Sood, Geeta; Perl, Trish M
Outbreaks and pseudo-outbreaks in health care settings can be complex and should be evaluated systematically using epidemiologic tools. Laboratory testing is an important part of an outbreak evaluation. Health care personnel, equipment, supplies, water, ventilation systems, and the hospital environment have been associated with health care outbreaks. Settings including the neonatal intensive care unit, endoscopy, oncology, and transplant units are areas that have specific issues which impact the approach to outbreak investigation and control. Certain organisms have a predilection for health care settings because of the illnesses of patients, the procedures performed, and the care provided. PMID:27515142
Lambert, B L; Salmon, J W; Stubbings, J; Gilomen-Study, G; Valuck, R J; Kezlarian, K
This multi-site, cross-sectional, observational study sought to identify attitudinal and social normative factors associated with the prescribing of oral antibiotics to ambulatory patients in a managed care setting. Participants were 25 physicians specializing in internal medicine, family practice or pediatrics from five ambulatory care clinics within a large, fully integrated health care system in a major midwestern U.S. city. The main outcome measure was number of prescriptions per physician written in the fourth quarter of 1994 for each of seven selected antibiotics. Correlational and multiple regression analyses revealed that behavioral intentions were significantly associated (P antibiotic prescribing behavior. Prescribing behavior may have been a function of patient-specific rather than general beliefs about antibiotics. Methodological limitations related to the sample size and the sparseness of the utilization data may also have prevented a significant effect of intentions on behavior from being detected. Alternatively, in managed care settings, it is hypothesized that prescribing behavior may have been influenced more by non-psychological factors, such as management systems, formularies and therapeutic substitution programs, than they were by internal, psychological factors such as attitudes, subjective norms and intentions. Managed care is altering the role of the physician as an autonomous decision-maker. In response, models of prescribing must either incorporate variables such as perceived behavioral control to aid in the prediction of non-volitional behavior, model the decision-making of non-physician managers, or forego psychological models in favor of structural or system-level models of drug utilization. PMID:9447627
Franck, Kristina T; Fonager, Jannik; Ersbøll, Annette K;
Norovirus (NoV) is a major cause of gastroenteritis. NoV genotype II.4 (GII.4) is the predominant genotype in health care settings but the reason for this finding is unknown. Stool samples containing isolates with a known NoV genotype from 2,109 patients in Denmark (patients consulting a general...
Wang, Jing; Xiao, Lily Dongxia; Li, Xiaomei; De Bellis, Anita; Ullah, Shahid
The aim of this study was to investigate caregiver distress in reacting to the care recipient's behavioral and psychological symptoms of dementia (BPSD) and factors contributing to caregiver distress in the community setting in China. One hundred and fifty-two family caregivers of people with dementia in community settings were assessed using the Chinese version of the Neuropsychiatric Inventory-Questionnaire and the Social Support Rating Scale. The prevalence of BPSD and caregiver distress in reacting to BPSD was higher in China than those reported in high income countries. The most common individual BPSD were apathy/indifference, depression/dysphoria and night-time behaviors. Delusions, hallucinations and apathy/indifference were rated as the most distressing to caregivers. BPSD contributed most to caregiver distress. The high level of caregiver distress identified in this study suggests that dementia services and caregiver support should be established in the public healthcare system to target the needs of people with dementia and their caregivers. PMID:26005192
O'Neil, Caroline; Ball, Kelly; Wood, Helen; McMullen, Kathleen; Kremer, Pamala; Jafarzadeh, S Reza; Fraser, Victoria; Warren, David
OBJECTIVE To evaluate a central line care maintenance bundle to reduce central line-associated bloodstream infection (CLABSI) in non-intensive care unit settings. DESIGN Before-after trial with 12-month follow-up period. SETTING A 1,250-bed teaching hospital. PARTICIPANTS Patients with central lines on 8 general medicine wards. Four wards received the intervention and 4 served as controls. INTERVENTION A multifaceted catheter care maintenance bundle consisting of educational programs for nurses, update of hospital policies, visual aids, a competency assessment, process monitoring, regular progress reports, and consolidation of supplies necessary for catheter maintenance. RESULTS Data were collected for 25,542 catheter-days including 43 CLABSI (rate, 1.68 per 1,000 catheter-days) and 4,012 catheter dressing observations. Following the intervention, a 2.5% monthly decrease in the CLABSI incidence density was observed on intervention floors but this was not statistically significant (95% CI, -5.3% to 0.4%). On control floors, there was a smaller but marginally significant decrease in CLABSI incidence during the study (change in monthly rate, -1.1%; 95% CI, -2.1% to -0.1%). Implementation of the bundle was associated with improvement in catheter dressing compliance on intervention wards (78.8% compliance before intervention vs 87.9% during intervention/follow-up; Pcontrol wards (84.9% compliance before intervention vs 90.9% during intervention/follow-up; P=.001). CONCLUSIONS A multifaceted program to improve catheter care was associated with improvement in catheter dressing care but no change in CLABSI rates. Additional study is needed to determine strategies to prevent CLABSI in non-intensive care unit patients. Infect Control Hosp Epidemiol 2016;37:692-698. PMID:26999746
Lukewich, Julia; Corbin, Renée; Elizabeth G VanDenKerkhof; Edge, Dana S.; Williamson, Tyler; Tranmer, Joan E.
Rationale, aims and objectives Given the increasing emphasis being placed on managing patients with chronic diseases within primary care, there is a need to better understand which primary care organizational attributes affect the quality of care that patients with chronic diseases receive. This study aimed to identify, summarize and compare data collection tools that describe and measure organizational attributes used within the primary care setting worldwide. Methods Systematic search and r...
This qualitative study determined the prevalence of inpatient falls that were associated with toileting in a Michigan community hospital. Of all falls, 45.2% were related to toileting. The most common theme was falling on the way from the bed or chair to the bathroom. Nurses should focus on safe patient transfers and on using the completed risk assessment and should develop an individualized prevention plan for each patient based on their needs. PMID:19553863
Eating disorders are a complex set of illnesses most commonly affecting white adolescent girls and young women. The most common eating disorders seen in the primary care setting are anorexia nervosa, bulimia nervosa, and binge eating disorder. Treatment in the primary care environment ideally involves a physician, therapist, and nutritionist, although complex cases may require psychiatric and other specialist care. Early diagnosis and treatment are associated with improved outcomes, whereas the consequences of untreated eating disorders, particularly anorexia nervosa, can be devastating, including death. PMID:27262009
Campbell, Jill L; Coyer, Fiona M; Osborne, Sonya R
The purpose of this cross-sectional study was to identify the prevalence of incontinence and incontinence-associated dermatitis (IAD) in Australian acute care patients and to describe the products worn to manage incontinence, and those provided at the bedside for perineal skin care. Data on 376 inpatients were collected over 2 days at a major Australian teaching hospital. The mean age of the sample group was 62 years and 52% of the patients were male. The prevalence rate of incontinence was 24% (91/376). Urinary incontinence was significantly more prevalent in females (10%) than males (6%) (χ(2) = 4·458, df = 1, P = 0·035). IAD occurred in 10% (38/376) of the sample group, with 42% (38/91) of incontinent patients having IAD. Semi-formed and liquid stool were associated with IAD (χ(2) = 5·520, df = 1, P = 0·027). Clinical indication of fungal infection was present in 32% (12/38) of patients with IAD. Absorbent disposable briefs were the most common incontinence aids used (80%, 70/91), with soap/water and disposable washcloths being the clean-up products most commonly available (60%, 55/91) at the bedside. Further data are needed to validate this high prevalence. Studies that address prevention of IAD and the effectiveness of management strategies are also needed. PMID:24974872
Haesler, Emily; Bauer, Michael; Nay, Rhonda
Background Modern healthcare philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's well-being. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family involvement in the healthcare of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the healthcare environment to benefit from the involvement of their family members, healthcare professionals need an understanding of the issues surrounding family presence in the healthcare environment and the strategies to best support it. Objectives The objectives of the systematic review were to present the best available evidence on the strategies, practices and organisational characteristics that promote constructive staff-family relationships in the care of older adults in the healthcare setting. Specifically this review sought to investigate how staff and family members perceive their relationships with each other; staff characteristics that promote constructive relationships with the family; and interventions that support staff-family relationships. Search strategy A literature search was performed using the following databases for the years 1990-2005: Ageline, APAIS Health, Australian Family and Society Abstracts (FAMILY), CINAHL, Cochrane Library, Dare, Dissertation Abstracts, Embase, MEDLINE, PsycINFO and Social Science Index. Personal communication from expert panel members was also used to identify studies for inclusion. A second search stage
Boulet, Sheree L.; Parker, Christopher; Atrash, Hani
Objectives: This literature review briefly describes international programs, policies, and activities related to preconception care and resulting pregnancy outcomes. Methods: Electronic databases were searched and findings supplemented with secondary references cited in the original articles as well as textbook chapters, declarations, reports, and recommendations. Results: Forty-two articles, book chapters, declarations, and other published materials were reviewed. Policies, programs, and rec...
Benich, Joseph J; Bragg, Scott W; Freedy, John R
Psychopharmacology requires clinicians to stay current on the latest guidelines and to use dynamic treatment strategies. Psychiatric conditions are prevalent in the primary care population. Choice of treatment with psychopharmacology should be based on controlling the patient's predominant symptoms while taking into consideration patient age, treatment compliance, patient past response to treatments, dosing frequency, patient preference, medication side effects, potential medication interactions, drug precautions/warnings, and cost. Response to therapy, as well as side effects, needs to be evaluated at regular intervals. The goal is to minimize symptoms and return patients to their maximal level of functioning. PMID:27262011
Full Text Available Studies from sub-Saharan Africa have shown that a substantial proportion of patients diagnosed with HIV enter into HIV medical care late. However, data from low or middle-income countries outside Africa are scarce. In this study, we investigated risk factors associated with delayed entry into care stratified by gender in a large cohort study in India. 7701 patients were diagnosed with HIV and 5410 entered into care within three months of HIV diagnosis. Nearly 80% entered into care within a year, but most patients who did not enter into care within a year remained lost to follow up or died. Patient with risk factors related to having a low socio-economic status (poverty, being homeless, belonging to a disadvantaged community and illiteracy were more likely to enter into care late. In addition, male gender and being asymptomatic at the moment of HIV infection were factors associated with delayed entry into care. Substantial gender differences were found. Younger age was found to be associated with delayed entry in men, but not in women. Widows and unmarried men were more likely to enter into care within three months. Women belonging to disadvantaged communities or living far from a town were more likely to enter into care late. The results of this study highlight the need to improve the linkage between HIV diagnosis and HIV treatment in India. HIV programmes should monitor patients diagnosed with HIV until they engage in HIV medical care, especially those at increased risk of attrition.
U.S. Department of Health & Human Services — The Long-Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status that forms the foundation of the comprehensive...
Grill, Eva; Penger, Mathias; Kentala, Erna
Vertigo and dizziness are frequent complaints in primary care that lead to extensive health care utilization. The objective of this systematic review was to examine health care of patients with vertigo and dizziness in primary care settings. Specifically, we wanted to characterize health care utilization, therapeutic and referral behaviour and to examine the outcomes associated with this. A search of the MEDLINE and EMBASE databases was carried out in May 2015 using the search terms ‘vertigo’...
Walter, Angela Wangari; Cheng, Debbie M; Lloyd-Travaglini, Christine A; Samet, Jeffrey H; Bernstein, Judith; Saitz, Richard
Drug use is associated with increased sexual risk behaviors. We examined whether decreases in drug use risk are associated with reduction in HIV-related sex risk behaviors among adults. Data was from a cohort of participants (n = 574) identified by drug use screening in a randomized trial of brief intervention for drug use in an urban primary care setting. Inverse probability of treatment weighted (IPTW) logistic regression models were used to examine the relationship between decreases in drug use risk and sex-related HIV risk behavior reduction from study entry to six months. Weights were derived from propensity score modeling of decreases in drug use risk as a function of potential confounders. Thirty seven percent of the study participants (213/574) reported a decrease in drug use risk, and 7% (33/505) reported decreased sex-related HIV risk behavior at the six-month follow-up point. We did not detect a difference in reduction of risky sexual behaviors for those who decreased drug use risk (unadjusted: OR 1.32, 95% CI 0.65-2.70; adjusted OR [AOR] 1.12, 95% CI 0.54-2.36). Adults who screened positive for high drug use risk had greater odds of reducing sex risk behavior in unadjusted analyses OR 3.71, 95% CI 1.81-7.60; but the results were not significant after adjusting for confounding AOR 2.50, 95% CI 0.85-7.30). In this primary care population, reductions in HIV sex risk behaviors have complex etiologies and reductions in drug use risk do not appear to be an independent predictor of them. PMID:27570734
LaCrosse, Lisa M.; Heermann, Judith; Azevedo, Karen; Sorrentino, Catherine; Straub, Dawn; O'Dowd, Gloria
The process for developing the nursing care planning (NCP) function for integration into a clinical information system (CIS) will be described. This NCP system uses evidence based order sets or interventions that are specific to a problem with associated patient focused goals or outcomes. The problem, order set, goal framework will eventually be used by all disciplines in the patient focused record.
Tsai, Shih-Hung; Lin, Yen-Yue; Hsu, Chin-Wang; Cheng, Chien-Sheng; Chu, Der-Ming
Hypoglycemia is a common finding in both daily clinical practice and acute care settings. The causes of severe hypoglycemia (SH) are multi-factorial and the major etiologies are iatrogenic, infectious diseases with sepsis and tumor or autoimmune diseases. With the advent of aggressive lowering of HbA1c values to achieve optimal glycemic control, patients are at increased risk of hypoglycemic episodes. Iatrogenic hypoglycemia can cause recurrent morbidity, sometime irreversible neurologic comp...
... Testimony AHCA/NCAL PAC Federal Political Directors Political Events Solutions Facility Operations Affordable Care Act Clinical Emergency Preparedness Finance Health Information Technology Integrity Medicaid Medicare Patient Privacy and ...
Nöstlinger, Christiana; Rojas Castro, Daniela; Platteau, Tom; Dias, Sonia; Le Gall, Jean
This cross-sectional European study assessed self-reported HIV-related discrimination and its associated factors in health care settings. Socio-demographics, health status, support needs relating to sexual and reproductive health (SRH), and self-reported HIV-related discrimination were measured using an anonymous survey in a sample of 1549 people living with HIV from 14 countries. Thirty-two per cent of the participants had experienced HIV-related discrimination during the previous 3 years; a...
Real-world hospital costs for nonchemotherapy drugs and nondrug care associated with platinum-based doublets in the first-line setting for advanced nonsquamous non-small-cell lung cancer in Chinese patients: a retrospective cohort study
Chen, Jianhua; Wu, Shengqi; Hu, Chenping; Yang, Yicheng; Rajan, Narayan; Chen, Yun; Yang, Canjuan; Li, Jianfeng; Chen, Wendong
Objective The objective of this study was to compare hospital costs per treatment cycle (HCTC) for nonchemotherapy drugs and nondrug care associated with platinum-based doublets in the first-line setting for advanced nonsquamous non-small-cell lung cancer (AdvNS-NSCLC) in Chinese patients. Methods Patients receiving platinum-based doublets in the first-line setting for AdvNS-NSCLC from 2010 to 2012 in two Chinese tertiary hospitals were identified to create the retrospective study cohort. Propensity score methods were used to create matched treatment groups for head-to-head comparisons on HCTC between pemetrexed–platinum and other platinum-based doublets. Multiple linear regression analyses were performed to rank studied platinum-based doublets for their associations with the log10 scale of HCTC for nonchemotherapy drugs and nondrug care. Results Propensity score methods created matched treatment groups for pemetrexed–platinum versus docetaxel–platinum (61 pairs), paclitaxel–platinum (39 pairs), gemcitabine–platinum (93 pairs), and vinorelbine–platinum (73 pairs), respectively. Even though the log10 scale of HCTC for nonchemotherapy drugs and nondrug care associated with pemetrexed–platinum was ranked lowest in all patients (coefficient −0.174, P=0.015), which included patients experiencing any hematological adverse events (coefficient −0.199, P=0.013), neutropenia (coefficient −0.426, P=0.021), or leukopenia (coefficient −0.406, P=0.001), pemetrexed–platinum had the highest total HCTC (median difference from RMB 1,692 to RMB 7,400, Pline setting for AdvNS-NSCLC, the higher acquisition costs for nonplatinum cytotoxic drugs associated with pemetrexed–platinum could be partially offset by its significantly lower hospital costs for nonchemotherapy drugs and nondrug care.
Henderson, Claire; Noblett, Jo; Parke, Hannah; Clement, Sarah; Caffrey, Alison; Gale-Grant, Oliver; Schulze, Beate; Druss, Benjamin; Thornicroft, Graham
This Review considers the evidence for mental-health-related stigma in health-care and mental-health-care settings. Do mental-health-care and other health-care professionals stigmatise people using their services? If so, what are the effects on quality of mental and physical health care? How can stigma and discrimination in the context of health care be reduced? We show that the contact mental-health-care professionals have with people with mental illness is associated with positive attitudes about civil rights, but does not reduce stigma as does social contact such as with friends or family members with mental illness. Some evidence suggests educational interventions are effective in decreasing stigma especially for general health-care professionals with little or no formal mental health training. Intervention studies are needed to underpin policy; for instance, to decrease disparity in mortality associated with poor access to physical health care for people with mental illness compared with people without mental illness. PMID:26361202
Tyler, R D
One of the most utilitarian developments in the field of quality assurance in health care has been the introduction of industrial concepts of quality management. These concepts, coupled with buyer demand for accountability, are bringing new perspectives to health care quality assurance. These perspectives provide a new view of quality assurance as a major responsibility and strategic opportunity for management; a competitive and marketable commodity; and a method of improving safety, effectiveness, and satisfaction with medical care. PMID:10313405
Full Text Available This article introduces associated near sets of a collection of sets. The proposed approach introduces a means of defining as well as describing an ε-approach merotopy in terms of the members of associated sets of collections that are sufficiently near. A characterization for continuous functions is established using associated near sets. This article also introduces p-containment considered in the context of near sets. An application of the proposed approach is given in terms of digital image classification.
Marcoux, Rita M.; VOGENBERG, F. RANDY
Pharmaceutical waste has become an urgent public health and environmental protection issue in recent years, leading to a variety of sometimes-conflicting federal and state legislation and regulations that health care entities must take seriously.
Honig, Alice S.
This speech presents observations, made on a trip in June 1976, of the aesthetic environments of children in China, Japan, and Hong Kong. Home, school and day care environments are compared in terms of living and play space, room decor, the presence of art and toys, dramatic play and performance, music, nature and outdoor appreciation, food and…
Full Text Available INTRODUCTION: The neonatal mortality rate in India is high and stagnant. Special Care Newborn Units (SCNUs have been set up at different levels Health Care Delivery System to provide quality newborn - care services in several hospitals to meet this challenge. Many units are located in the districts where the burden of neonatal deaths is high, and access to special newborn care is poor. MATERIALS AND METHODS: The study was conducted to assess the functioning of SCNUs in six centers of India. The evaluation was based on an analysis of secondary data from the six units that had been functioning for at least three year. A cross - sectional survey was conducted to assess the availability of infrastructure, equipment’s and human resources and assessment of the beneficiaries. Desc riptive statistics were used for analyzing the inputs (R esources and outcomes ( A ssessment of the beneficiaries. Correlation coefficients were estimated to understand the possible association of satisfaction rate of beneficiaries with factors, such as bed : doctor ratio, bed: nurse ratio, average duration of stay, and bed occupancy rate. RESULTS: The major reasons for admission and the major causes of deaths were birth asphyxia, sepsis, and LBW/prematurity. Likart’s Analysis is used to analyze Beneficiaries Assessment. Beneficiaries were not found at Level I NBSUs at the time of evaluation. The units had a varying nurse: bed ratio (1:1 - 1:2.14. The bed occupancy rate ranged from 83% to 121% (median 115%, and the average duration of stay ranged from three da ys to 8 days (median 5 days. Repair and maintenance of equipment were a major concern. CONCLUSION: It is possible to set up and manage quality SCNUs and improve the survival of newborns with LBW and sepsis in developing countries, although several challen ges relating to infrastructure, human resources and maintenance of equipment remain.
As the health care revolution progresses, so must the management styles of today's leaders. The authors must ask ourselves if we are managing tomorrow's work force or the work force of the past. Participatory management may better meet the needs of today's work force. This paper identifies the reasons participatory management is a more effective management style, the methods used to implement a participatory management program, its benefits (such as higher productivity and more efficient, effective implementation and acceptance of change), and the difficulties experienced
Schifano, Elizabeth D.; Epstein, Michael P.; Bielak, Lawrence F.; Jhun, Min A; Kardia, Sharon L. R.; Peyser, Patricia A; Lin, Xihong
Genome-wide association studies (GWAS) are a popular approach for identifying common genetic variants and epistatic effects associated with a disease phenotype. The traditional statistical analysis of such GWAS attempts to assess the association between each individual Single Nucleotide Polymorphism (SNP) and the observed phenotype. Recently, kernel machine-based tests for association between a SNP set (e.g., SNPs in a gene) and the disease phenotype have been proposed as a useful alternative...
Ivy, D. Dunbar
The prostacyclins-prostanoids were one of the first medications used to treat pulmonary arterial hypertension (PAH). Three prostanoids have been developed to treat PAH: epoprostenol, treprostinil, and iloprost. In the acute setting, experience is growing, using the inhaled forms of these three medications. Inhalation may improve ventilation/perfusion matching, whereas in the intravenous form these medications may cause nonselective pulmonary vasodilation and may worsen ventilation/perfusion m...
Cilene Saghabi de Medeiros Silva
Full Text Available OBJECTIVES: A number of complications exist with invasive mechanical ventilation and with the use of and withdrawal from prolonged ventilator support. The use of protocols that enable the systematic identification of patients eligible for an interruption in mechanical ventilation can significantly reduce the number of complications. This study describes the application of a weaning protocol and its results. METHODS: Patients who required invasive mechanical ventilation for more than 24 hours were included and assessed daily to identify individuals who were ready to begin the weaning process. RESULTS: We studied 252 patients with a median mechanical ventilation time of 3.7 days (interquartile range of 1 to 23 days, a rapid shallow breathing index value of 48 (median, a maximum inspiratory pressure of 40 cmH(20, and a maximum expiratory pressure of 40 cm H(20 (median. Of these 252 patients, 32 (12.7% had to be reintubated, which represented weaning failure. Noninvasive ventilation was used postextubation in 170 (73% patients, and 15% of these patients were reintubated, which also represented weaning failure. The mortality rate of the 252 patients studied was 8.73% (22, and there was no significant difference in the age, gender, mechanical ventilation time, and maximum inspiratory pressure between the survivors and nonsurvivors. CONCLUSIONS: The use of a specific weaning protocol resulted in a lower mechanical ventilation time and an acceptable reintubation rate. This protocol can be used as a comparative index in hospitals to improve the weaning system, its monitoring and the informative reporting of patient outcomes and may represent a future tool and source of quality markers for patient care.
Intravenous (IV) levetiracetam (LEV) is currently approved as an alternative or replacement therapy for patients unable to take the oral form of this antiepileptic drug (AED). The oral form has Food and Drug Administration (FDA) indications for adjunctive therapy in the treatment of partial onset epilepsy ages 1 month or more, myoclonic seizures associated with juvenile myoclonic epilepsy starting with the age of 12 and primary generalized tonic-clonic seizures in people 6 years and older. ...
Landman, W A; Henley, L D
The new South African constitution commits the government to guarantee "basic health services" for every child under 18. Primary health care for pregnant women and children under six and elements of essential primary health care have received priority. At present, there is little analysis of the moral considerations involved in making choices about more advanced or costly health care which may, arguably, also be "basic". This paper illustrates some of the tensions in setting priorities for a ...
McCune, Renee L.
Patient health literacy skills are critical to effective healthcare communication and safe care delivery in primary care settings. Methods and strategies to identify patient health literacy (HL) capabilities and provider/staff knowledge, attitudes and beliefs (KAB) regarding HL must be known before addressing provider/staff communication skills.…
Real-world hospital costs for nonchemotherapy drugs and nondrug care associated with platinum-based doublets in the first-line setting for advanced nonsquamous non-small-cell lung cancer in Chinese patients: a retrospective cohort study
Full Text Available Jianhua Chen,1 Shengqi Wu,2 Chenping Hu,3 Yicheng Yang,4 Narayan Rajan,5 Yun Chen,4 Canjuan Yang,6 Jianfeng Li,6 Wendong Chen7 1Department of Medical Oncology, 2Department of Research and Education, Hunan Province Tumor Hospital, 3Department of Respiratory, Xiangya Hospital, Central South University, Changsha, Hunan, 4Lilly Suzhou Pharmaceutical Co., Ltd. Shanghai Branch, Shanghai, People's Republic of China; 5Global Health Outcomes Research, Eli Lilly and Co, Indianapolis, IN, USA; 6Division of Health Outcome Research, Normin Health Changsha Representative Office, Changsha, Hunan, People's Republic of China; 7Normin Health, Toronto, ON, Canada Objective: The objective of this study was to compare hospital costs per treatment cycle (HCTC for nonchemotherapy drugs and nondrug care associated with platinum-based doublets in the first-line setting for advanced nonsquamous non-small-cell lung cancer (AdvNS-NSCLC in Chinese patients. Methods: Patients receiving platinum-based doublets in the first-line setting for AdvNS-NSCLC from 2010 to 2012 in two Chinese tertiary hospitals were identified to create the retrospective study cohort. Propensity score methods were used to create matched treatment groups for head-to-head comparisons on HCTC between pemetrexed–platinum and other platinum-based doublets. Multiple linear regression analyses were performed to rank studied platinum-based doublets for their associations with the log10 scale of HCTC for nonchemotherapy drugs and nondrug care. Results: Propensity score methods created matched treatment groups for pemetrexed–platinum versus docetaxel–platinum (61 pairs, paclitaxel–platinum (39 pairs, gemcitabine–platinum (93 pairs, and vinorelbine–platinum (73 pairs, respectively. Even though the log10 scale of HCTC for nonchemotherapy drugs and nondrug care associated with pemetrexed–platinum was ranked lowest in all patients (coefficient –0.174, P=0.015, which included patients experiencing
Goodrich, David E.; Kilbourne, Amy M.; Nord, Kristina M; Bauer, Mark S
Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems as well as engaging patients in their care through self-management support and linkages to community resources. Th...
Stanos, Steven; Brodsky, Marina; Argoff, Charles; Clauw, Daniel J; D'Arcy, Yvonne; Donevan, Sean; Gebke, Kevin B; Jensen, Mark P; Lewis Clark, Evelyn; McCarberg, Bill; Park, Peter W; Turk, Dennis C; Watt, Stephen
Chronic pain substantially impacts patient function and quality of life and is a burden to society at large in terms of increased health care utilization and loss of productivity. As a result, there is an increasing recognition of chronic pain as a public health crisis. However, there remains wide variability in clinical practices related to the prevention, assessment, and treatment of chronic pain. Certain fundamental aspects of chronic pain are often neglected including the contribution of the psychological, social, and contextual factors associated with chronic pain. Also commonly overlooked is the importance of understanding the likely neurobiological mechanism(s) of the presenting pain and how they can guide treatment selection. Finally, physicians may not recognize the value of using electronic medical records to systematically capture data on pain and its impact on mood, function, and sleep. Such data can be used to monitor onset and maintenance of treatments effects at the patient level and evaluate costs at the systems level. In this review we explain how these factors play a critical role in the development of a coordinated, evidence-based treatment approach tailored to meet specific needs of the patient. We also discuss some practical approaches and techniques that can be implemented by clinicians in order to enhance the assessment and management of individuals with chronic pain in primary care settings. PMID:27166559
Maluka, Stephen; Kamuzora, Peter; Sebastiån, Miguel San;
care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents...... were also gathered and group priority-setting in the district was observed. The results indicate that, while Tanzania has a decentralized public health care system, the reality of the district level priority-setting process was that it was not nearly as participatory as the official guidelines suggest......Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health...
Advances in medical radiation technology have resulted in significant gains in the diagnosis and treatment of human diseases. Medical use of ionizing radiation has become by far the largest artificial source of radiation exposure. Although individual cancer risk associated with diagnostic exposures is low, overall exposure is becoming a public health concern due to the widespread use of radiation in health care settings, which is foreseen to continue rising. According to its global health mandate, WHO has an important role to play in preventing unjustified exposures while promoting and ensuring safe use of radiation in medicine. In order to underscore its commitment to this field, WHO started a global initiative on Radiation Safety in Health Care Settings to support Member States in the implementation of the international radiation safety standards in medicine. This new initiative will bring together key stakeholders, including international organizations, professional and scientific societies, health authorities and policy makers. Actions of the initiative will focus on public health aspects related to risks and benefits of diagnostic radiology, image guided interventions, radiotherapy and nuclear medicine. Based on a scientific evidence, special consideration will be given to critical sub-populations (e.g. children and pregnant women), to high dose procedures and to unintended exposures. Practical materials focusing on the justification and optimization principles of radiation protection will be developed and disseminated, such as evidence-based good practice manuals. In addition, advocacy and communication tools will be produced and made available widely. Contribution to the development of education and training programs will be also considered. (author)
Sydnor, Emily R. M.; Perl, Trish M.
Summary: Health care-associated infections (HAIs) have become more common as medical care has grown more complex and patients have become more complicated. HAIs are associated with significant morbidity, mortality, and cost. Growing rates of HAIs alongside evidence suggesting that active surveillance and infection control practices can prevent HAIs led to the development of hospital epidemiology and infection control programs. The role for infection control programs has grown and continues to...
Lawler, Patrick R; Norheim, Ole F
This editorial discusses the potential role that physician-authored clinical practice guidelines could play in health care priority setting decisions in the United States. We briefly review the challenges associated with increasingly obligate health care priority setting in the United States and discuss accountability for these decisions. We then propose a potential role for clinical practice guidelines in addressing these challenges, while considering the ethical foundations of such a proposal. PMID:26342516
Stellefson, Michael; Dipnarine, Krishna; Stopka, Christine
Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academi...
Defechereux, T.; Paolucci, F.; Mirelman, A.; Youngkong, S.; Botten, G.; Hagen, T.P.; Niessen, L.W.
BACKGROUND: Priority setting in population health is increasingly based on explicitly formulated values. The Patients Rights Act of the Norwegian tax-based health service guaranties all citizens health care in case of a severe illness, a proven health benefit, and proportionality between need and tr
Unqualified social care workers are increasingly delegated the responsibility of both assisting with and administering medication in the domiciliary care setting. This article discusses the considerations required before the delegation of these roles by both commissioners and nurses. In particular, variations in training, policies and provision are explored with reference to the Care Quality Commission guidance and Nursing and Midwifery Council standards. The levels of support and their definitions are clarified for use in policy documents, and the effectiveness of devices used to support self-care are critiqued within a legal framework. The importance of joint working to provide a seamless medication management service are highlighted using reflections on examples from practice. PMID:23124424
Children represent the most vulnerable members of our global society, a truth that is magnified when they are physically wounded. In much of the developed world, society has responded by offering protection in the form of law, injury prevention guidelines, and effective trauma systems to provide care for the injured child. Much of our world, though, remains afflicted by poverty and a lack of protective measures. As the globe becomes smaller by way of ease of travel and technology, surgeons are increasingly able to meet these children where they live and in doing so offer their hands and voices to care and protect these young ones. This article is intended as an overview of current issues in pediatric trauma care in the developing world as well as to offer some tips for the volunteer surgeon who may be involved in the care of the injured child in a setting of limited resource availability. PMID:26831134
Full Text Available Background: Family members are critical partners in the plan of care for patients both in the hospital and at home. Involving the members of the family in acute care can help the nursing staff in emergency. The present study was aimed to find out the role of the family members while caring for the patients admitted in emergency unit of a tertiary care hospital. Materials and Methods: A total of 400 family members of the patients were conveniently selected. Only one member per family was interviewed and their role in taking care of the patient in acute care setting was evaluated. Results: The mean age of patients admitted in acute care setting was 46.6 yrs ± 18.8 with the age range of 18-84 years. Majority (39% of the patients were in the age group of 31-60 years. More than half of the caregivers of patients were males and 88% of them were first-degree relatives. The major tasks performed by the caregivers during the patient care was communicating with doctors/ nursing staff (98%, cleaning and dressing the patient (94%, feeding the patient (90%, procuring medication and other supplies (88%, administering oral medications (74%, changing position and helping for back care (65%, shifting the patients for investigations (60%, collecting reports (35% and providing physiotherapy (25%. Conclusions: The results of the study concluded that family involvement in acute care setting can help the nursing staff in taking care of the patient in acute care setting and it also provides the opportunity for preparing them for after care of the patients at home following discharge.
Full Text Available Rachel Mills,1 Deepak Voora,1,2 Bruce Peyser,3 Susanne B Haga1,2 1Duke Institute for Genome Sciences and Policy, 2Duke Center for Personalized and Precision Medicine, 3Duke University Medical Center, Pickett Road Primary Care Clinic, Duke University, Durham, NC, USA Abstract: Pharmacogenetic testing refers to a type of genetic test to predict a patient's likelihood to experience an adverse event or not respond to a given drug. Despite revision to several labels of commonly prescribed drugs regarding the impact of genetic variation, the use of this testing has been limited in many settings due to a number of factors. In the primary care setting, the limited office time as well as the limited knowledge and experience of primary care practitioners have likely attributed to the slow uptake of pharmacogenetic testing. This paper provides talking points for primary care physicians to discuss with patients when pharmacogenetic testing is warranted. As patients and physicians become more familiar and accepting of pharmacogenetic testing, it is anticipated that discussion time will be comparable to that of other clinical tests. Keywords: pharmacogenetics, primary care, pharmacogenetic testing, patient education
Soto, Eliezer; Stewart, Douglas R; Mannes, Andrew J.; Sarah L Ruppert; Baker, Karen; Zlott, Daniel; Handel, Daniel; Berger, Ann M.
Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to be effective not only for its anesthetic properties but also for the analgesic and opiate-sparing effects. However, data on efficacy and safety of oral ketamine for the treatment of neuropathic or cancer pain syndromes is limited with most of the evidence based on small clinical trials and anecdotal experiences. In this review, we will analyze the clinical data on oral ketamine in the palliative care setting. Afte...
Mapp, Fiona; Hutchinson, Jane; Estcourt, Claudia
HIV shared care is uncommon in the UK although shared care could be a beneficial model of care. We review the literature on HIV shared care to determine current practice and clinical, economic and patient satisfaction outcomes. We searched MEDLINE, EMBASE, NICE Evidence, Cochrane collaboration, Google and websites of the British HIV Association, Aidsmap, Public Health England, World Health Organization and Terrence Higgins Trust using relevant search terms in August 2014. Studies published after 2000, from healthcare settings comparable to the UK that described links between primary care and specialised HIV services were included and compared using principles of the Critical Appraisal Skills Programme and Authority, Accuracy, Coverage, Objectivity, Date, Significance frameworks. Three of the nine included models reported clinical or patient satisfaction outcomes but data collection and analyses were inadequate. None reported economic outcomes although some provided financial costings. Facilitators of shared care included robust clinical protocols, training and timely communication. Few published examples of HIV shared care exist and quality of evidence is poor. There is no consistent association with improved clinical outcomes, cost effectiveness or acceptability. Models are context specific, driven by local need, although some generalisable features could inform novel service delivery. Further evaluative research is needed to determine optimal components of shared HIV care. PMID:25804421
The approach to nursing in long-term care settings for people living with dementia continues to evolve from a traditional, task-oriented culture to one that is person-centred. Such change can be difficult to manage and may encounter considerable opposition; having an understanding of change management and leadership styles may help to make this transition easier. This article discusses the differences between task-oriented and person-centred care, theories of management, motivation and leadership styles, and focuses on those that are most appropriate for this type of change. An improved understanding of these theories will enable nurses to support others in the delivery of person-centred care. PMID:26938420
Immergluck, Lilly Cheng; Satola, Sarah W.; Jain, Shabnam; Courtney, McCracken; Watson, J. Reneé; Chan, Trisha; Traci, Leong; Gottlieb, Edward; Jerris, Robert C
Staphylococcus aureus colonization rates in pediatric health care workers from different types of outpatient settings were determined from December 2008 through May 2010. Colonization rates for Staphylococcus aureus and, specifically, methicillin-resistant Staphylococcus aureus (MRSA) rates were similar to the rates that have been reported for the general population. The predominant MRSA pulsed-field gel electrophoresis type associated with colonization in these health care workers is not MRS...
Ibrahim, Ahmed; Aro, Arja R.; Rasch, Vibeke;
of this study showed that VIA has higher sensitivity and lower specificity compared to Pap smear, but a combination of both tests has greater sensitivity and specificity than each test independently. It indicates that VIA is useful for screening of cervical cancer in the primary health care setting in Sudan......OBJECTIVE: To determine the feasibility of visual inspection with the use of acetic acid (VIA) as a screening method for cervical cancer, an alternative to the Pap smear used in primary health care setting in Sudan, and to compare sensitivity, specificity, positive and negative predictive values......, and histological diagnosis of positive cases of both tests. METHODS: A cross-sectional study of 934 asymptomatic women living in Khartoum, Sudan, was conducted during 2009-2010. A semi-structured questionnaire containing socio-economic and reproductive variables was used to collect data from each participant...
Greene, Talya; Neria, Yuval; Gross, Raz
Research suggests that posttraumatic stress disorder (PTSD) is common, debilitating and frequently associated with comorbid health conditions, including poor functioning, and increased health care utilization. This article systematically reviewed the empirical literature on PTSD in primary care settings, focusing on prevalence, detection and correlates. Twenty-seven studies were identified for inclusion. Current PTSD prevalence in primary care patients ranged widely between 2 % to 39 %, with significant heterogeneity in estimates explained by samples with different levels of trauma exposure. Six studies found detection of PTSD by primary care physicians (PCPs) ranged from 0 % to 52 %. Studies examining associations between PTSD and sociodemographic variables yielded equivocal results. High comorbidity was reported between PTSD and other psychiatric disorders including depression and anxiety, and PTSD was associated with functional impairment or disability. Exposure to multiple types of trauma also raised the risk of PTSD. While some studies indicated that primary care patients with PTSD report higher levels of substance and alcohol abuse, somatic symptoms, pain, health complaints, and healthcare utilization, other studies did not find these associations. This review proposes that primary care settings are important for the early detection of PTSD, which can be improved through indicated screening and PCP education. PMID:26868222
Olesen, Birgitte Ravn; Nordentoft, Helle Merete; Nørtoft, Kamilla
In the paper we explore challenges in facilitating interdisciplinary knowledge and power relations in a health care setting. Communication practices in health care are dominated by different models for how communication with patients should take place. Our pedagogical approach differs from the...... tension in a productive way and qualify health professionals´ communication competences (Nordentoft & Wistoft, 2012). Our point of departure is to see tensions and differences as dynamic and transformative forces which allow for different voices to be heard. So our intention as facilitators is to make...... and gender. This became particularly obvious in two role plays in which males with a different ethnical background played professionals. Consequently we conclude that a learning design with role play video narratives and peer collaboration has the potential 1) expose interdisciplinary diversity and...
Full Text Available Abstract Background Pediatrics ethics education should enhance medical students' skills to deal with ethical problems that may arise in the different settings of care. This study aimed to analyze the ethical problems experienced by physicians who have medical education and pediatric care responsibilities, and if those problems are associated to their workplace, medical specialty and area of clinical practice. Methods A self-applied semi-structured questionnaire was answered by 88 physicians with teaching and pediatric care responsibilities. Content analysis was performed to analyze the qualitative data. Poisson regression was used to explore the association of the categories of ethical problems reported with workplace and professional specialty and activity. Results 210 ethical problems were reported, grouped into five areas: physician-patient relationship, end-of-life care, health professional conducts, socioeconomic issues and health policies, and pediatric teaching. Doctors who worked in hospitals as well as general and subspecialist pediatricians reported fewer ethical problems related to socioeconomic issues and health policies than those who worked in Basic Health Units and who were family doctors. Conclusions Some ethical problems are specific to certain settings: those related to end-of-life care are more frequent in the hospital settings and those associated with socioeconomic issues and public health policies are more frequent in Basic Health Units. Other problems are present in all the setting of pediatric care and learning and include ethical problems related to physician-patient relationship, health professional conducts and the pediatric education process. These findings should be taken into consideration when planning the teaching of ethics in pediatrics. Trial registration This research article didn't reports the results of a controlled health care intervention. The study project was approved by the Institutional Ethical Review
Ćosić Gorana; Stefanović Slavica
Introduction. The goal is to investigate epidemiological characteristics of outbreaks of health-care-associated infections in health care institutions such as hospitals, nursing homes and ambulatory care settings. Material and methods. Relevant data associated with outbreaks in health-care settings in the period from 1980 to 2004 were retrospectively collected from epidemiological annual reports of infectious diseases in Vojvodina. Descriptive statistics were applied to the data. Results. The...
Soto, Eliezer; Stewart, Douglas R; Mannes, Andrew J; Ruppert, Sarah L; Baker, Karen; Zlott, Daniel; Handel, Daniel; Berger, Ann M
Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to be effective not only for its anesthetic properties but also for the analgesic and opiate-sparing effects. However, data on efficacy and safety of oral ketamine for the treatment of neuropathic or cancer pain syndromes is limited with most of the evidence based on small clinical trials and anecdotal experiences. In this review, we will analyze the clinical data on oral ketamine in the palliative care setting. After an extensive search using five major databases, a total of 19 relevant articles were included. No official clinical guidelines for the use of oral ketamine in this patient population were found. Studies on oral ketamine for cancer and neuropathic pain have shown mixed results which could be partially due to significant differences in hepatic metabolism. In addition, we will include a case report of a 38-year-old female with neurofibromatosis type 1 (NF1) with history of chronic, severe pain in her fingertips secondary to multiple glomus tumors which evolved into CRPS resistant to multiple therapies but responsive to oral ketamine. Based on our experience with oral ketamine, this drug should be administered after an intravenous trial to monitor response and side effects in patients with an adequate functional status. However, patients in the palliative care and hospice setting, especially the one at the end of their lives, may also benefit from oral ketamine even if an intravenous trial is not feasible. PMID:21803784
Molloy, C Johnston
A pre-school offering a full-day-care service provides for children aged 0-5 years for more than 4 h\\/d. Researchers have called for studies that will provide an understanding of nutrition and physical activity practices in this setting. Obesity prevention in pre-schools, through the development of healthy associations with food and health-related practices, has been advocated. While guidelines for the promotion of best nutrition and health-related practice in the early years\\' setting exist in a number of jurisdictions, associated regulations have been noted to be poor, with the environment of the child-care facility mainly evaluated for safety. Much cross-sectional research outlines poor nutrition and physical activity practice in this setting. However, there are few published environmental and policy-level interventions targeting the child-care provider with, to our knowledge, no evidence of such interventions in Ireland. The aim of the present paper is to review international guidelines and recommendations relating to health promotion best practice in the pre-school setting: service and resource provision; food service and food availability; and the role and involvement of parents in pre-schools. Intervention programmes and assessment tools available to measure such practice are outlined; and insight is provided into an intervention scheme, formulated from available best practice, that was introduced into the Irish full-day-care pre-school setting.
Hecker, Kent G; Norris, Jill; Coe, Jason B
Workplace-based assessment (WBA) is the process of directly observing students' work within a clinical setting, assessing their performance, and providing specific, goal oriented feedback. Assessment methods used for workplace-based assessment include tools developed for clinical interaction (e.g., the mini clinical evaluation exercise [mini-CEX]), for procedural or technical skills (e.g., the direct observation of procedural skills [DOPS]), and multi-source feedback tools to assess interpersonal and technical skills. While several of these assessment methods are being adopted by veterinary schools to evaluate students' progress through their clinical rotations, there is little reported at this time about their utility and effectiveness within the veterinary context. This article provides an introduction to the use of these tools and offers guidance in selecting appropriate methods for assessment in the primary health care setting. PMID:22951458
Mathai E; Allegranzi B; Kilpatrick C; Pittet D
Determined actions are required to address the burden due to health care-associated infections worldwide and improve patient safety. Improving hand hygiene among health care workers is an essential intervention to achieve these goals. The World Health Organization (WHO) First Global Patient Safety Challenge, Clean Care is Safer Care, pledged to tackle the problem of health care-associated infection at its launch in 2005 and has elaborated a comprehensive set of guidelines for use in both deve...
Smith, Neale; Mitton, Craig; Peacock, Stuart
Priority setting research in health economics has traditionally employed quantitative methodologies and been informed by post-positivist philosophical assumptions about the world and the nature of knowledge. These approaches have been rewarded with well-developed and validated tools. However, it is now commonly noted that there has been limited uptake of economic analysis into actual priority setting and resource allocation decisions made by health-care systems. There seem to be substantial organizational and political barriers. The authors argue in this paper that understanding and addressing these barriers will depend upon the application of qualitative research methodologies. Some efforts in this direction have been attempted; however these are theoretically under-developed and seldom rooted in any of the established qualitative research traditions. Two such approaches - narrative inquiry and discourse analysis - are highlighted here. These are illustrated with examples drawn from a real-world priority setting study. The examples demonstrate how such conceptually powerful qualitative traditions produce distinctive findings that offer unique insight into organizational contexts and decision-maker behavior. We argue that such investigations offer untapped benefits for the study of organizational priority setting and thus should be pursued more frequently by the health economics research community. PMID:18972324
Mark I Weinberger
Full Text Available Mark I Weinberger1, Camila Mateo2, Jo Anne Sirey11Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA; 2College of Public Health and Health Professions, University of Florida, Gainesville, FL, USAObjective: Older adults are particularly vulnerable to the deleterious effects of depression and tend to underutilize mental health services. The current study aims to characterize the perceived barriers to care and goal setting in a sample of depressed, community-dwelling older adults. Methods: We report on the association among perceived barriers to care, goal setting and accepting a mental health referral using a subset of data from a larger study. The Patient Health Questionnaire (PHQ-9 was used to assess depressive symptoms. Results: Forty-seven participants completed the study (Mean age = 82, SD = 7.8, 85% female. Accessing and paying for mental health treatment were the barriers most frequently cited by participants. Clinical improvement and improved socialization were most cited goals. In bivariate associations, participants who set goals (χ2 = 5.41, p = 0.02 and reported a logistic barrier (χ2 = 5.30, p = 0.02 were more likely to accept a mental health referral.Conclusion: Perceived barriers to care and goal setting appear to be central to accepting a mental health referral among community dwelling older, depressed adults. Developing interventions that can be used to increase mental health service utilization of older adults is necessary. Keywords: depression, older adults, community, perceived barriers to care
Peterson, Sarah J; Braunschweig, Carol A
Sarcopenia refers to age-associated decrease in muscle mass and function. The condition was originally described in the elderly, but emerging evidence suggests that it is also a concern among the chronically ill nonelderly. Currently there are a number of definitions for diagnosing sarcopenia; however, in the clinical setting, abdominal computed tomography (CT) scans completed for diagnostic purposes can be utilized to identify CT-defined sarcopenia. Recent studies suggest that prevalence of CT-defined sarcopenia is high among chronically ill patients, ranging from 15%-50% in patients with cancer, 30%-45% with liver failure, and 60%-70% for critically ill patients in the intensive care unit. Depleted muscle mass is associated with infectious complications, prolonged duration of mechanical ventilation, longer hospitalization, greater need for rehabilitation care after hospital discharge, and higher mortality. In consideration of the growing population of older adults with multiple comorbidities, more research is needed to identify sarcopenia and develop interventions that are directed at attenuating or reversal muscle loss. PMID:26703961
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.
King, C E
Energy-medicine therapy such as healing touch is a powerful way to promote relaxation and enhance the healing process. Healing touch is a sacred healing art and a way of caring in which practitioners use their hands as channels to assess and balance the energy field that encircles the body in order to promote the innate ability to heal. A collection of energy-based treatment modalities are used to assess and treat the human energy system. The energy system that is life is influenced by healing touch, which is used extensively in the nursing profession. This energy-medicine therapy is used in all areas of nursing. This article discusses the concepts of healing touch, the human energy field, and applications of healing touch in professional practice in the perianesthesia setting. PMID:11866025
The outcome of the chemotherapy for pulmonary, extraplumonary and disseminated tuberculosis is not well documented, especially in developing countries. This study assessed tuberculosis treatment outcome, cure-to-treatment ratio and mortality among all types of tuberculosis patients in a tertiary care setting in Saudi Arabia. All cases diagnosed and treated for active Mycobacterium tuberculosis infection between 1991 and 2000 were included retrospectively. Data collected included type of tuberculosis involvement, treatment outcome, relapse and co-morbidities. Over a ten-year period, 535 case of tuberculosis were diagnosed and treated. Isolated pulmonary tuberculosis was identified in 141 cases (26.4%), extrapulmonary tuberculosis in 339 cases (63.3%). Co-morbidities were noted in 277 (52%) patients. Immunosuppression was found in 181 (34%) cases. The cure rate was 82%. The cure-to-treatment ratio was 86% in extrapulmonary tuberculosis and 65% in disseminated tuberculosis. Overall mortality was 18%. Disseminated tuberculosis had the highest mortality (34.9%), followed by pulmonary (21.8%), the extrapulmonary tuberculosis (13.6%). Forty-seven percent of all mortalities were directly related to tuberculosis. Relapse was documented in 14 out of 349 patients (4%) who had 24 months of follow-up. Despite tertiary care support, complicated tuberculosis carries a high mortality. Earlier diagnosis and complete appropriate chemotherapy are essential for improved outcome. (author)
School nurses are in a unique position to provide care for students with special health care needs in the school setting. The incidence of chronic conditions and improved technology necessitate care of complex health care needs that had formerly been managed in inpatient settings. Delegation is a tool that may be used by registered nurses to allow…
Cohen, Bevin; Vawdrey, David K; Liu, Jianfang; Caplan, David; Furuya, E Yoko; Mis, Frederick W; Larson, Elaine
The rapidly expanding use of electronic records in health-care settings is generating unprecedented quantities of data available for clinical, epidemiological, and cost-effectiveness research. Several challenges are associated with using these data for clinical research, including issues surrounding access and information security, poor data quality, inconsistency of data within and across institutions, and a paucity of staff with expertise to manage and manipulate large clinical data sets. In this article, we describe our experience with assembling a data-mart and conducting clinical research using electronic data from four facilities within a single hospital network in New York City. We culled data from several electronic sources, including the institution's admission-discharge-transfer system, cost accounting system, electronic health record, clinical data warehouse, and departmental records. The final data-mart contained information for more than 760,000 discharges occurring from 2006 through 2012. Using categories identified by the National Institutes of Health Big Data to Knowledge initiative as a framework, we outlined challenges encountered during the development and use of a domain-specific data-mart and recommend approaches to overcome these challenges. PMID:26351216
Brandt, Nicole J; Heil, Emily
Improving the use of antimicrobial medications in the post-acute long-term care setting is critical for combating resistance and reducing adverse events in older adults. Antimicrobial stewardship refers to a set of commitments and actions designed to optimize the treatment of infectious diseases while minimizing the adverse effects associated with antimicrobial medication use. The Centers for Disease Control and Prevention recommend all nursing homes take steps to improve antimicrobial prescribing practices and reduce inappropriate use. The current article highlights initiatives and clinical considerations through a case discussion. [Journal of Gerontological Nursing, 42 (7), 10-14.]. PMID:27337183
Full Text Available Background: Infectious disease and malnutrition are common in children. Primary health care came into being to decrease the morbidity. Quality assessment is neither clinical research nor technology assessment. It is primarily an administrative device used to monitor performance to determine whether it continues to remain within acceptable bounds. Aims and Objectives: To assess the quality of service in the delivery of child health care in a primary health care setting. To evaluate client satisfaction. To assess utilization of facilities by the community. Materials and Methods: Study Type: Cross-sectional community-based study. Quality assessment was done by taking 30-50%, of the service provider. Client satisfaction was determined with 1 Immunization and child examination-90 clients each. Utilization of services was assessed among 478 households. Statistical Analysis: Proportions, Likert′s scale to grade the services and Chi-square. Results: Immunization service: Identification of needed vaccine, preparation and care was average. Vaccination technique, documentation, EPI education, maintenance of cold chain and supplies were excellent. Client satisfaction was good. Growth monitoring: It was excellent except for mother′s education andoutreach educational session . Acute respiratory tract infection care: History, physical examination, ARI education were poor. Classification, treatment and referral were excellent. Client satisfaction was good. Diarrheal disease care: History taking was excellent. But examination, classification, treatment, ORT education were poor. Conclusion: Mothers education was not stressed by service providers. Service providers′ knowledge do not go with the quality of service rendered. Physical examination of the child was not good. Except for immunization other services were average.
Wong, Martin C S; Wang, Harry H X; Kwan, Mandy W M; Chan, Wai Man; Fan, Carmen K M; Liang, Miaoyin; Li, Shannon Ts; Fung, Franklin D H; Yeung, Ming Sze; Chan, David K L; Griffiths, Sian M
The prevalence of diabetes mellitus has been increasing both globally and locally. Primary care physicians (PCPs) are in a privileged position to provide first contact and continuing care for diabetic patients. A territory-wide Reference Framework for Diabetes Care for Adults has been released by the Hong Kong Primary Care Office in 2010, with the aim to further enhance evidence-based and high quality care for diabetes in the primary care setting through wide adoption of the Reference Framework.A valid questionnaire survey was conducted among PCPs to evaluate the levels of, and the factors associated with, their adoption of the Reference Framework.A total of 414 completed surveys were received with the response rate of 13.0%. The average adoption score was 3.29 (SD 0.51) out of 4. Approximately 70% of PCPs highly adopted the Reference Framework in their routine practice. Binary logistic regression analysis showed that the PCPs perceptions on the inclusion of sufficient local information (adjusted odds ratio [aOR] = 4.748, 95%CI 1.597-14.115, P = 0.005) and reduction of professional autonomy of PCPs (aOR = 1.859, 95%CI 1.013-3.411, P = 0.045) were more likely to influence their adoption level of the Reference Framework for diabetes care in daily practices.The overall level of guideline adoption was found to be relatively high among PCPs for adult diabetes in primary care settings. The adoption barriers identified in this study should be addressed in the continuous updating of the Reference Framework. Strategies need to be considered to enhance the guideline adoption and implementation capacity. PMID:27495018
Jan P. Vlasblom
Full Text Available Many patients wish to discuss spiritual issues with nurses. Previous work has shown that nurses do so infrequently. A mixed methods research approach was used to investigate the perceptions of spiritual care of nurses and patients. Fifty-one nurses and 75 patients of five hospital departments of a non-academic hospital in the Netherlands were surveyed in 2007. We recorded the nurses’ perception of patient wishes, perceived relevance of spiritual care for patients, spiritual care provided in practice, and their evaluation of the spiritual care provided for the patients. With regard to the patients the nurses cared for, we recorded their satisfaction with the information and experiences of spiritual care provided by the nurses. Furthermore, semi-structured qualitative interviews with eight nurses examined the nurses’ perceptions of spiritual care including perceived barriers and facilitators of spiritual care giving. The nurses generally perceived spiritual care as important. The quantitative and qualitative research indicated that time to listen, availability, empathic skills, openness to other opinions, and a good relationship of trust were important facilitators. Fortyone per cent of the nurses said that few patients received sufficient attention to their spiritual needs. Patients also experienced limitations in the support for and registration of their spiritual needs. Both nurses and patients acknowledged shortcomings in the provision of spiritual care. Even though some issues may be improved relatively easily, such as registering needs, in practice giving spiritual care is complex, as it requires being available and building a relationship with the patient.
Full Text Available Abstract Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care
Paez, Kathryn A; Allen, Jerilyn K; Carson, Kathryn A; Cooper, Lisa A
A multilevel approach that enhances the cultural competence of clinicians and healthcare systems is suggested as one solution to reducing racial/ethnic disparities in healthcare. The primary objective of this cross-sectional study was to determine if there is a relationship between the cultural competence of primary care providers and the clinics where they work. Forty-nine providers from 23 clinics in Baltimore, Maryland and Wilmington, Delaware, USA completed an on-line survey which included items assessing provider and clinic cultural competence. Using simple linear regression, it was found that providers with attitudes reflecting greater cultural motivation to learn were more likely to work in clinics with a higher percent of nonwhite staff, and those offering cultural diversity training and culturally adapted patient education materials. More culturally appropriate provider behavior was associated with a higher percent of nonwhite staff in the clinic, and culturally adapted patient education materials. Enhancing provider and clinic cultural competence may be synergistic strategies for reducing healthcare disparities. PMID:18164114
Neergaard, Mette Asbjørn; Olesen, Frede; Jensen, Anders Bonde;
Background: Knowledge about the quality and organisation of care to terminally ill cancer patients with a relatives' view in a primary health care setting is limited. The aim of the study is to analyse experiences and preferences of bereaved relatives to terminally ill cancer patients in a primary...... care setting to explore barriers and facilitators for delivery of good palliative home care. Methods: Three focus group interviews with fourteen bereaved relatives in Aarhus County, Denmark. Results: Three main categories of experience were identified: 1) The health professionals' management, where a...... need to optimize was found. 2) Shared care, which was lacking. 3) The relatives' role, which needs an extra focus. Conclusion: Relatives experience insufficient palliative care mainly due to organizational and cultural problems among professionals. Palliative care in primary care in general needs...
Full Text Available Razatul Shima,1,3 Mohd Hairi Farizah,1,2 Hazreen Abdul Majid1,2 1Department of Social and Preventive Medicine; 2Centre for Population Health, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 3Ministry of Health Malaysia, Putrajaya, Malaysia Purpose: The aim of this study was to explore patients’ experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes in primary health clinic settings. Patients and methods: A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis.Results: There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients’ attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups.Conclusion: Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their
Omar Khairani; Midin Marhani; Thambu Maniam; ZamZam Ruzanna; Kaur Pervesh
Abstract Background Screening for psychiatric disorders in primary care can improve the detection rate and helps in preventing grave consequences of unrecognised and untreated psychiatric morbidity. This is relevant to the Malaysian setting where mental health care is now also being provided at primary care level. The aim of this paper is to report the prevalence of psychiatric illness in a semi-urban primary care setting in Malaysia using the screening tool Patient Health Questionnaire (PHQ)...
Full Text Available Abstract Background Screening for psychiatric disorders in primary care can improve the detection rate and helps in preventing grave consequences of unrecognised and untreated psychiatric morbidity. This is relevant to the Malaysian setting where mental health care is now also being provided at primary care level. The aim of this paper is to report the prevalence of psychiatric illness in a semi-urban primary care setting in Malaysia using the screening tool Patient Health Questionnaire (PHQ. Methods This is a cross-sectional study carried out in a semi-urban primary healthcare centre located south of Kuala Lumpur. Systematic random sampling was carried out and a total of 267 subjects completed the PHQ during the study period. Results The proportion of respondents who had at least one PHQ positive diagnosis was 24.7% and some respondents had more than one diagnosis. Diagnoses included depressive illness (n = 38, 14.4%, somatoform disorder (n = 32, 12.2%, panic and anxiety disorders (n = 17, 6.5%, binge eating disorder (n = 9, 3.4% and alcohol abuse (n = 6, 2.3%. Younger age (18 to 29 years and having a history of stressors in the previous four weeks were found to be significantly associated (p = 0.036 and p = 0.044 respectively with PHQ positive scores. Conclusion These findings are broadly similar to the findings of studies done in other countries and are a useful guide to the probable prevalence of psychiatric morbidity in primary care in other similar settings in Malaysia.
Gulmans, J.; Vollenbroek-Hutten, M.M.R.; Gemert-Pijnen, van, Julia E.W.C.; Harten, van, W.H.
Introduction: To improve communication in the integrated care setting of children with cerebral palsy, we developed a web-based system for parent-professional and inter-professional communication. The present study aimed to evaluate parents' experiences regarding the system's contribution to their communication with professionals during a 6-months pilot in three Dutch care regions. In addition, factors associated with parents' system use and non-use were analyzed. Theory and methods: The syst...
Lingler, Jennifer Hagerty; Jablonski, Rita A; Bourbonniere, Meg; Kolanowski, Ann
Informed consent to nursing home research is a two-tiered process that begins with obtaining the consent of a long-term care community at the institutional level and progresses to the engagement of individuals in the consent process. Drawing on a review of the literature and the authors’ research experiences and institutional review board service, this paper describes the practical implications of nurse investigators’ obligation to ensure informed consent among participants in long-term care ...
Iliffe, S.; Davies, N; Manthorpe, J; Crome, P; Ahmedzai, S.; Vernooij-Dassen, M; Engels, Y.
Background: There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England. / Methods: 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service...
Iliffe, Steve; Davies, Nathan; Manthorpe, Jill; Crome, Peter; Ahmedzai, Sam H; Vernooij-Dassen, Myrra; Engels, Yvonne
Background: There is a gap between readily available evidence of best practice and its use in everyday palliative care. The IMPACT study evaluated the potential of facilitated use of Quality Indicators as tools to improve palliative care in different settings in England.Methods: 1) Modelling palliative care services and selecting a set of Quality Indicators to form the core of an intervention, 2) Case studies of intervention using the Quality Indicator set supported by an expert in service ch...
This article tells the story of the 4-year consensus-building process to design quality standards for the field of family child care. Working with the National Association for Family Child Care, the Family Child Care Project at Wheelock College was funded to create an accreditation system for home-based child care programs using innovative methods…
Belche, Jean; Duchesnes, Christiane; Darras, Christian; Van der Vennet, Jean; Monet, Francis; Unger, Jean-Pierre; Giet, Didier
Integration between levels of care is not facilitated by the Belgian health system. Indeed, patients have uninhibited access to every level of care, there is no gatekeeping system, and no structural coordination between levels of care. Meanwhile, on one hand, the occurrence of more complex care situations in the ambulatory setting is enhancing the need for coordination while on the other hand, hospitals face financial constraints to provide care in the community. The aim of the research ...
Greco, Giampaolo; Shi, Wei; Michler, Robert E.; Meltzer, David O.; Ailawadi, Gorav; Hohmann, Samuel F.; Thourani, Vinod; Argenziano, Michael; Alexander, John; Sankovic, Kathy; Gupta, Lopa; Blackstone, Eugene H.; Acker, Michael A.; Russo, Mark J.; Lee, Albert; Burks, Sandra G.; Gelijns, Annetine C.; Bagiella, Emilia; Moskowitz, Alan J.; Gardner, Timothy J.
BACKGROUND Health care-associated infections (HAIs) are the most common noncardiac complications after cardiac surgery and are associated with increased morbidity and mortality. Current information about their economic burden is limited. OBJECTIVES To determine the cost associated with major types of HAIs during the first 2 months after cardiac surgery. METHODS Prospectively collected data from a multicenter observational study of the Cardiothoracic Surgery Clinical Trials Network, in which patients were monitored for infections for 65 days after surgery, were merged with related financial data, routinely collected by the University HealthSystem Consortium. Incremental length of stay (LOS) and cost associated with HAIs were estimated using generalized linear models, adjusting for patient demographics, clinical history, baseline laboratory values, and surgery type. RESULTS Among 4,320 cardiac surgery patients, mean age of 64 ± 13 years, 119 (2.8%) experienced a major HAI during the index hospitalization. The most common HAIs were pneumonia (48%), sepsis (20%) and C. Difficile colitis (18%). On average, the estimated incremental cost associated with a major HAI was nearly $38,000, of which 47% was related to intensive care unit services. The incremental LOS was 14 days. Overall, there were 849 readmissions, among these, 8.7% were attributed to major HAIs. The cost of readmissions due to major HAI was on average nearly three times as much as readmissions not related to HAI. CONCLUSIONS Hospital cost, length of stay, and readmissions are strongly associated with HAIs. These associations suggest the potential for large reductions in costs if HAIs following cardiac surgery can be reduced. PMID:25572505
Le, Sidney T; Hsia, Renee Y
Objectives To determine the community characteristics associated with non-hospital-based urgent care centres wherever they are located. Design National cross-sectional study evaluating the association between non-hospital-based urgent care centers, and their demographic characteristics in a community, using descriptive statistics and multivariate logistic regressions. Setting Communities in the USA with non-hospital-based urgent care centers, as identified using a 2014 national database from ...
Tsai, S P; Bernacki, E J; Reedy, S M
This article presents the mental health care utilization and costs among 14,162 employees and their families, covered under a major medical policy of a large multinational corporation for the 1984 policy year. Mental health care costs comprise a substantial portion of the total health care dollars expended (8.1%) for a relatively small fraction of the total number of claims (2.8%). The average hospital stay for mental disorders (20 days for employees; 15 days for spouses; 43 days for dependents) was significantly longer than for other illnesses (6.1 days for employees; 6.2 days for spouses; 4.4 days for dependents). Although the average daily hospital cost for mental disorders was less than that for non-mental conditions, total expenditures per admission were approximately three times higher due to the long lengths of stay. Case management, peer utilization review, and day treatment are recommended to reduce these costs. PMID:3681492
Cowan, Andrew J; Altemeier, William A; Johnston, Christine; Gernsheimer, Terry; Becker, Pamela S
Patients with acute myeloid leukemia (AML) who are newly diagnosed or relapsed and those who are receiving cytotoxic chemotherapy are predisposed to conditions such as sepsis due to bacterial and fungal infections, coagulopathies, hemorrhage, metabolic abnormalities, and respiratory and renal failure. These conditions are common reasons for patients with AML to be managed in the intensive care unit (ICU). For patients with AML in the ICU, providers need to be aware of common problems and how to manage them. Understanding the pathophysiology of complications and the recent advances in risk stratification as well as newer therapy for AML are relevant to the critical care provider. PMID:24756309
Kleiren, P; Sohawon, S; Noordally, S O
Even if Belgium (2002), The Netherlands (2002) and Luxemburg (2009) are the first three countries in the world to have legalized active euthanasia, there still is not a law on the do not resuscitate concept (NTBR or DNR). Nevertheless, numerous royal decrees and some consensus as well as advice given by the Belgian Medical Council, hold as jurisprudence. These rules remain amenable to change so as to suite the daily practice in intensive care units. This article describes the actual Belgian legal environment surrounding the intensive care specialist when he has to take such decisions. PMID:20687449
Full Text Available At a recent conference, a definition was drawn up that is most appropriate to the South African situation: “ Primary health care is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation, and at a cost that the community and country can afford. It forms an integral part both of the country’s health system of which it is the nucleus, and of the overall social and economic development of the community.”
Sathish, Thirunavukkarasu; Kannan, Srinivasan; Sarma, P Sankara; Razum, Oliver; Thrift, Amanda Gay; Thankappan, Kavumpurathu Raman
We used the data of 297 participants (15-64 years old) from a cohort study (2003-2010) who were free from hypertension at baseline, to develop a risk score to predict hypertension by primary health care workers in rural India. Age ≥35 years, current smoking, prehypertension, and central obesity were significantly associated with incident hypertension. The optimal cutoff value of ≥3 had a sensitivity of 78.6%, specificity of 65.2%, positive predictive value of 41.1%, and negative predictive value of 90.8%. The area under the receiver operating characteristic curve of the risk score was 0.802 (95% confidence interval = 0.748-0.856). This simple and easy to administer risk score could be used to predict hypertension in primary care settings in rural India. PMID:26354334
Explored how primary care clinician-teachers actually attempt to convey empathy to medical students and residents. Found that they stress the centrality of role modeling in teaching, and most used debriefing strategies as well as both learner- and patient-centered approaches in instructing learners about empathy. (EV)
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
Vlasblom, J.P.; Steen, van der J.T.; Jochemsen, H.
The Trent Universities Interprofessional Learning in Practice (TUILIP) project aimed to establish interprofessional learning (IPL) for healthcare students in clinical practice settings. Ten IPL facilitators were employed in eight varied practice setting pilot sites for up to a year to research, deve
Background In Kenya, cancers as a disease group rank third as a cause of death after infectious and cardiovascular diseases. It is estimated that the annual incidence of cancer is about 37,000 new cases with an annual mortality of 28,000 cases (Kenya National Cancer Control Strategy 2010). The incidence of non-communicable diseases accounts for more than 50% of total hospital admissions and over 55% of hospital deaths (Kenya National Strategy for the Prevention and Control of Non Communicable Diseases 2015–2020). The prevalence of HIV is 6.8 (KIAS 2014). Most of these patients will benefit from palliative care services, hence the need to integrate palliative care services in the public healthcare system. Method The process of integrating palliative care in public hospitals involved advocacy both at the national level and at the institutional level, training of healthcare professionals, and setting up services within the hospitals that we worked with. Technical support was provided to each individual institution as needed. Results Eleven provincial hospitals across the country have now integrated palliative care services (Palliative Care Units) and are now centres of excellence. Over 220 healthcare providers have been trained, and approximately, over 30,000 patients have benefited from these services. Oral morphine is now available in the hospital palliative care units. Conclusion As a success of the pilot project, Kenya Hospices and Palliative Care Association (KEHPCA) is now working with the Ministry of Health Kenya to integrate palliative care services in 30 other county hospitals across the country, thus ensuring more availability and access to more patients. Other developing countries can learn from Kenya’s successful experience.
Ms. Sanober Shaikh
Full Text Available In this paper a new mining algorithm is defined based on frequent item set. Apriori Algorithm scans the database every time when it finds the frequent item set so it is very time consuming and at each step it generates candidate item set. So for large databases it takes lots of space to store candidate item set. The defined algorithm scans the database at the start only once and then makes the undirected item set graph. From this graph by considering minimum support it finds the frequent item set and by considering the minimum confidence it generates the association rule. If database and minimum support is changed, the new algorithm finds the new frequent items by scanning undirected item set graph. That is why it’s executing efficiency is improved distinctly compared to traditional algorithm.
Full Text Available Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence of Levofloxacin-associated anaphylaxis is rare and delirium secondary to Levofloxacin is a seldom occurrence with only few published case reports. It is an extremely rare occurrence to see this phenomenon in combination. Early identification and prompt intervention reduces both mortality and morbidity. A 17-year-old male with synovial sarcoma of right thigh with chest wall and lung metastasis and with no prior psychiatric morbidity presented to palliative medicine outpatient department with community-acquired pneumonia. He was initiated on intravenous (IV Ceftriaxone and IV Levofloxacin. Post IV Levofloxacin patient developed anaphylaxis and acute delirium necessitating IV Hydrocortisone, IV Chlorpheneramine, Oxygen and IV Haloperidol. Early detection and prompt intervention helped in complete recovery. Patient was discharged to hospice for respite after 2 days of hospitalization and then discharged home. Acute palliative care approach facilitated management of two life-threatening medical complications in a palliative care setting improving both quality and length of life.
Jennifer Rossiter; Gursharan Soor; Deanna Telner; Babak Aliarzadeh; Jennifer Lake
Purpose. Monitoring patients' international normalized ratio (INR) within a family medicine setting can be challenging. Novel methods of doing this effectively and in a timely manner are important for patient care. The purpose of this study was to determine the effectiveness of a pharmacist-led point-of-care (POC) INR clinic. Methods. At a community-based academic Family Health Team in Toronto, Canada, charts of patients with atrial fibrillation managed by a pharmacist with usual care (bloodt...
Pierce, S F
With the advent of profit maximization in health care came an increased focus on defining quality through outcomes achieved. The article describes an analysis of the nursing literature from 1974 to 1996 using Donabedian's structure-process-outcome framework and the specific indicators identified by the American Nurses Association report card, the Institute of Medicine, and the nursing-sensitive outcomes classification. Although evidence exists documenting nursing's positive impact on patient outcomes, this analysis suggests a real need to integrate our clinical and administrative studies and to employ a more comprehensive, longitudinal, multifacility approach if we are to answer the scientific question regarding which nursing structures and processes truly produce the best health outcomes. PMID:9097521
Miller, Susan C; Mor, Vince N.T.
The last days of life for a substantial proportion of dying older adults are spent in nursing homes. Considering this, the provision of Medicare hospice care in nursing homes would appear to be an equitable use of Medicare expenditures as well as a valid investment in improving the quality of life for dying nursing home residents. However, government concerns regarding possible abuse of the hospice benefit in nursing homes, as well as suggestion that the payment for the benefit in nursing hom...
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...
Paez, Kathryn A; Allen, Jerilyn K.; Carson, Kathryn A.; Cooper, Lisa A.
A multilevel approach that enhances the cultural competence of clinicians and healthcare systems is suggested as one solution to reducing racial/ethnic disparities in healthcare. The primary objective of this cross-sectional study was to determine if there is a relationship between the cultural competence of primary care providers and the clinics where they work. Forty-nine providers from 23 clinics in Baltimore, Maryland and Wilmington, Delaware, USA. completed an on-line survey which includ...
Krystal, Andrew D; Sorscher, Adam J
Insomnia is a common feature of both medical and psychiatric disorders. Whether as a symptom of an illness or as a comorbid disorder, insomnia worsens patient outcomes related to quality of life, functioning, workplace productivity, and health care expenditures. This CME webcast covers how to screen for insomnia in patients with both medical and mental illnesses and how to develop a comprehensive treatment plan. The authors also review evidence-based therapies for insomnia, including psychological/behavioral interventions and medications. PMID:27137433
Konrad Obermann; Keith Tolley
A structured questionnaire survey of all 131 health authorities in England, Wales and Scotland was carried out between September 1995 and January 1996. The priority setting questionnaire was sent to chairpersons or chief executives of each health authority, although respondents had a variety of job titles. The objectives of the survey was to assess (i) To assess the extent to which health authorities in England, Wales and Scotland perceive themselves as involved in setting priorities for heal...
Full Text Available Introduction: The Ramsay Hunt syndrome is characterized by combination of herpes infection and lower motor neuron type of facial nerve palsy. The disease is caused by a reactivation of Varicella Zoster virus and can be unrepresentative since the herpetic lesions may not be always be present (zoster sine herpete and might mimic other severe neurological illnesses. Case Report: A 63-year-old man known case of carcinoma of gall bladder with liver metastases, post surgery and chemotherapy with no scope for further disease modifying treatment, was referred to palliative care unit for best supportive care. He was on regular analgesics and other supportive treatment. He presented to Palliative Medicine outpatient with 3 days history of ipsilateral facial pain of neuropathic character, otalgia, diffuse vesciculo-papular rash over ophthalmic and maxillary divisions of left trigeminal nerve distribution of face and ear, and was associated with secondary bacterial infection and unilateral facial edema. He was clinically diagnosed to have Herpes Zoster with superadded bacterial infection. He was treated with tablet Valacyclovir 500 mg four times a day, Acyclovir cream for local application, Acyclovir eye ointment for prophylactic treatment of Herpetic Keratitis, low dose of Prednisolone, oral Amoxicillin and Clindamycin for 7 days, and Pregabalin 150 mg per day. After 7 days of treatment, the rash and vesicles had completely resolved and good improvement of pain and other symptoms were noted. Conclusion: Management of acute infections and its associated complications in an acute palliative care setting improves both quality and length of life.
Young children bite each other frequently in child care settings, but the bites rarely break the skin and the risk of infection is minimal. Nevertheless, parents and child care personnel may be concerned about infection, especially with blood-borne viruses. The present document reviews the literature concerning infections following bites in child care settings, and provides recommendations for prevention and management of such incidents.
Swafford, Kristen L.; Miller, Lois L.; Herr, Keela; Forcucci, Chris; Kelly, Anne Marie L.; Bakerjian, Debra
Pain in older adults is a prevalent problem that affects quality of life and challenges nurses, particularly those caring for older adults living in long term care settings. Despite the national priority of pain management, insufficient knowledge of nurses about geriatric pain is a documented barrier to effective geriatric pain management in all long term care settings. To address this knowledge gap, a website (GeriatricPain.org) was developed by the National Geriatric Pain Collaborative with...
Haycock-Stuart, Elaine; Kean, Susanne
Aim To examine perceptions about how nursing leadership affects quality of care in the community setting.Background Quality care is considered an essential component of nursing work and recent policy has emphasized the role of leadership in meeting the quality agenda. As shifting the balance of nursing care from the hospital to the community occurs in the UK, there is an imperative to confirm more effectively the quality of care that patients and families receive from nurses working in the ...
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.
Research suggests that the experience of being a lesbian or bisexual woman influences women's interactions with health care providers, and their perception of the quality of care. Limited research to date, however, has examined how ageing and sexuality mediates women's experiences of quality, when accessing health care in the community. To fill a gap in the literature, this study investigated older lesbian and bisexual women's perspectives on the meaning of quality of care in the context of receiving home care services. This was a qualitative single case study. Sixteen participants, aged 55-72 from Ontario, Canada, participated in semi-structured interviews between 2011 and 2012. The interviews were recorded and transcribed. The interview data were analysed using iterative thematic analysis and guided by a feminist ethic of care perspective. Participants described quality of care in ways that were in line with a feminist ethic of care; that is, they wanted care providers to be responsive and attentive to their needs, to involve them in the caring process and to demonstrate respect and caring. Participants also indicated that providers' comfort with, and knowledge of, sexual diversity was important for enabling quality of care. These findings deepen our understanding of how to support quality of care for this population through changes to provider education and training, and health policy. PMID:25919504
James R Warren
Full Text Available Deficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins.We linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR and usual provider continuity index (UPI for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR and 95% confidence interval (CI for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample.36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04-1.06 for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15-1.54.Greater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.
Elizabeth A Blain, Timothy J CraigPenn State Hershey Medical Center, Hershey, PA, USAObjective: To determine the use of spirometry in family practice, internal medicine, and pediatric outpatient settings.Methods: Data were collected from 45 outpatient offices in the central Pennsylvania area via phone survey that asked a set of four questions: 1) Do you have spirometry in your office? 2) Do you use spirometry for asthma patients? 3) In what situation do you use spirometry for? 4) Do you use s...
Flanagan, J. R.; Walker, K. P.
In a new primary care setting with three medical disciplines participating, a vaccine history and order entry system was implemented along with other online documentation systems as the primary documentation tools for the clinic. Reminders were generated based upon a set of algorithms consistent with 1998 nationally accepted vaccine guidelines. Vaccine compliance data were analyzed for the entire population cared for in this setting for a 6 month period. Rates of compliance with national reco...
Independent sets play a key role into the study of graphs and important problems arising in graph theory reduce to them. We define the monomial ideal of independent sets associated to a finite simple graph and describe its homological and algebraic invariants in terms of the combinatorics of the graph. We compute the minimal primary decomposition and characterize the Cohen--Macaulay ideals. Moreover, we provide a formula for computing the Betti numbers, which depends only on the coefficients ...
Nowell, Zoe C; Thornton, Amanda; Simpson, Jane
Within the social psychological understanding of dementia, individuals' personhood is central. A respect for personhood has been linked to successful person-centred care, yet research exploring subjective personhood in dementia is scarce. This study aimed to understand personhood by exploring the subjective experiences of those with dementia. Seven individuals with dementia were interviewed and interpretative phenomenological analysis was used to identify themes across accounts. Themes identified were: (1) working out the system and adapting in order to survive it--the 'peoplehood' of the system; (2) using past and future roles and experiences to manage the present--the transient nature of personhood; (3) being both an individual and a member of a group--the conflict of a dual role. The themes highlighted showed that individuals with dementia supported their personhood by drawing on their own, others' and the system's resources. The findings are discussed and links with existing literature and clinical implications are considered. PMID:24336951
Hakan Tağrıkulu,; Dilek Memiş; Nesrin Turan
Objective: Mechanical ventilator associated pneumonia is a serious infection occurred frequently in intensive care units and associated with high mortality. In this study we aimed to investigate the incidence of ventilator associated pneumonia, the duration of mechanical ventilation, length of intensive care unit stay, complication occurrence and mortality rates on patients undergoing mechanical ventilation for more than 48 hours. Material and Method: Two hundred...
Stevens, Wendy; Gous, Natasha; Ford, Nathan; Scott, Lesley E
Improved access to anti-retroviral therapy increases the need for affordable monitoring using assays such as CD4 and/or viral load in resource-limited settings. Barriers to accessing treatment, high rates of loss to initiation and poor retention in care are prompting the need to find alternatives to conventional centralized laboratory testing in certain countries. Strong advocacy has led to a rapidly expanding repertoire of point-of-care tests for HIV. point-of-care testing is not without its challenges: poor regulatory control, lack of guidelines, absence of quality monitoring and lack of industry standards for connectivity, to name a few. The management of HIV increasingly requires a multidisciplinary testing approach involving hematology, chemistry, and tests associated with the management of non-communicable diseases, thus added expertise is needed. This is further complicated by additional human resource requirements and the need for continuous training, a sustainable supply chain, and reimbursement strategies. It is clear that to ensure appropriate national implementation either in a tiered laboratory model or a total decentralized model, clear country-specific assessments need to be conducted. PMID:25197773
Wilbur, Kerry; Al-Okka, Maha; Jumaat, Ebaa; Eissa, Nesma; Elbashir, Merwa; Al-Yafei, Sumaya M Al Saadi
Purpose Cancer treatments are frequently associated with adverse effects, but there may be a cultural reluctance by care providers to be forthcoming with patients regarding these risks for fear of promoting nonadherence. Conversely, research in a number of countries indicates high levels of patient desire for this information. We sought to explore cancer patient experiences, satisfaction, and preferences for medication risk communication in a Middle East care setting. Methods We developed and administered a ten-item questionnaire (Arabic and English) to a convenience sample of consenting adult patients receiving treatment at the National Center for Cancer Care and Research in Qatar. Results One hundred and forty-three patients were interviewed. Most (88%) stated that the level of side effect information they received was sufficient, with physicians (86%) followed by pharmacists (39%) as the preferred sources. The majority (97%) agreed that knowing about possible side effects would help them recognize and manage the reaction, and 92% agreed that it would help them understand how to minimize or prevent the risks. Eighteen percent indicated that this information would make them not want to take treatment. Two-thirds (65%) had previously experienced intolerance to their cancer treatment regimen. Conclusion Most patients surveyed expressed preference for the details of possible side effects they may encounter in their treatment. However, one in five considered such information a factor for nonadherence, indicating the need for patient-specific approaches when communicating medication risks. PMID:27175061
Benign prostate hyperplasia (BPH) occurs in up to 50% of men by age 50, and the incidence increases with age. This common clinical problem is diagnosed by history, including the International Prostate Symptom Score (IPSS) questionnaire, and physical examination by digital rectal examination (DRE). Initial management for BPH includes lifestyle modification, and smooth muscle relaxant alpha blocker therapy. Alpha blockers usually take effect quickly within 3-5 days, and have minimal side effects. Current commonly used alpha blockers include the selective alpha blockers tamsulosin (Flomax), alfusosin (Xatral), and silodosin (Rapaflo). For patients with larger prostates, the 5-alpha reductase inhibitor class (finasteride (Proscar) and dutasteride (Avodart)) work effectively to shrink prostate stroma resulting in improved voiding. The 5-ARI class of drugs, in addition to reducing prostate size, also reduce the need for future BPH-related surgery, and reduce the risk of future urinary retention. Drugs from the phosphodiesterase-5 (PDE-5) inhibitor class may now be considered for treating BPH. Once daily 5 mg tadalafil has been shown to improve BPH-related symptoms and is currently approved to treat patients with BPH. Referral to a urologist can be considered for patients with a rising prostate-specific antigen (PSA), especially while on 5-ARI, failure of urinary symptom control despite maximal medical therapy, suspicion of prostate cancer, hematuria, recurrent urinary infections, urinary retention, or renal failure. Currently the primary care physician is armed with multiple treatment options to effectively treat men with symptomatic BPH. PMID:23089343
Perry, M.; Draskovic, I.; Achterberg, T. van; Eijken, M.I.J. van; Lucassen, P.L.B.J.; Vernooij-Dassen, M.J.F.J.; Olde Rikkert, M.G.M.
OBJECTIVES: To construct a set of quality indicators (QIs) for dementia diagnosis and management in a primary care setting. DESIGN: RAND modified Delphi method, including a postal survey, a stakeholders consensus meeting, a scientific expert consensus meeting, and a demonstration project. SETTING: P
Liu, Xiaotong; Shen, Han-Wei
The heterogeneity and complexity of multivariate characteristics poses a unique challenge to visual exploration of multivariate scientific data sets, as it requires investigating the usually hidden associations between different variables and specific scalar values to understand the data's multi-faceted properties. In this paper, we present a novel association analysis method that guides visual exploration of scalar-level associations in the multivariate context. We model the directional interactions between scalars of different variables as information flows based on association rules. We introduce the concepts of informativeness and uniqueness to describe how information flows between scalars of different variables and how they are associated with each other in the multivariate domain. Based on scalar-level associations represented by a probabilistic association graph, we propose the Multi-Scalar Informativeness-Uniqueness (MSIU) algorithm to evaluate the informativeness and uniqueness of scalars. We present an exploration framework with multiple interactive views to explore the scalars of interest with confident associations in the multivariate spatial domain, and provide guidelines for visual exploration using our framework. We demonstrate the effectiveness and usefulness of our approach through case studies using three representative multivariate scientific data sets. PMID:26529739
Platt, Richard; Caldwell, Blake
Managed-care organizations have a unique opportunity, still largely unrealized, to collaborate with health-care providers and epidemiologists to prevent health care-associated infections. Several attributes make these organizations logical collaborators for infection control programs: they have responsibility for defined populations of enrollees and for their overall health, including preventive care; they possess unique data resources about their members and their care; and they are able to ...
Justin K. Benzer
Full Text Available Objective. There is limited theory regarding the real-world implementation of mental health care in the primary care setting: a type of organizational coordination intervention. The purpose of this study was to develop a theory to conceptualize the potential causes of barriers and facilitators to how local sites responded to this mandated intervention to achieve coordinated mental health care. Methods. Data from 65 primary care and mental health staff interviews across 16 sites were analyzed to identify how coordination was perceived one year after an organizational mandate to provide integrated mental health care in the primary care setting. Results. Standardized referral procedures and communication practices between primary care and mental health were influenced by the organizational factors of resources, training, and work design, as well as provider-experienced organizational boundaries between primary care and mental health, time pressures, and staff participation. Organizational factors and provider experiences were in turn influenced by leadership. Conclusions. Our emergent theory describes how leadership, organizational factors, and provider experiences affect the implementation of a mandated mental health coordination intervention. This framework provides a nuanced understanding of the potential barriers and facilitators to implementing interventions designed to improve coordination between professional groups.
Full Text Available Preetinder S Gill,1 Ashwini Kamath,2 Tejkaran S Gill31College of Technology, Eastern Michigan University, Ypsilanti, MI, USA; 2School of Information, University of Texas, Austin, TX, USA; 3College of Engineering, University of Michigan, Ann Arbor, MI, USAAbstract: Smartphone use in health care work settings presents both opportunities and challenges. The benefits could be severely undermined if abuse and overuse are not kept in check. This practice-focused research paper examines the current panorama of health software applications. Findings from existing research are consolidated to elucidate the level and effects of distraction in health care work settings due to smartphone use. A conceptual framework for crafting guidelines to regulate the use of smartphones in health care work settings is then presented. Finally, specific guidelines are delineated to assist in creating policies for the use of smartphones in a health care workplace.Keywords: smartphone, health care, distraction, workplace, mobile apps, health informatics
Rabia, K; Khoo, E M
The aims of the study were to determine the prevalence of peripheral arterial disease (PAD) in diabetic patients and in different ethnic groups at a primary care setting, and to evaluate risk factors associated with PAD in these diabetic patients. A cross sectional study of 200 diabetic patients over 18 years old who attended a primary care clinic at a teaching hospital in Kuala Lumpur, Malaysia was carried out. Face-to-face interviews were conducted using structured questionnaires for demographic characteristics and risk factors evaluation. Blood pressure measurements, assessment of peripheral neuropathy and ankle brachial pressures were performed. PAD was diagnosed by an ankle brachial pressure index (ABPI) of <0.9 on either leg. The overall prevalence of PAD was 16% in this diabetic population. The prevalence of PAD was 5.8% in Malays, 19.4% in Chinese and 19.8% in Indians. The prevalence of peripheral neuropathy was 41%, foot ulcer 9.5%, and gangrene 3.0%. The presence of foot ulcer was weakly associated with PAD (P=0.052). No significant relationships were found between age, gender, smoking status, duration of diabetes mellitus, hypertension, dyslipidaemia, and PAD. PAD is common in the diabetic population of this study. PMID:18705445
Mansfield Richard J
Full Text Available Abstract Background Although shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting. Methods We performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000. Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection were examined. Results Shoulder pain was associated with an injury in one third (33.2% (230/692 of office visits in this population of US primary care physicians. Males, and younger adults (age ≤ 52 more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202 of visits. An x-ray was performed in 29.0% (164/566 of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound was infrequently performed (6.5%, 37/566. Physiotherapy was ordered in 23.9% (135/566 of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set. Conclusion These data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices.
Morsø, Lars; Kent, Peter; Manniche, Claus; Albert, Hanne B
The predictive ability of the STarT Back Tool (SBT) in secondary care settings has not been investigated. The aim of this study was to determine the SBT's predictive ability in a Danish secondary care setting and compare this to a Danish primary care setting.......The predictive ability of the STarT Back Tool (SBT) in secondary care settings has not been investigated. The aim of this study was to determine the SBT's predictive ability in a Danish secondary care setting and compare this to a Danish primary care setting....
Napolskikh, J.; Selby, D.; Bennett, M.; Chow, E.; Harris, K; Sinclair, E.; Myers, J.
Background Canadian data describing inpatient palliative care unit (pcu) utilization are scarce. In the present study, we performed a quality assessment of a 24-bed short-term pcu with a 3-months-or-less life expectancy policy in a tertiary care setting. Methods Using a retrospective chart review, we explored wait time (wt) for admission (May 2005 to April 2006), length of stay [los (February 2005 to January 2006)], and patient demographics. Results The wt data showed 508 referrals, with 242 ...
Webair, Hana H; Al-assani, Salwa S.; Al-haddad, Reema H.; Al-Shaeeb, Wafa H.; Bin Selm, Manal A.; Alyamani, Abdulla S.
Background Patient safety culture in primary care is the first step to achieve high quality health care. This study aims to provide a baseline assessment of patient safety culture in primary care settings in Al-Mukala, Yemen as a first published study from a least developed country. Methods A survey was conducted in primary healthcare centres and units in Al-Mukala District, Yemen. A comprehensive sample from the available 16 centres was included. An Arabic version of the Medical Office Surve...
Testuz, Ariane Marie; Müller, Hajo; Keller, Pierre-Frédéric; Meyer, Philippe; Stampfli, Tomoe Elianne Lybia; Sekoranja, Lucka; Vuille, Cédric; Burri, Haran Kumar
Pocket-size echographs may be useful for bedside diagnosis in acute cardiac care, but their diagnostic accuracy in this setting has not been well tested. Our aim was to evaluate this tool in patients requiring an urgent echocardiogram.
Cornelissen, Evelyn; Mitton, Craig; Davidson, Alan; Reid, Colin; Hole, Rachelle; Visockas, Anne-Marie; Smith, Neale
Purpose - Program budgeting and marginal analysis (PBMA) is a priority setting approach that assists decision makers with allocating resources. Previous PBMA work establishes its efficacy and indicates that contextual factors complicate priority setting, which can hamper PBMA effectiveness. The purpose of this paper is to gain qualitative insight into PBMA effectiveness. Design/methodology/approach - A Canadian case study of PBMA implementation. Data consist of decision-maker interviews pre (n=20), post year-1 (n=12) and post year-2 (n=9) of PBMA to examine perceptions of baseline priority setting practice vis-à-vis desired practice, and perceptions of PBMA usability and acceptability. Findings - Fit emerged as a key theme in determining PBMA effectiveness. Fit herein refers to being of suitable quality and form to meet the intended purposes and needs of the end-users, and includes desirability, acceptability, and usability dimensions. Results confirm decision-maker desire for rational approaches like PBMA. However, most participants indicated that the timing of the exercise and the form in which PBMA was applied were not well-suited for this case study. Participant acceptance of and buy-in to PBMA changed during the study: a leadership change, limited organizational commitment, and concerns with organizational capacity were key barriers to PBMA adoption and thereby effectiveness. Practical implications - These findings suggest that a potential way-forward includes adding a contextual readiness/capacity assessment stage to PBMA, recognizing organizational complexity, and considering incremental adoption of PBMA's approach. Originality/value - These insights help us to better understand and work with priority setting conditions to advance evidence-informed decision making. PMID:27296887
Guruge, Sepali; McGilton, Katherine; Yetman, Linda; Campbell, Heather; Librado, Ruby; Bloch, Lois; Ladak, Salima
Most literature on staff-family relationships has come from studies of long-term care settings, has focused mainly on the families' perspectives on factors affecting their relationships with staff, and has included scant findings from the staff's perspective. No studies that examined staff-family relationships in complex continuing care (CCC)…
N Ann Scott
Full Text Available OBJECTIVE: To ascertain knowledge gaps in the diagnosis and treatment of acute and chronic low back pain (LBP in the primary care setting to prepare a scoping survey for identifying knowledge gaps in LBP management among Alberta’s primary care practitioners, and to identify potential barriers to implementing a multidisciplinary LBP guideline.
Lim, Cynthia; Lim, Sirene May-Yin
While there has been extensive research exploring the quality of caregiver-child interactions in programmes for preschool children, comparatively less international research has explored the nature of caregiver-child interactions in centre-based infant-care programmes. Nine caregivers in six Singapore infant-care settings were observed and…
Massey, Philip M.; Prelip, Michael; Calimlim, Brian M.; Quiter, Elaine S.; Glik, Deborah C.
The current emphasis on preventive health care and wellness services suggests that measures of skills and competencies needed to effectively navigate the health care system need to be better defined. We take an expanded perspective of health literacy and define it as a set of skills used to organize and apply health knowledge, attitudes and…
L. V. Laktionova
Full Text Available The paper discusses the issues of setting up a quality management system in a multidisciplinary specialized clinical research center. It describes the experience with information technologies used in a prophylactic facility to set up effective out- and inpatient health care control. Measures to optimize work under present-day conditions to upgrade the quality of health care are given using the federal health facility as an example.
Yemofio Francis; Akhanjee Lutful; Farooq Muhammad A; Bell Douglas; Hindman David; Bazargan Mohsen; Ani Chizobam; Baker Richard; Rodriguez Michael
Abstract Background To examine the agreement between depression symptoms using an assessment tool (PHQ-9), and physician documentation of the same symptoms during a clinic visit, and then to examine how the presence of these symptoms affects depression diagnosis in primary care settings. Methods Interviewer administered surveys and medical record reviews. A total of 304 participants were recruited from 2321 participants screened for depression at two large urban primary care community setting...
Teichert, Martina; Schoenmakers, Tim; Kylstra, Nico; Mosk, Berend; Bouvy, Marcel L; van de Vaart, Frans; De Smet, Peter A G M; Wensing, Michel
Background The quality of pharmaceutical care in community pharmacies in the Netherlands has been assessed annually since 2008. The initial set has been further developed with pharmacists and patient organizations, the healthcare inspectorate, the government and health insurance companies. The set over 2012 was the first set of quality indicators for community pharmacies which was validated and supported by all major stakeholders. The aims of this study were to describe the validated set of q...
Hussein, Shereen; Manthorpe, Jill
In the UK context of financial austerity and the promotion of the social responsibility through the concept of the "Big Society," volunteers are becoming a more important part of the labor workforce. This is particularly so in the long-term care (LTC) sector, where both shortages of staff and demands for support are particularly high. This article investigate the levels and profile of contribution of volunteers in the LTC sector using a large national data set, National Minimum Data Set for Social Care, linked to local area levels of rurality and socio-economic status. The analysis shows that volunteer activity in formal care services varies between sectors and service types, with no strong relationship between local area deprivation, unemployment levels, and levels of volunteering. However, some significant association was found with level of rurality. The contribution of volunteers is most evident in provision of counseling, support, advocacy, and advice. PMID:25332302
Mariet Caroline, MPT,
Full Text Available Child care workers are those who take care of children in the absence of their parents. Child care workers are exposed to various kinds of occupational injuries which include infections, sprains and strains, trauma like bites from children, trip falls and noise exposure. The risks of injury among these workers are due to their nature of the job. One of the common occupational risks found in these workers is musculoskeletal injury, it occurs as a result of working in awkward postures such as bending, twisting, lifting and carrying in incorrect positions, which may result in various injuries like strain, sprain and soft tissue ruptures. Workers with poor physical conditioning may tend to undergo these changes very rapidly. The purpose of this study was to find out the prevalence of various musculoskeletal disorders in child care workers who are taking care of the babies. The study was conducted around various day care centres, among 160 women from who were chosen for the study and were given musculoskeletal analysis questionnaires (Nordic musculoskeletal questionnaire , The Questionnaires were evaluated using descriptive statistics, analysed using SPSS and the results were computed in percentage. Following the analysis, it was concluded that low back injury was predominant among 44% of workers followed by 18% with neck pain, 11% of shoulder pain, 9% of knee pain, 7% of elbow, 6% of wrist, 4% of others and surprisingly 1 % had no musculoskeletal complaints.
Thomson, E M
In 1985, the ADHA, in response to the changing health care environment, identified six roles for the future of dental hygiene. The administrator/manager role, one of the six, is an expansion of dental hygiene skills to facilitate the provision of quality oral health care. Oral health care settings require personnel trained in management to accomplish practice-related goals and objectives. Dental hygiene is preparing individuals to assume managerial roles to fill this health care need. This paper discusses the skills and knowledge level required to assume managerial roles and strategies for marketing the dental hygienist as a manager. PMID:2637342
Irons, Brian; Evans, Lance; Bogschutz, Renee; Panasci, Kathryn; Sun, Grace
Interprofessional education (IPE) is an important component of healthcare professional curriculum in order to optimally prepare students for their roles as part of the healthcare team. Integrating IPE activities into direct patient care in the primary care clinic setting can help improve perceptions and student understanding of other healthcare professionals' responsibilities in this ever-evolving practice setting. This report describes the implementation of an interprofessional clinic including a variety of healthcare professionals and students in the context of the Medicare Annual Wellness Visits (AWV). Design of the clinic and general roles of the professionals in optimising preventive care are described. Student perceptions of IPE and their knowledge of other healthcare professionals were also surveyed. Student knowledge of other professionals mildly improved. Student perception of actual cooperation and interprofessional interaction statistically improved, while perception of interprofessional learning slightly worsened. Utilising Medicare AWVs can be a way for various professionals to improve IPE in the primary care setting. PMID:27219719
Full Text Available Abstract Background Population ageing, the emergence of chronic illness, and the shift away from institutional care challenge conventional approaches to assessment systems which traditionally are problem and setting specific. Methods From 2002, the interRAI research collaborative undertook development of a suite of assessment tools to support assessment and care planning of persons with chronic illness, frailty, disability, or mental health problems across care settings. The suite constitutes an early example of a "third generation" assessment system. Results The rationale and development strategy for the suite is described, together with a description of potential applications. To date, ten instruments comprise the suite, each comprising "core" items shared among the majority of instruments and "optional" items that are specific to particular care settings or situations. Conclusion This comprehensive suite offers the opportunity for integrated multi-domain assessment, enabling electronic clinical records, data transfer, ease of interpretation and streamlined training.
Courtney, M; Tong, S; Walsh, A
Many studies reporting nurses' knowledge of and attitudes toward older patients in long-term care settings have used instruments designed for older people. However, nurses' attitudes toward older patients are not as positive as their attitudes toward older people. Few studies investigate acute care nurses' knowledge of and attitudes toward older patients. In order to address these shortcomings, a self-report questionnaire was developed to determine nurses' knowledge of, and attitudes and practices toward, older patients in both rural and metropolitan acute care settings. Rural nurses were more knowledgeable about older patients' activities during hospitalisation, the likelihood of them developing postoperative complications and the improbability of their reporting incontinence. Rural nurses also reported more positive practices regarding pain management and restraint usage. However, metropolitan nurses reported more positive attitudes toward sleeping medications, decision making, discharge planning and the benefits of acute gerontological units, and were more knowledgeable about older patients' bowel changes in the acute care setting. PMID:11111426
Mintzer, Ira L.; Eisenberg, Mark; Terra, Maria; MacVane, Casey; Himmelstein, David U.; Woolhandler, Steffie
PURPOSE Office-based treatment of opioid addiction with a combination of buprenorphine and naloxone was approved in 2002. Efficacy of this treatment in nonresearch clinical settings has not been studied. We examined the efficacy and practicality of buprenorphine-naloxone treatment in primary care settings.
Silberstein, Stephen D
Migraine is a common disabling brain disorder that affects one in seven US citizens annually. The burden of migraine is substantial, both in economic terms and for individual patients and their close family members. Initial medical consultations for migraine are usually with a primary care physician (PCP), and it is predominantly managed in a primary care setting; therefore, PCPs need a thorough understanding of migraine and the treatment options. This review provides an overview of the prevalence, symptoms, burden, and diagnosis of migraine with a focus on adults. Important aspects of migraine management, such as medication overuse and chronic migraine, are highlighted and insight is provided into factors for consideration when prescribing acute/abortive treatment for migraine to ensure that individual patients receive optimal pharmaceutical management. The effects of associated symptoms, e.g. nausea/vomiting, on treatment efficacy are pertinent in migraine; however, many therapy options, including alternative delivery systems, are available, thus facilitating the selection of optimal treatment for an individual patient. PMID:27078039
Kaasalainen, Sharon; Brazil, Kevin; Wilson, Donna M; Willison, Kathleen; Marshall, Denise; Taniguchi, Alan; Williams, Allison
Nurses have key roles in the coordination and delivery of community-based palliative care. The purpose of this study was to examine the differences between rural and urban community nurses' delivery of palliative care services. A survey was distributed to 277 nurses employed by a community agency in Ontario, Canada, and a 60% response rate was obtained. Nurses reported spending 27% of their time providing palliative care. Rural and urban nurses had similar roles in palliative care but rural nurses spent more time travelling and were more confident in their ability to provide palliative care. Both groups of nurses reported moderate job satisfaction and moderate satisfaction with the level of interdisciplinary collaboration in their practice. Several barriers to and facilitators of optimal palliative care provision were identified. The study results provide information about the needs of nurses that practise in these settings and may provide a basis for the development of strategies to address these needs. PMID:21841703
Full Text Available Oral care is a crucial routine for patients with dysphagia that, when completed routinely, can prevent the development of aspiration pneumonia. There is no standardised protocol for oral care within government hospitals in South Africa. This study aimed to investigate the outcome of an oral care protocol. Participants were patients with oropharyngeal dysphagia, with either stroke or traumatic brain injury as the underlying medical pathology, and nurses. All participants were recruited from one tertiary level government hospital in Gauteng, South Africa. 139 nurses participated in the study and received training on the oral care protocol. There were two groups of participants with oropharyngeal dysphagia. Group one (study group, n = 23 was recruited by consecutive sampling, received regular oral care and were not restricted from drinking water; however, all other liquids were restricted. Group two (comparison group, n = 23 was recruited via a retrospective record review, received inconsistent oral care and were placed on thickened liquids or liquid restricted diets. Results showed that a regimen of regular oral care and free water provision when combined with dysphagia intervention did prevent aspiration pneumonia in patients with oropharyngeal dysphagia. The article highlights two key findings: that regular and routine oral care is manageable within an acute government hospital context and a strict routine of oral care can reduce aspiration pneumonia in patients with oropharyngeal dysphagia. An implication from these findings is confirmation that teamwork in acute care settings in developing contexts must be prioritised to improve dysphagia management and patient prognosis.
Seedat, Jaishika; Penn, Claire
Oral care is a crucial routine for patients with dysphagia that, when completed routinely, can prevent the development of aspiration pneumonia. There is no standardised protocol for oral care within government hospitals in South Africa. This study aimed to investigate the outcome of an oral care protocol. Participants were patients with oropharyngeal dysphagia, with either stroke or traumatic brain injury as the underlying medical pathology, and nurses. All participants were recruited from one tertiary level government hospital in Gauteng, South Africa. 139 nurses participated in the study and received training on the oral care protocol. There were two groups of participants with oropharyngeal dysphagia. Group one (study group, n = 23) was recruited by consecutive sampling, received regular oral care and were not restricted from drinking water; however, all other liquids were restricted. Group two (comparison group, n = 23) was recruited via a retrospective record review, received inconsistent oral care and were placed on thickened liquids or liquid restricted diets. Results showed that a regimen of regular oral care and free water provision when combined with dysphagia intervention did prevent aspiration pneumonia in patients with oropharyngeal dysphagia. The article highlights two key findings: that regular and routine oral care is manageable within an acute government hospital context and a strict routine of oral care can reduce aspiration pneumonia in patients with oropharyngeal dysphagia. An implication from these findings is confirmation that teamwork in acute care settings in developing contexts must be prioritised to improve dysphagia management and patient prognosis. PMID:26974243
Hummel, Manuela; Metzeler, Klaus H.; Buske, Christian; Bohlander, Stefan K.; Mansmann, Ulrich
Background The development of expression-based gene signatures for predicting prognosis or class membership is a popular and challenging task. Besides their stringent validation, signatures need a functional interpretation and must be placed in a biological context. Popular tools such as Gene Set Enrichment have drawbacks because they are restricted to annotated genes and are unable to capture the information hidden in the signature’s non-annotated genes. Methodology We propose concepts to relate a signature with functional gene sets like pathways or Gene Ontology categories. The connection between single signature genes and a specific pathway is explored by hierarchical variable selection and gene association networks. The risk score derived from an individual patient’s signature is related to expression patterns of pathways and Gene Ontology categories. Global tests are useful for these tasks, and they adjust for other factors. GlobalAncova is used to explore the effect on gene expression in specific functional groups from the interaction of the score and selected mutations in the patient’s genome. Results We apply the proposed methods to an expression data set and a corresponding gene signature for predicting survival in Acute Myeloid Leukemia (AML). The example demonstrates strong relations between the signature and cancer-related pathways. The signature-based risk score was found to be associated with development-related biological processes. Conclusions Many authors interpret the functional aspects of a gene signature by linking signature genes to pathways or relevant functional gene groups. The method of gene set enrichment is preferred to annotating signature genes to specific Gene Ontology categories. The strategies proposed in this paper go beyond the restriction of annotation and deepen the insights into the biological mechanisms reflected in the information given by a signature. PMID:19812786
Pandey, Anjana; Pardasani, K. R.
In this paper, the mining of hybrid association rules with rough set approach is investigated as the algorithm RSHAR.The RSHAR algorithm is constituted of two steps mainly. At first, to join the participant tables into a general table to generate the rules which is expressing the relationship between two or more domains that belong to several different tables in a database. Then we apply the mapping code on selected dimension, which can be added directly into the information system as one cer...
van de Sande-Bruinsma, Nienke; Leverstein van Hall, Maurine A; Janssen, Maria; Nagtzaam, Nynke; Leenders, Sander; Sabine C de Greeff; Schneeberger, Peter M
Objectives The Netherlands is known for a stringent search and destroy policy to prevent spread of MRSA. In the hospital setting, livestock-associated MRSA (LA-MRSA) is frequently found in patients coming from the high density farming area in the south of the Netherlands. The aim of the study was to determine the contribution of LA-MRSA in the epidemiology of MRSA in cases found following the Dutch search and destroy policy. Patients and methods From two hospitals serving a population of 550,...
Holtzer-Goor Kim M
Full Text Available Abstract Background Healthcare systems are challenged by a demand that exceeds available resources. One policy to meet this challenge is task substitution-transferring tasks to other professions and settings. Our study aimed to explore stakeholders’ perceived feasibility of transferring hospital-based monitoring of stable glaucoma patients to primary care optometrists. Methods A case study was undertaken in the Rotterdam Eye Hospital (REH using semi-structured interviews and document reviews. They were inductively analysed using three implementation related theoretical perspectives: sociological theories on professionalism, management theories, and applied political analysis. Results Currently it is not feasible to use primary care optometrists as substitutes for optometrists and ophthalmic technicians working in a hospital-based glaucoma follow-up unit (GFU. Respondents’ narratives revealed that: the glaucoma specialists’ sense of urgency for task substitution outside the hospital diminished after establishing a GFU that satisfied their professionalization needs; the return on investments were unclear; and reluctant key stakeholders with strong power positions blocked implementation. The window of opportunity that existed for task substitution in person and setting in 1999 closed with the institutionalization of the GFU. Conclusions Transferring the monitoring of stable glaucoma patients to primary care optometrists in Rotterdam did not seem feasible. The main reasons were the lack of agreement on professional boundaries and work domains, the institutionalization of the GFU in the REH, and the absence of an appropriate reimbursement system. Policy makers considering substituting tasks to other professionals should carefully think about the implementation process, especially in a two-step implementation process (substitution in person and in setting such as this case. Involving the substituting professionals early on to ensure all
In this paper, the mining of hybrid association rules with rough set approach is investigated as the algorithm RSHAR.The RSHAR algorithm is constituted of two steps mainly. At first, to join the participant tables into a general table to generate the rules which is expressing the relationship between two or more domains that belong to several different tables in a database. Then we apply the mapping code on selected dimension, which can be added directly into the information system as one certain attribute. To find the association rules, frequent itemsets are generated in second step where candidate itemsets are generated through equivalence classes and also transforming the mapping code in to real dimensions. The searching method for candidate itemset is similar to apriori algorithm. The analysis of the performance of algorithm has been carried out.
Abdou, Cleopatra M; Fingerhut, Adam W
The first of its kind, the present experiment applied stereotype threat-the threat of being judged by or confirming negative group-based stereotypes-to the health sciences. Black and White women (N = 162) engaged in a virtual health care situation. In the experimental condition, one's ethnic identity and negative stereotypes of Black women specifically were made salient. As predicted, Black women in the stereotype threat condition who were strongly identified as Black (in terms of having explored what their ethnic identity means to them and the role it plays in their lives) reported significantly greater anxiety while waiting to see the doctor in the virtual health care setting than all other women. It is hypothesized that stereotype threat experienced in health care settings is one overlooked social barrier contributing to disparities in health care utilization and broader health disparities among Black women. PMID:25045944
Estrada, Carlos A.; Rosman, Howard S.; Prasad, Niraj K; Battilana, Guido; Alexander, Myrna; Held, Arthur C; Young, Mark J.
To determine if the American College of Cardiology (ACC) cardiac monitoring guidelines accurately stratify patients according to their risks for developing clinically significant arrhythmias in non–intensive-care settings, we conducted a prospective cohort study of 2,240 consecutive patients admitted to a non–intensive-care telemetry unit over 7 months. Sixty-one percent of patients were assigned to ACC class I (telemetry indicated in most patients), 38% to class II (telemetry indicated in so...
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...
Simon Steven R; Kleinman Kenneth P; Soto Carlos M
Abstract Background Documentation in the medical record facilitates the diagnosis and treatment of patients. Few studies have assessed the quality of outpatient medical record documentation, and to the authors' knowledge, none has conclusively determined the correlates of chart documentation. We therefore undertook the present study to measure the rates of documentation of quality of care measures in an outpatient primary care practice setting that utilizes an electronic medical record. Metho...
Murphy, Jill; Elliot M. Goldner; Goldsmith, Charles H; Oanh, Pham Thi; Zhu, William; Corbett, Kitty K; Nguyen, Vu Cong
Depression is an important and growing contributor to the burden of disease around the world and evidence suggests the experience of depression varies cross-culturally. Efforts to improve the integration of services for depression in primary care are increasing globally, meaning that culturally valid measures that are acceptable for use in primary care settings are needed. We conducted a scoping review of 27 studies that validated or used 10 measures of depression in Vietnamese populations. W...
Introduction, definition, rationale and scope: Lasers are now becoming an integral part of dermatological practice in India, with more and more dermatologists starting laser dermatology practice. Lasers, when are used with care, by properly trained operators, in carefully designed environment, can deliver a range of useful aesthetic and dermatologic treatments. Facility: Laser treatment is an office procedure, hence it does not require hospital set-up. The laser room facility requires car...
Nelson, David; Kane, Ros; Davies, Helen; Mansfield, Paul
People affected by cancer (PABC) have social care needs as well as health needs and existing research has highlighted that these needs go unmet. Despite this, we lack an in-depth understanding regarding of specific needs in a rural setting. The aim of this paper is to explore the social care needs of a sample of cancer patients and carers in the rural English county of Lincolnshire.
J. Hermanides; T.M. Vriesendorp; R.J. Bosman; D.F. Zandstra; J.B. Hoekstra; J.H. DeVries
OBJECTIVE: Mounting evidence suggests a role for glucose variability in predicting intensive care unit (ICU) mortality. We investigated the association between glucose variability and intensive care unit and in-hospital deaths across several ranges of mean glucose. DESIGN: Retrospective cohort study
López, Mónica; del Valle, Jorge F.; Montserrat, Carme; Bravo, Amaia
In this paper, we analyse reunification processes from family foster care, both kinship and non-kinship, and the variables associated with them in a Spanish sample. Data collection was carried out after a review of child protection and foster care files, and those responsible for the cases were also
Full Text Available Joshua R Burke, Rachael Morley, Mustafa Khanbhai Academic Surgery Unit, Education and Research Centre, University Hospital of South Manchester, Manchester, UK Abstract: Negative pressure wound therapy (NPWT is the continuous or intermittent application of subatmospheric pressure to the surface of a wound that improves the wound environment, accelerates healing, and reduces wound closure time. Since its first documented use, this technology has lent itself to a number of adaptations, most notably, the development of portable devices facilitating treatment in the home care setting. With advancing surgical standards, wound healing is an important rate-limiting factor in early patient discharge and often a major cost of inpatient treatment. The efficacy of NPWT in the home care setting has been investigated through rate of wound closure, time in care, and patient experience. Rate of wound closure is the most appropriate primary end point. Much can be gleaned from patient experience, but the future success of portable NPWT will be measured on time in care and therefore cost effectiveness. However, there is a lack of level 1a evidence demonstrating increased efficacy of portable over inpatient NPWT. The development of portable NPWT is an encouraging innovation in wound care technology, and extending the benefits to the home care setting is both possible and potentially more beneficial. Keywords: portable, negative pressure wound therapy, vacuum-assisted closure, topical negative pressure therapy
Ogrinc, Greg; Hoffman, Kimberly G.; Stevenson, Katherine M.; Shalaby, Marc; Beard, Albertine S.; Thörne, Karin E.; Coleman, Mary T.; Baum, Karyn D.
Problem Current models of health care quality improvement do not explicitly describe the role of health professions education. The authors propose the Exemplary Care and Learning Site (ECLS) model as an approach to achieving continual improvement in care and learning in the clinical setting. Approach From 2008–2012, an iterative, interactive process was used to develop the ECLS model and its core elements—patients and families informing process changes; trainees engaging both in care and the improvement of care; leaders knowing, valuing, and practicing improvement; data transforming into useful information; and health professionals competently engaging both in care improvement and teaching about care improvement. In 2012–2013, a three-part feasibility test of the model, including a site self-assessment, an independent review of each site’s ratings, and implementation case stories, was conducted at six clinical teaching sites (in the United States and Sweden). Outcomes Site leaders reported the ECLS model provided a systematic approach toward improving patient (and population) outcomes, system performance, and professional development. Most sites found it challenging to incorporate the patients and families element. The trainee element was strong at four sites. The leadership and data elements were self-assessed as the most fully developed. The health professionals element exhibited the greatest variability across sites. Next Steps The next test of the model should be prospective, linked to clinical and educa tional outcomes, to evaluate whether it helps care delivery teams, educators, and patients and families take action to achieve better patient (and population) outcomes, system performance, and professional development. PMID:26760058
Kilinc Balci, F Selcen
Although they play an important role in infection prevention and control, textile materials and personal protective equipment (PPE) used in health care settings are known to be one of the sources of cross-infection. Gowns are recommended to prevent transmission of infectious diseases in certain settings; however, laboratory and field studies have produced mixed results of their efficacy. PPE used in health care is regulated as either class I (low risk) or class II (intermediate risk) devices in the United States. Many organizations have published guidelines for the use of PPE, including isolation gowns, in health care settings. In addition, the Association for the Advancement of Medical Instrumentation published a guidance document on the selection of gowns and a classification standard on liquid barrier performance for both surgical and isolation gowns. However, there is currently no existing standard specific to isolation gowns that considers not only the barrier resistance but also a wide array of end user desired attributes. As a result, infection preventionists and purchasing agents face several difficulties in the selection process, and end users have limited or no information on the levels of protection provided by isolation gowns. Lack of knowledge about the performance of protective clothing used in health care became more apparent during the 2014 Ebola epidemic. This article reviews laboratory studies, regulations, guidelines and standards pertaining to isolation gowns, characterization problems, and other potential barriers of isolation gown selection and use. PMID:26391468
Shoff, Carla; Yang, Tse-Chuan; Matthews, Stephen A.
We use a geographically weighted regression (GWR) approach to examine how the relationships between a set of predictors and prenatal care vary across the continental US. At its most fundamental, GWR is an exploratory technique that can facilitate the identification of areas with low prenatal care utilization and help better understand which predictors are associated with prenatal care at specific locations. Our work complements existing prenatal care research in providing an ecological, place...
Izzo, Charles V; Smith, Elliott G; Holden, Martha J; Norton, Catherine I; Nunno, Michael A; Sellers, Deborah E
The current study examined the impact of a setting-level intervention on the prevention of aggressive or dangerous behavioral incidents involving youth living in group care environments. Eleven group care agencies implemented Children and Residential Experiences (CARE), a principle-based program that helps agencies use a set of evidence-informed principles to guide programming and enrich the relational dynamics throughout the agency. All agencies served mostly youth referred from child welfare. The 3-year implementation of CARE involved intensive agency-wide training and on-site consultation to agency leaders and managers around supporting and facilitating day-to-day application of the principles in both childcare and staff management arenas. Agencies provided data over 48 months on the monthly frequency of behavioral incidents most related to program objectives. Using multiple baseline interrupted time series analysis to assess program effects, we tested whether trends during the program implementation period declined significantly compared to the 12 months before implementation. Results showed significant program effects on incidents involving youth aggression toward adult staff, property destruction, and running away. Effects on aggression toward peers and self-harm were also found but were less consistent. Staff ratings of positive organizational social context (OSC) predicted fewer incidents, but there was no clear relationship between OSC and observed program effects. Findings support the potential efficacy of the CARE model and illustrate that intervening "upstream" at the setting level may help to prevent coercive caregiving patterns and increase opportunities for healthy social interactions. PMID:27138932
Eric A. Coleman
Full Text Available Objective: To investigate the association between care co-ordination and use of the Emergency Department (ED in older managed care enrollees. Design: Nested case-control with 103 cases (used the ED and 194 controls (did not use the ED. Patients and methods: Older patients with multiple chronic illnesses enrolled in a care management programme of a large group-model health maintenance organisation with more than 50,000 members over the age of 64. Better care co-ordination was defined as timely follow-up after a change in treatment; fewer decision-makers involved with the care plan; and a higher patient-perceived rating of overall care co-ordination. Logistic regression was used to assess the relationship between ED use (the outcome variable and measures of care co-ordination (the predictor variables. Results: Self-reported care co-ordination was not significantly different between cases and controls for any of the four classifications of inappropriate ED use. Similarly, no differences were found in the number of different physicians or medication prescribers involved in the patients' care. Four-week follow-up after potentially high-risk events for subsequent ED use, including changes in chronic disease medications, missed encounters, and same day encounters, did not differ between subjects with inappropriate ED use and controls. Conclusion: Existing measures of care co-ordination were not associated with inappropriate ED use in this study of older adults with complex care needs. The absence of an association may, in part, be attributable to the paucity of validated measures to assess care co-ordination, as well as the methodological complexity inherent in studying this topic. Future research should focus on the development of new measures and on approaches that better isolate the role of care co-ordination from other potential variables that influence utilisation.
Carolyn Dunn, PhD
Full Text Available Background Childhood overweight continues to increase in the United States. Children should begin establishing healthy eating and physical activity behaviors at a young age. Context Many children spend a large part of their day in child care settings, whether in preschools or home day care settings. Child care providers in these settings have an opportunity to establish and reinforce habits that promote good health. However, the providers need training and creative educational materials to teach children about healthy eating and physical activity. Color Me Healthy is an educational program focusing on nutrition and physical activity that was developed for children aged 4 and 5 years by three of the authors (C.D., C.T., and L.P.. Methods In 2001 and 2002, the program was implemented in 47 North Carolina counties and the North Carolina Cherokee reservation. In December 2001, we used an information-dissemination model called Train the Trainer during a session to teach county teams comprising local public health professionals and cooperative extension employees how to teach child care providers in their communities to use the curriculum. The child care providers were then trained between March and August 2002. Follow-up evaluation forms were given to trained child care providers 8 weeks after the training. Consequences Of the providers who completed the evaluations (n = 486, 92.0% indicated that using the Color Me Healthy curriculum increased the physical activity of their students, and 91.8% indicated that it increased the children’s knowledge about movement. In addition, 93.0% of providers also indicated that using Color Me Healthy had increased the children’s knowledge about healthy eating. Interpretation Child care providers need educational materials on healthy eating and physical activity and should be trained to use them. The Train the Trainer model is an effective way to teach public health professionals to train child care providers on
Gonzales, Lucia K; Delmastro, Margaret A; Boyd, Denise M; Sterling, Melvyn L; Aube, Patricia A; Le, Rosemary N; Traucht, Lisa; Quinal, Leonida R; Georges, Jane M; Glaser, Dale N
In palliative medicine, constipation is the third most common symptom after pain and anorexia, causing some patients to discontinue opioid therapy. Women experience higher incidence of constipation than men. The prevalence of infrequent bowel movements (<3 times/wk) and adherence to an established bowel regimen among women receiving opioids were studied. Referral to the palliative care team decreased the prevalence of infrequent bowel movements from 72% to 45%, and algorithm adherence increased from 38% to 78%. Education of oncology nurses decreased the prevalence of infrequent bowel movements among patients with cancer from 71% to 60%, and algorithm adherence increased from 0% to 10%. Patients benefit from stool softeners and stimulants when receiving opioids. PMID:25964648
Hageman, Jeffrey C; Hazim, Carmen; Wilson, Katie; Malpiedi, Paul; Gupta, Neil; Bennett, Sarah; Kolwaite, Amy; Tumpey, Abbigail; Brinsley-Rainisch, Kristin; Christensen, Bryan; Gould, Carolyn; Fisher, Angela; Jhung, Michael; Hamilton, Douglas; Moran, Kerri; Delaney, Lisa; Dowell, Chad; Bell, Michael; Srinivasan, Arjun; Schaefer, Melissa; Fagan, Ryan; Adrien, Nedghie; Chea, Nora; Park, Benjamin J
The 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa underscores the need for health care infection prevention and control (IPC) practices to be implemented properly and consistently to interrupt transmission of pathogens in health care settings to patients and health care workers. Training and assessing IPC practices in general health care facilities not designated as Ebola treatment units or centers became a priority for CDC as the number of Ebola virus transmissions among health care workers in West Africa began to affect the West African health care system and increasingly more persons became infected. CDC and partners developed policies, procedures, and training materials tailored to the affected countries. Safety training courses were also provided to U.S. health care workers intending to work with Ebola patients in West Africa. As the Ebola epidemic continued in West Africa, the possibility that patients with Ebola could be identified and treated in the United States became more realistic. In response, CDC, other federal components (e.g., Office of the Assistant Secretary for Preparedness and Response) and public health partners focused on health care worker training and preparedness for U.S. health care facilities. CDC used the input from these partners to develop guidelines on IPC for hospitalized patients with known or suspected Ebola, which was updated based on feedback from partners who provided care for Ebola patients in the United States. Strengthening and sustaining IPC helps health care systems be better prepared to prevent and respond to current and future infectious disease threats.The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html). PMID:27390018
Ching, Siew-Mooi; Pang, Yong-Kek; Price, David; Cheong, Ai-Theng; Lee, Ping-Yein; Irmi, Ismail; Faezah, Hassan; Ruhaini, Ismail; Chia, Yook-Chin
Background and objective Early diagnosis of chronic obstructive pulmonary disease (COPD) in primary care settings is difficult to achieve chiefly due to lack of availability of spirometry. This study estimated the prevalence of airflow limitation among chronic smokers using a handheld spirometer in this setting. Methods This is a cross-sectional study performed on consecutive patients who were ≥40 years old with ≥10 pack-years smoking history. Face-to-face interviews were carried out to obtai...
Robinson, JD; Tate, A.; Heritage, J
© 2015 Elsevier Ireland Ltd. Objective: Soliciting patients' complete agendas of concerns (aka. 'agenda setting') can improve patients' health outcomes and satisfaction, and physicians' time management. We assess the distribution, content, and effectiveness of physicians' post-chief-complaint, agenda-setting questions. Methods: We coded videotapes/transcripts of 407 primary-, acute-care visits between adults and 85 general-practice physicians operating in 46 community-based clinics in two sta...
Budd, C; Fisher, B; Parrinder, D; Price, L.
This paper describes an acupuncture and osteopathy service offered free of charge to patients at a National Health Service general practice. The background to the setting up of this service, its organization, funding, aims and philosophy, and the ethical and legal implications for the general practitioners whose patients are treated by complementary therapists are discussed. This service provides a model of cooperation between allopathic and complementary medicine in a primary care setting an...
Chen, Serene I; Fox, Erin R; Hall, M Kennedy; Ross, Joseph S; Bucholz, Emily M; Krumholz, Harlan M; Venkatesh, Arjun K
Early evidence suggests that provisions of the Food and Drug Administration Safety and Innovation Act of 2012 are associated with reductions in the total number of new national drug shortages. However, drugs frequently used in acute unscheduled care such as the care delivered in emergency departments may be increasingly affected by shortages. Our estimates, based on reported national drug shortages from 2001 to 2014 collected by the University of Utah's Drug Information Service, show that although the number of new annual shortages has decreased since the act's passage, half of all drug shortages in the study period involved acute care drugs. Shortages affecting acute care drugs became increasingly frequent and prolonged compared with non-acute care drugs (median duration of 242 versus 173 days, respectively). These results suggest that the drug supply for many acutely and critically ill patients in the United States remains vulnerable despite federal efforts. PMID:27140985
Full Text Available Homeless health is government and NGO’s responsibilities for creating optimal citizen health status. Homeless is one of community health nursing clients. The Self Care Theory is used in nursing science for giving conceptual framework as a practical guidance and building self care knowledge through research. Orem described self care as a continuing intervention. It was needed and done by adult to be survived, healthy, and wellness. This theory is also used in homeless setting by many experts. This article aims to describe Orem’s Self Care Theory, describe homeless’ self care, and apply Orem’s Self Care Theory in homeless setting.
Page, Charles M.; And Others
The CARES project (Coordinated Ambulatory Rehabilitation Evaluation Services) presents a model to provide multidisciplinary services for multiply disabled children in rural settings. Background, information about model components, and descriptive data are presented to illustrate project evolution and operation. Nearly 400 children with multiple…
Schryer, Catherine; McDougall, Allan; Tait, Glendon R.; Lingard, Lorelei
This article investigates an emerging practice in palliative care: dignity therapy. Dignity therapy is a psychotherapeutic intervention that its proponents assert has clinically significant positive impacts on dying patients. Dignity therapy consists of a physician asking a patient a set of questions about his or her life and returning to the…
Full Text Available Diagnosis of mild cognitive impairment relies on the presence of memory complaints. However, memory complaints are very frequent in healthy people. The objective of this study was to determine the severity and type of memory difficulties presented by elderly patients who seek for clinical help, as compared to the memory difficulties reported by subjects in the community. Assessment of subjective memory complaints was done with the subjective memory complaints scale (SMC. The mini-mental state examination was used for general cognitive evaluation and the geriatric depression scale for the assessment of depressive symptoms. Eight-hundred and seventy-one nondemented subjects older than 50 years were included. Participants in the clinical setting had a higher total SMC score (10.3±4.2 than those in the community (5.1±3.0. Item 3 of the SMC, Do you ever forget names of family members or friends? contributed significantly more to the variance of the total SMC score in the clinical sample (18% as compared to the community sample (11%. Forgetting names of family members or friends plays an important role in subjective memory complaints in the clinical setting. This symptom is possibly perceived as particularly worrisome and likely drives people to seek for clinical help.
Rossiter, Jennifer; Soor, Gursharan; Telner, Deanna; Aliarzadeh, Babak; Lake, Jennifer
Purpose. Monitoring patients' international normalized ratio (INR) within a family medicine setting can be challenging. Novel methods of doing this effectively and in a timely manner are important for patient care. The purpose of this study was to determine the effectiveness of a pharmacist-led point-of-care (POC) INR clinic. Methods. At a community-based academic Family Health Team in Toronto, Canada, charts of patients with atrial fibrillation managed by a pharmacist with usual care (bloodtesting at lab and pharmacist follow up of INR by phone) from February 2008 to April 2008 were compared with charts of patients attending a weekly POC INR clinic from February 2010 to April 2010. Time in therapeutic range (TTR) was measured for both groups. Results. 119 patient charts were reviewed and 114 had TTR calculated. After excluding patients with planned inconsistent Coumadin use (20), such as initiating Coumadin treatment or stopping for a surgical procedure, the mean TTR increased from 64.41% to 77.09% with the implementation of the POC clinic. This was a statistically significant difference of 12.68% (CI: 1.18, 24.18; P = 0.03). Conclusion. A pharmacist-led POC-INR clinic improves control of anticoagulation therapy in patients receiving warfarin and should be considered for implementation in other family medicine settings. PMID:24455250
Kamal, AH; Bull, J; Ritchie, CS; Kutner, JS; Hanson, LC; Friedman, F; Jr, TDH; Grp, AAHPMRCW
Measuring What Matters (MWM) for palliative care has prioritized data collection efforts for evaluating quality in clinical practice. How these measures can be implemented across diverse clinical settings using point-of-care data collection on quality is unknown.To evaluate the implementation of MWM measures by exploring documentation of quality measure adherence across six diverse clinical settings inherent to palliative care practice.We deployed a point-of-care quality data collection syste...
Full Text Available Health care systems are faced with the challenge of resource scarcity and have insufficient resources to respond to all health problems and target groups simultaneously. Hence, priority setting is an inevitable aspect of every health system. However, priority setting is complex and difficult because the process is frequently influenced by political, institutional and managerial factors that are not considered by conventional priority-setting tools. In a five-year EU-supported project, which started in 2006, ways of strengthening fairness and accountability in priority setting in district health management were studied. This review is based on a PhD thesis that aimed to analyse health care organisation and management systems, and explore the potential and challenges of implementing Accountability for Reasonableness (A4R approach to priority setting in Tanzania. A qualitative case study in Mbarali district formed the basis of exploring the sociopolitical and institutional contexts within which health care decision making takes place. The study also explores how the A4R intervention was shaped, enabled and constrained by the contexts. Key informant interviews were conducted. Relevant documents were also gathered and group priority-setting processes in the district were observed. The study revealed that, despite the obvious national rhetoric on decentralisation, actual practice in the district involved little community participation. The assumption that devolution to local government promotes transparency, accountability and community participation, is far from reality. The study also found that while the A4R approach was perceived to be helpful in strengthening transparency, accountability and stakeholder engagement, integrating the innovation into the district health system was challenging. This study underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority-setting
David C. Currow
Full Text Available AbstractIn Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary. The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two ‘plain English’ booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers. The resources are intended to facilitate home care that acknowledges and plans for the client’s deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations
Nagadomi, Noriko; Norimine, Tadayuki; Motegi, Rei; Kawasaki, Yurie; Nagashima, Kazuko; Kashima, Hiroyuki
In the revision of prescribed medicinal compensation act of April 2008, it is possible for health insurance pharmacy to allocate an injection medicine and to add a medical treatment material. In addition to that, the newly established fees like "Joint guidance fee when patient is discharged from hospital", "Joint guidance fee such as an urgent home care of patients", and "Medical management guidance fee for homecare patient emergency visit", and so on, would strengthen in the home medical care. Therefore, we expect that more health insurance pharmacies will have an opportunity to participate in the home medical care business. On the other hand, there are problems associated with specific operational home medical care that are invisible from the system. We herein report the problems associated with "Home Visiting Medicinal Management Guidelines," that was performed in the last 6 months, mainly centered on home delivery expenses. PMID:20443308
A. V. Kontsevaya
Full Text Available Aim. To analyze costs of health care in Russia associated with smoking in 2009. Material and methods. Cardiovascular diseases, cancers and chronic obstructive pulmonary diseases (COPD were included in the analysis. Calculation was performed on the basis of the relative risks of diseases associated with smoking, and obtained from foreign surveys, official statistics on morbidity and health system resources expenditure, and costs of health-seeking in line with state program of guaranteed free medical care. Results. In 2009 total costs of the health care system associated with smoking exceeded RUR 35.8 bln. It corresponded to 0.1% of gross domestic product in Russia in 2009. The costs structure was the following: hospitalization – RUR 26.2 bln, emergency calls – RUR 1.4 bln, and outpatient health-seeking – RUR 8.2 bln. Costs of outpatient pharmacotherapy were not included into analysis because of lack of baseline data needed for calculations. Cardiovascular diseases caused 62% of the health care costs associated with smoking, cancers – 20.2%, and COPD – 17.8%. Conclusion. The smoking in Russia is associated with significant health care costs. It makes needed resources investment in preventive programs to reduce smoking prevalence.
Mücke, M.; Mochamat; Cuhls, H; Peuckmann-Post, V.; Minton, O.; Stone, P.; Radbruch, L.
BACKGROUND: This review updates the original review, 'Pharmacological treatments for fatigue associated with palliative care' and also incorporates the review 'Drug therapy for the management of cancer-related fatigue'.In healthy individuals, fatigue is a protective response to physical or mental stress, often relieved by rest. By contrast, in palliative care patients' fatigue can be severely debilitating and is often not counteracted with rest, thereby impacting daily activity and quality of...
Maluka, Stephen; Kamuzora, Peter; San Sebastiån, Miguel; Byskov, Jens; Olsen, Øystein E; Shayo, Elizabeth; Ndawi, Benedict; Hurtig, Anna-Karin
Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents were also gathered and group priority-setting in the district was observed. The results indicate that, while Tanzania has a decentralized public health care system, the reality of the district level priority-setting process was that it was not nearly as participatory as the official guidelines suggest it should have been. Priority-setting usually occurred in the context of budget cycles and the process was driven by historical allocation. Stakeholders' involvement in the process was minimal. Decisions (but not the reasoning behind them) were publicized through circulars and notice boards, but there were no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did not satisfy all four conditions of Accountability for Reasonableness; namely relevance, publicity, appeals and revision, and enforcement. This paper aims to make two important contributions to this problematic situation. First, it provides empirical analysis of priority-setting at the district level in the contexts of low-income countries. Second, it provides guidance to decision-makers on how to improve fairness, legitimacy, and sustainability of the priority-setting process. PMID
Full Text Available Garumma Tolu Feyissa1, Lakew Abebe1, Eshetu Girma1, Mirkuzie Woldie21Department of Health Education and Behavioral Sciences, 2Department of Health Services Management, Jimma University, Jimma, EthiopiaBackground: Stigma and discrimination (SAD against people living with human immunodeficiency virus (HIV are barriers affecting effective responses to HIV. Understanding the causes and extent of SAD requires the use of a psychometrically reliable and valid scale. The objective of this study was to validate an HIV-related stigma scale among health care providers in a resource-poor setting.Methods: A cross-sectional validation study was conducted in 18 health care institutions in southwest Ethiopia, from March 14, 2011 to April 14, 2011. A total of 255 health care providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support (PIS and HIV-related SAD. Exploratory factor analysis (EFA with principal component extraction and varimax with Kaiser normalization rotation were employed to develop scales for SAD. Eigenvalues greater than 1 were used as a criterion of extraction. Items with item-factor loadings less than 0.4 and items loading onto more than one factor were dropped. The convergent validity of the scales was tested by assessing the association with HIV knowledge, PIS, training on topics related to SAD, educational status, HIV case load, presence of an antiretroviral therapy (ART service in the health care facility, and perceived religiosity.Results: Seven factors emerged from the four dimensions of SAD during the EFA. The factor loadings of the items ranged from 0.58 to 0.93. Cronbach's alphas of the scales ranged from 0.80 to 0.95. An in-depth knowledge of HIV, perceptions of institutional support, attendance of training on topics related to SAD, degree or higher education levels, high HIV case loads, the availability of ART in the health care facility and claiming oneself as
Orlandi, M A
Changes in lifestyle that promote health-enhancing behaviors and inhibit health-compromising behaviors have been recommended by the U.S. Surgeon General as an integral component of our general strategy for improving the health of the nation. A variety of innovations including new knowledge, new products, and new services have been developed with this recommendation in mind, and a major objective of these efforts is to identify settings for the effective diffusion and adoption of these new approaches into population groups that can make use of them. Health care settings such as hospitals, clinics, community health centers, health maintenance organizations, and private physicians' offices offer unique possibilities in this regard. Though opportunities exist for promoting health and preventing disease in other settings like schools and worksites, the primary objectives of such organizations are unrelated to health. Despite the obvious potential, however, our health care system has, in general, retained as its primary emphasis the treatment of disease rather than the enhancement of health. This article reviews the opportunities for health promotion and disease prevention in health care settings and identifies a range of barriers to such efforts. These barriers are discussed within a framework that focuses on dissemination and implementation as critical steps in the knowledge transfer process. Strategies for overcoming these barriers are described within the context of general linkage theory. PMID:3823010
Full Text Available Introduction. The goal is to investigate epidemiological characteristics of outbreaks of health-care-associated infections in health care institutions such as hospitals, nursing homes and ambulatory care settings. Material and methods. Relevant data associated with outbreaks in health-care settings in the period from 1980 to 2004 were retrospectively collected from epidemiological annual reports of infectious diseases in Vojvodina. Descriptive statistics were applied to the data. Results. The mean number of outbreaks is 7 per year (ranging from 0 to 13 outbreaks involving 22 cases per outbreak (ranging from 2 to 74 cases. The most frequently involved settings (51% were nursing homes and most (31% of the patients were more than 60 years old. This surveillance documented that wards for children less than 12 months of age were the most frequently (57.5% associated with nosocomial outbreaks in hospitals. The leading diseases were gastrointestinal tract infections with case fatality rale of 1.8%, that is 10-100 fold higher than rales in general population. The leading transmission route in 70% of outbreaks was contact, demonstrating the association between infections and poor general and hand-hygiene policies. Conclusion. The proportion of nosocomial outbreaks in total number of outbreaks is 9%. The most frequent are gastrointestinal outbreaks transmited in long-term-care facilities by contact route, involving elderly patients. Introducing proper environmental and hand hygiene policies in health-care settings with strict implementation of procedures may significantly decrease the number of nosocomial infections and prevent nosocomial outbreaks. .
Martin Douglas K
Full Text Available Abstract Background Hospitals and regional health authorities must set priorities in the face of resource constraints. Decision-makers seek practical ways to set priorities fairly in strategic planning, but find limited guidance from the literature. Very little has been reported from the perspective of Board members and senior managers about what criteria, processes and parameters of success they would use to set priorities fairly. Discussion We facilitated workshops for board members and senior leadership at three health care organizations to assist them in developing a strategy for fair priority setting. Workshop participants identified 8 priority setting criteria, 10 key priority setting process elements, and 6 parameters of success that they would use to set priorities in their organizations. Decision-makers in other organizations can draw lessons from these findings to enhance the fairness of their priority setting decision-making. Summary Lessons learned in three workshops fill an important gap in the literature about what criteria, processes, and parameters of success Board members and senior managers would use to set priorities fairly.
Teichert, Martina; Schoenmakers, Tim; Kylstra, Nico; Mosk, Berend; Bouvy, Marcel L; van de Vaart, Frans; De Smet, Peter A G M; Wensing, Michel
Background The quality of pharmaceutical care in community pharmacies in the Netherlands has been assessed annually since 2008. The initial set has been further developed with pharmacists and patient organizations, the healthcare inspectorate, the government and health insurance companies. The set over 2012 was the first set of quality indicators for community pharmacies which was validated and supported by all major stakeholders. The aims of this study were to describe the validated set of quality indicators for community pharmacies and to report their scores over 2012. In subanalyses the score development over 5 years was described for those indicators, that have been surveyed before and remained unchanged. Methods Community pharmacists in the Netherlands were invited in 2013 to provide information for the set of 2012. Quality indicators were mapped by categories relevant for pharmaceutical care and defined for structures, processes and dispensing outcomes. Scores for categorically-measured quality indicators were presented as the percentage of pharmacies reporting the presence of a quality aspect. For numerical quality indicators, the mean of all reported scores was expressed. In subanalyses for those indicators that had been questioned previously, scores were collected from earlier measurements for pharmacies providing their scores in 2012. Multilevel analysis was used to assess the consistency of scores within one pharmacy over time by the intra-class correlation coefficient (ICC). Results For the set in 2012, 1739 Dutch community pharmacies (88 % of the total) provided information for 66 quality indicators in 10 categories. Indicator scores on the presence of quality structures showed relatively high quality levels. Scores for processes and dispensing outcomes were lower. Subanalyses showed that overall indicators scores improved within pharmacies, but this development differed between pharmacies. Conclusions A set of validated quality indicators provided
Cioffi, R N Jane
Communication with culturally and linguistically diverse (CLD) patients has been shown to be difficult. This study describes nurses' experiences of communicating with CLD patients in an acute care setting. A purposive sample of registered nurses and certified midwives (n=23) were interviewed. Main findings were: interpreters, bilingual health workers and combinations of different strategies were used to communicate with CLD patients; some nurses showed empathy, respect and a willingness to make an effort in the communication process with others showing an ethnocentric orientation. Main recommendations were: prioritising access to appropriate linguistic services, providing nurses with support from health care workers, e.g., bilingual health care workers who are able to provide more in-depth information, increasing nurses' understanding of legal issues within patient encounters, supporting nurses to translate their awareness of cultural diversity into acceptance of, appreciation for and commitment to CLD patients and their families. PMID:12605952
Langhan, Melissa L.; Riera, Antonio; Kurtz, Jordan C.; Schaeffer, Paula; Asnes, Andrea G.
Objective Technologies are not always successfully implemented into practise. We elicited experiences of acute care providers with the introduction of technology and identified barriers and facilitators in the implementation process. Methods A qualitative study using one-on-one interviews among a purposeful sample of 19 physicians and nurses within ten emergency departments and intensive care units was performed. Grounded theory, iterative data analysis and the constant comparative method were used to inductively generate ideas and build theories. Results Five major categories emerged: decision-making factors, the impact on practise, technology's perceived value, facilitators and barriers to implementation. Barriers included negative experiences, age, infrequent use, and access difficulties. A positive outlook, sufficient training, support staff, and user friendliness were facilitators. Conclusions This study describes strategies implicated in the successful implementation of newly adopted technology in acute care settings. Improved implementation methods and evaluation of implementation processes are necessary for successful adoption of new technology. PMID:25367721
Jitske Gulmans; Miriam Vollenbroek-Hutten; Lisette van Gemert-Pijnen; Wim van Harten
Introduction: To improve communication in the integrated care setting of children with cerebral palsy, we developed a web-based system for parent-professional and inter-professional communication. The present study aimed to evaluate parents' experiences regarding the system's contribution to their communication with professionals during a 6-months pilot in three Dutch care regions. In addition, factors associated with parents' system use and non-use were analyzed.Theory and methods: The syste...
Bar-Sela, Gil; Bentur, Netta; Schultz, Michael; Corn, Benjamin W
Faced with a serious, incurable illness, disability, and other symptoms, both physical and mental, some patients find themselves wondering about the meaning of their Lives. They need the help of a professional who can perceive their mental turmoil and identify their spiritual needs, and who knows how to help them find meaning in their uncertain state. Spiritual care providers are professionals whose role it is to provide patients with support in their hour of need, to help them preserve their identity in life-threatening situations, and to help them re-endow their world with meaning, employing a special language and set of tools that enable patients to get in touch with their spiritual resources and internal powers of healing. Spiritual care providers serve on the medical staff in Western countries. In the United States, some 2,600 are employed in general hospitals, psychiatric hospitals, long-term care facilities, and palliative care units. Approximately ten years ago, the profession began developing in Israel. Today, dozens of spiritual care providers are now working in the healthcare system. There is a spiritual care network with 21 member organizations. Although the profession is laying down roots in the healthcare system in this country, it is still in its infancy and has to contend with substantial barriers and challenges, including professional recognition, creating positions, and identifying sources of funding for positions. The profession still has much room to grow as it is further incorporated into the healthcare system and continues undergoing adaptation to the Israeli cultural setting. PMID:25112121
Mavalankar, Dileep V; Rosenfield, Allan
Maternal mortality remains one of the most daunting public health problems in resource-poor settings, and reductions in maternal mortality have been identified as a prominent component of the United Nations Millennium Development Goals. The World Health Organization estimates that 515000 women die each year from pregnancy-related causes, and almost all of these deaths occur in developing countries. Evidence has shown that access to and utilization of high-quality emergency obstetric care (EmOC) is central to efforts aimed at reducing maternal mortality. We analyzed health care policies that restrict access to life-saving EmOC in most resource-poor settings, focusing on examples from rural India, a country of more than 1 billion people that contributes approximately 20% to 24% of the world's maternal deaths. PMID:15671450
M A Muckaden
Full Text Available Background: Volunteers are an integral part of the palliative care services in the Tata Memorial Hospital, Mumbai, Maharashtra, India. These volunteers are an important resource for the department. Thus, it is necessary for the department to determine what motivates these volunteers to continue to work in the setting, acknowledge them and direct efforts toward retaining them and giving them opportunities to serve to the best of their desire and abilities. Aims: The current study aimed at understanding the motivation of volunteers to work in palliative care, to identify the challenges they face and also the effect of their work on their self and relationships. Methodology: In-depth interviews were conducted using semistructured interview guide to study above mentioned aspects. Themes were identified and coding was used to analyze the data. Results: The results suggested that the basic motivation for all the volunteers to work in a palliative care setting is an inherent urge, a feeling of need to give back to the society by serving the sick and the suffering. Other motivating factors identified were team spirit, comfort shared, warm and respectful treatment by the team, satisfying nature of work, experience of cancer in the family, and aligned values and beliefs. Some intrinsic rewards mentioned by volunteers were joy of giving, personal growth, enriching experiences, and meaningful nature of work. Conclusion: The study attempted to improve opportunities of working for these volunteers. Although limited in scope, it offers insight for future research in the area of volunteerism in palliative care setup.
Murthy, Srinivas; Adhikari, Neill K
The care of the critically ill patient in low-resource settings is challenging because of many factors, including limitations in the existing infrastructure, lack of disposables, and low numbers of trained healthcare workers. Although cost constraints in low-resource settings have traditionally caused critical care to be relegated to a low priority, ethical issues and the potential for mitigation of the lethal effects of often reversible acute conditions, such as sepsis and traumatic hemorrhage, argue for prudent deployment of critical care resources. Given these challenges, issues that require prioritization include timely and reliable delivery of evidence-based or generally accepted interventions to acutely ill patients before the development of organ failure, context-specific adaptation and evaluation of clinical evidence, and sustained investments in quality improvement and health systems strengthening. Specific examples include fluid resuscitation algorithms for patients with sepsis and reliable, low-cost, high-flow oxygen concentrators for patients with pneumonia. The lessons from new research on clinical management and sustainable education and quality improvement approaches will likely improve the care of critically ill patients worldwide. PMID:24161054
Lie Reidar K
Full Text Available Abstract All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities. We review explicit priority setting efforts in Norway, Sweden, Israel, the Netherlands, Denmark, New Zealand, the United Kingdom and the state of Oregon in the US. The approaches used can be divided into those centered on outlining principles versus those that define practices. In order to establish the main lessons from their experiences we consider (1 the process each country used, (2 criteria to judge the success of these efforts, (3 which approaches seem to have met these criteria, and (4 using their successes and failures as a guide, how to proceed in setting priorities. We demonstrate that there is little evidence that establishment of a values framework for priority setting has had any effect on health policy, nor is there evidence that priority setting exercises have led to the envisaged ideal of an open and participatory public involvement in decision making.
In medicine, a satisfactory medical care depends upon effective communication between patients and health providers. Ineffective communication can result in wrong diagnosis and delayed or unsuitable medical treatment. It is assumed that poor communication reduces the healthcare quality and causes anger and a lack of trust among patients. The main purpose of this study is to examine language use in the Algerian healthcare settings where a multilingual situation is prevailing. It reports on ...
Anindo Majumdar; Jayaprakash Sahoo; Gautam Roy; Sadishkumar Kamalanathan
In the recent years, outbreaks of blood-borne infections have been reported from assisted living facilities, which were traced back to improper blood glucose monitoring practices. Needle-stick injuries have been implicated in many such cases. This directly raises concerns over sharp disposal practices of diabetic patients self-managing their condition in home care settings. With India being home to a huge diabetic population, this issue, if neglected, can cause substantial damage to the healt...
Jeannette Painovich; Herman, Patricia M.
Purpose. To evaluate the acceptance and effectiveness of acupuncture in a hospital setting. Methods. This 18-month pragmatic randomized controlled trial used a two-tiered consent process for all patients admitted to the acute care unit by study physician groups. The primary study comparison was between those randomized (using biased-coin randomization after initial consent) to be offered acupuncture or not. The primary outcome was length of stay (LOS). Other measures include costs, self-repor...
Sen S.; Bowen JF; Ganetsky VS; Hadley D; Melody K; Otsuka S; Vanmali R; Thomas T
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...
Ajay, Vamadevan S; Prabhakaran, Dorairaj
Diabetes has emerged as a major public health concern in developing nations. Health systems in most developing countries are yet to integrate effective prevention and control programs for diabetes into routine health care services. Given the inadequate human resources and underfunctioning health systems, we need novel and innovative approaches to combat diabetes in developing-country settings. In this regard, the tremendous advances in telecommunication technology, particularly cell phones, c...
Lysaght, Susan; Ersek, Mary
Although place of death has been routinely studied in end-of-life (EOL) care, more analysis on place of death within hospice is needed because of the recent, dramatic rise in the number of hospice patients dying in inpatient settings. Using a case study to illustrate the complexity of determinants of place of death within hospice, this article highlights important known factors and elucidate gaps for further research. Individual and system level factors, sociocultural meanings, caregiving and...
Axelsson, L; Svensson, P G
The development of any health care system towards setting goals and targets and intended outcomes--with national guidelines, a legislative framework, limited resources, consumer influence and competitive forces--makes great demands on the control mechanisms required. The Swedish health care system has no tradition of goal formulation of this type. Hence, the purpose of this article is to clarify the goal-setting process of performance standards, and to examine whether goal setting is a relevant method within the organization of a Swedish county council. Goal setting can be seen partly as a control method and partly as an administrative process. The approach used is a combination of qualitative and quantitative methods. Data have been collected from interviews, observations, notes taken in the field and available performance statistics. The analysis shows that working towards a goal is made easier through a common and simple concept. It 'stands and falls' with the management of the work and its manager. Good communications and information are important prerequisites if goal formulation, through dialogue, is to succeed. This process takes time and can be described as an iterative process, in which a common behaviour pattern develops a 'we-feeling' which spreads among the staff. It is important that the goal is relevant and directly related to the basic objects of the work. It is also crucial that the goal is realistic and reflects a priority. Goal formulation relating to performance standards can be a contributing factor to staff's experience of job satisfaction through increased engagement and motivation, and to the satisfaction of patients/relatives with the care given. It is difficult to formulate performance standards; there are many problems and obstacles. If goal formulation as a control method within the health care system in Sweden is to work, clearer manifestations of political will are necessary and also better measuring methods in order to guage
This research study was designed to evaluate whether or not Gestalt therapy approaches could be used effectively when intervening with aggressive acts in a day care setting. Five focus children were observed at timed intervals as to whether or not they were aggressive, how the caretaker intervened, and how the children responded to the caretaker intervention. After a baseline of aggressive acts was established, caretakers were trained to use Gestalt therapy interventio...
Thomas A Barnes1, Len Fromer21Department of Cardiopulmonary Sciences, Northeastern University, Boston, MA, USA; 2David Geffen School of Medicine at UCLA, Los Angeles, CA, USAObjective: To describe a practical method for family practitioners to stage chronic obstructive pulmonary disease (COPD) by the use of office spirometry.Methods: This is a review of the lessons learned from evaluations of the use of office spirometry in the primary care setting to identify best practices using the most re...
Selim, Heba Sayed; Abaza, Amani Farouk
Aim: This study aimed at investigating the microbial contamination of mobile phones in a hospital setting. Methods: Swab samples were collected from 40 mobile phones of patients and health care workers at the Alexandria University Students’ Hospital. They were tested for their bacterial contamination at the microbiology laboratory of the High Institute of Public Health. Quantification of bacteria was performed using both surface spread and pour plate methods. Isolated bacterial agents were id...
Coverage and development of specialist palliative care services across the World Health Organization European region (2005-2012): results from a European association for palliative care task force survey of 53 countries
Centeno, Carlos; Lynch, Thomas; Garralda, Eduardo; Carrasco, José Miguel; Guillen-Grima, Francisco; Clark, David
Background: The evolution of the provision of palliative care specialised services is important for planning and evaluation. Aim: To examine the development between 2005 and 2012 of three specialised palliative care services across the World Health Organization European Region – home care teams, hospital support teams and inpatient palliative care services. Design and setting: Data were extracted and analysed from two editions of the European Association for Palliative Care Atlas of Pal...
Full Text Available Abstract Background The roles of pharmacists have evolved from product oriented, dispensing of medications to more patient-focused services such as the provision of pharmaceutical care. Such pharmacy service is also becoming more widely practised in Malaysia but is not well documented. Therefore, this study is warranted to fill this information gap by identifying the types of pharmaceutical care issues (PCIs encountered by primary care patients with diabetes mellitus, hypertension or hyperlipidaemia in Malaysia. Methods This study was part of a large controlled trial that evaluated the outcomes of multiprofessional collaboration which involved medical general practitioners, pharmacists, dietitians and nurses in managing diabetes mellitus, hypertension and hyperlipidaemia in primary care settings. A total of 477 patients were recruited by 44 general practitioners in the Klang Valley. These patients were counselled by the various healthcare professionals and followed-up for 6 months. Results Of the 477 participants, 53.7% had at least one PCI, with a total of 706 PCIs. These included drug-use problems (33.3%, insufficient awareness and knowledge about disease condition and medication (20.4%, adverse drug reactions (15.6%, therapeutic failure (13.9%, drug-choice problems (9.5% and dosing problems (3.4%. Non-adherence to medications topped the list of drug-use problems, followed by incorrect administration of medications. More than half of the PCIs (52% were classified as probably clinically insignificant, 38.9% with minimal clinical significance, 8.9% as definitely clinically significant and could cause patient harm while one issue (0.2% was classified as life threatening. The main causes of PCIs were deterioration of disease state which led to failure of therapy, and also presentation of new symptoms or indications. Of the 338 PCIs where changes were recommended by the pharmacist, 87.3% were carried out as recommended. Conclusions This study
Larson, Nicole; Ward, Dianne; Neelon, Sara Benjamin; Story, Mary
Child-care settings provide numerous opportunities to promote healthy eating and physical activity behaviors among preschool children. The majority of U.S. children are placed in some form of non-parental care during their preschool years. While approximately 15 percent of preschool children are primarily cared for by their relatives, most…
Doran, Diane M; Reid-Haughian, Cheryl; Chilcote, Autumn; Bai, Yu Qing
The purpose of this study was to evaluate the implementation of a clinical information system (CIS) in a community setting. The researchers used a mixed-method design involving interviews, focus groups, and surveys. An independent cross-sectional sample of nurses was surveyed. At time 1 a total of 118 nurses responded and at time 2 a total of 81. Respondents were moderately satisfied with features of the CIS. User satisfaction was positively associated with access to structural and electronic resources and social capital and negatively associated with nurses' age at time 1. Social capital was positively associated with user satisfaction at time 2. Younger age was associated with overall research use at both time 1 and time 2. Research use was negatively associated with evaluation and feedback but positively associated with formal interactions. This evaluation identified the importance of educational support, user-centred design, and responsiveness to successful implementation of CISs in a community setting. PMID:23789527
Ventilator-associated pneumonia (VAP) is the leading cause of death with hospital-acquired infections, and preventing it is one of the Saving Lives initiatives ( Department of Health 2007 ). This article discusses the implementation of a purpose-designed VAP care bundle in a children's intensive care unit and examines the unique role of nurses in the management of the change process. A nurse-led VAP education, implementation and surveillance programme was set up. Nurse education was paramount, as nursing staff acceptance and involvement was a key feature. A multi-method training strategy was implemented, providing staff with multiple training opportunities and introducing VAP project education as a routine part of staff induction. Bundle compliance was monitored regularly and graphs of the results produced quarterly; feedback proved to be useful in keeping staff informed and engaged in VAP reduction. Comparison of VAP incidence before and after introduction of the care bundle showed a reduction after its implementation. With a co-ordinated, multidisciplinary approach, VAP care bundles can result in significant and sustained reductions in VAP rates in the paediatric intensive care unit. Effective co-ordination and leadership is crucial to successful implementation of the VAP bundle, and nurses are well placed to undertake this role. PMID:27156419
Full Text Available Jordana K Schmier,1 Carolyn K Hulme-Lowe,1 Svetlana Semenova,2 Juergen A Klenk,3 Paul C DeLeo,4 Richard Sedlak,5 Pete A Carlson6 1Health Sciences, Exponent, Inc., Alexandria, VA, 2EcoSciences, Exponent, Inc., Maynard, MA, 3Health Sciences, Exponent, Inc., Alexandria, VA, 4Environmental Safety, 5Technical and International Affairs, American Cleaning Institute, Washington, DC, 6Regulatory Affairs, Ecolab, Saint Paul, MN, USA Objectives: Health care-associated infections (HAIs pose a significant health care and cost burden. This study estimates annual HAI hospital costs in the US avoided through use of health care antiseptics (health care personnel hand washes and rubs; surgical hand scrubs and rubs; patient preoperative and preinjection skin preparations. Methods: A spreadsheet model was developed with base case inputs derived from the published literature, supplemented with assumptions when data were insufficient. Five HAIs of interest were identified: catheter-associated urinary tract infections, central line-associated bloodstream infections, gastrointestinal infections caused by Clostridium difficile, hospital- or ventilator-associated pneumonia, and surgical site infections. A national estimate of the annual potential lost benefits from elimination of these products is calculated based on the number of HAIs, the proportion of HAIs that are preventable, the proportion of preventable HAIs associated with health care antiseptics, and HAI hospital costs. The model is designed to be user friendly and to allow assumptions about prevention across all infections to vary or stay the same. Sensitivity analyses provide low- and high-end estimates of costs avoided. Results: Low- and high-end estimates of national, annual HAIs in hospitals avoided through use of health care antiseptics are 12,100 and 223,000, respectively, with associated hospital costs avoided of US$142 million and US$4.25 billion, respectively. Conclusion: The model presents a novel
Vest, Susanne; Moll, Lill; Petersen, Marelis; Buch, Tove Fedder; Bruun, Ditte Marie; Rask, Marie; Wester, Anette; Linneberg, Allan
There is limited experience with implementation of chronic obstructive pulmonary disease (COPD) rehabilitation in primary care settings. We aimed to evaluate the implementation of a COPD rehabilitation programme in a primary care setting and compare the effects with those obtained in a secondary...
Johansen Inger; Lindbak Morten; Stanghelle Johan K; Brekke Mette
Background The optimal setting and content of primary health care rehabilitation of older people is not known. Our aim was to study independence, institutionalization, death and treatment costs 18 months after primary care rehabilitation of older people in two different settings. Methods Eighteen months follow-up of an open, prospective study comparing the outcome of multi-disciplinary rehabilitation ...
Griffin, Brenda; Bushby, Philip A; McCobb, Emily; White, Sara C; Rigdon-Brestle, Y Karla; Appel, Leslie D; Makolinski, Kathleen V; Wilford, Christine L; Bohling, Mark W; Eddlestone, Susan M; Farrell, Kelly A; Ferguson, Nancy; Harrison, Kelly; Howe, Lisa M; Isaza, Natalie M; Levy, Julie K; Looney, Andrea; Moyer, Michael R; Robertson, Sheilah Ann; Tyson, Kathy
As community efforts to reduce the overpopulation and euthanasia of unwanted and unowned cats and dogs have increased, many veterinarians have increasingly focused their clinical efforts on the provision of spay-neuter services. Because of the wide range of geographic and demographic needs, a wide variety of spay-neuter programs have been developed to increase delivery of services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, community cat programs, and services provided through private practitioners. In an effort to promote consistent, high-quality care across the broad range of these programs, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinary medical care guidelines for spay-neuter programs. These guidelines consist of recommendations for general patient care and clinical procedures, preoperative care, anesthetic management, surgical procedures, postoperative care, and operations management. They were based on current principles of anesthesiology, critical care medicine, infection control, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs regardless of location, facility, or type of program. The Association of Shelter Veterinarians envisions that these guidelines will be used by the profession to maintain consistent veterinary medical care in all settings where spay-neuter services are provided and to promote these services as a means of reducing sheltering and euthanasia of cats and dogs. PMID:27379593
Hospitalists play an important role in treating current and preventing future acute exacerbations of chronic obstructive pulmonary disease (AECOPD), which are associated with high rates of medical resource use and morbidity. Comprehensive admission screening and diagnostic tests are important in enabling hospitalists to reliably identify patients with AECOPD, the severity of the episode, and related issues that may prolong patients' hospital length of stay. Recurring exacerbations, especially those that require repeated acute care, can reduce physical activity and accelerate pulmonary decline and risk of death. Recommended pharmacotherapies for AECOPD should include short-acting bronchodilators, systemic corticosteroids, and appropriate antibiotics in cases of suspected bacterial infection. Patients with demonstrable hypoxemia or respiratory failure may benefit from oxygen and/or ventilatory support. Long-term disease management with the goal of preventing future exacerbations should include ongoing emphasis toward smoking cessation and up-to-date vaccination, in addition to prescribing maintenance pharmacotherapies in accordance with respiratory treatment guidelines. Additional benefits may be derived from nonpharmacologic therapies, such as pulmonary rehabilitation, weight-loss recommendations, and treatment of obstructive sleep dyspnea when present. Effective communication among members of the inpatient and outpatient health care teams, the patient, and his or her caregivers is an important aspect of care transitions. Hospital discharge summaries should be transmitted to the patient's primary care physician and be readily available at the first follow-up visit. Discharge coaches and other allied health care providers can aid hospitalists in reinforcing self-management skills and patient education, and in emphasizing the importance of follow-up visits. Recent findings suggest that health and cost benefits are associated with improved COPD management. This article
Lenzen, Stephanie Anna; Dongen, Jerôme Jean Jacques van; Daniëls, Ramon; van Bokhoven, Marloes Amantia; Weijden, Trudy; Beurskens, Anna
Background: There is an increasing number of patients with a chronic illness demanding primary care services. This demands for effective self-management support, including collaborative goal setting. Despite the fact that primary care professionals seem to have difficulties implementing goal setting, little information is available about the factors influencing the complexity of this process in primary care. Objective: The aim of this study was to contribute to an understanding of the complex...
Darrel J. Weinkauf; Boris Kralj
Reductions in health care funding by both the federal and provincial governments in recent years have focused attention on the cost-effectiveness of health care delivery, particularly on the delivery of primary care services. We use data extracted from the Ontario Health Insurance Plan (OHIP) claims database to assess differences between walk-in clinics and other primary care delivery settings in initial visit costs, follow-up visit costs, service duplication, and diagnoses treated. Our analy...
Full Text Available Abstract Background It is important that healthcare provided in crisis settings is based on the best available research evidence. We reviewed guidelines for child and perinatal health care in crisis situations to determine whether they were based on research evidence, whether Cochrane systematic reviews were available in the clinical areas addressed by these guidelines and whether summaries of these reviews were provided in Evidence Aid. Methods Broad internet searches were undertaken to identify relevant guidelines. Guidelines were appraised using AGREE and the clinical areas that were relevant to perinatal or child health were extracted. We searched The Cochrane Database of Systematic Reviews to identify potentially relevant reviews. For each review we determined how many trials were included, and how many were conducted in resource-limited settings. Results Six guidelines met selection criteria. None of the included guidelines were clearly based on research evidence. 198 Cochrane reviews were potentially relevant to the guidelines. These reviews predominantly addressed nutrient supplementation, breastfeeding, malaria, maternal hypertension, premature labour and prevention of HIV transmission. Most reviews included studies from developing settings. However for large portions of the guidelines, particularly health services delivery, there were no relevant reviews. Only 18 (9.1% reviews have summaries in Evidence Aid. Conclusions We did not identify any evidence-based guidelines for perinatal and child health care in disaster settings. We found many Cochrane reviews that could contribute to the evidence-base supporting future guidelines. However there are important issues to be addressed in terms of the relevance of the available reviews and increasing the number of reviews addressing health care delivery.
Schafer, Katherine Montag; Reidt, Shannon
Advancing age is associated with an increased risk of herpes zoster (shingles) infection and latent effects such as postherpetic neuralgia. The herpes zoster vaccine is recommended in those 60 years of age and older and has been shown to prevent both the primary disease and associated complications. While this recommendation applies to those living in long-term care facilities, there is little clinical evidence to support use in this population. Additionally, there are logistical barriers that may complicate the use of the vaccine. The article examines the evidence for vaccinating residents in long-term care facilities and discusses logistical barriers to vaccination. Pharmacists and providers may consider life expectancy and other factors when evaluating which patients should receive the vaccination. PMID:26803085
Full Text Available Objectives: To determine the effectiveness of nutritional screening programmes in improving quality of care and patient outcomes compared with usual care. Methods: Searches were performed on MEDLINE, EMBASE, CINHAL, the Cochrane database, and Current Controlled Trials. Due to the assumed scarcity of high quality evidence, interventional studies in hospital or primary care settings with adequate reporting and comparisons were considered as eligible. Team members met after reviewing the papers. Decisions on inclusion or exclusion of papers were made when all agreed. Two reviewers independently extracted data from included studies. Results: 705 abstracts were considered and thirty full-text papers were ordered and reviewed. Following further review of the extracted data two papers met the inclusion criteria. One was a clustered randomized study of 26 general practices to evaluate the effectiveness of screening for elderly ailments including malnutrition. It concluded nutritional screening did not improve referral to dieticians, detection of nutritional problems, or patients’ quality of life. This study was underpowered for evaluating the effectiveness of nutritional screening. A non-randomized controlled before-after study of four hospital wards concluded that intervention improved weight recording, but not referral to dieticians or care at the mealtime of at risk patients. Discussion: Very few studies assess the effectiveness of nutritional screening with relevant outcomes and acceptable quality. The available evidence does not support systematic application of screening tools to hospital, or general practice patients. Given the current level of interest and political support for nutritional screening, further studies are urgently required.
Singh, Anurag; Agarwal, Sheesham
This cross-sectional study compared 120 children having severe acute malnutrition with 120 healthy children for exposure to 40 behaviors, by measuring psychosocial care based on Home Observation for Measurement of the Environment (HOME) inventory. The mean (SD) psychosocial care score of cases and controls significantly differed [18.2 (2.2) vs 23.5 (2.1); P<0.001]. A score of less than 14 was significantly associated with severe acute malnutrition (OR 23.2; 95% CI 8.2, 50). PMID:27254059
Forester, Brent P.; Oxman, Thomas E.
Noncognitive symptoms associated with Alzheimer's disease and related dementias include psychosis, mood disturbances, personality changes, agitation, aggression, pacing, wandering, altered sexual behavior, changed sleep patterns, and appetite disturbances. These noncognitive symptoms of dementia are common, disabling to both the patient and the caregiver, and costly. Primary care physicians will often play a major role in diagnosing and treating dementia and related disorders in the community...
Sim, Leslie A.; McAlpine, Donald E.; Grothe, Karen B.; Himes, Susan M.; Cockerill, Richard G.; Clark, Matthew M.
Eating disorders, which are associated with a host of adverse medical morbidities, negative psychological sequelae, and considerable reductions in quality of life, should be diagnosed and treated promptly. However, primary care physicians may find it uniquely challenging to detect eating disorders in their early stages, before obvious physical problems arise and while psychological symptoms are subtle. Although psychological symptoms may dominate the presentation, the physician is an integral...
Vallejo-Torres, Laura; Morris, Stephen
Rising demand for and costs of health care have led to an increasing role of practice nurses in primary care in many countries, including the United Kingdom. Previous research has explored how practice nurse care differs from that provided by general practitioners (GPs) in terms of costs and health outcomes, and has highlighted the importance of matching skills and experience with roles and responsibilities. However, there has been little research to compare the characteristics of patients seen by GPs and practice nurses in primary care. We aim to investigate the factors associated with the use of practice nurse visits, and to compare these with the factors associated with GP use. We jointly model the use of practice nurse and GP visits using a bivariate probit regression model with a large set of covariates taken from two rounds of the Health Survey for England (2001, 2002). We find that practice nurse use is associated with age and gender, health, socioeconomic and supply variables. There are differences in the factors associated with practice nurse and GP use. Chronically ill patients are more likely to see a practice nurse, while acute ill health has a stronger association with the probability of seeing the GP. Practice nurse use is also correlated with a narrower range of health conditions compared with GP use. We also found differences between practice nurse and GP visits with respect to the association with economic activity, ethnic group, number of children, degree of urbanisation, and distance to practice. PMID:20496159
Oakley, Laura L; Renfrew, Mary J; Kurinczuk, Jennifer J; Quigley, Maria A.
Objectives To identify the sociodemographic factors associated with variation in area-based breastfeeding in England; to calculate the predicted breastfeeding rates adjusted for sociodemographic variations. Design Ecological analysis of routine data using random effects logistic regression. Setting All 151 primary care trusts (PCTs) in England 2010–2011. Outcome measures PCT level data on breastfeeding: initiation, any and exclusive breastfeeding at 6–8 weeks. Results There was considerable v...
Lordly, Daphne; Taper, Janette
Traditionally, an emphasis has been placed on dietetic interns' attainment of entry-level clinical competence in acute care facilities. The perceived risks and benefits of acquiring entry-level clinical competence within long-term and acute care clinical environments were examined. The study included a purposive sample of recent graduates and dietitians (n=14) involved in an integrated internship program. Study subjects participated in in-depth individual interviews. Data were thematically analyzed with the support of data management software QSR N6. Perceived risks and benefits were associated with receiving clinical training exclusively in either environment; risks in one area surfaced as benefits in the other. Themes that emerged included philosophy of care, approach to practice, working environment, depth and breadth of experience, relationships (both client and professional), practice outcomes, employment opportunities, and attitude. Entry-level clinical competence is achievable in both acute and long-term care environments; however, attention must be paid to identified risks. Interns who consider gaining clinical competence exclusively in one area can reduce risks and better position themselves for employment in either practice area by incorporating an affiliation in the other area into their internship program. PMID:18334052
de Jong, Fransina J.; van Steenbergen-Weijenburg, Kirsten M; Huijbregts, Klaas M.L.; Vlasveld, Moniek C; van Marwijk, Harm W. J.; Beekman, Aartjan T.F.; van der Feltz-Cornelis, Christina M
Background: In the Depression Initiative, a promising collaborative care model for depression that was developed in the US was adapted for implementation in the Netherlands. Aim: Description of a collaborative care model for major depressive disorder (MDD) and of the factors influencing its implementation in the primary care setting in the Netherlands. Data sources: Data collected during the preparation phase of the CC:DIP trial of the Depression Initiative, literature, policy documents, in...
Homeless health is government and NGO’s responsibilities for creating optimal citizen health status. Homeless is one of community health nursing clients. The Self Care Theory is used in nursing science for giving conceptual framework as a practical guidance and building self care knowledge through research. Orem described self care as a continuing intervention. It was needed and done by adult to be survived, healthy, and wellness. This theory is also used in homeless setting by many exp...
Tirath Singh; Anil Kumar Kashyap; Gautam Ahluwalia; Deepinder Chinna; Sandeep Singh Sidhu
Background: During recent years, fungal infections have risen exponentially and are a cause of significant morbidity and mortality in hospitalized patients, especially in the critical care setting. There is paucity of data from India on fungal pathogens. Methods: We prospectively studied patients admitted to medical and surgical critical care section of a tertiary care institute in northern India. The clinical samples of patients were processed in Department of Microbiology for isolatio...
Dalia Badawi; Shadi Saleh; Nabil Natafgi; Yara Mourad; Kazem Behbehani
Diabetes Mellitus is one of the major public health challenges, affecting more than 347 million adults worldwide. The impact of diabetes necessitates assessing the quality of care received by people with diabetes, especially in countries with a significant diabetes burden such as Kuwait. This paper aimed at piloting an approach for measuring Type II diabetes care performance through the use of a diabetes quality indicator set (DQIS) in primary health care. The DQIS for Kuwait was adapted from...
Samuel G Smith
Full Text Available OBJECTIVE: There is ongoing debate on whether health literacy represents a skill-based construct for health self-management, or if it also more broadly captures personal 'activation' or motivation to manage health. This research examines 1 the association between patient activation and health literacy as they are most commonly measured and 2 the independent and combined associations of patient activation and health literacy skills with physical and mental health. METHODS: A secondary analysis of baseline cross-sectional data from the LitCog cohort of older adults was used. Participants (n = 697 were recruited from multiple US-based health centers. During structured face-to-face interviews, participants completed the Test of Functional Health Literacy in Adults (TOFHLA, the Patient Activation Measure (PAM, the SF-36 physical health summary subscale, and Patient Reported Outcomes Measurement Information Service (PROMIS short form subscales for depression and anxiety. RESULTS: The relationship between health literacy and patient activation was weak, but significant (r = 0.11, p<0.01. In models adjusted for participant characteristics, lower health literacy was associated with worse physical health (β = 0.13, p<0.001 and depression (β = -0.16, p<0.001. Lower patient activation was associated with worse physical health (β = 0.19, p<0.001, depression (β = -0.27, p<0.001 and anxiety (β-0.24, p<0.001. CONCLUSIONS: The most common measures of health literacy and patient activation are weakly correlated with each other, but also independently correlated with health outcomes. This suggests health literacy represents a distinct skill-based construct, supporting the Institute of Medicine's definition. Deficits in either construct could be useful targets for behavioral intervention.
Adel Dimian; Anne-Valerie Ohlsson
This is the case of a Singapore-based nonprofit organization in need of strategic turnaround. Funding changes from the Singapore government were the primary cause of Hospice Care Association's (HCA) critical financial situation. Additionally, staffing response to changes in operations was severe and negative. Dr. Akhileswaran is thrust into a position of leadership that initially overwhelms and surprises him, given that his expected role — and the role he had agreed to take on — was that of M...
Udo, Tomoko; White, Marney A; Lydecker, Janet L; Barnes, Rachel D; Genao, Inginia; Garcia, Rina; Masheb, Robin M; Grilo, Carlos M
This study examined racial differences in eating-disorder psychopathology, eating/weight-related histories, and biopsychosocial correlates in women (n = 53 Caucasian and n = 56 African American) with comorbid binge eating disorder (BED) and obesity seeking treatment in primary care settings. Caucasians reported significantly earlier onset of binge eating, dieting, and overweight, and greater number of times dieting than African American. The rate of metabolic syndrome did not differ by race. Caucasians had significantly elevated triglycerides whereas African Americans showed poorer glycaemic control (higher glycated haemoglobin A1c [HbA1c]), and significantly higher diastolic blood pressure. There were no significant racial differences in features of eating disorders, depressive symptoms, or mental and physical health functioning. The clinical presentation of eating-disorder psychopathology and associated psychosocial functioning differed little by race among obese women with BED seeking treatment in primary care settings. Clinicians should assess for and institute appropriate interventions for comorbid BED and obesity in both African American and Caucasian patients. PMID:26640009
Aschenbrener, C A; Siders, C T
Physician executives face low to mid-level intensity conflicts, day-to-day issues and problems associated with pressures and changes in the health care environment. Such conflicts can be sorted on the basis of relationship, duration, and intensity. The authors apply the five major modes of conflict management--competition, avoidance, compromise, accommodation, and collaboration--to specific scenarios taken from their work in health care and suggest guidelines for managing conflicts with peers, supervisees, and authority figures. Thorough preparation and a portfolio of skills build flexibility through the conflict management process. In part 1 of this article series, the authors presented the conflict management checklist, a diagnostic tool for assessing conflict in organizations. PMID:10558283
Zamperetti, Nereo; Piccinni, Mariassunta; Bellomo, Rinaldo; Citerio, Giuseppe; Mistraletti, Giovanni; Gristina, Giuseppe; Giannini, Alberto
Clinical research is an essential component of medical activity, and this is also true in intensive care. Adequate information and consent are universally considered necessary for the protection of research subjects. However, in emergency situations, the majority of critical patients are unable to consent and a valid legal representative is often unavailable. The situation is even more complex in Italy, where the relevant legislation fails to specify how investigators should manage research in emergency or critical care setting when it involves incompetent patients who do not have an appointed legal representative. While special measures for the protection of incompetent subjects during emergency research are necessary, not allowing such research at all dooms critically ill patients to receive non-evidence-based treatments without the prospect of improvement. The recently-issued EU Regulation n. 536/2014 will probably help shed light on this situation. Indeed, it specifically addresses the issue of "research in emergency situations" and introduces detailed rules aimed at protecting patients while allowing research. In this article, we argue that obtaining informed consent during emergency research on incompetent subjects in unrealistic, and that in most cases substituted judgment on the part of a proxy carries major flaws. Strict criteria in evaluating the risk-benefit ratio of proposed intervention and a careful evaluation of the trial by a local or national Research Ethics Committee are perhaps the most practicable solution. PMID:26154445
Full Text Available Hemichorea hemiballismus (HCHB is a rare and debilitating presentation of hyperglycemia and subcortical stroke. Early identification, proper assessment and management of HCHB can lead to complete symptom relief. We describe a case of HCHB presenting to a palliative care setting. A 63-year-old diabetic and hypertensive lady, with history of ovarian cancer presented to Palliative Medicine outpatient clinic with two days history of right HCHB. Blood investigations and brain imaging showed high blood sugar levels and lacunar subcortical stroke. Blood sugar levels were controlled with human insulin and Aspirin. Clopidogrel and Atorvastatin were prescribed for the management of lacunar stroke. HCHB reduced markedly post-treatment, leading to significant reduction in morbidity and improvement in quality of life. The symptoms completely resolved within one week of starting the treatment and the patient was kept on regular home and outpatient follow up for further monitoring. Acute palliative care (APC approach deals with the management of comorbidities and their complications along with supportive care. Prompt assessment and management of such complications lead to better patient outcomes.
Cowin, Leanne S
Poor collegial relations can cause communication breakdown, staff attrition and difficulties attracting new nursing staff. Underestimating the potential power of nursing team relationships means that opportunities to create better working environments and increase the quality of nursing care can be missed. Previous research on improving collegiality indicates that professionalism and work satisfaction increases and that staff attrition decreases. This study explores challenges, strengths and strategies used in nursing team communication in order to build collegial relationships. A qualitative approach was employed to gather nurses experiences and discussion of communication within their nursing teams and a constant comparison method was utilised for data analysis. A convenience sampling technique was employed to access both Registered Nurses and Enrolled Nurses to partake in six focus groups. Thirty mostly female nurses (ratio of 5:1) participated in the study. Inclusion criteria consisted of being a nurse currently working in acute care settings and the exclusion criteria included nursing staff currently working in closed specialty units (i.e. intensive care units). Results revealed three main themes: (1) externalisation and internalisation of nursing team communication breakdown, (2) the importance of collegiality for retention of nurses and (3) loss of respect, and civility across the healthcare workplace. A clear division between hierarchies of nurses was apparent in how nursing team communication was delivered and managed. Open, respectful and collegial communication is essential in today's dynamic and complex health environments. The nurses in this study highlighted how important nursing communication can be to work motivation and how leadership fosters teamwork. PMID:23898600
Michelle D. Park
Full Text Available Background. Socioeconomic factors and insurance status have not been correlated with differential use of healthcare services in inflammatory bowel disease (IBD. Aim. To describe IBD-related expenditures based on insurance and household income with the use of inpatient, outpatient, emergency, and office-based services, and prescribed medications in the United States (US. Methods. We evaluated the Medical Expenditure Panel Survey from 1996 to 2011 of individuals with Crohn’s disease (CD or ulcerative colitis (UC. Nationally weighted means, proportions, and multivariate regression models examined the relationships between income and insurance status with expenditures. Results. Annual per capita mean expenditures for CD, UC, and all IBD were $10,364 (N = 238, $7,827 (N = 95, and $9,528, respectively, significantly higher than non-IBD ($4,314, N = 276, 372, p < 0.05. Publicly insured patients incurred the highest costs ($18,067 over privately insured ($8,014, p < 0.05 or uninsured patients ($5,129, p < 0.05. Among all IBD patients, inpatient care composed the highest proportion of costs ($3,392, p < 0.05. Inpatient costs were disproportionately higher for publicly insured patients. Public insurance had higher odds of total costs than private (OR 2.13, CI [1.08–4.19] or no insurance (OR 4.94, CI [1.26–19.47], with increased odds for inpatient and emergency care. Private insurance had higher costs associated with outpatient care, office-based care, and prescribed medicines. Low-income patients had lower costs associated with outpatient (OR 0.38, CI [0.15–0.95] and office-based care (OR 0.21, CI [0.07–0.62]. Conclusions. In the US, high inpatient utilization among publicly insured patients is a previously unrecognized driver of high IBD costs. Bridging this health services gap between SES strata for acute care services may curtail direct IBD-related costs.
Chin Yee Cheong
Full Text Available Background/Aims: The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT programme on mood and engagement in older patients with delirium and/or dementia (PtDD in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods: Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4 were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy on 3 consecutive days: day 1 (control condition without music and days 2 and 3 (with CMT. Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES and Observed Emotion Rating Scale (OERS. Results: Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01 in MPES and pleasure and general alertness (Z = 3.188,p = 0.01 in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014. Negative engagement (Z = 2.582, p = 0.01 and affect (Z = 2.004, p = 0.045 were both lower during CMT compared to no music. Conclusion: These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation.
Cheong, Chin Yee; Tan, Jane An Qi; Foong, Yi-Lin; Koh, Hui Mien; Chen, Denise Zhen Yue; Tan, Jessie Joon Chen; Ng, Chong Jin; Yap, Philip
Background/Aims The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT) programme on mood and engagement in older patients with delirium and/or dementia (PtDD) in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4) were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy) on 3 consecutive days: day 1 (control condition without music) and days 2 and 3 (with CMT). Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES) and Observed Emotion Rating Scale (OERS). Results Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01) in MPES and pleasure and general alertness (Z = 3.188,p = 0.01) in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014). Negative engagement (Z = 2.582, p = 0.01) and affect (Z = 2.004, p = 0.045) were both lower during CMT compared to no music. Conclusion These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation. PMID:27489560
Simon Steven R
Full Text Available Abstract Background Documentation in the medical record facilitates the diagnosis and treatment of patients. Few studies have assessed the quality of outpatient medical record documentation, and to the authors' knowledge, none has conclusively determined the correlates of chart documentation. We therefore undertook the present study to measure the rates of documentation of quality of care measures in an outpatient primary care practice setting that utilizes an electronic medical record. Methods We reviewed electronic medical records from 834 patients receiving care from 167 physicians (117 internists and 50 pediatricians at 14 sites of a multi-specialty medical group in Massachusetts. We abstracted information for five measures of medical record documentation quality: smoking history, medications, drug allergies, compliance with screening guidelines, and immunizations. From other sources we determined physicians' specialty, gender, year of medical school graduation, and self-reported time spent teaching and in patient care. Results Among internists, unadjusted rates of documentation were 96.2% for immunizations, 91.6% for medications, 88% for compliance with screening guidelines, 61.6% for drug allergies, 37.8% for smoking history. Among pediatricians, rates were 100% for immunizations, 84.8% for medications, 90.8% for compliance with screening guidelines, 50.4% for drug allergies, and 20.4% for smoking history. While certain physician and patient characteristics correlated with some measures of documentation quality, documentation varied depending on the measure. For example, female internists were more likely than male internists to document smoking history (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.27 – 2.83 but were less likely to document drug allergies (OR, 0.51; 95% CI, 0.35 – 0.75. Conclusions Medical record documentation varied depending on the measure, with room for improvement in most domains. A variety of
Full Text Available Background and Objectives: As part of an ongoing evaluation of the process of care, the management of type 2 diabetes in primary healthcare settings was studied in a series of audits with the objective of improving diabetes care in a primary care center of the Saudi National Guard Health Affairs, Riyadh, Saudi Arabia. Methods: A sample of 30 files was randomly selected every 2 weeks from a sampling frame of medical records of type 2 diabetes patients seen over the previous two weeks. The criterion of good management was arbitrarily defined as a glycated hemoglobin (HbA 1c less than 7%, with a test frequency of once every 3 months. The proportion of patients not conforming to the criterion was reported back to the care providers. Specially trained nurses did all randomization, data extraction, and entry. Results: Data were extracted form 651 medical records, including 355 (54.5% for females and 296 (45.5% for males. Both the mean and median age of those studied was 53 years. Mean HbA1c was 9.0±2.0%, mean fasting plasma glucose was 9.9±3.9 mmol/L, and mean 2-hour postprandial plasma glucose was 15.0±5.3 mmol/L. In 20.6% (134/651 (95% CI, 17.5%-23.9% of patients the HbA 1c level was less than 7%. Only 10.4% (68/651 (95% CI, 8.2%-13.0% had HbA 1c measured in the previous 3 months that was less than 7.0% and thus met the criterion for good management. In the previous 3 months, 55.4% (95% CI, 51.5%-59.3% had been tested for HbA 1c . Conclusions: Management of diabetes at the primary care level leaves much to be desired. There is a need for an ongoing process of evaluation to follow up the implementation of care guidelines.
This comprehensive synthesis of published literature from a team in Northern Ireland focused on the perspectives of healthcare professionals in relation to ACP for people with dementia living in long-term care settings. From the 14 papers discussed, the authors identified that people with dementia are often not recognised as having a terminal illness. Four key themes were identified: ■ Early integration and planning for palliative care in dementia is important. ■ Healthcare professionals' perspectives on ACP are influenced by ethical and moral concerns including presumptions regarding capacity of the person with dementia towards ACP and the impact of the increased role of the family in the decision-making processes. ■ Challenges in communicating with people who have dementia and their families. ■ A need for improvement in healthcare professionals' knowledge of the disease trajectory of dementia with emphasis on end of life care, and a greater understanding of the process of ACP itself. This would assist them in engaging in ACP discussions. PMID:27231081