working hours/week. The oversupply of dentists has been dramatically affected by the addition of almost 1000 dentists who emigrated to Israel in 1991-92. To prevent a significant unemployment rate among dentists and an uncontrolled free market, it is urgently suggested for the benefit of both provider and consumer that; the demand for services be increased and additional financing of dental care be made available, that the total number of dentists be decreased by various measures and that their geographical distribution be improved. If necessary limits should be placed on the number of practices or the number of patients permitted per practice. PMID:8276515
... reviewed by a physician, or by a physical therapist or speech pathologist respectively. (a) Standard.... (1) For each patient there is a written plan of care established by the physician or by the physical therapist or speech-language pathologist who furnishes the services. (2) The plan of care for...
El-mouelhy, M T
The Government of Egypt is introducing policies to reduce the mortality of women of reproductive age. However, family planning and maternal-child health care programs are unlikely to have the desired impact without corresponding improvements in the status of Egyptian women. Women's status in the areas of education, health, poverty, employment, the family, government, and the community is a crucial determinant of their willingness and ability to accept a smaller family size ideal and become contraceptive users. At present, only 6% of Egyptian women are a part of the work force and 60% are illiterate. In a society in which women are valued on the basis of the number of children they produce for their husbands, those practice birth control risk abandonment and isolation. The powerlessness and insecurity that lead Egyptian women to have an average of at least 5 children impeded national development and thus delay creation of the socioeconomic conditions that could liberate women from their domestic role. Equal opportunities in education and employment would represent a first step toward improving women's status by giving them a source of income and increased independence. Also needed are modifications in archaic marriage, divorce, and custody laws. PMID:12317075
Rajguru. S. A
There is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations. In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious, or other coordinate bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often e...
Ana María Ruiz Galán
Full Text Available Personality is unique for each individual and can be defined as the dynamic collection of characteristics relative to emotions, thought and behaviour.Personality trout’s only mean a Personality Disorder (PD when they are inflexible and maladjusted and cause notable functional deterioration or uneasiness.According to Bermudez personality is “the enduring organization of structural and functional features, innate and acquired under the special conditions of each one’s development that shape the particular and specific collection of behaviour to face different situations”.According to the Diagnostic a Statistical Manual of Mental Disorders (DSM-IV, a Personality Disorder is “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the person’s culture is pervasive and an inflexible, is stable over time and leads to distress or impairment. The onset of these patterns of behaviour is the beginning of the adulthood and, in rare instances, early adolescence”.There are several types of Personality Disorders (paranoid, schizoid, borderline, antisocial, dependent…. Dependent Personality Disorder is one of the most frequent in the Mental Health Services.People who suffer from this disorder are unable to take a decision by themselves because they don’t have confidence in themselves. They need a lot of social support and affection until the point of deny their individuality by subordinating their desires to other person’s desires and permitting these persons to manage their lives. Maybe they feel desolated by separation and loss and can support any situation, even maltreatment to keep a relationship.As we a deduce this diagnosis is sensible to cultural influences. This work aims to elaborate an standarized plan of cares for the patient with Dependent Personality Disorder by using nursing Diagnosis of NANDA II, Outcomes Criteria (NOC and Interventions Criteria (NIC.
Stein, G L; Bonuck, K A
Gay men and lesbians have special interests in documenting their preferences regarding advance care planning and end-of-life care. A 64-item survey instrument was developed to ascertain the preferences of this community regarding approaches to end-of-life care, viewpoints on physician-assisted suicide (PAS) and euthanasia, and practices regarding advance care planning. The survey was completed by 575 participants recruited through community-based health care and social service organizations serving the lesbian and gay community, primarily in the New York metropolitan area. Respondents represent a diverse group of women (36%) and men (63%) from various age, racial/ethnic, and religious/spiritual backgrounds; 10% were human immunodeficiency virus (HIV)-positive. Respondents' perspectives on end-of-life care are generally consistent with findings from other attitudinal studies of U.S. adults: a majority supported legalization of PAS and preferred a palliative approach to end-of-life care. However, the gay community sample revealed even stronger support for assisted suicide and palliative care. Although respondents completed advance directives at a higher rate than adults generally, the legal importance for gay men and lesbians to execute directives should encourage health care providers and community organizations to assume a larger educational role on advance care planning. Results confirm other reports on the need to address provider communication skills. It is speculated that the HIV epidemic was a major influence behind these results because of the overwhelming personal impact of the epidemic on most gay men and lesbians during the past two decades. PMID:11441626
Full Text Available Long term care (LTC homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descriptive study conducted 34 individual semistructured interviews in two LTC homes, located in Canada. The participants were 31 family members and three staff, consisting of a front line care worker, a registered nurse, and a nurse practitioner. All participants perceived ACP conversations as valuable to provide “resident-centred care”; however, none of the participants had a good understanding of ACP, limiting its effectiveness. Strategies generated through the research to improve ACP were as follows: educating families and staff on ACP and end-of-life care options; better preparing staff for ACP conversations; providing staff skills training and guidelines; and LTC staff initiating systematic, proactive conversations using careful timing. These strategies can guide quality improvement of palliative care and development of ACP tools and resources specific to the LTC home sector.
Canabarro, Simone Travi; Velozo, Kelly Dayane Stochero; Eidt, Olga Rosária; Piva, Jefferson Pedro; Garcia, Pedro Celiny Ramos
This study aims to describe, through an integrative review of literature, the historical trajectory of therapeutic intervention scores with emphasis on Nine Equivalents of Nursing Manpower Use Score in Intensive Care Units. The descriptors "Intensive care units" and "scales" were looked up in publications issued between 2000 and 2009. The terms selected were: "Nine Equivalents of Nursing Manpower Use Score" or "NEMS", "Unidade de Terapia Intensiva", "Therapeutic Intervention Scoring System-76", "Therapeutic Intervention Scoring System-28 or "TISS-28". As to the publications, "Medical Literature Analysis and Retrieval System Online" (MEDLINE) and "Literatura Latino-Americana e do Caribe em Ciências da Saúde" (LILACS) were selected Among the 295 papers reviewed, 18 were chosen, of which 55,5% were in English. The studies deal with NEMS (33,3%), Therapeutic Intervention Scoring System-76 (11,1%), TISS-28 (33,3%), among others. Research emphasized that NEMS has been a useful, operational and succinct tool. PMID:21574347
Simpson, A; Bannigan, B.; Coffey, M.; Barlow, S.; Cohen, R.; Jones, A.; Všetečková,, J.; Faulkner, A.; Thornton, A; Cartwright, M
Background: In the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require service users to have a care coordinator, written care plan and regular reviews of their care. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in ...
Simpson, Alan; Hannigan, Ben; Coffey, Michael; Barlow, Sally; Cohen, Rachel; Jones, Aled; Všetečková, Jitka; Faulkner, Alison; Thornton, Alexandra; Cartwright, Martin
Background In the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require service users to have a care coordinator, written care plan and regular reviews of their care. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in c...
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The availability of adequately qualified manpower is the major challenge of the nation's power programme. Without qualified manpower, no nuclear power plant can be planned, built or operated properly. It is estimated that about 800 - 1000 personnel would be needed for the successful operation of the planned 1000MW nuclear power plant in Nigeria. Presently, the country has only a handful of nuclear professionals, and thus the need for an increase in human capital development efforts cannot be overemphasized. This paper examined the existing organisational, educational and industrial structure in terms of capacity building and access to and transfer of nuclear knowledge. It recommended strategies based on lessons learnt and good practices elsewhere that will catalyze the development of knowledge and human resources needed for the nuclear power programme.
Brodsky, Karen L.; Baron, Richard J.
Medicaid managed care is delivered through organizations operating in very heterogeneous environments that confront similar barriers to success. Because Medicaid managed care is implemented differently in each state, health plans have been isolated from each other and have not had an opportunity to learn how others may have surmounted commonly encountered barriers. After interviewing Medicaid health plan medical directors, we developed a learning collaborative model based on shared categories...
Andreassen, Pernille; Neergaard, Mette Asbjørn; Brogaard, Trine; Skorstengaard, Marianne Hjorth; Jensen, Anders Bonde
OBJECTIVE: Advance care planning (ACP) discussions are emphasized as a valuable way of improving communication about end-of-life care. Yet we have very little knowledge of what goes on during actual ACP discussions. The aim of our study was to explore how the sensitive topics of end-of-life decis...
The possible occurrence of accidents involving sources of ionizing radiation calls for response plans to mitigate the consequences of radiological accidents. An emergency planning framework is suggested for institutions which use medical applications of ionizing radiation. Bearing in mind that the prevention of accidents is of prime importance in dealing with radioactive materials and other sources of ionizing radiation, it is recommended that emergency instructions and procedures address certain aspects of the causes of these radiological events. Issues such as identification of radiological events in medical practices and their consequences, protective measures, planning for an emergency response and maintenance of emergency capacity are considered. (author)
Hailemariam, M; Fekadu, A.; Selamu, M; Alem, A.; Medhin, G; Giorgis, TW; DeSilva, M.; Breuer, E
Background Scaling up mental healthcare through integration into primary care remains the main strategy to address the extensive unmet mental health need in low-income countries. For integrated care to achieve its goal, a clear understanding of the organisational processes that can promote and hinder the integration and delivery of mental health care is essential. Theory of Change (ToC), a method employed in the planning, implementation and evaluation of complex community initiatives, is an i...
De Vleminck, Aline; Pardon, Koen; Beernaert, Kim; Houttekier, Dirk; Vander Stichele, Robert; Deliens, Luc
Objectives To explore how GPs conceptualise advance care planning (ACP), based on their experiences with ACP in their practice. Methods Five focus groups were held with 36 GPs. Discussions were analysed using a constant comparative method. Results Four overarching themes in the conceptualisations of ACP were discerned: (1) the organisation of professional care required to meet patients’ needs, (2) the process of preparing for death and discussing palliative care options, (3) the discussion of...
Anne E. Hall
I estimate the welfare, both gross and net, provided by the Medicare managed care program in 1999 through 2002. First, I estimate a model of demand for the benefits offered by managed care plans to Medicare beneficiaries. I then use the demand estimates to form estimates of welfare provided by the program. Medicare beneficiaries derived $14.9 billion of gross welfare per year from the Medicare HMO program. Depending on the amount of selection in the program, the Medicare managed care program ...
Gristina, Giuseppe R; Orsi, Luciano; Carlucci, Annalisa; Causarano, Ignazio R; Formica, Marco; Romanò, Massimo
In Italy the birth rate decrease together with the continuous improvement of living conditions on one hand, and the health care progress on the other hand, led in recent years to an increasing number of patients with chronic mono- or multi-organ failures and in an extension of their life expectancy. However, the natural history of chronic failures has not changed and the inescapable disease's worsening at the end makes more rare remissions, increasing hospital admissions rate and length of stay. Thus, when the "end-stage" get close clinicians have to engage the patient and his relatives in an advance care planning aimed to share a decision making process regarding all future treatments and related ethical choices such as patient's best interests, rights, values, and priorities. A right approach to the chronic organ failures end-stage patients consists therefore of a careful balance between the new powers of intervention provided by the biotechnology and pharmacology (intensive care), both with the quality of remaining life supplied by physicians to these patients (proportionality and beneficence) and the effective resources rationing and allocation (distributive justice). However, uncertainty still marks the criteria used by doctors to assess prognosis of these patients in order to make decisions concerning intensive or palliative care. The integrated care pathway suggested in this position paper shared by nine Italian medical societies, has to be intended as a guide focused to identify end-stage patients and choosing for them the best care option between intensive treatments and palliative care. PMID:24553592
Examines the roles and influence of grandmothers with respect to nutrition, breastfeeding, quality of child care and family planning usage; the maternal grandmother is much more involved with grandchildren than the paternal grandmother. Accordingly this category may be a target for programmes and activities to promote child welfare and family planning.
Hudson, Lucy; Almeida, Connie; Bentley, Dawn; Brown, Josie; Harlin, Daria; Norris, Judy
Family reunification is not always possible for children who have been removed from the care of their biological parents because of abuse or neglect. Concurrent planning puts into place a secondary plan for a permanent home should family reunification prove to be impossible. Working in four diverse communities around the country in an innovative…
POLLIARD, FORBES W.
TO DETERMINE THE FEASIBILITY OF A STUDY, MEETINGS WERE HELD WITH GROUPS INCLUDING PATHOLOGISTS, RADIOLOGISTS, AND COMMUNITY HEALTH AND EDUCATIONAL LEADERS, 30 ADDITIONAL PERSONS CONCERNED WITH HEALTH SERVICES AND EDUCATION WERE INTERVIEWED, DISCUSSIONS WERE HELD WITH OTHER GROUPS AND INDIVIDUALS INTERESTED IN HEALTH MANPOWER RESEARCH AND PLANNING,…
The current study assessed the role of health care provider constraints and perceived consequences on plan complexity for conversations with patients about end-of-life care. Meta-goal constraints, perceived consequences associated with conversational engagement and planning theory provides the basis for research questions and hypotheses posed. Findings suggested that while the meta-goals of efficiency and politeness were each recognized as important, providers indicated greater concern for politeness during patient interactions concerning treatment options. Reported constraints had no impact on plan complexity. Perceived consequences of conversational engagement were predominantly positive and concerned the patient. Findings may enhance the understanding of social workers in their educational role regarding the potential training needs of health care team members in palliative care contexts. PMID:26654064
The \\'Let Me Decide\\' Advance Care Planning (LMD-ACP) programme offers a structured approach to End-of-Life (EoL) care planning in long-term care for residents with and without capacity to complete an advance care directive\\/plan. The programme was implemented in three homes in the South of Ireland, with a view to improving quality of care at end of life. This paper will present an evaluation of the systematic implementation of the LMD-ACP programme in the homes.
This annex deals with manpower and documentation. Several initiatives were implemented during the suspension period to preserve manpower and documentation at Angra 2 NPP. They have paid off and construction of the NPP was resumed with relatively little unexpected difficulties. This annex outlines the essentials of these initiatives. (author)
Recently, the resource management of nuclear engineering manpower has become an important issue in Korean nuclear industry. The government's plan for increasing the number of domestic nuclear power plants and the recent success of nuclear power plant export to UAE (United Arab Emirates) will increase demand for nuclear engineers in Korea. Accordingly, the Korean government decided to supplement 2,246 engineers in the public sector of nuclear industry in the year 2010 to resolve the manpower shortage problem in the short term. However, the experienced engineers which are essentially important in the nuclear industry cannot be supplied in the short term. Therefore, development of the long term manpower demand forecast model of nuclear industry is needed. The system dynamics (SD) is useful method for forecasting nuclear manpower demand. It is because the time-delays which is important in constructing plants and in recruiting and training of engineers, and the feedback effect including the qualitative factor can be effectively considered in the SD method. Especially, the qualitative factor like 'Productivity' is very important concept in Human Resource Management (HRM) but it cannot be easily considered in the other methods. In this paper, the concepts of the nuclear manpower demand forecast model using the SD method are presented and the some simulation results are being discussed especially for the 'Operation Sector'
Bollig, Georg; Gjengedal, Eva; Rosland, Jan Henrik
Background: Residents living in long-term care facilities are a vulnerable population. For many residents, a nursing home is their place of death. Palliative care and end-of-life decisions are important components of their care provision. Aim: To study the views of cognitively able residents and relatives on advance care planning, end-of-life care, and decision-making in nursing homes. Design: A qualitative study with in-depth interviews with nursing home residents and focus group inter...
Tsiachristas, Apostolos; Lionis, Christos; Yfantopoulos, John
The health, social and economic impact of chronic diseases is well documented in Europe. However, chronic diseases threaten relatively more the 'memorandum and peripheral' Eurozone countries (i.e., Greece, Spain, Portugal and Ireland), which were under heavy recession after the economic crisis in 2009. Especially in Greece, where the crisis was the most severe across Europe, the austerity measures affected mainly people with chronic diseases. As a result, the urgency to tackle the threat of chronic diseases in Greece by promoting public health and providing effective chronic care while flattening the rising health care expenditure is eminent. In many European countries, integrated care is seen as a means to achieve this. The aim of this paper was to support Greek health policy makers to develop an action plan from 2015 onwards, to integrate care by bridging local policy context and needs with knowledge and experience from other European countries. To achieve this aim, we adopted a conceptual framework developed by the World Health Organization on one hand to analyse the status of integrated care in Greece, and on the other to develop an action plan for reform. The action plan was based on an analysis of the Greek health care system regarding prerequisite conditions to integrate care, a clear understanding of its context and successful examples of integrated care from other European countries. This study showed that chronic diseases are poorly addressed in Greece and integrated care is in embryonic stage. Greek policy makers have to realise that this is the opportunity to make substantial reforms in chronic care. Failing to reform towards integrated care would lead to the significant risk of collapse of the Greek health care system with all associated negative consequences. The action plan provided in this paper could support policy makers to make the first serious step to face this challenge. The details and specifications of the action plan can only be decided by
Full Text Available The health, social and economic impact of chronic diseases is well documented in Europe. However, chronic diseases threaten relatively more the ‘memorandum and peripheral’ Eurozone countries (i.e., Greece, Spain, Portugal and Ireland, which were under heavy recession after the economic crisis in 2009. Especially in Greece, where the crisis was the most severe across Europe, the austerity measures affected mainly people with chronic diseases. As a result, the urgency to tackle the threat of chronic diseases in Greece by promoting public health and providing effective chronic care while flattening the rising health care expenditure is eminent. In many European countries, integrated care is seen as a means to achieve this.The aim of this paper was to support Greek health policy makers to develop an action plan from 2015 onwards, to integrate care by bridging local policy context and needs with knowledge and experience from other European countries. To achieve this aim, we adopted a conceptual framework developed by the World Health Organization on one hand to analyse the status of integrated care in Greece, and on the other to develop an action plan for reform. The action plan was based on an analysis of the Greek health care system regarding prerequisite conditions to integrate care, a clear understanding of its context and successful examples of integrated care from other European countries. This study showed that chronic diseases are poorly addressed in Greece and integrated care is in embryonic stage.Greek policy makers have to realise that this is the opportunity to make substantial reforms in chronic care. Failing to reform towards integrated care would lead to the significant risk of collapse of the Greek health care system with all associated negative consequences. The action plan provided in this paper could support policy makers to make the first serious step to face this challenge. The details and specifications of the action plan
Violeta Radulescu; Iuliana Cetina; Gheorghe Orzan
The integration of marketing in the field of health care, starting with the 50’s, was accompanied by a series of controversies generated by the ethical and moral aspects that this type of services imply, as well as by the difficulty in determining exactly the demand, the unequal access to information of participants, the regulated mechanism for the establishment of prices and of rates and the intervention of the third party payer, the significant role of the state in ensuring the fair access ...
Full Text Available To survey the recent medical literature reporting effects of intensive care unit (ICU design on patients’ and family members’ well-being, safety and functionality. Features of ICU design linked to the needs of patients and their family are single-rooms, privacy, quiet surrounding, exposure to daylight, views of nature, prevention of infection, a family area and open visiting hours. Other features such as safety, working procedures, ergonomics and logistics have a direct impact on the patient care and the nursing and medical personnel. An organization structured on the needs of the patient and their family is mandatory in designing a new intensive care. The main aims in the design of a new department should be patient centered care, safety, functionality, innovation and a future-proof concept.
Goh, James C H
The Biomedical Sciences (BMS) Cluster is one of four key pillars of the Singapore economy. The Singapore Government has injected research funding for basic and translational research to attract companies to carry out their commercial R&D activities. To further intensify the R&D efforts, the National Research Foundation (NRF) was set up to coordinate the research activities of different agencies within the larger national framework and to fund strategic R&D initiatives. In recent years, funding agencies began to focus on support of translational and clinical research, particularly those with potential for commercialization. Translational research is beginning to have traction, in particular research funding for the development of innovation medical devices. Therefore, the Biomedical Sciences sector is projected to grow which means that there is a need to invest in human capital development to achieve sustainable growth. In support of this, education and training programs to strengthen the manpower capabilities for the Biomedical Sciences industry have been developed. In recent years, undergraduate and graduate degree courses in biomedical engineering/bioengineering have been developing at a rapid rate. The goal is to train students with skills to understand complex issues of biomedicine and to develop and implement of advanced technological applications to these problems. There are a variety of career opportunities open to graduates in biomedical engineering, however regardless of the type of career choices, students must not only focus on achieving good grades. They have to develop their marketability to employers through internships, overseas exchange programs, and involvement in leadership-type activities. Furthermore, curriculum has to be developed with biomedical innovation in mind and ensure relevance to the industry. The objective of this paper is to present the NUS Bioengineering undergraduate program in relation to manpower development for the biomedical
Full Text Available Jorunn Bjerkan,1,2 Solfrid Vatne,3 Anne Hollingen4 1Norwegian Research Centre for Electronic Health Records (EHR, Medical Faculty, Norwegian University of Science and Technology, Trondheim, 2Faculty of Health Science, Nord-Trøndelag University College, Levanger, 3Faculty of Health Science, Molde University College, 4Møre og Romsdal Hospital Trust, Molde, Norway Background and objective: The Individual Care Plan (ICP was introduced in Norway to meet new statutory requirements for user participation in health care planning, incorporating multidisciplinary and cross-sector collaboration. A web-based solution (electronic ICP [e-ICP] was used to support the planning and documentation. The aim of this study was to investigate how web-based collaboration challenged user and professional roles. Methods: Data were obtained from 15 semistructured interviews with users and eight with care professionals, and from two focus-group interviews with eight care professionals in total. The data were analyzed using systematic text condensation in a stepwise analysis model. Results: Users and care professionals took either a proactive or a reluctant role in e-ICP collaboration. Where both user and care professionals were proactive, the pairing helped to ensure that the planning worked well; so did pairings of proactive care professionals and reluctant users. Proactive users paired with reluctant care professionals also made care planning work, thanks to the availability of information and the users' own capacity or willingness to conduct the planning. Where both parties were reluctant, no planning activities occurred. Conclusion: Use of the e-ICP challenged the user–professional relationship. In some cases, a power transition took place in the care process, which led to patient empowerment. This knowledge might be used to develop a new understanding of how role function can be challenged when users and care professionals have equal access to health care
Tatiana Oliveira Silva Bittencourt
Full Text Available This study aimed to identify studies on the Master Plan for Primary Health Care from the year 2003. We conducted a bibliographic study on MEDLINE, LILACS, SCIELO , BDENF and Google Scholar . The results are detailed in tables and discussed from four themes. The Master Plan for Primary Health Care is an innovative and daring in the reorganization of primary care in the municipalities miners. Gave the participants an important opportunity for professional qualification. Difficulties in its implementation outperformed the potential and were present in most of the municipalities surveyed. Among the main challenges for its implementation highlights the lack of professional motivation and credibility by some involved in this process. The literature made little progress on this issue , and we hope that further research be undertaken in order to contribute to studies of evaluation of public policies and in particular the extension and consolidation of this plan.
Carley, S; Mackway-Jones, K; Donnan, S
This paper describes a Delphi study used to identify and improve areas of concern in the planning of care for children in major incidents. The Delphi was conducted over three rounds and used a multidisciplinary panel of 22 experts. Experts were selected to include major incident, immediate care, emergency medicine, and paediatric specialists. This paper presents a series of consensus statements that represent the Delphi group's opinion on the management of children in maj...
Kononovas, K.; Black, G.; Taylor, J; Raine, R
INTRODUCTION: Due to their scale, the Olympic and Paralympic Games have the potential to place significant strain on local health services. The Sydney 2000, Athens 2004, Beijing 2008, Vancouver 2010, and London 2012 Olympic host cities shared their experiences by publishing reports describing health care arrangements. HYPOTHESIS: Olympic planning reports were compared to highlight best practices, to understand whether and which lessons are transferable, and to identify recurring health care p...
Hirdes John P; Zhang Zhanyang; Zhu Mu; Stolee Paul
Abstract Background Targeting older clients for rehabilitation is a clinical challenge and a research priority. We investigate the potential of machine learning algorithms – Support Vector Machine (SVM) and K-Nearest Neighbors (KNN) – to guide rehabilitation planning for home care clients. Methods This study is a secondary analysis of data on 24,724 longer-term clients from eight home care programs in Ontario. Data were collected with the RAI-HC assessment system, in which the Activities of D...
Purpose: To conduct a survey of the process of treatment planning for the radiation treatment of Hodgkin's Disease in the United States, and to compare survey results with consensus guidelines as determined by recognized experts. Methods and Materials: A consensus committee developed guidelines for the radiotherapeutic management of Hodgkin's Disease. A series of survey forms were designed to evaluate the standards of practice and compare these with the consensus guidelines. A total of 61 facilities divided evenly into the strata of academic, hospital based, and free standing had eligible Hodgkin's Disease cases. There were 275 eligible cases of Hodgkin's Disease evaluated. Data collected from the radiation oncology records included treatment-specific parameters such as energy, dose, blocking, and calculations, as well as treatment planning practices. Statistical analysis was performed on each data element and for all institution strata. Results: For a number of treatment parameters, there were some discrepancies noted between the current United States practice and the consensus guidelines. Some significant differences were found in practice between the stratified institution types. A representative sample of results are: the majority of Hodgkin's Disease patients are treated with x-ray energies in the recommended range, between 4 and 10 MV. Standard mantle (for upper extended field treatment) and modified spade (for lower extended field treatments) are the fields of choice for all types of facilities. The consensus guidelines recommended that dose calculations at multiple points be obtained; however, 15% of patients in the survey received only a single point calculation. Current irregular field dosimetry calculation software does not take account of inhomogeneities. Thirty percent of Hodgkin's Disease patients do not receive a gap calculation for the abutment of upper and lower extended fields. In 70% of treatment fields, no compensation is used. Very few patients
Vandervoort, An; Houttekier, Dirk; Vander Stichele, Robert; van der Steen, Jenny T; Van den Block, Lieve
Background Advance care planning is considered a central component of good quality palliative care and especially relevant for people who lose the capacity to make decisions at the end of life, which is the case for many nursing home residents with dementia. We set out to investigate to what extent (1) advance care planning in the form of written advance patient directives and verbal communication with patient and/or relatives about future care and (2) the existence of written advance general...
An extensive programme of health service reform has begun in England. Improvement in the quality of care is a key objective of the reforms, and several initiatives are being introduced in response. These include systems to provide national guidance about appropriate treatment and services, a local system to support quality improvement and arrangements to monitor performance, including a new performance framework, an inspection agency and an annual survey of patients. The local quality improvement system has features of particular interest. These include arrangements for setting objectives for quality improvement, the use of various quality improvement methods tailored to local needs and a new system to provide accountability to both the health service and the public. The introduction of clinical governance and all the other reforms presents primary care practitioners with a major challenge. However, if sufficient time is allowed and adequate resources are made available, the reforms do have the potential to improve health care in England. PMID:10944059
Full Text Available Abstract Background This study explores with patients, carers and health care professionals if, when and how Advance Care Planning conversations about patients’ preferences for place of care (and death were facilitated and documented. Methods The study adopted an exploratory case study design using qualitative interviews, across five services delivering palliative care to cancer and non-cancer patients within an urban and rural English region. The study recruited 18 cases made up of patients (N = 18; 10 men; 8 women; median age 75; nominated relatives (N = 11; 7 women; 4 men; median age 65 and healthcare professionals (N = 15 caring for the patient. Data collection included: 18 initial interviews (nine separate interviews with patients and 9 joint interviews with patients and relatives and follow up interviews in 6 cases (involving a total of 5 patients and 5 relatives within one year of the first interview. Five group interviews were conducted with 15 healthcare professionals; 8 of whom also participated in follow up interviews to review their involvement with patients in our study. Results Patients demonstrated varying degrees of reticence, evasion or reluctance to initiate any conversations about end of life care preferences. Most assumed that staff would initiate such conversations, while staff were often hesitant to do so. Staff-identified barriers included the perceived risks of taking away hope and issues of timing. Staff were often guided by cues from the patient or by intuition about when to initiate these discussions. Conclusions This study provides insights into the complexities surrounding the initiation of Advance Care Planning involving conversations about end of life care preferences with patients who are identified as having palliative care needs, in particular in relation to the risks inherent in the process of having conversations where mortality must be acknowledged. Future research is needed to examine how to
Health-care policy recognises the importance of engaging people in making decisions related to the management of their health. Advance care planning (ACP) offers a framework for decision making on end-of-life care. There are positive indicators that ACP enables health professionals to meet people's preferences. However, there are reports of insensitive attempts to engage people in end-of-life care decision making. District nurses are in the ideal position to facilitate ACP, as they have the opportunity to build relationships with the people they are caring for--an antecedent to sensitive ACP--and in recognising and fulfilling this role, they could ameliorate the risk of insensitive ACP. Distric nurse leaders also have a role to play in ensuring that organisational and environmental factors support appropriate ACP facilitation including: training, fostering a team culture that empowers district nurses to recognise and meet their ACP role, and advocating for appropriate ACP evaluation outcome measures. PMID:26940617
Dinan, Michaela A; Simmons, Leigh Ann; Snyderman, Ralph
The Patient Protection and Affordable Care Act of 2010 (PPACA) mandates the exploration of new approaches to coordinated health care delivery--such as patient-centered medical homes, accountable care organizations, and disease management programs--in which reimbursement is aligned with desired outcomes. PPACA does not, however, delineate a standardized approach to improve the delivery process or a specific means to quantify performance for value-based reimbursement; these details are left to administrative agencies to develop and implement. The authors propose that coordinated care can be implemented more effectively and performance quantified more accurately by using personalized health planning, which employs individualized strategic health planning and care relevant to the patient's specific needs. Personalized health plans, developed by providers in collaboration with their patients, quantify patients' health and health risks over time, identify strategies to mitigate risks and/or treat disease, deliver personalized care, engage patients in their care, and measure outcomes. Personalized health planning is a core clinical process that can standardize coordinated care approaches while providing the data needed for performance-based reimbursement. The authors argue that academic health centers have a significant opportunity to lead true health care reform by adopting personalized health planning to coordinate care delivery while conducting the research and education necessary to enable its broad clinical application. PMID:20844424
Rebecca L Sudore
Full Text Available INTRODUCTION: Advance directives have traditionally been considered the gold standard for advance care planning. However, recent evidence suggests that advance care planning involves a series of multiple discrete behaviors for which people are in varying stages of behavior change. The goal of our study was to develop and validate a survey to measure the full advance care planning process. METHODS: The Advance Care Planning Engagement Survey assesses "Process Measures" of factors known from Behavior Change Theory to affect behavior (knowledge, contemplation, self-efficacy, and readiness, using 5-point Likert scales and "Action Measures" (yes/no of multiple behaviors related to surrogate decision makers, values and quality of life, flexibility for surrogate decision making, and informed decision making. We administered surveys at baseline and 1 week later to 50 diverse, older adults from San Francisco hospitals. Internal consistency reliability of Process Measures was assessed using Cronbach's alpha (only continuous variables and test-retest reliability of Process and Action Measures was examined using intraclass correlations. For discriminant validity, we compared Process and Action Measure scores between this cohort and 20 healthy college students (mean age 23.2 years, SD 2.7. RESULTS: Mean age was 69.3 (SD 10.5 and 42% were non-White. The survey took a mean of 21.4 minutes (±6.2 to administer. The survey had good internal consistency (Process Measures Cronbach's alpha, 0.94 and test-retest reliability (Process Measures intraclass correlation, 0.70; Action Measures, 0.87. Both Process and Action Measure scores were higher in the older than younger group, p<.001. CONCLUSION: A new Advance Care Planning Engagement Survey that measures behavior change (knowledge, contemplation, self-efficacy, and readiness and multiple advance care planning actions demonstrates good reliability and validity. Further research is needed to assess whether survey
Full Text Available Introduction: This research was performed in 2008 in order to design an operational planning model for Iranian primary health care systems at level one. Methods: In this applied study, which was done in a descriptive and cross-sectional manner, some countries and international organizations which had comprehensive planning systems and some local organizations were studied. The required data from the selected countries were collected through data collection forms, and for local organizations, the data were collected through interview, and the initial model was presented accordingly. The model was tested via Delphi technique and taking the authorities’ views into account, the required changes were made and the ultimate model was prepared. Results: All the studied overseas and indigenous organizations had programming systems. However, none of the level-one Iranian primary health care units had a coherent planning system, and they did not follow any specific models. Since 2008, the model of operational planning has also been utilized by Iranian Ministry of Health, Care and Medical Education at headquarters levels; however, there was no model at lower levels especially in rural and urban health care centers. In all selected countries, the model of programs included title, objectives or expected results, schedule, activities, budget system and evaluation and monitoring indexes. Though these parts existed in the common models in Iran, no scientific basis could be observed in compiling the operational programs. The mechanism of designing the initial suggested operational planning had eight stages, but after three stages of reviewing by authorities, seven stages were ratified. Conclusion: Utilizing the suggested operational planning model can enhance the level-one performance indicators of health care networks in Iran
A study is made of the manpower required for initiating and carrying out a nuclear power programme in countries which have not developed their own nuclear technology but where the technical and economic level is such to permit a substantial input from local industry. The discussion is based on Spanish experience. The three basic elements in a nuclear programme are taken to be the operating company, the regulating authority and the engineering firm involved. The role of each of these is briefly considered and the manpower requirements during the design, construction and operational phases of a power station are evaluated. A short account is also given of the manpower requirements of other enterprises such as those involved in the civil engineering, the assembly and construction control. The variations in the labour force are described with the aim of deriving estimates of the number of people involved in the development of a nuclear power programme as a function of time: actual numbers are given for the case of the Spanish national energy plan. A brief description is given of the various courses on nuclear science and engineering provided in Spain and the requirements laid down by the regulations. A short account is given of Spanish nuclear development, with emphasis on the work carried out by the Nuclear Energy Board, not only as a research organization but also in its promotional and training capacities and as a source of personnel for industry. Finally, some comments are made on the possibilities opened up by international co-operation. (author)
Thoonsen, Bregje; Groot, Marieke; Verhagen, Stans; van Weel, Chris; Vissers, Kris; Engels, Yvonne
Background Palliative care is mainly restricted to terminal care. General practitioners (GPs) are not trained to early identify palliative patients with cancer, COPD or heart failure. With the help of the RADboud indicators for PAlliative Care needs (RADPAC), we trained GPs to identify patients’ needs and to make a proactive care plan. They were also able to join two role-plays where they discussed the patient’s future, and consulted a palliative care consultant to fine-tune the care plan. We...
Vietnam began to be interested in education and training on nuclear sciences and related subjects since the early 1960's. A department of Nuclear Physics and Engineering was established in 1970 at the Hanoi University of Technology (HUT), which is the biggest interdisciplinary technological education centre of the country. In Vietnam there are several institutions where exist programmes of education on nuclear sciences and nuclear engineering. But HUT has been being since 1970 the only institution that has underway programme of education on nuclear engineer degree. Although the Department was renamed and its education programme was adjusted, but the objectives of its education programme have been being followed without changes. These objectives are as follows: 1) To develop peaceful applications of atomic energy in Vietnam; 2) To train up engineers on nuclear instrumentation for supporting the first objective; and 3) To prepare initial manpower for introduction of Nuclear Power in Vietnam. Nuclear community of Vietnam is still not so large. Total number of its members increased until 1986, and then decreases up to now. Present average age of members of the community is of 45. In 15 coming years at least 500-700 young people must be educated on programmes on nuclear engineer degree and on nuclear bachelor degree. This is a very difficult task for a developing country such as Vietnam. From a point of view of development, the above-mentioned number is too small, and it must be much more. This makes the task much more difficult. In addition, education on nuclear engineering in the country at present is in a hard situation because of lacking in experienced people, as well as in teaching material and equipment, and, because of weakness of the education programme. So, it may be impossible to achieve success in realization of the task without a large and effective international cooperation in education on nuclear science and engineering. That is why the Asian Network for
In this study, the author evaluated a project in The Netherlands that aimed to promote family members' participation in care plan meetings at a psychogeriatric nursing home. The small-scale pilot project, which was conducted in four wards of the nursing home, was designed to involve families in heal
... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for payment of care plan oversight. 414.39 Section 414.39 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH...
Hospital providers voice concerns about a proposed rule by the Centers for Medicare and Medicaid Services (CMS) that would require providers to devote more resources to discharge planning. The rule would apply to inpatients as well as emergency patients requiring comprehensive discharge plans as opposed to discharge instructions. CMS states that the rule would ensure the prioritization of patient preferences and goals in the discharge planning process, and also would prevent avoidable complications and readmissions. However, hospital and emergency medicine leaders worry that community resources are not yet in place to facilitate the links and follow-up required in the proposed rule, and that the costs associated with implementation would be prohibitive. The proposed rule would apply to acute care hospitals, EDs, long-term care facilities, inpatient rehabilitation centers, and home health agencies. Regardless of the setting, though, CMS is driving home the message that patient preferences should be given more weight during the discharge planning process. Under the rule, hospitals or EDs would need to develop a patient-centered discharge plan within 24 hours of admission or registration, and complete the plan prior to discharge or transfer to another facility. Under the rule, emergency physicians would determine which patients require a comprehensive discharge plan. Both the American Hospital Association and the American College of Emergency Physicians worry that hospitals will have to take on more staff, invest in training, and make changes to their electronic medical record systems to implement the provisions in the proposed rule. PMID:26979045
Hughes, Mark; Cartwright, Colleen
Despite the devastating impact of HIV/AIDS, end-of-life care planning among lesbian, gay, bisexual and transgender (LGBT) communities is relatively under-researched, especially in Australia. This paper reports findings of a survey of 305 LGBT people living in New South Wales, which examined their knowledge of and attitudes towards end-of-life care. The focus of this paper is their preparedness to discuss with healthcare providers any end-of-life care plans. The results highlight that while the majority of respondents were aware of three of the four key end-of-life care planning options available in New South Wales--enduring powers of attorney, enduring guardians and person responsible (only a minority had heard of advance healthcare directives)--a much smaller number of people had actually taken up these options. Only a minority of respondents were able to identify correctly who had the legal right to make treatment decisions for a person who is unconscious following a car accident. A small proportion of people had discussed end-of-life care options with general practitioners or another main healthcare provider, and only in very few cases were these issues raised by the practitioners themselves. Those most likely to not feel comfortable discussing these issues with practitioners included younger people, those not fully open about their sexuality to family members, and transgender people and others who do not define their gender as male or female. The paper highlights the importance of education strategies to raise awareness of the end-of-life care planning options among LGBT people, as well as strategies for increasing health providers' preparedness to discuss these issues with LGBT patients. PMID:24935483
Salazar, Ximena; Núnez-Curto, Arón; Villayzán, Jana; Castillo, Regina; Benites, Carlos; Caballero, Patricia; Cáceres, Carlos F
Introduction As a group, transwomen in Peru have the highest prevalence of HIV (>20%) in the country, but they have little access to HIV prevention, testing and care services. Until recently, Peru's national HIV programme did not recognize transwomen and had remained essentially static for decades. This changed in December 2014, when the Ministry of Health expressed its commitment to improve programming for transwomen and to involve transwomen organizations by prioritizing the development of a “Targeted Strategy Plan of STIs/HIV/AIDS Prevention and Comprehensive Care for Transwomen.” Discussion A policy dialogue between key stakeholders – Peru's Ministry of Health, academic scientists, civil society, transgender leaders and international agencies – created the conditions for a change in Peru's national HIV policy for transwomen. Supported by the effective engagement of all sectors, the Ministry of Health launched a plan to provide comprehensive HIV prevention and care for transwomen. The five-year plan includes new national guidelines for HIV prevention, care and support, and country-level investments in infrastructure and equipment. In addition to new biomedical strategies, the plan also incorporates several strategies to address structural factors that contribute to the vulnerability of transwomen. We identified three key factors that created the right conditions for this change in Peru's HIV policy. These factors include (1) the availability of solid evidence, based on scientific research; (2) ongoing efforts within the transwomen community to become better advocates of their own rights; and (3) a dialogue involving honest discussions between stakeholders about possibilities of changing the nation's HIV policy. Conclusions The creation of Peru's national plan for HIV prevention and care for transwomen shows that long-term processes, focused on human rights for transwomen in Peru, can lead to organizational and public-policy change. PMID:27431469
Full Text Available Abstract Background Advance care planning (ACP is a process of discussion about goals of care and a means of setting on record preferences for care of patients who may lose capacity or communication ability in the future. Implementation of ACP is widely promoted by policy makers. This study examined how community palliative care nurses in England understand ACP and their roles within ACP. It sought to identify factors surrounding community nurses' implementation of ACP and nurses' educational needs. Methods An action research strategy was employed. 23 community nurses from two cancer networks in England were recruited to 6 focus group discussions and three follow up workshops. Data were analysed using a constant comparison approach. Findings Nurses understood ACP to be an important part of practice and to have the potential to be a celebration of good nursing care. Nurses saw their roles in ACP as engaging with patients to elicit care preferences, facilitate family communication and enable a shift of care focus towards palliative care. They perceived challenges to ACP including: timing, how to effect team working in ACP, the policy focus on instructional directives which related poorly to patients' concerns; managing differences in patients' and families' views. Perceived barriers included: lack of resources; lack of public awareness about ACP; difficulties in talking about death. Nurses recommended the following to be included in education programmes: design of realistic scenarios; design of a flow chart; practical advice about communication and documentation; insights into the need for clinical supervision for ACP practice. Conclusions Nurses working in the community are centrally involved with patients with palliative care needs who may wish to set on record their views about future care and treatment. This study reveals some important areas for practice and educational development to enhance nurses' use and understanding of ACP.
O’Sullivan, Ronan; Murphy, Aileen; O’Caoimh, Rónán; Cornally, Nicola; Svendrovski, Anton; Daly, Brian; Fizgerald, Carol; Twomey, Cillian; McGlade, Ciara; Molloy, D. William
Background Although advance care planning (ACP) and the use of advanced care directives (ACD) and end-of-life care plans are associated with a reduction in inappropriate hospitalisation, there is little evidence supporting the economic benefits of such programmes. We assessed the economic impact (gross savings) of the Let Me Decide (LMD) ACP programme in Ireland, specifically the impact on hospitalisations, bed days and location of resident deaths, before and after systematic implementation o...
Ducak, Kate; Keller, Heather H
Factors that influence the menu planning process in Ontario long-term care (LTC) homes were studied, as were key informants' perspectives on how this process could be improved to promote resident-centred menus. Key informants were interviewed by telephone to obtain qualitative data through standardized open-ended questions. The key informants (n=35) were randomly selected nutrition managers of Ontario LTC homes. Selected registered dietitians from the Ontario Long-Term Care Action Group also participated (n=5). Descriptive thematic analysis was completed on data provided. Three over arching themes emerged from the data as drivers in the menu planning process: resource limitations, Ontario Ministry of Health and Long-Term Care standards, and the accommodation of diverse and evolving preferences. Challenges involving resources include insufficient food labour and raw food funding, the workload involved with altering menus, and providing food items for special diets or preferences. In terms of ministry standards, participants reported barriers to complying with rotation and portion standards. Other common obstacles within LTC homes include accommodating personal preferences, cultural preferences, and therapeutic diets. Ontario LTC homes face numerous challenges in the planning of menus for residents, regardless of a home's size, location, or profit status. Suggestions are aimed at improving the menu planning process and providing high-quality, palatable, and culturally appropriate food in these homes so that menus are resident-centred. PMID:21645428
Corlette, Sabrina; Lucia, Kevin W; Levin, Max
To improve the adequacy of private health insurance, the Affordable Care Act requires insurers to cover a minimum set of medical benefits, known as "essential health benefits." In implementing this requirement, states were asked to select a "benchmark plan" to serve as a reference point. This issue brief examines state action to select an essential health benefits benchmark plan and finds that 24 states and the District of Columbia selected a plan. All but five states will have a small-group plan as their benchmark. Each state, whether or not it made a benchmark selection, will have a set of essential health benefits that reflects local, employer-based health insurance coverage currently sold in the state. States adopted a variety of approaches to selecting a benchmark, including intergovernmental collaboration, stakeholder engagement, and research on benchmark options. PMID:23547335
Johnson, Iris Crenshaw; Robertson, Ramon V.
The Physician Information System, a computerized monitoring system developed by the Southern Illinois University of Medicine, is described. It obtains information about the distribution and practice characteristics of area physicians. (MLW)
Schwartz, Linda Matula; Iobst, Barbara
Integrating knowledge-based resources at the point of care is an important opportunity for hospital library involvement. In the progression of an IAIMS planning grant, the digital library is recognized as pivotal to the success of information domain integration throughout the institution. The planning process, data collection, and evolution of the planning project are discussed. PMID:18844088
Rietjens, Judith; Dunleavy, Lesley Jane; Preston, Nancy Jean; Payne, Sheila Alison
Background Awareness of preferences regarding medical care should be a central component of the care of patients with advanced cancer. Open communication can facilitate this but can occur in an ad hoc or variable manner. Advance care planning (ACP) is a formalized process of communication between patients, relatives and professional caregivers about patients’ values and care preferences. It raises awareness of the need to anticipate possible future deterioration of health. ACP has the potenti...
Rietjens, Judith AC; Korfage, Ida J.; Dunleavy, Lesley; Preston, Nancy J.; Jabbarian, Lea J.; Christensen, Caroline Arnfeldt; de Brito, Maja; Bulli, Francesco; Caswell, Glenys; Červ, Branka; Delden, Johannes; Deliens, Luc; Gorini, Giuseppe; Groenvold, Mogens; Houttekier, Dirk
Background: Awareness of preferences regarding medical care should be a central component of the care of patients with advanced cancer. Open communication can facilitate this but can occur in an ad hoc or variable manner. Advance care planning (ACP) is a formalized process of communication between patients, relatives and professional caregivers about patients' values and care preferences. It raises awareness of the need to anticipate possible future deterioration of health. ACP has the potent...
Corazzini, Kirsten; Rapp, Carla Gene; McConnell, Eleanor S.; Anderson, Ruth A.
Staff development nurses in long-term care are challenged to implement training programs that foster quality unlicensed assistive personnel (UAP) care and improve the transfer of their observations to licensed nursing staff for care planning. This study describes the outcomes of a program where UAP recorded behavioral problems of residents to inform care. Findings suggest staff development nurses who aim to improve UAP reporting without simultaneously targeting licensed nursing staff behavior...
Weathers, Elizabeth; O'Caoimh, Rónán; Cornally, Nicola; Fitzgerald, Carol; Kearns, Tara; Coffey, Alice; Daly, Edel; O'Sullivan, Ronan; McGlade, Ciara; Molloy, D William
Advance care planning (ACP), involving discussions between patients, families and healthcare professionals on future healthcare decisions, in advance of anticipated impairment in decision-making capacity, improves satisfaction and end-of-life care while respecting patient autonomy. It usually results in the creation of a written advanced care directive (ACD). This systematic review examines the impact of ACP on several outcomes (including symptom management, quality of care and healthcare utilisation) in older adults (>65years) across all healthcare settings. Nine randomised controlled trials (RCTs) were identified by searches of the CINAHL, PubMed and Cochrane databases. A total of 3646 older adults were included (range 72-88 years). Seven studies were conducted with community dwellers and the other two RCTs were conducted in nursing homes. Most studies did not implement a standardised ACD, or measure the impact on quality of end-of-life care or on the death and dying experience. All studies had some risk of bias, with most scoring poorly on the Oxford Quality Scale. While ACP interventions are well received by older adults and generally have positive effects on outcomes, this review highlights the need for well-designed RCTs that examine the economic impact of ACP and its effect on quality of care in nursing homes and other sectors. PMID:27451328
Shannon Harris,1 Laura Reichenbach,2 Karen Hardee2 1Public Health Consultant, Seattle, WA, USA; 2The Evidence Project, Population Council, Washington, DC, USA Abstract: Despite decades of emphasis on quality of care, qualitative research continues to describe incidents of poor quality client–provider interactions in family planning provision. Using an emerging framework on disrespect and abuse (D and A) in maternal health services, we reviewed the global published literature for qu...
Harris S; Reichenbach L; Hardee K
Shannon Harris,1 Laura Reichenbach,2 Karen Hardee2 1Public Health Consultant, Seattle, WA, USA; 2The Evidence Project, Population Council, Washington, DC, USA Abstract: Despite decades of emphasis on quality of care, qualitative research continues to describe incidents of poor quality client–provider interactions in family planning provision. Using an emerging framework on disrespect and abuse (D and A) in maternal health services, we reviewed the global published literature for quanti...
Colón-Emeric, Cathleen S.; Lekan-Rutledge, Deborah; Utley-Smith, Queen; Ammarell, Natalie; Bailey, Donald; Piven, Mary L.; Corazzini, Kirsten; Anderson, Ruth A.
We describe how connections among nursing home staff impact the care planning process using a complexity science framework. We completed six-month case studies of four nursing homes. Field observations (n = 274), shadowing encounters (n = 69), and in-depth interviews (n = 122) of 390 staff at all levels were conducted. Qualitative analysis produced a conceptual/thematic description and complexity science concepts were used to produce conceptual insights. We observed that greater levels of sta...
Reed, Mary E; Graetz, Ilana; Fung, Vicki; Newhouse, Joseph P; Hsu, John
Consumer-directed health plans are plans with high deductibles that typically require patients to bear no out-of-pocket costs for preventive care, such as annual physicals or screening tests, in order to ease financial barriers and encourage patients to seek such care. We surveyed people in California who had a consumer-directed health plan and found that fewer than one in five understood that their plan exempted preventive office visits, medical tests, and screenings from their deductible, meaning that this care was free or had a modest copayment. Roughly one in five said that they had delayed or avoided a preventive office visit, test, or screening because of cost. Those who were confused about the exemption were significantly more likely to report avoiding preventive visits because of cost concerns. Special efforts to educate consumers about preventive care cost-sharing exemptions may be necessary as more health plans, including Medicare, adopt this model. PMID:23213148
The Physician Orders for Life-Sustaining Treatment (POLST) is a planning tool representative of an emerging paradigm aimed at facilitating elicitation of patient end-of-life care preferences. This study assessed the impact of the POLST document on provider goals and plans for conversations about end-of-life care treatment options. A 2 (POLST: experimental, control) × 3 (topic of possible patient misunderstanding: cardiopulmonary resuscitation, medical intervention, artificially administered nutrition) experimental design was used to assess goals, plan complexity, and strategies for plan alterations by medical professionals. Findings suggested that the POLST had little impact on plan complexity or reaction time with initial plans. However, preliminary evidence suggested that the utility of the POLST surfaced with provider responses to patient misunderstanding, in which differences in conditions were identified. Significant differences in goals reported as most important in driving conversational engagement emerged. Implications for findings are discussed. PMID:27442346
The need for improved operations was never higher than today in the oil industry. The world's demand for energy, especially for oil and natural gas, is rising rapidly and for many years to come. In order to meet this rising demand and to keep price volatility to a minimum; oil companies worldwide are looking for ways to improve operations in order to achieve increased production with decreased costs. This paper describes data from Southern Area Oil Operations (SAOO); an organization within the Saudi Arabian Oil Company (ARAMCO), to show how manpower management can be used to achieve improved operations. For the years 1983 to 2004, manpower management in SAOO focused on addressing both the quantity and quality dimensions of manpower. First, the level of manpower gradually declined by 35% for both the Saudi Arab and Expatriate categories for the entire period. Expatriate labor is defined as labor in three main categories: US/Canadian, UK, and Asians and Other Arabs. Second, the level of training slowly increased to align manpower to better fit organizational functions and work responsibilities. Not only a number of new training and development programs were initiated but also the percentage of employees involved in such programs doubled from 4.5% in 1990 to 8.9% in 2004. Third, technology based initiatives such as the use of computers, Internet, and intranet were heavily introduced to employees in the last 10 yrs. Due to these three changes reduced costs and increased manpower efficiency were achieved. In the period 1983 to 2004 the total labor bill declined by 35% and Net Direct Expenditures NDE by 24% after adjusting for inflation and using 2004 dollars. Net Direct Expenditure NDE is defined by SAOO to be the summation of labor cost, material cost, invoices cost, and net service income. In addition two signs of improved efficiency of manpower were apparent in the same period. First, SAOO manpower, despite its smaller size, could actually sustain an increased
Thoresen, Lisbeth; Ahlzén, Rolf; Solbrække, Kari Nyheim
Advance care planning (ACP) is an international concept for improving patient autonomy and communication in the context of anticipated deterioration and end-of-life care. In a preparatory conversation, health care professionals facilitate one or more conversations where nursing home residents are invited to reflect on, and articulate wishes and preferences concerning future medical treatment and end-of-life care. Our aim with this study was to increase knowledge of existing ACP practices in Norwegian nursing homes. We wanted to know how nursing home residents, relatives and nursing home staff take part in the conversations, and to what extent these conversations can be regarded as promoting autonomy, legal rights and individual needs for the residents. We conducted participant observation of seven preparatory conversations, followed by interviews with health care staff (together) and resident and relative (together). In the result section, we present an informative case example of an ACP conversation where common and important characteristics running through our data are present. These are further elaborated under the following headings: Life critical questions, Residents' quiet participation in the conversations, the Dying phase - a clinical issue, Nurses and physicians; different domains and Timing. We find that nursing home staff in our study wants to contribute to open awareness, autonomy and a good death, but there are little reflections about the purpose and content of the conversations, how they should be carried out and when, and what frail nursing home residents are able to understand and express in ACP conversations. PMID:27531449
Rubenstein Lisa V
Full Text Available Abstract Background Little is known about effective strategies for disseminating and implementing complex clinical innovations across large healthcare systems. This paper describes processes undertaken and tools developed by the U.S. Department of Veterans Affairs (VA Mental Health Quality Enhancement Research Initiative (MH-QUERI to guide its efforts to partner with clinical leaders to prepare for national dissemination and implementation of collaborative care for depression. Methods An evidence-based quality improvement (EBQI process was used to develop an initial set of goals to prepare the VA for national dissemination and implementation of collaborative care. The resulting product of the EBQI process is referred to herein as a "National Dissemination Plan" (NDP. EBQI participants included: a researchers with expertise on the collaborative care model for depression, clinical quality improvement, and implementation science, and b VA clinical and administrative leaders with experience and expertise on how to adapt research evidence to organizational needs, resources and capacity. Based on EBQI participant feedback, drafts of the NDP were revised and refined over multiple iterations before a final version was approved by MH-QUERI leadership. 'Action Teams' were created to address each goal. A formative evaluation framework and related tools were developed to document processes, monitor progress, and identify and act upon barriers and facilitators in addressing NDP goals. Results The National Dissemination Plan suggests that effectively disseminating collaborative care for depression in the VA will likely require attention to: Guidelines and Quality Indicators (4 goals, Training in Clinical Processes and Evidence-based Quality Improvement (6 goals, Marketing (7 goals, and Informatics Support (1 goal. Action Teams are using the NDP as a blueprint for developing infrastructure to support system-wide adoption and sustained implementation of
Full Text Available Theresa Green1, Shreyas Gandhi2, Tessa Kleissen1, Jessica Simon1,3, Shelley Raffin-Bouchal1, Karla Ryckborst41Faculty of Nursing, University of Calgary, Calgary, AB, Canada; 2Health Sciences, McMaster University, Hamilton, ON, Canada; 3Department of Medicine, University of Calgary, Calgary, AB, Canada; 4Calgary Stroke Program, Alberta Health Services, Calgary, AB, CanadaPurpose: Individuals who experience stroke have a higher likelihood of subsequent stroke events, making it imperative to plan for future medical care. In the event of a further serious health event, engaging in the process of advanced care planning (ACP can help family members and health care professionals (HCPs make medical decisions for individuals who have lost the capacity to do so. Few studies have explored the views and experiences of patients with stroke about discussing their wishes and preferences for future medical events, and the extent to which stroke HCPs engage in conversations around planning for such events. In this study, we sought to understand how the process of ACP unfolded between HCPs and patients post-stroke.Patients and methods: Using grounded theory (GT methodology, we engaged in direct observation of HCP and patient interactions on an acute stroke unit and two stroke rehabilitation units. Using semi-structured interviews, 14 patients and four HCPs were interviewed directly about the ACP process.Results: We found that open and continual ACP conversations were not taking place, patients experienced an apparent lack of urgency to engage in ACP, and HCPs were uncomfortable initiating ACP conversations due to the sensitive nature of the topic.Conclusion: In this study, we identified lack of engagement in ACP post-stroke, attributable to patient and HCP factors. This encourages us to look further into the process of ACP in order to develop open communication between the patient with stroke, their families, and stroke HCPs.Keywords: qualitative, engagement
Htut, Y; Shahrul, K; Poi, P J H
The provision of optimum care for the ageing population is dependent on the understanding of their views and values on end of life issues. A qualitative descriptive study was conducted to describe views of elderly Malaysians on Advanced Care Planning (henceforth ACP) and Advanced Directives (henceforth AD), and explore factors influencing these views. Fifteen elderly subjects with ages ranging from 65 to 83 years, representing different ethnic and religious groups in Malaysia were selected for in-depth interviews guided by a questionnaire. Five core themes were extracted from the interviews: 1) Considering the future 2) Contingency plans for future illnesses 3) Attitudes towards life prolonging treatment procedures 4) Doctor-patient relationships and 5) Influence of religion on decisions related to future illness. Despite the lack of knowledge on ACP and AD, older respondents were very receptive to their concept. Although the majority agreed on the importance of planning for future medical management and having open discussion on end of life issues with their doctor, they felt it unnecessary to make a formal written AD. Most felt that the future was best left to fate or God, and none had made any contingency plan for severe future illnesses citing religion as reason for this view. Cardiopulmonary resuscitation, mechanical ventilation and dialysis were considered by most to be invasive life prolonging treatments. We suggest that doctors initiate discussions on end of life care with every older patient and their family so as to promote awareness and introduce the concept of ACP/AD to a Malaysian setting. PMID:18330404
This comprehensive synthesis of published literature from a team in Northern Ireland focused on the perspectives of healthcare professionals in relation to ACP for people with dementia living in long-term care settings. From the 14 papers discussed, the authors identified that people with dementia are often not recognised as having a terminal illness. Four key themes were identified: ■ Early integration and planning for palliative care in dementia is important. ■ Healthcare professionals' perspectives on ACP are influenced by ethical and moral concerns including presumptions regarding capacity of the person with dementia towards ACP and the impact of the increased role of the family in the decision-making processes. ■ Challenges in communicating with people who have dementia and their families. ■ A need for improvement in healthcare professionals' knowledge of the disease trajectory of dementia with emphasis on end of life care, and a greater understanding of the process of ACP itself. This would assist them in engaging in ACP discussions. PMID:27231081
Elwyn, Glyn; Hocking, Paul; Burtonwood, Ann; Harry, Karan; Turner, Arthur
A shift from continuing medical education towards professional and organisational development policies, coupled with the introduction of accountability frameworks (clinical governance), has generated interest in professional and practice development plans (PPDPs) in general practice. The problems of implementing this change in an independent contractor-based service remain unexplored and the aims of this study were to focus on the facilitator's experience of the issues that hampered or fostered development in general practice. Facilitators of PPDPs were asked to document their experience of supporting 12 practices in an all Wales feasibility study. In order to maintain organisational anonymity while reporting accurate accounts of the obstacles encountered, a method known as critical fiction was employed. This method allowed the authors to write detailed reflective accounts that were then fictionalised. The culture of general practice reflects the development of an independent contractor service that has developed into partnerships that employ some professionals (practice nurses, managers and administrative staff) and collaborate with others in variable arrangements (community nurses, health visitors, midwives and others). Developing organisation-wide systems in so-called 'primary health care teams' is a difficult exercise, given the ethos of autonomous decision-making processes and the lack of experience of 'whole systems' approaches in primary care. The potential for multiprofessional synergy and the evidence that systematic changes lead to sustained health care improvements are well established. But the implementation issues of these concepts have not been addressed. Existing educational policies are based in uniprofessional paradigms and the protected time requirements and funding streams required for PPDPs have not been clarified. PMID:12487843
Collins, Sara R; Gunja, Munira; Rasmussen, Petra W; Doty, Michelle M; Beutel, Sophie
Most employers who provide health insurance to employees subsidize their premiums and provide a comprehensive benefit package. Before the Affordable Care Act, people who lacked health insurance through a job and purchased it on their own paid the full cost of their plans, which often came with skimpy benefit packages and high deductibles. Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March--May 2015, indicate that the law's tax credits have made premium costs in health plans sold through the marketplaces roughly comparable to employer plans, at least for people with low and moderate incomes. At higher incomes, the phase-out of the subsidies means that adults in marketplace plans have higher premium costs than those in employer plans. Overall, larger shares of adults in marketplace plans reported deductibles of $1,000 or more, compared with those in employer plans, though these differences were narrower among low-and moderate-income adults. PMID:26445739
Mary Ellen Dellefield
Full Text Available Development of the comprehensive care plan (CCP is a requirement for nursing homes participating in the federal Medicare and Medicaid programs, referred to as skilled nursing facilities. The plan must be developed within the context of the comprehensive interdisciplinary assessment framework—the Resident Assessment Instrument (RAI. Consistent compliance with this requirement has been difficult to achieve. To improve the quality of CCP development within this framework, an increased understanding of complex factors contributing to inconsistent compliance is required. In this commentary, we examine the history of the comprehensive care plan; its development within the RAI framework; linkages between the RAI and registered nurse staffing; empirical evidence of the CCP’s efficacy; and the limitations of extant standards of practices in CCP development. Because of the registered nurse’s educational preparation, professional practice standards, and licensure obligations, the essential contributions of professional nurses in CCP development are emphasized. Recommendations for evidence-based micro and macro level practice changes with the potential to improve the quality of CCP development and regulatory compliance are presented. Suggestions for future research are given.
Purpose: To conduct a study of the structure and process of treatment planning in the United States. Methods and Materials: A Patterns of Care treatment planning consensus committee developed a survey form that was used to gather data for 106 items relating to the structure and process of treatment planning. These questions were general in nature and not specific to any particular disease site. Seventy-three facilities were randomly selected for site visits from the 1321 radiation therapy facilities in the United States: 21 academic, 26 hospital, and 26 free-standing. During the site visit the facility physicist, assisted by the site-visit physicist, completed the form. Results: Twenty-nine percent of facilities have cobalt-60 machines; 25% have 4 MV linacs; 75% have photon energies in the range of 5-8 MV; and less than 10% have energies greater than 20 MV. Academic facilities led hospital and free-standing facilities by about 30 percentage points in the availability of all electron energies (88 vs. 58%, approximately, in the range 4-13 MeV and scaling downward to about 60 vs. 30% at the highest energies). The national averages for the availability of Cs-137, Ir-192, and I-125 were 87, 73, and 44%, respectively. Computerized tomography (CT) scanning is not available or not used in 15% of hospital and free-standing facilities. Ninety-six percent of facilities have treatment planning computers; at 10% of facilities physicians do not participate in treatment planning. The estimated national averages of facilities having formal quality assurance (QA) programs for treatment planning systems, simulators, film processors, and blocking systems are 44, 79, 62, and 55%, respectively. Sixty-three percent of facilities obtain independent machine calibrations. Conclusion: This is the first patterns of treatment planning study carried out in the United States and the results reported here will establish a baseline for future studies. The present study has identified some
Full Text Available Christine Patterson,1 Heather Arthur,1,2 Gladys Peachey,1 Julie Vohra,1 David Price,3 Dave Pearson,4 Rob Mariani51School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; 2Heart and Stroke Foundation of Ontario/Michael G DeGroote Endowed Chair in Cardiovascular Nursing Research, McMaster University, Hamilton, ON, Canada; 3Department of Family Medicine, McMaster University, Hamilton, ON, Canada; 4Central West Local Health Integration Network, Brampton, ON, Canada; 5Ascentum Consulting, Ottawa, ON, CanadaImportance: Resources to support change are needed for solo practitioners who are transitioning to family health teams (FHTs which involve multiple health disciplines working together to provide team-based care.Objective: The purpose of this project was: (1 to explore the use of an online resource, the Interprofessional Resource Centre (IRC, when planning for interprofessional change and; (2 to explore the experience of planning interprofessional change.Design and setting: Six FHTs organized under the structure of one Local Health Integrated Network (LHIN in Ontario, Canada.Intervention: Participants in six FHTs were directed to the IRC to support planning interprofessional change. In addition, two of the six FHTs participated in pilot site meetings with investigators where they received in-person support to apply the information from the IRC to an interprofessional activity.Results: Pilot site participants reported the IRC was useful for planning, but they cited lack of time to use it as a key barrier. When planning for interprofessional change, providers experienced challenges with physician buy-in and team dynamics. As a strategy for change, providers would like to learn from other FHTs who have experienced success with interprofessional change; at the LHIN level, they saw a need for more educational opportunities. Participation was found to be low among those only receiving online support.Conclusion and
An examination is made of the organization and administration of fisheries training institutes in Nigeria, highlighting their inadequacies in achieving required goals. A systems approach to fisheries manpower training is described which is based on 4 principles: 1) wholeness; 2) systematization; 3) compatibility; and 4) optimization
Withers, Glenn Alexander
The study examines military manpower procurement for peacetime. It considers the broad alternative systems of conscription and voluntarism and develops models of demand and supply for military labor to show how these are affected by the choice of procurement system. Empirical applications are made using evidence from Australia, Canada, Great…
McCullough, Paul M.
A project explored the manpower issue termed "burnout" and the impact of this phenomenon on mental health service programs. (In the framework of this study burnout is defined as that state of non-productivity, non-motivation, and indifference which interferes with a worker's delivering services effectively.) Existing literature does not clearly…
As the largest organ of the body, the human skin protects all subcutaneous tissues. Despite its many attributes, the skin is vulnerable to pressure ulcers. The number of pressure ulcers and venous leg ulcers is on the rise, but healing rates have not improved over the past decade. The reason may be a tendency to focus on one or two fundamentals of wound healing, but not on all 3 fundamentals equally. The 3 fundamentals of wound healing are (1) pressure relief and nursing care, (2) dressings, and (3) nutrition. Nutrition is the area that is most often overlooked, which commonly causes the care plan to be out of balance. In the United States, few clinicians would consider malnutrition to be an issue in the homecare and long-term care setting, yet nutritional status and risk for pressure ulcer formation are well documented and strongly correlated. Our aging population will continue to survive previously catastrophic events, only to present with pressure ulcers or the potential for developing pressure ulcers. Clinicians caring for residents with pressure ulcers must strike a balance between pressure relief, dressings, and nutrition. Functional gastrointestinal-tract impairments must be diagnosed and addressed. Wounds must be treated aggressively with high-protein calorically-balanced diets because wounds heal from the inside out. PMID:24527147
Fine, Robert L.; Yang, Zhiyong; Spivey, Christy; Boardman, Bonnie; Courtney, Maureen
Barriers to traditional advance care planning (ACP) and advance directive (AD) creation have limited the promise of ACP/AD for individuals and families, the healthcare team, and society. Our objectives were to determine the results of a digital ACP/AD through which consumers create, store, locate, and retrieve their ACP/AD at no charge and with minimal physician involvement, and the ACP/AD can be integrated into the electronic health record. The authors chose 900 users of MyDirectives, a digi...
Forgione, D A
Recently, at an all-day professional meeting that was targeted at about 100 junior-level health care financial professionals, we covered a whole spectrum of subjects. We covered topics ranging from the Hill-Burton Act to Medicare managed care organizations (MCOs) and capitation; the Stark rules on physician self-referral; the financial incentives within various payment systems for physicians, hospitals, and other providers; Medicare fraud and abuse rules; and the need for well-designed corporate compliance plans. After responding to a number of the participants' questions, I could not help but be reminded of the students every semester who ask me, "Will this be on the test?" In other words, if there are no real teeth in the subject, then they have too many other urgent priorities demanding their attention to give the issue serious consideration. Perhaps this highlights the need for taking corporate compliance planning seriously--starting at the top levels of the organization. It is well documented that leadership attitudes filter downward in any organization. If change for the better is going to take place in the area of corporate compliance, it needs to begin with each of us as individuals, from the top down. PMID:9612741
US Fish and Wildlife Service, Department of the Interior — The Wildlife Inventory Plan discusses the following protocols; wildlife inventory procedures, physical facility needs, manpower days, and special considerations.
Barbara Elyan Edwige Vololonarivelo
Full Text Available Background: Recorded contraceptive prevalence may not represent all the women using contraceptives. Nevertheless, it serves as a fundamental tool in decision-making at Ministry and international level. This study aims to determine the actual contraceptive prevalence and identify factors determining users positions about modern contraception and local services deliveries in the district of Antananarivo Avaradrano. Methods: A cross-sectional survey was conducted, where an interviewer-administered questionnaire has been used to collect data. Targeted female respondents aged 18-39 were asked about their contraceptive use, knowledge and information sources on family planning, perception of social support and perception on the local health care providers. Results: Contraceptive prevalence is underestimated. Moreover, it is higher among women aged 35 to 39 and those having two children or more, but lower among those who have reached university level of education. Women who are able to tell two benefits of family planning, informed by the community health agents (CHA, and deciding with their partners on contraception use are more likely to use contraceptives on a regular basis. Women complain on their poor relationship with health care providers and doubt about their real competence. Conclusions: This study demonstrates the evidence of an underestimation of contraceptive prevalence. The challenge is how to collect reliable data, thus recording systems have to be improved. Besides, government efforts in increasing contraceptive use ought to be targeted on adolescents and young people aged 20-25, the couple itself, health-care provider woman relationship, and on the CHAs activities. [Int J Res Med Sci 2013; 1(3.000: 204-211
Boillot, J; Delahaye, J P; Myers, S; CERN. Geneva. AB Department
The present report summarises the staff plan of the newly created Accelerators and Beams (AB) Division following the restructuring of the Accelerator Sector and covering the period 2003 to 2010. It underlines the refocusing of the staff on priority work, especially the LHC Project and is coherent with the recently adopted CERN Long Term Plan (LTP). It compares the requested and available manpower (both staff and industrial support) for each Project, Programme and Activity (PPA) split in work packages and highlights the missing manpower for each category of personnel.
Full Text Available BACKGROUND: Accreditation of healthcare organizations is a widely used method to assess and improve quality of healthcare. Our aim was to determine the effectiveness of improvement plans in practice accreditation of primary care practices, focusing on cardiovascular risk management (CVRM. METHOD: A two-arm cluster randomized controlled trial with a block design was conducted with measurements at baseline and follow-up. Primary care practices allocated to the intervention group (n = 22 were instructed to focus improvement plans during the intervention period on CVRM, while practices in the control group (n = 23 could focus on any domain except on CVRM and diabetes mellitus. Primary outcomes were systolic blood pressure <140 mmHg, LDL cholesterol <2.5 mmol/l and prescription of antiplatelet drugs. Secondary outcomes were 17 indicators of CVRM and physician's perceived goal attainment for the chosen improvement project. RESULTS: No effect was found on the primary outcomes. Blood pressure targets were reached in 39.8% of patients in the intervention and 38.7% of patients in the control group; cholesterol target levels were reached in 44.5% and 49.0% respectively; antiplatelet drugs were prescribed in 82.7% in both groups. Six secondary outcomes improved: smoking status, exercise control, diet control, registration of alcohol intake, measurement of waist circumference, and fasting glucose. Participants' perceived goal attainment was high in both arms: mean scores of 7.9 and 8.2 on the 10-point scale. CONCLUSIONS: The focus of improvement plans on CVRM in the practice accreditation program led to some improvements of CVRM, but not on the primary outcomes. ClinicalTrials.gov NCT00791362.
Purpose: The importance of evaluating and improving quality in clinical practice is now generally acknowledged. In this study we estimated different sources of variation in radiotherapy planning for breast cancer patients after mastectomy and sought to test the applicability of a reproducibility and repeatability (R and R) study in a clinical context. Methods: Eleven radiation oncologists planned radiotherapy three times for three different kinds of breast cancer patients without knowing they were handling the same patient three times. Variation was divided into different components: physicians as operators, patients as parts, and repeated measurements as trials. Variation due to difference across trials (repeatability), that across the physicians (reproducibility), and that across the patients (variability) were estimated, as well as interactions between physicians and patients. Calculation was based on the sum of squares, and analysis was supported by various graphical presentations such as range charts and box plots. Results: Some parts of the planning process were characterized by higher and different kinds of variation than the others. Interphysician variation (i.e., reproducibility) was not high but there were some clearly outlying physicians. The highest variation was in repeatability (intraphysician variation). The major part of the variation was, however, that from patient to patient: 33% of the total in Parameter 1 and 85% of the total in Parameter 2. Conclusions: R and R studies are applicable and are needed to evaluate and improve quality in clinical practice. This kind of analysis provides opportunities to establish which kinds of patients require particularly careful attention, which points in the process are most critical for variation, which are the most difficult aspects for each physician and call for more careful description in documents, and which physicians need further training
Ratekin, Cindy; Bess, Gary
Argues that strategic planning by all involved in a child care center facilitates planning for the future. This planning includes representation of all parties concerned; attendance at planning events; equal participation; analysis of center's current status; planning sessions in places encouraging creativity; and a skilled, impartial facilitator.…
Full Text Available Abstract Introduction In common with other jurisdictions, Alberta faces challenges in ensuring a balance in health worker supply and demand. As the provider organization with province-wide responsibility, Alberta Health Services needed to develop a forecasting tool to inform its position on key workforce parameters, in the first instance focused on modeling the situation for Registered Nurses, Licensed Practical Nurses and health care aides. This case study describes the development of the model, highlighting the choices involved in model development. Case description A workforce planning model was developed to test the effect of different assumptions (for instance about vacancy rates or retirement and different policy choices (for example about the size of intakes into universities and colleges, different composition of the workforce. This case study describes the choices involved in designing the model. The workforce planning model was used as part of a consultation process and to develop six scenarios (based on different policy choices. Discussion and evaluation The model outputs highlighted the problems with continuation of current workforce strategies and the impact of key policy choices on workforce parameters. Conclusions Models which allow for transparency of the underlying assumptions, and the ability to assess the sensitivity of assumptions and the impact of policy choices are required for effective workforce planning.
Warner, Echo L; Wu, Yelena P; Hacking, Claire C; Wright, Jennifer; Spraker-Perlman, Holly L; Gardner, Emmie; Kirchhoff, Anne C
Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care. PMID:25893925
Francoeur, Richard B; Burke, Nancy; Wilson, Alicia M
Spiritual values and beliefs of patients and families influence resilience during chronic illness and shape patient choices during advance care planning. The spiritual needs of Baby Boomers will be more diverse than previous generations, in connection with the questioning, experimental mind-set of this group and the fact that it includes a higher proportion of immigrant populations outside the Judeo-Christian tradition. Social workers are trained explicitly to intervene with diverse populations and are well positioned to offer spiritual support in ways that do not necessarily conform to traditional religions. To the extent of their individual expertise and competence, social workers should assess and provide spiritual care to clients, including those who either are underserved or prefer not to seek assistance from clergy or chaplains because they feel alienated from religious institutions and representatives. They should also be aware of ethical dilemmas in consulting with spiritual care professionals in developing spiritual interventions. Social work education should address clients' humanistic and existential concerns, beliefs and behaviors of the major religions, and forms of nontraditional religious and spiritual experiences; it should also provide experiential opportunities for engaging with grief and earlier advance care planning. There should be attention to different theodical perspectives of the major religions regarding the problem of good and evil, which may preoccupy even clients who no longer participate in organized religion, because these unresolved existential issues may weaken client coping with chronic conditions and may diminish clarity and self-awareness for engaging authentically and effectively in advance care planning. PMID:27187806
Full Text Available The dynamics of human resource recruitment and training in an uncertain environment creates a challenge for many policy makers in various organisations. In the presence of fuzzy manpower demand and training capacity, many companies fear losing critical human resources when their employees leave. As such, the development of effective dynamic policies for recruitment and training in a fuzzy dynamic environment is imperative. In this frame of mind, a fuzzy systems dynamics modelling approach is proposed to enable the policy maker to develop reliable dynamic policies relating recruitment, training, and available skills, from a systems perspective. It is anticipated in this study that fuzzy system dynamics and optimization approach would help organizations to design effective manpower policies and strategies.
The main factors that influenced the development of the manpower resources required by CNEA over its thirty years of life are discussed: a careful specialized training; basic and applied research groups as a basic support for the other activities; teams responsible for the applications and for the concrete realizations of increasing complexity carried out by CNEA, culminating with the nuclear power plants; CNEA's relations with the national educational system regarding nuclear specialization; CNEA's international interaction, either by the participation of foreigners in its internal courses, by the commissioning of Argentinians abroad, and by the cooperation with international agencies in organizing courses, seminars and conferences; the influence of the radiological protection and nuclear safety requirements on the training programs, on nuclear industry, and on the users of radioisotopes and radiations; the importance of feeding the results of each activity back into the system so as to obtain a dynamic programming adapted to the requirements at all times. (M.E.L.)
Ambrosis de Libanati, N. (Comision Nacional de Energia Atomica, Buenos Aires (Argentina). Dept. de Capacitacion y Evaluacion de Personal)
The main factors that influenced the development of the manpower resources required by CNEA over its thirty years of life are discussed: a careful specialized training; basic and applied research groups as a basic support for the other activities; teams responsible for the applications and for the concrete realizations of increasing complexity carried out by CNEA, culminating with the nuclear power plants; CNEA's relations with the national educational system regarding nuclear specialization; CNEA's international interaction, either by the participation of foreigners in its internal courses, by the commissioning of Argentinians abroad, and by the cooperation with international agencies in organizing courses, seminars and conferences; the influence of the radiological protection and nuclear safety requirements on the training programs, on nuclear industry, and on the users of radioisotopes and radiations; the importance of feeding the results of each activity back into the system so as to obtain a dynamic programming adapted to the requirements at all times.
Ho, Sin C.; Leung, Janny M. Y.
We study a manpower scheduling problem with job time-windows and job-skills compatibility constraints. This problem is motivated by airline catering operations, whereby airline meals and other supplies are delivered to aircrafts on the tarmac just before the flights take-off. Jobs (flights) must...... simulated annealing heuristic approach to solve the problem. Computational experiments show that the tabu search approach outperforms the simulated annealing approach, and is capable of finding good solutions....
M.G. Kucherov; E.S. Olenсo; A.I. Kodochigova; V.F. Kirichuk; A. A. Svistunov; P.V. Glybochko; E.A. Krovaykova
In 90-ies years of last century in our country happened the crash of the system of values with transition to the standards of capitalistic society, and it lead to the formation of chronicle psychosocial stress of high and medium levels. Medics of all directions started to face functional psychosomatic diseases. Raised the necessity in grounding of health manpower in discipline of clinical psychology, with the learning of psychophisiological bases of diseases and possibilities if their correct...
Mbohwa, C; M. Mutingi
The dynamics of human resource recruitment and training in an uncertain environment creates a challenge for many policy makers in various organisations. In the presence of fuzzy manpower demand and training capacity, many companies fear losing critical human resources when their employees leave. As such, the development of effective dynamic policies for recruitment and training in a fuzzy dynamic environment is imperative. In this frame of mind, a fuzzy systems dynamics modelling approach is ...
Arab, M.; Tajvar, M; F Akbari
This research has tried to find most proper leadership styles based on a approved model to direct hospital manpower appropriately. The main objective of this research was the comparison between manager’s existing leadership styles and suggested styles to them in order to direct existing styles toward suggested ones. In this cross- sectional study all Qom province hospital managers participated. From the hospital the staff, 385 persons were selected by randomized stratifying sampling. Data wer...
Paul H K Ho
Full Text Available Recently, there has been a massive infrastructure development and an increasing demand for public and private housing, resulting in a shortage of qualified quantity surveyors. This study aims to forecast the demand for qualified quantity surveyors in Hong Kong from 2013 to 2015. Literature review indicates that the demand for quantity surveyors is a function of the gross values of building, civil engineering and maintenance works. The proposed forecasting method consists of two steps. The first step is to estimate the gross values of building, civil engineering and maintenance works by time series methods and the second step is to forecast the manpower demand for quantity surveyors by causal methods. The data for quantity surveyors and construction outputs are based on the ‘manpower survey reports of the building and civil engineering industry’ and the ‘gross value of construction works performed by main contractors’ respectively. The forecasted manpower demand for quantity surveyors in 2013, 2014 and 2015 are 2,480, 2,632 and 2,804 respectively. Due to the low passing rate of the assessment of professional competence (APC and the increasing number of retired qualified members, there will be a serious shortage of qualified quantity surveyors in the coming three years.
The Science and Engineering Research Council (SERC) published its first Corporate Plan in 1985 and its second in 1989. This third plan comes at a time of considerable change for the Council. Funding is tightly constrained, with the costs of research rising. Changes in funding patterns have made the pursuit of research in the higher-education sector - where the SERC deploys much of its resource -much harder, yet major new challenges and opportunities are opening up. The refocusing of a large organisation like the SERC is not accomplished overnight and needs careful preparation. This plan is therefore an interim document describing some important decisions recently taken and the reviews now being carried out to set future priorities. A fourth plan, to be published early in 1993, will describe the outcome of this reappraisal and set a definitive path towards the end of the century. The aims for the following programmes are stated and the funding objectives stated: the science board materials commission, engineering board, astronomy and planetary science board, nuclear physics board, fellowships, central computing, repayment work administration. Corporate plan actions for the neutron facilities, nuclear structure research, particle physics, information technology, engineering and international cooperation are presented. The impact of the reused plan on the manpower requirements is discussed. (author)
Vieira AH; Leles CR
Antonio Hélio Vieira, Cláudio Rodrigues Leles Department of Prevention and Oral Rehabilitation, School of Dentistry, Federal University of Goias, Goiania, Goias, Brazil Abstract: Motivations for seeking and undergoing prosthodontic care are poorly understood and are not often explored for clinical purposes when determining treatment need and understanding the factors related to the demand for health care and effective use. This article uses the Theory of Planned Behavi...
Beiranvand; Asadizaker; Fayazi; Yaralizadeh
Background It is known that health education on foot care is a common strategy for preventing diabetic foot and reducing the rate of lower limb amputation. Objectives To evaluate the efficacy of an intervention based on the theory of planned behavior for improving foot care in patients with type II diabetes in 2013 in Ahvaz, Iran. Patients and Methods In this clinical trial, 69 pat...
Hirdes John P
Full Text Available Abstract Background Targeting older clients for rehabilitation is a clinical challenge and a research priority. We investigate the potential of machine learning algorithms – Support Vector Machine (SVM and K-Nearest Neighbors (KNN – to guide rehabilitation planning for home care clients. Methods This study is a secondary analysis of data on 24,724 longer-term clients from eight home care programs in Ontario. Data were collected with the RAI-HC assessment system, in which the Activities of Daily Living Clinical Assessment Protocol (ADLCAP is used to identify clients with rehabilitation potential. For study purposes, a client is defined as having rehabilitation potential if there was: i improvement in ADL functioning, or ii discharge home. SVM and KNN results are compared with those obtained using the ADLCAP. For comparison, the machine learning algorithms use the same functional and health status indicators as the ADLCAP. Results The KNN and SVM algorithms achieved similar substantially improved performance over the ADLCAP, although false positive and false negative rates were still fairly high (FP > .18, FN > .34 versus FP > .29, FN. > .58 for ADLCAP. Results are used to suggest potential revisions to the ADLCAP. Conclusion Machine learning algorithms achieved superior predictions than the current protocol. Machine learning results are less readily interpretable, but can also be used to guide development of improved clinical protocols.
Guilhem, Dirce; Azevedo, Anamaria Ferreira
This study is an ethical reflection on the formulation and application of public policies regarding reproductive health in Brazil. The Integral Assistance Program for Women's Health (PAISM) can be considered advanced for a country in development. Universal access for family planning is foreseen in the Brazilian legislation, but the services do not offer contraceptive methods for the population in a regular and consistent manner. Abortion is restricted by law to two cases: risk to the woman's life and rape. This reality favors the practice of unsafe abortion, which is the third largest cause of maternal death in Brazil. Legal abortion is regulated by the State and the procedure is performed in public health centers. However, there is resistance on the part of professionals to attend these women. Prenatal care is a priority strategy for promoting the quality of life of these women and of future generations. Nonetheless, it is still difficult for these women to access the prenatal care services and to have the required number of consultations. Moreover, managers and health professionals need to be made aware of the importance of implementing the actions indicated by the public policies in the area of sexual and reproductive health, favoring respect for autonomy in a context of personal freedom. PMID:17614992
Garcia, Sofia F; Kircher, Sheetal M; Oden, Megan; Veneruso, Aubri; McKoy, June M; Pearman, Timothy; Penedo, Frank J
Cancer survivorship care plans (SCPs) have been recommended to improve clinical care and patient outcomes. Research is needed to establish their efficacy and identify best practices. Starting in 2015, centers accredited by the American College of Surgeons Commission on Cancer must deliver SCPs to patients completing primary cancer treatment with curative intent. We describe how we established routine SCP delivery at the Robert H Lurie Comprehensive Cancer Center in Chicago, Illinois, using the Quality Implementation Framework. We evaluated local practices, gathered clinician and patient stakeholder input, developed customized SCP templates within the electronic health record (EHR), and implemented 2 complementary delivery models. Clinician interviews (n = 41) and survey responses (n = 12), along with input from patients (n = 68) and a patient advisory board (n = 15), indicated support for SCPs and survivorship services. To promote feasible implementation and leverage existing workflows, we harmonized 2 SCP delivery models: integrated care within clinics where patients received treatment, and referral to a centralized survivorship clinic. We are implementing SCP delivery with prominent disease sites and will extend services to survivors of other cancers in the future. We developed four electronic disease-specific SCP templates for breast, colorectal, lung, and prostate cancers and a fifth, generic template that can be used for other malignancies. The templates reduced free-text clinician entry by auto-populating 20% of the fields from existing EHR data, and using drop-down menus for another 65%. Mean SCP completion time is 12 minutes (range, 10-15; n = 64). We designed our framework to facilitate ongoing evaluation of implementation and quality improvement. Funding/sponsorship Robert H Lurie Comprehensive Cancer Center, the Coleman Foundation, and the Lynn Sage Cancer Research Foundation. PMID:27258051
Masri, Maysoun Demachkie; Oetjen, Reid M; Campbell, Claudia
When Americans voted in November 2008, many had the presidential candidates' positions on health care reform in mind. Health savings accounts, which are high deductible health plans coupled with a tax-protected savings account, are 1 type of consumer-directed health plan (CDHP) that gained strong support from the Bush administration. Despite evidence of the effectiveness of CDHPs in constraining costs in other countries, the Obama health plan contains no mention of their role in future US health reform. This article seeks to provide the reader with a better understanding of how CDHPs can help to improve the use of health resources and reduce national health care expenditures by exploring the history and previous research on several types of consumer-directed plans and by providing a comparative analysis of the use of CDHPs in other countries. PMID:20686396
Bromley, Mark Calvin
This study is an investigation of the long-term care planning entered into by 170 adult children who had independent parents. A decision-making process with four stages was hypothesized. Sons and daughters entered into planning activities primarily at the "consideration" and "discussion" stages. This involvement proceeds along a sequence of stages with lower stage activities being completed before entering into more advanced stages. Minimal involvement from adult children in "preliminary p...
Office of the Assistant Secretary of Defense for Manpower and Reserve Affairs (DOD), Washington, DC.
Good record keeping--along with a constant and detailed knowledge of expenses, income, profit, and loss--is the first step toward profitable management of a child care center. Good record keeping is especially important in a center that provides "drop-in" or occasional care because income may fluctuate greatly as a result of the variable number of…
Jia-yuan LIAO; Meng-ye PENG; Er-sheng GAO
@@ With the mainstreaming being the demand from the people at reproductive age, we systematically analyzed the ideas and ways to implement quality care (QC) in family planning (FP) in Qianjiang, including advocating the conception of quality care, carrying out health education and counseling, strengthening capacity building of service system and reforming measurement of the evaluation and other aspects. The demand-oriented QC in FP has met personalized and verified demands from people of reproductive age satisfactorily, and kept the fertility rate at a lower level while uplifting satisfaction of the public. The demand-oriented QC in FP in Qianjiang county proved to be a successful and great worth practice.
Galbraith Alison A
Full Text Available Abstract Background Recent increases in patient cost-sharing for health care have lent increasing importance to monitoring cost-related changes in health care use. Despite the widespread use of survey questions to measure changes in health care use and related behaviors, scant data exists on the reliability of such questions. Methods We administered a cross-sectional survey to a stratified random sample of families in a New England health plan's high deductible health plan (HDHP with ≥ $500 in annualized out-of-pocket expenditures. Enrollees were asked about their knowledge of their plan, information seeking, behavior change associated with having a deductible, experience of delay in care due in part to cost, and hypothetical delay in care due in part to cost. Initial respondents were mailed a follow-up survey within two weeks of each family returning the original survey. We computed several agreement statistics to measure the test-retest reliability for select questions. We also conducted continuity adjusted chi-square, and McNemar tests in both the original and follow-up samples to measure the degree to which our results could be reproduced. Analyses were stratified by self-reported income. Results The test-retest reliability was moderate for the majority of questions (0.41 - 0.60 and the level of test-retest reliability did not differ substantially across each of the broader domains of questions. The observed proportions of respondents with delayed or foregone pediatric, adult, or any family care were similar when comparing the original and follow-up surveys. In the original survey, respondents in the lower-income group were more likely to delay or forego pediatric care, adult care, or any family care. All of the tests comparing income groups in the follow-up survey produced the same result as in the original survey. Conclusions In this population of HDHP beneficiaries, we found that survey questions concerning plan knowledge, information
Balogh, Erin P; Ganz, Patricia A; Murphy, Sharon B; Nass, Sharyl J; Ferrell, Betty R; Stovall, Ellen
The Institute of Medicine's National Cancer Policy Forum recently convened a workshop on patient-centered cancer treatment planning, with the aim of raising awareness about this important but often overlooked aspect of cancer treatment. A primary goal of patient-centered treatment planning is to engage patients and their families in meaningful, thorough interactions with their health care providers to develop an accurate, well-conceived treatment plan, using all available medical information appropriately while also considering the medical, social, and cultural needs and desires of the patient and family. A cancer treatment plan can be shared among the patient, family, and care team in order to facilitate care coordination and provide a roadmap to help patients navigate the path of cancer treatment. There are numerous obstacles to achieving patient-centered cancer treatment planning in practice. Some of these challenges stem from the patient and include patients' lack of assertiveness, health literacy, and numeracy, and their emotional state and concurrent illnesses. Others are a result of physician limitations, such as a lack of time to explain complex information and a lack of tools to facilitate treatment planning, as well as insensitivity to patients' informational, cultural, and emotional needs. Potential solutions to address these obstacles include better training of health care providers and patients in optimal communication and shared decision making, and greater use of support services and tools such as patient navigation and electronic health records. Other options include greater use of quality metrics and reimbursement for the time it takes to develop, discuss, and document a treatment plan. PMID:22128118
Geurts, Marlies M E; Ivens, Martijn; van Gelder, Egbert; de Gier, Johan J
BACKGROUND: In medication therapy management there is a need for a tool to document medication reviews and pharmaceutical care plans (PCPs) as well as facilitate collaboration and sharing of patient data between different healthcare providers. Currently, pharmacists and general practitioners (GPs) h
Through the comparative analysis on the theories and practical experience of the development of old-age care (OAC) in both China and other countries,and based on the interview and questionnaire survey in Zhejiang Province and Hangzhou City,this paper proposes the research and analysis framework for the old-age service system,i.e.,"OAC mode-OAC service system-OAC facility system." The paper argues that,oriented by OAC mode of "taking community-and home-based care as the main body and institution-based care as supplement," China should build an OAC facility system and planning thoughts that take "continuum of care" as concept and long-term care system as core.Taking Zhejiang Province and Hangzhou City as examples,the paper conducts the optimization research on current OAC facilities planning in terms of hierarchical system,scale,and differentiation,so as to formulate more systematic and operable planning standards for OAC facilities.
Kodner, D L
In the next two decades, rapid, fundamental changes will take place in the way we finance, organize, and provide long-term care services. Because the elderly make up such a large portion of the patient population, America's hospitals should be concerned--and involved. There are six keys to the future of long-term care: a sharp increase in elderly population, a new generation of elderly, restrained government role, intergenerational strains, growing corporate concern, and the rise of "gerotechnology." These trends and countertrends will result in a new look in the long-term care landscape. By the year 2010, changes will include a true public-private financing system, provider reimbursement on the basis of capitation and prospective payment, coordinated access to services, dominant alternative delivery systems, a different breed of nursing homes, fewer staffing problems, patient-centered care, a new importance in housing, and an emphasis on prevention. For hospitals, this future vision of long-term care means that significant opportunities will open up to meet the needs of the elderly-at-risk and to achieve a competitive position in the burgeoning elderly care industry. PMID:10313396
Kwak, Jung; De Larwelle, Jessica A; Valuch, Katharine O'Connell; Kesler, Toni
Health care proxies make important end-of-life decisions for individuals with dementia. A cross-sectional survey was conducted to examine the role of advance care planning in proxy decision making for 141 individuals with cognitive impairment, Alzheimer's disease, or other types of dementia. Proxies who did not know the preferences of individuals with dementia for life support treatments reported greater understanding of their values. Proxies of individuals with dementia who did not want life support treatments anticipated receiving less support and were more uncertain in decision making. The greater knowledge proxies had about dementia trajectory, family support, and trust of physicians, the more informed, clearer, and less uncertain they were in decision making. In addition to advance care planning, multiple factors influence proxy decision making, which should be considered in developing interventions and future research to support informed decision making for individuals with dementia and their families. [Res Gerontol Nurs. 2016; 9(2):72-80.]. PMID:26020579
Full Text Available Objectives: To assess and understand the awareness and experience of brain tumour (BT patients in discussing Advance Care Planning (ACP, to identify main symptoms experienced, physical and functional status perceived quality of life, and level of coping. Methods: A prospective cohort study with an initial open-ended questionnaire followed by semi-structured interview questions regarding ACP with 18 patients diagnosed with BT (WHO Grade I-IV, metastatic BT in hospital and community. Standardized assessments measured coping strategies, and quality of life (QoL. Interview transcripts regarding ACP discussions were analyzed, coded and interpreted using qualitative analytic techniques for thematic analyses. Results: Participants' mean age was 51 years (range 22-65 years, female (61%; median time since BT diagnosis was 1.5 years and just over half (56% had glioblastoma multiforme (GBM. Fatigue was the most common symptom reported by 83% of participants. Overall, participants indicated good QoL and used more problem-focused coping strategies including ‘acceptance’ and ‘positive reframing’. Thematic analyses indicated that participants had limited awareness and understanding of ACP, variable views on appropriate timing of ACP discussions and change of decisions over illness trajectory. Most felt able to discuss ACP and preferred dedicated sessions by a trained health professional. Conclusion: This study highlights the importance of providing timely information regarding ACP to BT patients during the course of their disease. Established ACP discussions have an important role in enhancing patient autonomy and to guide delivery of end-of-life care. The demonstrated low uptake of ACP in this pilot study shows need for improved awareness in clinical practice for timely ACP discussions and multifaceted interventions system-wide in implementing ACP
Full Text Available Christian Gausvik,1 Ashley Lautar,2 Lisa Miller,2 Harini Pallerla,3 Jeffrey Schlaudecker4,5 1University of Cincinnati College of Medicine, 2The Christ Hospital, Cincinnati, OH, USA; 3Department of Family and Community Medicine, 4Division of Geriatric Medicine, University of Cincinnati, Cincinnati, OH, USA; 5Geriatric Medicine Fellowship Program, University of Cincinnati/The Christ Hospital, Cincinnati, OH, USA Abstract: Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR on an acute care for the elderly (ACE unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer
Liou, James J. H.; Tzeng, Gwo-Hshiung
Human resource management (HRM) is an important issue for today’s competitive airline marketing. In this paper, we discuss a multi-objective model designed from the De Novo perspective to help airlines optimize their maintenance manpower portfolio. The effectiveness of the model and solution algorithm is demonstrated in an empirical study of the optimization of the human resources needed for airline line maintenance. Both De Novo and traditional multiple objective programming (MOP) methods are analyzed. A comparison of the results with those of traditional MOP indicates that the proposed model and solution algorithm does provide better performance and an improved human resource portfolio.
Full Text Available In 90-ies years of last century in our country happened the crash of the system of values with transition to the standards of capitalistic society, and it lead to the formation of chronicle psychosocial stress of high and medium levels. Medics of all directions started to face functional psychosomatic diseases. Raised the necessity in grounding of health manpower in discipline of clinical psychology, with the learning of psychophisiological bases of diseases and possibilities if their correction. This direction of development of soviet medical education and health service in general seems progressive and prospective.
Full Text Available In this paper a two graded organization is considered in which depletion of manpower occurs due to its policy decisions. Three mathematical models are constructed by assuming the loss of man-hours and the inter-decision times form an order statistics. Mean and variance of time to recruitment are obtained using an univariate recruitment policy based on shock model approach and the analytical results are numerically illustrated by assuming different distributions for the thresholds. The influence of the nodal parameters on the system characteristics is studied and relevant conclusions are presented.
Karthik Nagesh, N; Razak, Abdul
Globally, newborn health is now considered as high-level national priority. The current neonatal and infant mortality rate in India is 29 per 1000 live births and 42 per 1000 live births, respectively. The last decade has seen a tremendous growth of neonatal intensive care in India. The proliferation of neonatal intensive care units, as also the infusion of newer technologies with availability of well-trained medical and nursing manpower, has led to good survival and intact outcomes. There is good care available for neonates whose parents can afford the high-end healthcare, but unfortunately, there is a deep divide and the poor rural population is still underserved with lack of even basic newborn care in few areas! There is increasing disparity where the 'well to do' and the 'increasingly affordable middle class' is able to get the most advanced care for their sick neonates. The underserved urban poor and those in rural areas still contribute to the overall high neonatal morbidity and mortality in India. The recent government initiative, the India Newborn Action Plan, is the step in the right direction to bridge this gap. A strong public-private partnership and prioritisation is needed to achieve this goal. This review highlights the current situation of neonatal intensive care in India with a suggested plan for the way forward to achieve better neonatal care. PMID:26944066
In this paper I shall give a short history of the development of neutron scattering at the Research Centre for Nuclear Techniques (PPTN), in Bandung, and the early development of a more advanced facilities at the Neutron Scattering Laboratory (NSL BATAN), Centre of Technology for Nuclear Industrial Materials, in Serpong. The first research reactor in Indonesia was the TRIGA MARK II in Bandung, which became operational in 1965, with a power of 250 KW, upgraded to 1 MW in 1971, and to 2 MW in 2000. The neutron scattering activities was started in 1967, with the design and construction of the first powder diffractometer, and put in operation in 1970. It was followed by the second instrument, the filter detector spectrometer built in 1975 in collaboration with the Bhabha Atomic Research Centre (BARC), India. A powder diffractometer for magnetic studies was built in 1980, and finally, a modification of the filter detector spectrometer to measure textures was made in 1986. A brief description of the design and construction of the instruments, and a highlight of some research topics will be presented. Early developments of neutron scattering activities at the 30 MW, RSG-GAS reactor in Serpong in choosing suitable research program, which will be mainly centred around materials testing/characterization, and materials/condensed matter researches has been agreed. Instrument planning and layout which were appropriate to carry out the program had been decided. Manpower development for the neutron scattering laboratory is a severe problem. The efforts to overcome this problem has been solved. International Cooperation through workshops and on the job trainings also support the supply of qualified manpower
In this paper I shall give a short history of the development of neutron scattering at the Research Centre for Nuclear Techniques (PPTN), in Bandung, and the early development of a more advanced facilities at the Neutron Scattering Laboratory (NSL BATAN), Centre of Technology for Nuclear Industrial Materials, in Serpong. The first research reactor in Indonesia was the TRIGA MARK II in Bandung, which became operational in 1965, with a power of 250 KW, upgraded to 1 MW in 1971, and to 2 MW in 2000. The neutron scattering activities was started in 1967, with the design and construction of the first powder diffractometer, and put in operation in 1970. It was followed by the second instrument, the filter detector spectrometer built in 1975 in collaboration with the Bhabha Atomic Research Centre (BARC), India. A powder diffractometer for magnetic studies was built in 1980, and finally, a modification of the filter detector spectrometer to measure textures was made in 1986. A brief description of the design and construction of the instruments, and a highlight of some research topics will be presented. Early developments of neutron scattering activities at the 30 MW, RSG-GAS reactor in Serpong in choosing suitable research program, which will be mainly centred around materials testing/characterization, and materials/condensed matter researches has been agreed. Instrument planning and layout which were appropriate to carry out the program had been decided. Manpower development for the neutron scattering laboratory is a severe problem. The efforts to overcome this problem has been solved. International Cooperation through workshops and on the job trainings also support the supply of qualified manpower.
Ahmadian, Mohammad Javad
The purpose of the study reported in this article was twofold: First, to see whether guided careful online planning assists intermediate learners of English as a foreign language (EFL) in accurate oral production of English articles ("an/a" and "the"); and, second, to see whether guided careful online planning has any effects on global complexity…
Sinclair, James B; Oyebode, Jan R; Owens, R Glynn
The uptake of advance care planning (ACP) is particularly low among people with dementia. This may reflect barriers to communication between professionals, patients and families in the face of lack of consensus about the process. This study aimed to methodically investigate consensus views of how ACP should be explained and carried out with people with dementia. A three-round Delphi study explored views of how and when ACP should be addressed, what should be covered, who should be involved and why rates of ACP are low. Seventeen participants took part comprising family members, old age psychiatrists and policy makers. Thirty-two items reached consensus. The panel agreed on 11 different areas for discussion. They concurred that ACP was best addressed after the person has come to terms with the diagnosis when the individual feels ready to do so. There was a consensus view that the process should be couched in terms of 'certain possibilities'. Consensus items emphasised personal choice and autonomy, while also prioritising the need to discuss financial aspects and to include spouses. There was no consensus that professionals should be involved, although the panel viewed them as carrying some responsibility for low uptake. It is suggested that ACP should include general discussion of values as well as coverage of specific points. Professionals need to offer discussion and information on ACP, but also make clear that the patient has the right to choose whether to pursue ACP or not. PMID:25684278
Full Text Available As a result of enhanced professionalism and commercialization in the field of sports, it has become an industry of its own. Professionalism and industrialization are correlated; therefore sports actors’ performance achieved as a result of their professionalism lead to the commercialization, and even to the industrialization of certain (branches of sports. On the other hand, it is considered that industrialization which involves the commercial aspect is able to maintain, and even enhance sports actors’ professionalism/performance. In practice, such correlation is not always directly proportional, but inversely proportional. There have been cases of issues related to sports actors’ welfare not being properly fulfilled, in fact, being far below the general manpower standards applicable to people doing work (workers/laborers. In general such cases include late or non-payment of wages, reducing bonuses, implementation of contract not accordance with the initial agreement, unilateral termination of contract without compensation for damages and others. The frequently arising question is whether sports actors, particularly athletes, have the status of ‘nonemployee’ professionals, or the status of ‘employees’. The various existing opinions related to such issue of status raise certain legal implications, particularly from the manpower aspect which emphasizes the welfare and legal protection of ‘workers’, which are also often experienced by athletes. It is expected that this article will be able to provide to the readers a broader view regarding the status of athletes’ ‘manpower’ status.
The purpose is to train and develop the adequately qualified manpower in the areas of nuclear science and technology. Various options were introduced by the science departments, based on the existing facilities within the university. Twenty final year students were selected annually to attend a summer school in reactor physics and technology at the Karlsruhe Institute for Nuclear Research in West Germany. Also, there was approval for an annual recruitment quota of twelve graduate assistants for the nuclear project. Fifty qualified students were trained for various courses in nuclear science and technology both in the country and abroad. There had been graduates in nuclear science and technology courses up to the doctorate degree level. Part of efforts in the manpower has been directed towards the acquisition of adequate equipment for the teaching laboratories. The establishment of a training center in nuclear technology at Ahmadu Bello University and at University of Ife can only be considered as the zero phase in the nuclear programme of Nigeria. Funding of the nuclear programme must be guaranteed. It is also suggested that the nuclear project be allocated sufficient foreign exchange to meet all its commitments. (A.S.)
Elwyn, G.; Hocking, P.; Burtonwood, A.; Harry, K.; Turner, A.
A shift from continuing medical education towards professional and organisational development policies, coupled with the introduction of accountability frameworks (clinical governance), has generated interest in professional and practice development plans (PPDPs) in general practice. The problems of