Ryan, Joanne C.; Cleland, Charles M.; Mei R. Fu
Lymphedema, a debilitating and chronic condition, is considered to be one of the most distressing adverse effects of cancer treatment. The purpose of this study was to understand the practice patterns in lymphedema care and identify predictors influencing those patterns among oncology nurses, with a focus on advanced practice nurses. Random and purposive sampling was utilized to recruit 238 oncology nurses who completed the Web-based study. Participants included advanced practice nurses (nurs...
Sheth, Ujash; Wasserstein, David; Moineddin, Rahim; Jenkinson, Richard; Kreder, Hans; Jaglal, Susan
Objectives: Over the last decade, there has been a growing body of level I evidence supporting non-operative management (focused on early range of motion and weight bearing) of acute Achilles tendon ruptures. Despite this emerging evidence, there have been very few studies evaluating its uptake. Our primary objective was to determine whether the findings from a landmark trial assessing the optimal management strategy for acute Achilles tendon ruptures influenced the practice patterns of orthopaedic surgeons in Ontario, Canada over a 12-year time period. As a second objective we examined whether patient and provider predictors of surgical repair utilization differed before and after dissemination of the landmark trial results. Methods: Using provincial health administrative databases, we identified Ontario residents ≥ 18 years of age with an acute Achilles tendon rupture from April 2002 to March 2014. The proportion of surgically repaired ruptures was calculated for each calendar quarter and year. A time series analysis using an interventional autoregressive integrated moving average (ARIMA) model was used to determine whether changes in the proportion of surgically repaired ruptures were chronologically related to the dissemination of results from a landmark trial by Willits et al. (first quarter, 2009). Spline regression was then used to independently identify critical time-points of change in the surgical repair rate to confirm our findings. A multivariate logistic regression model was used to assess for differences in patient (baseline demographics) and provider (hospital type) predictors of surgical repair utilization before and after the landmark trial. Results: In 2002, ˜19% of acute Achilles tendon ruptures in Ontario were surgically repaired, however, by 2014 only 6.5% were treated operatively. A statistically significant decrease in the rate of surgical repair (p < 0.001) was observed after the results from a landmark trial were presented at a major
Full Text Available Background. This study was designed to understand the patterns and determinants of three essential newborn care practices: safe cord care, optimal thermal care, and neonatal feeding practices. Methods. A community-based cross-sectional study was carried out on a sample of 404 lactating mothers who have delivered a live baby at home within the past one year prior to the study. Results. Overall, the prevalence of essential newborn practices on safe cord care and optimal thermal care was exceptionally low. Of the 404 newborns, only 0.2% (1 had safe cord care, 5.2% (21 optimal thermal care, and 50.2% (203 were considered to have had adequate neonatal feeding. In logistic regression analysis, the main predictors of good neonatal feeding were maternal age, timing of the first antenatal care (ANC, and maternal knowledge of newborn danger signs. Women who could mention at least 4 danger signs of the neonate were 4 times more likely to give good neonatal feeding to their babies (AOR = 4.7, Cl: 2.43–9.28, P<0.001. Conclusion. Evidence from this study strongly suggests that the expected essential newborn care practices are not available to a substantial number of the newborns. Efforts should therefore be made by the Ghana Health Service (GHS to expand essential newborn care interventions beyond institutional level into the communities.
Chokshi, Tejas; Alaparthi, Gopala Krishna; Krishnan, Shyam; Vaishali, K; Zulfeequer, C.P.
Objective: To determine practice pattern of physiotherapists in the neonatal intensive care units (ICUs) in India with regards to cardiopulmonary and neuromuscular physiotherapy. Materials and Methods: A cross-sectional survey was conducted across India, in which 285 questionnaires were sent via e-mail to physiotherapists working in neonatal intensive care units. Results: A total of 139 completed questionnaires were returned with a response rate of 48.7%, with a majority of responses from Kar...
Subar, Paul; Chávez, Elisa M; Miles, Jeffrey; Wong, Allen; Glassman, Paul; Labarre, Eugene
There has been limited research into the impact of predoctoral experiences and postdoctoral general dentistry residencies on the practice patterns of dentists in the care of patients with special or complex needs. This study was undertaken to determine if educational experiences with special populations had a relationship to practice patterns after graduation or residency. University of the Pacific alumni who graduated between 1997 and 2007 were surveyed regarding their pre- and postdoctoral dental education and their practice patterns for the care of patients categorized as medically compromised, frail elders, and developmentally disabled. Definitions for each patient category were provided. Alumni were asked about their practice setting and postdoctoral education. Thirty-one percent (n=526) of those surveyed responded. Regression analyses showed respondents not in private practice were more likely to have completed a postdoctoral general dentistry program (Advanced Education in General Dentistry or General Practice Residency) after dental school compared to respondents in private practice (pspecial needs populations appear to have a relationship to graduates' practice setting and patient population. PMID:23225681
Beehler, Gregory P; Funderburk, Jennifer S; King, Paul R; Wade, Michael; Possemato, Kyle
Primary care-mental health integration (PC-MHI) is growing in popularity. To determine program success, it is essential to know if PC-MHI services are being delivered as intended. The investigation examines responses to the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) to explore PC-MHI provider practice patterns. Latent class analysis was used to identify clusters of PC-MHI providers based on their self-report of adherence on the PPAQ. Analysis revealed five provider clusters with varying levels of adherence to PC-MHI model components. Across clusters, adherence was typically lowest in relation to collaboration with other primary care staff. Clusters also differed significantly in regard to provider educational background and psychotherapy approach, level of clinic integration, and previous PC-MHI training. The PPAQ can be used to identify PC-MHI provider practice patterns that have relevance for future clinical effectiveness studies, development of provider training, and quality improvement initiatives. PMID:26622911
Divatia, Jigeeshu V.; Amin, Pravin R.; Ramakrishnan, Nagarajan; Kapadia, Farhad N.; Todi, Subhash; Sahu, Samir; Govil, Deepak; Chawla, Rajesh; Kulkarni, Atul P.; Samavedam, Srinivas; Jani, Charu K.; Rungta, Narendra; Samaddar, Devi Prasad; Mehta, Sujata; Venkataraman, Ramesh; Hegde, Ashit; Bande, BD; Dhanuka, Sanjay; Singh, Virendra; Tewari, Reshma; Zirpe, Kapil; Sathe, Prachee
Aims: To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs). Patients and Methods: An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs. Results: On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality. Conclusions: The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.
Full Text Available Edward Ewen,1 Zugui Zhang,1 Teresa A Simon,2 Paul Kolm,1 Xianchen Liu,3,4 William S Weintraub11Christiana Care Health System, Newark, DE, USA; 2Bristol-Myers Squibb, Princeton, NJ, USA; 3Indiana University School of Medicine, Indianapolis, IN, USA; 4Pfizer, Groton, CT, USABackground: Warfarin is recommended for stroke prevention in high-risk patients with atrial fibrillation. However, it is often underutilized and inadequately managed in actual clinical practice.Objectives: To examine the patterns of warfarin use and their relationship with stroke and bleeding in atrial fibrillation patients in community-based primary care practices.Design: Retrospective longitudinal cohort study.Participants: A total of 1141 atrial fibrillation patients were selected from 17 primary care practices with a shared electronic medical record and characterized by stroke risk, potential barriers to anticoagulation, and comorbid conditions.Main measures: Duration and number of warfarin exposures, interruptions in warfarin exposure > 45 days, stroke, and bleeding events.Results: Among 1141 patients with a mean age of 70 years (standard deviation 13.3 and mean follow-up of 3.4 years (standard deviation 3.0, 764 (67% were treated with warfarin. Warfarin was discontinued within 1 year in 194 (25.4%, and 349 (45.7% remained on warfarin at the end of follow-up. Interruptions in warfarin use were common, occurring in 32.6% (249 of 764 of patients. Those with two or more interruptions were younger and at lower baseline stroke risk when compared to those with no interruptions. There were 76 first strokes and 73 first-bleeding events in the follow-up period. When adjusted for baseline stroke risk, time to warfarin start, and total exposure time, two or more interruptions in warfarin use was associated with an increased risk of stroke (relative risk, 2.29; 95% confidence interval: 1.29–4.07. There was no significant association between warfarin interruptions and bleeding events
Ewen E; Zhang Z; Simon TA; Kolm P; Liu X; Weintraub WS
Edward Ewen,1 Zugui Zhang,1 Teresa A Simon,2 Paul Kolm,1 Xianchen Liu,3,4 William S Weintraub11Christiana Care Health System, Newark, DE, USA; 2Bristol-Myers Squibb, Princeton, NJ, USA; 3Indiana University School of Medicine, Indianapolis, IN, USA; 4Pfizer, Groton, CT, USABackground: Warfarin is recommended for stroke prevention in high-risk patients with atrial fibrillation. However, it is often underutilized and inadequately managed in actual clinical practice.Objectives: To examine the pat...
Anthias, Chloe; Shaw, Bronwen E; Kiefer, Deidre M; Liesveld, Jane L; Yared, Jean; Kamble, Rammurti T; D'Souza, Anita; Hematti, Peiman; Seftel, Matthew D; Norkin, Maxim; DeFilipp, Zachariah; Kasow, Kimberly A; Abidi, Muneer H; Savani, Bipin N; Shah, Nirali N; Anderlini, Paolo; Diaz, Miguel A; Malone, Adriana K; Halter, Joerg P; Lazarus, Hillard M; Logan, Brent R; Switzer, Galen E; Pulsipher, Michael A; Confer, Dennis L; O'Donnell, Paul V
Recent investigations have found a higher incidence of adverse events associated with hematopoietic cell donation in related donors (RDs) who have morbidities that if present in an unrelated donor (UD) would preclude donation. In the UD setting, regulatory standards ensure independent assessment of donors, one of several crucial measures to safeguard donor health and safety. A survey conducted by the Center for International Blood and Marrow Transplant Research (CIBMTR) Donor Health and Safety Working Committee in 2007 reported a potential conflict of interest in >70% of US centers, where physicians had simultaneous responsibility for RDs and their recipients. Consequently, several international organizations have endeavored to improve practice through regulations and consensus recommendations. We hypothesized that the changes in the 2012 Foundation for the Accreditation of Cellular Therapy and the Joint Accreditation Committee-International Society for Cellular Therapy and European Society for Blood and Marrow Transplantation standards resulting from the CIBMTR study would have significantly impacted practice. Accordingly, we conducted a follow-up survey of US transplantation centers to assess practice changes since 2007, and to investigate additional areas where RD care was predicted to differ from UD care. A total of 73 centers (53%), performing 79% of RD transplantations in the United States, responded. Significant improvements were observed since the earlier survey; 62% centers now ensure separation of RD and recipient care (P management does not meet international donor care standards, however. Particular concerns include counseling and assessment of donors before HLA typing, with 61% centers first disclosing donor HLA results to an individual other than the donor, the use of unlicensed mobilization agents, and the absence of long-term donor follow-up. Recommendations for improvement are made. PMID:26597080
Full Text Available Context: As physiotherapy (PT is a young profession in Nepal, there is a dearth of insight into the common practices of physiotherapists in critical care. Aims: To identify the availability of PT services in Intensive Care Units (ICUs and articulate the common practices by physiotherapists in ICUs of Nepal. Settings and Design: All tertiary care hospitals across Nepal with ICU facility via an exploratory cross-sectional survey. Subjects and Methods: An existing questionnaire was distributed to all the physiotherapists currently working in ICUs of Nepal with 2 years of experience. The survey was sent via E-mail or given in person to 86 physiotherapists. Statistical Analysis Used: Descriptive and inferential statistics according to nature of data. Results: The response rate was 60% (n = 52. In the majority of hospitals (68%, PT service was provided only after a physician consultation, and few hospitals (13% had established hospital criteria for PT in ICUs. Private hospitals (57.1% were providing PT service in weekends compared to government hospitals (32.1% (P = 0.17. The likelihood of routine PT involvement varied significantly with the clinical scenarios (highest 71.2% status cerebrovascular accident, lowest 3.8% myocardial infarction, P < 0.001. The most preferred PT treatment was chest PT (53.8% and positioning (21.2% while least preferred was therapeutic exercise (3.8% irrespective of clinical scenarios. Conclusions: There is a lack of regular PT service during weekends in ICUs of Nepal. Most of the cases are treated by physiotherapists only after physician's referral. The preferred intervention seems to be limited only to chest PT and physiotherapists are not practicing therapeutic exercise and functional mobility training to a great extent.
The Patterns of Care Study reviewed the processes and outcome of 682 patients with carcinoma of the prostate treated with radiation therapy from 1973-1976. The study and patient sampling were designed to reflect a valid representation of how prostate cancer is treated by radiation oncologists in the United States. The outcome results represent national benchmarks. The three year actuarial survival was 91% for Stage A, 88% for Stage B, and 76% for Stage C. Stage, grade, elevated serum acid phosphatase, Karnofsky performance status, previous hormonal therapy, age, and prior transurethral resection were identified by multivariate regression analysis to be important independent prognostic variables. Local control was related to the dose of the primary site, paraprostatic region, and pelvic sidewall. Major complications occurred in 9% of patients with Stage A, 2% of Stage B, and 6% with Stage C disease. Complications were related to dose and treatment technique. The Patterns of Care Process Survey identified that only 60% of patients surveyed had the necessary pretreatment evaluation studies required for best current management of adenocarcinoma of the prostate
Rajeev A Annigeri
Full Text Available Aim: Recent advances in dialysis therapy have made an impact on the clinical practice of renal replacement therapy (RRT in acute kidney injury (AKI in Intensive Care Unit (ICU. We studied the impact of RRT practice changes on outcomes in AKI in ICU over a period of 8 years. Subjects and Methods: AKI patients requiring RRT in ICU referred to a nephrologist during two different periods (period-1: Between May 2004 and May 2007, n = 69; period-2: Between August 2008 and May 2011, n = 93 were studied. The major changes in the dialysis practice during the period-2, compared to period-1 were introduction of prolonged intermittent RRT (PIRRT, early dialysis for metabolic acidosis, early initiation of RRT for anuria and positive fluid balance and use of bicarbonate-based fluids for continuous RRT (CRRT instead of lactate buffer. The primary study outcome was 28-day hospital mortality. Results: The mean age was 53.8 ± 16.1 years and 72.6% were male. Introduction of PIRRT resulted in 37% reduction in utilization of CRRT during period-2 (from 85.5% to 53.7%. The overall mortality was high (68% but was significantly reduced during period-2 compared to period-1 (59% vs. 79.7%, P = 0.006. Metabolic acidosis but not the mode of RRT, was the significant factor which influenced mortality. Conclusions: Adaption of PIRRT resulted in 37% reduction of utilization of CRRT. The mortality rate was significantly reduced during the period of adaption of PIRRT, possibly due to early initiation of RRT in the latter period for indications such as anuria and metabolic acidosis.
textabstractThe 2008 financial crisis has demonstrated the failure of both utilitarian and deontological ethics in finance. Alternatives do not need to be created from nothing, because the crisis itself has stimulated the emergence of ethically sound finance practices from within the sector. This article presents two cases of such alternatives, which can be understood as caring finance. Caring finance is built around more personal relationships, responsibility, and risk reduction. The example...
Ezeaka, Chinyere V; Ugwu, Rosemary O; Mukhtar-Yola, Mariya; Ekure, Ekanem N; Olusanya, Bolajoko O
Background Nigeria is frequently associated with disproportionately high rates of severe neonatal jaundice (NNJ) underpinned by widespread Glucose-6-phosphate dehydrogenase (G6PD) deficiency. Timely and appropriate treatment of NNJ is crucial for preventing the associated morbidity and neuro-developmental sequelae. Since mothers are likely to be the first mostly to observe the onset of severe illness in their newborns, we set out to identify the pattern and predictors of maternal care-seeking...
Celentano, D D
Career patterns and practice correlates of 143 New Health Professionals (NHPs) educated at one institution are studied to determine similarities among different types of practitioners (Health Associates and Nurse Practitioners). Employment since graduation has been high with low job turnover. Nurse Practitioners (NPs) are found most often in metropolitan areas, while over 50 per cent of Health Associates (HAs) are employed in rural settings. More NPs work in hospitals than HAs, who have a higher rate of employment in private practices, HAs are also involved in a wider range of medical specialties than NPs. In terms of patient care, HAs see more patients than NPs and also have larger primary care caseloads. From a functional perspective, only minimal differences are found in comparing the activities of the practitioners. Most NHPs have high job satisfaction, although HAs anticipate a high rate of job turnover; no differences were found in levels of perceived responsibility nor in the amount of supervision in patient care. Although there were only small differences in the activities of the two groups, numerous contextual and practice correlates were found to differentiate the NHPs, a finding which argues against the current practice of conceptualizing NHPs as a single group. PMID:29997
Halling, Anders; Kristensen, Troels; Ranstad, Karin;
Objectives: The objective is to describe and analyze the prevalence of comorbidity and multimorbidity among older people with extensive and complex care needs. Next, the main objective is to present and discuss papers on the association between healthcare utilisation in general practice and...... important areas of healthcare utilisation in general practice in the Nordic countries. In the future, this demand for healthcare services among the elderly is expected to increase. For instance, it is likely that people live longer and advanced technologies continue to be developed, affecting demand and...... diabetes). Today we have limited information on the need for social services and health care services for the elderly in the Nordic countries. There is a need for improved understanding of variation in healthcare utilization and methods to measure the actual need for healthcare services among older...
ARÉVALO SÁNCHEZ, ELIZABETH
The purposeofthisresearch istovalue thecarepractices that mothers perform on themselves and on the baby to whom she is going to give birth. 150 pregnant women that go to the Centro Operativo Local Engativá medical facility, registered on project 7317: "Preganant Families: healthy and desired babies of the Administrative DepartmentofSocialWellbeing", using a quantitative and descriptive methodology. We applied the "Instrument to value those care practices that are performed on themselves and o...
Vijayamahantesh. M. Bijapur
.6%, Pamphlets (59.2%, Friends (57.8%, Radio (52.7%, posters (51.3%, nursing and other staff (47.8% and others (25.5%. Of those 888 willing to donate 95.2% (845 subjects would be doing as a noble deed, 745 (83.9% for pleasure to help blind, 690 (77.7% were motivated by the idea of giving vision to someone after their death. Of 212 unwilling, 178 participants (83.9% disliked the idea of body being tampered with and 124 participants (58.5% had objection by family members. Conclusion: The reasons for not donating need to be considered while creating awareness about eye donation in the community. Knowledge, attitude and practice in the context of eye donation may not complement each other and need to be addressed to bring about a change in patterns observed.
Norton, Peter G.; Dunn, Earl V.; Bed, Liane Soberman
As the demographics of practising physicians change, especially as the number of women doctors in an area increases, it is important that those planning for the provision of medical care in the future understand the relationships between the demographics and changes in practice patterns.
A survey of stoma care in general practice is reported. It demonstrates a wide diversity in the patterns of care provided to ostomates, with only half of the general practitioners reporting regular follow-up by a member of the health care team. Dealing with appliance difficulties was found to be an aspect of stoma care in which a majority of general practitioners have little confidence. The district nurse and stoma nurse are considered to be the most valuable sources of back-up. It is suggest...
Roebroeck, M.E.; Dekker, J.; Oostendorp, R.A.B.; Bosveld, W.
The goal of this study is to describe treatment patterns by Dutch physiotherapists for patients with lateral ankle sprains, and to compare them with assumptions on expected treatment that are derived from the literature. For this purpose, data of 251 patients with a sprain of the ankle were compared
Roebroeck, M.E.; Dekker, J; Oostendorp, R.A.B.; Bosveld, W.
The goal of this study is to describe treatment patterns by Dutch physiotherapists for patients with lateral ankle sprains, and to compare them with assumptions on expected treatment that are derived from the literature. For this purpose, data of 251 patients with a sprain of the ankle were compared with a reference group of 16,823 patients with different medical diagnoses. Data concerned patient characteristics, treatment sessions, goals pursued (defined in terms of impairments and disabilit...
I.P. van Staveren (Irene)
textabstractThe 2008 financial crisis has demonstrated the failure of both utilitarian and deontological ethics in finance. Alternatives do not need to be created from nothing, because the crisis itself has stimulated the emergence of ethically sound finance practices from within the sector. This ar
Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247\\/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.
Purpose: External beam radiotherapy (RT) is commonly indicated for the palliation of symptomatic bone metastases, but there is evidence of underutilization of this treatment modality in palliative care for cancer populations. This study was conducted to investigate factors that influenced the use of palliative RT services at a regional comprehensive cancer center. Methods and Materials: A cohort of patients with radiographically confirmed bone metastases and first-time users of palliative RT between 2003 and 2005 was retrospectively reviewed from the time of initial diagnosis of bone metastases to death or last follow-up. Type of radiation treatment service provider used (rapid access or routine access) and patient-, tumor-, and treatment-related factors were analyzed for their influences on the number of treatment courses given over the duration of disease. Results: A total of 887 patients received 1,354 courses of palliative RT for bone metastases at a median interval of 4.0 months between courses. Thirty-three percent of patients required more than one RT course. Increased age and travel distance reduced the likelihood and number of treatment courses, while service through a rapid access clinic was independently associated with an increase in subsequent use of palliative RT. Conclusions: A rapid access service model for palliative RT facilitated access to RT. Travel distance and other factors remained substantial barriers to use of palliative RT services. The pattern of practice suggests an unmet need for symptom control in patients with bone metastases.
John M Conly; Stiver, H. Grant; Weiss, Karl A.; Becker, Debbie L; Rosner, Andrew J; Miller, Elizabeth
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infections are increasingly being encountered and pose an increasing burden to the health care system in Canada.OBJECTIVE: To elucidate and characterize the factors influencing the current MRSA treatment patterns in patients with skin and soft tissue infections (SSTIs) before linezolid became available on the Canadian market.METHODS: A retrospective study collected demographic, treatment and resource use data on patients hospitali...
Purpose: The Patterns of Care Study survey process evaluation has been an effective means of assessing the evaluation and treatment practices used by radiation oncologists in the United States for Stage I-II breast cancer. The current 1998-1999 report updates the previous 1989 and 1993-1994 analyses and reflects the recent changes in surgery and systemic therapy observed nationally in the management of early-stage disease. Methods and Materials: A weighted sample size of 71,877 patient records of women treated with breast-conserving surgery and radiotherapy (RT) was obtained from a stratified two-stage sampling of 353 patient records. These cases were centrally reviewed from academic and private radiation oncology practices across the United States. The data collected included patient characteristics, clinical and pathologic factors, and surgical and RT details. The results were compared with those of previous Patterns of Care Study survey reports. Results: Of the patients in the current survey, 97% had undergone mammography before biopsy. A review of the primary tumor pathologic findings indicated improved quantification of an intraductal component from 7.0% in 1993-1994 to 20.4% in 1998-1999 (p = 0.01). The tumor characteristics were better defined, with estrogen and progesterone receptor measurement performed in 91.4% and 91.3% in the 1998-1999 survey vs. 83.7% and 80.3% in the 1989 survey, respectively (p = 0.03 and p = 0.002, respectively). Axillary dissection was performed in 82.2% in the present survey compared with 93.6% in the 1993-1994 survey (p = 0.0004); sentinel node biopsy was performed in 20.1% of the present cases. The use of CT for planning was increased in the current survey, with 22.9% cases CT planned vs. 9% in 1993-1994 (p = 0.10). In the present survey, 100% had received whole breast RT. When a supraclavicular field was added, the dose was prescribed to a specified depth in 67.5% of cases, most commonly 3 cm. When an axillary field was added
Babar M Qureshi
Full Text Available Since the launching of Global Initiative, VISION 2020 "the Right to Sight" many innovative, practical and unique comprehensive eye care services provision models have evolved targeting the underserved populations in different parts of the World. At places the rapid assessment of the burden of eye diseases in confined areas or utilizing the key informants for identification of eye diseases in the communities are promoted for better planning and evidence based advocacy for getting / allocation of resources for eye care. Similarly for detection and management of diabetes related blindness, retinopathy of prematurity and avoidable blindness at primary level, the major obstacles are confronted in reaching to them in a cost effective manner and then management of the identified patients accordingly. In this regard, the concept of tele-ophthalmology model sounds to be the best solution. Whereas other models on comprehensive eye care services provision have been emphasizing on surgical output through innovative scales of economy that generate income for the program and ensure its sustainability, while guaranteeing treatment of the poorest of the poor.
Groenewegen, P.P.; Heinemann, Stephanie; Greß, Stefan; Schäfer, Willemijn
Health care needs in the population change through ageing and increasing multimorbidity. Primary health care might accommodate to this through the composition of practices in terms of the professionals working in them. The aim of this article is to describe the composition of primary care practices
Purpose: Over the last two decades, the chance for the cure of localized prostate cancer by radiation has been improved by the widespread use of PSA for early detection and by a number of technical advances in treatment delivery. This study was designed to determine whether the stage of presentation and the quality of radiation treatment delivered are comparable between Caucasian and minority patients nationally and within minority-rich areas. Methods and Materials: A random survey conducted for the Patterns of Care Study in Radiation Oncology of 80 facilities treating patients with radiation in the USA. Of these, 67 comprise the 'National Survey' and 13 a 'Minority-Rich' survey (>40% of treated patients are minorities). Nine hundred twenty-six men with localized prostate cancer were treated in 1994. Five hundred ninety-five were in the national and 331 in the minority-rich survey. The main outcome measures were the clinical features of Caucasian and minority men at presentation and technical characteristics of the treatment delivered to them. Results: African-American men presented with more advanced disease (higher-presenting PSA and T-stage) than Caucasians in both the national and the minority-rich surveys. Hispanics also presented with later disease and could be grouped with African-American men rather than Caucasians. Overall the stage and PSA at presentation was earlier than seen in the previous Patterns of Care Study survey of 1989. The quality of treatment delivered has improved since 1989, with no distinction seen between those facilities sampled nationally and those within minority-rich areas. Conclusion: African-American and Hispanic men with prostate cancer present for therapy at a later stage than Caucasian men, but when they do, the treatment received is of comparable quality
Sokolowski, Ineta; Kjeldgaard, Anette Hvenegaard; Olesen, Frede;
recently diagnosed with cancer and among previous cancer patients. Materials and methods: In a nationwide database in Denmark (population 5.5 million) all contacts to the health care system are registered. We describe the pattern of contact with all parts of the health care system for a) the total...... who have recently undergone treatment and patients in the survivorship phase of cancer use different parts of the health care system, and how much they use FP. Information about this will enable us to discuss the need for shared care, integrated care and information exchange and create a platform for......Aims: We know that in Denmark some 90% of citizens have contact with family practice (FP) during a year and around 40% has contact with secondary care. This demands efforts to create integrated and shared care. The aim of this study is to document the pattern of contacts with FP among patients...
Neuwelt, Pat M; Kearns, Robin A; Cairns, Isobel R
INTRODUCTION The care work of general practice receptionists has received limited research attention, despite receptionists position at the beginning of patients' journeys in many health care systems. We examine receptionists' perceptions of their work and the opportunities and constraints they experience in caring for patients while providing administrative support to practices. METHODS Data were collected in focus group interviews with 32 receptionists from urban and rural general practices in the Auckland and Northland regions of New Zealand. We employed tools from inductive thematic analysis and Straussian grounded theory in interpreting the data. FINDINGS We found that the way receptionists identified with a caring role strongly challenged the pejorative view of them in public discourse. Receptionists provide care in two key ways: for the practice and for patients. The juggling they do between the demands of the practice and of patients creates considerable work tensions that are often invisible to other staff members. CONCLUSION Receptionists have a critical role as the first step in the patient care pathway, bridging health care system and community. For general practice to be patient-centred and improve accessibility for the most vulnerable, the care work of receptionists must be considered core. KEYWORDS Receptionists; general practice; care; New Zealand. PMID:27477554
Mmajapi E. Chokwe
Full Text Available Background: Caring forms the core of nursing and midwifery. Despite caring being an important emotional aspect of midwifery and nursing, there are general public complaints about uncaring behaviour in midwifery. Therefore, there is a need to explore caring from midwives’ point of view with the hope of identifying solutions and recommendations for midwifery practice. Furthermore, the study aimed to stimulate debate and discussion about the caring behaviour of midwives.Objective: To explore caring during clinical practice as perceived and experienced by midwives.Method: The study was contextual, exploratory and qualitative. The participants were midwives working in state and private hospitals in Tshwane,South Africa where BTech II and III midwifery learners were allocated for work integrated learning (WIL. Data collection was carried out through self-report using a questionnaire and focus group. Questionnaires were distributed to 40 midwives at private and state hospitals in Tshwane. This was followed by two focus group sessions to ensure that data is enriched. The hermeneutic interpretive approach was used to analyse data, and analysis continued until saturation.Results: Themes of caring and uncaring related to patient care and midwives emerged. Thefindings illustrated that the midwives had excellent theoretical knowledge of caring, but someof them did not display caring behaviour during clinical practice.Conclusion: Some of the midwives did not display caring behaviour. Implication for practicewas provided based on the research findings. Recommendations included measures of improving caring behaviours during midwifery practice.
Jespersen, Astrid Pernille; Bønnelycke, Julie; Eriksen, Hanne Hellerup
the focus to reflect everyday practices would foster better targeted public health campaigns. This article is based on our participation in FINE, a multidisciplinary Danish research project. The core methodology of FINE was a randomised controlled trial in which 61 moderately overweight men were put...... into different exercise groups. In this article we analyse the scientific work of the trial as representing entangled processes of bodywork, where data are extracted and objectified bodies are manipulated and care practices address the emotional, social and mundane aspects of the participants' everyday...... lives. Care practices are an inherent part of producing scientific facts but they are removed from the recognised results of scientific practice and thus from common public health recommendations. However, knowledge about the strategic use of care practices in lifestyle interventions is important for...
Vadrot, Georges Lambert
Hypnosis is practicing in hospital, especially in palliative care and in pain consultation. This technique is used in a well-defined field by doctors, psychologists and caregivers, all specificially trained. PMID:25710997
MELGUIZO HERRERA, ESTELA; ALZATE POSADA, MARTHA LUCÍA
The objective is to review the concepts of beliefs and practices of health care as cultural expressions in order to highlight to caregivers the necessary aspects for them to provide a culturally consistent care, a more human and effective one. From the conception of culture as a human creation which influences and shapes people's beliefs and practices, some definitions of the concepts as of social psicology, anthropology, sociology and transcultural nursing aspects are revised. We found that ...
Gallagher-Lepak, Susan; Kubsch, Sylvia
Watson's carative factors offer general guidance to nurses but do not specify explicit nursing actions. On the basis of a qualitative analysis of clinical stories written by registered nurses, a transpersonal caring intervention guideline was developed. The protocol will assist nurses in using caring more intentionally and effectively in practice. PMID:19411996
Graber, Abraham D; Bhandary, Asha; Rizzo, Matthew
Accountable Care Organizations (ACOs) are a key mechanism of the Patient Protection and Affordable Care Act (PPACA). ACOs will influence incentives for providers, who must understand these changes to make well-considered treatment decisions. Our paper defines an ethical framework for physician decisions and action within ACOs. Emerging ethical pressures providers will face as members of an ACO were classified under major headings representing three of the four principles of bioethics: autonomy, beneficence, and justice (no novel conflicts with non-maleficence were identified). Conflicts include a bias against transient populations, a motive to undertreat conditions lacking performance measures, and the mandate to improve population health incentivizing life intrusions. After introducing and explaining each conflict, recommendations are offered for how providers ought to precede in the face of novel ethical choices. Our description of novel ethical choices will help providers know what to expect and our recommendations can guide providers in choosing well. PMID:26002491
Collins, B A; Hawks, J W; Davis, R
Diffusion of Innovations and Opinion Leader theories can be translated into practical applications to improve health care delivery and financial performance by applying them to influence referral patterns and decrease variations in care. Health care organizations can rapidly spread "better practices" to their practicing physicians by understanding the social and communication networks that are naturally developed by those practitioners. Physicians view this diffusion process as promoting autonomy, and as a legitimate approach to adoption of information needed in daily practice. PMID:18540342
Ho, Chester H; Bogie, Kath M
The process of integrating wound care research into clinical practice incorporates research methodology--i.e., the standardized practices, procedures, and rules by which research is performed--and an evidence-based approach. Using examples from the literature and clinician experience treating pressure ulcers in a 32-bed regional spinal cord injury unit in a tertiary referral center in Cleveland, Ohio, the authors describe this process and review the challenges faced by an interdisciplinary skin care team tasked with implementing evidence-based care. Additional considerations include determining the amount of current wound care that is evidence-based and whether wound prevention and care outcomes are improved through the use of evidence-based medicine. Five years after establishing the skin care team and implementing evidence-based care, improvements in care processes and short-term outcomes--specifically, pressure ulcer prevention and treatment protocols including documentation--have been realized. Studies to ascertain the effects of these changes on long-term outcomes are planned. PMID:17978411
This book is a practical guide packed with clear examples that will help you get to grips with the best practices in Laravel design patterns to create advanced web applications. This book is intended for web application developers working with Laravel who want to increase the efficiency of their web applications. It assumes that you have some experience with the Laravel PHP framework and are familiar with coding OOP methods.
Palla Shana L
Full Text Available Abstract Background Interventions to change practice patterns among health care professionals have had mixed success. We tested the effectiveness of a practice centered intervention to increase screening for domestic violence in primary care practices. Methods A multifaceted intervention was conducted among primary care practice in North Carolina. All practices designated two individuals to serve as domestic violence resources persons, underwent initial training on screening for domestic violence, and participated in 3 lunch and learn sessions. Within this framework, practices selected the screening instrument, patient educational material, and content best suited for their environment. Effectiveness was evaluated using a pre/post cross-sectional telephone survey of a random selection of female patients from each practice. Results Seventeen practices were recruited and fifteen completed the study. Baseline screening for domestic violence was 16% with a range of 2% to 49%. An absolute increase in screening of 10% was achieved (range of increase 0 to 22%. After controlling for clustering by practice and other patient characteristics, female patients were 79% more likely to have been screened after the intervention (OR 1.79, 95% CI 1.43–2.23. Conclusion An intervention that allowed practices to tailor certain aspects to fit their needs increased screening for domestic violence. Further studies testing this technique using other outcomes are needed.
Full Text Available Christopher R Freeman,1 W Neil Cottrell,1 Greg Kyle,2 Ian D Williams,3 Lisa M Nissen11School of Pharmacy, University of Queensland, Brisbane, Australia; 2Faculty of Health, University of Canberra, Canberra, Australia; 3Camp Hill Healthcare, Camp Hill, Brisbane, AustraliaBackground: In 2009, a pharmacist commenced working in a nondispensing role at a primary care medical center located in a metropolitan suburb of Brisbane, Australia. Research into the role and function of a practice pharmacist in this setting is still in its infancy.Methods: Ethnographic methods were used over a 3-month period to record activities undertaken by the practice pharmacist on a daily basis.Results: During the 3-month period, 296 hours of activity were documented. Activities the practice pharmacist performed most frequently included medication review, “pharmaceutical opinion,” student supervision, drug information, and administrative tasks.Conclusion: This study demonstrates the broad range of activities which were conducted by a practice pharmacist in the primary care setting as part of a multidisciplinary team.Keywords: practice pharmacist, general practice, integration, medical center
A large acute trust in the East Midlands looked to the US to inform its implementation of hourly rounding, otherwise known as intentional rounding. A combination of transformational leadership and meaningful interactions form the basis of a new approach to rounding--Caring around the Clock. The trust piloted the concept on 10 wards with results showing a 32% reduction in call lights. The successful change in practice required an investment in staff education to equip staff with the necessary skills. The trust is currently rolling out Caring around Hourly rounding can reducethe Clock to 79 inpatient wards. PMID:23342834
If you want to learn how best to utilize commonly found patterns and learn best practices in developing applications with Django, this is the book for you. This book, like Django itself, is accessible to amateur and professional developers alike and assumes little in the way of prior experience. Although written for Python 3, the majority of the code in this book works in Python 2 or can be easily translated.
Isbi Practice Guidelines Committee
Practice guidelines (PGs) are recommendations for diagnosis and treatment of diseases and injuries, and are designed to define optimal evaluation and management. The first PGs for burn care addressed the issues encountered in developed countries, lacking consideration for circumstances in resource-limited settings (RLS). Thus, the mission of the 2014-2016 committee established by the International Society for Burn Injury (ISBI) was to create PGs for burn care to improve the care of burn patients in both RLS and resource-abundant settings. An important component of this effort is to communicate a consensus opinion on recommendations for burn care for different aspects of burn management. An additional goal is to reduce costs by outlining effective and efficient recommendations for management of medical problems specific to burn care. These recommendations are supported by the best research evidence, as well as by expert opinion. Although our vision was the creation of clinical guidelines that could be applicable in RLS, the ISBI PGs for Burn Care have been written to address the needs of burn specialists everywhere in the world. PMID:27542292
Atle Fretheim; Oxman, Andrew D.; Kari Håvelsrud; Shaun Treweek; Kristoffersen, Doris T; Arild Bjørndal
Editors' Summary Background. An important issue in health care is “getting research into practice,” in other words, making sure that, when evidence from research has established the best way to treat a disease, doctors actually use that approach with their patients. In reality, there is often a gap between evidence and practice. An example concerns the treatment of people who have high blood pressure (hypertension) and/or high cholesterol. These are common conditions, and both increase the ...
The objective of this study was to evaluate the changing trends of standards and practices for postoperative radiotherapy (RT) for patients with prostate cancer in Japan. The Japanese Patterns of Care Study (PCS) conducted a national survey in 84 institutions from 1996 to 1998 (PCS96-98) and 76 institutions from 1999 to 2001 (PCS99-01). Detailed information relevant to RT was collected on a total of 169 patients (64 from 1996 to 1998 and 105 from 1999 to 2001) with prostate cancer who had undergone radical prostatectomy. The fraction of clinical T3-4 tumours before prostatectomy decreased from 63% in the period 1996-98 to 26% in the period 1999-2001 (P=0.0004). The pre-RT prostate-specific antigen level was significantly lower in 1999-2001 than in 1996-98 (P=0.0002). We did not find a significant difference in the percentage of patients who received pelvic irradiation in the time periods between PCS96-98 and PCS99-01 (P=0.18). Although the median radiation doses of 60 Gy were not changed between the surveys, various doses (from 20 to 74.6 Gy) were delivered to the prostatic bed. In the 1999-2001 survey, 73 of 105 patients received a median dose of 56 Gy in an adjuvant setting, while the other 32 received a median dose of 60 Gy in a salvage setting (P=0.0015). These data suggest that consensus has not been reached on the practice and management of postoperative RT for patients with prostate cancer in Japan. (author)
Samba, M; Guinan, J C; Sangare, A; Da-Danho, V; Bakayoko-Ly, R
Abidjan, the economical capital of Ivory Coast has a CAO of 2.7 with index O practically nil. The professional density is one surgeon for 12.000 inhabitants. Abidjan population, despite the requirements in increasing care has not recourse to the dental surgeons for their assumption of responsibility. The general objective of our study is to describe the therapeutic itinerary in odonto-stomatology of the Abidjan population. We have realised a questionnaire survey beside of population sample. The results show that 25 per cent of our population gives up care despite the presence of pain or embarrassment. Our study has allowed highlighting all the other recourses to the care. Indeed, the people who give up the care have much other recourse which has be identified in order of importance: the modern and traditional self-medication. Let us note in our study, that the choice of dental surgeon knows a constant evolution from the first to the third recourse. The lack of financial means constitutes however the first obstacle at the accessibility to the oral care in Ivory Coast. PMID:15900823
Purpose: There are multiple current strategies for breast radiotherapy (RT). The alignment of physician practice patterns with best evidence and patient preferences will enhance patient autonomy and improve cancer care. However, there is little information describing patient preferences for breast RT and physician practice patterns. Methods and Materials: Using a reliable and valid instrument, we assessed the preferences of 5,000 randomly selected women (with or without cancer) undergoing mammography. To assess practice patterns, 2,150 randomly selected physician-members of American Society for Radiation Oncology were surveyed. Results: A total of 1,807 women (36%) and 363 physicians (17%) provided usable responses. The 95% confidence interval is < ±2.3% for patients and < ±5.3% for physicians. Patient preferences were hypofractionated whole breast irradiation (HF-WBI) 62%, partial breast irradiation (PBI) 28%, and conventionally fractionated whole breast irradiation (CF-WBI) 10%. By comparison, 82% of physicians use CF-WBI for more than 2/3 of women and 56% never use HF-WBI. With respect to PBI, 62% of women preferred three-dimensional (3D)-PBI and 38% favor brachytherapy-PBI, whereas 36% of physicians offer 3D-PBI and 66% offer brachytherapy-PBI. 70% of women prefer once-daily RT over 10 days vs. twice-daily RT over 5 days. 55% of physicians who use PBI do not offer PBI on clinical trial. Conclusions: HF-WBI, while preferred by patients and supported by evidence, falls behind the unproven and less preferred strategy of PBI in clinical practice. There is a discrepancy between women’s preferences for PBI modality and type of PBI offered by physicians. Further alignment is needed between practice patterns, patient preferences, and clinical evidence.
Glasdam, Stinne; Henriksen, Nina; Kjær, Lone;
‘Client involvement’ has been a mantra within health policies, education curricula and healthcare institutions over many years, yet very little is known about how ‘client involvement’ is practised in home-care services. The aim of this article is to analyse ‘client involvement’ in practise seen......, political and administrative frames that rule home- care practice. Client involvement is shown within four constructed analytical categories: ‘Structural conditions of providing and receiving home care’; ‘Client involvement inside the home: performing a professional task and living an everyday life......’; ‘Client involvement outside the home: liberal business and mutual goal setting’; and ‘Converting a home to a working place: refurnishing a life’. The meaning of involvement is depending on which position it is viewed from. On the basis of this analysis, we raise the question of the extent to which...
Zoffmann, Vibeke; Hörnsten, Åsa; Storbækken, Solveig;
OBJECTIVE: Person-centred care [PCC] can engage people in living well with a chronic condition. However, translating PCC into practice is challenging. We aimed to compare the translational potentials of three approaches: motivational interviewing [MI], illness integration support [IIS] and guided...... managing ambivalence. IIS and GSD were based on grounded theories, and MI was intuitively developed. All apply processes and strategies to advance professionals' communication skills and engagement; GSD includes context-specific reflection sheets. All offer training programs; MI and GSD include fidelity...
Rostgaard, Tine; Szebehely, Marta
continued the generous provision of home care. This article focuses on the implication of such diverse policies for the provision and combination of formal and informal care resources for older people. Using data from Level of Living surveys (based on interviews with a total of 1,158 individuals aged 67......Despite pursuing the policy of ageing in place, the two Nordic countries of Denmark and Sweden have taken diverse roads in regard to the provision of formal, public tax-financed home care for older people. Whilst Sweden has cut down home care and targeted services for the most needy, Denmark has...... countries tax-funded home care is used across social groups but targeting of resources at the most needy in Sweden creates other inequalities: Older people with shorter education are left with no one to resort to but the family, whilst those with higher education purchase help from market providers...
Balas, E A; Li, Z. R.; Mitchell, J. A.; Spencer, D. C.; Brent, E; Ewigman, B G
Several studies documented substantial variation in medical practice patterns, but physicians often do not have adequate information on the cumulative clinical and financial effects of their decisions. The purpose of developing an expert system for the analysis of clinical practice patterns was to assist providers in analyzing and improving the process and outcome of patient care. The developed QFES (Quality Feedback Expert System) helps users in the definition and evaluation of measurable qu...
Berlin: Fridrich Ebert Stiftung, 2015 - (Magbunduku, E.), s. 7-15 [Global Care Chains: Why should we care?. Berlin (DE), 22.10.2014-23.10.2014] Institutional support: RVO:68378025 Keywords : care * migration * gender Subject RIV: AO - Sociology, Demography http://www.fes.de/GPol/pdf/Global_Care_Chains_Conference_Reader2015.pdf
BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.
Bruera, E; Neumann, C M; Gagnon, B.; Brenneis, C; Kneisler, P; Selmser, P; J Hanson
The Edmonton Regional Palliative Care Program was established in July 1995 to measure the access of patients with terminal cancer to palliative care services, decrease the number of cancer-related deaths in acute care facilities and increase the participation of family physicians in the care of terminally ill patients. In this retrospective study the authors compared the pattern of care and site of deaths before establishment of the program (1992/93) and during its second year of operation (1...
Brown, Glenn Russell
One commonly expressed goal of environmental education (EE) is to create positive attitudes. The dominant approaches emphasize factual information, assuming that attitudes will result, but results are mixed. I investigate conceptions of attitude, the psychology of attitude and how attitudes are learned. I also examine recent scholarship describing learning and teaching, since EE literature does not draw upon many of these ideas. I consider applications of these two perspectives to public schools while working within mainstream (Tbilisi) EE guidelines. It turns out to be important to identify specific, concrete objects and behaviours as targets for attitudes. "Environment" is general and abstract. Strongly related to attitudes, but little discussed, is the self-concept, which influences what one thinks, feels and does. I found that goals about attitudes can be more precisely phrased in terms of care, a positive concern for or interest in an object. I conclude that affective EE goals can be achieved through thoughtful and self-reflective care about local habitats and the species and individuals that inhabit them. Psychologists note that people are better able to manage their knowledge, to transfer ideas to new contexts, and to identify and solve problems if they learn within a group participating in realistic projects. Such interactions also integrate knowledge, skills and attitudes related to the group's work. Building on the Community of Learners model of teaching, I offer a framework for EE curriculum called Habitat Workshops. Its goals are knowledge of, care about and problem solving practices with habitats. Habitat Workshops engage classroom communities in the design and creation of local habitats within a group narrative of care and understanding. They involve both school subject knowledge as well as habitat-specific problems and responses that reflect real-world environmental issues. Habitat Workshops can be simple or progressively more complex. I provide an
Through the development in recent years, China's under-forest breeding pattern can be divided into four kinds of practice form of under-forest breeding pattern (the pattern of breeding driven by leading enterprises; the pattern of breeding driven by intermediary economic organizations; the pattern of breeding driven by the professional wholesale market; the pattern of breeding driven by the modern animal husbandry demonstration areas), according to difference in the main body participating in...
Grace, Sherry M.
Background: In 2011, a large integrated healthcare organization implemented a primary care team redesign in five pilot practices to improve the delivery of patient-centered chronic illness care and augment the physician-medical assistant dyads by adding two new primary care team roles for each practice - a nurse care manager (NCM) and a patient health coach (PHC). This work examines three aspects of implementing the care team redesign: 1) The facilitators and barriers of implementation, 2) Th...
Learn to combine security theory and code to produce secure systems Security is clearly a crucial issue to consider during the design and implementation of any distributed software architecture. Security patterns are increasingly being used by developers who take security into serious consideration from the creation of their work. Written by the authority on security patterns, this unique book examines the structure and purpose of security patterns, illustrating their use with the help of detailed implementation advice, numerous code samples, and descriptions in UML. Provides
U.S. Department of Health & Human Services — The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen...
Dionne S Kringos; van den Broeke, Jennifer R.; van der Lee, Arnold P. M.; Plochg, Thomas; Stronks, Karien
Background To explore changes in utilization patterns for general practice (GP) and hospital care of people living in deprived neighbourhoods when primary care providers work in a more coherent and coordinated manner by applying an integrated approach. Methods We compared expected (based on consumption patterns of a health insurers’ total population) and actual utilization patterns in a deprived Dutch intervention district in the city of Utrecht (Overvecht) with control districts 1 (Noordwest...
Through the development in recent years, China’s under-forest breeding pattern can be divided into four kinds of practice form of under-forest breeding pattern (the pattern of breeding driven by leading enterprises; the pattern of breeding driven by intermediary economic organizations; the pattern of breeding driven by the professional wholesale market; the pattern of breeding driven by the modern animal husbandry demonstration areas), according to difference in the main body participating in signing the operation contract in breeding pattern. In the production practice of under-forest breeding pattern, the most widely used and successful pattern is the pattern of breeding driven by leading enterprises and its derivative forms.
van Bruggen, J.A.R.
In the Netherlands, a quality incentive is expected to ensue from improved collaboration between healthcare professionals. Whether this view is supported by sufficient evidence is, however, questionable. Therefore, the first study included in this thesis is a systematic review of studies on the effects of sharing and delegating diabetes care tasks. It became apparent that sharing and delegating care tasks can improve the process of care and glycaemic control. Sharing or delegating care, howev...
American Psychologist, 2013
Psychologists practice in an increasingly diverse range of health care delivery systems. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts. These…
A problem shared is a problem halved; a very poignant proverb that forms the essence of this year's World Council of Enterostomal Therapists (WCET) UK conference in Coventry. Sharing experiences from practice is invalid if clinical practice is to grow and develop. It raises awareness, offering the opportunity to question and review practice. Sharing practice offers opportunities to enquiring minds. PMID:19797996
McConnell, K. John; Lindrooth, Richard C; Wholey, Douglas R; Maddox, Thomas M.; Bloom, Nicholas
Importance:- To improve the quality of health care, many researchers have suggested that health care institutions adopt management approaches that have been successful in the manufacturing and technology sectors. However, relatively little information exists about how these practices are disseminated in hospitals and whether they are associated with better performance. Objectives:- To describe the variation in management practices among a large sample of hospital cardiac care units; asses...
Maina, Geoffrey; Mill, Judy; Chaw-Kant, Jean; Caine, Vera
Best practices in HIV care have the potential to improve patient outcomes and inform practice. We conducted a systematic review of best practices in HIV care that were published from 2003 to 2013. Practices that demonstrated success in achieving desired results based on their objectives were included in the review. Two themes emerged from the eight articles reviewed: (a) the importance of linking newly diagnosed people living with HIV to care and (b) the role of integrated and comprehensive service provision in improving patient outcomes. Inconsistencies in reporting and arbitrary use of the term “best practices” were hurdles in this review. PMID:27152102
Marcelle Miranda da Silva; Marléa Chagas Moreira; Joséte Luzia Leite; Alacoque Lorenzini Erdmann
The objective was to identify evidences of comprehensive care in the professional practice of the nursing staff in the context of oncology palliative care. In this descriptive, qualitative study, seven nurses and four nursing technicians were interviewed. Thematic analysis resulted two thematic units: Evidences of comprehensive care in the practice of the nursing professionals and teamwork as the premise of comprehensive care. The nursing staff’s actions are based on communication, converging...
Full Text Available Abstract Background "Integrative health care" has become a common term to describe teams of health care providers working together to provide patient care. However this term has not been well-defined and likely means many different things to different people. The purpose of this paper is to develop a conceptual framework for describing, comparing and evaluating different forms of team-oriented health care practices that have evolved in Western health care systems. Discussion Seven different models of team-oriented health care practice are illustrated in this paper: parallel, consultative, collaborative, coordinated, multidisciplinary, interdisciplinary and integrative. Each of these models occupies a position along the proposed continuum from the non-integrative to fully integrative approach they take to patient care. The framework is developed around four key components of integrative health care practice: philosophy/values; structure, process and outcomes. Summary This framework can be used by patients and health care practitioners to determine what styles of practice meet their needs and by policy makers, healthcare managers and researchers to document the evolution of team practices over time. This framework may also facilitate exploration of the relationship between different practice models and health outcomes.
Blum, Cynthia A
Self-care is imperative to personal health, sustenance to continue to care for others, and professional growth. This article briefly reviews stressors common to students and nurses and the importance of practicing self-care to combat stress and promote health in practice. Florida Atlantic University offers a course for all levels of undergraduate nursing students called Caring for Self. The course, supported by principles of Adult Learning Theory, focuses on guiding the nurse to practice and model self-care. The author describes the evolution of this self-care initiative by discussing the needs assessment, course description and strategies, examples of course activities, and an exemplar of student impact. The conclusion offers discussion of challenges and lessons noted by faculty and students. PMID:26824151
Mol, Annemarie; Moser, Ingunn; Piras, Enrico Maria; Turrini, Mauro; Pols, Jeanette; Zanutto, Alberto
In recent years many STS scholars have dealt with care practices in dif¬ferent fields. Starting from Care in Practice. On Tinkering in Clinics, Homes and Farms [Transcript-Verlag, Bielefield, 2010, 325 pp.], a book edited by Annemarie Mol, Ingunn Moser and Jeannette Pols, this debate aims to discuss the meaning and de-velopment of the concept of care and its accomplishment in practice. Mauro Turrini, Enrico Maria Piras and Alberto Zanutto wrote two commentaries on the book, while the editors ...
Powers, Bethel Ann; Norton, Sally A; Schmitt, Madeline H; Quill, Timothy E; Metzger, Maureen
Objective. To illustrate distinctions and intersections of palliative care (PC) and end-of-life (EOL) services through examples from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital palliative care consultation service. Methods. Qualitative narrative and thematic analysis. Results. Description of four practice paradigms (EOL transitions, prognostic uncertainty, discharge planning, and patient/family values and preferences) and identification of the underlying structure and communication patterns of PC consultation services common to them. Conclusions. Consistent with reports by other researchers, study data support the need to move beyond equating PC with hospice or EOL care and the notion that EOL is a well-demarcated period of time before death. If professional health care providers assume that PC services are limited to assisting with and helping patients and families prepare for dying, they miss opportunities to provide care considered important to older individuals confronting life-limiting illnesses. PMID:21584232
Methods for managing complex software construction following the practices, principles and patterns of Domain-Driven Design with code examples in C# This book presents the philosophy of Domain-Driven Design (DDD) in a down-to-earth and practical manner for experienced developers building applications for complex domains. A focus is placed on the principles and practices of decomposing a complex problem space as well as the implementation patterns and best practices for shaping a maintainable solution space. You will learn how to build effective domain models through the use of tactical pat
Yokoyama, Yoko; Kakudate, Naoki; Sumida, Futoshi; Matsumoto, Yuki; Gilbert, Gregg H.; Gordan, Valeria V.
Objective The purposes of this study were to (1) quantify dentists' practice patterns regarding caries prevention and (2) test the hypothesis that certain dentists' characteristics are associated with these practice patterns. Design The study used a cross-sectional study design consisting of a questionnaire survey. Participants The study queried dentists who worked in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan, which seeks to engage d...
Caring for older people and listening attentively to what they say about themselves and their varied health situations, especially in relation to quality of life and peace of mind, body, and soul, are important matters to nurses aligned with Watson's caring-healing theory. Assumptions and key concepts of Watson's framework are described with examples that illustrate how a nursing framework has shaped the author's advanced nursing practice. Some of the key concepts discussed include intersubjectivity, transpersonal caring, spirituality, and caring moments. Watson's framework of caring-healing is shown to inform practice, education, and research. PMID:15090087
Cláudia Rayanna Silva Mendes
Full Text Available Objective: to evaluate the practice of self-care performed by patients with systemic arterial hypertension in primary health care. Methods: this is a descriptive and cross-sectional study, conducted with 92 individuals with arterial hypertension in a primary care unit. The data collection occurred through script and data analyzed using descriptive statistics (frequency, mean and standard deviation and through the understanding of the adaption between capacity and self-care demand. Results: it was identified as a practice of self-care: adequate water intake, salt intake and restricted coffee, satisfactory sleep period, abstinence from smoking and alcoholism, continuing pharmacological treatment and attending medical appointments. As the demands: inadequate feeding, sedentary lifestyle, had no leisure activities, self-reported stress, and limited knowledge. Conclusion: although patients performed treatment a few years ago, still showed up self-care deficits, highlighting the need for nurses to advise and sensitize about the importance of self-care practice.
Goldschneider, Kenneth R; Good, Julie; Harrop, Emily; Liossi, Christina; Lynch-Jordan, Anne; Martinez, Anna E; Maxwell, Lynne G; Stanko-Lopp, Danette
Background Inherited epidermolysis bullosa (EB) comprises a group of rare disorders that have multi-system effects and patients present with a number of both acute and chronic pain care needs. Effects on quality of life are substantial. Pain and itching are burdensome daily problems. Experience with, and knowledge of, the best pain and itch care for these patients is minimal. Evidence-based best care practice guidelines are needed to establish a base of knowledge and practice for practitioner...
Conclusions: The current study mainly summarizes the different patterns of cancer incidence in the tertiary care centre region. Cancer incidence is increasing gradually among the population and there is raise of cancer incidence in females compared to their counterparts. [Int J Res Med Sci 2016; 4(6.000: 2153-2163
Full Text Available Context: Oral care is an essential aspect of critical care nursing. However, no study has been published on oral care practice of Iranian and Asian nurses. The majority of published studies were conducted in western and European countries. Aims: This study aimed to evaluate the nurses′ opinions and practice about oral care in patients under mechanical ventilation. Settings and Design: A cross-sectional study was conducted on 130 intensive care nurses from 6 intensive care units in the university hospitals of Iran. Materials and Methods: A questionnaire was used to gather the data and charts of 45 patients were evaluated. Statistical analysis: Descriptive statistical analysis are presented. Results: Oral care obtained the 7 th rank in prority and a mean score of 5.7 on a scale of 1-10. More than 21% of subjects did not perform oral care in their usual duties. High load of writing tasks and personnel shortages were the major barriers to oral care. Only 20% of the patients′ charts contained a report on oral care. Conclusions: Nurses did not consider oral care in intensive care patients as a high priority. This result highlights the need to continue education programs on oral care for improving the knowledge and attitude of intensive care nurses with respect to oral care.
Ständer, S; Ständer, H F; Steinke, S; Bruland, P; Dugas, M; Augustin, M
Chronic pruritus is a highly prevalent, multifactorial symptom requiring extensive diagnostics, treatment and consideration of accompanying symptoms (reduced quality of life, sleep disorders, psychic factors). Patient care is thus complex and requires consideration of individual treatment goals. Patients indicate their wish for a symptom-free life an explanation of the causes and a trustful physician-patient relationship. The targeted use of questionnaires is thus advisable in order to structurally survey the history, pruritus intensity, quality of life and treatment progression. Nevertheless, there are many administrative and economical hurdles in the health care system to overcome in order to provide patients with chronic pruritus the best possible care, also per the recommended guidelines. The development of specialized centers and training courses for medical practitioners is thus urgently needed. PMID:27316924
Rissardo, Leidyani Karina; Alvim, Neide Aparecida Titonelli; Marcon, Sonia Silva; Carreira, Lígia
This research aims to understand the care practices of health professionals who assist the elderly Kaingang. It is a qualitative study, supported in ethnography, conducted by ten professionals working in primary health care in the indigenous land of Faxinal, Paraná, Brazil. The data was collected from November 2010 to February 2012 by participant observation and interviews, and analyzed based on the Transcultural Care Theory. Was identified the preoccupation of the carers practices with the medication and immunization, as well as traditional medical care. To achieve these, care professionals had strategies that implemented maintenance of older people in care. We conclude that cultural values and integrate scientific need assistance to improve the health of elderly indigenous. PMID:25590882
Sørensen, Mariann B.
The article concerns the issue: How to deal with the increasing challenges of communication in the health care sector? On the one hand, it focuses on how to include the patient’s and relatives´ perspectives. On the other hand, it focuses on the existential/spiritual perspective which is now...... included in various official visions papers and recommendations. The main question is pedagogical: How do practitioners in the health sector i.e. in nursing deal with these perspectives? The materials are the Danish Health Board´s program of rehabilitation and palliative care, data from a focus group study...
Frølich, Anne; Bellows, Jim; Nielsen, Bo Friis;
Of fifteen diabetes care management practices, our data indicate that high performance is most associated with provider alerts and more weakly associated with action plans and with guideline distribution and training. Lack of convergence in the literature on effective care management practices...... suggests that factors contributing to high performance may be highly context-dependent or that the factors involved may be too numerous or their implementation too nuanced to be reliably identified in observational studies....
Full-day-care pre-schools contribute significantly to the nutritional intake and acquisition of dietary habits of the pre-school child. The present study investigated nutritional practices in full-day-care pre-schools in Dublin, Ireland, aiming to determine the nutritional support that pre-school managers deem necessary, thereby facilitating the amelioration of existing pre-school nutritional training and practices.
Kleisiaris, Christos F.; Sfakianakis, Chrisanthos; Papathanasiou, Ioanna V.
Asclepius and Hippocrates focused medical practice on the natural approach and treatment of diseases, highlighting the importance of understanding the patient’s health, independence of mind, and the need for harmony between the individual, social and natural environment, as reflected in the Hippocratic Oath. The aim of this study was to present the philosophy of care provision in ancient Greece and to highlight the influence of the Hippocratic ideal in modern health care practices. A literatu...
The medical care of prisoners "declaring sick" to the medical officer and hospital officers in Bedford Prison was surveyed and compared with the medical care given to the medical officer's patients in general practice. The consultation rate of prisoners was higher than that of patients in the practice. Part of this increase was because household remedies were not available to prisoners except through the prison medical service and part may also have been due to the stresses of life in prison....
Banerjee, I.; Bhadury, T
Background: Self-medication is a widely prevalent practice in India. It assumes a special significance among medical students as they are the future medical practitioners. Aim: To assess the pattern of self-medication practice among undergraduate medical students. Settings and Design: Tertiary care medical college in West Bengal, India. Material and Methods: A cross-sectional questionnaire-based study was conducted among the undergraduate medical students. Results: Out of 500 students of the ...
The book takes a step-by-step approach to help you understand CommonJS and Titanium architecture patterns, with easy to follow samples and plenty of in-depth explanations If you're an existing Titanium developer or perhaps a new developer looking to start off your Titanium applications "the right way", then this book is for you. With easy to follow examples and a full step-by-step account of architecting a sample application using CommonJS and MVC, along with chapters on new features such as ACS, you'll be implementing enterprise grade Titanium solutions in no time. You should have some JavaSc
Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.;
Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients...... with type 2 diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by insurance data analysis. Intervention: We compared protocol-based care management including structured assessment, action...
Lothian, Judith A.
In this column, the associate editor of The Journal of Perinatal Education (JPE) discusses the decision to devote an issue of JPE to the ethics of childbirth and maternity care. The current crisis in maternity care mandates a careful look at the ethical principles that provide the foundation for practice. The contents of this special issue include: a broad overview of ethics of childbearing, historical perspectives and contemporary understanding of informed decision making, the ethical issues...
As an early childhood professional for 30 years operating both traditional and employer child care programs, the author believes that traditional center owners and operators have an opportunity to grow their business, serve more children and families, and stay relevant for future workforce needs by integrating employer child care practices into…
... AGENCY Best Management Practices for Unused Pharmaceuticals at Health Care Facilities AGENCY... guidance document entitled, Best Management Practices for Unused Pharmaceuticals at Health Care Facilities... been studying unused pharmaceutical disposal practices at health care facilities, prompted by...
Kleisiaris, Christos F; Sfakianakis, Chrisanthos; Papathanasiou, Ioanna V
Asclepius and Hippocrates focused medical practice on the natural approach and treatment of diseases, highlighting the importance of understanding the patient's health, independence of mind, and the need for harmony between the individual, social and natural environment, as reflected in the Hippocratic Oath. The aim of this study was to present the philosophy of care provision in ancient Greece and to highlight the influence of the Hippocratic ideal in modern health care practices. A literature review was carried out using browser methods in international databases. According to the literature, "healthy mind in a healthy body" was the main component of the Hippocratic philosophy. Three main categories were observed in the Hippocratic provision of care: health promotion, interventions on trauma care, and mental care and art therapy interventions. Health promotion included physical activity as an essential part of physical and mental health, and emphasized the importance of nutrition to improve performance in the Olympic Games. Interventions on trauma care included surgical practices developed by Hippocrates, mainly due to the frequent wars in ancient Greece. Mental care and art therapy interventions were in accordance with the first classification of mental disorders, which was proposed by Hippocrates. In this category music and drama were used as management tools in the treatment of illness and in the improvement of human behavior. The role of Asclepieion of Kos was highlighted which clearly indicates a holistic health care model in care provision. Finally, all practices regarded detailed recordings and evaluation of information within the guidelines. The Hippocratic philosophy on health care provision focused on the holistic health care model, applying standards and ethical rules that are still valid today. PMID:25512827
Fleming, Sara A.; Gutknecht, Nancy C.
Naturopathy is a distinct type of primary care medicine that blends age-old healing traditions with scientific advances and current research. It is guided by a unique set of principles that recognize the body's innate healing capacity, emphasize disease prevention, and encourage individual responsibility to obtain optimal health. Naturopathic treatment modalities include diet and clinical nutrition, behavioral change, hydrotherapy, homeopathy, botanical medicine, physical medicine, pharmaceut...
Newman, Christy E; de Wit, John B F; Crooks, Levinia; Reynolds, Robert H; Canavan, Peter G; Kidd, Michael R
As the management of HIV changes and demand for HIV health services in primary care settings increases, new approaches to engaging the general practice workforce with HIV medicine are required. This paper reports on qualitative research conducted with 47 clinicians who provide HIV care in general practice settings around Australia, including accredited HIV s100 prescribers as well as other GPs and general practice nurses. Balanced numbers of men and women took part; less than one-quarter were based outside of urban metropolitan settings. The most significant workforce challenges that participants said they faced in providing HIV care in general practice were keeping up with knowledge, navigating low caseload and regional issues, balancing quality care with cost factors, and addressing the persistent social stigma associated with HIV. Strategic responses developed by participants to address these challenges included thinking more creatively about business and caseload planning, pursuing opportunities to share care with specialist clinicians, and challenging prejudiced attitudes amongst patients and colleagues. Understanding and supporting the needs of the general practice workforce in both high and low HIV caseload settings will be essential in ensuring Australia has the capacity to respond to emerging priorities in HIV prevention and care. PMID:24581265
McConnell, Eleanor Schildwachter; Lekan, Deborah; Hebert, Catherine; Leatherwood, Lisa
Learning in practice disciplines suffers when gaps exist between classroom instruction and students' observations of routine clinical practices.(1) Academic institutions, therefore, have a strong interest in fostering the rapid and effective translation of evidence-based care techniques into routine practice. Long-term care (LTC) practice sites are particularly vulnerable to gaps between classroom teaching and how daily care is implemented, owing to the recent rapid advances in the scientific bases of care for frail older adults, the relative isolation of most LTC sites from academic settings,(2) and the relatively small number of registered nurses (RNs) available in LTC settings who can facilitate translation of research-based practices into care.(3) The aim of this project was to demonstrate the feasibility and value of an academic practice partnership to implement evidence-based approaches to solving resident care problems in LTC, as many scientifically proven practices hold promise for improving resident outcomes yet adoption is often slow.(4) We developed and implemented a clinical practice improvement process, based on diffusion of innovations theory and research,(5-8) to serve as a new model of academic-practice collaboration between a university school of nursing, LTC facility management and direct-care staff, as a means of developing high quality clinical sites for student rotations. The goal was to implement a sustainable evidence-based oral care program as an exemplar of how scientific evidence can be translated into LTC practice. This project focused on oral hygiene because the staff was dissatisfied with their existing resident oral care program, and an evidence-base for oral care in LTC existed that had not yet been incorporated into care routines. This article describes a systematic, replicable process for linking advanced practice registered nurse expertise with staff insights about care systems to reduce the gap between teaching and practice in
Tonia C Onyeka
Full Text Available Everyone, young and old, male and female, rich and poor, should have access to excellent care during the course of a serious illness and at the end of life. Therefore, a denial of such care becomes an infringement of the individual′s human rights. Because of the efforts of pioneers in this field of Medicine in Africa and beyond, both living and immortalized, we can now say that palliative care in the African context is affordable and achievable. In this article, some of the challenges faced in setting up and running a new palliative care practice in an emerging and developing economy are examined.
Hersh, Lauren; Salzman, Brooke; Snyderman, Danielle
Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concrete steps, limiting the focus of a visit to three key points or tasks, and assessing for comprehension. Additionally, printed information should be written at or below a fifth- to sixth-grade reading level. Visual aids, graphs, or pictures can enhance patient understanding, as can more concrete presentation of numerical information. PMID:26176370
Beck, Andrew F; Tschudy, Megan M; Coker, Tumaini R; Mistry, Kamila B; Cox, Joanne E; Gitterman, Benjamin A; Chamberlain, Lisa J; Grace, Aimee M; Hole, Michael K; Klass, Perri E; Lobach, Katherine S; Ma, Christine T; Navsaria, Dipesh; Northrip, Kimberly D; Sadof, Matthew D; Shah, Anita N; Fierman, Arthur H
More than 20% of children nationally live in poverty. Pediatric primary care practices are critical points-of-contact for these patients and their families. Practices must consider risks that are rooted in poverty as they determine how to best deliver family-centered care and move toward action on the social determinants of health. The Practice-Level Care Delivery Subgroup of the Academic Pediatric Association's Task Force on Poverty has developed a roadmap for pediatric providers and practices to use as they adopt clinical practice redesign strategies aimed at mitigating poverty's negative impact on child health and well-being. The present article describes how care structures and processes can be altered in ways that align with the needs of families living in poverty. Attention is paid to both facilitators of and barriers to successful redesign strategies. We also illustrate how such a roadmap can be adapted by practices depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health. In addition, ways in which practices can advocate for families in their communities and nationally are identified. Finally, given the relative dearth of evidence for many poverty-focused interventions in primary care, areas that would benefit from more in-depth study are considered. Such a focus is especially relevant as practices consider how they can best help families mitigate the impact of poverty-related risks in ways that promote long-term health and well-being for children. PMID:26933205
Møller Pedersen, Kjeld; Andersen, John Sahl; Søndergård, Jens
challenges. Practice units are fairly small: close to 2 GPs per unit plus nurses and secretaries. The units are fully computerized, that is, with computer-based patient records and submission of prescriptions digitally to pharmacies etc. Over the past few years a decrease in solo practices has been seen and......General practice is the corner stone of Danish primary health care. General practitioners (GPs) are similar to family physicians in the United States. On average, all Danes have 6.9 contacts per year with their GP (in-person, telephone, or E-mail consultation). General practice is characterized by...... postgraduate education. The contract is (re)negotiated every 2 years. General practice is embedded in a universal tax-funded health care system in which GP and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new...
Dirk De Meester
Full Text Available Accommodating the real diversity of user populations,including those with physical and / or mental impairments and functional limitations, requires a large amount of designinformation in connection with human dis-abilities(limitations and possibilities. In order to collect andorganise this information for designers and decision makers, Universal Design Patterns (UD Patterns offer descriptive information about, on the one hand, CONFLICTS between users and built environments, and on the other hand,empirically evident design RESOLUTIONS. Directcollaboration with users / experts was tested in thedevelopment of a specific UD Pattern for a (Semi- ambulant accessible toilet for personal care, with specific emphasis onstoma-care in public facilities. The paper illustrates howpeople with ostomies and care-givers communicate with researchers, and how relevant design information is extracted and structured. On a more general level, results show how environment-related dimensions of human functioning differ from medical aspects, and how direct involvement of end-users enriches the content of design information.
Johnson, Tammie M; Richards, Jennifer; Churilla, James R
Objective. Previous studies have shown that receiving diabetes self-management education (DSME) is associated with increased care utilization. However, the relationship between DSME duration and care utilization patterns remains largely unexamined. Our purpose is to characterize DSME duration and examine the relationship between DSME duration and clinical- and self-care utilization patterns. Methods. The study sample included 1,446 adults who were ≥18 years of age, had diabetes, and had participated in the 2008 Florida Behavioral Risk Factor Surveillance System survey. Clinical- and self-care outcomes were derived using responses to the survey's diabetes module and were based on minimum standards of care established by the American Diabetes Association. The outcomes examined included self-monitoring of blood glucose at least once per day; receiving at least one eye exam, one foot exam, A1C tests, and an influenza vaccination in the past year; and ever receiving a pneumococcal vaccination. DSME duration was categorized as no DSME, >0 to 10 hours. Results. After adjusting for sociodemographic variables, compared to those who did not receive DSME, those who had 4-10 or 10+ hours of DSME were more likely to receive two A1C tests (odds ratio [95% CI] 2.69 [1.30-5.58] and 2.63 [1.10-6.31], respectively) and have a pneumococcal vaccination (1.98 [1.03-3.80] and 1.92 [1.01-3.64], respectively). Those receiving 10+ hours of DSME were 2.2 times (95% CI 1.18-4.09) as likely to have an influenza vaccination. Conclusion. These data reveal a positive relationship between DSME duration and utilization of some diabetes clinical care services. PMID:26300613
Full Text Available Background Child care practices are important for a growth and development, and are influenced by cultural determinants. Indicators of infant care practices have not been determinated for the Minangkabau ethnic group. Objective To determine indicators of infant care among a Minangkabau ethnic community. Methods A cross-sectional study was done in Solok, West Sumatera, a region populated by largely Minangkabau ethnic groups. Infants feeing care (IFC, infant health care (IHC, infant clean care (ICC, and infant psychosocial stimulation care (IPSC were the components of infant care used as indicators. Data on these four components were obtained through interviews with parents and direct observation. A score was assigned to each component. We used the confirmatory factors analysis (CFA method to determine whether the indicators were valid in the studied population. Results We enrolled 417 infants in the study, with a mean age of 8.7 months, and 51.6% were female. IFC scores were fair in 72.7%, high in 20.4%, and low in 6.7%. IHC scores were poor in 25.7%, fair in 58.8%, and good in 15.5%. ICC scores were poor in 0.7%, fair in 42.2%, and good in 58.1%. IPSC scores were poor in 10.6%, fair in 84.9%, and high in 4.5%. On CFA, ICC contributed least to the indicator model (l:0.5 and 0.47, respectively. Goodness of fit of the to the model (l:0.5 and 0.46, respectively. Goodness of fit of the model was good (P>0.005. Root mean square error apporximation was 0.9 Conclusions Infant clean care was the most significant contributor to the infant care practice indicator in the Minangkabau ethnic community. Similar studies need to be done in other Indonesian ethnic groups.
Chaoul, Alejandro; Milbury, Kathrin; Sood, Anil K; Prinsloo, Sarah; Cohen, Lorenzo
Being diagnosed with a life-threatening disease such as cancer and undergoing treatment can cause unwanted distress and interferes with quality of life. Uncontrolled stress can have a negative effect on a number of biological systems and processes leading to negative health outcomes. While some distress is normal, it is not benign and must be addressed, as failure to do so may compromise health and QOL outcomes. We present the evidence for the role of stress in cancer biology and mechanisms demonstrating how distress is associated with worse clinical outcomes. The National Comprehensive Cancer Network states that all patients be screened with the single-item distress thermometer and to also indicate the source of distress and to get appropriate referral. In addition to the many conventional approaches for managing distress from the fields of psychology and psychiatry, many patients are seeking strategies to manage their distress that are outside conventional medicine such as mind-body techniques. Mind-body techniques such as meditation, yoga, tai chi, and qigong have been found to lower distress and lead to improvements in different aspects of quality of life. It is essential that the standard of care in oncology include distress screening and the delivery of different techniques to help patients manage the psychosocial challenges of diagnosis and treatment of cancer. PMID:25325936
Gilliland, Jill; Donnellan, Amy; Justice, Lindsey; Moake, Lindy; Mauney, Jennifer; Steadman, Page; Drajpuch, David; Tucker, Dawn; Storey, Jean; Roth, Stephen J; Koch, Josh; Checchia, Paul; Cooper, David S; Staveski, Sandra L
The addition of advanced practice providers (APPs; nurse practitioners and physician assistants) to a pediatric cardiac intensive care unit (PCICU) team is a health care innovation that addresses medical provider shortages while allowing PCICUs to deliver high-quality, cost-effective patient care. APPs, through their consistent clinical presence, effective communication, and facilitation of interdisciplinary collaboration, provide a sustainable solution for the highly specialized needs of PCICU patients. In addition, APPs provide leadership, patient and staff education, facilitate implementation of evidence-based practice and quality improvement initiatives, and the performance of clinical research in the PCICU. This article reviews mechanisms for developing, implementing, and sustaining advance practice services in PCICUs. PMID:26714997
Bridges, Elizabeth; McNeill, Margaret; Munro, Nancy
During the past year, studies were published that will lead to practice change, address challenges at the bedside, and introduce new care strategies. This article summarizes some of this important work and considers it in the context of previous research and practice. Examples of research-based practice changes include the performance and assessment of septic shock resuscitation, and the integration of tourniquets and massive transfusions in civilian trauma. Care challenges addressed include ethical considerations in light of the Ebola epidemic, infection prevention associated with chlorhexidine bathing, bedside alarm management, evidence to enhance moral courage, and interventions to mitigate thirst in critically ill patients. Research that portends future care includes a discussion of fecal microbiota transplant for patients with refractory infection with refractory infection with Clostridium difficile. PMID:26724298
Tessaro, Irene; Campbell, Marci K.; Golden, Shannon; Gellin, Mindy; McCabe, Mary; Syrjala, Karen; Ganz, Patricia A.; Jacobs, Linda; Baker, Scott; Miller, Kenneth D.; Rosenstein, Donald L.
The LIVESTRONG Centers of Excellence were funded to increase the effectiveness of survivorship care in oncology practice. This study describes the ongoing process of adopting and implementing survivorship care using the framework of the diffusion of innovation theory of change. Primary data collection included telephone interviews with 39 members from the eight centers and site visits. Organizational characteristics, overall progress, and challenges for implementation were collected from prop...
P. A. Archanalakshmi; Meriton Stanly A.; Christina Mary Paul
Background: Hand hygiene is the most important measure to avoid the transmission of harmful germs and prevent health care-associated infections. Hand washing with plain soap removes loose transient flora even though it does not remove pathogens from the hands of healthcare workers. Proper hand hygiene is cheap, most effective, easiest and foremost method of reducing health care associated infections. This study was carried out to know the present status of hand hygiene practices and the barri...
Shilling, Teri; Romano, Amy M.; DiFranco, Joyce T.
This updated edition of Care Practice Paper #2 presents the evidence for the benefits of allowing freedom of movement in labor. Physiologic and anatomical principles that support the benefits of movement are explained. The authors review common obstacles to movement in labor, including the routine use of interventions that inhibit women's ability to walk or change position. Women are encouraged to plan to be active in labor and to select care providers and birth settings that provide the full...
This book describes the pattern recognition by MATLAB practice. It includes possibility and limit of AI, introduction of pattern recognition a vector and matrix, basic status and a probability theory, a random variable and probability distribution, statistical decision theory, data-mining, gaussian mixture model, a nerve cell modeling such as Hebb's learning rule, LMS learning rule, genetic algorithm, dynamic programming and DTW, HMN on Markov model and HMM's three problems and solution, introduction of SVM with KKT condition and margin optimum, kernel trick and MATLAB practice.
Aljawad, Mohammed; Yoshida, Eric M; Uhanova, Julia; Marotta, Paul; Chandok, Natasha
BACKGROUND: Percutaneous liver biopsy (PLB) is the standard procedure to obtain histological samples essential for the management of various liver diseases. While safe, many hepatologists no longer perform their own PLBs; the reasons for this practice shift are unknown.OBJECTIVE: To describe the attitudes, practice patterns and barriers to PLB among hepatologists in Canada.METHODS: A survey was distributed to all hepatologists in Canada.RESULTS: Thirty-two of 40 (80%) hepatologists completed ...
Full Text Available Objectives: To determine the feasibility of using the activPAL3TM activity monitor, and, to describe the activity patterns of residential aged care residents. Design: Cross-sectional. Setting: Randomly selected aged care facilities within 100 km of the Gold Coast, Queensland, Australia. Participants: Ambulatory, older (≥60 years residential aged care adults without cognitive impairment. Measurements: Feasibility was assessed by consent rate, sleep/wear diary completion, and through interviews with staff/participants. Activity patterns (sitting/lying, standing, and stepping were measured via activPAL3TM monitors worn continuously for seven days. Times spent in each activity were described and then compared across days of the week and hours of the day using linear mixed models. Results: Consent rate was 48% (n = 41. Activity patterns are described for the 31 participants (mean age 84.2 years who provided at least one day of valid monitor data. In total, 14 (45% completed the sleep/wear diary. Participants spent a median (interquartile range of 12.4 (1.7 h sitting/lying (with 73% of this accumulated in unbroken bouts of ≥30 min, 1.9 (1.3 h standing, and 21.4 (36.7 min stepping during their monitored waking hours per day. Activity did not vary significantly by day of the week (p ≥ 0.05; stepping showed significant hourly variation (p = 0.018. Conclusions: Older adults in residential aged care were consistently highly sedentary. Feasibility considerations for objective activity monitoring identified for this population include poor diary completion and lost monitors.
Chard, Robin; Makary, Martin A
The successful and safe transfer of the patient from one phase of care to another is contingent on optimal communication by all team members. Nurses are often in a natural leadership position to improve safe practices during hand overs. A holistic understanding of the patient allows the perioperative nurse the opportunity to identify issues and choose a nursing diagnosis based on key elements of a patient's needs and goals--information that should be relayed during patient transfers. This article reviews best practices in transfer-of-care communication to enable perioperative RNs to take an active, leading role in hand-over processes. PMID:26411818
Latika Nath Sinha
Full Text Available Background: In India, the Home Based Postnatal Newborn Care programme by Accredited Social Health Activists (ASHAs under the National Rural Health Mission was initiated in 2011 to reduce neonatal mortality rates (NMRs. ASHAs get cash incentives for six postnatal home visits for newborn care. We studied newborn care practices among mothers in Mewat, Haryana, having a high NMR and determined risk factors for unsafe practices and described the knowledge and skills of ASHAs during home visits. Methods: A cross-sectional survey was conducted among mothers who had delivered a child during the previous seven months using cluster sampling. We interviewed mothers and ASHAs in the selected subcentres using semi–structured questionnaires on the six safe newborn care practices, namely safe breastfeeding, keeping cord and eyes clean, wrapping baby, kangaroo care, delayed bathing and hand washing. Results: We interviewed 320 mothers, 61 ASHAs and observed 19 home visits. Overall, 60% of mothers adopted less than three safe practices. Wrapping newborns (96% and delayed bathing (64% were better adopted than cord care (49%, safe breastfeeding (48%, hand washing (30%, kangaroo care (20% and eye care (9%. Cultural beliefs and traditional birth attendants influenced the mother’s practices. The lack of supervision by auxiliary nurse midwives (ANM, delayed referral and transportation were the other challenges. Conclusion: Knowledge–practice gaps existed among mothers counselled by ASHAs. Poor utilization of reproductive and child health services decreased opportunities for ASHA–mother dialogue on safe practices. Recommendations included training ANMs, training TBAs as ASHAs, innovative communication strategies for ASHAs and improved referral system.
Full Text Available BACKGROUND: Despite efforts by government and other agencies, neonatal morbidity and mortality continues to be high in India. Among other reasons, newborn care practices are major contributors for such high rates. AIMS: To find out the newborn care practices including delivery practices, immediate care given after birth and breast-feeding practices in an urban slum of Delhi. SETTINGS AND DESIGN : Community based, cross-sectional survey in a resettlement colony (a type of urban slum. MATERIALS AND METHODS : Semi-structured, pre-tested schedule was used to interview 82 mothers of newborns in the study area. STATISTICAL ANALYSIS : Data was analyzed using Epi - info version 6.04. Fischer exact test and c2 test were applied. A P value of less than 0.05 was considered significant. RESULTS AND CONCLUSION : More than half i.e. 26 (56.1% of home deliveries, which were mostly conducted by dais (24, 91.3% or relatives in 4 (8.7% of home deliveries. Bathing the baby immediately after birth was commonly practiced in 38 (82.6% of home deliveries. Finger was used to clean the air passage in most of the home deliveries (29, 63%. About 61% (28 of home delivered newborns were not weighed at birth. Rooming in was practiced in majority of the cases. A few of home delivered neonates (12 were given injection tetanus toxoid by unqualified practitioners. Use of clip, band or sterile thread to tie the cord and no application to the cord was significantly higher in institutional deliveries. Breast milk as the first feed was significantly more in institutional deliveries. There is an urgent need to reorient health care providers and to educate mothers on clean delivery practices and early neonatal care.
Rasmussen, F.V.; Borgeskov, H.; Dollerup, J.; Jensen, M.S.; Roslind, K.; Nielsen, L.M.; Lange, Peter
We investigated whether the quality of management of COPD in general practice could be improved by the participation of general practitioners and their staff in a COPD-specific educational programme. One-hundred and fifty-four doctors participated in the study, and 2549 patient record forms were...... programme can improve the quality of COPD care in general practice Udgivelsesdato: 2008/8/25...
The aim of the studies described in this thesis was to analyze nutrition guidance practices of primary-care physicians (PCPs), their nutritional attitudes and knowledge and their interest in the role of nutrition in health and disease. A second objective was to identify the determinants of nutrition guidance practices as well as their working mechanism. In addition one study is described, on consumers expectations of such nutrition guidance.The consumer study revealed that PCPs appeared to be...
Brandstorp, Helen; Kirkengen, Anna Luise; Sterud, Birgitte; Haugland, Bjørgun; Halvorsen, Peder Andreas
The present study, framed as critical action research, aimed at contributing to the improvement of training emergency teams in primary care. The first author was a participating observer in local simulation sessions performed by 10 different teams. Leadership practice as interaction was analysed in three types of communicative spaces: in the review and debriefing sessions; in the author group; and in focus groups involving local stakeholders. The teams practiced both designated and distribute...
Wu, Xiangmei May; Bennett, Deborah H; Ritz, Beate; Cassady, Diana L; Lee, Kiyoung; Hertz-Picciotto, Irva
Given the concern over the potential for health risks associated with certain ingredients (e.g., phthalates) in personal care products, usage patterns of ∼30 types of personal care products (e.g., shampoo, sunscreen, fragrance, etc.) were collected in 604 California households through a telephone interview. Preferences in selecting products, e.g., scented or unscented, aerosol, and brand loyalty, were also investigated. Participants were recruited in three age groups, children (mostly preschoolers), their parents, and adults age 55 or older. Use frequencies of various product types varied by sex, age group, race, education, and climatic region. Product use by parent and child from the same household were correlated. Use frequencies of products in the same class (e.g., skincare) were moderately correlated, which may impact aggregate exposures. Use frequencies observed in this study were generally in the same range as those reported in the EPA Exposure Factor Handbook, but we found differences for some individual products. Our study provides additional data on population-based usage patterns of a large collection of commonly used personal care products pertaining to several age groups and socio-demographic strata. This information will be valuable for exposure and risk assessments. PMID:20696198
Atienza, Gerardo; Bañeres, Joaquim; Gracia, Francisco Javier
Clinical practice guidelines are intended to serve as a bridge between the decision levels and the sources of knowledge, giving decision makers the best synthesis of scientific evidence and an analysis of context, to provide elements of judgement and to transfer scientific knowledge into clinical practice. However, the actual impact on health care is variable and effectiveness in changing medical practice, moderate. Qualitative and quantitative studies show that most primary care physicians consider that the guides are a valuable source of advice and training and a kind of improving the quality of healthcare. However, they underline its rigidity, the difficulty to apply to individual patients and that their main goal is to reduce healthcare costs. In Spain, there are several experiences as GuíaSalud in developing clinical practice guidelines aimed specifically at primary care. However, the proper implementation of a clinical practice guideline includes not only the quality and thoroughness of the evidence, but the credibility of professionals and organizations and other contextual factors such as characteristics of patients, providers and organizations or systems. An important step in future research is to develop a better theoretical understanding of organizational change that is required for management and professionals to give appropriate guidance to the implementation of the clinical practice guidelines. PMID:21993072
Goffredo, Paolo; Jillard, Christa; Thomas, Samantha; Scheri, Randall P; Sosa, Julie Ann; Roman, Sanziana
Some studies have reported that minimally invasive follicular carcinoma (MIFC) with vascular invasion is associated with compromised prognosis, leading to an ongoing debate regarding extent of surgery for MIFC. Our goal was to identify predictors of vascular invasion and determine its impact on patterns of care. Adult patients with MIFC were culled from the National Cancer Database, 2010-2011, and segregated according to the presence/absence of capsular or vascular invasion. Variables of interest were examined using Chi-square and student's t tests. Multivariate analysis was performed with logistic regression. A total of 617 patients with MIFC were identified: 54% with capsular invasion only and 46% with vascular invasion. Demographic characteristics were similarly distributed between the two groups. Tumor size was larger in patients with vascular invasion (mean = 35.7 vs. 29.2 mm capsular invasion only, p standardization of practice patterns and improvement in quality of care. PMID:26077949
Trakroo P L
Full Text Available In this paper an attempt has been made to assess the perception and management of sickness among rural population in Haryana State. The relationship between medical care seeking behaviour with dependency scale and skepticism about medical care scale has also been explained. The dependency scale measures the degree of dependence on others for management of sickness and the skepticism scale highlights the degree of reliance on other systems of medicine than modern medical care for treatment of sickness in a person (Edward Suchman1995. This study is based on 273 households drawn from three villages of Beri Block in Rohtak District. Out of the 34 villages in block, one village named as PHC village was selected having institutional facility of primary health center and from it 10 percent of the total households were drawn on simple random sampling basis. The two other villages named as non PHC villages were drawn form those villages which were around 10-15 kilometers away from any health facility and out of these villages 50 percent of the households were selected. Information from all householders were collected through interview schedules. An attempt has also been made to establish a pattern of seeking medical care in terms of the socio-economic classification of villagers as well as its caste structure
Lange, Peter; Rasmussen, Finn Vejlø; Borgeskov, Hanne;
We studied the quality of care for COPD patients in a large sample of general practices in Denmark. We focussed on whether participation by general practitioners (GPs) in an educational programme could enhance the use of spirometry in the diagnosis and staging of the disease and improve adherence...
Akubue, B. N.; Anikweze, G. U.
The purpose of this study was to investigate the health care practices for medical textiles in government hospitals Enugu State, Nigeria. Specifically, the study determined the availability and maintenance of medical textiles in government hospitals in Enugu State, Nigeria. A sample of 1200 hospital personnel were studied. One thousand two hundred…
Richie, Mary Fern; And Others
Psychiatric nursing faculty practice offers the academic nurse opportunity to generate salary support and integrate students into the real world of mental health care. It promotes scholarship and knowledge-building and has a direct impact on the lives of patients. (Author/JOW)
The implications of the practitioner's personal values are explored in relation to the professional issues of child and youth care practice. Values are inevitably a component of decision-making and therefore are integrally connected to ethics in the field. The prevalence of subjectivity over objectivity is emphasized in relation to in-the-moment…
The Japanese Patterns of Care Study (PCS) conducted a third nationwide survey of care process for patients with limited-disease small cell lung cancer (PCS 03-05). The PCS investigated changes in the care process including continuous technical evolution in radiotherapy as compared with preceding surveys (PCS 95-97, PCS 99-01) and assessed their influence on early outcome. PCS 99-01 showed that evidence based practice pattern had well penetrated into clinical practice. PCS 03-05 demonstrated several changes in patterns of radiotherapy. Decrease in the use of twice-daily radiotherapy did not influence early outcome. Results support the general consideration that technical evolution in radiotherapy has essential role in the era of intensive chemoradiation for small cell lung cancer. (author)
Glasdam, Stinne; Kjær, Lone; Præstegaard, Jeanette
one client, his cohabitant family and the involved healthcare professionals. Results: Client involvement in home care service is shown within the constructed categories: The schism between wishing for and actually being helped; The chronological order can be negotiated; not the content; Liberal...... business gives the client full influence into the treatment and the therapist gold; and Converting a home to at working place and a home. Client involvement in practice seems to be very limited. Conclusion: All in all, involvement of clients in home care service seems to be more of a political illusion......Background: Through the last 35 years, ‘client involvement’ has been a mantra within health policies, education curriculums and health care institutions, yet very little is known about how ‘client involvement’ is practiced in the meetings with clients and health professionals. Aim: To analyse and...
Full Text Available Over the last few years, there has been increased awareness and use of complementary/alternative therapies (CAM in many countries without the health care infrastructure to support it. The National Centre for Complementary and Alternative Medicine referred to the combining of mainstream medical therapies and CAM as integrative medicine. The creation of integrative health care teams will definitely result in redefining roles, but more importantly in a change in how services are delivered. The purpose of this paper is to describe a model of the necessary health care agency resources to support an integrative practice model. A logic model is used to depict the findings of a review of current evidence. Logic models are designed to show relationships between the goals of a program or initiative, the resources to achieve desired outputs and the activities that lead to outcomes. The four major resource categories necessary for implementing integrative care are within the domains of a professional and research development, b health human resource planning, c regulation and legislation and d practice and management in clinical areas. It was concluded that the system outcomes from activities within these resource categories should lead to freedom of choice in health care; a culturally sensitive health care system and a broader spectrum of services for achieving public health goals.
Soffer, Ann Katrine B.
The implementation of skills labs in Danish nursing education can, in itself, be viewed as a complexity. The students are expected to eventually carry out their work in a situated hospital practice, but they learn their professional skills in a different space altogether, detached and removed from...... as part of care practices of nurses rendering the ability to detach in engagement with patients a professional skill that students also need to learn. In the analysis to follow, attached and detached engagements are located on an equal plane by integrating both in to the same conceptual framework...... the hospitals and practicing on plastic dummies. Despite the apparent artiﬁciality of the skills lab, this article will show that it is possible to analyse some of the fundamental aspects of care in nursing by ethnographically following this phenomenon of simulation-based training. These particular...
Deeg Evelin; Plate Tanja; Krekler Michael; Gitt Anselm K; Binz Christiane; Bramlage Peter; Tschöpe Diethelm
Abstract Background Patients with type 2 diabetes are at an increased risk for disease and treatment related complications after the initial approach of oral mono/dual antidiabetic therapy has failed. Data from clinical practice with respect to this patient group are however scarce. Therefore we set up a registry in primary care documenting the course and outcomes of this patient group. Methods Diabetes Treatment Patterns and Goal Achievement in Primary Diabetes Care (DiaRegis) is a prospecti...
Ahrenkiel, Annegrethe; Warring, Niels; Nielsen, Birger Steen;
In Denmark more than 9 out 10 children attend day care centers that are publicly funded and regulated. The main part of employees, the social educators, at day care centers have attended a 3½ years educational programme with both theoretical and practical elements. Nevertheless it has been hard...... for the social educators to get recognition for their professional competencies and the societal importance of their work. Neoliberal governance has imposed a lot of demands for documentation, evaluation etc., and a growing focus on children’s learning in day care centers has resulted in national goals...... hand it can tend to underestimate the value of a large part of their work which is embedded in what in the paper will be explored as unnoticed professional competences. Building on empirical results from research in day care centers based on mixed methods (observations, interviews and action research...
Ganio, L.M.; Torgersen, C.E.; Gresswell, R.E.
The shape and configuration of branched networks influence ecological patterns and processes. Recent investigations of network influences in riverine ecology stress the need to quantify spatial structure not only in a two-dimensional plane, but also in networks. An initial step in understanding data from stream networks is discerning non-random patterns along the network. On the other hand, data collected in the network may be spatially autocorrelated and thus not suitable for traditional statistical analyses. Here we provide a method that uses commercially available software to construct an empirical variogram to describe spatial pattern in the relative abundance of coastal cutthroat trout in headwater stream networks. We describe the mathematical and practical considerations involved in calculating a variogram using a non-Euclidean distance metric to incorporate the network pathway structure in the analysis of spatial variability, and use a non-parametric technique to ascertain if the pattern in the empirical variogram is non-random.
Veinot, Tiffany C; Zheng, Kai; Lowery, Julie C; Souden, Maria; Keith, Rosalind
While there has been considerable attention devoted to the deployment of electronic health record (EHR) systems, there has been far less attention given to their appropriation for use in clinical encounters - particularly in the context of complex, chronic illness. The Department of Veterans' Affairs (VA) has been at the forefront of EHR adoption and, as such, provides a unique opportunity to examine a mature EHR system in widespread use. Moreover, with a high prevalence of diabetes in its patient population, the VA provides a useful platform for examining EHR use in the context of chronic disease care. We conducted a sequential, exploratory qualitative study at two VA Medical Centers in the Midwest. First, we conducted observations of 64 clinical consultations with diabetes patients. These observations involved 31 different health care providers. Second, using insights from these observations, we conducted in-depth, semi-structured interviews with 39 health care providers focusing on their use of information in diabetes patient care. Field notes and interview transcripts were analyzed using a grounded theory approach. Our analysis generated several categories of EHR use in clinical encounters: priming, structuring, assessing, informing, and continuing. We also outline some mismatches between EHR system design and VA diabetes care practices. We conclude by discussing implications of these emergent system uses for improving the software design of EHRs to better support chronic disease care, as well as for our understanding of the integration of technologies in health care. PMID:25264545
Full Text Available Abstract Background To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners by primary care patients with osteoarthritis (OA. Methods Cross-sectional survey among 1250 consecutively addressed patients from 75 primary care practices in Germany. All patients suffered from OA of the knee or hip according to ACR criteria. They received questionnaires collecting sociodemographic data, data about health service utilisation, prescriptions, comorbidities. They also included established instruments as the Arthritis Impact Measurement Scale (AIMS2-SF to assess disease-specific quality of life and the Patient Health Questionnaire (PHQ-9 to assess depression. Hierarchical stepwise multiple linear regression models were used to reveal significant factors influencing health service utilization. Results 1021 of 1250 (81.6% questionnaires were returned. Nonrespondents did not differ from participants. Factors associated with health service use (HSU varied between providers of care. Not being in a partnership, achieving a high score on the PHQ-9, increased pain severity reflected in the “symptom” scale of the AIMS2-SF, and an increased number of drug prescriptions predicted a high frequency of GP visits. The PHQ-9 score was also a predictor for visits to orthopaedists, as were previous GP contacts, a high score in the "symptom" scale as well as a high score in the "lower limb scale" of the AIMS2-SF. Regarding visits to alternative practitioners, a high score in the AIMS -"social" scale was a positive predictor as older people were less likely to visit them. Conclusion Our results emphasize the need for awareness of psychological factors contributing to the use of health care providers. Addressing the revealed factors associated with HSU appropriately may lead to decreased health care utilization. But further research is needed to assess how this can be done
This retrospective study aims to explore any associations between socioeconomic factors and lung cancer management and outcome in the Australian setting. The study population consisted of patients newly diagnosed with lung cancer in 1996 who were living in the Northern Sydney Area Health Service (NSAHS) or South Western Sydney Area Health Service (SWSAHS). These two Area Health Services differ in socioeconomic profiles based on socioeconomic indexes for areas (SEIFA), median income, education level and unemployment rate. Data on patient demographics, tumour characteristics, management details, recurrence and survival were collected, and the patterns of care were analysed. Socioeconomic status indicators of the two Area Health Services were imputed from the Australian Bureau of Statistics data. There were 270 and 256 new cases of lung cancer identified in NSAHS and SWSAHS respectively. Patients in NSAHS were slightly older (median age 73 versus 68 years) and there was less male predominance. The stage distributions and performance status of the two cohorts were similar. There were no significant differences in the utilisation rates of different treatment modalities between the two areas: radiotherapy (54% in NSAHS and 55% in SWSAHS), chemotherapy (34% and 25%), surgery (26% and 21%) and no treatment (22% and 25%). The 5-year overall survival was slightly in favour of NSAHS (10.5% and 7.4%), but did not reach statistical significance. Despite differences in socioeconomic profiles between the two area health services, patients with lung cancer had similar patterns of care and survival
Tessaro, Irene; Campbell, Marci K; Golden, Shannon; Gellin, Mindy; McCabe, Mary; Syrjala, Karen; Ganz, Patricia A; Jacobs, Linda; Baker, Scott; Miller, Kenneth D; Rosenstein, Donald L
The LIVESTRONG Centers of Excellence were funded to increase the effectiveness of survivorship care in oncology practice. This study describes the ongoing process of adopting and implementing survivorship care using the framework of the diffusion of innovation theory of change. Primary data collection included telephone interviews with 39 members from the eight centers and site visits. Organizational characteristics, overall progress, and challenges for implementation were collected from proposals and annual reports. Creating an awareness of cancer survivorship care was a major accomplishment (relative advantage). Adoption depended on the fit within the cancer center (compatibility), and changed over time based on trial and error (trialability). Implementing survivorship care within the existing culture of oncology and breaking down resistance to change was a lengthy process (complexity). Survivorship care became sustainable as it became reimbursed, and more new patients were seen (observability). Innovators and early adopters were crucial to success. Diffusion of innovation theory can provide a strategy to evaluate adoption and implementation of cancer survivorship programs into clinical practice. PMID:24073165
de Moerloose, Philippe; Arnberg, Daniel; O'Mahony, Brian; Colvin, Brian
At the 2014 Annual Congress of the European Haemophilia Consortium (EHC) held in Belfast, Northern Ireland, Pfizer initiated and funded a satellite symposium entitled: 'Improving Patient Care Through Sharing Best Practice'. Co-chaired by Brian Colvin (Pfizer Global Innovative Pharma Business, Rome, Italy) and Brian O'Mahony [President of the EHC, Brussels, Belgium], the symposium provided an opportunity to consider patient care across borders, to review how patient advocacy groups can successfully engage with policymakers in healthcare decision-making and to discuss the importance of patient involvement in data collection to help shape the future environment for people with haemophilia. Professor Philippe de Moerloose (University Hospitals and Faculty of Medicine of Geneva, Switzerland) opened the session by discussing the gap between the haemophilia management guidelines and the reality of care for many patients living in Europe, highlighting the importance of sharing of best practice and building a network of treaters and patient organisations to support the improvement of care across Europe. Daniel Arnberg (SCISS AB, Hägersten, Sweden) reviewed the health technology assessment process conducted in Sweden, the first for haemophilia products, as a case study, focusing on the role of the patient organisation. Finally, Brian O'Mahony reflected on the central role of patients as individuals and also within patient organisations in shaping the future of haemophilia care. PMID:26338268
Parks, Jennifer A
This essay will focus on the moral issues relating to surrogacy in the global context, and will critique the liberal arguments that have been offered in support of it. Liberal arguments hold sway concerning reproductive arrangements made between commissioning couples from wealthy nations and the surrogates from socioeconomically weak backgrounds that they hire to do their reproductive labor. My argument in this paper is motivated by a concern for controlling harms by putting the practice of globalized commercial surrogacy into the context of care ethics. As I will argue, the unstable situations into which children of global surrogacy arrangements are born is symbolic of the crisis of care that the practice raises. Using the Baby Manji case as my touch point, I will suggest that liberalism cannot address the harms experienced by Manji and children like her who are created through the global practice of assisted reproductive technology. I will argue that, if commissioning couples consider their proposed surrogacy contracts from a care ethics point of view, they will begin to think relationally about their actions, considering the practice from an ethical lens, not just an economic or contractual one. PMID:20690917
Fierman, Arthur H; Beck, Andrew F; Chung, Esther K; Tschudy, Megan M; Coker, Tumaini R; Mistry, Kamila B; Siegel, Benjamin; Chamberlain, Lisa J; Conroy, Kathleen; Federico, Steven G; Flanagan, Patricia J; Garg, Arvin; Gitterman, Benjamin A; Grace, Aimee M; Gross, Rachel S; Hole, Michael K; Klass, Perri; Kraft, Colleen; Kuo, Alice; Lewis, Gena; Lobach, Katherine S; Long, Dayna; Ma, Christine T; Messito, Mary; Navsaria, Dipesh; Northrip, Kimberley R; Osman, Cynthia; Sadof, Matthew D; Schickedanz, Adam B; Cox, Joanne
Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them. Identification of needs can be accomplished with a variety of established screening tools. Interventions may include resource directories, best maintained in collaboration with local/regional public health, community, and/or professional organizations; programs embedded in the practice (eg, Reach Out and Read, Healthy Steps for Young Children, Medical-Legal Partnership, Health Leads); and collaboration with home visiting programs. Changes to health care financing are needed to support the delivery of these enhanced services, and active advocacy by child health providers continues to be important in effecting change. We highlight the ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty. PMID:27044692
The nutritional care of patients is one of the primary responsibilities of all registered nurses (Persenius et al, 2008). A poor nutritional status can lead to malnutrition, which can have serious consequences for an individual\\'s quality of life (Field and Smith, 2008). This paper commences with an introduction to the concept of nutrition, provides an overview of nutritional guidelines and nutritional screening tools which identify those at risk of malnutrition. It reviews the literature on nurses\\' knowledge, attitudes and practices in the provision of nutritional care and debates challenges and opportunities encountered to help nurses ensure adequate patient nutrition.
Rodney A. Lambert
Full Text Available Routine general practice (GP care is rarely comprehensively described in clinical trials. This paper examines routine GP care within the lifestyle approach to managing panic (LAMP study. The aim of this paper is to describe/discuss routine GP care for panic disorder (PD patients within both study arms in the LAMP study. An unblinded pragmatic randomised controlled trial in 15 East of England GP practices (2 primary care trusts. Participants met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for PD with/without agoraphobia. Follow-up measures recorded at 20 weeks/10 months following randomisation. Control arm, unrestricted routine GP care (practice appointments, referrals and prescriptions. Trial arm, occupational therapyled lifestyle treatment comprising lifestyle review of fluid intake, diet pattern, exercise, caffeine, alcohol and nicotine. Primary outcome measure: beck anxiety inventory. At baseline, participants attended 2-3 times more GP appointments than population average, reducing at 10 months to 1.6 times population average for routine GP care and 0.97 population average for lifestyle arm. At 10 months, 33% fewer referrals (6 referrals; 0 mental health than at baseline (9 referrals; 2 mental health were made for lifestyle arm patients compared with 42% increase (from 12 referrals; 8 mental health at baseline to 17 referrals; 7 mental health in GP care arm. Selective serotonin reuptake inhibitors were prescribed most often. Benzodiazepines and beta-blockers were prescribed more often than tricyclic against current clinical guidelines. In conclusion, we found that PD patients at baseline were high healthcare resource users. Treatment in both study arms reduced resource use. Routine GP care requires further review for this patient group.
Canestraro, Alyssa; Nakhle, Anthony; Stack, Malissa; Strong, Kelly; Wright, Ashley; Beauchamp, Marla; Berg, Katherine; Brooks, Dina
Purpose: Rehabilitation is increasingly recognized as an important therapeutic intervention for people with cancer. The main objective of this study was to explore the current practice pattern and provision of oncology rehabilitation in Canada. Methods: A descriptive cross-sectional online survey was administered to Canadian facilities offering cancer treatment and/or listed as offering rehabilitation services during or after cancer treatment (cancer centres, rehabilitation hospitals, communi...
Ralf Bebenroth; Donghao Li
Our empirical study provides the first insights of executive staffing practice patterns in foreign-owned multinational company (MNC) subsidiaries based in Japan. We explore determinants for parent country nationals (PCN) as top managing directors and - new in the International Human Resource Management (IHRM) literature - also the ratio of PCN found on the board (Ratio) and examine under which conditions they are prevalent in the subsidiaries. We sampled the full range of 3,241 foreign compan...
PATTERSON, Miles L.; 飯塚, 雄一; Miles L., PATTERSON; Yuichi, IIZUKA
Nonverbal communication is a pervasive influence in every life. Furthermore, in most setting, nonverbal communication has a greater impact on interactions than does verbal communication. In this article, we first describe the basic processes involved in nonverbal communication and then briefly examine the factors affecting patterns of nonverbal communication - biology, culture, gender, and personality. Finally, we discuss the role of nonverbal communication in health care settings. Nonverbal ...
Babita Gupta; Pramendra Agrawal; Soni, Kapil D; Vikas Yadav; Roshni Dhakal; Shally Khurana; M C Misra
Background: Adequate nutritional support is important for the comprehensive management of patients in intensive care units (ICUs). Aim: The study was aimed to survey prevalent enteral nutrition practices in the trauma intensive care unit, nurses′ perception, and their knowledge of enteral feeding. Study Design: The study was conducted in the ICU of a level 1 trauma center, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India. The study design used an audit. Materials...
Møller Pedersen, Kjeld; Andersen, John Sahl; Søndergaard, Jens
postgraduate education. The contract is (re)negotiated every 2 years. General practice is embedded in a universal tax-funded health care system in which GP and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new...... is expected to accelerate, in part because of the GP age structure, with many GPs retiring and new GPs not wanting to practice alone. This latter workforce trend is pointing toward a new model with employed GPs, particularly in rural areas....
Kristensen, Troels; Rose Olsen, Kim
Aim: We analyze total operating costs and activities in Danish General Practice units to assess whether there are unexploited economies of scope in the production of primary care services. Methods: We apply stochastic frontier analysis to derive cost functions and associated cost complementarities...... between GP services and overall economies of scope. Data: Cross-section data for a sample of 331 primary care practices with 1-8 GPs from the year 2006. This is a unique combined dataset consisting of survey and register data. Results: We find a trend towards cost complementarities between the production...... positive economies of scope in the production of GP services. Conclusions: Our preliminary results show that there were overall economies of scope associated with the joint production of a) standard consultations, b) email/phone consultations and c) home visits. Cost complementarities between standard...
Woof, W R
This paper discusses the future of bereavement care in British general practice by providing an insight into existing practice and then speculating on influences that may shape developments. There have been calls for the specialty to build on this traditional role and expand its bereavement service. Specific suggestions for the content of such a service are summarised. This emphasis reflects the increasing awareness in bereavement by other health organisations. This image of an expanding service needs to be contextualised within a primary care system that is feeling more pressurised due to increasing workload. This will continue to inhibit extensive service development. In addition it is important for the profession to consider the appropriateness of this activity. This complex debate has received little attention and research is required to inform and provide the necessary direction. PMID:9233164
Jayaprakash, Paul T
Uniqueness being unprovable, it has recently been argued that individualization in forensic science is irrelevant and, probability, as applied for DNA profiles, should be applied for all identifications. Critiques against uniqueness have omitted physical matching, a realistic and tangible individualization that supports uniqueness. Describing case examples illustrating pattern matches including physical matching, it is indicated that individualizations are practically relevant for forensic science as they establish facts on a definitive basis providing firm leads benefitting criminal investigation. As a tenet of forensic identification, uniqueness forms a fundamental paradigm relevant for individualization. Evidence on the indeterministic and stochastic causal pathways of characteristics in patterns available in the related fields of science sufficiently supports the proposition of uniqueness. Characteristics involved in physical matching and matching achieved in patterned evidence existing in the state of nature are not events amenable for counting; instead these are ensemble of visible units occupying the entire pattern area stretching the probability of re-occurrence of a verisimilitude pattern into infinity offering epistemic support to uniqueness. Observational methods are as respectable as instrumental or statistical methods since they are capable of generating results that are tangible and obviously valid as in physical matching. Applying the probabilistic interpretation used for DNA profiles to the other patterns would be unbefitting since these two are disparate, the causal pathways of the events, the loci, in the manipulated DNA profiles being determinable. While uniqueness enables individualizations, it does not vouch for eliminating errors. Instead of dismissing uniqueness and individualization, accepting errors as human or system failures and seeking remedial measures would benefit forensic science practice and criminal investigation. PMID:23849815
Ahrenkiel, Annegrethe; Warring, Niels; Nielsen, Birger Steen;
the social educators to get recognition for their professional competencies and the societal importance of their work. Neoliberal governance has imposed a lot of demands for documentation, evaluation etc., and a growing focus on children’s learning in day care centers has resulted in national goals...... other hand it can tend to underestimate the value of a large part of their work which is embedded in what in the paper will be explored as unnoticed professional competences. Building on empirical results from research in day care centers based on mixed methods (observations, interviews and action...... research based workshops) the paper will discuss work practice in an everyday life perspective. This perspective opens for understanding professional competence as part of creating coherence in children’s and families’ lives as well as during the day in the day care centers. It also opens for a discussion...
Ujwal Lakshman Yeole; Ankita Ramesh Chand; Nandi, Biplab B.; Pravin P Gawali; Adkitte, Roshan G.
Purpose: To find out the current physiotherapy practices in Intensive Care Unit (ICU) across Maharashtra. Materials and Methods: Study design was exploratory cross-sectional survey. Questionnaires were sent to the physiotherapists working in hospitals across Maharashtra state, India. Four weeks for completion of questionnaire was given in an attempt to ensure good response rates. Result: Of 200, 73 questionnaires were received representing a 36% response rate. The study revealed that 76% of t...
i Abstract Aims: This study sought to assess the knowledge, skills, attitudes and practice of nurses towards the issue of culture, in order to assess their level of cultural competence (CC) and its impact upon healthcare provision within the speciality of elderly care. Background: The UK continues to be an increasingly diverse and ageing population; hence, it is important that healthcare professionals become aware of the needs of older ethnic minority patients. CC is one approach...
Smellie, W S A; Wilson, D; McNulty, C A M; Galloway, M. J.; Spickett, G A; Finnigan, D I; Bareford, D A; Greig, M A; Richards, J
This first best practice review examines four series of common primary care questions in laboratory medicine, namely: (i) measurement and monitoring of cholesterol and of liver and muscle enzymes in patients in the context of lipid lowering drugs, (ii) diagnosis and monitoring of vitamin B12/folate deficiency, (iii) investigation and monitoring of paraprotein bands in blood, and (iv) management of Helicobacter pylori infection. The review is presented in a question–answer format, referenced f...
Dayanne Rakelly de Oliveira; Gabriela Bezerra Dantas
Objective: To understand the cultural practices of care among mothers of infants with respiratory infection in a pediatric outpatient clinic, from the recognition of the importance of the use of traditional medicine in Brazil. Methods: We applied a descriptive and exploratory study, qualitative, with twenty-eight mothers of infants with respiratory infection seen at a referral center in the city of Barbalha - CE, Brazil. Data were collected between the monthsof November and December of 2010 t...
At the margins of modern medical practice, pushing the very limits of science, and indefatigably rendering the precincts of public discourse, still functional remnants of Christian civilization continue to provide care for the hopeless, perform healing sacraments for the incurable, and curate objects of votive devotion for the suffering and needy. These public services go largely unaccounted for, though they secure an ordered world, structure perception, and serve as ontological anchors. Lost...
Tansella, M; Bellantuono, C
The main features of the psychiatric system and of the general practice system in Italy since the psychiatric reform and the introduction of a national health service are briefly described. Research conducted in Italy confirms that a large proportion of patients seen by general practitioners have psychological disorders and that only some of those patients whose psychological problems are identified by general practitioners are referred to specialist psychiatric care. Thus, the need to identi...
Ruch, Gillian Margaret
In recent years there has been a steady increase in risk-averse, bureaucratic responses to the uncertainty, ambiguity and risk inherent in contemporary child care social work. This thesis argues that for these conditions to be effectively addressed professional responses are required that challenge the domination of ineffective bureaucratic approaches, which have as their primary objective the elimination of uncertainty and risk. The emergence of relationship-based practice is an approach to ...
Anthony, Denise L; Stablein, Timothy
Purpose - The purpose of this paper is to explore different health care professionals' discourse about privacy - its definition and importance in health care, and its role in their day-to-day work. Professionals' discourse about privacy reveals how new technologies and laws challenge existing practices of information control within and between professional groups in health care, with implications not only for patient privacy, but also for the role of information control in professions more generally. Design/methodology/approach - The authors conducted in-depth, semi-structured interviews with n=83 doctors, nurses, and health information professionals in two academic medical centers and one veteran's administration hospital/clinic in the Northeastern USA. Interview responses were qualitatively coded for themes and patterns across groups were identified. Findings - The health care providers and the authors studied actively sought to uphold the protection (and control) of patient information through professional ethics and practices, as well as through the use of technologies and compliance with legal regulations. They used discourses of professionalism, as well as of law and technology, to sometimes accept and sometimes resist changes to practice required in the changing technological and legal context of health care. The authors found differences across professional groups; for some, protection of patient information is part of core professional ethics, while for others it is simply part of their occupational work, aligned with organizational interests. Research limitations/implications - This qualitative study of physicians, nurses, and health information professionals revealed some differences in views and practices for protecting patient information in the changing technological and legal context of health care that suggest some professional groups (doctors) may be more likely to resist such changes and others (health information professionals) will actively
Hardy, Sally; Jackson, Carrie; Webster, Jonathan; Manley, Kim
Over the past 20 years health care reform has influenced the development of advanced level practitioner roles and expectations. How advanced level practitioners work to survive the highly stimulating, yet sometimes overwhelming aspects of balancing high quality provision with political reform agendas, amidst economic constraint is considered. Transformational approaches (encompassing education and practice led service development) can provide, promote and 'provoke' a harnessing of complex issues workplace environment to produce creative solutions. Transformational Practice Development provides a structured, rigorous, systematic approach that practitioners, teams and health care consumers alike can utilise to achieve skills and attributes needed for successful innovation. The authors present case study materials from action orientated locally delivered Practice Development, as a complex strategic intervention approach to influence and promote advanced level practice expertise. Initiated through facilitation of transformational leadership, and resultant team based improvements, we present how strategic collaborative processes can harness work chaos and complexity to provide sustainable and productive workplace cultures of effectiveness. PMID:23453607
managerial terms, the analysis points to the utility of formal statistical analysis of hospitalisation rates as a prelude to non-statistical investigation of primary care resourcing and organisation. For example, there may be implications for the location of staff involved in community management of chronic conditions; health managers may also investigate whether some practices have unusual populations (homeless, asylum seekers, students that explain different hospital use patterns.
Full Text Available INTRODUCTION: Multimorbidity is a major concern in primary care. Nevertheless, evidence of prevalence and patterns of multimorbidity, and their determinants, are scarce. The aim of this study is to systematically review studies of the prevalence, patterns and determinants of multimorbidity in primary care. METHODS: Systematic review of literature published between 1961 and 2013 and indexed in Ovid (CINAHL, PsychINFO, Medline and Embase and Web of Knowledge. Studies were selected according to eligibility criteria of addressing prevalence, determinants, and patterns of multimorbidity and using a pretested proforma in primary care. The quality and risk of bias were assessed using STROBE criteria. Two researchers assessed the eligibility of studies for inclusion (Kappa= 0.86. RESULTS: We identified 39 eligible publications describing studies that included a total of 70,057,611 patients in 12 countries. The number of health conditions analysed per study ranged from 5 to 335, with multimorbidity prevalence ranging from 12.9% to 95.1%. All studies observed a significant positive association between multimorbidity and age (odds ratio [OR], 1.26 to 227.46, and lower socioeconomic status (OR, 1.20 to 1.91. Positive associations with female gender and mental disorders were also observed. The most frequent patterns of multimorbidity included osteoarthritis together with cardiovascular and/or metabolic conditions. CONCLUSIONS: Well-established determinants of multimorbidity include age, lower socioeconomic status and gender. The most prevalent conditions shape the patterns of multimorbidity. However, the limitations of the current evidence base means that further and better designed studies are needed to inform policy, research and clinical practice, with the goal of improving health-related quality of life for patients with multimorbidity. Standardization of the definition and assessment of multimorbidity is essential in order to better understand this
Aim: The primary objective of the survey was to evaluate clinical skin care practice in radiotherapy departments across the United Kingdom. Methods and sample: A questionnaire containing sixty-one questions grouped into eight themed sections was developed and a link to an on-line survey, using the Survey Monkey™ tool, was e-mailed to all radiotherapy department managers in the United Kingdom (N = 67). Each recipient was invited to provide one response per department. Key results: Fifty-four departments responded within the allocated timeframe giving a final response rate of 81%. Products and their use for skin conditions varied and some outdated and unfounded practices were still being used which did not always reflect the current evidence base. The amount of data routinely collected on skin toxicity was limited making it difficult to quantify the extent of skin morbidity following radiotherapy. Conclusion: The survey demonstrated variability in skin care practice in radiotherapy departments across the UK, with limited practice based on evidence or on skin toxicity measurement and monitoring.
Green Michael E
Full Text Available Abstract Purpose To evaluate the appropriateness of potential data sources for the population of performance indicators for primary care (PC practices. Methods This project was a cross sectional study of 7 multidisciplinary primary care teams in Ontario, Canada. Practices were recruited and 5-7 physicians per practice agreed to participate in the study. Patients of participating physicians (20-30 were recruited sequentially as they presented to attend a visit. Data collection included patient, provider and practice surveys, chart abstraction and linkage to administrative data sets. Matched pairs analysis was used to examine the differences in the observed results for each indicator obtained using multiple data sources. Results Seven teams, 41 physicians, 94 associated staff and 998 patients were recruited. The survey response rate was 81% for patients, 93% for physicians and 83% for associated staff. Chart audits were successfully completed on all but 1 patient and linkage to administrative data was successful for all subjects. There were significant differences noted between the data collection methods for many measures. No single method of data collection was best for all outcomes. For most measures of technical quality of care chart audit was the most accurate method of data collection. Patient surveys were more accurate for immunizations, chronic disease advice/information dispensed, some general health promotion items and possibly for medication use. Administrative data appears useful for indicators including chronic disease diagnosis and osteoporosis/ breast screening. Conclusions Multiple data collection methods are required for a comprehensive assessment of performance in primary care practices. The choice of which methods are best for any one particular study or quality improvement initiative requires careful consideration of the biases that each method might introduce into the results. In this study, both patients and providers were
Findley, Sally; Rosenthal, Michael; Bryant-Stephens, Tyra; Damitz, Maureen; Lara, Marielena; Mansfield, Carol; Matiz, Adriana; Nourani, Vesall; Peretz, Patricia; Persky, Victoria W; Valencia, Gilberto Ramos; Uyeda, Kimberly; Viswanathan, Meera
Care coordination programs have been used to address chronic illnesses, including childhood asthma, but primarily via practice-based models. An alternative approach employs community-based care coordinators who bridge gaps between families, health care providers, and support services. Merck Childhood Asthma Network, Inc. (MCAN) sites developed community-based care coordination approaches for childhood asthma. Using a community-based care coordination logic model, programs at each site are described along with program operational statistics. Four sites used three to four community health workers (CHWs) to provide care coordination, whereas one site used five school-based asthma nurses. This school-based site had the highest caseload (82.5 per year), but program duration was 3 months with 4 calls or visits. Other sites averaged fewer cases (35 to 61 per CHW per year), but families received more (7 to 17) calls or visits over a year. Retention was 43% to 93% at 6 months and 24% to 75% at 12 months. Pre-post cross-site data document changes in asthma management behaviors and outcomes. After program participation, 93% to 100% of caregivers had confidence in controlling their child's asthma, 85% to 92% had taken steps to reduce triggers, 69% to 100% had obtained an asthma action plan, and 46% to 100% of those with moderate to severe asthma reported appropriate use of controller medication. Emergency department visits for asthma decreased by 36% to 63%, and asthma-related hospitalizations declined by 26% to 78%. More than three fourths had fewer school absences. In conclusion, MCAN community-based care coordination programs improved management behaviors and decreased morbidity across all sites. PMID:22068360
Full Text Available Dental caries are largely preventable, and epidemiological evidence for a relationship between diet and oral health is abundant. To date, however, dentists' perceptions about the role of diet and dentists' practice patterns regarding diet counseling have not been clarified.THE PURPOSES OF THIS STUDY WERE TO: (1 examine discordance between dentists' perception of the importance of diet in caries treatment planning and their actual provision of diet counseling to patients, and (2 identify dentists' characteristics associated with their provision of diet counseling.The study used a cross-sectional study design consisting of a questionnaire survey in Japan.The study queried dentists working in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan (JDPBRN, which aims to allow dentists to investigate research questions and share experiences and expertise (n = 282.Dentists were asked about their perceptions on the importance of diet and their practice patterns regarding diet counseling, as well as patient, practice, and dentist background data.The majority of participants (n = 116, 63% recognized that diet is "more important" to oral health. However, among participants who think diet is "more important" (n = 116, only 48% (n = 56 provide diet counseling to more than 20% of their patients. Multiple logistic regression analysis suggested that several variables were associated with providing diet counseling; dentist gender, practice busyness, percentage of patients interested in caries prevention, caries risk assessment, and percentage of patients who receive blood pressure screening.Some discordance exists between dentists' perception of the importance of diet in caries treatment planning and their actual practice pattern regarding diet counseling to patients. Reducing this discordance may require additional dentist education, including nutritional and systemic disease concepts; patient
Management guidelines for many rheumatic diseases are published in specialty rheumatology literature but rarely in general medical journals. Musculoskeletal disorders comprise 14% of all consultations in primary care. Formal post-graduate training in rheumatology is limited or absent for many primary care practitioners. Primary care practitioners can be trained to effectively treat complex diseases and have expressed a preference for interactive educational courses. The Rheumatology General Practice (GP) Toolbox is an intensive one day course designed to offer up to date information to primary care practitioners on the latest diagnostic and treatment guidelines for seven common rheumatic diseases. The course structure involves a short lecture on each topic and workshops on arthrocentesis, joint injection and DXA interpretation. Participants evaluated their knowledge and educational experience before, during and after the course. Thirty-two primary care practitioners attended, who had a median of 13 (IQR 6.5, 20) years experience in their specialty. The median number of educational symposia attended in the previous 5 years was 10 (IQR-5, 22.5), with a median of 0 (IQR 0, 1) in rheumatology. All respondents agreed that the course format was appropriate. Numerical improvements were demonstrated in participant\\'s confidence in diagnosing and managing all seven common rheumatologic conditions, with statistically significant improvements (p < 0.05) in 11 of the 14 aspects assessed. The Rheumatology Toolbox is an effective educational method for disseminating current knowledge in rheumatology to primary care physicians and improved participant\\'s self-assessed competence in diagnosis and management of common rheumatic diseases.
In 1974 the Patterns of Care Study began investigating radiation therapy of endometrial cancers in the United States. This endeavor required development of a methodology to survey the care of patients who had similar disease and who were treated at various institutions. Analysis of 919 questionnaires revealed a substantial difference nationwide in treatment approaches to this site. Outcome studies and ongoing research projects, combined with this survey of Patterns of Care, can provide a sound base for educational efforts to improve patient care
Jacobsen, Charlotte; Jacobsen, Susanne; Grove, H.;
, although different subsets of protein spots were selected. The explorative approach of using multivariate data analysis and variable selection in the analyses of 2-DEs seems to be promising as a fast, reliable and convenient way of screening and transforming many gel images into spot quantities.......Practical approaches to the use of multivariate data analysis of 2-DE protein patterns are demonstrated by three independent strategies for the image analysis and the multivariate analysis on the same set of 2-DE data. Four wheat varieties were selected on the basis of their baking quality. Two...
Lin, D. H.; Cui, D. J.; Li, B.; Teng, Y.; Zheng, G. L.; Wang, X. Q.
In this paper, we attempt to introduce briefly the significance, the present status, as well as the working principle of the primary patterns of the superconducting energy storage system, first of all. According to the defect on the lower energy storage density of existed superconducting energy storage device, we proposed some new ideas and strategies about how to improve the energy storage density, in which, a brand-new but a tentative proposal regarding the concept of energy compression was emphasized. This investigation has a certain reference value towards the practical application of the superconducting energy storage.
Dayanne Rakelly de Oliveira
Full Text Available Objective: To understand the cultural practices of care among mothers of infants with respiratory infection in a pediatric outpatient clinic, from the recognition of the importance of the use of traditional medicine in Brazil. Methods: We applied a descriptive and exploratory study, qualitative, with twenty-eight mothers of infants with respiratory infection seen at a referral center in the city of Barbalha - CE, Brazil. Data were collected between the monthsof November and December of 2010 through semi-structured interview with a tape recorder. The speeches were analyzed by thematic-categorical analysis, which allowed the creation of four themes: cultural practices of care among mothers, sources of information on medicinal plants, modes of preparation of medicinal herbs and plants used by mothers. To ensure anonymity of participants, they received enumeration following the order of interviews. Results: The study showed that mothers make use of folk medicine, through the preparationof home remedies in order to treat and cure respiratory infections of their children; the leaking tea and herbal medicine are worth mentioning. Mothers place great confidence and give real meaning to the use of homemade preparations. It was observed that this knowledge comes from their mothers, grandparents, relatives and neighbors. Conclusion: Mothersattach great importance to popular practice, the traditional knowledge of relevant culturalvalue, as it is transmitted from generation to generation and has been rebuilt over time.
Full Text Available Targeted temperature management (TTM in today′s modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21 st century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings. TTM is an unique therapeutic modality for salvaging neurological tissue viability in critically ill patients viz. Post-cardiac arrest, traumatic brain injury (TBI, meningitis, acute liver failure and stroke. TTM is standard of care in post-cardiac arrest situations; there has been a lot of controversy of late regarding temperature ranges to be used for the same. In patients with TBI, it reduces intracranial pressure, but has not shown any favorable neurologic outcome. Hypothermia is generally accepted treatment for hypoxic ischemic encephalopathy in newborns. The current available technology to induce and maintain hypothermia allows for precise temperature control. Future studies should focus on optimizing hypothermic treatment to full benefit of our patients and its application in other clinical scenarios.
Miller, William L; Cohen-Katz, Joanne
The renewal of primary care waits just ahead. The patient-centered medical home (PCMH) movement and a refreshing breeze of collaboration signal its arrival with demonstration projects and pilots appearing across the country. An early message from this work suggests that the development of collaborative, cross-disciplinary teams may be essential for the success of the PCMH. Our focus in this article is on training existing health care professionals toward being thriving members of this transformed clinical care team in a relationship-centered PCMH. Our description of the optimal conditions for collaborative training begins with delineating three types of teams and how they relate to levels of collaboration. We then describe how to create a supportive, safe learning environment for this type of training, using a different model of professional socialization, and tools for building culture. Critical skills related to practice development and the cross-disciplinary collaborative processes are also included. Despite significant obstacles in readying current clinicians to be members of thriving collaborative teams, a few next steps toward implementing collaborative training programs for existing professionals are possible using competency-based and adult learning approaches. Grasping the long awaited arrival of collaborative primary health care will also require delivery system and payment reform. Until that happens, there is an abundance of work to be done envisioning new collaborative training programs and initiating a nation-wide effort to motivate and reeducate our colleagues. PMID:21299280
Herborg, Hanne; Sørensen, Ellen Westh; Frøkjaer, Bente
OBJECTIVE: To review the current status of Danish community pharmacy in both practice and research and discuss future trends. FINDINGS: Denmark has a social welfare system that provides health care, social services, and pensions to its population. Medical care and surgery are free. Prescription...... medicines are reimbursed by an average of 56%. Community pharmacies are privately owned, but the health authorities regulate drug prices and the number of pharmacies. At present, Denmark has 322 pharmacies, corresponding to 1 pharmacy per 16,700 inhabitants. All pharmacies provide prescription and over......-the-counter products, advice about medicine use, dose dispensing, generic substitutions, and administration of individual reimbursement registers. Except for very simple processes, compounding is centralized at 3 pharmacies. Many pharmacies offer measurement of blood glucose, blood pressure, and cholesterol, and 60...
Glasdam, Stinne; Henriksen, Nina; Kjær, Lone;
‘Client involvement’ has been a mantra within health policies, education curricula and healthcare institutions over many years, yet very little is known about how ‘client involvement’ is practised in home-care services. The aim of this article is to analyse ‘client involvement’ in practise seen......, political and administrative frames that rule home- care practice. Client involvement is shown within four constructed analytical categories: ‘Structural conditions of providing and receiving home care’; ‘Client involvement inside the home: performing a professional task and living an everyday life......’; ‘Client involvement outside the home: liberal business and mutual goal setting’; and ‘Converting a home to a working place: refurnishing a life’. The meaning of involvement is depending on which position it is viewed from. On the basis of this analysis, we raise the question of the extent to which...
Buchanan Patricia A
Full Text Available Abstract Background The Feldenkrais Method® of somatic education purports to guide people of varying ages and abilities to improve function. Many people choose this method to aid with recovery from injury, manage chronic conditions, or enhance performance even though limited research supporting its safety and effectiveness exists to guide decisions about use and referral. Very little information about practitioner characteristics and practice patterns is publicly available to assist researchers in the design of appropriate safety and effectiveness studies. The purpose of this study was to obtain an initial overview of the characteristics of United States Guild Certified Feldenkrais PractitionersCM. Methods Of 1300 certified Feldenkrais® practitioners at the time of the study, there were 1193 practitioners with email accounts who were sent invitations to complete a web-based survey. The survey inquired about practice locations, additional credentials, service patterns and workloads during the previous 3 months. Response rate and descriptive statistics were calculated. Results The survey had a 32.3% (385/1193 response rate. The top states in which responders practiced were California (n = 92 and New York (n = 44. Most responders did not hold other credentials as traditional health care providers or as complementary and alternative medicine providers. Among those who did, the most common credentials were physical therapist (n = 83 and massage therapist (n = 38. Just over a third of traditional health care providers only provided Feldenkrais lessons, compared to 59.3% of complementary and alternative providers. On average, responders saw 7.6 ± 8.1 (median = 5 clients per week for individual lessons, 8.4 ± 11.5 (median = 5 clients per week for group lessons, and 2.9 ± 3.9 (median = 2 new clients per month for individual lessons. Conclusions This preliminary survey of United States Guild Certified Feldenkrais Practitioners indicated that most
Full Text Available Takashi Takeda, Tze Fang Wong, Mari Kitamura, Nobuo YaegashiDepartment of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi, JapanPurpose: Traditionally, oral estrogens have been used for hormone replacement therapy. However, in Japan, additional estrogen formulations have been used, including transdermal patches and transdermal gels. The latter have a unique commonality with cosmetics because both of them are applied to the skin. Beauty care is one of the most important lifestyle factors for women, and it has been reported that the amount of attention paid to beauty care has an effect in determining whether or not women will choose to undergo HRT during menopause. Therefore, our study focused on estrogen formulations and beauty care practices.Patients and methods: Fifty women who use hormone replacement therapy were recruited from the outpatient clinic of Tohoku University Hospital. They were treated with oral conjugated estrogen (n = 11, transdermal 17ß -estradiol patch (n = 11, and transdermal 17ß-estradiol gel (n = 28. They completed a questionnaire to assess their lifestyle (beauty care practices and exercise habits and their compliance. The transdermal gel users were further interviewed about their subjective impressions regarding “smell”, “sticky feeling”, “spreadability”, and “irritation” on the skin using a five-grade scale.Results: There were no differences in the usability of medicines and patient compliance among the estrogen formulations. We observed a positive tendency between the level of beauty care and transdermal gel use (P = 0.0645, ordinary logistic regression analysis. The gel users placed top priority on a lack of “sticky feeling” but the subjective impression regarding “sticky feeling” was worst among the four factors (P < 0.01, Steel–Dwass test. Correspondence analysis showed that the subjective impressions of transdermal gel corresponding to usability in the
Background: An adverse drug reaction is unintentional which occurs at doses used for prophylaxis, diagnosis or treatment. Objectives: To determine the frequency of various cutaneous drug eruptions that occur in patients in a tertiary care hospital setting. Patients and Methods: All patients with cutaneous drug eruptions seen at the Dermatology Department of Mayo Hospital, Lahore, over 6 months were enrolled and the pattern of drug eruptions like urticaria, angioedema, fixed drug eruption, maculopapular rash, erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis etc. were recorded, along with drugs that caused it. Results:A total of 160 patients (86 males, 74 females) were included in the study. Mean age of patients was 30.7+-15.4 years. Major eruptions were fixed drug eruption (21.3%) followed by urticaria without angioedema (10%), maculopapular rash (9.3%), lichenoid drug eruption (8.7%), acneiform drug eruption (7.5%), Stevens-Johnson syndrome (6.9%), vesiculobullous eruption (5.6%), erythema multiforme and eczematous eruption (5% each). Common drugs causing eruptions were sulfonamides (16.3%), followed by NSAIDs (14.4%), herbal and homeopathic medications (12.5%), penicillins (9.3%), tetracyclines (8.7%), antituberculous drugs, cephalosporins and antiepileptics (6.3% each). Conclusion: Fixed drug eruption and urticaria without angioedema were commonest eruptions while, sulfonamides and NSAIDs were the major causative drugs. Policy message: Reporting of adverse drug reactions is not done in Pakistan and needs to be done in each hospital. (author)
Full Text Available Abstract Background The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed. Methods Combining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision. Results The delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy". Conclusions Efforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker
Full Text Available Background: Kangaroo Mother Care (KMC is dened as skin-to-skin contact between a mother and her newborn baby derived from practical similarities to marsupial care giving, proximately exclusive breastfeeding and early discharge from hospital. This concept was proposed as an alternative to conventional methods of care for low birth weight (LBW infants, and in replication to quandaries of earnest overcrowding in Neonatal Intensive Care Units (NICUs. KMC essentially utilizes the mother as a natural incubator Aim and Objectives: The aim was to assess the feasibility, acceptability and the effectiveness of KMC in LBW infants. It avoids agitation routinely experienced in busy ward. Material and Methods: A pilot open-labeled quasi-randomised clinical trial was conducted in Level III NICU of a teaching institution. 60 newborn infants <2500 g, meeting inclusion criteria were alternatively randomised into two groups: Kangaroo Mother Care (KMC and Conventional Methods of Care (CMC. Kangaroo mother care was practiced with minimum total period of eight hours a day intermittently for the intervention group while the controls remained in incubators or cots. Weight, head circumference, length, morbidity episodes, hospital stay, feeding patterns were monitored for all infants till postmenstrual age of 42 weeks in preterm babies or till a weight of 2500 g is achieved in term SGA babies. Results: The pilot study conrmed that trial processes were efcient, the intervention was acceptable (to mothers and nurses and that the outcome measures were appropriate; KMC babies achieved signicantly better growth at the end of the study (For preterm babies, weight, length and head circumference gain were signicantly higher in the KMC group (weight 19.28±2.9g/day, length 0.99±0.56cm/week and head circumference 0.72±0.07 cm/week than in the CMC group (P <0.001. A signicantly higher number of babies in the CMC group suffered from hypothermia, hypoglycemia, and
Marcelle Miranda da Silva
Full Text Available The objective was to identify evidences of comprehensive care in the professional practice of the nursing staff in the context of oncology palliative care. In this descriptive, qualitative study, seven nurses and four nursing technicians were interviewed. Thematic analysis resulted two thematic units: Evidences of comprehensive care in the practice of the nursing professionals and teamwork as the premise of comprehensive care. The nursing staff’s actions are based on communication, converging efforts, and forming a network with other professionals to meet the multiple needs of the individuals and their families in order to offer comfort and quality of life. Self-worth and self-perception of the nursing team should be encouraged as key elements in the dynamics and organization of the work, while the availability of resources is primordial to be able to apply the instruments of interaction and the organizational policy that supports being interdisciplinary and therefore complete and comprehensive. doi: 10.5216/ree.v16.i4.25700.
Contatore, Octávio Augusto; de Barros, Nelson Filice; Durval, Melissa Rossati; Barrio, Pedro Cristóvão Carneiro da Cunha; Coutinho, Bernardo Diniz; Santos, Júlia Amorim; do Nascimento, Juliana Luporini; Oliveira, Silene de Lima; Peres, Silvia Miguel de Paula
The use of Complementary and Integrative Practices (CIP) is on the increase and its institutionalization in Primary Health Care (PHC) is a challenge. This article discusses the use, care, and policies of CIP at international and national levels found in the indexed literature. A review of the literature in PubMed/Medline and the Virtual Health Library was conducted using the key search words "Homeopathy", "Acupuncture", "Herbal Medicine", "Body Practices", "Primary Health Care" and other related terms in English, Spanish and Portuguese between 2002 and 2011. The use in the literature of CIP for the treatment of specific diseases from a biomedical perspective was observed, as well as evaluations of its use for the treatment of specific diseases focused on the reaction of the users and professionals and the analysis of the political, economic and social viability of CIP in health services. The conclusion drawn is that what is predominant in the literature is the quest for the scientific validation of CIP and a biomedical methodological bias in the designs of the studies, which does not contribute to clarifying the potential care of CIP in PHC. PMID:26465866
Full Text Available At the margins of modern medical practice, pushing the very limits of science, and indefatigably rendering the precincts of public discourse, still functional remnants of Christian civilization continue to provide care for the hopeless, perform healing sacraments for the incurable, and curate objects of votive devotion for the suffering and needy. These public services go largely unaccounted for, though they secure an ordered world, structure perception, and serve as ontological anchors. Lost in the vague, scientifically unrarified notions of spirituality that brace a general, undifferentiated worldwide metaphysical experience and disregard immense cultural, functional, geographic and performative distinctness, Catholic sacramental practices aimed at alleviating suffering and promoting healthy lifestyles are receiving only marginal mention in scientific literature(1, despite the fact that they make up daily reality in large parts of contemporary Europe and Latin America. Writing this editorial from the Northeast of Brazil, where traditional religious practice has sustained generations through the calamities of severe droughts, slavery, extreme poverty, high child mortality, failed political orders, and a harsh global economic reality, it is difficult to underestimate the power of sacramental experience to sustain a cultural identity. It was defined the concept of care of the sick in the context of the religious experience of the Northeast of Brazil which is historically relevant to health promotion. Until the emergence of national health care in the late nineteenth century, it was largely the order of the Franciscan friars that was charged with promoting healthy lives in the region. The Catholic concept of care that guided their efforts structures three procedural reality principles: the psychological reality of the transference to the person in one’s charge (care/caritas, the performative practice of religious sacrament such as the anointment
Maria Valeria Jimenez-Baez
Full Text Available Objectives: Determine the domain of preventive dentistry in nursing personnel assigned to a primary care unit. Methods: Prospective descriptive study, questionnaire validation, and prevalence study. In the first stage, the questionnaire for the practice of preventive dentistry (CPEP, for the term in Spanish was validated; consistency and reliability were measured by Cronbach's alpha, Pearson's correlation, factor analysis with intra-class correlation coefficient (ICC. In the second stage, the domain in preventive dental nurses was explored. Results: The overall internal consistency of CPEP is α= 0.66, ICC= 0.64, CI95%: 0.29-0.87 (p >0.01. Twenty-one subjects in the study, average age 43, 81.0% female, average seniority of 12.5 were included. A total of 71.5% showed weak domain, 28.5% regular domain, and there was no questionnaire with good domain result. The older the subjects were, the smaller the domain; female nurses showed greater mastery of preventive dentistry (29%, CI95%: 0.1-15.1 than male nurses. Public health nurses showed greater mastery with respect to other categories (50%, CI95%: 0.56-2.8. Conclusions: The CDEP has enough consistency to explore the domain of preventive dentistry in health-care staff. The domain of preventive dentistry in primary care nursing is poor, required to strengthen to provide education in preventive dentistry to the insured population. Normal 0 false false false EN-US X-NONE X-NONE
Boo, N Y; Gan, C Y; Gian, Y W; Lim, K S L; Lim, M W; Krishna-Kumar, H
This study aimed to determine the gaps of knowledge and practices of care of neonatal jaundice among Malaysian mothers. It was a cross sectional study of 400 mothers who attended the obstetric clinics or were admitted to the obstetric wards of a general hospital. They were surveyed with a structured set of questionnaire. The results showed that a majority (93.8%) of them knew about neonatal jaundice, and 71.7% knew that jaundice lasting more than 2 weeks was abnormal. However, only 34.3% of them were aware that jaundice appearing during the first 36 hours of life was abnormal. Less than 20% knew about glucose-6-phosphate dehydrogenase deficiency and that fetal-maternal blood group differences could cause jaundice. Although 71.7% and 69.7%, respectively, of the mothers knew that severe jaundice could cause death and brain damage, only 38.4% of them were aware that severe jaundice could result in hearing impairment. A very low proportion (27.1%) of them was aware that putting jaundiced infants under the direct sun could result in dehydration and worsening of jaundice. Out of a maximum score of 15, the mean maternal knowledge score was 7.4 (95% confidence intervals: 7.1, 7.7). Majority (83.1%) of the multiparous mothers with a past history of having children developing neonatal jaundice (n = 154) practiced placing their infants under the direct sun. This study revealed that there was a wide knowledge gap among Malaysian mothers on care of neonatal jaundice. Placing infants under the direct sun was still a common practice. PMID:22111448
Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim
Objectives: To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design: Longitudinal study with three points of measurement. Setting: Primary care practices in Switzerland. Participants: In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes: The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed ...
Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim
Objectives To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design Longitudinal study with three points of measurement. Setting Primary care practices in Switzerland. Participants In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quali...
Kim, Tae Youn; Lang, Norma M.; Berg, Karen; Weaver, Charlotte; Murphy, Judy; Ela, Sue
Delivery of safe, effective and appropriate health care is an imperative facing health care organizations globally. While many initiatives have been launched in a number of countries to address this need from a medical perspective, a similar focus for generating evidence-based nursing knowledge has been missing . This paper reports on a collaborative evidence-based practice (EBP) research initiative that adds nursing knowledge into computerized care protocols. Here, a brief overview of the study’s aims, purpose and methodology is presented as well as results of data analysis and lessons learned. The research team examined nurses’ adoption patterns of EBP recommendations with respect to activity tolerance using four-month patient data collected from a pilot hospital. Study findings indicate a need for more focus on the system design and implementation process with the next rollout phase to promote evidence-based nursing practice. PMID:18693871
Price, Marilyn; Recupero, Patricia R; Strong, David R; Gutheil, Thomas G
In the past 25 years, the number of female forensic psychiatrists has increased dramatically. To assess whether there are gender differences in the practice patterns of forensic psychiatry experts, members of the American Academy of Psychiatry and the Law were surveyed during an annual business meeting. Women in the sample were shown to perform fewer categories of evaluation than men. Women were less likely than men to do criminal work, civil commitment/involuntary medication evaluations, and testamentary capacity evaluations, but there was no significant difference in the percentage of those performing some personal injury/disability/fitness for duty, custody, sexual harassment, or malpractice evaluations. Gender was not a significant factor in determining hourly rate. When subjects were asked to comment on whether they thought that gender was a factor in the selection of a forensic expert, 80 percent of the women, but only 41 percent of the men, believed that gender was a consideration. PMID:15515912
Highlights: • Proposed some new ideas and strategies about how to improve the energy storage density for SMES system. • Increasing the effective current density in the superconducting coils or optimizing the configuration of the SMES coil could improve the energy storage density. • A new conceive of energy compression is also proposed. -- Abstract: In this paper, we attempt to introduce briefly the significance, the present status, as well as the working principle of the primary patterns of the superconducting energy storage system, first of all. According to the defect on the lower energy storage density of existed superconducting energy storage device, we proposed some new ideas and strategies about how to improve the energy storage density, in which, a brand-new but a tentative proposal regarding the concept of energy compression was emphasized. This investigation has a certain reference value towards the practical application of the superconducting energy storage
Lin, D.H., E-mail: firstname.lastname@example.org [College of Physics, Chongqing University, JD Duz (USA)-CQU Institute for Superconductivity, Chongqing 400030 (China); Cui, D.J.; Li, B.; Teng, Y.; Zheng, G.L. [College of Physics, Chongqing University, JD Duz (USA)-CQU Institute for Superconductivity, Chongqing 400030 (China); Wang, X.Q. [College of Physics, Chongqing University, JD Duz (USA)-CQU Institute for Superconductivity, Chongqing 400030 (China); State Key Laboratory of Mechanical Transmission, Chongqing University, Chongqing 400030 (China)
Highlights: • Proposed some new ideas and strategies about how to improve the energy storage density for SMES system. • Increasing the effective current density in the superconducting coils or optimizing the configuration of the SMES coil could improve the energy storage density. • A new conceive of energy compression is also proposed. -- Abstract: In this paper, we attempt to introduce briefly the significance, the present status, as well as the working principle of the primary patterns of the superconducting energy storage system, first of all. According to the defect on the lower energy storage density of existed superconducting energy storage device, we proposed some new ideas and strategies about how to improve the energy storage density, in which, a brand-new but a tentative proposal regarding the concept of energy compression was emphasized. This investigation has a certain reference value towards the practical application of the superconducting energy storage.
Battistella, R M; Kuder, J M
Policy disconnected from economic reality is bad policy. Neither government financed health insurance nor an employer mandated health insurance approach are in the national interest. Higher national priorities compel a reallocation of resources from consumption to investment. This need not, however, cause an abandonment of efforts to deal with the problems of the uninsured and other health reforms. Successful health care reform is achievable provided it is responsive to higher priorities for economic growth. A strong economy and the production of wealth are indispensable to economic justice. Toward this end, a program of universal access is proposed whereby families and individuals are required to pay for their own health insurance up to a fixed percentage of disposable personal income before public payments kick in. Government's chief role is to establish a standard package of cost-effective benefits to be offered by all insurance carriers, the cost of which is approximately 40 percent less than conventional insurance coverage because of the elimination of reimbursement for clinically non-efficacious and cost-ineffective services. Public financing is relegated to a residual role in which subsidies are targeted on the needy. Much of the momentum for cost control is transferred to consumers and private insurers, both of whom acquire a vested interest in obtaining value for money. Uniform rules for underwriting, eligibility, and enrollment practices guard against socially harmful practices such as experience rating and exclusion of preexisting conditions. The household responsibility and equity plan described herein could free up as much as $90 billion or more for public investment in economic growth and national debt reduction while assuring access to health care regardless of ability to pay. Economic revitalization will be assisted by changes in household savings. With health care no longer a free good and government social programs concentrated on the truly needy
To determine the pattern of nosocomial infections in two ICUs' of a teaching hospital in terms of frequency, common sites of infection, the pathogens involved and the antibiotic sensitivity patterns. It was conducted in two medical ICUs (Neurology and Nephrology) of a public tertiary care hospital. Data was collected prospectively on patients suspected to have developed nosocomial infection after 48 hours of admission to the ICU according to objective. There were 101 cases of suspected nosocomial infection out of a total of 254 patients. The frequency of nosocomial infection was 39.7%. UTI developed in 44.6%, while 27% had blood stream infection, and 21% had pneumonia. Each of the three major sites of infection was strongly associated with the use of invasive devices. Escherichia (E.) coli was the most common organism isolated followed by Pseudomonas aeruginosa and Klebsiella. E. coli and Klebsiella showed a maximum sensitivity to Imipenem followed by Tazocin (pipericillin + tazobactam). Pseudomonas aeruginosa was sensitive to Amikacin and Fosfomycin. The high frequency of nosocomial infection suggests that more strict measures regarding invasive devices should be taken in future to control the infection and limit the emergence of antibiotic resistant organisms. (author)
Ekers, David; Wilson, Rea
Introduction Depression is a common and debilitating condition. A body of evidence exists about improving depression outcomes in primary care, using collaborative care models. Such approaches, however, have not been routinely adopted within general practice settings. In this paper we outline the results of an audit of an enhanced care initiative that trained practice nurses to deliver such approaches.
Full Text Available Walter F Stewart,1 Xiaowei Yan,1 Joseph A Boscarino,1 Daniel D Maeng,1 Jack Mardekian,2 Robert J Sanchez,3 Michael R Von Korff41Geisinger Center for Health Research, 2Pfizer, Inc., 3Regeneron Pharmaceuticals, Inc., 4Group Health Research Institute, Seattle, WA, USABackground: The purpose of this study was to determine if primary care patients with low back pain (LBP cluster into definable care utilization subgroups that can be explained by patient and provider characteristics.Materials and methods: Adult primary care patients with an incident LBP encounter were identified from Geisinger Clinic electronic health records over 5 years. Two-thirds of the cohort had only one to two encounters. Principal component analysis was applied to the data from the remaining one-third on use of ambulatory, inpatient, emergency department, and surgery care and use of magnetic resonance imaging, injections, and opioids in 12 months following the incident encounter. Groups were compared on demographics, health behaviors, chronic and symptomatic disease burden, and a measure of physician efficiency.Results: Six factors with eigenvalues >1.5 explained 71% of the utilization variance. Patient subgroups were defined as: 1–2 LBP encounters; 2+ surgeries; one surgery; specialty care without primary care; 3+ opioid prescriptions; laboratory dominant care; and others. The surgery and 3+ opioid subgroups, while accounting for only 10.4% of the cohort, had used disproportionately more magnetic resonance imaging, emergency department, inpatient, and injectable resources. The specialty care subgroup was characterized by heavy use of inpatient care and the lowest use of injectables. Anxiety disorder and depression were not more prevalent among the surgery patients than in the others. Surgery patients had features in common with specialty care patients, but were older, had higher prevalence of Fibromyalgia, and were associated primary care physicians with worse efficiency
Purpose: To identify factors significantly influencing accrual to clinical protocols by analyzing radiation Patterns of Care Study (PCS) surveys of 3,047 randomly selected radiotherapy (RT) patients. Methods and Materials: Patterns of Care Study surveys from disease sites studied for the periods 1992-1994 and 1996-1999 (breast cancer, n = 1,080; prostate cancer, n = 1,149; esophageal cancer, n = 818) were analyzed. The PCS is a National Cancer Institute-funded national survey of randomly selected RT institutions in the United States. Patients with nonmetastatic disease who received RT as definitive or adjuvant therapy were randomly selected from eligible patients at each institution. To determine national estimates, individual patient records were weighted by the relative contribution of each institution and patients within each institution. Data regarding participation in clinical trials were recorded. The factors age, gender, race, type of insurance, and practice type of treating institution (academic or not) were studied by univariate and multivariate analyses. Results: Overall, only 2.7% of all patients were accrued to clinical protocols. Of these, 57% were enrolled on institutional review board-approved institutional trials, and 43% on National Cancer Institute collaborative group studies. On multivariate analysis, patients treated at academic facilities (p = 0.0001) and white patients (vs. African Americans, p = 0.0002) were significantly more likely to participate in clinical oncology trials. Age, gender, type of cancer, and type of insurance were not predictive. Conclusions: Practice type and race significantly influence enrollment onto clinical oncology trials. This suggests that increased communication and education regarding protocols, particularly focusing on physicians in nonacademic settings and minority patients, will be essential to enhance accrual
In all systems of health care there are certain essential levels of care and service. These take the form of self-care within the family unit; primary professional care by general medical nursing or social practitioners within a local neighbourhood; general specialist care in a district and super-specialist care in a region. Each of these has its own special roles and responsibilities and each is considered in this paper.
Keerti Swarnkar; Jayanta Vagha
Background: Kangaroo Mother Care (KMC) is dened as skin-to-skin contact between a mother and her newborn baby derived from practical similarities to marsupial care giving, proximately exclusive breastfeeding and early discharge from hospital. This concept was proposed as an alternative to conventional methods of care for low birth weight (LBW) infants, and in replication to quandaries of earnest overcrowding in Neonatal Intensive Care Units (NICUs). KMC essentially...
Brink-Muinen, A. van den; Van Dulmen, S.; Messerli-Rohrbach, V.; BENSING, J
From the viewpoint of quality of care, doctor-patient communication has become more and more important. Gender is an important factor in communication. Besides, cultural norms and values are likely to influence doctor-patient communication as well. This study examined (1) whether or not communication patterns of gender-dyads in general practice consultations differ across and between Western-European countries, and (2) if so, whether these differences continue to exist when controlling for pa...
Brink-Muinen, A. van den; van Dulmen, S.; Messerli-Rohrbach, V.; BENSING, J
From the viewpoint of quality of care, doctor–patient communication has become more and more important. Gender is an important factor in communication. Besides, cultural norms and values are likely to influence doctor–patient communication as well. This study examined (1)whether or not communication patterns of gender-dyads in general practice consultations differ across and between Western-European countries, and (2) if so, whether these differences continue to exist when controlling for pat...
Brink-Muinen, A. van den; van Dulmen, S.; Messerli-Rohrbach, V.; BENSING, J
From the viewpoint of quality of care, doctor-patient communication has become more and more important. Gender is an important factor in communication. Besides, cultural norms and values are likely to influence doctor-patient communication as well. This study examined (1) whether or not communication patterns of gender-dyads in general practice consultations differ across and between Western-European countries, and (2) if so, whether these differences continue to exist when controlling for pa...
Purpose: Multiple randomized controlled trials have demonstrated the equivalence of multifraction and single-fraction (SF) radiotherapy for the palliation of painful bone metastases (BM). However, according to previous surveys, SF schedules remain underused. The objectives of this study were to determine the current patterns of practice internationally and to investigate the factors influencing this practice. Methods and Materials: The members of three global radiation oncology professional organizations (American Society for Radiology Oncology [ASTRO], Canadian Association of Radiation Oncology [CARO], Royal Australian and New Zealand College of Radiologists) completed an Internet-based survey. The respondents described what radiotherapy dose fractionation they would recommend for 5 hypothetical cases describing patients with single or multiple painful BMs from breast, lung, or prostate cancer. Radiation oncologists rated the importance of patient, tumor, institution, and treatment factors, and descriptive statistics were compiled. The chi-square test was used for categorical variables and the Student t test for continuous variables. Logistic regression analysis identified predictors of the use of SF radiotherapy. Results: A total of 962 respondents, three-quarters ASTRO members, described 101 different dose schedules in common use (range, 3 Gy/1 fraction to 60 Gy/20 fractions). The median dose overall was 30 Gy/10 fractions. SF schedules were used the least often by ASTRO members practicing in the United States and most often by CARO members. Case, membership affiliation, country of training, location of practice, and practice type were independently predictive of the use of SF. The principal factors considered when prescribing were prognosis, risk of spinal cord compression, and performance status. Conclusion: Despite abundant evidence, most radiation oncologists continue to prescribe multifraction schedules for patients who fit the eligibility criteria of
Buzmakov, Aleksey; Egho, Elias; Jay, Nicolas; Kuznetsov, Sergei O.; Napoli, Amedeo; Raïssi, Chedy
In this paper, we are interested in the analysis of sequential data and we propose an original framework based on Formal Concept Analysis (FCA). For that, we introduce sequential pattern structures, an original specification of pattern structures for dealing with sequential data. Pattern structures are used in FCA for dealing with complex data such as intervals or graphs. Here they are adapted to sequences. For that, we introduce a subsumption operation for sequence comparison, based on subse...
Lambert, Rodney A.
Routine general practice (GP) care is rarely comprehensively described in clinical trials. This paper examines routine GP care within the lifestyle approach to managing panic (LAMP) study. The aim of this paper is to describe/discuss routine GP care for panic disorder (PD) patients within both study arms in the LAMP study. An unblinded pragmatic randomised controlled trial in 15 East of England GP practices (2 primary care trusts). Participants met Diagnostic and Statistical Manual of Mental ...
Stead, W W; Olsen, A J; Benner, S A; Blackwelder, M; Cooperstock, L; Paton, J A; Russell, F K; Van Hine, P
The eighth annual workshop of the IAIMS Consortium was devoted to exploring how information technology might provide the tools to allow health care practices to compete in the new health care environment while maintaining independence. The options that were discussed included: optimizing care of the patient in the local setting; reducing practice overhead by improving efficiency and effectiveness; and finding innovative strategies for providing health care and new products. PMID:9067890
Gray, Jodi; Haji Ali Afzali, Hossein; Beilby, Justin; Holton, Christine; Banham, David; Karnon, Jonathan
Background Most evidence on the effect of collaborative care for depression is derived in the selective environment of randomised controlled trials. In collaborative care, practice nurses may act as case managers. The Primary Care Services Improvement Project (PCSIP) aimed to assess the cost-effectiveness of alternative models of practice nurse involvement in a real world Australian setting. Previous analyses have demonstrated the value of high level practice nurse involvement in the manageme...
Eccles Martin P; Goh Teik T; Steen Nick
Abstract Background Quality of care in general practice may be affected by the team climate perceived by its health and non-health professionals. Better team working is thought to lead to higher effectiveness and quality of care. However, there is limited evidence available on what affects team functioning and its relationship with quality of care in general practice. This study aimed to explore individual and practice factors that were associated with team climate, and to explore the relatio...
Ladden, Maryjoan D; Bodenheimer, Thomas; Fishman, Nancy W; Flinter, Margaret; Hsu, Clarissa; Parchman, Michael; Wagner, Edward H
Many primary care practices are changing the roles played by the members of their health care teams. The purpose of this article is to describe some of these new roles, using the authors' preliminary observations from 25 site visits to high-performing primary care practices across the United States in 2012-2013. These sites visits, to practices using their workforce creatively, were part of the Robert Wood Johnson Foundation-funded initiative, The Primary Care Team: Learning From Effective Ambulatory Practices.Examples of these new roles that the authors observed on their site visits include medical assistants reviewing patient records before visits to identify care gaps, ordering and administering immunizations using protocols, making outreach calls to patients, leading team huddles, and coaching patients to set self-management goals. The registered nurse role has evolved from an emphasis on triage to a focus on uncomplicated acute care, chronic care management, and hospital-to-home transitions. Behavioral health providers (licensed clinical social workers, psychologists, or licensed counselors) were colocated and integrated within practices and were readily available for immediate consults and brief interventions. Physicians have shifted from lone to shared responsibility for patient panels, with other team members empowered to provide significant portions of chronic and preventive care.An innovative team-based primary care workforce is emerging. Spreading and sustaining these changes will require training both health professionals and nonprofessionals in new ways. Without clinical experiences that model this new team-based care and role models who practice it, trainees will not be prepared to practice as a team. PMID:24128622
Khera, Rohan; Jain, Snigdha; Lodha, Rakesh; Ramakrishnan, Sivasubramanian
Gender-based discrimination is reported across the spectrum of paediatric healthcare including emergency, inpatient, outpatient and preventive care and is mostly reported from South Asia and China with sporadic reports from Africa and South America. Biases against young girls have been documented even in immunisation percentage, home food allocation, seeking medical care for childhood ailments and percentage of household healthcare expenditures allocated to them. Such gender discrimination in access to medical care is likely to have an influence on the overall health of female children. Over the last five decades, the under-5 sex ratios are worsening in India with declining number of girls. Deliberate parental neglect of girls' essential and life-saving medical care is also an important contributing factor apart from sex-selective abortions to the declining gender ratios. Corrective measures and focused action are needed. PMID:24344176
Reynolds, Rae Brana; McCoy, Kimberly
Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs), generally referred to as Advanced Practice Providers (APPs), are fundamental to interdisciplinary oncology care. As the projected demand for oncology services is anticipated to outpace the supply of oncologists, APPs will become increasingly vital in the delivery of oncology care and services. The training, education, and scope of practice for APPs gives the interdisciplinary care team professionals that deliver high-quality clinical services and provide valuable contributions and leadership to health care quality improvement initiatives. Optimizing the integration of APPs in oncology care offers immense advantages towards improvement of clinical outcomes. PMID:27197514
Stewart WF; Yan X; Boscarino JA; Maeng DD; Mardekian J; Sanchez RJ; Von Korff MR
Walter F Stewart,1 Xiaowei Yan,1 Joseph A Boscarino,1 Daniel D Maeng,1 Jack Mardekian,2 Robert J Sanchez,3 Michael R Von Korff41Geisinger Center for Health Research, 2Pfizer, Inc., 3Regeneron Pharmaceuticals, Inc., 4Group Health Research Institute, Seattle, WA, USABackground: The purpose of this study was to determine if primary care patients with low back pain (LBP) cluster into definable care utilization subgroups that can be explained by patient and provider characteristics.Materials and m...
Atekyereza, Peter R; Mubiru, Kenneth
Maternal mortality remains a challenge in Sub-Saharan Africa including Uganda. Antenatal Care (ANC) is one of the recommended measures to improve maternal and child health. However, the influence of pregnancy definition and perception on patterns of seeking regular and timely antenatal care among women in the reproductive age group (15-49 years) is not known. The objectives of this study were to: (i) understand the women's social definitions and perceptions on their pregnancy; (ii) understand the socio-cultural beliefs related to pregnancy among women of the reproductive age group; and, (iii) examine the influence of social definitions, perceptions and beliefs about pregnancy on women's antenatal care seeking behaviour patterns to inform the decentralised health care delivery system in Uganda. A total of 45 women, mothers and expectant women who were purposively selected from Kimanya sub county of Masaka district in Uganda participated in the study. Ten key informant interviews and four Focus Group Discussions (FGDs) were also conducted. Key findings indicate that the women's socio-definitions and perceptions of pregnancy influence their seeking behaviour on antenatal health care. To the women with a positive orientation towards antenatal care, pregnancy provides joy, happiness, pride, promotes their social status and safe-guards their marriage. Pregnancy is rewarding with care, love, support and gifts. Women who shun antenatal care perceive pregnancy to be a source of misery, sadness, pain and suffering. It is an uncomfortable and regrettable experience. Women also hold socio-cultural beliefs on pregnancy, which are culturally constructed and rooted in taboos, rituals and practices of their communities. It is therefore important to sensitise women and those who attend to them when they are pregnant to understand these perceptions and definitions to motivate them to seek antenatal and postnatal care for better maternal and child health. PMID:26891521
Full Text Available INTRODUCTION: Patients with heart failure have a significant symptom burden and other palliative care needs often over a longer period than patients with cancer. It is acknowledged that this need may be unmet but by how much has not been quantified in primary care data at the population level. METHODS: This was the first use of Clinical Practice Research Datalink, the world's largest primary care database to explore recognition of the need for palliative care. Heart failure and cancer patients who had died in 2009 aged 18 or over and had at least one year of primary care records were identified. A palliative approach to care among patients with heart failure was compared to that among patients with cancer using entry onto a palliative care register as a marker for a palliative approach to care. RESULTS: Among patients with heart failure, 7% (234/3 122 were entered on the palliative care register compared to 48% (3 669/7 608 of cancer patients. Of heart failure patients on the palliative care register, 29% (69/234 were entered onto the register within a week of their death. CONCLUSIONS: This confirms that the stark inequity in recognition of palliative care needs for people with heart failure in a large primary care dataset. We recommend a move away from prognosis based criteria for palliative care towards a patient centred approach, with assessment of and attention to palliative needs including advance care planning throughout the disease trajectory.
Hsueh, Martha; Dorcy, Kathleen
Gaps in complex oncology care coordination between inpatient and outpatient settings can result in treatment and monitoring delays and omissions, which can negatively affect patient outcomes. Gaps also exist for patients facing complex treatment modalities and collaborations between multiple care teams working at geographically distant sites. A pilot advanced practice nurse care coordinator (APNCC) role to coordinate these complex care transitions and implement processes for safer and more efficient care has shown promise. . PMID:27206289
Full Text Available Abstract Background HIV/AIDS is fast becoming a chronic disease with the advent of antiretroviral drugs, therefore making home based care key in the management of chronically ill HIV/AIDS patient. The objective of this study was to determine the perception and practice of health care workers on HIV/AIDS related home based care in the health facilities in Ogun state, Nigeria. Methods This study is an analytical cross-sectional study. A multistage cluster sampling technique was used to obtain a representative sample of the primary health care workers in Ogun state. An interviewer administered structured questionnaire was administered by trained health workers to elicit the required information. Result A total of 350 health care workers were interviewed, 70% of the respondents could adequately describe the components of home based care. Only 38.7% were aware of the National guideline on home based care practices and 17.1% believe that home based care will not significantly improve the prognosis of PLWAs. Few 19.1% had ever been trained or ever involved 16.6% in home based care practices. Only 20 [5.7%] are involved on a weekly basis, 16 [4.6%] monthly and 22 [6.3%] quarterly. Reasons given for non implementation of home based care are inadequate number of healthcare workers 45%, lack of political will 24.4%, lack of implementation by facility managers 14% and inadequate funds 16.6%. Factors that were significantly associated with the practice of home based care were perception of its relevance in improving prognosis [OR = 54.21, C.I = 23.22-129.52] and presence of a support group in the facility [OR = 4.80, C.I = 2.40-9.57]. There was however no statistically significant relationship between adequate knowledge of home based care [OR = 0.78, C.I = 0.39-1.54] and previous training on home based care (OR = 1.43, C.I = 0.66-3.06]. Conclusion The practice of home based care for HIV/AIDS among the study population is low
Purpose: To provide data on the pattern of practice of palliative radiotherapy (RT) on the African continent. Methods and Materials: A questionnaire was distributed to participants in a regional training course of the International Atomic Energy Agency in palliative cancer care and sent by e-mail to other institutions in Africa. Requested information included both infrastructure and human resources available and the pattern of RT practice for metastatic and locally advanced cancers. Results: Of 35 centers contacted, 24 (68%) completed the questionnaire. Although RT is used by most centers for most metastatic cancers, liver and lung metastases are treated with chemotherapy. Of 23 centers, 14 (61%) had a single RT regimen as an institutional policy for treating painful bone metastases, but only 5 centers (23%) of 23 used 8 Gy in 1 fraction. Brain metastases were being treated by RT to the whole brain to 30 Gy in 10 fractions, either exclusively (n = 13, 56%) or in addition to the use of 20 Gy in 5 fractions (n = 3, 14%). Conclusion: Radiotherapy is a major component of treatment of cancer patients in African countries. There is consensus among few centers for treatment schedules for almost all sites regarding time and dose-fractionation characteristics of RT regimens used and/or indications for the use of RT in this setting
Ujwal Lakshman Yeole
Full Text Available Purpose: To find out the current physiotherapy practices in Intensive Care Unit (ICU across Maharashtra. Materials and Methods: Study design was exploratory cross-sectional survey. Questionnaires were sent to the physiotherapists working in hospitals across Maharashtra state, India. Four weeks for completion of questionnaire was given in an attempt to ensure good response rates. Result: Of 200, 73 questionnaires were received representing a 36% response rate. The study revealed that 76% of the respondents were bachelors qualified, 15% were masters in physiotherapy with only 4% specialized in cardio-respiratory physiotherapy; 82% had <5 years experience in ICU. Almost 19% had not at all attended any seminars/workshops related to ICU management while 61% attended up to three within last 2 years. The availability of a physiotherapist during the night was affirmed by 63%, 58% responded initiation of physiotherapy to be "always physician referred" and 39% mentioned "physiotherapist initiated." Almost 80% performed chest wall techniques, 86% positioning, 27% postural drainage, 5% manual hyperinflation, 12% application of nebulizer, and 56% bedsores management. Only 5% reported involvement in ventilator setting, 11% had their opinion sought before weaning from ventilator, 29% practiced noninvasive ventilation, 11% were involved in decision-making for extubation and 44% reported involvement in patient family education. Conclusion: The study showed that physiotherapists among the responding ICUs surveyed lack in experience and updated knowledge. Physician reference is necessary to initiate physiotherapy and there exists no established criteria for physiotherapy treatment in ICU. All physiotherapists were routinely involved in chest physiotherapy, mobilization, and positioning.
Villarroel, Nazmy; Artazcoz, Lucía
This study aims to analyze the differences in the use of primary care (PC), hospital, and emergency services between people born in Spain and immigrants. Data were obtained from the 2006 Spanish National Health Survey. The sample was composed of individuals aged 16-64 years from Spain and the seven countries with most immigrants in Spain (n = 22,224). Hierarchical multiple logistic regression models were fitted. Romanian men were less likely to use health care at all levels compared to men from other countries. Women from Argentina, Bolivia and Ecuador reported a lower use of PC. Among women, there were no differences in emergency visits or hospitalizations between countries. Bolivian men reported more hospitalizations than Spanish men, whereas Argentinean men reported more emergency visits than their Spanish counterparts. In Spain, most immigrants made less than, or about the same use of health care services as the native Spanish population. PMID:25862208
Dirk De Meester; Ann Heylighen; Evelien Verdonck; Hubert Froyen
Accommodating the real diversity of user populations, including those with physical and/or mental impairments and functional limitations, requires a large amount of design information in connection with human dis-abilities(limitations and possibilities). In order to collect and organise this information for designers and decision makers, Universal Design Patterns(UD PAtterns) offer descriptive information about, on the one hand, CONFLICTS, between users and built environments, and on the othe...
Full Text Available Purpose: To study the patterns of uveitis in the paediatric age group in a referral eye care centre in south India. Materials and Methods: Thirty-one patients 15 years or younger with uveitis, examined in the year 2000, were included in this study. The uveitis was classified according to the anatomical site of ocular involvement and the most probable aetiological factor. The final diagnosis was based on clinical manifestations and results of specific laboratory investigations. Results: A total 31 (6.29% paediatric uveitis cases were seen among the 493 uveitic cases in the year 2000. The male: female ratio was 17:14. Anterior (9 cases, intermediate (9 cases and posterior uveitis (9 cases were seen in equal number. Four patients had panuveitis. Twenty-seven patients had visual acuity of 6/36 or better at presentation. Approximately 25% (8 of 31 patients had cataract secondary to inflammation. Immunosuppressives were administered in 4 patients and one patient required cataract surgery. Conclusion: Uveitis in children comprises approximately 6% of uveitis cases in a referral practice in south India. Anterior, intermediate and posterior uveitis are seen in equal numbers. We recommend that intermediate uveitis be ruled out in all cases of anterior uveitis by careful clinical evaluation including examination under anesthesia (EUA when required.
Joanna M. Smith; Sullivan, S. John; Baxter, G David
Background: Massage therapy has grown in popularity, yet little is known globally or in New Zealand about massage therapists and their practices. Purpose and Setting: The aims of this study were to describe the practice patterns of trained Massage New Zealand massage therapists in New Zealand private practice, with regard to therapist characteristics; practice modes and settings, and therapy characteristics; referral patterns; and massage therapy as an occupation. Research Design and Particip...
Objective: To describe the results of laparoscopic procedures at a Urology - Nephrology tertiary care centre. Study Design: Case series / observational study. Place and Duration of Study: The Kidney Centre Postgraduate Training Institute, Karachi, from August 2007 to March 2012. Methodology: Medical records of all planned laparoscopic surgery conducted during the study period were reviewed. Those cases which to open surgery were excluded. All were performed by a single surgeon, initially as supervised and later independently. Data was maintained for demographic data, procedure details, length of hospital stay, and complications including conversion to open surgeries. Data was analyzed through SPSS 17.0. Results: There were 36 planned laparoscopic surgeries in the specified period. Out of 36 cases, 8 were converted to open surgery. Those who underwent laparoscopic surgery include two diagnostic procedures and renal cyst deroofing each, four ureterolithotomy, nineteen simple nephrectomy and one radical nephrectomy. So in total 28 cases were performed on 15 females and 13 males with mean age of 33.01 A +- 10.9 years. The mean operative time was 216 A +- 100 minutes and mean length of hospital stay was as 2.7 A +- 1.04 days. There were 10 complications in 28 cases, majority being Clavien Grade II including 7% (2/28) blood transfusion. Conclusion: There are technical challenges in learning laparoscopy for practicing urologists. Following some learning model in a systematic manner will help surmounting the technical challenges in learning laparoscopy. (author)
Full Text Available Background: Adequate nutritional support is important for the comprehensive management of patients in intensive care units (ICUs. Aim: The study was aimed to survey prevalent enteral nutrition practices in the trauma intensive care unit, nurses′ perception, and their knowledge of enteral feeding. Study Design: The study was conducted in the ICU of a level 1 trauma center, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India. The study design used an audit. Materials and Methods: Sixty questionnaires were distributed and the results analyzed. A database was prepared and the audit was done. Results: Forty-two (70% questionnaires were filled and returned. A majority (38 of staff nurses expressed awareness of nutrition guidelines. A large number (32 of staff nurses knew about nutrition protocols of the ICU. Almost all (40 opined enteral nutrition to be the preferred route of nutrition unless contraindicated. All staff nurses were of opinion that enteral nutrition is to be started at the earliest (within 24-48 h of the ICU stay. Everyone opined that the absence of bowel sounds is an absolute contraindication to initiate enteral feeding. Passage of flatus was considered mandatory before starting enteral nutrition by 86% of the respondents. Everyone knew that the method of Ryle′s tube feeding in their ICU is intermittent boluses. Only 4 staff nurses were unaware of any method to confirm Ryle′s tube position. The backrest elevation rate was 100%. Gastric residual volumes were always checked, but the amount of the gastric residual volume for the next feed to be withheld varied. The majority said that the unused Ryle′s tube feed is to be discarded after 6 h. The most preferred (48% method to upgrade their knowledge of enteral nutrition was from the ICU protocol manual. Conclusion: Information generated from this study can be helpful in identifying nutrition practices that are lacking and may be used to review and revise enteral feeding
Stuart Gail W
Full Text Available Abstract Background Implementing change in primary care is difficult, and little practical guidance is available to assist small primary care practices. Methods to structure care and develop new roles are often needed to implement an evidence-based practice that improves care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of cardiovascular disease in primary care practices that used a common electronic medical record (EMR. Methods Multiple conceptual frameworks informed the design of this study designed to explain the complex phenomena of implementing change in primary care practice. Qualitative methods were used to examine the processes of change that practice members used to implement the guidelines. Purposive sampling in eight primary care practices within the Practice Partner Research Network-Translating Researching into Practice (PPRNet-TRIP II clinical trial yielded 28 staff members and clinicians who were interviewed regarding how change in practice occurred while implementing clinical guidelines for primary and secondary prevention of cardiovascular disease and strokes. Results A conceptual framework for implementing clinical guidelines into primary care practice was developed through this research. Seven concepts and their relationships were modelled within this framework: leaders setting a vision with clear goals for staff to embrace; involving the team to enable the goals and vision for the practice to be achieved; enhancing communication systems to reinforce goals for patient care; developing the team to enable the staff to contribute toward practice improvement; taking small steps, encouraging practices' tests of small changes in practice; assimilating the electronic medical record to maximize clinical effectiveness, enhancing practices' use of the electronic tool they have invested in for patient care improvement; and providing feedback within a culture of
Full Text Available Abstract Background Organizational context plays a central role in shaping the use of research by healthcare professionals. The largest group of professionals employed in healthcare organizations is nurses, putting them in a position to influence patient and system outcomes significantly. However, investigators have often limited their study on the determinants of research use to individual factors over organizational or contextual factors. Methods The purpose of this study was to examine the determinants of research use among nurses working in acute care hospitals, with an emphasis on identifying contextual determinants of research use. A comparative ethnographic case study design was used to examine seven patient care units (two adult and five pediatric units in four hospitals in two Canadian provinces (Ontario and Alberta. Data were collected over a six-month period by means of quantitative and qualitative approaches using an array of instruments and extensive fieldwork. The patient care unit was the unit of analysis. Drawing on the quantitative data and using correspondence analysis, relationships between various factors were mapped using the coefficient of variation. Results Units with the highest mean research utilization scores clustered together on factors such as nurse critical thinking dispositions, unit culture (as measured by work creativity, work efficiency, questioning behavior, co-worker support, and the importance nurses place on access to continuing education, environmental complexity (as measured by changing patient acuity and re-sequencing of work, and nurses' attitudes towards research. Units with moderate research utilization clustered on organizational support, belief suspension, and intent to use research. Higher nursing workloads and lack of people support clustered more closely to units with the lowest research utilization scores. Conclusion Modifiable characteristics of organizational context at the patient care unit
de Vries, Jan; Timmins, Fiona
Care erosion - gradual decline in care level - is an important problem in health care today. Unfortunately, the mechanism whereby it occurs is complex and poorly understood. This paper seeks to address this by emphasising problems in reflective nursing practice. Critical reflection on quality of care which should drive good care instead spawns justifications, denial, and trivialisation of deficient care. This perpetuates increasingly poor care levels. We argue that cognitive dissonance theory provides a highly effective understanding of this process and suggest for this approach to be incorporated in all efforts to address care erosion. The paper includes a detailed discussion of examples and implications for practice, in particular the need to restore critical reflection in nursing, the importance of embracing strong values and standards, and the need for increased awareness of signs of care erosion. PMID:26733428
Margison, Judith A.; Shore, Bruce M.
Calls for increased collaborative practices in school psychology parallel similar advances in the realm of health care. This article overviews the concepts associated with collaborative practice in school psychology and in health care (e.g., interaction, teamwork, and collaboration) and discusses how the literature emerging from interprofessional…
Atla Bhagyalakshmi; Anem Venkatalakshmi; Regidi Subhash; Seeram Satish kumar
Background: This study is an attempt to know the incidence of cancer in a tertiary care centre. Statistics for all newly diagnosed cancer cases by correlation with factors like age, gender and organ systems involved with complete histopathological evaluation is presented. Emphasis is given to segregating each cancer and grouping them into their respective order for statistical analysis. Objectives of the study was to conduct a prospective statistical analysis, computing and comparing rates,...
Groot, C.M.; Vernooy-Dassen, M.J.F.J.; Crul, B.J.P.; Grol, R.P.T.M.
BACKGROUND: General practitioners (GPs) play a crucial part in palliative care. The quality of care can be improved by investigating and addressing barriers perceived by GPs in daily practice. The aim of this study was to investigate GPs' task perception and barriers involved in palliative care. MET
Bautista, Cristina M.
Due to tight fiscal budget, health care planners have started to explore alternative financing mechanisms. These alternatives can be effectively implemented given thorough understanding of mechanisms that direct household demand for health care. This paper investigates the factors of households’ health seeking behavior to determine the implications for health care financing reforms. In addition, it looks into the responsiveness of households to changes in prices and income. Insights of househ...
Fisher, Pamela; Owen, Jenny
This article considers findings from two recent qualitative studies in the UK, identifying parallels in the ways in which 'ecologies of practice' in two high-profile areas of health-related intervention underpin processes of empowerment and recognition. The first project focused on policy and practice in relation to teenage motherhood in a city in the North of England. The second project was part of a larger research programme, Changing Families, Changing Food, and investigated the ways in which 'family' is constructed through policy and practice interventions concerning food and health. While UK Government health policy stresses that health and social care agencies should 'empower' service users, it is argued here that this predominantly reflects a managerialist discourse, equating citizenship with individualised self-sufficiency in the 'public' sphere. Drawing critically on Honneth's politics of recognition (Honneth, A. (2001). Recognition or redistribution? Changing perspective on the moral order of society. Theory, Culture and Society, 18(2-3), 43-55.), we suggest that formal health policy overlooks the inter-subjective processes that underpin a positive sense of self, emphasising instead an individualised ontology. While some research has positioned practitioners as one-dimensional in their adherence to the current audit culture of the public sector in the UK, our study findings demonstrate how practitioners often circumvent audit-based 'economies of performance' with more flexible 'ecologies of practice.' The latter open up spaces for recognition through inter-subjective processes of identification between practitioners and service users. Ecologies of practice are also informed by practitioners' experiential knowledge. However, this process is largely unacknowledged, partly because it does not fall within a managerialist framework of 'performativity' and partly because it often reflects taken-for-granted, gendered patterns. It is argued here that a critical
Full Text Available Glendon R Tait,1 Joanna Bates,2 Kori A LaDonna,3 Valerie N Schulz,4 Patricia H Strachan,5 Allan McDougall,3 Lorelei Lingard3 1Department of Psychiatry and Division of Medical Education, Dalhousie University, Halifax, NS, 2Centre for Health Education Scholarship, Vancouver General Hospital, Vancouver, BC, 3Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, 4Palliative Care, London Health Sciences Centre, University Hospital, London; 5School of Nursing, McMaster University, Hamilton, ON, Canada Background: Heart failure (HF, one of the three leading causes of death, is a chronic, progressive, incurable disease. There is growing support for integration of palliative care’s holistic approach to suffering, but insufficient understanding of how this would happen in the complex team context of HF care. This study examined how HF care teams, as defined by patients, work together to provide care to patients with advanced disease. Methods: Team members were identified by each participating patient, generating team sampling units (TSUs for each patient. Drawn from five study sites in three Canadian provinces, our dataset consists of 209 interviews from 50 TSUs. Drawing on a theoretical framing of HF teams as complex adaptive systems (CAS, interviews were analyzed using the constant comparative method associated with constructivist grounded theory. Results: This paper centers on the dominant theme of system practices, how HF care delivery is reported to work organizationally, socially, and practically, and describes two subthemes: “the way things work around here”, which were commonplace, routine ways of doing things, and “the way we make things work around here”, which were more conscious, effortful adaptations to usual practice in response to emergent needs. An adaptive practice, often a small alteration to routine, could have amplified effects beyond those intended by the innovating team
Full Text Available ABSTRACT: INTRODUCTION: Ten to thirty percent of the patients admitted to hospitals in India acquire nosocomial infections as against 5% i n the developed world. The first and foremost principle of Universal Safety Precaution is “HANDWASHING”. But the Health Care Workers often forget to wash their hands before int eracting with the patient. Such contaminated hands plays major role in transmitting infections. HCWs are also at an increased risk of needle stick injuries. According to data fr om EPINet system, hospital workers incur approximately 30 needle stick injuries per 100 beds per year on average – an alarming figure by no exaggeration. (5 OBJECTIVE: To assess the knowledge and perception of HCWs toward s hand hygiene and to know the incident of NSI and the fac tors associated with it. STUDY METHOD: Cross sectional study with purposive sampling was car ried out in a tertiary care hospital. Out of 275 participants 55 were doctors, 143 nurses and 77 i nterns. Self administered questionnaire was used to collect information. RESULTS : Ninety one percent doctors, 86% interns and 81% nurses had good knowledge about hand hygiene. 73% d octors, 61% interns and 56% nurses knew the duration required for hand rub. The main h indrance for not practicing hand hygiene was due to lack of resources (37%. Knowledge abou t recapping of the needle was poor and incident of injury due to needle stick was 50% amon g nurses. CONCLUSIONS : Study demonstrated adequate knowledge regarding hand hygi ene. The knowledge should be converted into practice. There is a need for educati onal programme about universal precautions especially about handling of the sharps
Pati, Sanghamitra; Chauhan, Abhimanyu S; Panda, Madhusmita; Swain, Subhashish; Hussain, Mohammad A
Neonatal care practices have been shown to vary across tribal communities. This cross-sectional study was conducted in tribal block in Nabarangpur district of Odisha, India, to measure perinatal and antenatal practices by qualitative inquiries of 55 mothers who had babies aged breast-feeding and 'Budu practices' were common. Cultural issues, decision of family members and traditional beliefs still play a crucial role in shaping neonatal care practice in tribal communities. Awareness on child care, ethnographic understanding of health-seeking behavior of tribal community and mobilization of community by health workers can be useful in improving health status of mothers and newborn babies in tribal population. PMID:24519674
Hazzard, Anthony; Harris, Wendy; Howell, David
Human consciousness is inextricable from communication. The conditions of communication in the clinical context are defined by the caring intention and the unequal relationship, which imply special responsibilities on the part of the clinician. The conventional hermeneutic model of communication proposes a close examination of the context of the other, and an objective effort to get close to their consciousness by interpretation of their expressions. The clinician is supposed to lay aside subjective factors but make use of her/his clinical knowledge and skills. At University College Hospital Critical Care follow-up clinic, the communicative task involves history taking; partly by questionnaire and partly by attention to the patient's agenda - assessing needs, providing information and facilitating access to further help. In recent years the provision of Critical Care has become ever more complex, both in terms of the sophisticated medical and nursing techniques it can offer to patients and in the range of conditions it can undertake to treat. This range and complexity is reflected in the variety of problems and consequences that may be encountered at follow-up. Communicative techniques should take account of the emotional vulnerability of patients emerging from severe illness. Attentive listening should identify special anxieties, and care with phraseology aims to avoid further distress. Issues of memory, depression and trauma may be expected, and the interview technique must be flexible enough to offer emotional containment if need be. The consultation should be therapeutic in its conduct but should not embark upon actual psychotherapy or seek to dismantle the patient's defences. Contemporary hermeneutic perspectives emphasise the contextual situatedness of the clinician's consciousness, and propose a model of communication as 'blending of horizons' rather than as objective interpretation. Systems theory contributes to an understanding of the influence on
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
Full Text Available Abstract Background Health organizations the world over are required to set priorities and allocate resources within the constraint of limited funding. However, decision makers may not be well equipped to make explicit rationing decisions and as such often rely on historical or political resource allocation processes. One economic approach to priority setting which has gained momentum in practice over the last three decades is program budgeting and marginal analysis (PBMA. Methods This paper presents a detailed step by step guide for carrying out a priority setting process based on the PBMA framework. This guide is based on the authors' experience in using this approach primarily in the UK and Canada, but as well draws on a growing literature of PBMA studies in various countries. Results At the core of the PBMA approach is an advisory panel charged with making recommendations for resource re-allocation. The process can be supported by a range of 'hard' and 'soft' evidence, and requires that decision making criteria are defined and weighted in an explicit manner. Evaluating the process of PBMA using an ethical framework, and noting important challenges to such activity including that of organizational behavior, are shown to be important aspects of developing a comprehensive approach to priority setting in health care. Conclusion Although not without challenges, international experience with PBMA over the last three decades would indicate that this approach has the potential to make substantial improvement on commonly relied upon historical and political decision making processes. In setting out a step by step guide for PBMA, as is done in this paper, implementation by decision makers should be facilitated.
Brouillette, Janine E.
The purpose of the study was to develop a profile that describes the patterns and practices of the 27 women who served as public school superintendents in Alabama during the 2006-2007 school year. This study explored the relationship between the profiles, patterns, and practices found in research and the manifestations in the lives and careers of…
Full Text Available Objective: To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC models in the inpatient, ambulatory, and community practice settings. Methods: TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models. Results: Pharmacists are an essential part of the multidisciplinary team and play a key role in providing care to patients as they move between health care settings or from a health care setting to home. Pharmacists can participate in many aspects of the inpatient, ambulatory care, and community pharmacy practice settings to implement and ensure optimal TOC processes. This article describes establishing the pharmacist’s TOC role and practicing within multiple health care settings. In these models, pharmacists focus on medication reconciliation, discharge counseling, and optimization of medications. Additionally, a checklist has been created to assist other pharmacists in developing the pharmacist’s TOC roles in a practice environment or incorporating more TOC elements in their practice setting. Conclusion: Optimizing the TOC process, reducing medication errors, and preventing adverse events are important focus areas in the current health care system, as emphasized by The Joint Commission and other health care organizations. Pharmacists have the unique opportunity and skillset to develop and participate in TOC processes that will enhance medication safety and improve patient care.
Full Text Available Caring teaching is a conceptual framework used to gain an insight into the moral aspect of teaching. Using a quantitative research approach, we studied 556 teachers in order to explore their perceived dimensions of caring teaching. Drawing on existing literature, we found that caring teaching has been elaborated in line with two broad concepts: personal care and academic care. Considering these concepts, we developed the Caring Teaching Scale with which we identified four dimensions of caring teaching: the nurturing of a student's character, didactical bias, awareness, and respectful didactics. A meta-analysis reflection suggests that the nurturing of students' characters and awareness represent personal care while didactical bias and respectful didactics call for academic care. Further analysis showed that these teachers attached more pedagogical value to personal care. Controlling for two demographic variables, we found statistically significant differences with regard to gender and caring teaching.
textabstractIn this thesis we target cardiovascular preventive care from a continuous quality improvement point of view in a project called CARPE (CArdiovascular Risk reduction in Primary carE). We created a multifaceted intervention based on a ·quality cycle· and used outreach visitors for its implementation, since this approach has proven successful in modifying professional behavior. 13 In addressing prevention we considered Donebedian's model 14 to assess quality of care: i.e. we distingu...
Hafner, A W; Schwarz, M R
The American health care system is experiencing a period of unprecedented change. This paper identifies and discusses the major changes in patient care, research, control of the health care system, and medical education, and their implications for health sciences librarians. These changes have resulted in new demands for effective information delivery and a broader health sciences library clientele. There are both challenges and opportunities for health sciences librarians as they respond to ...
Prashant Garg; Snigdha Reddy; Chaitanya Nelluri
One of the crucial factors to make high quality eye care services available, accessible and affordable to all is the availability of appropriately trained human resources. Providing health through a health care team is a better and cost effective alternative. The concept of the team approach is based on the principles of working together; task shifting; and ensuring continuity of care. Composition of a team varies based on the community needs, population characteristics and disease burden. Bu...
Child and Youth Care practice in North America is, as it should be, in constant evolution. A review of the literature, conversations about practice and participation in the activities of the field reveal certain treads or themes which reft.ect the state of the field at this particular point in time. This paper identifies and reft.ects on some of those that seem most relevant to contemporary Child and Youth Care practice in North America.
Pereira, Rui Pedro Gomes; Martins, Alice; Peixoto, Maria José; Martins, Teresa; Barbieri, Maria do Céu; Carneiro, António Vaz
Introduction: Currently, the importance of a clinical practice based on the best available evidence justifies the development of investigation to construct a situational diagnosis that allows to identify in different contexts of care, barriers, attitudes and practices towards an evidence-based nursing. Objective: In this investigation we aim to identify barriers regarding the adoption of an Evidence Based Practice (EBP) in different care settings and describe the main nurse’s attitudes and pr...
Dunn, N; R. Pickering
BACKGROUND: Audit of diabetic care is becoming common in general practice. Most of this audit is concerned with structure and process; outcome audit is much more difficult to achieve. AIM: To determine whether the structure of general practice diabetic care influenced the process or outcome and whether efficiency of process predicted improved outcome. METHOD: Cross-sectional survey, by questionnaire and review of notes, among general practices in the East Dorset district, involving diabetic p...
Stokes, Sonya; Seritan, Andreea L; Miller, Elizabeth
This study explored patterns of abuse and care seeking among women victims of gender-based violence (GBV) in Afghanistan. Individual, semi-structured interviews were conducted with 22 Afghan women (M age = 19 years) living in a shelter for victims of GBV. Interviews were analyzed thematically. Participants reported experiencing multiple forms of abuse. The majority received medical treatment for abuse-related health concerns. However, less than half reported abuse to health care providers or were asked by health care providers about the context of their injuries. Strategies to improve health care responses to GBV are needed to ensure safety and support for Afghan women. PMID:26681300