WorldWideScience

Sample records for advance care planning

  1. Advance Care Planning

    Science.gov (United States)

    ... put on a breathing machine. Organ and tissue donation allows organs or body parts from a generally healthy person ... to your driver’s license. Some people also include organ donation in their advance care planning documents. At the ...

  2. Advance Care Planning i sykehjem

    OpenAIRE

    Hydal, Anne-Marthe Bering

    2015-01-01

    Bakgrunn: Advance care planning (ACP) er en kommunikativ prosess, som utforsker pasienters preferanser for fremtidig medisinsk behandling og pleie ved livets slutt. Flere land har tatt i bruk ACP, men i Norge finnes få føringer for nedtegnelse av pasientpreferanser. Hensikt: Undersøke hvilke ACP programmer som er implementert i sykehjem utenfor Norge, og hva de ulike programmene inneholder. Videre å undersøke hvilke implementeringsstrategier som er tatt i bruk, og hvilke erfaringer som beskri...

  3. Advance care planning in South Korea: Social work perspective.

    Science.gov (United States)

    Kwon, Sung Ae; Kolomer, Stacey

    2016-08-01

    As ethical issues arise concerning the continuation of futile medical treatment for dying patients in Korean society, advance directive planning initiatives have been put into place to guide practice. This article describes the awareness and attitudes of social workers in Korea regarding advance care planning and related factors. A total of 246 gerontological/geriatric social workers completed a mailed or in-person survey regarding awareness and attitudes toward advance care planning. Seventy-three percent (n = 180) of the participants reported no knowledge of advance directives. Social workers who emphasized self-determination as a professional value, professed a preference for hospice care, and who were comfortable discussing death were more likely to have a positive attitudes toward advance care planning. This study reinforces the need for the infusion of advance care planning and end-of-life training in social work education in Korea. PMID:27428654

  4. Advance Care Planning in Nursing Homes: Correlates of Capacity and Possession of Advance Directives

    Science.gov (United States)

    Allen, Rebecca S.; DeLaine, Shermetra R.; Chaplin, William F.; Marson, Daniel C.; Bourgeois, Michelle S.; Dijkstra, Katinka; Burgio, Louis D.

    2003-01-01

    Purpose: The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. Design…

  5. Reliability of an Interactive Computer Program for Advance Care Planning

    OpenAIRE

    Schubart, Jane R.; Levi, Benjamin H.; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J.

    2012-01-01

    Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demon...

  6. Advance Care Planning: Medical Issues to Consider

    Science.gov (United States)

    ... cancer or end stage chronic illness accompanied by anorexia (lack of appetite) and cachexia (muscles wasting away ... care and administrative program support. Share this: Twitter Facebook Google Search for: Choosing a Hospice: 16 Questions ...

  7. Development and evaluation of an aged care specific Advance Care Plan

    OpenAIRE

    Silvester, William; Parslow, Ruth A; Lewis, Virginia J; Fullam, Rachael S; Sjanta, Rebekah; Jackson, Lynne; White, Vanessa; Hudson, Rosalie

    2013-01-01

    Objectives To report on the quality of advance care planning (ACP) documents in use in residential aged care facilities (RACF) in areas of Victoria Australia prior to a systematic intervention; to report on the development and performance of an aged care specific Advance Care Plan template used during the intervention. Design An audit of the quality of pre-existing documentation used to record resident treatment preferences and end-of-life wishes at participating RACFs; development and pilot ...

  8. Development and Validation of a Questionnaire to Detect Behavior Change in Multiple Advance Care Planning Behaviors

    OpenAIRE

    Sudore, Rebecca L.; Stewart, Anita L.; Knight, Sara J.; McMahan, Ryan D.; Feuz, Mariko; Miao, Yinghui; Barnes, Deborah E.

    2013-01-01

    Introduction Advance directives have traditionally been considered the gold standard for advance care planning. However, recent evidence suggests that advance care planning involves a series of multiple discrete behaviors for which people are in varying stages of behavior change. The goal of our study was to develop and validate a survey to measure the full advance care planning process. Methods The Advance Care Planning Engagement Survey assesses “Process Measures” of factors known from Beha...

  9. Impact of advance care planning on the care of patients with heart failure: study protocol for a randomized controlled trial

    OpenAIRE

    Malhotra, Chetna; Sim, David Kheng Leng; Jaufeerally, Fazlur; Vikas, Nivedita Nadkarni; Sim, Genevieve Wong Cheng; Tan, Boon Cheng; Ng, Clarice Shu Hwa; Tho, Pei Leng; Lim, Jingfen; Chuang, Claire Ya-Ting; Fong, Florence Hui Mei; Liu, Joy; Finkelstein, Eric A.

    2016-01-01

    Background Despite the promise and popularity of advance care planning, there is insufficient evidence that advance care planning helps patients to meet their end-of-life care preferences, especially in Asian settings. Thus, the proposed study aims to assess whether patients with advanced heart failure who are receiving advance care planning have a greater likelihood of receiving end-of-life care consistent with their preferences compared to patients receiving usual care. Secondary objectives...

  10. Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions.

    Science.gov (United States)

    Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J

    2016-01-01

    People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population. PMID:27053406

  11. Reliability of an interactive computer program for advance care planning.

    Science.gov (United States)

    Schubart, Jane R; Levi, Benjamin H; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J

    2012-06-01

    Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83-0.95, and 0.86-0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time. PMID:22512830

  12. Reliability of an Interactive Computer Program for Advance Care Planning

    Science.gov (United States)

    Levi, Benjamin H.; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J

    2012-01-01

    Abstract Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83–0.95, and 0.86–0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time. PMID:22512830

  13. Care of Patients at the End of Life: Advance Care Planning.

    Science.gov (United States)

    Ackermann, Richard J

    2016-08-01

    Advance directives are legal documents that give instructions about how to provide care when patients develop life-threatening illnesses and can no longer communicate their wishes. Two types of documents are widely used-a living will and a durable power of attorney for health care. Most states also authorize physician orders for life-sustaining treatment. Physicians should encourage patients, particularly those with severe chronic or terminal conditions, to prepare advance directives. Medicare now reimburses billing codes for advance care consultations. Directions regarding cardiopulmonary resuscitation and artificial ventilation often are included in advance care plans, and use of artificial nutrition and hydration (ANH) also should be addressed, particularly for patients with advanced dementia. Evidence shows that in such patients, ANH does not prolong survival, increase comfort, or improve quality of life. Given the lack of benefit, physicians should recommend against use of ANH for patients with dementia. Finally, physicians should encourage use of hospice services by patients whose life expectancy is 6 months or less. Although Medicare and most other health care insurers cover hospice care, and despite evidence that patient and family satisfaction increase when hospice services are used, many patients do not use these services. PMID:27490070

  14. The economic evidence for advance care planning: systematic review of evidence

    OpenAIRE

    Dixon, Josie; Matosevic, Tihana; Knapp, Martin

    2015-01-01

    Background: Advance care planning (ACP), a process of discussion and review concerning future care in the event of losing capacity. Aimed at improving the appropriateness and quality of care, it is also often considered a means of controlling health spending at the end of life. Aim: To review and summarise economic evidence on advance care planning. Design: A systematic review of academic literature. Data sources: We searched for English language peer-reviewed journal articles, 1990 to 201...

  15. Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members

    OpenAIRE

    Kimberly Ramsbottom; Mary Lou Kelley

    2014-01-01

    Long term care (LTC) homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP) important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descript...

  16. The views of older Malaysians on advanced directive and advanced care planning: a qualitative study.

    Science.gov (United States)

    Htut, Y; Shahrul, K; Poi, P J H

    2007-01-01

    The provision of optimum care for the ageing population is dependent on the understanding of their views and values on end of life issues. A qualitative descriptive study was conducted to describe views of elderly Malaysians on Advanced Care Planning (henceforth ACP) and Advanced Directives (henceforth AD), and explore factors influencing these views. Fifteen elderly subjects with ages ranging from 65 to 83 years, representing different ethnic and religious groups in Malaysia were selected for in-depth interviews guided by a questionnaire. Five core themes were extracted from the interviews: 1) Considering the future 2) Contingency plans for future illnesses 3) Attitudes towards life prolonging treatment procedures 4) Doctor-patient relationships and 5) Influence of religion on decisions related to future illness. Despite the lack of knowledge on ACP and AD, older respondents were very receptive to their concept. Although the majority agreed on the importance of planning for future medical management and having open discussion on end of life issues with their doctor, they felt it unnecessary to make a formal written AD. Most felt that the future was best left to fate or God, and none had made any contingency plan for severe future illnesses citing religion as reason for this view. Cardiopulmonary resuscitation, mechanical ventilation and dialysis were considered by most to be invasive life prolonging treatments. We suggest that doctors initiate discussions on end of life care with every older patient and their family so as to promote awareness and introduce the concept of ACP/AD to a Malaysian setting. PMID:18330404

  17. Talking about sensitive topics during the advance care planning discussion: A peek into the black box

    DEFF Research Database (Denmark)

    Andreassen, Pernille; Neergaard, Mette Asbjørn; Brogaard, Trine; Skorstengaard, Marianne Hjorth; Jensen, Anders Bonde

    2015-01-01

    OBJECTIVE: Advance care planning (ACP) discussions are emphasized as a valuable way of improving communication about end-of-life care. Yet we have very little knowledge of what goes on during actual ACP discussions. The aim of our study was to explore how the sensitive topics of end-of-life decis...

  18. Quality of Dying in Nursing Home Residents Dying with Dementia: Does Advanced Care Planning Matter? A Nationwide Postmortem Study

    OpenAIRE

    Vandervoort, An; Houttekier, Dirk; Vander Stichele, Robert; van der Steen, Jenny T; Van den Block, Lieve

    2014-01-01

    Background Advance care planning is considered a central component of good quality palliative care and especially relevant for people who lose the capacity to make decisions at the end of life, which is the case for many nursing home residents with dementia. We set out to investigate to what extent (1) advance care planning in the form of written advance patient directives and verbal communication with patient and/or relatives about future care and (2) the existence of written advance general...

  19. How Do General Practitioners Conceptualise Advance Care Planning in Their Practice? A Qualitative Study

    OpenAIRE

    De Vleminck, Aline; Pardon, Koen; Beernaert, Kim; Houttekier, Dirk; Vander Stichele, Robert; Deliens, Luc

    2016-01-01

    Objectives To explore how GPs conceptualise advance care planning (ACP), based on their experiences with ACP in their practice. Methods Five focus groups were held with 36 GPs. Discussions were analysed using a constant comparative method. Results Four overarching themes in the conceptualisations of ACP were discerned: (1) the organisation of professional care required to meet patients’ needs, (2) the process of preparing for death and discussing palliative care options, (3) the discussion of...

  20. Advance Care Planning and Goals of Care Communication in Older Adults with Cardiovascular Disease and Multi-Morbidity.

    Science.gov (United States)

    Lum, Hillary D; Sudore, Rebecca L

    2016-05-01

    This article provides an approach to advance care planning (ACP) and goals of care communication in older adults with cardiovascular disease and multi-morbidity. The goal of ACP is to ensure that the medical care patients receive is aligned with their values and preferences. In this article, the authors outline common benefits and challenges to ACP for older adults with cardiovascular disease and multimorbidity. Recognizing that these patients experience diverse disease trajectories and receive care in multiple health care settings, the authors provide practical steps for multidisciplinary teams to integrate ACP into brief clinic encounters. PMID:27113144

  1. Development and validation of a questionnaire to detect behavior change in multiple advance care planning behaviors.

    Directory of Open Access Journals (Sweden)

    Rebecca L Sudore

    Full Text Available INTRODUCTION: Advance directives have traditionally been considered the gold standard for advance care planning. However, recent evidence suggests that advance care planning involves a series of multiple discrete behaviors for which people are in varying stages of behavior change. The goal of our study was to develop and validate a survey to measure the full advance care planning process. METHODS: The Advance Care Planning Engagement Survey assesses "Process Measures" of factors known from Behavior Change Theory to affect behavior (knowledge, contemplation, self-efficacy, and readiness, using 5-point Likert scales and "Action Measures" (yes/no of multiple behaviors related to surrogate decision makers, values and quality of life, flexibility for surrogate decision making, and informed decision making. We administered surveys at baseline and 1 week later to 50 diverse, older adults from San Francisco hospitals. Internal consistency reliability of Process Measures was assessed using Cronbach's alpha (only continuous variables and test-retest reliability of Process and Action Measures was examined using intraclass correlations. For discriminant validity, we compared Process and Action Measure scores between this cohort and 20 healthy college students (mean age 23.2 years, SD 2.7. RESULTS: Mean age was 69.3 (SD 10.5 and 42% were non-White. The survey took a mean of 21.4 minutes (±6.2 to administer. The survey had good internal consistency (Process Measures Cronbach's alpha, 0.94 and test-retest reliability (Process Measures intraclass correlation, 0.70; Action Measures, 0.87. Both Process and Action Measure scores were higher in the older than younger group, p<.001. CONCLUSION: A new Advance Care Planning Engagement Survey that measures behavior change (knowledge, contemplation, self-efficacy, and readiness and multiple advance care planning actions demonstrates good reliability and validity. Further research is needed to assess whether survey

  2. Attitudes on end-of-life care and advance care planning in the lesbian and gay community.

    Science.gov (United States)

    Stein, G L; Bonuck, K A

    2001-01-01

    Gay men and lesbians have special interests in documenting their preferences regarding advance care planning and end-of-life care. A 64-item survey instrument was developed to ascertain the preferences of this community regarding approaches to end-of-life care, viewpoints on physician-assisted suicide (PAS) and euthanasia, and practices regarding advance care planning. The survey was completed by 575 participants recruited through community-based health care and social service organizations serving the lesbian and gay community, primarily in the New York metropolitan area. Respondents represent a diverse group of women (36%) and men (63%) from various age, racial/ethnic, and religious/spiritual backgrounds; 10% were human immunodeficiency virus (HIV)-positive. Respondents' perspectives on end-of-life care are generally consistent with findings from other attitudinal studies of U.S. adults: a majority supported legalization of PAS and preferred a palliative approach to end-of-life care. However, the gay community sample revealed even stronger support for assisted suicide and palliative care. Although respondents completed advance directives at a higher rate than adults generally, the legal importance for gay men and lesbians to execute directives should encourage health care providers and community organizations to assume a larger educational role on advance care planning. Results confirm other reports on the need to address provider communication skills. It is speculated that the HIV epidemic was a major influence behind these results because of the overwhelming personal impact of the epidemic on most gay men and lesbians during the past two decades. PMID:11441626

  3. Exploring the district nurse role in facilitating individualised advance care planning.

    Science.gov (United States)

    Boot, Michelle

    2016-03-01

    Health-care policy recognises the importance of engaging people in making decisions related to the management of their health. Advance care planning (ACP) offers a framework for decision making on end-of-life care. There are positive indicators that ACP enables health professionals to meet people's preferences. However, there are reports of insensitive attempts to engage people in end-of-life care decision making. District nurses are in the ideal position to facilitate ACP, as they have the opportunity to build relationships with the people they are caring for--an antecedent to sensitive ACP--and in recognising and fulfilling this role, they could ameliorate the risk of insensitive ACP. Distric nurse leaders also have a role to play in ensuring that organisational and environmental factors support appropriate ACP facilitation including: training, fostering a team culture that empowers district nurses to recognise and meet their ACP role, and advocating for appropriate ACP evaluation outcome measures. PMID:26940617

  4. End-of-life communication in Korean older adults: With focus on advance care planning and advance directives.

    Science.gov (United States)

    Shin, Dong Wook; Lee, Ji Eun; Cho, BeLong; Yoo, Sang Ho; Kim, SangYun; Yoo, Jun-Hyun

    2016-04-01

    The present article aimed to provide a comprehensive review of current status of end-of-life (EOL) care and sociocultural considerations in Korea, with focus on the EOL communication and use of advance directives (AD) in elderly Koreans. Through literature review, we discuss the current status of EOL care and sociocultural considerations in Korea, and provide a look-ahead. In Korea, patients often receive life-sustaining treatment until the very end of life. Advance care planning is rare, and most do-not-resuscitate decisions are made between the family and physician at the very end of patient's life. Koreans, influenced mainly by Confucian tradition, prefer a natural death and discontinuation of life-sustaining treatment. Although Koreans generally believe that death is natural and unavoidable, they tend not to think about or discuss death, and regard preparation for death as unnecessary. As a result, AD are completed by just 4.7% of the general adult population. This situation can be explained by several sociocultural characteristics including opting for natural death, wish not to burden others, preference for family involvement and trust in doctor, avoidance of talking about death, and filial piety. Patients often receive life-sustaining treatment until the very EOL, advance care planning and the use of AD is not common in Korea. This was related to unique sociocultural characteristics of Korea. A more active role of physicians, development of a more deliberate EOL discussion process, development of culturally appropriate AD and promotion of advance care planning might be required to provide good EOL care in Korea. Geriatr Gerontol Int 2016; 16: 407-415. PMID:26459613

  5. Economic (gross cost) analysis of systematically implementing a programme of advance care planning in three Irish nursing homes

    OpenAIRE

    O’Sullivan, Ronan; Murphy, Aileen; O’Caoimh, Rónán; Cornally, Nicola; Svendrovski, Anton; Daly, Brian; Fizgerald, Carol; Twomey, Cillian; McGlade, Ciara; Molloy, D. William

    2016-01-01

    Background Although advance care planning (ACP) and the use of advanced care directives (ACD) and end-of-life care plans are associated with a reduction in inappropriate hospitalisation, there is little evidence supporting the economic benefits of such programmes. We assessed the economic impact (gross savings) of the Let Me Decide (LMD) ACP programme in Ireland, specifically the impact on hospitalisations, bed days and location of resident deaths, before and after systematic implementation o...

  6. Advance care planning: A systematic review of randomised controlled trials conducted with older adults.

    Science.gov (United States)

    Weathers, Elizabeth; O'Caoimh, Rónán; Cornally, Nicola; Fitzgerald, Carol; Kearns, Tara; Coffey, Alice; Daly, Edel; O'Sullivan, Ronan; McGlade, Ciara; Molloy, D William

    2016-09-01

    Advance care planning (ACP), involving discussions between patients, families and healthcare professionals on future healthcare decisions, in advance of anticipated impairment in decision-making capacity, improves satisfaction and end-of-life care while respecting patient autonomy. It usually results in the creation of a written advanced care directive (ACD). This systematic review examines the impact of ACP on several outcomes (including symptom management, quality of care and healthcare utilisation) in older adults (>65years) across all healthcare settings. Nine randomised controlled trials (RCTs) were identified by searches of the CINAHL, PubMed and Cochrane databases. A total of 3646 older adults were included (range 72-88 years). Seven studies were conducted with community dwellers and the other two RCTs were conducted in nursing homes. Most studies did not implement a standardised ACD, or measure the impact on quality of end-of-life care or on the death and dying experience. All studies had some risk of bias, with most scoring poorly on the Oxford Quality Scale. While ACP interventions are well received by older adults and generally have positive effects on outcomes, this review highlights the need for well-designed RCTs that examine the economic impact of ACP and its effect on quality of care in nursing homes and other sectors. PMID:27451328

  7. Developing Strategies to Improve Advance Care Planning in Long Term Care Homes: Giving Voice to Residents and Their Family Members

    Directory of Open Access Journals (Sweden)

    Kimberly Ramsbottom

    2014-01-01

    Full Text Available Long term care (LTC homes, also known as residential care homes, commonly care for residents until death, making palliative care and advance care planning (ACP important elements of care. However, limited research exists on ACP in LTC. In particular, research giving voice to family members and substitute decision makers is lacking. The objective of this research was to understand experiences, perspectives, and preferences to guide quality improvement of ACP in LTC. This qualitative descriptive study conducted 34 individual semistructured interviews in two LTC homes, located in Canada. The participants were 31 family members and three staff, consisting of a front line care worker, a registered nurse, and a nurse practitioner. All participants perceived ACP conversations as valuable to provide “resident-centred care”; however, none of the participants had a good understanding of ACP, limiting its effectiveness. Strategies generated through the research to improve ACP were as follows: educating families and staff on ACP and end-of-life care options; better preparing staff for ACP conversations; providing staff skills training and guidelines; and LTC staff initiating systematic, proactive conversations using careful timing. These strategies can guide quality improvement of palliative care and development of ACP tools and resources specific to the LTC home sector.

  8. Early experience with digital advance care planning and directives, a novel consumer-driven program

    OpenAIRE

    Fine, Robert L.; Yang, Zhiyong; Spivey, Christy; Boardman, Bonnie; Courtney, Maureen

    2016-01-01

    Barriers to traditional advance care planning (ACP) and advance directive (AD) creation have limited the promise of ACP/AD for individuals and families, the healthcare team, and society. Our objectives were to determine the results of a digital ACP/AD through which consumers create, store, locate, and retrieve their ACP/AD at no charge and with minimal physician involvement, and the ACP/AD can be integrated into the electronic health record. The authors chose 900 users of MyDirectives, a digi...

  9. Advance care planning – a multi-centre cluster randomised clinical trial: the research protocol of the ACTION study

    OpenAIRE

    Rietjens, Judith; Dunleavy, Lesley Jane; Preston, Nancy Jean; Payne, Sheila Alison

    2016-01-01

    Background Awareness of preferences regarding medical care should be a central component of the care of patients with advanced cancer. Open communication can facilitate this but can occur in an ad hoc or variable manner. Advance care planning (ACP) is a formalized process of communication between patients, relatives and professional caregivers about patients’ values and care preferences. It raises awareness of the need to anticipate possible future deterioration of health. ACP has the potenti...

  10. Advance care planning - a multi-centre cluster randomised clinical trial: the research protocol of the ACTION study

    OpenAIRE

    Rietjens, Judith AC; Korfage, Ida J.; Dunleavy, Lesley; Preston, Nancy J.; Jabbarian, Lea J.; Christensen, Caroline Arnfeldt; de Brito, Maja; Bulli, Francesco; Caswell, Glenys; Červ, Branka; Delden, Johannes; Deliens, Luc; Gorini, Giuseppe; Groenvold, Mogens; Houttekier, Dirk

    2016-01-01

    Background: Awareness of preferences regarding medical care should be a central component of the care of patients with advanced cancer. Open communication can facilitate this but can occur in an ad hoc or variable manner. Advance care planning (ACP) is a formalized process of communication between patients, relatives and professional caregivers about patients' values and care preferences. It raises awareness of the need to anticipate possible future deterioration of health. ACP has the potent...

  11. Evaluating the systematic implementation of the 'Let Me Decide' advance care planning programme in long term care through focus groups: staff perspectives.

    LENUS (Irish Health Repository)

    Cornally, Nicola

    2015-11-01

    The \\'Let Me Decide\\' Advance Care Planning (LMD-ACP) programme offers a structured approach to End-of-Life (EoL) care planning in long-term care for residents with and without capacity to complete an advance care directive\\/plan. The programme was implemented in three homes in the South of Ireland, with a view to improving quality of care at end of life. This paper will present an evaluation of the systematic implementation of the LMD-ACP programme in the homes.

  12. Implementing advance care planning: a qualitative study of community nurses' views and experiences

    Directory of Open Access Journals (Sweden)

    Kennedy Sheila

    2010-04-01

    Full Text Available Abstract Background Advance care planning (ACP is a process of discussion about goals of care and a means of setting on record preferences for care of patients who may lose capacity or communication ability in the future. Implementation of ACP is widely promoted by policy makers. This study examined how community palliative care nurses in England understand ACP and their roles within ACP. It sought to identify factors surrounding community nurses' implementation of ACP and nurses' educational needs. Methods An action research strategy was employed. 23 community nurses from two cancer networks in England were recruited to 6 focus group discussions and three follow up workshops. Data were analysed using a constant comparison approach. Findings Nurses understood ACP to be an important part of practice and to have the potential to be a celebration of good nursing care. Nurses saw their roles in ACP as engaging with patients to elicit care preferences, facilitate family communication and enable a shift of care focus towards palliative care. They perceived challenges to ACP including: timing, how to effect team working in ACP, the policy focus on instructional directives which related poorly to patients' concerns; managing differences in patients' and families' views. Perceived barriers included: lack of resources; lack of public awareness about ACP; difficulties in talking about death. Nurses recommended the following to be included in education programmes: design of realistic scenarios; design of a flow chart; practical advice about communication and documentation; insights into the need for clinical supervision for ACP practice. Conclusions Nurses working in the community are centrally involved with patients with palliative care needs who may wish to set on record their views about future care and treatment. This study reveals some important areas for practice and educational development to enhance nurses' use and understanding of ACP.

  13. Planning Ahead: Advanced Heart Failure

    Science.gov (United States)

    ... Pressure High Blood Pressure Tools & Resources Stroke More Planning Ahead: Advanced Heart Failure Updated:Jul 7,2016 ... making your preferences known is called advance care planning. It allows you to speak for yourself, even ...

  14. They know! - do they? A qualitative study of residents and relatives views on advance care planning, end-of-life care, and decision-making in nursing homes.

    OpenAIRE

    Bollig, Georg; Gjengedal, Eva; Rosland, Jan Henrik

    2015-01-01

    Background: Residents living in long-term care facilities are a vulnerable population. For many residents, a nursing home is their place of death. Palliative care and end-of-life decisions are important components of their care provision. Aim: To study the views of cognitively able residents and relatives on advance care planning, end-of-life care, and decision-making in nursing homes. Design: A qualitative study with in-depth interviews with nursing home residents and focus group inter...

  15. Advance Care Planning in Norwegian nursing homes-Who is it for?

    Science.gov (United States)

    Thoresen, Lisbeth; Ahlzén, Rolf; Solbrække, Kari Nyheim

    2016-08-01

    Advance care planning (ACP) is an international concept for improving patient autonomy and communication in the context of anticipated deterioration and end-of-life care. In a preparatory conversation, health care professionals facilitate one or more conversations where nursing home residents are invited to reflect on, and articulate wishes and preferences concerning future medical treatment and end-of-life care. Our aim with this study was to increase knowledge of existing ACP practices in Norwegian nursing homes. We wanted to know how nursing home residents, relatives and nursing home staff take part in the conversations, and to what extent these conversations can be regarded as promoting autonomy, legal rights and individual needs for the residents. We conducted participant observation of seven preparatory conversations, followed by interviews with health care staff (together) and resident and relative (together). In the result section, we present an informative case example of an ACP conversation where common and important characteristics running through our data are present. These are further elaborated under the following headings: Life critical questions, Residents' quiet participation in the conversations, the Dying phase - a clinical issue, Nurses and physicians; different domains and Timing. We find that nursing home staff in our study wants to contribute to open awareness, autonomy and a good death, but there are little reflections about the purpose and content of the conversations, how they should be carried out and when, and what frail nursing home residents are able to understand and express in ACP conversations. PMID:27531449

  16. Advance care planning in stroke: influence of time on engagement in the process

    Directory of Open Access Journals (Sweden)

    Green T

    2014-01-01

    Full Text Available Theresa Green1, Shreyas Gandhi2, Tessa Kleissen1, Jessica Simon1,3, Shelley Raffin-Bouchal1, Karla Ryckborst41Faculty of Nursing, University of Calgary, Calgary, AB, Canada; 2Health Sciences, McMaster University, Hamilton, ON, Canada; 3Department of Medicine, University of Calgary, Calgary, AB, Canada; 4Calgary Stroke Program, Alberta Health Services, Calgary, AB, CanadaPurpose: Individuals who experience stroke have a higher likelihood of subsequent stroke events, making it imperative to plan for future medical care. In the event of a further serious health event, engaging in the process of advanced care planning (ACP can help family members and health care professionals (HCPs make medical decisions for individuals who have lost the capacity to do so. Few studies have explored the views and experiences of patients with stroke about discussing their wishes and preferences for future medical events, and the extent to which stroke HCPs engage in conversations around planning for such events. In this study, we sought to understand how the process of ACP unfolded between HCPs and patients post-stroke.Patients and methods: Using grounded theory (GT methodology, we engaged in direct observation of HCP and patient interactions on an acute stroke unit and two stroke rehabilitation units. Using semi-structured interviews, 14 patients and four HCPs were interviewed directly about the ACP process.Results: We found that open and continual ACP conversations were not taking place, patients experienced an apparent lack of urgency to engage in ACP, and HCPs were uncomfortable initiating ACP conversations due to the sensitive nature of the topic.Conclusion: In this study, we identified lack of engagement in ACP post-stroke, attributable to patient and HCP factors. This encourages us to look further into the process of ACP in order to develop open communication between the patient with stroke, their families, and stroke HCPs.Keywords: qualitative, engagement

  17. Advance care planning in patients with brain tumours: A prospective cohort study

    Directory of Open Access Journals (Sweden)

    Krystal Song

    2015-08-01

    Full Text Available Objectives: To assess and understand the awareness and experience of brain tumour (BT patients in discussing Advance Care Planning (ACP, to identify main symptoms experienced, physical and functional status perceived quality of life, and level of coping. Methods: A prospective cohort study with an initial open-ended questionnaire followed by semi-structured interview questions regarding ACP with 18 patients diagnosed with BT (WHO Grade I-IV, metastatic BT in hospital and community. Standardized assessments measured coping strategies, and quality of life (QoL. Interview transcripts regarding ACP discussions were analyzed, coded and interpreted using qualitative analytic techniques for thematic analyses. Results: Participants' mean age was 51 years (range 22-65 years, female (61%; median time since BT diagnosis was 1.5 years and just over half (56% had glioblastoma multiforme (GBM. Fatigue was the most common symptom reported by 83% of participants. Overall, participants indicated good QoL and used more problem-focused coping strategies including ‘acceptance’ and ‘positive reframing’. Thematic analyses indicated that participants had limited awareness and understanding of ACP, variable views on appropriate timing of ACP discussions and change of decisions over illness trajectory. Most felt able to discuss ACP and preferred dedicated sessions by a trained health professional. Conclusion: This study highlights the importance of providing timely information regarding ACP to BT patients during the course of their disease. Established ACP discussions have an important role in enhancing patient autonomy and to guide delivery of end-of-life care. The demonstrated low uptake of ACP in this pilot study shows need for improved awareness in clinical practice for timely ACP discussions and multifaceted interventions system-wide in implementing ACP

  18. Consensus views on advance care planning for dementia: a Delphi study.

    Science.gov (United States)

    Sinclair, James B; Oyebode, Jan R; Owens, R Glynn

    2016-03-01

    The uptake of advance care planning (ACP) is particularly low among people with dementia. This may reflect barriers to communication between professionals, patients and families in the face of lack of consensus about the process. This study aimed to methodically investigate consensus views of how ACP should be explained and carried out with people with dementia. A three-round Delphi study explored views of how and when ACP should be addressed, what should be covered, who should be involved and why rates of ACP are low. Seventeen participants took part comprising family members, old age psychiatrists and policy makers. Thirty-two items reached consensus. The panel agreed on 11 different areas for discussion. They concurred that ACP was best addressed after the person has come to terms with the diagnosis when the individual feels ready to do so. There was a consensus view that the process should be couched in terms of 'certain possibilities'. Consensus items emphasised personal choice and autonomy, while also prioritising the need to discuss financial aspects and to include spouses. There was no consensus that professionals should be involved, although the panel viewed them as carrying some responsibility for low uptake. It is suggested that ACP should include general discussion of values as well as coverage of specific points. Professionals need to offer discussion and information on ACP, but also make clear that the patient has the right to choose whether to pursue ACP or not. PMID:25684278

  19. Role of Advance Care Planning in Proxy Decision Making Among Individuals With Dementia and Their Family Caregivers.

    Science.gov (United States)

    Kwak, Jung; De Larwelle, Jessica A; Valuch, Katharine O'Connell; Kesler, Toni

    2016-03-01

    Health care proxies make important end-of-life decisions for individuals with dementia. A cross-sectional survey was conducted to examine the role of advance care planning in proxy decision making for 141 individuals with cognitive impairment, Alzheimer's disease, or other types of dementia. Proxies who did not know the preferences of individuals with dementia for life support treatments reported greater understanding of their values. Proxies of individuals with dementia who did not want life support treatments anticipated receiving less support and were more uncertain in decision making. The greater knowledge proxies had about dementia trajectory, family support, and trust of physicians, the more informed, clearer, and less uncertain they were in decision making. In addition to advance care planning, multiple factors influence proxy decision making, which should be considered in developing interventions and future research to support informed decision making for individuals with dementia and their families. [Res Gerontol Nurs. 2016; 9(2):72-80.]. PMID:26020579

  20. The Role of Social Workers in Spiritual Care to Facilitate Coping With Chronic Illness and Self-Determination in Advance Care Planning.

    Science.gov (United States)

    Francoeur, Richard B; Burke, Nancy; Wilson, Alicia M

    2016-01-01

    Spiritual values and beliefs of patients and families influence resilience during chronic illness and shape patient choices during advance care planning. The spiritual needs of Baby Boomers will be more diverse than previous generations, in connection with the questioning, experimental mind-set of this group and the fact that it includes a higher proportion of immigrant populations outside the Judeo-Christian tradition. Social workers are trained explicitly to intervene with diverse populations and are well positioned to offer spiritual support in ways that do not necessarily conform to traditional religions. To the extent of their individual expertise and competence, social workers should assess and provide spiritual care to clients, including those who either are underserved or prefer not to seek assistance from clergy or chaplains because they feel alienated from religious institutions and representatives. They should also be aware of ethical dilemmas in consulting with spiritual care professionals in developing spiritual interventions. Social work education should address clients' humanistic and existential concerns, beliefs and behaviors of the major religions, and forms of nontraditional religious and spiritual experiences; it should also provide experiential opportunities for engaging with grief and earlier advance care planning. There should be attention to different theodical perspectives of the major religions regarding the problem of good and evil, which may preoccupy even clients who no longer participate in organized religion, because these unresolved existential issues may weaken client coping with chronic conditions and may diminish clarity and self-awareness for engaging authentically and effectively in advance care planning. PMID:27187806

  1. Quality of dying in nursing home residents dying with dementia: does advanced care planning matter? A nationwide postmortem study.

    Directory of Open Access Journals (Sweden)

    An Vandervoort

    Full Text Available Advance care planning is considered a central component of good quality palliative care and especially relevant for people who lose the capacity to make decisions at the end of life, which is the case for many nursing home residents with dementia. We set out to investigate to what extent (1 advance care planning in the form of written advance patient directives and verbal communication with patient and/or relatives about future care and (2 the existence of written advance general practitioner orders are related to the quality of dying of nursing home residents with dementia.Cross-sectional study of deaths (2010 using random cluster-sampling. Representative sample of nursing homes in Flanders, Belgium. Deaths of residents with dementia in a three-month period were reported; for each the nurse most involved in care, GP and closest relative completed structured questionnaires.We identified 101 deaths of residents with dementia in 69 nursing homes (58% response rate. A written advance patient directive was present for 17.5%, GP-orders for 56.7%. Controlling for socio-demographic/clinical characteristics in multivariate regression analyses, chances of having a higher mean rating of emotional well-being (less fear and anxiety on the Comfort Assessment in Dying with Dementia scale were three times higher with a written advance patient directive and more specifically when having a do-not-resuscitate order (AOR 3.45; CI,1.1-11 than for those without either (AOR 2.99; CI,1.1-8.3. We found no association between verbal communication or having a GP order and quality of dying.For nursing home residents with dementia there is a strong association between having a written advance directive and quality of dying. Where wishes are written, relatives report lower levels of emotional distress at the end of life. These results underpin the importance of advance care planning for people with dementia and beginning this process as early as possible.

  2. One day at a time: living with frailty: implications for the practice of advance care planning: a multiple case study

    OpenAIRE

    Bramley, Louise

    2016-01-01

    Background: Advance care planning (ACP) was originally designed to promote autonomy and is commonly conceptualised as informing treatment and decisions in the event of a person’s loss of capacity. In the UK, healthcare policy has emphasised the potential for ACP to significantly contribute to improvements in experiences of death and dying for patients and their significant others. Older people with progressive frailty are at high risk of mortality, loss of capacity and increasing dependency o...

  3. Palliative care in advanced dementia.

    Science.gov (United States)

    Merel, Susan E; Merel, Susan; DeMers, Shaune; Vig, Elizabeth

    2014-08-01

    Because neurodegenerative dementias are progressive and ultimately fatal, a palliative approach focusing on comfort, quality of life, and family support can have benefits for patients, families, and the health system. Elements of a palliative approach include discussion of prognosis and goals of care, completion of advance directives, and a thoughtful approach to common complications of advanced dementia. Physicians caring for patients with dementia should formulate a plan for end-of-life care in partnership with patients, families, and caregivers, and be prepared to manage common symptoms at the end of life in dementia, including pain and delirium. PMID:25037291

  4. [Advance Care Planning and Decisions to limit treatment at the end of life - the view from medical ethics and psychooncology].

    Science.gov (United States)

    Winkler, Eva C; Heußner, Pia

    2016-03-01

    Decisions to limit treatment are important in order to avoid overtreatment at the end of life. They proceed more than half of expected deaths in Europe and the US, but are not always communicated with the patient in advance. One reason for non-involvement is that conversations that prepare patients for end-of-life decisions and work out their preferences do not take place on a regular basis. At the same time there is growing evidence that such communication improves patients' quality of life, reduces anxiety and depression and allows patients to develop a realistic understanding of their situation - which in turn is a prerequisite for shared decision making about limiting treatment.In this paper we define "treatment limitation" and explain the medical ethics perspective. The main focus, however, is on the causes that hinder advanced care planning and conversations about limiting treatment in the care of patients with advanced disease. Finally the evidence for approaches to improve the situation is presented with concrete suggestions for solutions. PMID:26983109

  5. 38 CFR 17.32 - Informed consent and advance care planning.

    Science.gov (United States)

    2010-07-01

    .... Decision-making capacity. The ability to understand and appreciate the nature and consequences of health... communicate decisions concerning health care. If the patient lacks decision-making capacity or has been... lack decision-making capacity in the following order of priority: (1) Health care agent; (2)...

  6. Role of the community matron in advance care planning and 'do not attempt CPR' decision-making: a qualitative study.

    Science.gov (United States)

    Kazmierski, Mandy; King, Nigel

    2015-01-01

    The community matron (CM) is often the key worker caring for patients with chronic, life-limiting, long-term conditions, but these patients are not always recognised as palliative cases. This study explored the experiences of CMs with regard to advance care planning (ACP) and 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision-making to understand whether or not they felt adequately prepared for this aspect of their role, and why. Qualitative data were generated from six CMs using a broad interpretive phenomenological approach. Face-to-face recorded interviews were analysed using template analysis. The study found that although participants faced complex ethical situations around ACP and DNACPR almost on a daily basis, none had received any formal training despite the emphasis on training in national and local guidelines. Participants often struggled to get their patients accepted on to the Gold Standards Framework. The research found variability and complexity of cases to be the main barriers to clear identification of the palliative phase. PMID:25559025

  7. Advance care planning - a multi-centre cluster randomised clinical trial

    DEFF Research Database (Denmark)

    Rietjens, Judith A C; Korfage, Ida J; Dunleavy, Lesley;

    2016-01-01

    , and improve their quality of life. METHODS/DESIGN: We will study the effects of the ACP program Respecting Choices on the quality of life of patients with advanced lung or colorectal cancer. In a phase III multicenter cluster randomised controlled trial, 22 hospitals in 6 countries will be randomised...... of their disease trajectory, is an important next step in an era of increased focus on patient centered healthcare and shared decision-making. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number: ISRCTN63110516 . Date of registration: 10/3/2014....

  8. A complex regional intervention to implement advance care planning in one town's nursing homes: Protocol of a controlled inter-regional study

    OpenAIRE

    Briggs Linda; Hammes Bernard J; Rixen Stephan; Mellert Christine; Rothärmel Sonja; in der Schmitten Jürgen; Wegscheider Karl; Marckmann Georg

    2011-01-01

    Abstract Background Advance Care Planning (ACP) is an emerging strategy to ensure that well-reflected, meaningful and clearly documented treatment preferences are available and respected when critical decisions about life-sustaining treatment need to be made for patients unable to consent. In Germany, recent legislation confirms that advance directives (AD) have to be followed if they apply to the medical situation, but implementation of ACP has not yet been described. Methods/Design In a lon...

  9. Health care professionals' perspectives of advance care planning for people with dementia living in long-term care settings: a narrative review of the literature.

    Science.gov (United States)

    2016-05-27

    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

  10. Advance care planning preferences among dialysis patients and factors influencing their decisions

    International Nuclear Information System (INIS)

    To determine the resuscitation preferences of hemodialysis (HD) Saudi patients, we conducted a cross-sectional, observational descriptive questionnaire study in two major tertiary hospitals in Saudi Arabia from March to December 2007. We enrolled all the patients on HD for two years or more, and excluded the patients who were transplant candidates, confused, or demented. The questionnaire was composed of 4 sections. The first 3 sections were concerned with demographic data, education levels, employment, family size, number of children, and functionality status besides knowledge about cardiopulmonary resuscitation (CPR), mechanical ventilation, and ICU admission. The fourth section contained different scenarios and questions on personal and preferences such as end of life decisions, medical interventions, CPR, ICU admission, and the decision maker in these events. A total of 100 patients (53% males, 67% Saudis, and 85% married) were enrolled in the study. The mean duration on dialysis was 6.0 years (+- 4.1). More than 70% of the patients viewed themselves as above average in the religiosity score, and 44% disclosed a good life quality. More than 95% had little or no knowledge about cardiac resuscitation, intubation, and mechanical ventilation. The majority of the patients authorized their treating physician to decide for them about cardiac resuscitation in case they did not make advanced directives and only 22% believed that this decision should be made by their family members. If their physician believed their condition was hopeless, 77% preferred to stay at home. We conclude that the majority of our patients had limited awareness about cardiac resuscitation measures. The majority of the patients trust their physicians to decide about the futility of resuscitation. Patients were able to decide reasonably well when they are well informed. (author)

  11. Discussing dying in the diaspora: attitudes towards advance care planning among first generation Dutch and Italian migrants in rural Australia.

    Science.gov (United States)

    Sinclair, Craig; Smith, Jessica; Toussaint, Yann; Auret, Kirsten

    2014-01-01

    Western cultural practices and values have largely shaped advance care planning (ACP) policies across the world. Low uptake of ACP among ethnic minority groups in Western countries has been interpreted with reference to cultural differences. This paper adopts a life-history approach to explore attitudes towards ACP among older, first-generation Dutch-Australian and Italian-Australian migrants. Thirty people participated in extended ethnographic interviews (N = 17) and group discussions (N = 13) during 2012. Transcripts were thematically analyzed and interpreted using a Foucauldian perspective on knowledge and power. Migration experiences, ongoing contact with the native country and participation in migrant community support networks influenced attitudes towards ACP. Dutch participants framed ACP discussions with reference to euthanasia, and adopted a more individualist approach to medical decision-making. Italian participants often spoke of familial roles and emphasized a family-based decision making style. The importance of migrant identity has been neglected in previous discussions of cultural factors influencing ACP uptake among ethnic minority groups. The unique migration experience should be considered alongside culturally appropriate approaches to decision-making, in order to ensure equitable access to ACP among migrant groups. PMID:24560228

  12. Advance Care Planning in Dementia: Do Family Carers Know the Treatment Preferences of People with Early Dementia?

    Science.gov (United States)

    King, Michael; Jones, Louise; Vickestaff, Victoria; Sampson, Elizabeth L.

    2016-01-01

    Background and Aims When a person with dementia (PWD) has lost the ability to make treatment decisions, clinicians often rely on family carers to know and articulate these preferences with assumed accuracy. This study used the Life Support Preferences Questionnaire (LSPQ) to explore whether family carers’ choices show agreement with the end of life care preferences of the person with dementia for whom they care and what factors influence this. Methods A cross-sectional study interviewing 60 dyads (a person with early dementia and preserved capacity and their family carer) each completing a modified LSPQ. We assessed how closely carers’ choices resembled the PWD’s preferences for treatment in three proposed health states: the here and now; severe stroke with coma; terminal cancer. Agreement between the PWD and their family carer responses was assessed using Kappa and Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) statistics. We examined whether carer burden and distress, and relationship quality, influenced agreement. Results In interviews PWD were able to indicate their treatment preferences across all three scenarios. In the here-and-now most wanted antibiotics (98%), fewer cardio-pulmonary resuscitation (CPR) (50%) and tube feeding (47%). In severe stroke and coma antibiotics remained the more preferred treatment (88%), followed by CPR (57%) and tube feeding (30%). In advanced cancer PWD expressed lower preferences for all treatments (antibiotics 68%; CPR 50%; tube feeding 37%). Carers’ choices were similar to the PWDs’ preferences in the here-and-now (71% (k = 0.03; PABAK = 0.4) with less agreement for future hypothetical health states. In severe stroke and coma carers tended wrongly to suggest that the PWD preferred more intervention (antibiotic, 67%; k = -0.022; PABAK = -0.60; CPR, 73%; k = 0.20; PABAK = -0.20, tube feeding, 66%; k = 0.25; PABAK = -0.12). In advanced cancer the agreement between PWD and carers was low (antibiotics; k = -0.03; PABAK

  13. Center to Advance Palliative Care

    Science.gov (United States)

    ... Discussion Forum The IPAL Project Palliative Care Leadership Centers (PCLC) Member Resources National Seminar Quick Links Certification ... a Job Manage Job Posts About About The Center to Advance Palliative Care (CAPC) is a national ...

  14. A randomised controlled trial on the efficacy of advance care planning on the quality of end-of-life care and communication in patients with COPD: the research protocol

    OpenAIRE

    Houben, Carmen H M; Spruit, Martijn A.; Wouters, Emiel F.M.; Janssen, Daisy J A

    2014-01-01

    Introduction Recent research shows that advance care planning (ACP) for patients with chronic obstructive pulmonary disease (COPD) is uncommon and poorly carried out. The aim of the present study was to explore whether and to what extent structured ACP by a trained nurse, in collaboration with the chest physician, can improve outcomes in Dutch patients with COPD and their family. Methods and analysis A multicentre cluster randomised controlled trial in patients with COPD who are recently disc...

  15. Collaborative Health Care Plan Support

    OpenAIRE

    Amir, Ofra; Grosz, Barbara J.; Law, Edith Lok Man; Stern, Roni

    2013-01-01

    This paper envisions a multi-agent system that assists patients and their health care providers. This system would support a diverse, evolving team in formulating, monitoring and revising a shared "care plan" that operates on multiple time scales in uncertain environments. It would also enhance communication of health information within this planning framework. The coordination of care for children with complex conditions (CCC), which is a compelling societal need, is presented as a model env...

  16. A complex regional intervention to implement advance care planning in one town's nursing homes: Protocol of a controlled inter-regional study

    Directory of Open Access Journals (Sweden)

    Briggs Linda

    2011-01-01

    Full Text Available Abstract Background Advance Care Planning (ACP is an emerging strategy to ensure that well-reflected, meaningful and clearly documented treatment preferences are available and respected when critical decisions about life-sustaining treatment need to be made for patients unable to consent. In Germany, recent legislation confirms that advance directives (AD have to be followed if they apply to the medical situation, but implementation of ACP has not yet been described. Methods/Design In a longitudinal controlled study, we compare 1 intervention region (4 nursing homes [n/hs], altogether 421 residents with 2 control regions (10 n/hs, altogether 985 residents. Inclusion went from 01.02.09 to 30.06.09, observation lasted until 30.06.10. Primary endpoint is the prevalence of ADs at follow-up, 17 (12 months after the first (last possible inclusion. Secondary endpoints compare relevance and validity of ADs, process quality, the rate of life-sustaining interventions and, in deceased residents, location of death and intensity of treatment before death. The regional multifaceted intervention on the basis of the US program Respecting Choices® comprises training of n/h staff as facilitators, training of General Practitioners, education of hospital and ambulance staff, and development of eligible tools, including Physician Orders for Life-Sustaining Treatment in case of Emergency (POLST-E. Participation data: Of 1406 residents reported to live in the 14 n/hs plus an estimated turnover of 176 residents until the last possible inclusion date, 645 (41% were willing to participate. Response rates were 38% in the intervention region and 42% in the control region. Non-responder analysis shows an equal distribution of sex and age but a bias towards dependency on nursing care in the responder group. Outcome analysis of this study will become available in the course of 2011. Discussion Implementing an ACP program for the n/hs and related health care providers of a

  17. The diverse impact of advance care planning: a long-term follow-up study on patients' and relatives' experiences

    DEFF Research Database (Denmark)

    Andreassen, Pernille; Neergaard, Mette Asbjørn; Brogaard, Trine;

    2015-01-01

    : A qualitative follow-up interview study. Interviews were recorded, transcribed and analysed using thematic synthesis. SETTING/PARTICIPANTS: 3 patients with a life-limiting disease (lung or heart disease), affiliated with a major Danish hospital, and 7 relatives were interviewed 1 year after participating...... in an ACP discussion. RESULTS: The experiences were diverse. Some patients and relatives felt 'relieved', 'more secure' and more in control due to ACP. To some, ACP had led to open communication rather than 'beating around the bush', and to spending more quality time together. However, others perceived ACP...... issues being 'tucked away'. CONCLUSIONS: The study reveals great diversity in patient and relative experiences of ACP. The study challenges previous research which mainly emphasises ACP as a valuable tool to optimise EOL care. This study stresses the importance of awareness of the highly individual...

  18. Medicare and Advance Planning: The Importance of Context.

    Science.gov (United States)

    Dresser, Rebecca

    2016-05-01

    In January 2016, a long-delayed Medicare change took effect. The Medicare program will now reimburse doctors for time they spend talking with patients about end-of-life care. This is the move that Sarah Palin and other Affordable Care Act critics said would authorize government "death panels" to decide whether older Americans should live or die. Today virtually no one buys into Palin's death panel rhetoric. But many people do think the Medicare change is a big deal. Representative Earl Blumenauer, a Democrat from Oregon who sponsored the original ACA reimbursement proposal, lauded the Medicare provision as "a turning point in end-of-life care." Others are not so sure about that. After all, laws promoting advance care planning have existed for decades. The federal Patient Self-Determination Act of 1990 and the many court decisions and state laws supporting advance care planning have had relatively little impact. Similarly, legal recognition of physician orders for life-sustaining treatment as advance planning instruments have not produced the improvements that were predicted. And from a broad perspective, advance care planning is a small piece of the puzzle. The effort to improve end-of-life care must take into account the limitations of advance decision-making, as well as the overriding importance of the general standard of care for terminally ill patients. PMID:27150411

  19. How to plan research in palliative care

    Directory of Open Access Journals (Sweden)

    Santosh K Chaturvedi

    2011-01-01

    Full Text Available Research in palliative care has its challenges. However, research in different aspects of palliative care is important. This paper gives simple methods of planning and conducting a research in the area of palliative care in India.

  20. Interdisciplinary Care Planning and the Written Care Plan in Nursing Homes: A Critical Review

    Science.gov (United States)

    Dellefield, Mary Ellen

    2006-01-01

    Purpose: This article is a critical review of the history, research evidence, and state-of-the-art technology in interdisciplinary care planning and the written plan of care in American nursing homes. Design and Methods: We reviewed educational and empirical literature. Results: Interdisciplinary care planning and the written care plan are…

  1. A personalized care plan in chronic care: implementation and evaluation

    OpenAIRE

    Jeanny Engels; Marjolein Rebel; Doortje Boshuizen

    2012-01-01

    Purpose Implementation and evaluation of a personalized care plan for approximately 350 people with (an increased risk of) cardiovascular disease in ten general practices in the Netherlands. Context The ‘Healthy Vessels’ (‘Vitale Vaten’) care standard of 2009 describes the optimum care for people with (an increased risk of) cardiovascular disease and is based on the Chronic Care Model. New: working with a personalized care plan, with detailed attention for the promotion of self-management and...

  2. Is it safe? Talking to teens with HIV/AIDS about death and dying: a 3-month evaluation of Family Centered Advance Care (FACE) planning – anxiety, depression, quality of life

    OpenAIRE

    Lyon, Maureen E.; Garvie, Patricia A.; Briggs, Linda; He, Jianping; Malow, Robert; D’Angelo, Lawrence J; McCarter, Robert

    2010-01-01

    Purpose To determine the safety of engaging HIV-positive (HIV+) adolescents in a Family Centered Advance Care (FACE) planning intervention. Patients and methods We conducted a 2-armed, randomized controlled clinical trial in 2 hospital-based outpatient clinics from 2006–2008 with HIV+ adolescents and their surrogates (n = 76). Three 60–90 minutes sessions were conducted weekly. FACE intervention groups received: Lyon FCACP Survey©, the Respecting Choices® interview, and completion of The Five...

  3. Advanced technologies in trauma critical care management.

    Science.gov (United States)

    Cannon, Jeremy W; Chung, Kevin K; King, David R

    2012-08-01

    Care of critically injured patients has evolved over the 50 years since Shoemaker established one of the first trauma units at Cook County Hospital in 1962. Modern trauma intensive care units offer a high nurse-to-patient ratio, physicians and midlevel providers who manage the patients, and technologically advanced monitors and therapeutic devices designed to optimize the care of patients. This article describes advances that have transformed trauma critical care, including bedside ultrasonography, novel patient monitoring techniques, extracorporeal support, and negative pressure dressings. It also discusses how to evaluate the safety and efficacy of future advances in trauma critical care. PMID:22850154

  4. Managed Care Plans: Getting Good Care for Your Child

    Science.gov (United States)

    ... a Pediatrician Family Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting Involved in Your Community Healthy Children > Family Life > Medical Home > Health Insurance > Managed Care Plans: Getting Good Care for Your Child Family ...

  5. Advanced Fuels Campaign Execution Plan

    Energy Technology Data Exchange (ETDEWEB)

    Kemal Pasamehmetoglu

    2011-09-01

    The purpose of the Advanced Fuels Campaign (AFC) Execution Plan is to communicate the structure and management of research, development, and demonstration (RD&D) activities within the Fuel Cycle Research and Development (FCRD) program. Included in this document is an overview of the FCRD program, a description of the difference between revolutionary and evolutionary approaches to nuclear fuel development, the meaning of science-based development of nuclear fuels, and the 'Grand Challenge' for the AFC that would, if achieved, provide a transformational technology to the nuclear industry in the form of a high performance, high reliability nuclear fuel system. The activities that will be conducted by the AFC to achieve success towards this grand challenge are described and the goals and milestones over the next 20 to 40 year period of research and development are established.

  6. Advanced Fuels Campaign Execution Plan

    Energy Technology Data Exchange (ETDEWEB)

    Kemal Pasamehmetoglu

    2010-10-01

    The purpose of the Advanced Fuels Campaign (AFC) Execution Plan is to communicate the structure and management of research, development, and demonstration (RD&D) activities within the Fuel Cycle Research and Development (FCRD) program. Included in this document is an overview of the FCRD program, a description of the difference between revolutionary and evolutionary approaches to nuclear fuel development, the meaning of science-based development of nuclear fuels, and the “Grand Challenge” for the AFC that would, if achieved, provide a transformational technology to the nuclear industry in the form of a high performance, high reliability nuclear fuel system. The activities that will be conducted by the AFC to achieve success towards this grand challenge are described and the goals and milestones over the next 20 to 40 year period of research and development are established.

  7. Medicare Managed Care plan Performance, A Comparison...

    Data.gov (United States)

    U.S. Department of Health & Human Services — The study evaluates the performance of Medicare managed care, Medicare Advantage, Plans in comparison to Medicare fee-for-service Plans in three states with...

  8. Oncology Advanced Practitioners Bring Advanced Community Oncology Care.

    Science.gov (United States)

    Vogel, Wendy H

    2016-01-01

    Oncology care is becoming increasingly complex. The interprofessional team concept of care is necessary to meet projected oncology professional shortages, as well as to provide superior oncology care. The oncology advanced practitioner (AP) is a licensed health care professional who has completed advanced training in nursing or pharmacy or has completed training as a physician assistant. Oncology APs increase practice productivity and efficiency. Proven to be cost effective, APs may perform varied roles in an oncology practice. Integrating an AP into an oncology practice requires forethought given to the type of collaborative model desired, role expectations, scheduling, training, and mentoring. PMID:27249776

  9. Care plans and care planning in long term conditions: a conceptual model

    OpenAIRE

    Burt, J.; J. Rick; Blakeman, T; Protheroe, J; Roland, M; Bower, P.

    2013-01-01

    The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority for chronic disease management in a number of health care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between ‘care planni...

  10. Advanced Life Support Project Plan

    Science.gov (United States)

    2002-01-01

    Life support systems are an enabling technology and have become integral to the success of living and working in space. As NASA embarks on human exploration and development of space to open the space frontier by exploring, using and enabling the development of space and to expand the human experience into the far reaches of space, it becomes imperative, for considerations of safety, cost, and crew health, to minimize consumables and increase the autonomy of the life support system. Utilizing advanced life support technologies increases this autonomy by reducing mass, power, and volume necessary for human support, thus permitting larger payload allocations for science and exploration. Two basic classes of life support systems must be developed, those directed toward applications on transportation/habitation vehicles (e.g., Space Shuttle, International Space Station (ISS), next generation launch vehicles, crew-tended stations/observatories, planetary transit spacecraft, etc.) and those directed toward applications on the planetary surfaces (e.g., lunar or Martian landing spacecraft, planetary habitats and facilities, etc.). In general, it can be viewed as those systems compatible with microgravity and those compatible with hypogravity environments. Part B of the Appendix defines the technology development 'Roadmap' to be followed in providing the necessary systems for these missions. The purpose of this Project Plan is to define the Project objectives, Project-level requirements, the management organizations responsible for the Project throughout its life cycle, and Project-level resources, schedules and controls.

  11. Is it safe? Talking to teens with HIV/AIDS about death and dying: a 3-month evaluation of Family Centered Advance Care (FACE planning – anxiety, depression, quality of life

    Directory of Open Access Journals (Sweden)

    Maureen E Lyon

    2010-02-01

    Full Text Available Maureen E Lyon1, Patricia A Garvie2, Linda Briggs3, Jianping He4, Robert Malow5, Lawrence J D’Angelo1, Robert McCarter41Children’s National Medical Center and George Washington School of Medicine and Health Sciences, Washington, District of Columbia; 2St Jude Children’s Research Hospital, Memphis, Tennessee; 3Gundersen Lutheran Medical Foundation, Inc., Madison, Wisconsin; 4Children’s Research Institute, Washington, District of Columbia; 5Florida International University, Miami, FloridaPurpose: To determine the safety of engaging HIV-positive (HIV+ adolescents in a Family Centered Advance Care (FACE planning intervention.Patients and methods: We conducted a 2-armed, randomized controlled clinical trial in 2 hospital-based outpatient clinics from 2006–2008 with HIV+ adolescents and their surrogates (n = 76. Three 60–90 minutes sessions were conducted weekly. FACE intervention groups received: Lyon FCACP Survey©, the Respecting Choices® interview, and completion of The Five Wishes©. The Healthy Living Control (HLC received: Developmental History, Healthy Tips, Future Planning (vocational, school or vocational rehabilitation. Three-month post-intervention outcomes were: completion of advance directive (Five Wishes©; psychological adjustment (Beck Depression, Anxiety Inventories; quality of life (PedsQL™; and HIV symptoms (General Health Self-Assessment.Results: Adolescents had a mean age, 16 years; 40% male; 92% African-American; 68% with perinatally acquired HIV, 29% had AIDS diagnosis. FACE participants completed advance directives more than controls, using time matched comparison (P < 0.001. Neither anxiety, nor depression, increased at clinically or statistically significant levels post-intervention. FACE adolescents maintained quality of life. FACE families perceived their adolescents as worsening in their school (P = 0.018 and emotional (P = 0.029 quality of life at 3 months, compared with controls.Conclusions: Participating

  12. Computerized Nursing Care Planning Utilizing Nursing Diagnosis

    OpenAIRE

    Crosley, Joan M.

    1984-01-01

    This paper presents a brief description of the beginning phase of a long term project introducing computerized nursing care planning utilizing nursing diagnoses within one nursing department. Areas for future study are proposed.

  13. Standardized care plan of postpartum mastitis

    Directory of Open Access Journals (Sweden)

    Maria Ángeles Carrasco García

    2012-07-01

    Full Text Available Introduction: Puerperal mastitis or mastitis Breastfeeding is a postpartum condition that represents one of the main reasons for abandoning breastfeeding. Mainly usually occurs between weeks 2 and 3 ª postpartum. The scientific evidence confirms that the stop breastfeeding before an attack of mastitis is not conducive to recovery and that of exclusive breastfeeding and no restrictions are effective measures to prevent milk stasis and the spread of infection.Objective: The main objective is to unify criteria for the care and integrated health care levels of care through continuity of care to promote breast-specific care to prevent the emergence of this disease.Methodology: Development of a standardized care plan to enable effective communication between professionals and implementation of quality care.Conclusions: The midwife and the nurse plays an important role in identifying those women with early-onset symptoms of postpartum mastitis in the middle, both in the maternity ward and in the primary care clinic.

  14. Strategic Facilities Planning: A Focus On Health Care

    Directory of Open Access Journals (Sweden)

    Ellen D. Hoadley

    2011-01-01

    Full Text Available Turbulent market conditions have forced the health care sector to re-examine its business and operational practices.  Health care has become increasingly complex as decisions and planning are reframed in light of the current lagging economy, an increased demand for services, new global competition, and impending legislation reform.  The stress is felt most keenly within the nation’s hospitals and consortia of health care facilities.  Facility planning decisions are no exception.  Hospital administrators are abandoning the once commonplace rules governing aging infrastructure renovations.  Instead, administrators are basing decisions within their respective strategic context and are attempting to align buildings, services, personnel, and technology to an overall plan that looks at markets, operations, and finances as resources for competitive advantage.  This paper reviews the strategic facilities planning literature and applies those best practices which support this organizational alignment for health care.  An application in the mid-Atlantic demonstrates that hospital facilities, by design, need to support the current and future needs of health care delivery systems, while dated structures impede industry advances.  Health care infrastructure improvements must proactively address technological, regulatory, and financial changes facing the sector.

  15. Advanced access: reducing waiting and delays in primary care.

    Science.gov (United States)

    Murray, Mark; Berwick, Donald M

    2003-02-26

    Delay of care is a persistent and undesirable feature of current health care systems. Although delay seems to be inevitable and linked to resource limitations, it often is neither. Rather, it is usually the result of unplanned, irrational scheduling and resource allocation. Application of queuing theory and principles of industrial engineering, adapted appropriately to clinical settings, can reduce delay substantially, even in small practices, without requiring additional resources. One model, sometimes referred to as advanced access, has increasingly been shown to reduce waiting times in primary care. The core principle of advanced access is that patients calling to schedule a physician visit are offered an appointment the same day. Advanced access is not sustainable if patient demand for appointments is permanently greater than physician capacity to offer appointments. Six elements of advanced access are important in its application balancing supply and demand, reducing backlog, reducing the variety of appointment types, developing contingency plans for unusual circumstances, working to adjust demand profiles, and increasing the availability of bottleneck resources. Although these principles are powerful, they are counter to deeply held beliefs and established practices in health care organizations. Adopting these principles requires strong leadership investment and support. PMID:12597760

  16. Family Planning Services: An Essential Component of Preconception Care

    OpenAIRE

    Klerman, Lorraine V.

    2006-01-01

    Family planning services are necessary for the widespread adoption of preconception care for two reasons. First, preconception care is more likely if pregnancies are planned, and family planning services encourage pregnancy planning. Second, family planning services usually include counseling, and counseling provides an opportunity to discuss the advantages of preconception care. However, the potential of family planning services to promote preconception care is limited by underutilization of...

  17. Social marketing: planning before conceiving preconception care.

    Science.gov (United States)

    Prue, Christine E; Daniel, Katherine Lyon

    2006-09-01

    Social marketing approaches can help to shape the formation of and to create demand for preconception care services. This article describes four components of social marketing, often referred to as the 4 P's, that should be carefully researched and set in place before a national effort to launch and sustain preconception care services is pursued. First, the product or package of services must be defined and adapted using the latest in scientific and health care standards and must be based on consumer needs and desires. Second, the pricing of the services in financial or opportunity costs must be acceptable to the consumer, insurers, and health care service providers. Third, the promotion of benefits must be carefully crafted to reach and appeal to both consumers and providers. Fourth, the placement and availability of services in the marketplace must be researched and planned. With the application of market research practices that incorporate health behavior theories in their exploration of each component, consumer demand for preconception care can be generated, and providers can take preconception care to the market with confidence. PMID:16755400

  18. Environmental Development Plan for advanced isotope separation

    International Nuclear Information System (INIS)

    This EDP identifies the planning and management requirements and schedules needed to evaluate and assess the environmental, health, and safety aspects of the Advanced Isotope Separation (AIS) program. Current AIS processes include the molecular and atomic vapor laser processes and the plasma process. This document covers the technology program, environmental concerns and requirements, and environmental strategy

  19. End-of-Life Decisions and Palliative Care in Advanced Heart Failure.

    Science.gov (United States)

    Meyers, Deborah E; Goodlin, Sarah J

    2016-09-01

    Advanced heart failure (HF) therapies are focused on extending life and improving function. In contrast, palliative care is a holistic approach that focuses on symptom alleviation and patients' physical, psychosocial, and spiritual needs. HF clinicians can integrate palliative care strategies by incorporating several important components of planning and decision-making for HF patients. Future care planning (FCP) for HF patients should incorporate the basic tenets of shared decision-making (SDM). These include understanding the patient's perspective and care preferences, articulating what is medically feasible, and integrating these considerations into the overall care plan. Use of defined triggers for FCP can stimulate important patient-caregiver conversations. Guidelines advocate an annual review of HF status and future care preferences. Advance directives are important for any individual with a chronic, life-limiting illness and should be integrated into FCP. Nevertheless, use of advance directives by HF patients is extremely low. Consideration of illness trajectories and risk-scoring tools might facilitate prognostication and delivery of appropriate HF care. Decisions about heart transplantation or left ventricular assist device implantation should include planning for potential complications associated with these therapies. Such decisions also should include a discussion of palliative management, as an alternative to intervention and also as an option for managing symptoms or adverse events after intervention. Palliative care, including FCP and SDM, should be integrated into the course of all patients with advanced HF. Clinicians who provide HF care should acquire the skills necessary for conducting FCP and SDM discussions. PMID:27568873

  20. Pain: advances and issues in critical care.

    Science.gov (United States)

    Harrison, M; Cotanch, P H

    1987-09-01

    The milieu of the critical care unit is stressful for both the patient and health care professionals. As such, it has the potential to increase pain perception in patients, and decrease the nurse's awareness of pain relief needs of the patient. Several physical and pharmacologic methods of pain relief were discussed in this article. Nontechnologic analgesia such as hypnosis and relaxation were introduced as adjuncts or alternatives to more familiar methods of pain relief. Although critically ill patients are not always able to express their discomfort, it is the responsibility of the nurse to recognize the potential for pain, and plan treatment accordingly. This article suggests several strategies for dealing with pain in critically ill patients. PMID:3302958

  1. 42 CFR 441.103 - Alternate plans of care.

    Science.gov (United States)

    2010-10-01

    ... Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases § 441.103 Alternate plans of... otherwise need care in an institution for mental diseases. (b) These alternate plans of care must— (1)...

  2. 42 CFR 456.180 - Individual written plan of care.

    Science.gov (United States)

    2010-10-01

    ... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Plan of Care § 456.180 Individual written plan of care. (a) Before admission to a mental hospital...

  3. Usage Analysis of a Shared Care Planning System

    OpenAIRE

    Warren, Jim; Gu, Yulong; Humphrey, Gayl

    2012-01-01

    We examined the content of electronically mediated communications in a trial of shared care planning (SCP) for long-term condition management. Software supports SCP by sharing patient records and care plans among members of the multidisciplinary care team (with patient access). Our analysis focuses on a three-month period with 73 enrolled patients, 149 provider-assigned tasks, 64 clinical notes and 48 care plans with 162 plan elements. Results show that content of notes entries is often relat...

  4. A framework for health care planning and control

    OpenAIRE

    Hans, Erwin W.; Houdenhoven, van, M.; Hulshof, Peter J.H.

    2011-01-01

    Rising expenditures spur health care organizations to organize their processes more efficiently and effectively. Unfortunately, health care planning and control lags far behind manufacturing planning and control. Successful manufacturing planning and control concepts can not be directly copied, because of the unique nature of health care delivery. We analyze existing planning and control concepts or frameworks for health care operations management, and find that they do not properly address v...

  5. How to Create an Anti-Aging Skin Care Plan

    Science.gov (United States)

    ... library Find a dermatologist How to create an anti-aging skin care plan Skin care in your 40s ... Years of research supports each of these recommendations. Anti-aging skin care tips Protect your skin from the ...

  6. Advanced planning methodologies in food supply chains

    DEFF Research Database (Denmark)

    Farahani, Poorya

    chain perspective, this thesis mainly focuses on the part of the chain which starts from the food processing industry: the food processing industry, the distribution industry, and final consumers. In the second chapter of this thesis, a thorough review is presented classifying the related contributions......The food industry is an important sector both because of its direct impacts on the daily lives of people and its large share of GDP compared with other economic sectors. This thesis discusses and develops advanced planning methodologies to optimize operations in food supply chains. From a supply...... in strategic, tactical, and operational studies, aiming to explain how several key food distribution planning challenges have been dealt with in the Operations Management literature. The next two chapters discuss specific production and distribution planning problems from the foodservice sector. Generic...

  7. [Palliative care needs in advanced chronic illness].

    Science.gov (United States)

    Tripodoro, Vilma A; Rynkiewicz, María C; Llanos, Victoria; Padova, Susana; De Lellis, Silvina; De Simone, Gustavo

    2016-01-01

    About 75% of population will die from one or more chronic progressive diseases. From this projection WHO urged countries to devise strategies for strengthening palliative treatment as part of comprehensive care. In Catalonia, Spain, direct measurement of the prevalence of these patients with NECPAL CCOMS-ICO© tool was 1.5% of the population. This tool is an indicative, not dichotomous, quali-quantitative multifactorial evaluation to be completed by the treating physician. In Argentina there is no information on these patients. Our goal was to explore and characterize the proportion of chronically ill patients in palliative care needs, by NECPAL CCOMS-ICO© tool, in an accessible population of the City of Buenos Aires. General hospitals of the Health Region 2 (Piñero, álvarez and Santojanni) and its program areas were surveyed. In Health Region 1, we surveyed the Udaondo gastroenterology hospital. A total of 53 physicians (704 patients) were interviewed. It was identified that 29.5% of these patients were affected by advanced chronic diseases; 72.1% of them were NECPAL positive, younger (median 64) than in others studies, and more than 98% presented high levels of comorbidity. Palliative care demand (31.4%) and needs (52.7%) were recorded. Specific indicators of fragility, progression, severity and kind of chronic disease were described. The main finding was to identify, with an instrument not based on mortality that, in Buenos Aires City, 1 in 3 patients with chronic diseases could die in the next year and had palliative care needs. PMID:27295702

  8. Advanced Materials Laboratory User Test Planning Guide

    Science.gov (United States)

    Orndoff, Evelyne

    2012-01-01

    Test process, milestones and inputs are unknowns to first-time users of the Advanced Materials Laboratory. The User Test Planning Guide aids in establishing expectations for both NASA and non-NASA facility customers. The potential audience for this guide includes both internal and commercial spaceflight hardware/software developers. It is intended to assist their test engineering personnel in test planning and execution. Material covered includes a roadmap of the test process, roles and responsibilities of facility and user, major milestones, facility capabilities, and inputs required by the facility. Samples of deliverables, test article interfaces, and inputs necessary to define test scope, cost, and schedule are included as an appendix to the guide.

  9. A review of certain recent advances in primary health care

    OpenAIRE

    Baldacchino, Marilyn; Bezzina, Glorianne; Scerri, Anne Marie; Sammut, Mario R.

    2014-01-01

    A strong primary health care system is the keystone of health care and helps patients manage their health conditions in the community, whilst also providing disease prevention services. Primary care is a continuously evolving specialty, with recent exciting innovations, aiming to improve all aspects of care and to meet people’s needs and expectations. A search for articles focusing on the specific aspects of recent advances in primary health care was done using interne...

  10. Medical Planning and Care in Radiation Accidents

    International Nuclear Information System (INIS)

    As part of a broad effort intended to mitigate the consequences of radiation accidents, the United States Atomic Energy Commission has developed a program to train physicians and to orient hospital staffs in the treatment of accident victims. Seminars have been conducted to date for approximately 120 physicians on medical planning and care in radiation accidents. This paper presents the scope and specific topics covered in the seminars, together with an analysis of. experience gained during development and presentation of the seminars. More recently the program has been expanded to encompass orientation of hospital administrators and other para-medical personnel on the handling and admittance of victims of radiation accidents. The latter problem is the subject of a new color film premiered at the Symposium. (author)

  11. Identifying the Factors That Facilitate or Hinder Advance Planning by Persons With Dementia

    OpenAIRE

    Hirschman, Karen B.; Kapo, Jennifer M.; Karlawish, Jason H.T.

    2008-01-01

    We performed semistructured interviews with 30 family members of patients with advanced dementia to identify the factors that facilitate or hinder advance planning by persons with dementia. All interviews were analyzed using qualitative data analysis techniques. The majority (77%) of family members reported that their relative had some form of written advance directive, and at least half reported previous discussions about health care preferences (57%), living situation or placement issues (5...

  12. Advanced Education and Technology Business Plan, 2008-11

    Science.gov (United States)

    Alberta Advanced Education and Technology, 2008

    2008-01-01

    The Ministry of Advanced Education and Technology's 2008-11 business plan identifies how it plans to work over the next three years to enhance advanced learning opportunities and innovation for all Albertans. Alberta's advanced learning system is composed of public board-governed institutions, the apprenticeship and industry training system,…

  13. Models of advance directives in mental health care: stakeholder views

    OpenAIRE

    Atkinson, J.M.; Garner, H.C.; Gilmour, W H

    2004-01-01

    Objective: The aim of this study was to examine perceptions of the place of advance directives in mental health care. Methods: Postal survey of stakeholders was carried out to assess their views on different models of advance directives in mental health care. A total of 473 responded. Results: In all, 28% of psychiatrists thought advance directives were needed compared to 89% of voluntary organisations and above two–thirds of the other stakeholder groups. There were clear tensions be...

  14. Models for Designing Long-Term Care Service Plans and Care Programs for Older People

    OpenAIRE

    Shogo Kato; Satoko Tsuru; Yoshinori Iizuka

    2013-01-01

    The establishment of a system for providing appropriate long-term care services for older people is a national issue in Japan, and it will likely become a worldwide issue in the years to come. Under Japanese Long-term Care Insurance System, long-term care is provided based on long-term care programs, which were designed by care providers on the basis of long-term care service plans, which were designed by care managers. However, defined methodology for designing long-term care service plans a...

  15. Multidisciplinary care planning in the primary care management of completed stroke: a systematic review

    Directory of Open Access Journals (Sweden)

    Erikssen Lars

    2008-08-01

    Full Text Available Abstract Background Chronic disease management requires input from multiple health professionals, both specialist and primary care providers. This study sought to assess the impact of co-ordinated multidisciplinary care in primary care, represented by the delivery of formal care planning by primary care teams or shared across primary-secondary teams, on outcomes in stroke, relative to usual care. Methods A Systematic review of Medline, EMBASE, CINAHL (all 1990–2006, Cochrane Library (Issue 1 2006, and grey literature from web based searching of web sites listed in the CCOHA Health Technology Assessment List Analysis used narrative analysis of findings of randomised and non-randomised trials, and observational and qualitative studies of patients with completed stroke in the primary care setting where care planning was undertaken by 1 a multi-disciplinary primary care team or 2 through shared care by primary and secondary providers. Results One thousand and forty-five citations were retrieved. Eighteen papers were included for analysis. Most care planning took part in the context of multidisciplinary team care based in hospitals with outreach to community patients. Mortality rates are not impacted by multidisciplinary care planning. Functional outcomes of the studies were inconsistent. It is uncertain whether the active engagement of GPs and other primary care professionals in the multidisciplinary care planning contributed to the outcomes in the studies showing a positive effect. There may be process benefits from multidisciplinary care planning that includes primary care professionals and GPs. Few studies actually described the tasks and roles GPs fulfilled and whether this matched what was presumed to be provided. Conclusion While multidisciplinary care planning may not unequivocally improve the care of patients with completed stroke, there may be process benefits such as improved task allocation between providers. Further study on the impact

  16. Advanced nurse roles in UK primary care.

    NARCIS (Netherlands)

    Sibbald, B.; Laurant, M.G.H.; Reeves, D.

    2006-01-01

    Nurses increasingly work as substitutes for, or to complement, general practitioners in the care of minor illness and the management of chronic diseases. Available research suggests that nurses can provide as high quality care as GPs in the provision of first contact and ongoing care for unselected

  17. Advanced Education and Technology Business Plan, 2010-13

    Science.gov (United States)

    Alberta Advanced Education and Technology, 2010

    2010-01-01

    This paper presents the business plan of the Ministry of Advanced Education and Technology for 2010 to 2013. Advanced Education and Technology supports the advanced learning system by providing funding for advanced learning providers, coordinating and approving programs of study at public institutions, licensing and approving programs at private…

  18. Advanced Planning for Tsunamis in California

    Science.gov (United States)

    Miller, K.; Wilson, R. I.; Larkin, D.; Reade, S.; Carnathan, D.; Davis, M.; Nicolini, T.; Johnson, L.; Boldt, E.; Tardy, A.

    2013-12-01

    The California Tsunami Program is comprised of the California Governor's Office of Emergency Services (CalOES) and the California Geological Survey (CGS) and funded through the National Tsunami Hazard Mitigation Program (NTHMP) and the Federal Emergency Management Agency (FEMA). The program works closely with the 20 coastal counties in California, as well as academic, and industry experts to improve tsunami preparedness and mitigation in shoreline communities. Inundation maps depicting 'worst case' inundation modeled from plausible sources around the Pacific were released in 2009 and have provided a foundation for public evacuation and emergency response planning in California. Experience during recent tsunamis impacting the state (Japan 2011, Chile 2010, Samoa 2009) has brought to light the desire by emergency managers and decision makers for even more detailed information ahead of future tsunamis. A solution to provide enhanced information has been development of 'playbooks' to plan for a variety of expected tsunami scenarios. Elevation 'playbook' lines can be useful for partial tsunami evacuations when enough information about forecast amplitude and arrival times is available to coastal communities and there is sufficient time to make more educated decisions about who to evacuate for a given scenario or actual event. NOAA-issued Tsunami Alert Bulletins received in advance of a distant event will contain an expected wave height (a number) for each given section of coast. Provision of four elevation lines for possible inundation enables planning for different evacuation scenarios based on the above number potentially alleviating the need for an 'all or nothing' decision with regard to evacuation. Additionally an analytical tool called FASTER is being developed to integrate storm, tides, modeling errors, and local tsunami run-up potential with the forecasted tsunami amplitudes in real-time when a tsunami Alert is sent out. Both of these products will help

  19. Abbreviated Pandemic Influenza Planning Template for Primary Care Offices

    Energy Technology Data Exchange (ETDEWEB)

    HCTT CHE

    2010-01-01

    The Abbreviated Pandemic Influenza Plan Template for Primary Care Provider Offices is intended to assist primary care providers and office managers with preparing their offices for quickly putting a plan in place to handle an increase in patient calls and visits, whether during the 2009-2010 influenza season or future influenza seasons.

  20. My Cancer Care Plan as a Web-Solution.

    Science.gov (United States)

    Westman, Bodil; Cornelius, Birgitta

    2016-01-01

    The Swedish National Cancerplan states that patients should be offered an Individual Care Plan (ICP) for the treatment and survivorship care and rehabilitation planning. As there is no web-solution for ICP available, the project aim is to develop a non-commercial web-solution based on communication between the contact nurse and the patient. PMID:27332410

  1. Environmental Development Plan (EDP): advanced isotope separation

    International Nuclear Information System (INIS)

    This Environmental Development Plan (EDP) identifies and examines the environmental, safety, health, and socioeconomic (ES and H) issues and corresponding requirements associated with the ERDA research, development, and demonstration of the Advanced Isotope Separation (AIS) program. This EDP has been limited to the consideration of (1) overall AIS processes from feed material to product recovery, (2) laser processes (molecular and atomic vapor), (3) the plasma process, and (4) the necessary research and development activities. The key issues and requirements identified in this EDP encompass items specific to the AIS technology and items which are generic to the nuclear fuel cycle (including AIS) or multiple components of the fuel cycle. The key specific issues and requirements addressed are (1) the proliferation of this sensitive technology for the production of weapons grade material and (2) the potential occupational health effects from lasers or process chemicals and exposure to magnetic fields and electromagnetic fields. The key generic issues (which are also AIS process related are (1) the needs for the development of ''as low as practicable'' (ALAP) emission capabilities for effluents and (2) the identification of the radioactive contaminants in the AIS feed material.The key environmental planning elements for implementing the identified requirements are (1) scheduling the needs against the three critical technology development milestones: process selection (1981), operation of an engineering demonstration facility (EDF) (1984), and operation of a uranium tails stripper module (1990); and (2) identification of NEPA requirements and schedules, one for the process selection and construction of the EDF and one for the decision to construct and operate the stripper module

  2. Clinical Curriculum Reform and Advanced Care Training at the New England College of Optometry.

    Science.gov (United States)

    Wilson, Roger

    1998-01-01

    Discusses how the New England College of Optometry has expanded clinical education so graduates are equipped to handle new and advanced clinical and patient-care responsibilities and meet the changing standards of professional entry-level competency. The reform process, third- and fourth-year curriculum components, rotations, and plans for…

  3. Advanced test reactor. Testing capabilities and plans

    International Nuclear Information System (INIS)

    The Advanced Test Reactor (ATR), at the Idaho National Laboratory (INL), is one of the world's premier test reactors for providing the capability for studying the effects of intense neutron and gamma radiation on reactor materials and fuels. The physical configuration of the ATR, a 4-leaf clover shape, allows the reactor to be operated at different power levels in the corner 'lobes' to allow for different testing conditions for multiple simultaneous experiments. The combination of high flux (maximum thermal neutron fluxes of 1E15 neutrons per square centimeter per second and maximum fast [E>1.0 MeV] neutron fluxes of 5E14 neutrons per square centimeter per second) and large test volumes (up to 122 cm long and 12.7 cm diameter) provide unique testing opportunities. For future research, some ATR modifications and enhancements are currently planned. In 2007 the US Department of Energy designated the ATR as a National Scientific User Facility (NSUF) to facilitate greater access to the ATR for material testing research by a broader user community. This paper provides more details on some of the ATR capabilities, key design features, experiments, and plants for the NSUF. (author)

  4. Social Marketing: Planning Before Conceiving Preconception Care

    OpenAIRE

    E. Prue, Christine; Daniel, Katherine Lyon

    2006-01-01

    Social marketing approaches can help to shape the formation of and to create demand for preconception care services. This article describes four components of social marketing, often referred to as the 4 P’s, that should be carefully researched and set in place before a national effort to launch and sustain preconception care services is pursued. First, the product or package of services must be defined and adapted using the latest in scientific and health care standards and must be based on ...

  5. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document...

  6. Palliative care in advanced cancer patients in a tertiary care hospital in Uttarakhand

    OpenAIRE

    Manisha Bisht; Bist, S. S.; Dhasmana, D. C.; Sunil Saini

    2008-01-01

    Aim: Advanced cancer, irrespective of the site of the cancer, is characterized by a number of associated symptoms that impair the quality of life of patients. The management of these symptoms guides palliative care. The present study aims to describe the symptoms and appropriate palliation provided in patients with advanced cancer in a tertiary care hospital in Uttarakhand. Methods: This was an observational study. A total of 100 patients with advanced cancer were included in the study. T...

  7. Advanced Education and Technology Business Plan, 2007-10

    Science.gov (United States)

    Alberta Enterprise and Advanced Education, 2007

    2007-01-01

    The Government of Alberta Strategic Business Plan addresses significant opportunities and challenges facing Alberta over the next three years and positions Alberta to make the most of its economic, social and natural advantages. It is a plan to strategically manage growth and plan for a sustainable and secure future. Advanced Education and…

  8. Advanced Education Business Plan 2005-2008

    Science.gov (United States)

    Alberta Advanced Education, 2005

    2005-01-01

    In collaboration with learning providers, the advanced education system, industry, communities, government agencies and non-governmental organizations, Advanced Education strives to create accessible, affordable and quality learning opportunities that are responsive to the ongoing learning needs of Albertans. The Ministry's 2005-08 Business Plan…

  9. Monte Carlo Treatment Planning for Advanced Radiotherapy

    DEFF Research Database (Denmark)

    Cronholm, Rickard

    validation of a Monte Carlo model of a medical linear accelerator (i), converting a CT scan of a patient to a Monte Carlo compliant phantom (ii) and translating the treatment plan parameters (including beam energy, angles of incidence, collimator settings etc) to a Monte Carlo input file (iii). A protocol...... more sophisticated than previous algorithms since it uses delineations of structures in order to include and/or exclude certain media in various anatomical regions. This method has the potential to reduce anatomically irrelevant media assignment. In house MATLAB scripts translating the treatment plan...... presented. Comparison between dose distribution for clinical treatment plans generated by a commercial Treatment Planning System and by the implemented Monte Carlo Treatment Planning workflow were conducted. Good agreement was generally found, but for regions involving large density gradients differences of...

  10. Health Care Procedure Considerations and Individualized Health Care Plans

    Science.gov (United States)

    Heller, Kathryn Wolff; Avant, Mary Jane Thompson

    2011-01-01

    Teachers need to maintain a safe, healthy environment for all their students in order to promote learning. However, there are additional considerations when students require health care procedures, such as tube feeding or clean intermittent catheterization. Teachers must effectively monitor their students and understand their roles and…

  11. Managing Health Care After Cancer Treatment: A Wellness Plan

    OpenAIRE

    Moye, Jennifer; Langdon, Maura; Jones, Janice M.; Haggstrom, David; Naik, Aanand D.

    2014-01-01

    Many patients and health care providers lack awareness of both the existence of, and treatments for, lingering distress and disability after treatment. A cancer survivorship wellness plan can help ensure that any referral needs for psychosocial and other restorative care after cancer treatment are identified.

  12. [Individualised care plan during extracorporeal membrane oxygenation. A clinical case].

    Science.gov (United States)

    Call Mañosa, S; Pujol Garcia, A; Chacón Jordan, E; Martí Hereu, L; Pérez Tejero, G; Gómez Simón, V; Estruga Asbert, A; Gallardo Herrera, L; Vaquer Araujo, S; de Haro López, C

    2016-01-01

    An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy. PMID:27137415

  13. Advanced Tourist Trip Planning Using Hybrid Recommender

    OpenAIRE

    Saso KOCESKI; Petrevska, Biljana

    2013-01-01

    The paper intends to underline that tourists’ and travelers’ behaviour and preferences have changed dramatically specifically in the way how they search for information. In order to create a tailor-made itinerary and enhance the way of planning a tourist trip, the paper suggests introduction of tourism recommendation systems. For this purpose, a methodology is proposed that assists all interested parties in planning their vacation in more intelligent and sophisticated way by generating a pers...

  14. Quality of Care in Family Planning Program in China

    Institute of Scientific and Technical Information of China (English)

    Zhen-ming XIE; Hong-yan LIU

    2006-01-01

    Objective To sum up the theory of quality care according to the experience of F.P. program in China.Methods The author summarized the QOC theory and draw on its experiences and strength in family planning program in China.Results The theory facilitated the earnest program of the population and family planning program during the tenth five-year plan period, benefited the realization of the innovation of system and mechanism in population and family planning work, and the creation of a nice population environment for the healthy social and economic development in China.Conclusion The development of QOC has displayed a conspicuous theory in China's family planning program.

  15. Action Planning for Daily Mouth Care in Long-Term Care: The Brushing Up on Mouth Care Project

    Directory of Open Access Journals (Sweden)

    Mary E. McNally

    2012-01-01

    Full Text Available Research focusing on the introduction of daily mouth care programs for dependent older adults in long-term care has met with limited success. There is a need for greater awareness about the importance of oral health, more education for those providing oral care, and organizational structures that provide policy and administrative support for daily mouth care. The purpose of this paper is to describe the establishment of an oral care action plan for long-term care using an interdisciplinary collaborative approach. Methods. Elements of a program planning cycle that includes assessment, planning, implementation, and evaluation guided this work and are described in this paper. Findings associated with assessment and planning are detailed. Assessment involved exploration of internal and external factors influencing oral care in long-term care and included document review, focus groups and one-on-one interviews with end-users. The planning phase brought care providers, stakeholders, and researchers together to design a set of actions to integrate oral care into the organizational policy and practice of the research settings. Findings. The establishment of a meaningful and productive collaboration was beneficial for developing realistic goals, understanding context and institutional culture, creating actions suitable and applicable for end-users, and laying a foundation for broader networking with relevant stakeholders and health policy makers.

  16. Advances in Husbandry Training in Marine Mammal Care Programs

    OpenAIRE

    Brando, Sabrina I. C. A.

    2010-01-01

    The aim of this paper is to illustrate how the training of marine mammals has facilitated improved marine mammal husbandry practices. The marine mammal community has seen many changes, refinements and improvements in animal care programs since the first marine mammals were brought in captivity in the early 19th century. Cross disciplinary fields such as veterinarian science, psychology, physiology and conservation biology have advanced the knowledge and care of the different species of cetace...

  17. Revised Faculty Compensation, Evaluation, and Advancement Plan. March, 1998.

    Science.gov (United States)

    May, Joe

    This report provides the revised faculty compensation, evaluation, and advancement plan for Pueblo Community College (PCC) in Colorado. Section 1 contains the PCC three-level salary plan and discusses guidelines for initial appointment and level placement of faculty, initial salary computations, and minimum initial employment requirements. Section…

  18. [Part I. End-stage chronic organ failures: a position paper on shared care planning. The Integrated Care Pathway].

    Science.gov (United States)

    Gristina, Giuseppe R; Orsi, Luciano; Carlucci, Annalisa; Causarano, Ignazio R; Formica, Marco; Romanò, Massimo

    2014-01-01

    In Italy the birth rate decrease together with the continuous improvement of living conditions on one hand, and the health care progress on the other hand, led in recent years to an increasing number of patients with chronic mono- or multi-organ failures and in an extension of their life expectancy. However, the natural history of chronic failures has not changed and the inescapable disease's worsening at the end makes more rare remissions, increasing hospital admissions rate and length of stay. Thus, when the "end-stage" get close clinicians have to engage the patient and his relatives in an advance care planning aimed to share a decision making process regarding all future treatments and related ethical choices such as patient's best interests, rights, values, and priorities. A right approach to the chronic organ failures end-stage patients consists therefore of a careful balance between the new powers of intervention provided by the biotechnology and pharmacology (intensive care), both with the quality of remaining life supplied by physicians to these patients (proportionality and beneficence) and the effective resources rationing and allocation (distributive justice). However, uncertainty still marks the criteria used by doctors to assess prognosis of these patients in order to make decisions concerning intensive or palliative care. The integrated care pathway suggested in this position paper shared by nine Italian medical societies, has to be intended as a guide focused to identify end-stage patients and choosing for them the best care option between intensive treatments and palliative care. PMID:24553592

  19. Health Care Consumerism: Lessons My 401(k) Plan Taught Me.

    Science.gov (United States)

    Steinberg, Allen T

    2015-01-01

    Changes to the U.S. health care system are here. As we think about how individuals will pay for health care--while actively employed and while retired--our experiences with 401(k) plans provide some valuable lessons. In order to support employees in this new health care world--a challenge arguably more daunting than the 401(k) challenge we faced 20 years ago--some very different types of support are needed. Employers should consider providing their employees with the resources to manage health care changes. PMID:26666089

  20. Recent advances in topical wound care

    Directory of Open Access Journals (Sweden)

    Sujata Sarabahi

    2012-01-01

    Full Text Available There are a wide variety of dressing techniques and materials available for management of both acute wounds and chronic non-healing wounds. The primary objective in both the cases is to achieve a healed closed wound. However, in a chronic wound the dressing may be required for preparing the wound bed for further operative procedures such as skin grafting. An ideal dressing material should not only accelerate wound healing but also reduce loss of protein, electrolytes and fluid from the wound, and help to minimize pain and infection. The present dictum is to promote the concept of moist wound healing. This is in sharp contrast to the earlier practice of exposure method of wound management wherein the wound was allowed to dry. It can be quite a challenge for any physician to choose an appropriate dressing material when faced with a wound. Since wound care is undergoing a constant change and new products are being introduced into the market frequently, one needs to keep abreast of their effect on wound healing. This article emphasizes on the importance of assessment of the wound bed, the amount of drainage, depth of damage, presence of infection and location of wound. These characteristics will help any clinician decide on which product to use and where,in order to get optimal wound healing. However, there are no ′magical dressings′. Dressings are one important aspect that promotes wound healing apart from treating the underlying cause and other supportive measures like nutrition and systemic antibiotics need to be given equal attention.

  1. After you: conversations between patients and healthcare professionals in planning for end of life care

    Directory of Open Access Journals (Sweden)

    Almack Kathryn

    2012-09-01

    Full Text Available Abstract Background This study explores with patients, carers and health care professionals if, when and how Advance Care Planning conversations about patients’ preferences for place of care (and death were facilitated and documented. Methods The study adopted an exploratory case study design using qualitative interviews, across five services delivering palliative care to cancer and non-cancer patients within an urban and rural English region. The study recruited 18 cases made up of patients (N = 18; 10 men; 8 women; median age 75; nominated relatives (N = 11; 7 women; 4 men; median age 65 and healthcare professionals (N = 15 caring for the patient. Data collection included: 18 initial interviews (nine separate interviews with patients and 9 joint interviews with patients and relatives and follow up interviews in 6 cases (involving a total of 5 patients and 5 relatives within one year of the first interview. Five group interviews were conducted with 15 healthcare professionals; 8 of whom also participated in follow up interviews to review their involvement with patients in our study. Results Patients demonstrated varying degrees of reticence, evasion or reluctance to initiate any conversations about end of life care preferences. Most assumed that staff would initiate such conversations, while staff were often hesitant to do so. Staff-identified barriers included the perceived risks of taking away hope and issues of timing. Staff were often guided by cues from the patient or by intuition about when to initiate these discussions. Conclusions This study provides insights into the complexities surrounding the initiation of Advance Care Planning involving conversations about end of life care preferences with patients who are identified as having palliative care needs, in particular in relation to the risks inherent in the process of having conversations where mortality must be acknowledged. Future research is needed to examine how to

  2. Center for Advanced Energy Studies Program Plan

    Energy Technology Data Exchange (ETDEWEB)

    Kevin Kostelnik

    2005-09-01

    The world is facing critical energy-related challenges regarding world and national energy demands, advanced science and energy technology delivery, nuclear engineering educational shortfalls, and adequately trained technical staff. Resolution of these issues is important for the United States to ensure a secure and affordable energy supply, which is essential for maintaining U.S. national security, continued economic prosperity, and future sustainable development. One way that the U.S. Department of Energy (DOE) is addressing these challenges is by tasking the Battelle Energy Alliance, LLC (BEA) with developing the Center for Advanced Energy Studies (CAES) at the Idaho National Laboratory (INL). By 2015, CAES will be a self-sustaining, world-class, academic and research institution where the INL; DOE; Idaho, regional, and other national universities; and the international community will cooperate to conduct critical energy-related research, classroom instruction, technical training, policy conceptualization, public dialogue, and other events.

  3. Primary care palliative and supportive care services: Experiences and perceptions of patients with advanced progressive disease and their informal carers

    OpenAIRE

    Hardy, Beth

    2009-01-01

    Palliative care can be defined as the active, holistic care of patients with advanced progressive illness, and incorporates symptom management with psychological, social and spiri-tual care (WHO, 1990). Palliative care is for patients in the advanced stages of illness. Supportive care follows people throughout the process of their disease, from pre-diagnosis, treatment, cure, continuing illness, death and into bereavement. The aim of supportive care is to maximise benefits of treatment and...

  4. Protein Innovations Advance Drug Treatments, Skin Care

    Science.gov (United States)

    2012-01-01

    Dan Carter carefully layered the sheets of tracing paper on the light box. On each sheet were renderings of the atomic components of an essential human protein, one whose structure had long been a mystery. With each layer Carter laid down, a never-before-seen image became clearer. Carter joined NASA s Marshall Space Flight Center in 1985 and began exploring processes of protein crystal growth in space. By bouncing intense X-rays off the crystals, researchers can determine the electron densities around the thousands of atoms forming the protein molecules, unveiling their atomic structures. Cultivating crystals of sufficient quality on Earth was problematic; the microgravity conditions of space were far more accommodating. At the time, only a few hundred protein structures had been mapped, and the methods were time consuming and tedious. Carter hoped his work would help reveal the structure of human serum albumin, a major protein in the human circulatory system responsible for ferrying numerous small molecules in the blood. More was at stake than scientific curiosity. Albumin has a high affinity for most of the world s pharmaceuticals, Carter explains, and its interaction with drugs can change their safety and efficacy. When a medication enters the bloodstream a cancer chemotherapy drug, for example a majority of it can bind with albumin, leaving only a small percentage active for treatment. How a drug interacts with albumin can influence considerations like the necessary effective dosage, playing a significant role in the design and application of therapeutic measures. In spite of numerous difficulties, including having no access to microgravity following the 1986 Space Shuttle Challenger disaster, the image Carter had hoped to see was finally clarifying. In 1988, his lab had acquired specialized X-ray and detection equipment a tipping point. Carter and his colleagues began to piece together albumin s portrait, the formation of its electron densities coalescing on

  5. Advanced Simulation and Computing Business Plan

    Energy Technology Data Exchange (ETDEWEB)

    Rummel, E. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2015-07-09

    To maintain a credible nuclear weapons program, the National Nuclear Security Administration’s (NNSA’s) Office of Defense Programs (DP) needs to make certain that the capabilities, tools, and expert staff are in place and are able to deliver validated assessments. This requires a complete and robust simulation environment backed by an experimental program to test ASC Program models. This ASC Business Plan document encapsulates a complex set of elements, each of which is essential to the success of the simulation component of the Nuclear Security Enterprise. The ASC Business Plan addresses the hiring, mentoring, and retaining of programmatic technical staff responsible for building the simulation tools of the nuclear security complex. The ASC Business Plan describes how the ASC Program engages with industry partners—partners upon whom the ASC Program relies on for today’s and tomorrow’s high performance architectures. Each piece in this chain is essential to assure policymakers, who must make decisions based on the results of simulations, that they are receiving all the actionable information they need.

  6. Establishment of Pediatric Cardiac Intensive Care Advanced Practice Provider Services.

    Science.gov (United States)

    Gilliland, Jill; Donnellan, Amy; Justice, Lindsey; Moake, Lindy; Mauney, Jennifer; Steadman, Page; Drajpuch, David; Tucker, Dawn; Storey, Jean; Roth, Stephen J; Koch, Josh; Checchia, Paul; Cooper, David S; Staveski, Sandra L

    2016-01-01

    The addition of advanced practice providers (APPs; nurse practitioners and physician assistants) to a pediatric cardiac intensive care unit (PCICU) team is a health care innovation that addresses medical provider shortages while allowing PCICUs to deliver high-quality, cost-effective patient care. APPs, through their consistent clinical presence, effective communication, and facilitation of interdisciplinary collaboration, provide a sustainable solution for the highly specialized needs of PCICU patients. In addition, APPs provide leadership, patient and staff education, facilitate implementation of evidence-based practice and quality improvement initiatives, and the performance of clinical research in the PCICU. This article reviews mechanisms for developing, implementing, and sustaining advance practice services in PCICUs. PMID:26714997

  7. Homecare Nurses' Decision-Making During Admission Care Planning.

    Science.gov (United States)

    Sockolow, Paulina; Bass, Ellen J; Eberle, Carl L; Bowles, Kathryn H

    2016-01-01

    The re-hospitalization rate of homecare patients within 60 days of hospital discharge is 30%. Enhanced care planning based on better information may reduce this rate. However, very little is known about the homecare admission and care planning processes. The research team collected data during observations of three nursing visits to admit homecare patients in Camden NJ, and conducted thematic content analysis on these data. Human factors methods helped to identify nurse decision-making related to selection of the plan of care problems, non-nursing resources, and the nursing visit pattern. They identified how the electronic health record (EHR) assisted the nurse in visit pattern frequency decisions. Major themes that emerged included reduced efficiency due to use of redundant intra-team communication methods to augment EHR documentation, redundant documentation, and workarounds and reorganization of clinical workflow. PMID:27332156

  8. Solving the Puzzle of Child Care: Report of the Cuyahoga County Child Day Care Planning Project.

    Science.gov (United States)

    Child Day Care Planning Project, Cleveland, OH.

    This report describes the Child Day Care Planning Project, which was developed by private and public representatives to meet the needs for child care in Cuyahoga County, Ohio. The project consisted of five major components. The first component, the Data Project, documented the needs and resources of the community. The second component, the Quality…

  9. Survivorship care plans: Prevalence and barriers to use

    OpenAIRE

    Birken, Sarah A.; Mayer, Deborah K.; Weiner, Bryan J.

    2013-01-01

    Survivorship care plans (SCPs) are intended to educate survivors and providers about survivors’ transition from cancer treatment to follow-up care. Using a survey of 23 cancer programs in the South Atlantic United States, we (1) describe the prevalence and barriers to SCP use and (2) assess relationships between SCP use and (a) barriers and (b) cancer program characteristics. Most cancer programs (86%) reported some SCP use; however, less than a quarter of cancer programs’ providers had ever ...

  10. Changing workforce demographics necessitates succession planning in health care.

    Science.gov (United States)

    Collins, Sandra K; Collins, Kevin S

    2007-01-01

    Health care organizations continue to be plagued by labor shortage issues. Further complicating the already existing workforce challenges is an aging population poised to retire en masse within the next few years. With fewer cohorts in the age group of 25 to 44 years (Vital Speeches Day. 2004:71:23-27), a more mobile workforce (Grow Your Own Leaders: How to Identify, Develop, and Retain Leadership Talent, 2002), and an overall reduction in the number of individuals seeking employment in the health care field (J Healthc Manag. 2003:48:6-11), the industry could be faced with an unmanageable number of vacant positions throughout the organization. Bracing for the potential impact of these issues is crucial to the ongoing business continuity of health care organization. Many health care organizations have embraced succession planning to combat the potential labor famine. However, the health care industry as a whole seems to lag behind other industries in terms of succession planning efforts (Healthc Financ Manage. 2005;59:64-67). This article seeks to provide health care managers with a framework for improving the systematic preparation of the next generation of managers by analyzing the succession planning process. The proposition of these models is to initiate and simplify the gap reduction between theoretical concepts and future organizational application. PMID:17992105

  11. Exploring the usefulness of comprehensive care plans for children with medical complexity (CMC: a qualitative study

    Directory of Open Access Journals (Sweden)

    Adams Sherri

    2013-01-01

    Full Text Available Abstract Background The Medical Home model recommends that Children with Special Health Care Needs (CSHCN receive a medical care plan, outlining the child’s major medical issues and care needs to assist with care coordination. While care plans are a primary component of effective care coordination, the creation and maintenance of care plans is time, labor, and cost intensive, and the desired content of the care plan has not been studied. The purpose of this qualitative study was to understand the usefulness and desired content of comprehensive care plans by exploring the perceptions of parents and health care providers (HCPs of children with medical complexity (CMC. Methods This qualitative study utilized in-depth semi-structured interviews and focus groups. HCPs (n = 15 and parents (n = 15 of CMC who had all used a comprehensive care plan were recruited from a tertiary pediatric academic health sciences center. Themes were identified through grounded theory analysis of interview and focus group data. Results A multi-dimensional model of perceived care plan usefulness emerged. The model highlights three integral aspects of the care plan: care plan characteristics, activating factors and perceived outcomes of using a care plan. Care plans were perceived as a useful tool that centralized and focused the care of the child. Care plans were reported to flatten the hierarchical relationship between HCPs and parents, resulting in enhanced reciprocal information exchange and strengthened relationships. Participants expressed that a standardized template that is family-centered and includes content relevant to both the medical and social needs of the child is beneficial when integrated into overall care planning and delivery for CMC. Conclusions Care plans are perceived to be a useful tool to both health care providers and parents of CMC. These findings inform the utility and development of a comprehensive care plan template as well as a model of how

  12. Discharge Planning in Acute Care Hospitals in Israel: Services Planned and Levels of Implementation and Adequacy

    Science.gov (United States)

    Auslander, Gail K.; Soskolne, Varda; Stanger, Varda; Ben-Shahar, Ilana; Kaplan, Giora

    2008-01-01

    This study aimed to examine the implementation, adequacy, and outcomes of discharge planning. The authors carried out a prospective study of 1,426 adult patients discharged from 11 acute care hospitals in Israel. Social workers provided detailed discharge plans on each patient. Telephone interviews were conducted two weeks post-discharge. Findings…

  13. Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program.

    Science.gov (United States)

    George, Susan; Leasure, A Renee

    2016-01-01

    Heart failure (HF) is a major health problem in United States, and it has reached epidemic proportions. Heart failure is associated with significant morbidity, mortality, and cost. Although the prognosis of HF is worse than many forms of cancer, many patients, families, and clinicians are unaware of the dire prognosis. As the disease progress to advanced HF, patients are faced with many challenges, such as poor quality of life due to worsening symptoms and frequent hospitalizations. Heart failure management adds significant financial burden to the health care system. Palliative care can be integrated into HF care to improve quality of life and symptom management and to address physical, spiritual, and psychosocial needs of patients and families. Palliative care can be used concurrently with or independent of curative or life-prolonging HF therapies. Transformational leadership principles were used to guide the development of a plan to enhance integration of palliative care within traditional advanced HF care. PMID:26836596

  14. Advanced Hybrid Particulate Collector Project Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    Miller, S.J.

    1995-11-01

    As the consumption of energy increases, its impact on ambient air quality has become a significant concern. Recent studies indicate that fine particles from coal combustion cause health problems as well as atmospheric visibility impairment. These problems are further compounded by the concentration of hazardous trace elements such as mercury, cadmium, selenium, and arsenic in fine particles. Therefore, a current need exists to develop superior, but economical, methods to control emissions of fine particles. Since most of the toxic metals present in coal will be in particulate form, a high level of fine- particle collection appears to be the best method of overall air toxics control. However, over 50% of mercury and a portion of selenium emissions are in vapor form and cannot be collected in particulate control devices. Therefore, this project will focus on developing technology not only to provide ultrahigh collection efficiency of particulate air toxic emissions, but also to capture vapor- phase trace metals such as mercury and selenium. Currently, the primary state-of-the-art technologies for particulate control are fabric filters (baghouses) and electrostatic precipitators (ESPs). However, they both have limitations that prevent them from achieving ultrahigh collection of fine particulate matter and vapor-phase trace metals. The objective of this project is to develop a highly reliable advanced hybrid particulate collector (AHPC) that can provide > 99.99 % particulate collection efficiency for all particle sizes between 0.01 and 50 14m, is applicable for use with all U.S. coals, and is cost-0443competitive with existing technologies. Phase I of the project is organized into three tasks: Task I - Project Management, Reporting, and Subcontract Consulting Task 2 - Modeling, Design, and Construction of 200-acfm AHPC Model Task 3 - Experimental Testing and Subcontract Consulting

  15. Advances in Pediatric Asthma in 2013: Coordinating Asthma Care

    OpenAIRE

    Szefler, Stanley J.

    2014-01-01

    Last year’s Advances in Pediatric Asthma: Moving Toward Asthma Prevention concluded that: “We are well on our way to creating a pathway around wellness in asthma care and also to utilize new tools to predict the risk for asthma and take steps to not only prevent asthma exacerbations but also to prevent the early manifestations of the disease and thus prevent its evolution to severe asthma.” This year’s summary will focus on recent advances in pediatric asthma on pre- and postnatal factors alt...

  16. Palliative care in advanced dementia; A mixed methods approach for the development of a complex intervention

    Directory of Open Access Journals (Sweden)

    Tookman Adrian

    2008-07-01

    Full Text Available Abstract Background There is increasing interest in improving the quality of care that patients with advanced dementia receive when they are dying. Our understanding of the palliative care needs of these patients and the natural history of advanced disease is limited. Many people with advanced dementia have unplanned emergency admissions to the acute hospital; this is a critical event: half will die within 6 months. These patients have complex needs but often lack capacity to express their wishes. Often carers are expected to make decisions. Advance care planning discussions are rarely performed, despite potential benefits such more consistent supportive healthcare, a reduction in emergency admissions to the acute hospital and better resolution of carer bereavement. Design/Methods We have used the MRC complex interventions framework, a "bottom-up" methodology, to develop an intervention for patients with advanced dementia and their carers aiming to 1 define end of life care needs for both patients and carers, 2 pilot a palliative care intervention and 3 produce a framework for advance care planning for patients. The results of qualitative phase 1 work, which involved interviews with carers, hospital and primary care staff from a range of disciplines, have been used to identify key barriers and challenges. For the exploratory trial, 40 patients will be recruited to each of the control and intervention groups. The intervention will be delivered by a nurse specialist. We shall investigate and develop methodology for a phase 3 randomised controlled trial. For example we shall explore the feasibility of randomisation, how best to optimise recruitment, decide on appropriate outcomes and obtain data for power calculations. We will evaluate whether the intervention is pragmatic, feasible and deliverable on acute hospital wards and test model fidelity and its acceptability to carers, patients and staff. Discussion Results of qualitative phase 1 work

  17. 42 CFR 409.43 - Plan of care requirements.

    Science.gov (United States)

    2010-10-01

    ... skilled nursing, physical therapy, speech-language pathology services, or occupational therapy visit in a... 42 Public Health 2 2010-10-01 2010-10-01 false Plan of care requirements. 409.43 Section 409.43 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

  18. Evidence Based Order Sets as a Nursing Care Planning System

    OpenAIRE

    LaCrosse, Lisa M.; Heermann, Judith; Azevedo, Karen; Sorrentino, Catherine; Straub, Dawn; O'Dowd, Gloria

    2002-01-01

    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.

  19. Integrating Palliative Care Into the Care of Patients With Advanced Lung Cancer.

    Science.gov (United States)

    Kapo, Jennifer M; Akgün, Kathleen M

    2015-01-01

    Lung cancer is the leading cause of death due to malignancy. Although lung cancer mortality has been decreasing in recent years, it remains substantially higher than other causes of cancer death. Median survival for patients with locally advanced non-small cell lung cancer, defined as lung cancer involving regional lymph nodes, is estimated to be approximately 10 to 17 months, and median survival for patients with metastatic disease is only 6 to 9 months. In addition, patients with advanced lung cancer often experience debilitating symptoms and poor quality of life. Pain, dyspnea, and fatigue are most frequently reported and affect at least 65% of patients with advanced lung cancer. Given this burden of symptoms and high mortality, patients and their families facing a diagnosis of advanced lung cancer are in need of support. Palliative care, with its focus on addressing the emotional, physical, and spiritual sources of suffering utilizing the expertise of an interdisciplinary team, can provide this comprehensive support. This review describes the role of supportive and palliative care integrated into the treatment of patients with a diagnosis of advanced lung cancer with sections focused on the evaluation and treatment of pain and dyspnea, approaches to challenging communication tasks, and the support of caregivers who care for patients with advanced lung cancer. PMID:26389769

  20. Understanding the Context for Long-Term Care Planning.

    Science.gov (United States)

    Broyles, Ila H; Sperber, Nina R; Voils, Corrine I; Konetzka, R Tamara; Coe, Norma B; Van Houtven, Courtney Harold

    2016-06-01

    Evolving family structure and economic conditions may affect individuals' ability and willingness to plan for future long-term care (LTC) needs. We applied life course constructs to analyze focus group data from a study of family decision making about LTC insurance. Participants described how past exposure to caregiving motivated them to engage in LTC planning; in contrast, child rearing discouraged LTC planning. Perceived institutional and economic instability drove individuals to regard financial LTC planning as either a wise precaution or another risk. Perceived economic instability also shaped opinions that adult children are ill-equipped to support parents' LTC. Despite concerns about viability of social insurance programs, some participants described strategies to maximize gains from them. Changing norms around aging and family roles also affected expectations of an active older age, innovative LTC options, and limitations to adult children's involvement. Understanding life course context can inform policy efforts to encourage LTC planning. PMID:26553887

  1. Advanced Education and Technology Business Plan, 2009-12. Highlights

    Science.gov (United States)

    Alberta Advanced Education and Technology, 2009

    2009-01-01

    Advanced Education and Technology provides strategic leadership for the development of the next generation economy in Alberta through the provision of accessible, affordable and quality learning opportunities for all Albertans and support for a dynamic and integrated innovation system. This paper provides the highlights of the business plan of the…

  2. Planning parenthood: Health care providers' perspectives on pregnancy intention, readiness, and family planning.

    Science.gov (United States)

    Stevens, Lindsay M

    2015-08-01

    A major health care goal in the United States is increasing the proportion of pregnancies that are planned. While many studies examine family planning from the perspective of individual women or couples, few investigate the perceptions and practices of health care providers, who are gatekeepers to medicalized fertility control. In this paper, I draw on 24 in-depth interviews with providers to investigate how they interpret and enact the objective to "plan parenthood" and analyze their perspectives in the context of broader discourses about reproduction, family planning, and motherhood. Interviews reveal two central discourses: one defines pregnancy planning as an individual choice, that is as patients setting their own pregnancy intentions; the second incorporates normative expectations about what it means to be ready to have a baby that exclude poor, single, and young women. In the latter discourse, planning is a broader process of achieving middle-class life markers like a long-term relationship, a good job, and financial stability, before having children. Especially illuminating are cases where a patient's pregnancy intention and the normative expectations of "readiness" do not align. With these, I demonstrate that providers may prioritize normative notions of readiness over a patient's own intentions. I argue that these negotiations of intention and readiness reflect broader tensions in family planning and demonstrate that at times the seemingly neutral notion of "planned parenthood" can mask a source of stratification in reproductive health care. PMID:26151389

  3. Challenges faced by palliative care physicians when caring for doctors with advanced cancer

    NARCIS (Netherlands)

    Noble, S. I. R.; Nelson, A.; Finlay, I. G.

    2008-01-01

    Background: It is possible that patients with advanced cancer, who are from the medical profession, have different or additional care needs than other patients. Previous training, professional experiences and access to information and services may influence their needs and subsequent illness behavio

  4. End-of-Life Care for Undocumented Immigrants With Advanced Cancer: Documenting the Undocumented.

    Science.gov (United States)

    Jaramillo, Sylvia; Hui, David

    2016-04-01

    There are approximately 11.1 million undocumented immigrants in the United States, with a majority being Latino. Cancer is now the leading cause of death in Latinos. There is little research guiding providers on how to deliver optimal end-of-life care in this population. We describe a case of an undocumented Latino patient with advanced cancer, and provide a review of the literature on end-of-life care in undocumented immigrants. Our patient encountered many challenges as he navigated through the healthcare system in the last months of life. These included delayed diagnosis, limited social support, financial issues, fear of deportation, and language and cultural barriers, which resulted in significant physical and psychological distress. Within the undocumented patient population, there is often a lack of advance care planning, prognostic understanding, mistrust, religious practices, and cultural beliefs that may affect decision making. Given the growing number of undocumented immigrants in the United States, it is important for clinicians and policy makers to have a better understanding of the issues surrounding end-of-life care for undocumented immigrants, and work together to improve the quality of life and quality of end-of-life care for these disadvantaged individuals. PMID:26681362

  5. AGU governance's decision-making process advances strategic plan

    Science.gov (United States)

    McPhaden, Michael; Finn, Carol; McEntee, Chris

    2012-10-01

    A lot has happened in a little more than 2 years, and we want give AGU members an update on how things are working under AGU's strategic plan and governance model. AGU is an organization committed to its strategic plan (http://www.agu.org/about/strategic_plan.shtml), and if you have not read the plan lately, we encourage you to do so. AGU's vision is to be an organization that "galvanizes a community of Earth and space scientists that collaboratively advances and communicates science and its power to ensure a sustainable future." We are excited about the progress we have made under this plan and the future course we have set for the Union. Everything the Board of Directors, Council, and committees put on their agendas is intended to advance AGU's strategic goals and objectives. Together with headquarters staff, these bodies are working in an integrated, effective manner to carry out this plan. The best way to demonstrate the progress made and each group's role is to walk through a recent example: the creation of a new Union-level award (see Figure 1).

  6. Advancing Primary Care Use of Electronic Medical Records in Canada

    Directory of Open Access Journals (Sweden)

    Jennifer Zelmer

    2014-10-01

    Full Text Available In 2010, the federal government's Economic Action Plan funded Canada Health Infoway to co-invest with provinces, territories, and health care providers in electronic medical records (EMRs in primary care. The goal is to help improve access to care, quality of health services, and productivity of the health system, as well as to deliver economic benefits. The decision to fund EMRs was consistent with a long-term framework for digital health established in consultation with stakeholders across the country, spurred by analysis demonstrating the economic impact of such investments and data on Canada's low rate of EMR use in primary care compared with other countries. The decision reflected widespread public and stakeholder consensus regarding the importance of such investments. EMR adoption has more than doubled since 2006, with evaluations identifying efficiency and patient care benefits (e.g., reduced time managing laboratory test results and fewer adverse drug events in community-based practices. These benefits are expected to rise further as EMR adoption continues to grow and practices gain more experience with their use.

  7. Home care for patients in need of advanced care and technology : a challenge for patients and their caregivers

    OpenAIRE

    Swedberg, Lena

    2014-01-01

    Background and aim: There is an ongoing trend of advanced care ‘moving out’ from hospitals and into patients' homes. In Sweden, caregivers with limited training, employed by municipalities or private agencies take 24-hour responsibility for patient care with limited support from healthcare professionals. The aim of this thesis was to explore and gain new and broadened understanding of 24-hour home care for patients in need of advanced care and technology. Material and methods: A multi ...

  8. Continuity of Care: Sharing the Medication Treatment Plan.

    Science.gov (United States)

    Spahni, Stéphane

    2016-01-01

    The shared medication treatment plan is a key element for supporting the continuity of care. Indeed a substantial amount of emergency hospitalization is linked to medication - 5% to 10% according to some studies. Methods and tools helping all healthcare providers to have a better knowledge of the complete medication plan are therefore required in order to limit side effects linked to an insufficient knowledge of what the patient is taking. The workshop intends to present various initiatives and open the discussion about the limits, pros and cons of various initiatives. PMID:27332315

  9. Urinary Stone Disease: Advancing Knowledge, Patient Care, and Population Health.

    Science.gov (United States)

    Scales, Charles D; Tasian, Gregory E; Schwaderer, Andrew L; Goldfarb, David S; Star, Robert A; Kirkali, Ziya

    2016-07-01

    Expanding epidemiologic and physiologic data suggest that urinary stone disease is best conceptualized as a chronic metabolic condition punctuated by symptomatic, preventable stone events. These acute events herald substantial future chronic morbidity, including decreased bone mineral density, cardiovascular disease, and CKD. Urinary stone disease imposes a large and growing public health burden. In the United States, 1 in 11 individuals will experience a urinary stone in their lifetime. Given this high incidence and prevalence, urinary stone disease is one of the most expensive urologic conditions, with health care charges exceeding $10 billion annually. Patient care focuses on management of symptomatic stones rather than prevention; after three decades of innovation, procedural interventions are almost exclusively minimally invasive or noninvasive, and mortality is rare. Despite these advances, the prevalence of stone disease has nearly doubled over the past 15 years, likely secondary to dietary and health trends. The NIDDK recently convened a symposium to assess knowledge and treatment gaps to inform future urinary stone disease research. Reducing the public health burden of urinary stone disease will require key advances in understanding environmental, genetic, and other individual disease determinants; improving secondary prevention; and optimal population health strategies in an increasingly cost-conscious care environment. PMID:26964844

  10. Contribution of FDOPA PET to radiotherapy planning for advanced glioma

    International Nuclear Information System (INIS)

    Despite radical treatment with surgery, radiotherapy and chemotherapy, advanced gliomas recur within months. Geographic misses in radiotherapy planning may play a role in this seemingly ineluctable recurrence. Planning is typically performed on post-contrast MRIs, which are known to underreport tumour volume relative to FDOPA PET scans. FDOPA PET fused with contrast enhanced MRI has demonstrated greater sensitivity and specificity than MRI alone. One sign of potential misses would be differences between gross target volumes (GTVs) defined using MRI alone and when fused with PET. This work examined whether such a discrepancy may occur. Materials and Methods: For six patients, a 75 minute PET scan using 3,4-dihydroxy-6-18F-fluoro-L-phynel-alanine (18F-FDOPA) was taken within 2 days of gadolinium enhanced MRI scans. In addition to standard radiotherapy planning by an experienced radiotherapy oncologist, a second gross target volume (GTV) was defined by an experienced nuclear medicine specialist for fused PET and MRI, while blinded to the radiotherapy plans. The volumes from standard radiotherapy planning were compared to the PET defined GTV. Results: The comparison indicated radiotherapy planning would change in several cases if FDOPA PET data was available. PET-defined contours were external to 95% prescribed dose for several patients. However, due to the radiotherapy margins, the discrepancies were relatively small in size and all received a dose of 50 Gray or more. Conclusions: Given the limited size of the discrepancies it is uncertain that geographic misses played a major role in patient outcome. Even so, the existence of discrepancies indicates that FDOPA PET could assist in better defining margins when planning radiotherapy for advanced glioma, which could be important for highly conformal radiotherapy plans.

  11. LGBT people's knowledge of and preparedness to discuss end-of-life care planning options.

    Science.gov (United States)

    Hughes, Mark; Cartwright, Colleen

    2014-09-01

    Despite the devastating impact of HIV/AIDS, end-of-life care planning among lesbian, gay, bisexual and transgender (LGBT) communities is relatively under-researched, especially in Australia. This paper reports findings of a survey of 305 LGBT people living in New South Wales, which examined their knowledge of and attitudes towards end-of-life care. The focus of this paper is their preparedness to discuss with healthcare providers any end-of-life care plans. The results highlight that while the majority of respondents were aware of three of the four key end-of-life care planning options available in New South Wales--enduring powers of attorney, enduring guardians and person responsible (only a minority had heard of advance healthcare directives)--a much smaller number of people had actually taken up these options. Only a minority of respondents were able to identify correctly who had the legal right to make treatment decisions for a person who is unconscious following a car accident. A small proportion of people had discussed end-of-life care options with general practitioners or another main healthcare provider, and only in very few cases were these issues raised by the practitioners themselves. Those most likely to not feel comfortable discussing these issues with practitioners included younger people, those not fully open about their sexuality to family members, and transgender people and others who do not define their gender as male or female. The paper highlights the importance of education strategies to raise awareness of the end-of-life care planning options among LGBT people, as well as strategies for increasing health providers' preparedness to discuss these issues with LGBT patients. PMID:24935483

  12. China's Experience of Quality Care in Family Planning

    Institute of Scientific and Technical Information of China (English)

    Er-sheng GAO; Wei YUAN; Ning LIU

    2006-01-01

    Objective To evaluate and overview the experience of quality care of family planning of China.Methods The framework of quality care of China was summarized and analyzed, that was clients, technology and management triangle program system.Results The 8 fundamental elements of quality care in China were presented:1) policy environment of QoC, 2) comprehensive services, 3) choice of method, 4) IEC to policy-makers and providers, 5) technical competence, 6) interpersonal communications, 7) institutional guideline and regulation, 8) appropriate constellation of service.Conclusion FP sectors should prepare different constellations of service to meet their individual reproductive health need for different clients and develop institutional guideline and regulation for FP service to follow up in practice. QoC should be a kind of standardized service process.

  13. Use of advanced technologies across the wound care spectrum: prologue.

    Science.gov (United States)

    Kirsner, Robert S; Romanelli, Marco

    2016-09-01

    The growing trends of ageing populations and increasing prevalence of diabetes have given rise to an expanding number of problematic acute and chronic wounds. Over the past two decades, the use of negative pressure wound therapy (NPWT) with and without instillation of topical wound solutions has expanded to include treatment of a large variety of wounds. Additionally, the use of NPWT specifically designed for use over closed surgical incisions has been associated with favourable results. The recent introduction of an automated epidermal harvesting system, which neither creates a donor site wound nor requires the use of a surgeon, operating room or anaesthesia, has facilitated the use of epidermal grafting. This supplement highlights some of the advanced wound approaches that have been developed to address challenging wounds and the growing burden of wound care affecting both the patient and the health care system. PMID:27547957

  14. SOCIAL RESEARCH AND HEALTH CARE PLANNING IN SOUTH ASIA - PART 1

    OpenAIRE

    Leslie, Charles

    1988-01-01

    This paper discuses the social research and health care planning systems of South Asia. Also, the Author attempts to indicate the scope and nature of this work done in this territory to identity elements relevant to health care planning.

  15. Planning for long-term care : filial behavior and relationship quality of adult children with independent parents

    OpenAIRE

    Bromley, Mark Calvin

    1990-01-01

    This study is an investigation of the long-term care planning entered into by 170 adult children who had independent parents. A decision-making process with four stages was hypothesized. Sons and daughters entered into planning activities primarily at the "consideration" and "discussion" stages. This involvement proceeds along a sequence of stages with lower stage activities being completed before entering into more advanced stages. Minimal involvement from adult children in "preliminary p...

  16. Palliative care in advanced cancer patients in a tertiary care hospital in Uttarakhand

    Directory of Open Access Journals (Sweden)

    Manisha Bisht

    2008-01-01

    Full Text Available Aim: Advanced cancer, irrespective of the site of the cancer, is characterized by a number of associated symptoms that impair the quality of life of patients. The management of these symptoms guides palliative care. The present study aims to describe the symptoms and appropriate palliation provided in patients with advanced cancer in a tertiary care hospital in Uttarakhand. Methods: This was an observational study. A total of 100 patients with advanced cancer were included in the study. The data obtained from the patients included symptoms reported by the patients, currently prescribed treatments and the site of cancer. Results: The average number of symptoms reported per patient was 5.33 ± 0.67 (mean ± SE. The most common symptoms were pain, weakness/fatigue, anorexia, insomnia, nausea/vomiting, dyspnea, constipation and cough. Polypharmacy was frequent. Patients consumed approximately 8.7 ± 0.38 (mean ± SE drugs on average during the 2-month period of follow-up. Conclusion: The result gives insight into the varied symptomatology of patients with advanced cancer. Polypharmacy was quite common in patients with advanced cancer, predisposing them to complicated drug interactions and adverse drug reactions.

  17. Care planning and decision-making in teams in Swedish elderly care: a study of interprofessional collaboration and professional boundaries.

    Science.gov (United States)

    Duner, Anna

    2013-05-01

    In front-line practice, joint working between different professionals in health/social care and rehabilitation is regarded as a means to reach a comprehensive assessment of the needs of the older care recipients, leading to decisions on appropriate care and services. The aim of this study was to examine professional collaboration and professional boundaries in interprofessional care planning teams. Two different care planning teams were studied, one performing care planning in the homes of older individuals and the other performing care planning for older people in hospital wards. The empirical data consisted of audio-recorded care planning meetings and interviews with the professionals in the teams. The integration between the professionals involved was most noticeable in the investigation and assessment phase, while it was lower in the planning phase and almost non-existent in decision-making. The home care planning team tended to work in a more integrated manner than the discharge planning team. The importance of clarifying the roles of all professions concerned with needs assessment and care planning for older people became evident in this study. PMID:23343434

  18. NATO Advanced Research Institute on the Application of Systems Science to Energy Policy Planning

    CERN Document Server

    Cherniavsky, E; Laughton, M; Ruff, L

    1981-01-01

    The Advanced Research Institute (ARI) on "The Application of Systems Science to Energy Policy Planning" was held under the auspices of the NATO Special Programme Panel on Systems Science in collaboration with the National Center for Analysis of Energy Sys­ tems, Brookhaven National Laboratory, USA, as a part of the NATO Science Committee's continuous effort to promote the advancement of science through international cooperation. Advanced Research Institutes are sponsored by the NATO Science Committee for the purposes of bringing together senior scientists to seek consensus on an assessment of the present state of knowl­ edge on a specific topic and to make recommendations for future research directions. Meetings are structured to encourage inten­ sive group discussion. Invitees are carefully selected so that the group as a whole will contain the experience and expertise neces­ sary to make the conclusions valid and significant. A final report is published presenting the various viewpoints and conclusions....

  19. Advanced methodology for generation expansion planning including interconnected systems

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, M.; Yokoyama, R.; Yasuda, K. [Tokyo Metropolitan Univ. (Japan); Sasaki, H. [Hiroshima Univ. (Japan); Ogimoto, K. [Electric Power Development Co. Ltd., Tokyo (Japan)

    1994-12-31

    This paper reviews advanced methodology for generation expansion planning including interconnected systems developed in Japan, putting focus on flexibility and efficiency in a practical application. First, criteria for evaluating flexibility of generation planning considering uncertainties are introduced. Secondly, the flexible generation mix problem is formulated as a multi-objective optimization with more than two objective functions. The multi-objective optimization problem is then transformed into a single objective problem by using the weighting method, to obtain the Pareto optimal solution, and solved by a dynamics programming technique. Thirdly, a new approach for electric generation expansion planning of interconnected systems is presented, based on the Benders Decomposition technique. That is, large scale generation problem constituted by the general economic load dispatch problem, and several sub problems which are composed of smaller scale isolated system generation expansion plans. Finally, the generation expansion plan solved by an artificial neural network is presented. In conclusion, the advantages and disadvantages of this method from the viewpoint of flexibility and applicability to practical generation expansion planning are presented. (author) 29 refs., 10 figs., 4 tabs.

  20. Advanced skin, scar and wound care centre for children: A new era of care

    Science.gov (United States)

    Burd, Andrew; Huang, Lin

    2012-01-01

    Advanced wound care centres are now a well established response to the growing epidemic of chronic wounds in the adult population. Is the concept transferable to children? Whilst there is not the same prevalence of chronic wounds in children there are conditions affecting the integumentary system that do have a profound effect on the quality of life of both children and their families. We have identified conditions involving the skin, scars and wounds which contribute to a critical number of potential patients that can justify the setting up of an advanced skin, scar and wound care centre for children. The management of conditions such as giant naevi, extensive scarring and epidermolysis bullosa challenge medical professionals and lead to new and novel treatments to be developed. The variation between and within such conditions calls for a customizing of individual patient care that involves a close relationship between research scientists and clinicians. This is translational medicine of its best and we predict that this is the future of wound care particularly and specifically in children. PMID:23162215

  1. Advanced skin, scar and wound care centre for children: A new era of care

    Directory of Open Access Journals (Sweden)

    Andrew Burd

    2012-01-01

    Full Text Available Advanced wound care centres are now a well established response to the growing epidemic of chronic wounds in the adult population. Is the concept transferable to children? Whilst there is not the same prevalence of chronic wounds in children there are conditions affecting the integumentary system that do have a profound effect on the quality of life of both children and their families. We have identified conditions involving the skin, scars and wounds which contribute to a critical number of potential patients that can justify the setting up of an advanced skin, scar and wound care centre for children. The management of conditions such as giant naevi, extensive scarring and epidermolysis bullosa challenge medical professionals and lead to new and novel treatments to be developed. The variation between and within such conditions calls for a customizing of individual patient care that involves a close relationship between research scientists and clinicians. This is translational medicine of its best and we predict that this is the future of wound care particularly and specifically in children.

  2. Quality Nursing Care for Hospitalized Patients with Advanced Illness: Concept Development

    OpenAIRE

    Izumi, Shigeko; Baggs, Judith G.; Knafl, Kathleen A.

    2010-01-01

    The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attribu...

  3. Cohort effects on the need for health care and implications for health care planning in Canada.

    Science.gov (United States)

    Whittaker, William; Birch, Stephen; MacKenzie, Adrian; Murphy, Gail Tomblin

    2016-01-01

    The sustainability of publicly funded health care systems is an issue for governments around the world. The economic climate limits governments' fiscal capacity to continue to devote an increasing share of public funds to health care. Meanwhile the demands for health care within populations continue to increase. Planning the future requirements for health care is typically based on applying current levels of health service use by age to demographic projections of the population. But changes in age-specific levels of health over time would undermine this 'constant use by age' assumption. We use representative Canadian survey data (Canadian Community Health Survey) covering the period 2001-2012, to identify the separate trends in demography (population ageing) and epidemiology (population health) on self-reported health. We propose an approach to estimating future health care requirements that incorporates cohort trends in health. Overall health care requirements for the population increase as the size and mean age of the population increase, but these effects are mitigated by cohort trends in health-we find the estimated need for health care is lower when models account for cohort effects in addition to age effects. PMID:26586614

  4. Cost accounting, management control, and planning in health care.

    Science.gov (United States)

    Siegrist, R B; Blish, C S

    1988-02-01

    Advantages and pharmacy applications of computerized hospital management-control and planning systems are described. Hospitals must define their product lines; patient cases, not tests or procedures, are the end product. Management involves operational control, management control, and strategic planning. Operational control deals with day-to-day management on the task level. Management control involves ensuring that managers use resources effectively and efficiently to accomplish the organization's objectives. Management control includes both control of unit costs of intermediate products, which are procedures and services used to treat patients and are managed by hospital department heads, and control of intermediate product use per case (managed by the clinician). Information from the operation and management levels feeds into the strategic plan; conversely, the management level controls the plan and the operational level carries it out. In the system developed at New England Medical Center, Boston, Massachusetts, the intermediate product-management system enables managers to identify intermediate products, develop standard costs, simulate changes in departmental costs, and perform variance analysis. The end-product management system creates a patient-level data-base, identifies end products (patient-care groupings), develops standard resource protocols, models alternative assumptions, performs variance analysis, and provides concurrent reporting. Examples are given of pharmacy managers' use of such systems to answer questions in the areas of product costing, product pricing, variance analysis, productivity monitoring, flexible budgeting, modeling and planning, and comparative analysis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3284338

  5. Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia.

    Science.gov (United States)

    Nicholas, Lauren H; Bynum, Julie P W; Iwashyna, Theodore J; Weir, David R; Langa, Kenneth M

    2014-04-01

    The number of older adults with cognitive impairment is increasing, and such adults often require a surrogate to make decisions about health care. However, little is known about the aggressiveness of end-of-life care for these people, especially those who reside in the community. We found that cognitive impairment is common among older adults approaching the end of life, whether they live in the community or in a nursing home, and that nearly 30 percent of patients with severe dementia remained in the community until death. Among those patients, having an advance directive in the form of a living will was associated with significantly less aggressive care at the end of life, compared to similar patients without an advance directive-as measured by Medicare spending ($11,461 less per patient), likelihood of in-hospital death (17.9 percentage points lower), and use of the intensive care unit (9.4 percentage points lower). In contrast, advance directives were not associated with differences in care for people with normal cognition or mild dementia, whether they resided in the community or in a nursing home. Timely advance care planning after a diagnosis of cognitive impairment may be particularly important for older adults who reside in the community. PMID:24711329

  6. A conceptual framework for advanced practice nursing in a pediatric tertiary care setting: the SickKids' experience.

    Science.gov (United States)

    LeGrow, Karen; Hubley, Pam; McAllister, Mary

    2010-05-01

    Advanced practice nurses (APNs) at The Hospital for Sick Children (SickKids) are pediatric healthcare providers who integrate principles and theories of advanced nursing with specialty knowledge to provide autonomous, independent, accountable, ethical and developmentally appropriate care in complex, often ambiguous and rapidly changing healthcare environments. Caring for children and adolescents requires culturally sensitive and family-centred approaches to care that incorporate a unique body of knowledge. Family-centred care is an approach to planning, delivery and evaluation of healthcare that is governed by the establishment of mutually beneficial partnerships among APNs, health professionals and children/families. The cornerstone of APN practice at SickKids is the recognition of "family" as the recipients of care. By valuing and developing relationships with families, APNs promote excellence in healthcare across the care continuum to optimize the child's and family's physical, emotional, social, psychological and spiritual well-being. This paper outlines the evolution of advanced practice nursing at SickKids, beginning with the introduction of APN roles in the 1970s and culminating in the current critical mass of APNs who have been integrated throughout the hospital's infrastructure. We describe the process used to create a common vision and a framework to guide pediatric advanced nursing practice. PMID:20530994

  7. Advanced High-Level Waste Glass Research and Development Plan

    Energy Technology Data Exchange (ETDEWEB)

    Peeler, David K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Vienna, John D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Schweiger, Michael J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Fox, Kevin M. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2015-07-01

    The U.S. Department of Energy Office of River Protection (ORP) has implemented an integrated program to increase the loading of Hanford tank wastes in glass while meeting melter lifetime expectancies and process, regulatory, and product quality requirements. The integrated ORP program is focused on providing a technical, science-based foundation from which key decisions can be made regarding the successful operation of the Hanford Tank Waste Treatment and Immobilization Plant (WTP) facilities. The fundamental data stemming from this program will support development of advanced glass formulations, key process control models, and tactical processing strategies to ensure safe and successful operations for both the low-activity waste (LAW) and high-level waste (HLW) vitrification facilities with an appreciation toward reducing overall mission life. The purpose of this advanced HLW glass research and development plan is to identify the near-, mid-, and longer-term research and development activities required to develop and validate advanced HLW glasses and their associated models to support facility operations at WTP, including both direct feed and full pretreatment flowsheets. This plan also integrates technical support of facility operations and waste qualification activities to show the interdependence of these activities with the advanced waste glass (AWG) program to support the full WTP mission. Figure ES-1 shows these key ORP programmatic activities and their interfaces with both WTP facility operations and qualification needs. The plan is a living document that will be updated to reflect key advancements and mission strategy changes. The research outlined here is motivated by the potential for substantial economic benefits (e.g., significant increases in waste throughput and reductions in glass volumes) that will be realized when advancements in glass formulation continue and models supporting facility operations are implemented. Developing and applying advanced

  8. Developing a promotion plan for health care marketing.

    Science.gov (United States)

    Hallums, A

    1994-07-01

    Promotion of a health care provider's services is essential for communication with its customers and consumers. It is relevant to an organization's marketing strategy and is an element of what is described as the marketing mix. This paper considers the relationship of promotion to the marketing of services and proposes a plan for the promotion of the organization as a whole which can also be applied to an individual service or specialty. Whilst specific reference is made to an National Health Service (NHS) Trust it is also relevant to a Directly Managed Unit. PMID:7952707

  9. Theory of Planned Behavior, Self-Care Motivation, and Blood Pressure Self-Care

    OpenAIRE

    Peters, Rosalind M.; Templin, Thomas N

    2010-01-01

    The theory of planned behavior (TPB) was integrated within the theory of self-care (SCT) to explore the predictive value of extending TPB to measure attitudes and beliefs regarding a behavioral goal, and determine the ability of goal beliefs to predict engagement in the combined, multiple behaviors necessary to control BP. The hypothesized model was evaluated in a sample of 306 community-dwelling African Americans between 21 and 65 years of age. Scales developed for the study achieved accepta...

  10. Planning document for the Advanced Landfill Cover Demonstration

    International Nuclear Information System (INIS)

    The Department of Energy and Department of Defense are faced with the closure of thousands of decommissioned radioactive, hazardous, and mixed waste landfills as a part of ongoing Environmental Restoration activities. Regulations on the closure of hazardous and radioactive waste landfills require the construction of a ''low-permeability'' cover over the unit to limit the migration of liquids into the underlying waste. These landfills must be maintained and monitored for 30 years to ensure that hazardous materials are not migrating from the landfill. This test plan is intended as an initial road map for planning, designing, constructing, evaluating, and documenting the Advanced Landfill Cover Demonstration (ALCD). It describes the goals/ objectives, scope, tasks, responsibilities, technical approach, and deliverables for the demonstration

  11. Knowledge Management Platform in Advanced Product Quality Planning

    Science.gov (United States)

    Chiliban, Bogdan; Baral, Lal Mohan; Kifor, Claudiu

    2014-12-01

    Knowledge is an essential part of organizational competitiveness. This vital resource must be managed correctly within organizations in order to achieve desired performance levels within all undertakings. The process of managing knowledge is a very difficult one due to the illusive nature of the resource itself. Knowledge is stored within every aspect of an organization starting from people and ending with documents and processes. The Knowledge Management Platform is designed as a facilitator for managers and employees in all endeavours knowledge related within the Advanced Product Quality Planning Procedure

  12. Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care

    Science.gov (United States)

    Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care, a 2010 workshop sponsored by the Epidemiology and Genomics Research Program.

  13. Advanced Reactor Technology -- Regulatory Technology Development Plan (RTDP)

    International Nuclear Information System (INIS)

    This DOE-NE Advanced Small Modular Reactor (AdvSMR) regulatory technology development plan (RTDP) will link critical DOE nuclear reactor technology development programs to important regulatory and policy-related issues likely to impact a ''critical path'' for establishing a viable commercial AdvSMR presence in the domestic energy market. Accordingly, the regulatory considerations that are set forth in the AdvSMR RTDP will not be limited to any one particular type or subset of advanced reactor technology(s) but rather broadly consider potential regulatory approaches and the licensing implications that accompany all DOE-sponsored research and technology development activity that deal with commercial non-light water reactors. However, it is also important to remember that certain ''minimum'' levels of design and safety approach knowledge concerning these technology(s) must be defined and available to an extent that supports appropriate pre-licensing regulatory analysis within the RTDP. Final resolution to advanced reactor licensing issues is most often predicated on the detailed design information and specific safety approach as documented in a facility license application and submitted for licensing review. Because the AdvSMR RTDP is focused on identifying and assessing the potential regulatory implications of DOE-sponsored reactor technology research very early in the pre-license application development phase, the information necessary to support a comprehensive regulatory analysis of a new reactor technology, and the resolution of resulting issues, will generally not be available. As such, the regulatory considerations documented in the RTDP should be considered an initial ''first step'' in the licensing process which will continue until a license is issued to build and operate the said nuclear facility. Because a facility license application relies heavily on the data and information generated by

  14. Advanced Reactor Technology -- Regulatory Technology Development Plan (RTDP)

    Energy Technology Data Exchange (ETDEWEB)

    Moe, Wayne Leland [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2015-05-01

    This DOE-NE Advanced Small Modular Reactor (AdvSMR) regulatory technology development plan (RTDP) will link critical DOE nuclear reactor technology development programs to important regulatory and policy-related issues likely to impact a “critical path” for establishing a viable commercial AdvSMR presence in the domestic energy market. Accordingly, the regulatory considerations that are set forth in the AdvSMR RTDP will not be limited to any one particular type or subset of advanced reactor technology(s) but rather broadly consider potential regulatory approaches and the licensing implications that accompany all DOE-sponsored research and technology development activity that deal with commercial non-light water reactors. However, it is also important to remember that certain “minimum” levels of design and safety approach knowledge concerning these technology(s) must be defined and available to an extent that supports appropriate pre-licensing regulatory analysis within the RTDP. Final resolution to advanced reactor licensing issues is most often predicated on the detailed design information and specific safety approach as documented in a facility license application and submitted for licensing review. Because the AdvSMR RTDP is focused on identifying and assessing the potential regulatory implications of DOE-sponsored reactor technology research very early in the pre-license application development phase, the information necessary to support a comprehensive regulatory analysis of a new reactor technology, and the resolution of resulting issues, will generally not be available. As such, the regulatory considerations documented in the RTDP should be considered an initial “first step” in the licensing process which will continue until a license is issued to build and operate the said nuclear facility. Because a facility license application relies heavily on the data and information generated by technology development studies, the anticipated regulatory

  15. Advances in laparoscopy for acute care surgery and trauma.

    Science.gov (United States)

    Mandrioli, Matteo; Inaba, Kenji; Piccinini, Alice; Biscardi, Andrea; Sartelli, Massimo; Agresta, Ferdinando; Catena, Fausto; Cirocchi, Roberto; Jovine, Elio; Tugnoli, Gregorio; Di Saverio, Salomone

    2016-01-14

    The greatest advantages of laparoscopy when compared to open surgery include the faster recovery times, shorter hospital stays, decreased postoperative pain, earlier return to work and resumption of normal daily activity as well as cosmetic benefits. Laparoscopy today is considered the gold standard of care in the treatment of cholecystitis and appendicitis worldwide. Laparoscopy has even been adopted in colorectal surgery with good results. The technological improvements in this surgical field along with the development of modern techniques and the acquisition of specific laparoscopic skills have allowed for its utilization in operations with fully intracorporeal anastomoses. Further progress in laparoscopy has included single-incision laparoscopic surgery and natural orifice trans-luminal endoscopic surgery. Nevertheless, laparoscopy for emergency surgery is still considered challenging and is usually not recommended due to the lack of adequate experience in this area. The technical difficulties of operating in the presence of diffuse peritonitis or large purulent collections and diffuse adhesions are also given as reasons. However, the potential advantages of laparoscopy, both in terms of diagnosis and therapy, are clear. Major advantages may be observed in cases with diffuse peritonitis secondary to perforated peptic ulcers, for example, where laparoscopy allows the confirmation of the diagnosis, the identification of the position of the ulcer and a laparoscopic repair with effective peritoneal washout. Laparoscopy has also revolutionized the approach to complicated diverticulitis even when intestinal perforation is present. Many other emergency conditions can be effectively managed laparoscopically, including trauma in select hemodynamically-stable patients. We have therefore reviewed the most recent scientific literature on advances in laparoscopy for acute care surgery and trauma in order to demonstrate the current indications and outcomes associated with a

  16. Improving Transitions of Care With an Advanced Practice Nurse: A Pilot Study.

    Science.gov (United States)

    Hsueh, Martha; Dorcy, Kathleen

    2016-06-01

    Gaps in complex oncology care coordination between inpatient and outpatient settings can result in treatment and monitoring delays and omissions, which can negatively affect patient outcomes. Gaps also exist for patients facing complex treatment modalities and collaborations between multiple care teams working at geographically distant sites. A pilot advanced practice nurse care coordinator 
(APNCC) role to coordinate these complex care transitions and implement processes for safer and more efficient care has shown promise.
. PMID:27206289

  17. Advance directives in action in a regional palliative care service: "road testing" the provisions of the Medical Treatment Act 1988 (VIC).

    Science.gov (United States)

    Brown, Margaret; Fisher, John W; Brumley, David J; Ashby, Michael A; Milliken, Jan

    2005-11-01

    In order to explore the usefulness and acceptability of the provisions of the Medical Treatment Act 1988 (Vic) for palliative care patients in a rural region in Victoria, Australia, between July and December 2004 patients were given information explaining the Act and the opportunity to discuss it with the research officer. Grounded theory methodology was used to evaluate client responses. Findings suggested that palliative care patients are willing to engage in advance care planning but they have to be well enough and need skilled, practical, face-to-face assistance to complete the required legal forms. Written materials alone are not adequate, but provide the opportunity for medical staff to have conversations about death and dying. Doctors and nurses should understand the provisions of the Act to assist patients and families. It is recommended that advance care planning, appropriate to the jurisdiction, be an integral part of the palliative care assessment process. PMID:16304759

  18. States, Congress confront abortion services under Medicaid, health care plan.

    Science.gov (United States)

    1994-01-13

    Abortion coverage under various health care reform proposals has dominated the political reproductive rights debate, while poor women's access to abortion under Medicaid presents a current practical concern. Under the Clinton administration's proposed Health Security Act, abortion would be covered under "services for pregnant women," and Medicaid would eventually be incorporated into the national health plan. A final version is a long way off. For now, the Hyde amendment, limiting Medicaid coverage of abortion, controls the issue. Congress has made only negligible progress in freeing federal funds for Medicaid abortions: only in situations of life endangerment, rape, or incest. States are required to cover abortions that are medically necessary under the new guidelines, which now include pregnancy arising from rape and incest. The federal policy defers to state law on the definition of rape and incest, allowing for reasonable reporting or documentation requirements, while disallowing unduly burdensome regulations by allowing the treating physician reimbursement when the physician certifies that the patient was unable for physical or psychological reasons to comply with the requirement. States disagreeing with the new abortion policy immediately registered their opposition. Utah's health department, which has a "life only" law, has pledged not to implement the new federal policy until there is further clarification. The Health Care Financing Administrator responded by writing that "the decision to implement this policy nationwide was not discretionary." Congress chose not to add statutory language deferring to the states, and under U.S. Constitutional law, where state law or policy conflicts with federal law, federal law takes precedence. The next battle will certainly center on attempts to amend the Hyde amendment itself as well as health care legislation along the "states' option" lines. PMID:12345518

  19. Space Station Freedom advanced photovoltaics and battery technology development planning

    Science.gov (United States)

    Brender, Karen D.; Cox, Spruce M.; Gates, Mark T.; Verzwyvelt, Scott A.

    1993-01-01

    Space Station Freedom (SSF) usable electrical power is planned to be built up incrementally during assembly phase to a peak of 75 kW end-of-life (EOL) shortly after Permanently Manned Capability (PMC) is achieved in 1999. This power will be provided by planar silicon (Si) arrays and nickel-hydrogen (NiH2) batteries. The need for power is expected to grow from 75 kW to as much as 150 kW EOL during the evolutionary phase of SSF, with initial increases beginning as early as 2002. Providing this additional power with current technology may not be as cost effective as using advanced technology arrays and batteries expected to develop prior to this evolutionary phase. A six-month study sponsored by NASA Langley Research Center and conducted by Boeing Defense and Space Group was initiated in Aug. 1991. The purpose of the study was to prepare technology development plans for cost effective advanced photovoltaic (PV) and battery technologies with application to SSF growth, SSF upgrade after its arrays and batteries reach the end of their design lives, and other low Earth orbit (LEO) platforms. Study scope was limited to information available in the literature, informal industry contacts, and key representatives from NASA and Boeing involved in PV and battery research and development. Ten battery and 32 PV technologies were examined and their performance estimated for SSF application. Promising technologies were identified based on performance and development risk. Rough order of magnitude cost estimates were prepared for development, fabrication, launch, and operation. Roadmaps were generated describing key issues and development paths for maturing these technologies with focus on SSF application.

  20. Importance of Advanced Planning of Manufacturing for Nuclear Industry

    Directory of Open Access Journals (Sweden)

    Shykinov Nick

    2016-06-01

    Full Text Available In the context of energy demands by growing economies, climate changes, fossil fuel pricing volatility, and improved safety and performance of nuclear power plants, many countries express interest in expanding or acquiring nuclear power capacity. In the light of the increased interest in expanding nuclear power the supply chain for nuclear power projects has received more attention in recent years. The importance of the advanced planning of procurement and manufacturing of components of nuclear facilities is critical for these projects. Many of these components are often referred to as long-lead items. They may be equipment, products and systems that are identified to have a delivery time long enough to affect directly the overall timing of a project. In order to avoid negatively affecting the project schedule, these items may need to be sourced out or manufactured years before the beginning of the project. For nuclear facilities, long-lead items include physical components such as large pressure vessels, instrumentation and controls. They may also mean programs and management systems important to the safety of the facility. Authorized nuclear operator training, site evaluation programs, and procurement are some of the examples. The nuclear power industry must often meet very demanding construction and commissioning timelines, and proper advanced planning of the long-lead items helps manage risks to project completion time. For nuclear components there are regulatory and licensing considerations that need to be considered. A national nuclear regulator must be involved early to ensure the components will meet the national legal regulatory requirements. This paper will discuss timing considerations to address the regulatory compliance of nuclear long-lead items.

  1. Syntactic flexibility and planning scope: The effect of verb bias on advance planning during sentence recall

    Directory of Open Access Journals (Sweden)

    Maartje evan de Velde

    2014-10-01

    Full Text Available In sentence production, grammatical advance planning scope depends on contextual factors (e.g., time pressure, linguistic factors (e.g., ease of structural processing, and cognitive factors (e.g., production speed. The present study tests the influence of the availability of multiple syntactic alternatives (i.e., syntactic flexibility on the scope of advance planning during the recall of Dutch dative phrases. We manipulated syntactic flexibility by using verbs with a strong bias or a weak bias towards one structural alternative in sentence frames accepting both verbs (e.g., strong/weak bias: De ober schotelt/serveert de klant de maaltijd [voor] 'The waiter dishes out/serves the customer the meal'. To assess lexical planning scope, we varied the frequency of the first post-verbal noun (N1, Experiment 1 or the second post-verbal noun (N2, Experiment 2. In each experiment, 36 speakers produced the verb phrases in a Rapid Serial Visual Presentation (RSVP paradigm. On each trial, they read a sentence presented one word at a time, performed a short distractor task, and then saw a sentence preamble (e.g., De ober… which they had to complete to form the presented sentence. Onset latencies were compared using linear mixed effects models. N1 frequency did not produce any effects. N2 frequency only affected sentence onsets in the weak verb bias condition and especially in slow speakers. These findings highlight the dependency of planning scope during sentence recall on the grammatical properties of the verb and the frequency of post-verbal nouns. Implications for utterance planning in everyday speech are discussed.

  2. Development of Advanced Multi-Modality Radiation Treatment Planning Software

    Energy Technology Data Exchange (ETDEWEB)

    Nigg, D W; Hartmann Siantar, C

    2002-02-19

    The Idaho National Engineering and Environmental Laboratory (INEEL) has long been active in development of advanced Monte-Carlo based computational dosimetry and treatment planning methods and software for advanced radiotherapy, with a particular focus on Neutron Capture Therapy (NCT) and, to a somewhat lesser extent, Fast-Neutron Therapy. The most recent INEEL software product system of this type is known as SERA, Simulation Environment for Radiotherapy Applications. SERA is at a mature level in its life cycle, it has been licensed for research use worldwide, and it has become well established as a computational tool for research. However, along with its strengths, SERA also has some limitations in its structure and computational methodologies. More specifically, it is optimized only for neutron-based applications. Although photon transport can be computed with SERA, the simplified model that is used is designed primarily for photons produced in the neutron transport process. Thus SERA is not appropriate for applications to, for example, standard external-beam photon radiotherapy, which is by far more commonly used in the clinic than neutron based therapy.

  3. Consensus statement on advancing research in emergency department operations and its impact on patient care.

    Science.gov (United States)

    Yiadom, Maame Yaa A B; Ward, Michael J; Chang, Anna Marie; Pines, Jesse M; Jouriles, Nick; Yealy, Donald M

    2015-06-01

    The consensus conference on "Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care," hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but understudied area. The EDOSG is a research consortium dedicated to promoting evidence-based clinical practice in emergency medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we call for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multisite clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence-based research; 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system, including observation units, fast tracks, waiting rooms, laboratories, and radiology subunits; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research, and nontraditional publications. PMID:26014365

  4. A new horizon for planning services and health care infrastructure for the elderly

    OpenAIRE

    Nauta, N.J.; Perenboom, R.J.M.; Galindo Garre, F.

    2009-01-01

    Since the devolution of capacity planning for care for the elderly in the Netherlands in 1998, no innovations on assessing health needs and on forecasting were made for planning health care services for the elderly. The introduction of Horizon in 2006, which uses needs and deficiencies instead of linear demographic planning has been warmly welcomed. The innovation is to step away from planning on the basis of policies and to forecast demands of services on the basis of actual deficiencies and...

  5. The role of Advanced Practice Providers in interdisciplinary oncology care in the United States.

    Science.gov (United States)

    Reynolds, Rae Brana; McCoy, Kimberly

    2016-06-01

    Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs), generally referred to as Advanced Practice Providers (APPs), are fundamental to interdisciplinary oncology care. As the projected demand for oncology services is anticipated to outpace the supply of oncologists, APPs will become increasingly vital in the delivery of oncology care and services. The training, education, and scope of practice for APPs gives the interdisciplinary care team professionals that deliver high-quality clinical services and provide valuable contributions and leadership to health care quality improvement initiatives. Optimizing the integration of APPs in oncology care offers immense advantages towards improvement of clinical outcomes. PMID:27197514

  6. Patterns of care for patients with advanced soft tissue sarcoma: experience from Australian sarcoma services

    OpenAIRE

    Bae, Susie; Crowe, Philip; Gowda, Raghu; Joubert, Warren; Carey-Smith, Richard; Stalley, Paul; Desai, Jayesh

    2016-01-01

    Background There is a paucity of data on the current management of patients with advanced soft tissue sarcoma (STS) in the Australian health care setting. This study utilised the Australian sarcoma database to evaluate the patterns of care delivered to patients with advanced STS at Australian sarcoma services. Methods Prospectively collected data from six sarcoma centres in Australia were sourced to identify patients diagnosed with advanced STS between 1 January 2010 and 31 December 2012. Des...

  7. 42 CFR 485.711 - Condition of participation: Plan of care and physician involvement.

    Science.gov (United States)

    2010-10-01

    ... reviewed by a physician, or by a physical therapist or speech pathologist respectively. (a) Standard.... (1) For each patient there is a written plan of care established by the physician or by the physical therapist or speech-language pathologist who furnishes the services. (2) The plan of care for...

  8. Family planning and maternal health care in Egypt.

    Science.gov (United States)

    El-mouelhy, M T

    1990-01-01

    The Government of Egypt is introducing policies to reduce the mortality of women of reproductive age. However, family planning and maternal-child health care programs are unlikely to have the desired impact without corresponding improvements in the status of Egyptian women. Women's status in the areas of education, health, poverty, employment, the family, government, and the community is a crucial determinant of their willingness and ability to accept a smaller family size ideal and become contraceptive users. At present, only 6% of Egyptian women are a part of the work force and 60% are illiterate. In a society in which women are valued on the basis of the number of children they produce for their husbands, those practice birth control risk abandonment and isolation. The powerlessness and insecurity that lead Egyptian women to have an average of at least 5 children impeded national development and thus delay creation of the socioeconomic conditions that could liberate women from their domestic role. Equal opportunities in education and employment would represent a first step toward improving women's status by giving them a source of income and increased independence. Also needed are modifications in archaic marriage, divorce, and custody laws. PMID:12317075

  9. [Necessary changes for advancing nursing as caring science].

    Science.gov (United States)

    de Pires, Denise Elvira Pires

    2013-09-01

    The article aimed to reflect upon the challenges involved in strengthening Nursing as a caring science. It is founded on the sociological theory, connecting three approaches: the historical-dialectic materialism perspective about the working process in health care and nursing; the sociology of professions from a critical perspective; and the philosophy of science. The discussion is organized considering the aspects of Nursing as a discipline, work and health care profession. It sustains that knowledge production should be driven both by the purpose of Nursing work which is providing care to human beings with health needs and to advocate for the indispensable work conditions to a safe and responsible practice. It concludes that to strengthening Nursing it is necessary to produce knowledge to support nursing care and the political actions defending safe work conditions, the universal right to health as well safe and high quality care. PMID:24092308

  10. The relatives' perspective on advanced cancer care in Denmark. A cross-sectional survey

    DEFF Research Database (Denmark)

    Johnsen, Anna T; Ross, Lone; Petersen, Morten A;

    2012-01-01

    In order to improve advanced cancer care, evaluations are necessary. An important element of such evaluations is the perspective of the patient's relatives who have the role of being caregivers as well as co-users of the health care system. The aims were to investigate the scale structure of the...... FAMCARE scale, to investigate satisfaction with advanced cancer care from the perspective of the relatives of a representative sample of advanced cancer patients, and to investigate whether some sub-groups of relatives were more dissatisfied than others....

  11. The planned photon diagnostics beamlines at the Advanced Photon Source

    International Nuclear Information System (INIS)

    We present the planned photon diagnostics beamlines at the Advanced Photon Source. The photon diagnostics beamlines of the storage ring include two bending magnet sources and a dedicated diagnostic undulator. The bending magnet lines will employ the conventional UV/visible imaging techniques (resolution σ congruent 10 μm) and the x-ray pinhole camera (resolution σ congruent 15 μm) for the measurement of the positron beam-size (design value: σ congruent 100 μm). The opening angle of die undulator radiation will be around σ congruent 3 μrad for its first hamionic (23.2--25.8 keV), and σ congruent=1.7 μrad for its third harmonic (70--72 keV), providing a good resolution for measuring the positron beam divergence size (design values: σ congruent 9 μrad for 10% vertical coupling and 3 μrad for 1% coupling). The undulator and its x-ray, optics are specifically optimized for full emittance measurement of the positron beam. A major developmental effort will be in the area of detecting very fast phenomena (nanosecond and sub-nanosecond) in particle dynamics

  12. LOCATION AND PLANNING OF HEALTH CARE DELIVERY SYSTEM AT THE DISTICT LEVEL

    OpenAIRE

    Rajguru. S. A

    2015-01-01

    There is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations. In some countries, health system planning is distributed among market participants. In others, there is a concerted effort among governments, trade unions, charities, religious, or other coordinate bodies to deliver planned health care services targeted to the populations they serve. However, health care planning has been described as often e...

  13. Advancing family involvement in collaborative health care: Next steps.

    Science.gov (United States)

    Rolland, John S

    2015-06-01

    Comments on the article "Don Bloch's vision for Collaborative Family Health Care: Progress and next steps" by C. J. Peek (see record 2015-25290-002). C. J. Peek has provided us with a masterful integration of Don Bloch's vision of collaborative family health care and the evolution over the past 20 years of the field. The current author was very fortunate to be part of the initial meeting at Wingspread in 1994. As a family systems-oriented community and public health-trained psychiatrist, my primary focus over 30 years has been on families facing chronic illness and disability and collaborative care efforts in specialty, primary, rehabilitation, and palliative care medicine. In my view, the ability of the health care consumer (patient and his or her family members) and professional worlds to collaborate in a more egalitarian and less hierarchical and wary manner remains a significant constraint to progress. PMID:26053574

  14. 45 CFR 307.15 - Approval of advance planning documents for computerized support enforcement systems.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Approval of advance planning documents for... § 307.15 Approval of advance planning documents for computerized support enforcement systems. (a... projected resource requirements for staff, hardware, and other needs and the resources available or...

  15. Anesthesia and Intensive care implications for pituitary surgery: Recent trends and advancements

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2011-01-01

    Full Text Available The advancements in neuro-endocrine surgical interventions have been well supported by similar advancements in anesthesiology and intensive care. Surgery of the pituitary tumor poses unique challenges to the anesthesiologists and the intensivists as it involves the principles and practices of both endocrine and neurosurgical management. A multidisciplinary approach involving the endocrine surgeon, neurosurgeon, anesthesiologist, endocrinologist and intensivist is mandatory for a successful surgical outcome. The focus of pre-anesthetic checkup is mainly directed at the endocrinological manifestations of pituitary hypo or hyper-secretion as it secretes a variety of essential hormones, and also any pathological state that can cause imbalance of pituitary secretions. The pathophysiological aspects associated with pituitary tumors mandate a thorough airway, cardiovascular, neurologic and endocrinological assessment. A meticulous preoperative preparation and definite plans for the intra-operative period are the important clinical components of the anesthetic strategy. Various anesthetic modalities and drugs can be useful to provide a smooth intra-operative period by countering any complication and thus providing an uneventful recovery period.

  16. Care plan for the patient with a dependent personality disorder

    Directory of Open Access Journals (Sweden)

    Ana María Ruiz Galán

    2010-11-01

    Full Text Available Personality is unique for each individual and can be defined as the dynamic collection of characteristics relative to emotions, thought and behaviour.Personality trout’s only mean a Personality Disorder (PD when they are inflexible and maladjusted and cause notable functional deterioration or uneasiness.According to Bermudez personality is “the enduring organization of structural and functional features, innate and acquired under the special conditions of each one’s development that shape the particular and specific collection of behaviour to face different situations”.According to the Diagnostic a Statistical Manual of Mental Disorders (DSM-IV, a Personality Disorder is “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the person’s culture is pervasive and an inflexible, is stable over time and leads to distress or impairment. The onset of these patterns of behaviour is the beginning of the adulthood and, in rare instances, early adolescence”.There are several types of Personality Disorders (paranoid, schizoid, borderline, antisocial, dependent…. Dependent Personality Disorder is one of the most frequent in the Mental Health Services.People who suffer from this disorder are unable to take a decision by themselves because they don’t have confidence in themselves. They need a lot of social support and affection until the point of deny their individuality by subordinating their desires to other person’s desires and permitting these persons to manage their lives. Maybe they feel desolated by separation and loss and can support any situation, even maltreatment to keep a relationship.As we a deduce this diagnosis is sensible to cultural influences. This work aims to elaborate an standarized plan of cares for the patient with Dependent Personality Disorder by using nursing Diagnosis of NANDA II, Outcomes Criteria (NOC and Interventions Criteria (NIC.

  17. Advanced Education and Technology Business Plan, 2010-13. Highlights

    Science.gov (United States)

    Alberta Advanced Education and Technology, 2010

    2010-01-01

    The Ministry of Advanced Education and Technology envisions Alberta's prosperity through innovation and lifelong learning. Advanced Education and Technology's mission is to lead the development of a knowledge-driven future through a dynamic and integrated advanced learning and innovation system. This paper presents the highlights of the business…

  18. Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC/Advancing Quality Alliance integrated care fellowship experience

    Directory of Open Access Journals (Sweden)

    Michael Gregory

    2015-05-01

    Full Text Available The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world.In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care.I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre.

  19. Integrating Compassionate, Collaborative Care (the "Triple C") Into Health Professional Education to Advance the Triple Aim of Health Care.

    Science.gov (United States)

    Lown, Beth A; McIntosh, Sharrie; Gaines, Martha E; McGuinn, Kathy; Hatem, David S

    2016-03-01

    Empathy and compassion provide an important foundation for effective collaboration in health care. Compassion (the recognition of and response to the distress and suffering of others) should be consistently offered by health care professionals to patients, families, staff, and one another. However, compassion without collaboration may result in uncoordinated care, while collaboration without compassion may result in technically correct but depersonalized care that fails to meet the unique emotional and psychosocial needs of all involved. Providing compassionate, collaborative care (CCC) is critical to achieving the "triple aim" of improving patients' health and experiences of care while reducing costs. Yet, values and skills related to CCC (or the "Triple C") are not routinely taught, modeled, and assessed across the continuum of learning and practice. To change this paradigm, an interprofessional group of experts recently recommended approaches and a framework for integrating CCC into health professional education and postgraduate training as well as clinical care. In this Perspective, the authors describe how the Triple C framework can be integrated and enhance existing competency standards to advance CCC across the learning and practice continuum. They also discuss strategies for partnering with patients and families to improve health professional education and health care design and delivery through quality improvement projects. They emphasize that compassion and collaboration are important sources of professional, patient, and family satisfaction as well as critical aspects of professionalism and person-centered, relationship-based high-quality care. PMID:26717505

  20. Doing the right thing: a geriatrician's perspective on medical care for the person with advanced dementia.

    Science.gov (United States)

    Gillick, Muriel R

    2012-01-01

    Developing a reasonable approach to the medical care of older people with dementia will be essential in the coming decades. Physicians are the locus of decision making for persons with dementia. It is the responsibility of the physician to assure that the surrogate understands the nature and trajectory of the disease and then to elicit the desired goal of care. Physicians need to ascertain whether any advance directives are available, and if so, whether they apply to the situation of advanced dementia. Finally, physicians should help surrogates understand how the goals of care are best translated into practice. When the goal is comfort, this is achieved by assuring dignity, minimizing suffering, and promoting caring. In general, comfort should be the default goal of care, best implemented through palliative care or hospice. PMID:22458462

  1. The Care Needs of Community-Dwelling Seniors Suffering from Advanced Chronic Obstructive Pulmonary Disease

    Science.gov (United States)

    Wilson, Donna M.; Ross, Carolyn; Goodridge, Donna; Davis, Penny; Landreville, Alison; Roebuck, Kim

    2008-01-01

    Aim: This study was undertaken to determine the care needs of Canadian seniors living at home with advanced chronic obstructive pulmonary disease (COPD). Background: COPD is a leading cause of morbidity and mortality worldwide. Although hospitalizations for illness exacerbations and end-stage care may be common, most persons with COPD live out…

  2. International Conference on Advancements of Medicine and Health Care through Technology

    CERN Document Server

    Ciupa, Radu

    2014-01-01

    This volume presents the contributions of the third International Conference on Advancements of Medicine and Health Care through Technology (Meditech 2014), held in Cluj-Napoka, Romania. The papers of this Proceedings volume present new developments in - Health Care Technology, - Medical Devices, Measurement and Instrumentation, - Medical Imaging, Image and Signal Processing, - Modeling and Simulation, - Molecular Bioengineering, - Biomechanics.

  3. Advanced lung cancer patients' experience with continuity of care and supportive care needs.

    Science.gov (United States)

    Husain, Amna; Barbera, Lisa; Howell, Doris; Moineddin, Rahim; Bezjak, Andrea; Sussman, Jonathan

    2013-05-01

    As cancer care becomes increasingly complex, the ability to coordinate this care is more difficult for health care providers, patients and their caregivers alike. Despite the widely recognized need for improving continuity and coordination of care, the relationship of continuity of care with patient outcomes has yet to be elucidated. Our study's main finding is that the Continuity and Coordination subscale of the widely used Picker System of Ambulatory Cancer Care Survey is able to distinguish between lung cancer patients with unmet supportive care needs and those without. Specifically, this study shows a new association between this widely implemented continuity and coordination survey and the 'psychological needs' domain, as well as the 'health system and information' domains of supportive care needs. The finding provides support for the idea that interventions to improve continuity may impact tangible indicators of patient care such as supportive care needs being met. The study focuses attention on continuity of care as an important aspect of optimizing outcomes in cancer care. PMID:23274923

  4. Advancing nursing leadership in long-term care.

    Science.gov (United States)

    O'Brien, Jennifer; Ringland, Margaret; Wilson, Susan

    2010-05-01

    Nurses working in the long-term care (LTC) sector face unique workplace stresses, demands and circumstances. Designing approaches to leadership training and other supportive human-resource strategies that reflect the demands of the LTC setting fosters a positive work life for nurses by providing them with the skills and knowledge necessary to lead the care team and to address resident and family issues. Through the St. Joseph's Health Centre Guelph demonstration site project, funded by the Nursing Secretariat of Ontario's Ministry of Health and Long-Term Care, the Excelling as a Nurse Leader in Long Term Care training program and the Mentor Team program were developed to address these needs. Evaluation results show that not only have individual nurses benefitted from taking part in these programs, but also that the positive effects were felt in other parts of the LTC home (as reported by Directors of Care). By creating a generally healthier work environment, it is anticipated that these programs will also have a positive effect on recruitment and retention. PMID:20463447

  5. Brazilian public policies for reproductive health: family planning, abortion and prenatal care.

    Science.gov (United States)

    Guilhem, Dirce; Azevedo, Anamaria Ferreira

    2007-08-01

    This study is an ethical reflection on the formulation and application of public policies regarding reproductive health in Brazil. The Integral Assistance Program for Women's Health (PAISM) can be considered advanced for a country in development. Universal access for family planning is foreseen in the Brazilian legislation, but the services do not offer contraceptive methods for the population in a regular and consistent manner. Abortion is restricted by law to two cases: risk to the woman's life and rape. This reality favors the practice of unsafe abortion, which is the third largest cause of maternal death in Brazil. Legal abortion is regulated by the State and the procedure is performed in public health centers. However, there is resistance on the part of professionals to attend these women. Prenatal care is a priority strategy for promoting the quality of life of these women and of future generations. Nonetheless, it is still difficult for these women to access the prenatal care services and to have the required number of consultations. Moreover, managers and health professionals need to be made aware of the importance of implementing the actions indicated by the public policies in the area of sexual and reproductive health, favoring respect for autonomy in a context of personal freedom. PMID:17614992

  6. Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study

    OpenAIRE

    Simpson, A; Bannigan, B.; Coffey, M.; Barlow, S.; Cohen, R.; Jones, A.; Všetečková,, J.; Faulkner, A.; Thornton, A; Cartwright, M

    2016-01-01

    Background: In the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require service users to have a care coordinator, written care plan and regular reviews of their care. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in ...

  7. Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study

    OpenAIRE

    Simpson, Alan; Hannigan, Ben; Coffey, Michael; Barlow, Sally; Cohen, Rachel; Jones, Aled; Všetečková, Jitka; Faulkner, Alison; Thornton, Alexandra; Cartwright, Martin

    2016-01-01

    Background In the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require service users to have a care coordinator, written care plan and regular reviews of their care. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in c...

  8. AN OVERVIEW OF THE ADVANCED PLANNING AND SCHEDULING SYSTEMS

    OpenAIRE

    Thales Botelho de Sousa; Carlos Eduardo Soares Camparotti; Fábio Müller Guerrini; Adauto Lucas da Silva; Walther Azzolini Júnior

    2014-01-01

    Currently, the activities of the planning and control of companies are becoming increasingly complex and the managers of this area are constantly pressured to reduce operating costs, maintain inventories at adequate levels, to fully meet the demand of customers, and to respond effectively to changes that occur. The planning and scheduling task is important for most companies, so according to some authors, there is a need for further analysis of the practical use of production planning and con...

  9. Advanced HIV disease at presentation to care in Nairobi, Kenya: late diagnosis or delayed linkage to care?—a cross-sectional study

    OpenAIRE

    van der Kop, Mia Liisa; Thabane, Lehana; Awiti, Patricia Opondo; Muhula, Samuel; Kyomuhangi, Lennie Bazira; Lester, Richard Todd; Ekström, Anna Mia

    2016-01-01

    Background Presenting to care with advanced HIV is common in sub-Saharan Africa and increases the risk of severe disease and death; however, it remains unclear whether this is a consequence of late diagnosis or a delay in seeking care after diagnosis. The objectives of this cross-sectional study were to determine factors associated with advanced HIV at presentation to care and whether this was due to late diagnosis or delays in accessing care. Methods Between 2013 and 2015, adults presenting ...

  10. Advanced Education and Technology Business Plan, 2011-14

    Science.gov (United States)

    Alberta Advanced Education and Technology, 2011

    2011-01-01

    Advanced Education and Technology's mission is to lead the development of a knowledge-driven future through a dynamic and integrated advanced learning and innovation system. Its core businesses are to: (1) provide strategic leadership for Campus Alberta and Alberta Innovates; and (2) engage learners, industry and the community in learning…

  11. Advanced Education and Technology Business Plan, 2009-12

    Science.gov (United States)

    Alberta Advanced Education and Technology, 2009

    2009-01-01

    The Ministry of Advanced Education and Technology consists of the following entities for budget purposes: Department of Advanced Education and Technology, the Access to the Future Fund, Alberta Enterprise Corporation, Alberta Research Council Inc., and iCORE Inc. Achieving the Ministry's goals involves the work and coordination of many…

  12. Impact of advanced technologies on rural trauma care

    Science.gov (United States)

    McGrane, Michael J.; Gainor, Dia; Buttrey, Jan M.; Taska, John D.; Pierce, Gregg E.; Wolff, Barack

    1994-03-01

    The high incidence of traumatic injury and death is significant among the western, rural United States. A number of characteristics and factors contribute to this concern, among them extremes in population, distance, terrain, and resources. Opportunity exists to apply current and future advanced technology to impact trauma prevention, communication, emergency response, trauma system support and monitor trauma outcome.

  13. Type of Plan and Provider Network (Affordable Care Act)

    Science.gov (United States)

    Skip navigation Individuals & Families Small Businesses Search Get Coverage Change or Update Your Plan Get Answers For Employers For Employees Get Answers Menu Log in Español Individuals & Families Small Businesses Log in Español Get Coverage Change or Update Your Plan Get Answers ...

  14. A “best practices” strategy to improve quality in Medicaid managed care plans

    OpenAIRE

    Brodsky, Karen L.; Baron, Richard J.

    2000-01-01

    Medicaid managed care is delivered through organizations operating in very heterogeneous environments that confront similar barriers to success. Because Medicaid managed care is implemented differently in each state, health plans have been isolated from each other and have not had an opportunity to learn how others may have surmounted commonly encountered barriers. After interviewing Medicaid health plan medical directors, we developed a learning collaborative model based on shared categories...

  15. Benefits of advanced software techniques for mission planning systems

    Science.gov (United States)

    Gasquet, A.; Parrod, Y.; Desaintvincent, A.

    1994-01-01

    The increasing complexity of modern spacecraft, and the stringent requirement for maximizing their mission return, call for a new generation of Mission Planning Systems (MPS). In this paper, we discuss the requirements for the Space Mission Planning and the benefits which can be expected from Artificial Intelligence techniques through examples of applications developed by Matra Marconi Space.

  16. Grid Integration Studies: Advancing Clean Energy Planning and Deployment

    Energy Technology Data Exchange (ETDEWEB)

    Katz, Jessica [National Renewable Energy Lab. (NREL), Golden, CO (United States); Chernyakhovskiy, Ilya [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-07-01

    Integrating significant variable renewable energy (VRE) into the grid requires an evolution in power system planning and operation. To plan for this evolution, power system stakeholders can undertake grid integration studies. This Greening the Grid document reviews grid integration studies, common elements, questions, and guidance for system planners.

  17. 45 CFR 1355.54 - Submittal of advance planning documents.

    Science.gov (United States)

    2010-10-01

    ... DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL... statewide automated child welfare information system, signed by the appropriate State official,...

  18. Reply to "transforming oncology care": advancing value, accessing innovation.

    Science.gov (United States)

    Paradis, Rebecca

    2015-09-01

    Alternative payment models in oncology are already successfully standardizing care, curbing costs, and improving the patient experience. Yet, it is unclear whether decision makers are adequately considering patient access to innovation when creating these models, which could have severe consequences for a robust innovation ecosystem and the lives of afflicted patients. The suggested chart includes recommendations on: Allowing for the adoption of new, promising therapies; Promoting the measurement of patient-centered outcomes; and Providing support for personalized medicine. PMID:26618436

  19. Cutaneous wound healing: Current concepts and advances in wound care

    OpenAIRE

    Kenneth C Klein; Somes Chandra Guha

    2014-01-01

    A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care. [1] It is a snapshot of a patient′s total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors. [2...

  20. Planning for a radiological emergency in health care institutions

    International Nuclear Information System (INIS)

    The possible occurrence of accidents involving sources of ionizing radiation calls for response plans to mitigate the consequences of radiological accidents. An emergency planning framework is suggested for institutions which use medical applications of ionizing radiation. Bearing in mind that the prevention of accidents is of prime importance in dealing with radioactive materials and other sources of ionizing radiation, it is recommended that emergency instructions and procedures address certain aspects of the causes of these radiological events. Issues such as identification of radiological events in medical practices and their consequences, protective measures, planning for an emergency response and maintenance of emergency capacity are considered. (author)

  1. Developing a mental health care plan in a low resource setting: the theory of change approach.

    OpenAIRE

    Hailemariam, M; Fekadu, A.; Selamu, M; Alem, A.; Medhin, G; Giorgis, TW; DeSilva, M.; Breuer, E

    2015-01-01

    Background Scaling up mental healthcare through integration into primary care remains the main strategy to address the extensive unmet mental health need in low-income countries. For integrated care to achieve its goal, a clear understanding of the organisational processes that can promote and hinder the integration and delivery of mental health care is essential. Theory of Change (ToC), a method employed in the planning, implementation and evaluation of complex community initiatives, is an i...

  2. The value of Medicare managed care plans and their prescription drug benefits

    OpenAIRE

    Anne E. Hall

    2007-01-01

    I estimate the welfare, both gross and net, provided by the Medicare managed care program in 1999 through 2002. First, I estimate a model of demand for the benefits offered by managed care plans to Medicare beneficiaries. I then use the demand estimates to form estimates of welfare provided by the program. Medicare beneficiaries derived $14.9 billion of gross welfare per year from the Medicare HMO program. Depending on the amount of selection in the program, the Medicare managed care program ...

  3. Reconciling employment with caring for a husband with an advanced illness

    Directory of Open Access Journals (Sweden)

    Gysels Marjolein

    2009-11-01

    Full Text Available Abstract Background Little is known about combining work with caring for a person with advanced illness. This is important given the increasing number of women in the workforce and current policy seeking to increase care in the community. The aim of this paper was to explore the meaning of work for women caring for a husband with an advanced illness and the consequences of combining these two roles. Methods A purposive sample of 15 carers was recruited from a hospital and from the community, via the patients they cared for. Their illnesses included chronic obstructive pulmonary disease, cancer, motor neurone disease, and heart failure. Data were collected through semi-structured, in-depth interviews that were tape-recorded and transcribed verbatim. A Grounded Theory approach was used and case studies were developed. NVivo software facilitated the management and analysis of the data. Results Caring presented challenges to carers' work life. It diminished productivity or the quality of work, and led to missed opportunities for promotion. Work had an effect on the quality of care and the relationship with the patient, which eventually led to work being given up for caring. Three carers resisted the pressures to give up work and used it as a coping strategy. Conclusion A positive choice to remain in employment does not necessarily signal reluctance to care. Caring arrangements need to be understood from the common and separate interests of carers and the people they support.

  4. Patient, carer and professional perspectives on barriers and facilitators to quality care in advanced heart failure.

    Directory of Open Access Journals (Sweden)

    Susan Browne

    Full Text Available BACKGROUND: Those with advanced heart failure (HF experience high levels of morbidity and mortality, similar to common cancers. However, there remains evidence of inequity of access to palliative care services compared to people with cancer. This study examines patient, carer, and professional perspectives on current management of advanced HF and barriers and facilitators to improved care. METHODS: Qualitative study involving semi-structured interviews and focus groups with advanced HF patients (n = 30, carers (n = 20, and professionals (n = 65. Data analysed using Normalisation Process Theory (NPT as the underpinning conceptual framework. FINDINGS: Uncertainty is ubiquitous in accounts from advanced HF patients and their caregivers. This uncertainty relates to understanding of the implications of their diagnosis, appropriate treatments, and when and how to seek effective help. Health professionals agree this is a major problem but feel they lack knowledge, opportunities, or adequate support to improve the situation. Fragmented care with lack of coordination and poor communication makes life difficult. Poor understanding of the condition extends to the wider circle of carers and means that requests for help may not be perceived as legitimate, and those with advanced HF are not prioritised for social and financial supports. Patient and caregiver accounts of emergency care are uniformly poor. Managing polypharmacy and enduring concomitant side effects is a major burden, and the potential for rationalisation exists. This study has potential limitations because it was undertaken within a single geographical location within the United Kingdom. CONCLUSIONS: Little progress is being made to improve care experiences for those with advanced HF. Even in the terminal stages, patients and caregivers are heavily and unnecessarily burdened by health care services that are poorly coordinated and offer fragmented care. There is evidence that these poor

  5. Cutaneous wound healing: Current concepts and advances in wound care

    Directory of Open Access Journals (Sweden)

    Kenneth C Klein

    2014-01-01

    Full Text Available A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care. [1] It is a snapshot of a patient′s total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors. [2] The vast majority of wounds would heal by such approach with variable degrees of residual morbidity, disability and even mortality. Globally, beyond the above therapies, newer tools of healing are selectively accessible to caregivers, for various logistical or financial reasons. Our review will focus on the use of hyperbaric oxygen therapy (HBOT, as used at our institution (CAMC, and some other modalities that are relatively accessible to patients. HBOT is a relatively safe and technologically simpler way to deliver care worldwide. However, the expense for including HBOT as standard of care for recognized indications per UHMS(Undersea and Hyperbaric Medical Society may vary widely from country to country and payment system. [3] In the USA, CMS (Centers for Medicare and Medicaid Services approved indications for HBOT vary from that of the UHMS for logistical reasons. [1] We shall also briefly look into other newer therapies per current clinical usage and general acceptance by the medical community. Admittedly, there would be other novel tools with variable success in wound healing worldwide, but it would be difficult to include all in this treatise.

  6. Grandmother and household viability in Botswana: family planning, child care and survival in changing tswana society.

    OpenAIRE

    Ingstad B

    1989-01-01

    Examines the roles and influence of grandmothers with respect to nutrition, breastfeeding, quality of child care and family planning usage; the maternal grandmother is much more involved with grandchildren than the paternal grandmother. Accordingly this category may be a target for programmes and activities to promote child welfare and family planning.

  7. Concurrent Planning and beyond: Family-Centered Services for Children in Foster Care

    Science.gov (United States)

    Hudson, Lucy; Almeida, Connie; Bentley, Dawn; Brown, Josie; Harlin, Daria; Norris, Judy

    2008-01-01

    Family reunification is not always possible for children who have been removed from the care of their biological parents because of abuse or neglect. Concurrent planning puts into place a secondary plan for a permanent home should family reunification prove to be impossible. Working in four diverse communities around the country in an innovative…

  8. Recent advances in the surgical care of breast cancer patients

    Directory of Open Access Journals (Sweden)

    Vitelli Carlo E

    2010-01-01

    Full Text Available Abstract A tremendous improvement in every aspect of breast cancer management has occurred in the last two decades. Surgeons, once solely interested in the extipartion of the primary tumor, are now faced with the need to incorporate a great deal of information, and to manage increasingly complex tasks. As a comprehensive assessment of all aspects of breast cancer care is beyond the scope of the present paper, the current review will point out some of these innovations, evidence some controversies, and stress the need for the surgeon to specialize in the various aspects of treatment and to be integrated into the multisciplinary breast unit team.

  9. Effects of Constraints and Consequences on Plan Complexity in Conversations About End-of-Life Care.

    Science.gov (United States)

    Russell, Jessica

    2015-01-01

    The current study assessed the role of health care provider constraints and perceived consequences on plan complexity for conversations with patients about end-of-life care. Meta-goal constraints, perceived consequences associated with conversational engagement and planning theory provides the basis for research questions and hypotheses posed. Findings suggested that while the meta-goals of efficiency and politeness were each recognized as important, providers indicated greater concern for politeness during patient interactions concerning treatment options. Reported constraints had no impact on plan complexity. Perceived consequences of conversational engagement were predominantly positive and concerned the patient. Findings may enhance the understanding of social workers in their educational role regarding the potential training needs of health care team members in palliative care contexts. PMID:26654064

  10. Induced abortion in China and the advances of post abortion family planning service

    Institute of Scientific and Technical Information of China (English)

    Li Ying; Cheng Yi-ming; Huang Na; Guo Xin; Wang Xian-mi

    2004-01-01

    This is a review of current situation of induced abortion and post abortion family planning service in China. Induced abortion is an important issue in reproductive health. This article reviewed the distribution of induced abortion in various time, areas, and population in China, and explored the character, reason, and harm to reproductive health of induced abortion.Furthermore, this article introduces the concept of Quality of Care Program in Family Planning,and discusses how important and necessary it is to introduce Quality of Care Program in Family Planning to China.

  11. AN OVERVIEW OF THE ADVANCED PLANNING AND SCHEDULING SYSTEMS

    Directory of Open Access Journals (Sweden)

    Thales Botelho de Sousa

    2014-12-01

    Full Text Available Currently, the activities of the planning and control of companies are becoming increasingly complex and the managers of this area are constantly pressured to reduce operating costs, maintain inventories at adequate levels, to fully meet the demand of customers, and to respond effectively to changes that occur. The planning and scheduling task is important for most companies, so according to some authors, there is a need for further analysis of the practical use of production planning and control systems. Within the context of production planning and control systems development, in the 1990s were launched the APS systems, which represent an innovation when compared to their predecessors. This paper intended to provide through a literature review, the concepts, structure, capabilities, implementation process and benefits of using APS systems in the companies production planning and control. The main contribution of this research is to show a strong conceptual understanding regarding APS systems, which can be used as a solid theoretical reference for future researches.

  12. Substance use disorders: Recent advances in treatment and models of care.

    Science.gov (United States)

    Abou-Saleh, Mohammed T

    2006-09-01

    Drug and alcohol misuse is a global health problem with great health economic costs to substance misusers, their families, and their communities. It is associated with high physical and psychiatric morbidity, and with high mortality. There are serious obstacles to its treatment, including the stigma associated with it. Major advances in assessment and treatment have enabled health professionals to tackle drug and alcohol problems in a variety of settings, including primary care setting. This overview focuses on recent advances in the treatment of substance use disorders and on optimal models of care and services, with reference to studies conducted in the United Arab Emirates. Community surveys in Dubai and Al-Ain have shown a high prevalence of these disorders. It is proposed that these problems be dealt with in primary care settings, and it has been found that primary health care workers have a key role to play and are often in an ideal position to coordinate the community's response. PMID:16938506

  13. Advancing the use of performance evaluation in health care

    DEFF Research Database (Denmark)

    Traberg, Andreas; Jacobsen, Peter

    2014-01-01

    Purpose – The purpose of this paper is to develop a framework for health care performance evaluation that enables decision makers to identify areas indicative of corrective actions. The framework should provide information on strategic pro-/regress in an operational context that justifies the need......, and two internal and five external databases are used for a quantitative data collection. Findings – By aggregating performance outcomes, collective measures of performance are achieved. This enables easy and intuitive identification of areas not strategically aligned. In general, the framework has...... proven helpful in an MRI unit, where operational decision makers have been struggling with extensive amounts of performance information. Research limitations/implications – The implementation of the framework in a single case in a public and highly political environment restricts the generalizing...

  14. Exercise And Heart Failure: Advancing Knowledge And Improving Care

    Science.gov (United States)

    Alvarez, Paulino; Hannawi, Bashar; Guha, Ashrith

    2016-01-01

    Exercise limitation is the hallmark of heart failure, and an increasing degree of intolerance is associated with poor prognosis. Objective evaluation of functional class (e.g., cardiopulmonary exercise testing) is essential for adequate prognostication in patients with advanced heart failure and for implementing an appropriate exercise training program. A graded exercise program has been shown to be beneficial in patients with heart failure and has become an essential component of comprehensive cardiac rehabilitation in these patients. An exercise program tailored to the patient's preferences, possibilities, and physiologic reserve has the greatest chance of being successful. Despite being safe, effective, and a guideline-recommended treatment to improve quality of life, exercise training remains grossly underutilized. Patient, physician, insurance and practice barriers need to be addressed to improve this quality gap. PMID:27486494

  15. Predictors of Practice Patterns for Lymphedema Care Among Oncology Advanced Practice Nurses

    OpenAIRE

    Ryan, Joanne C.; Cleland, Charles M.; Mei R. Fu

    2012-01-01

    Lymphedema, a debilitating and chronic condition, is considered to be one of the most distressing adverse effects of cancer treatment. The purpose of this study was to understand the practice patterns in lymphedema care and identify predictors influencing those patterns among oncology nurses, with a focus on advanced practice nurses. Random and purposive sampling was utilized to recruit 238 oncology nurses who completed the Web-based study. Participants included advanced practice nurses (nurs...

  16. Terminal Versus Advanced Cancer: Do the General Population and Health Care Professionals Share a Common Language?

    OpenAIRE

    Kim, Sang Hyuck; Shin, Dong Wook; Kim, So Young; Yang, Hyung Kook; Nam, Eunjoo; Jho, Hyun Jung; Ahn, Eunmi; Cho, Be Long; Park, Keeho; Park, Jong-Hyock

    2015-01-01

    Purpose Many end-of-life care studies are based on the assumption that there is a shared definition of language concerning the stage of cancer. However, studies suggest that patients and their families often misperceive patients’ cancer stages and prognoses. Discrimination between advanced cancer and terminal cancer is important because the treatment goals are different. In this study, we evaluated the understanding of the definition of advanced versus terminal cancer of the general populatio...

  17. Anesthesia and Intensive care implications for pituitary surgery: Recent trends and advancements

    OpenAIRE

    Sukhminder Jit Singh Bajwa; Sukhwinder Kaur Bajwa

    2011-01-01

    The advancements in neuro-endocrine surgical interventions have been well supported by similar advancements in anesthesiology and intensive care. Surgery of the pituitary tumor poses unique challenges to the anesthesiologists and the intensivists as it involves the principles and practices of both endocrine and neurosurgical management. A multidisciplinary approach involving the endocrine surgeon, neurosurgeon, anesthesiologist, endocrinologist and intensivist is mandatory for a successful su...

  18. Tamoxifen compared to best supportive care in advanced hepatocelluar carcinoma: A retrospective matched-cohort study

    OpenAIRE

    Ahmed Abdelmabood Zeeneldin; Salem Mohamed Eid; Amira Diaa Darweesh; Manar Mohamed Moneer; Mohamed Saadeldin

    2014-01-01

    Background: Hepatocelluar carcinoma (HCC) is a common cancer worldwide as well as in Egypt with hepatitis B and C, alcohol and aflatoxins being the commonest risk factors. Tamoxifen was initially reported to confer a marginal survival benefit in advanced HCC. However, later reports declined any benefit. Objective: To study the impact of tamoxifen on overall survival (OS) compared to best supportive care (BSC) in Egyptian patients with advanced HCC. Methods: This retrospective matched-co...

  19. Plan of advanced satellite communication experiments using ETS-6

    Science.gov (United States)

    Ikegami, Tetsushi

    1989-01-01

    In 1992, an Engineering Test Satellite 6 is scheduled to be launched by an H-2 rocket. The missions of ETS-6 are to establish basic technologies of inter-satellite communications using S-band, millimeter waves and optical beams and of fixed and mobile satellite communications using multibeam antenna on board the satellite. A plan of the experiments is introduced.

  20. Symptom severity of patients with advanced cancer in palliative care unit: longitudinal assessments of symptoms improvement

    OpenAIRE

    Tai, Shu-Yu; Lee, Chung-Yin; Wu, Chien-Yi; Hsieh, Hui-ya; Huang, Joh-Jong; Huang, Chia-Tsuan; Chien, Chen-Yu

    2016-01-01

    Background This study assessed the symptom severity of patients with advanced cancer in a palliative care unit and explored the factors associated with symptom improvement. Methods This study was conducted in a palliative care unit in Taiwan between October 2004 and December 2009. Symptom intensity was measured by the “Symptom Reporting Form”, and graded on a scale of 0 to 4 (0 = none, and 4 = extreme). These measures were assessed on the 1st, 3rd, 5th, and 7th Day in the palliative care unit...

  1. Development of Advanced Multi-Modality Radiation Treatment Planning Software for Neutron Radiotherapy and Beyond

    Energy Technology Data Exchange (ETDEWEB)

    Nigg, D; Wessol, D; Wemple, C; Harkin, G; Hartmann-Siantar, C

    2002-08-20

    The Idaho National Engineering and Environmental Laboratory (INEEL) has long been active in development of advanced Monte-Carlo based computational dosimetry and treatment planning methods and software for advanced radiotherapy, with a particular focus on Neutron Capture Therapy (NCT) and, to a somewhat lesser extent, Fast-Neutron Therapy. The most recent INEEL software system of this type is known as SERA, Simulation Environment for Radiotherapy Applications. As a logical next step in the development of modern radiotherapy planning tools to support the most advanced research, INEEL and Lawrence Livermore National Laboratory (LLNL), the developers of the PEREGRTNE computational engine for radiotherapy treatment planning applications, have recently launched a new project to collaborate in the development of a ''next-generation'' multi-modality treatment planning software system that will be useful for all modern forms of radiotherapy.

  2. Advancement of remote technology: past perspectives and future plans

    International Nuclear Information System (INIS)

    In the Consolidated Fuel Reprocessing Program at the Oak Ridge National Laboratory, a comprehensive remote systems development program has existed for the past five years. The new remote technology under development is expected to significantly improve remote operations by extending the range of admissible remote tasks and increasing remote work efficiency. The motivation and justification for the program are discussed by surveying the 40 years of remote operating experience which exists and considering the essential features of various old and new philosophies which have been, or are being, used in remote engineering. A future direction based upon the Remotex concept is explained, and recent progress in the development of an advanced servomanipulator-based maintenance concept is summarized to show that a new generation of remote systems capability is feasible through advanced technology. 20 references, 10 figures, 1 table

  3. Advancement of remote systems technology: past perspectives and future plans

    International Nuclear Information System (INIS)

    In the Consolidated Fuel Reprocessing Program at the Oak Ridge National Laboratory, a comprehensive remote systems development program has existed for the past five years. The new remote technology under development is expected to significantly improve remote operations by extending the range of admissible remote tasks and increasing remote work efficiency. The motivation and justification for the program are discussed by surveying the 40 years of remote operating experience which exists and considering the essential features of various old and new philosophies which have been, or are being, used in remote engineering. A future direction based upon the Remotex concept is explained, and recent progress in the development of an advanced servomanipulator-based maintenance concept is summarized to show that a new generation of remote systems capability is feasible through advanced technology. 9 references, 5 figures

  4. Advancement of remote systems technology: past perspectives and future plans

    International Nuclear Information System (INIS)

    In the Consolidated Fuel Reprocessing Program at the Oak Ridge National Laboratory, a comprehensive remote systems development program has existed for the past five years. The new remote technology under development is expected to significantly improve remote operations by extending the range of admissible remote tasks and increasing remote work efficiency. The motivation and justification for the program are discussed by surveying the 40 years of remote operating experience which exists and considering the essential features of various old and new philosophies which have been, or are being, used in remote engineering. A future direction based upon the Remotex concept is explained, and recent progress in the development of an advanced servomanipulator-based maintenance concept is summarized to show that a new generation of remote systems capability is feasible through advanced technology. 20 references, 10 figures, 1 table

  5. Advancement of remote technology: past perspectives and future plans

    International Nuclear Information System (INIS)

    In the Consolidated Fuel Reprocessing Program at the Oak Ridge National Laboratory, a comprehensive remote systems development program has existed for the past five years. The new remote technology under development is expected to significantly improve remote operations by extending the range of admissible remote tasks and increasing remote work efficiency. The motivation and justification for the program are discussed by surveying the 40 years of remote operating experience which exists and considering the essential features of various old and new philosophies which have been, or are being, used in remote engineering. A future direction based upon the Remotex concept is explained, and recent progress in the development of an advanced servomanipulator-based maintenance concept is summarized to show that a new generation of remote systems capability is feasible through advanced technology. 20 references, 9 figures, 1 table

  6. Advancement of remote systems technology: past perspectives and future plans

    International Nuclear Information System (INIS)

    In the Fuel Recycle Division, Consolidated Fuel Reprocessing Program, at the Oak Ridge National Laboratory, a comprehensive remote systems development program has existed for the past five years. The new remote technology under development is expected to significantly improve remote operations by extending the range of admissible remote tasks and increasing remote work efficiency. The motivation and justification for the program are discussed by surveying the 40 years of remote operating experience which exists and considering the essential features of various old and new philosophies which have been, or are being, used in remote engineering. A future direction based upon the Teletec concept is explained, and recent progress in the development of an advanced servomanipulator-based maintenance concept is summarized to show that a new generation of remote systems capability is feasible through advanced technology. 20 references, 9 figures, 1 table

  7. Waste management planned for the advanced fuel cycle facility

    International Nuclear Information System (INIS)

    The U.S. Department of Energy (DOE) Global Nuclear Energy Partnership (GNEP) program has been proposed to develop and employ advanced technologies to increase the proliferation resistance of spent nuclear fuels, recover and reuse nuclear fuel resources, and reduce the amount of wastes requiring permanent geological disposal. In the initial GNEP fuel cycle concept, spent nuclear fuel is to be reprocessed to separate re-usable transuranic elements and uranium from waste fission products, for fabricating new fuel for fast reactors. The separated wastes would be converted to robust waste forms for disposal. The Advanced Fuel Cycle Facility (AFCF) is proposed by DOE for developing and demonstrating spent nuclear fuel recycling technologies and systems. The AFCF will include capabilities for receiving and reprocessing spent fuel and fabricating new nuclear fuel from the reprocessed spent fuel. Reprocessing and fuel fabrication activities will generate a variety of radioactive and mixed waste streams. Some of these waste streams are unique and unprecedented. The GNEP vision challenges traditional U.S. radioactive waste policies and regulations. Product and waste streams have been identified during conceptual design. Waste treatment technologies have been proposed based on the characteristics of the waste streams and the expected requirements for the final waste forms. Results of AFCF operations will advance new technologies that will contribute to safe and economical commercial spent fuel reprocessing facilities needed to meet the GNEP vision. As conceptual design work and research and design continues, the waste management strategies for the AFCF are expected to also evolve. (authors)

  8. Advanced type placement and geonames database: comprehensive coordination plan

    Energy Technology Data Exchange (ETDEWEB)

    Barnes, A.E.; Gough, E.C.; Brown, R.M.; Zied, A.

    1983-01-01

    This paper presents a preliminary comprehensive coordination plan for the technical development and integration of an automated names database capture and management of an overall automated cartographic system, for the Defense Mapping Agency. It broadly covers the technical issues associated with system and associated subsystems functional requirements, inter-subsystem interaction common technologies in hardware, software, database, and artificial intelligence. The 3-phase RandD cycles for each and all subsystems are also outlined.

  9. Business plan for a technologically advanced security company

    OpenAIRE

    García Bonet, Francisco

    2008-01-01

    The purpose of this project is the creation of a Business Plan for a security company. The project is divided into 6 chapters that conforms a solid study containing the most important points in the creation of a new company. In order to achieve these objectives each chapter has its own subject. The first chapter constrains the business activity sector, its profile and the services offered by the company. The second chapter presents a selection of products in order to accomplish the different ...

  10. Bridging knowledge to develop an action plan for integrated care for chronic diseases in Greece.

    Science.gov (United States)

    Tsiachristas, Apostolos; Lionis, Christos; Yfantopoulos, John

    2015-01-01

    The health, social and economic impact of chronic diseases is well documented in Europe. However, chronic diseases threaten relatively more the 'memorandum and peripheral' Eurozone countries (i.e., Greece, Spain, Portugal and Ireland), which were under heavy recession after the economic crisis in 2009. Especially in Greece, where the crisis was the most severe across Europe, the austerity measures affected mainly people with chronic diseases. As a result, the urgency to tackle the threat of chronic diseases in Greece by promoting public health and providing effective chronic care while flattening the rising health care expenditure is eminent. In many European countries, integrated care is seen as a means to achieve this. The aim of this paper was to support Greek health policy makers to develop an action plan from 2015 onwards, to integrate care by bridging local policy context and needs with knowledge and experience from other European countries. To achieve this aim, we adopted a conceptual framework developed by the World Health Organization on one hand to analyse the status of integrated care in Greece, and on the other to develop an action plan for reform. The action plan was based on an analysis of the Greek health care system regarding prerequisite conditions to integrate care, a clear understanding of its context and successful examples of integrated care from other European countries. This study showed that chronic diseases are poorly addressed in Greece and integrated care is in embryonic stage. Greek policy makers have to realise that this is the opportunity to make substantial reforms in chronic care. Failing to reform towards integrated care would lead to the significant risk of collapse of the Greek health care system with all associated negative consequences. The action plan provided in this paper could support policy makers to make the first serious step to face this challenge. The details and specifications of the action plan can only be decided by

  11. Bridging knowledge to develop an action plan for integrated care for chronic diseases in Greece

    Directory of Open Access Journals (Sweden)

    Apostolos Tsiachristas

    2015-10-01

    Full Text Available The health, social and economic impact of chronic diseases is well documented in Europe. However, chronic diseases threaten relatively more the ‘memorandum and peripheral’ Eurozone countries (i.e., Greece, Spain, Portugal and Ireland, which were under heavy recession after the economic crisis in 2009. Especially in Greece, where the crisis was the most severe across Europe, the austerity measures affected mainly people with chronic diseases. As a result, the urgency to tackle the threat of chronic diseases in Greece by promoting public health and providing effective chronic care while flattening the rising health care expenditure is eminent. In many European countries, integrated care is seen as a means to achieve this.The aim of this paper was to support Greek health policy makers to develop an action plan from 2015 onwards, to integrate care by bridging local policy context and needs with knowledge and experience from other European countries. To achieve this aim, we adopted a conceptual framework developed by the World Health Organization on one hand to analyse the status of integrated care in Greece, and on the other to develop an action plan for reform. The action plan was based on an analysis of the Greek health care system regarding prerequisite conditions to integrate care, a clear understanding of its context and successful examples of integrated care from other European countries. This study showed that chronic diseases are poorly addressed in Greece and integrated care is in embryonic stage.Greek policy makers have to realise that this is the opportunity to make substantial reforms in chronic care. Failing to reform towards integrated care would lead to the significant risk of collapse of the Greek health care system with all associated negative consequences. The action plan provided in this paper could support policy makers to make the first serious step to face this challenge. The details and specifications of the action plan

  12. Planning the Marketing Activity in the Health Care Services

    OpenAIRE

    Violeta Radulescu; Iuliana Cetina; Gheorghe Orzan

    2008-01-01

    The integration of marketing in the field of health care, starting with the 50’s, was accompanied by a series of controversies generated by the ethical and moral aspects that this type of services imply, as well as by the difficulty in determining exactly the demand, the unequal access to information of participants, the regulated mechanism for the establishment of prices and of rates and the intervention of the third party payer, the significant role of the state in ensuring the fair access ...

  13. Structure and Function: Planning a New Intensive Care Unit to Optimize Patient Care

    Directory of Open Access Journals (Sweden)

    Jozef Kesecioğlu

    2014-08-01

    Full Text Available To survey the recent medical literature reporting effects of intensive care unit (ICU design on patients’ and family members’ well-being, safety and functionality. Features of ICU design linked to the needs of patients and their family are single-rooms, privacy, quiet surrounding, exposure to daylight, views of nature, prevention of infection, a family area and open visiting hours. Other features such as safety, working procedures, ergonomics and logistics have a direct impact on the patient care and the nursing and medical personnel. An organization structured on the needs of the patient and their family is mandatory in designing a new intensive care. The main aims in the design of a new department should be patient centered care, safety, functionality, innovation and a future-proof concept.

  14. Analyzing HEAT of Lesson Plans in Pre-Service and Advanced Teacher Education

    Directory of Open Access Journals (Sweden)

    Margaret Maxwell

    2011-05-01

    Full Text Available Higher-order thinking, Engagement, Authenticity, and Technology integration combine to form HEAT to boost the rigor of a lesson plan to impact K-12 student learning. This preliminary study examines both pre-service and advanced teachers’ lesson plans to determine the level in each of the HEAT components. Through this study an instrument has been revised and refined using previous research of HEAT. The researchers assessed the current HEAT level of lesson plans at both the undergraduate and graduate levels. The findings show a difference in HEAT performance of the pre-service and advanced teachers’ lesson plans; however, Higher-order thinking was the highest component of performance for both groups’ lesson plans. In this preliminary study, Technology was found to be the strongest predictor of overall HEAT performance.

  15. Advanced Simulation and Computing FY17 Implementation Plan, Version 0

    Energy Technology Data Exchange (ETDEWEB)

    McCoy, Michel [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Archer, Bill [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Hendrickson, Bruce [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Wade, Doug [National Nuclear Security Administration (NNSA), Washington, DC (United States). Office of Advanced Simulation and Computing and Institutional Research and Development; Hoang, Thuc [National Nuclear Security Administration (NNSA), Washington, DC (United States). Computational Systems and Software Environment

    2016-08-29

    The Stockpile Stewardship Program (SSP) is an integrated technical program for maintaining the safety, surety, and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational capabilities to support these programs. The Advanced Simulation and Computing Program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computational resources that support annual stockpile assessment and certification, study advanced nuclear weapons design and manufacturing processes, analyze accident scenarios and weapons aging, and provide the tools to enable stockpile Life Extension Programs (LEPs) and the resolution of Significant Finding Investigations (SFIs). This requires a balance of resource, including technical staff, hardware, simulation software, and computer science solutions. ASC is now focused on increasing predictive capabilities in a three-dimensional (3D) simulation environment while maintaining support to the SSP. The program continues to improve its unique tools for solving progressively more difficult stockpile problems (sufficient resolution, dimensionality, and scientific details), and quantifying critical margins and uncertainties. Resolving each issue requires increasingly difficult analyses because the aging process has progressively moved the stockpile further away from the original test base. Where possible, the program also enables the use of high performance computing (HPC) and simulation tools to address broader national security needs, such as foreign nuclear weapon assessments and counter nuclear terrorism.

  16. Web-based collaboration in individual care planning challenges the user and the provider roles – toward a power transition in caring relationships

    Directory of Open Access Journals (Sweden)

    Bjerkan J

    2014-12-01

    Full Text Available Jorunn Bjerkan,1,2 Solfrid Vatne,3 Anne Hollingen4 1Norwegian Research Centre for Electronic Health Records (EHR, Medical Faculty, Norwegian University of Science and Technology, Trondheim, 2Faculty of Health Science, Nord-Trøndelag University College, Levanger, 3Faculty of Health Science, Molde University College, 4Møre og Romsdal Hospital Trust, Molde, Norway Background and objective: The Individual Care Plan (ICP was introduced in Norway to meet new statutory requirements for user participation in health care planning, incorporating multidisciplinary and cross-sector collaboration. A web-based solution (electronic ICP [e-ICP] was used to support the planning and documentation. The aim of this study was to investigate how web-based collaboration challenged user and professional roles. Methods: Data were obtained from 15 semistructured interviews with users and eight with care professionals, and from two focus-group interviews with eight care professionals in total. The data were analyzed using systematic text condensation in a stepwise analysis model. Results: Users and care professionals took either a proactive or a reluctant role in e-ICP collaboration. Where both user and care professionals were proactive, the pairing helped to ensure that the planning worked well; so did pairings of proactive care professionals and reluctant users. Proactive users paired with reluctant care professionals also made care planning work, thanks to the availability of information and the users' own capacity or willingness to conduct the planning. Where both parties were reluctant, no planning activities occurred. Conclusion: Use of the e-ICP challenged the user–professional relationship. In some cases, a power transition took place in the care process, which led to patient empowerment. This knowledge might be used to develop a new understanding of how role function can be challenged when users and care professionals have equal access to health care

  17. PLAN FOR PRIMARY HEALTH CARE IN MINAS GERAIS AND SCIENTIFIC PRODUCTION

    Directory of Open Access Journals (Sweden)

    Tatiana Oliveira Silva Bittencourt

    2014-05-01

    Full Text Available This study aimed to identify studies on the Master Plan for Primary Health Care from the year 2003. We conducted a bibliographic study on MEDLINE, LILACS, SCIELO , BDENF and Google Scholar . The results are detailed in tables and discussed from four themes. The Master Plan for Primary Health Care is an innovative and daring in the reorganization of primary care in the municipalities miners. Gave the participants an important opportunity for professional qualification. Difficulties in its implementation outperformed the potential and were present in most of the municipalities surveyed. Among the main challenges for its implementation highlights the lack of professional motivation and credibility by some involved in this process. The literature made little progress on this issue , and we hope that further research be undertaken in order to contribute to studies of evaluation of public policies and in particular the extension and consolidation of this plan.

  18. Development and Implementation of the Advanced Practice Nurse Worldwide With an Interest in Geriatric Care.

    Science.gov (United States)

    Fougère, Bertrand; Morley, John E; Decavel, Frédérique; Nourhashémi, Fati; Abele, Patricia; Resnick, Barbara; Rantz, Marilyn; Lai, Claudia Kam Yuk; Moyle, Wendy; Pédra, Maryse; Chicoulaa, Bruno; Escourrou, Emile; Oustric, Stéphane; Vellas, Bruno

    2016-09-01

    Many countries are seeking to improve health care delivery by reviewing the roles of health professionals, including nurses. Developing new and more advanced roles for nurses could improve access to care in the face of a limited or diminishing supply of doctors and growing health care demand. The development of new nursing roles varies greatly from country to country. The United States and Canada established "nurse practitioners" (NPs) in the mid-1960s. The United Kingdom and Finland also have a long experience in using different forms of collaboration between doctors and nurses. In other countries, such as Australia, NPs were endorsed more recently in 2000. In France, Belgium, or Singapore, the formal recognition of advanced practice nurses is still in its infancy, whereas in other countries, such as Japan or China, advanced practice nurses are not licensed titles. The aims of this article were to define precisely what is meant by the term "advanced practice nurse (APN)," describe the state of development of APN roles, and review the main factors motivating the implementation of APN in different countries. Then, we examine the main factors that have hindered the development of APN roles. Finally, we explain the need for advanced practice roles in geriatrics. PMID:27321868

  19. [Hospital-based advanced home-care, models from Ekenäs, Finland].

    Science.gov (United States)

    Wikström, U; Weibull, H; Klockars, M

    1998-12-01

    In 1995, advanced home treatment services were introduced at Västra Nyland district hospital in Finland. For selected patients the new services constitute an alternative where hospitalisation would otherwise be necessary. Some of the hospital bed resources were moved to the patients' homes together with a trained team with immediate responsibility for the patients and providing 24-hour care, backed up by access to hospital resources in terms of specialised knowledge and sophisticated technology. Two years' experience of 500 patients so treated showed their diseases to have represented the complete spectrum of specialists fields. The most common diagnoses were oncological and infectious diseases. Although preliminary assessment suggests advanced home care to be a cheaper alternative than hospitalised care, the preeminent advantage from the patients' point of view was improved quality of life. PMID:9894412

  20. Educating advanced level practice within complex health care workplace environments through transformational practice development.

    Science.gov (United States)

    Hardy, Sally; Jackson, Carrie; Webster, Jonathan; Manley, Kim

    2013-10-01

    Over the past 20 years health care reform has influenced the development of advanced level practitioner roles and expectations. How advanced level practitioners work to survive the highly stimulating, yet sometimes overwhelming aspects of balancing high quality provision with political reform agendas, amidst economic constraint is considered. Transformational approaches (encompassing education and practice led service development) can provide, promote and 'provoke' a harnessing of complex issues workplace environment to produce creative solutions. Transformational Practice Development provides a structured, rigorous, systematic approach that practitioners, teams and health care consumers alike can utilise to achieve skills and attributes needed for successful innovation. The authors present case study materials from action orientated locally delivered Practice Development, as a complex strategic intervention approach to influence and promote advanced level practice expertise. Initiated through facilitation of transformational leadership, and resultant team based improvements, we present how strategic collaborative processes can harness work chaos and complexity to provide sustainable and productive workplace cultures of effectiveness. PMID:23453607

  1. Delphi study into planning for care of children in major incidents

    OpenAIRE

    Carley, S; Mackway-Jones, K; Donnan, S

    1999-01-01

    This paper describes a Delphi study used to identify and improve areas of concern in the planning of care for children in major incidents. The Delphi was conducted over three rounds and used a multidisciplinary panel of 22 experts. Experts were selected to include major incident, immediate care, emergency medicine, and paediatric specialists. This paper presents a series of consensus statements that represent the Delphi group's opinion on the management of children in maj...

  2. Improving Olympic health services: what are the common health care planning issues?

    OpenAIRE

    Kononovas, K.; Black, G.; Taylor, J; Raine, R

    2014-01-01

    INTRODUCTION: Due to their scale, the Olympic and Paralympic Games have the potential to place significant strain on local health services. The Sydney 2000, Athens 2004, Beijing 2008, Vancouver 2010, and London 2012 Olympic host cities shared their experiences by publishing reports describing health care arrangements. HYPOTHESIS: Olympic planning reports were compared to highlight best practices, to understand whether and which lessons are transferable, and to identify recurring health care p...

  3. Using machine learning algorithms to guide rehabilitation planning for home care clients

    OpenAIRE

    Hirdes John P; Zhang Zhanyang; Zhu Mu; Stolee Paul

    2007-01-01

    Abstract Background Targeting older clients for rehabilitation is a clinical challenge and a research priority. We investigate the potential of machine learning algorithms – Support Vector Machine (SVM) and K-Nearest Neighbors (KNN) – to guide rehabilitation planning for home care clients. Methods This study is a secondary analysis of data on 24,724 longer-term clients from eight home care programs in Ontario. Data were collected with the RAI-HC assessment system, in which the Activities of D...

  4. Mini Review of Integrated Care and Implications for Advanced Practice Nurse Role

    Science.gov (United States)

    McIntosh, Diana; Startsman, Laura F.; Perraud, Suzanne

    2016-01-01

    Literature related to primary care and behavioral health integration initiatives is becoming abundant. The United States’ 2010 Patient Protection and Affordable Care Act included provisions encouraging increased collaboration of care for individuals with behavioral and physical health service needs in the public sector. There is relatively little known of Advanced Practice Registered Nurses’ (APRNs) roles with integrating primary and behavioral healthcare. The goal of this review article is to: (a) define integration of physical and behavioral healthcare and potential models; (b) answer the question as to what are effective evidence based models/strategies for integrating behavioral health and primary care; (c) explore the future role and innovations of APRNs in the integration of physical and behavioral healthcare. Results: The evidence- based literature is limited to three systematic reviews and six randomized controlled trials. It was difficult to generalize the data and the effective integration strategies varied from such interventions as care management to use of sertraline to depression management and to access. There were, though, implications for the integrated care advanced practice nurse to have roles inclusive of competencies, leadership, engagement, collaboration and advocacy. PMID:27347258

  5. Advanced practice nursing, health care teams, and perceptions of team effectiveness.

    Science.gov (United States)

    Kilpatrick, Kelley; Lavoie-Tremblay, Mélanie; Ritchie, Judith A; Lamothe, Lise

    2014-01-01

    This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care team's perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families. PMID:25397338

  6. Treatment planning for Hodgkin's Disease: a patterns of care study

    International Nuclear Information System (INIS)

    Purpose: To conduct a survey of the process of treatment planning for the radiation treatment of Hodgkin's Disease in the United States, and to compare survey results with consensus guidelines as determined by recognized experts. Methods and Materials: A consensus committee developed guidelines for the radiotherapeutic management of Hodgkin's Disease. A series of survey forms were designed to evaluate the standards of practice and compare these with the consensus guidelines. A total of 61 facilities divided evenly into the strata of academic, hospital based, and free standing had eligible Hodgkin's Disease cases. There were 275 eligible cases of Hodgkin's Disease evaluated. Data collected from the radiation oncology records included treatment-specific parameters such as energy, dose, blocking, and calculations, as well as treatment planning practices. Statistical analysis was performed on each data element and for all institution strata. Results: For a number of treatment parameters, there were some discrepancies noted between the current United States practice and the consensus guidelines. Some significant differences were found in practice between the stratified institution types. A representative sample of results are: the majority of Hodgkin's Disease patients are treated with x-ray energies in the recommended range, between 4 and 10 MV. Standard mantle (for upper extended field treatment) and modified spade (for lower extended field treatments) are the fields of choice for all types of facilities. The consensus guidelines recommended that dose calculations at multiple points be obtained; however, 15% of patients in the survey received only a single point calculation. Current irregular field dosimetry calculation software does not take account of inhomogeneities. Thirty percent of Hodgkin's Disease patients do not receive a gap calculation for the abutment of upper and lower extended fields. In 70% of treatment fields, no compensation is used. Very few patients

  7. Plan of advanced satellite communications experiment using ETS-VI

    Science.gov (United States)

    Shiomi, Tadashi

    1988-01-01

    Communications Research Laboratory (CRL, Ministry of Posts and Telecommunications, Japan) has been engaged in development of three advanced satellite communication payloads aiming at experiments by Japan's 2-ton class Engineering Test Satellite VI (ETS-VI) which is to be launched in H-II rocket by NASDA in August 1992. CRL's three experimental systems are: (1) S-band inter-satellite communications; (2) millimeter-wave inter-satellite and personal-satellite communications; and (3) optical inter-satellite communications. CRL develops experimental optical communication system with telescope of 75 mm diameter which has gimbal mirror beam pointing/tracking mechanism. The onboard system has fundamental optical communication functions with laser diode transmitter of wavelength 0.83 micron, laser beam point-ahead mechanism, receiver of wavelength 0.51 micron, modulation/demodulation subsystem, and so on.

  8. The advanced neutron source research and development plan

    Energy Technology Data Exchange (ETDEWEB)

    Selby, D.L.

    1995-08-01

    The Advanced Neutron Source (ANS) is being designed as a user-oriented neutron research laboratory centered around the most intense continuous beams of thermal and subthermal neutrons in the world (an order of magnitude more intense than beams available from the most advanced existing reactors). The ANS will be built around a new research reactor of 330-MW fission power, producing an unprecedented peak thermal flux of >7 {center_dot} 10{sup 19} {center_dot} m{sup -2} {center_dot} s{sup -1}. Primarily a research facility, the ANS will accommodate more than 1000 academic, industrial, and government researchers each year. They will conduct basic research in all branches of science as well as applied research leading to better understanding of new materials, including high temperature super conductors, plastics, and thin films. Some 48 neutron beam stations will be set up in the ANS beam rooms and the neutron guide hall for neutron scattering and for fundamental and nuclear physics research. There also will be extensive facilities for materials irradiation, isotope production, and analytical chemistry. The top level work breakdown structure (WBS) for the project. As noted in this figure, one component of the project is a research and development (R&D) program (WBS 1.1). This program interfaces with all of the other project level two WBS activities. Because one of the project guidelines is to meet minimum performance goals without relying on new inventions, this R&D activity is not intended to produce new concepts to allow the project to meet minimum performance goals. Instead, the R&D program will focus on the four objectives described.

  9. The advanced neutron source research and development plan

    International Nuclear Information System (INIS)

    The Advanced Neutron Source (ANS) is being designed as a user-oriented neutron research laboratory centered around the most intense continuous beams of thermal and subthermal neutrons in the world (an order of magnitude more intense than beams available from the most advanced existing reactors). The ANS will be built around a new research reactor of 330-MW fission power, producing an unprecedented peak thermal flux of >7 · 1019 · m-2 · s-1. Primarily a research facility, the ANS will accommodate more than 1000 academic, industrial, and government researchers each year. They will conduct basic research in all branches of science as well as applied research leading to better understanding of new materials, including high temperature super conductors, plastics, and thin films. Some 48 neutron beam stations will be set up in the ANS beam rooms and the neutron guide hall for neutron scattering and for fundamental and nuclear physics research. There also will be extensive facilities for materials irradiation, isotope production, and analytical chemistry. The top level work breakdown structure (WBS) for the project. As noted in this figure, one component of the project is a research and development (R ampersand D) program (WBS 1.1). This program interfaces with all of the other project level two WBS activities. Because one of the project guidelines is to meet minimum performance goals without relying on new inventions, this R ampersand D activity is not intended to produce new concepts to allow the project to meet minimum performance goals. Instead, the R ampersand D program will focus on the four objectives described

  10. Reforming primary care in England--again. Plans for improving the quality of care.

    Science.gov (United States)

    Baker, R

    2000-06-01

    An extensive programme of health service reform has begun in England. Improvement in the quality of care is a key objective of the reforms, and several initiatives are being introduced in response. These include systems to provide national guidance about appropriate treatment and services, a local system to support quality improvement and arrangements to monitor performance, including a new performance framework, an inspection agency and an annual survey of patients. The local quality improvement system has features of particular interest. These include arrangements for setting objectives for quality improvement, the use of various quality improvement methods tailored to local needs and a new system to provide accountability to both the health service and the public. The introduction of clinical governance and all the other reforms presents primary care practitioners with a major challenge. However, if sufficient time is allowed and adequate resources are made available, the reforms do have the potential to improve health care in England. PMID:10944059

  11. US-RERTR advanced fuel development plans: 1999

    International Nuclear Information System (INIS)

    Twelve fuel alloys were included in the very-high-density RERTR-1 and RERTR-2 microplate irradiation experiments. Experience gained fabrication and results from the post-irradiation examination of these fuels has allowed us to narrow the focus of our fuel development efforts in preparation for the next set of irradiation experiments. Specific technical problems in both the areas of fuel fabrication and irradiation performance remain to be addressed. Examples of these are powder fabrication, fuel phase gamma stability versus density, and fuel-matrix interaction. In order to more efficiently address metal alloy fuel performance issues work will continue on establishing a theoretical basis for alloy dispersion fuel irradiation performance. Plans to address these fuel development issues in the coming year be presented. (author)

  12. Advanced Seismic Probabilistic Risk Assessment Demonstration Project Plan

    Energy Technology Data Exchange (ETDEWEB)

    Justin Coleman

    2014-09-01

    Idaho National Laboratories (INL) has an ongoing research and development (R&D) project to remove excess conservatism from seismic probabilistic risk assessments (SPRA) calculations. These risk calculations should focus on providing best estimate results, and associated insights, for evaluation and decision-making. This report presents a plan for improving our current traditional SPRA process using a seismic event recorded at a nuclear power plant site, with known outcomes, to improve the decision making process. SPRAs are intended to provide best estimates of the various combinations of structural and equipment failures that can lead to a seismic induced core damage event. However, in general this approach has been conservative, and potentially masks other important events (for instance, it was not the seismic motions that caused the Fukushima core melt events, but the tsunami ingress into the facility).

  13. Developing Navigation Competencies to Care for Older Rural Adults with Advanced Illness.

    Science.gov (United States)

    Duggleby, Wendy; Robinson, Carole A; Kaasalainen, Sharon; Pesut, Barbara; Nekolaichuk, Cheryl; MacLeod, Roderick; Keating, Norah C; Santos Salas, Anna; Hallstrom, Lars K; Fraser, Kimberly D; Williams, Allison; Struthers-Montford, Kelly; Swindle, Jennifer

    2016-06-01

    Navigators help rural older adults with advanced illness and their families connect to needed resources, information, and people to improve their quality of life. This article describes the process used to engage experts - in rural aging, rural palliative care, and navigation - as well as rural community stakeholders to develop a conceptual definition of navigation and delineate navigation competencies for the care of this population. A discussion paper on the important considerations for navigation in this population was developed followed by a four-phased Delphi process with 30 expert panel members. Study results culminated in five general navigation competencies for health care providers caring for older rural persons and their families at end of life: provide patient/family screening; advocate for the patient/family; facilitate community connections; coordinate access to services and resources; and promote active engagement. Specific competencies were also developed. These competencies provide the foundation for research and curriculum development in navigation. PMID:27093177

  14. Commentary: Personalized health planning and the Patient Protection and Affordable Care Act: an opportunity for academic medicine to lead health care reform.

    Science.gov (United States)

    Dinan, Michaela A; Simmons, Leigh Ann; Snyderman, Ralph

    2010-11-01

    The Patient Protection and Affordable Care Act of 2010 (PPACA) mandates the exploration of new approaches to coordinated health care delivery--such as patient-centered medical homes, accountable care organizations, and disease management programs--in which reimbursement is aligned with desired outcomes. PPACA does not, however, delineate a standardized approach to improve the delivery process or a specific means to quantify performance for value-based reimbursement; these details are left to administrative agencies to develop and implement. The authors propose that coordinated care can be implemented more effectively and performance quantified more accurately by using personalized health planning, which employs individualized strategic health planning and care relevant to the patient's specific needs. Personalized health plans, developed by providers in collaboration with their patients, quantify patients' health and health risks over time, identify strategies to mitigate risks and/or treat disease, deliver personalized care, engage patients in their care, and measure outcomes. Personalized health planning is a core clinical process that can standardize coordinated care approaches while providing the data needed for performance-based reimbursement. The authors argue that academic health centers have a significant opportunity to lead true health care reform by adopting personalized health planning to coordinate care delivery while conducting the research and education necessary to enable its broad clinical application. PMID:20844424

  15. Designing an Operational Planning Model for Level-one Iranian Primary Health Care Systems

    Directory of Open Access Journals (Sweden)

    Amir-Ashkan Nasiripour

    2008-01-01

    Full Text Available Introduction: This research was performed in 2008 in order to design an operational planning model for Iranian primary health care systems at level one. Methods: In this applied study, which was done in a descriptive and cross-sectional manner, some countries and international organizations which had comprehensive planning systems and some local organizations were studied. The required data from the selected countries were collected through data collection forms, and for local organizations, the data were collected through interview, and the initial model was presented accordingly. The model was tested via Delphi technique and taking the authorities’ views into account, the required changes were made and the ultimate model was prepared. Results: All the studied overseas and indigenous organizations had programming systems. However, none of the level-one Iranian primary health care units had a coherent planning system, and they did not follow any specific models. Since 2008, the model of operational planning has also been utilized by Iranian Ministry of Health, Care and Medical Education at headquarters levels; however, there was no model at lower levels especially in rural and urban health care centers. In all selected countries, the model of programs included title, objectives or expected results, schedule, activities, budget system and evaluation and monitoring indexes. Though these parts existed in the common models in Iran, no scientific basis could be observed in compiling the operational programs. The mechanism of designing the initial suggested operational planning had eight stages, but after three stages of reviewing by authorities, seven stages were ratified. Conclusion: Utilizing the suggested operational planning model can enhance the level-one performance indicators of health care networks in Iran

  16. IMRT, IGRT, SBRT - Advances in the Treatment Planning and Delivery of Radiotherapy

    CERN Document Server

    Meyer, JL

    2011-01-01

    Over the last 4 years, IMRT, IGRT, SBRT: Advances in the Treatment Planning and Delivery of Radiotherapy has become a standard reference in the field. During this time, however, significant progress in high-precision technologies for the planning and delivery of radiotherapy in cancer treatment has called for a second edition to include these new developments. Thoroughly updated and extended, this new edition offers a comprehensive guide and overview of these new technologies and the many clinical treatment programs that bring them into practical use. Advances in intensity-modulated radiothera

  17. NRC staff preliminary analysis of public comments on advance notice of proposed rulemaking on emergency planning

    International Nuclear Information System (INIS)

    The Nuclear Regulatory Commission (NRC) published an advance notice of proposed rulemaking on emergency planning on July 17, 1979 (44 FR 41483). In October and November 1979, the NRC staff submitted several papers to the Commission related to the emergency planning rulemaking. One of these papers was a preliminary analysis of public comments received on the advance notice (SECY-79-591B, November 13, 1979). This document consists of the preliminary analysis as it was submitted to the Commission, with minor editorial changes

  18. Social workers' roles in addressing the complex end-of-life care needs of elders with advanced chronic disease.

    Science.gov (United States)

    Kramer, Betty J

    2013-01-01

    This study examined social workers' roles in caring for low-income elders with advanced chronic disease in an innovative, community-based managed care program, from the perspective of elders, family, team members, and social workers. The results are drawn from a larger longitudinal, multimethod case study. Sources of data include survey reports of needs addressed by social workers for 120 deceased elders, five focus groups with interdisciplinary team members, and in-depth interviews with 14 elders and 10 of their family caregivers. A thematic conceptual matrix was developed to detail 32 distinctive social work roles that address divergent needs of elders, family, and team members. Distinctive perceptions of social workers' roles were identified for the different stakeholder groups (i.e., elders, family caregivers, team members, and social workers). Findings from this study may inform supervisors and educators regarding training needs of those preparing to enter the rapidly growing workforce of gerontological social workers who may be called upon to care for elders at the end of life. Training is particularly warranted to help social workers gain the skills needed to more successfully treat symptom management, depression, anxiety, agitation, grief, funeral planning, and spiritual needs that are common to the end of life. PMID:24295099

  19. Timely identification of palliative patients and anticipatory care planning by GPs: practical application of tools and a training programme

    OpenAIRE

    Thoonsen, Bregje; Groot, Marieke; Verhagen, Stans; van Weel, Chris; Vissers, Kris; Engels, Yvonne

    2016-01-01

    Background Palliative care is mainly restricted to terminal care. General practitioners (GPs) are not trained to early identify palliative patients with cancer, COPD or heart failure. With the help of the RADboud indicators for PAlliative Care needs (RADPAC), we trained GPs to identify patients’ needs and to make a proactive care plan. They were also able to join two role-plays where they discussed the patient’s future, and consulted a palliative care consultant to fine-tune the care plan. We...

  20. Coping with an Advanced Stage Lung Cancer Diagnosis: Patient, Caregiver, and Provider Perspectives on the Role of the Health Care System.

    Science.gov (United States)

    Islam, K M; Opoku, Samuel T; Apenteng, Bettye A; Fetrick, Ann; Ryan, June; Copur, M; Tolentino, Addison; Vaziri, Irfan; Ganti, Apar K

    2016-09-01

    Although lung cancer is the leading cause of cancer death in the USA, there have been few studies on patient-centered advanced lung cancer treatment practices. As part of a larger research study on how to use a patient-inclusive approach in late-stage lung cancer treatment, this present study describes patient, caregiver, and provider perspectives on the role of the health care system in helping patients cope with an advanced stage lung cancer diagnosis. Four focus group sessions were conducted with six to eleven participants per group for a total of 36 participants. Two focus groups were held with patients and family members/caregivers and two with physicians and nurses. A major theme that emerged concerned coping with an advanced lung cancer diagnosis, which is the subject of this paper. The patients, caregivers, and providers spoke passionately about interactions with the health care system and volunteered examples of supportive and non-supportive relationships between patients and clinicians. They advocated for better patient-provider communication practices as well as the expanded use of patient navigation and new patient orientation programs. This study contributes additional knowledge by including the perspectives of caregivers and providers who live and work closely with patients with advanced lung cancer. The findings can inform the development of comprehensive patient-centered care plans for patients living with an advanced lung cancer diagnosis. PMID:25900672

  1. Succession planning for advanced nursing practice; contingency or continuity? The Scottish experience

    OpenAIRE

    Currie, Kay

    2010-01-01

    Kay CurrieDepartment of Adult Nursing and Health, Glasgow Caledonian University, Glasgow, Scotland, UKAim: Succession planning involves identifying key posts within an organization and supporting the ongoing development of individuals ready to move into these roles, thus ensuring continuity of the service. This paper presents an analysis of the succession planning process and illustrates the ways in which key principles may by applied in the case of advanced nursing practice.Background: An ar...

  2. The Advanced Neutron Source research and development plan

    International Nuclear Information System (INIS)

    The Advanced Neutron Source (ANS) is being designed as a user-oriented neutron research laboratory centered around the most intense continuous beams of thermal and subthermal neutrons in the world. The ANS will be built around a new research reactor of ∼ 330 MW fission power, producing an unprecedented peak thermal flux of > 7 x 1019 M-2 · S-1. Primarily a research facility, the ANS will accommodate more than 1000 academic, industrial, and government researchers each year. They will conduct basic research in all branches of science-as well as applied research-leading to better understanding of new materials, including high temperature super conductors, plastics, and thin films. Some 48 neutron beam stations will be set up in the ANS beam rooms and the neutron guide hall for neutron scattering and for fundamental and nuclear physics research. There also will be extensive facilities for materials irradiation, isotope production, and analytical chemistry. The R ampersand D program will focus on the four objectives: Address feasibility issues; provide analysis support; evaluate options for improvement in performance beyond minimum requirements; and provide prototype demonstrations for unique facilities. The remainder of this report presents (1) the process by which the R ampersand D activities are controlled and (2) a discussion of the individual tasks that have been identified for the R ampersand D program, including their justification, schedule and costs. The activities discussed in this report will be performed by Martin Marietta Energy Systems, Inc. (MMES) through the Oak Ridge National Laboratory (ORNL) and through subcontracts with industry, universities, and other national laboratories. It should be noted that in general a success path has been assumed for all tasks

  3. Designing a hosting area as an advanced nursing care strategy in a pediatric nursing ward

    Directory of Open Access Journals (Sweden)

    Paola Pino A.

    2013-06-01

    Full Text Available Background: The most important comfort needs for caregivers are related to improving their hospital stay conditions, with more comfortable waiting rooms, a place to sleep, a toilette with shower, food and a safe place where to leave their belongings. Objective: To implement a hosting area that meets the comfort needs of parents who do not have their own accommodations during the hospitalization of their children. Methodology: Innovative strategies in providing advanced nursing care based on the theoretical model of Kolcaba, which allows us to bring the discipline of nursing care into practice, in direct benefit of patients. Results: We expect an increase in comfort perception of parents during hospitalization, which will lead to increased alertness of parents, effective participation in child care, improved response to educational interventions and effective linkages with the caring team. Conclusions: A hosting area for parents of hospitalized children, designed to meet the most important comfort needs reported in the literature and contextualized according to Kolcaba’s theory, can contribute to implement advanced nursing care, recovering the essence of nursing at the Pediatrics Service of the UC Hospital.

  4. Advanced Materials Development Program: Ceramic Technology for Advanced Heat Engines program plan, 1983--1993

    Energy Technology Data Exchange (ETDEWEB)

    1990-07-01

    The purpose of the Ceramic Technology for Advanced Heat Engines (CTAHE) Project is the development of an industrial technology base capable of providing reliable and cost-effective high temperature ceramic components for application in advanced heat engines. There is a deliberate emphasis on industrial'' in the purpose statement. The project is intended to support the US ceramic and engine industries by providing the needed ceramic materials technology. The heat engine programs have goals of component development and proof-of-concept. The CTAHE Project is aimed at developing generic basic ceramic technology and does not involve specific engine designs and components. The materials research and development efforts in the CTAHE Project are focused on the needs and general requirements of the advanced gas turbine and low heat rejection diesel engines. The CTAHE Project supports the DOE Office of Transportation Systems' heat engine programs, Advanced Turbine Technology Applications (ATTAP) and Heavy Duty Transport (HDT) by providing the basic technology required for development of reliable and cost-effective ceramic components. The heat engine programs provide the iterative component design, fabrication, and test development logic. 103 refs., 18 figs., 11 tabs.

  5. STARPAHC - Operational findings. [Space Technology Applied to Rural Papago Advanced Health Care

    Science.gov (United States)

    Belasco, N.; Pool, S. L.

    1976-01-01

    Delivery of quality health care to passengers of extended-mission spacecraft and to remote populations on earth (a major national problem) requires extending the knowledge and skills of the physician many kilometers distant from his physical location. The STARPAHC telemedicine system accomplishes this by using physician's assistants complemented with space technology in communications, data handling, and systems engineering. It is presently in operation and undergoing a 2-year evaluation on the Papago Indian Reservation, Arizona. Results have established its feasibility as a solution for remote area health care on earth, while providing information useful to the planners of advanced manned spacecraft missions.

  6. Family participation in care plan meetings : Promoting a collaborative organizational culture in nursing homes

    NARCIS (Netherlands)

    Dijkstra, Ate

    2007-01-01

    In this study, the author evaluated a project in The Netherlands that aimed to promote family members' participation in care plan meetings at a psychogeriatric nursing home. The small-scale pilot project, which was conducted in four wards of the nursing home, was designed to involve families in heal

  7. 42 CFR 414.39 - Special rules for payment of care plan oversight.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for payment of care plan oversight. 414.39 Section 414.39 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH...

  8. CMS proposes prioritizing patient preferences, linking patients to follow-up care in discharge planning process.

    Science.gov (United States)

    2016-03-01

    Hospital providers voice concerns about a proposed rule by the Centers for Medicare and Medicaid Services (CMS) that would require providers to devote more resources to discharge planning. The rule would apply to inpatients as well as emergency patients requiring comprehensive discharge plans as opposed to discharge instructions. CMS states that the rule would ensure the prioritization of patient preferences and goals in the discharge planning process, and also would prevent avoidable complications and readmissions. However, hospital and emergency medicine leaders worry that community resources are not yet in place to facilitate the links and follow-up required in the proposed rule, and that the costs associated with implementation would be prohibitive. The proposed rule would apply to acute care hospitals, EDs, long-term care facilities, inpatient rehabilitation centers, and home health agencies. Regardless of the setting, though, CMS is driving home the message that patient preferences should be given more weight during the discharge planning process. Under the rule, hospitals or EDs would need to develop a patient-centered discharge plan within 24 hours of admission or registration, and complete the plan prior to discharge or transfer to another facility. Under the rule, emergency physicians would determine which patients require a comprehensive discharge plan. Both the American Hospital Association and the American College of Emergency Physicians worry that hospitals will have to take on more staff, invest in training, and make changes to their electronic medical record systems to implement the provisions in the proposed rule. PMID:26979045

  9. Hospitalists caring for patients with advanced cancer: An experience-based guide.

    Science.gov (United States)

    Koo, Douglas J; Tonorezos, Emily S; Kumar, Chhavi B; Goring, Tabitha N; Salvit, Cori; Egan, Barbara C

    2016-04-01

    Every year, nearly 5 million adults with cancer are hospitalized. Limited evidence suggests that hospitalization of the cancer patient is associated with adverse morbidity and mortality. Hospitalization of the patient with advanced cancer allows for an intense examination of health status in the face of terminal illness and an opportunity for defining goals of care. This experience-based guide reports what is currently known about the topic and outlines a systematic approach to maximizing opportunities, improving quality, and enhancing the well-being of the hospitalized patient with advanced cancer. Journal of Hospital Medicine 2016;11:292-296. © 2015 Society of Hospital Medicine. PMID:26588430

  10. Factors associated with presentation to care with advanced HIV disease in Brussels and Northern France: 1997-2007

    Directory of Open Access Journals (Sweden)

    Choisy Philippe

    2011-01-01

    Full Text Available Abstract Background Our objective was to determine the frequency and determinants of presentation to care with advanced HIV disease in patients who discover their HIV diagnosis at this stage as well as those with delayed presentation to care after HIV diagnosis in earlier stages. Methods We collected data on 1,819 HIV-infected patients in Brussels (Belgium and Northern France from January 1997 to December 2007. "Advanced HIV disease" was defined as CD4 count 3 or clinically-defined AIDS at study inclusion and was stratified into two groups: (a late testing, defined as presentation to care with advanced HIV disease and HIV diagnosis ≤6 months before initiation of HIV care; and (b delayed presentation to care, defined as presentation to care with advanced HIV disease and HIV diagnosis >6 months before initiation of HIV care. We used multinomial logistic regression to determine the factors associated with delayed presentation to care and late testing. Results Of the 570 patients initiating care with advanced HIV disease, 475 (83.3% were tested late and 95 (16.7% had delayed presentation to care. Risk factors for delayed presentation to care were: age 30-50 years, injection drug use, and follow-up in Brussels. Risk factors for late testing were: sub-Saharan African origin, male gender, and older age. HIV transmission through heterosexual contact was associated with an increased risk of both delayed presentation to care and late testing. Patients who initiated HIV care in 2003-2007 were less likely to have been tested late or to have a delayed presentation to care than patients who initiated care before 2003. Conclusion A considerable proportion of HIV-infected patients present to care with advanced HIV disease. Late testing, rather than a delay in initiating care after earlier HIV testing, is the main determinant of presentation to care with advanced HIV disease. The factors associated with delay presentation to care differ from those associated

  11. How Peru introduced a plan for comprehensive HIV prevention and care for transwomen

    Science.gov (United States)

    Salazar, Ximena; Núnez-Curto, Arón; Villayzán, Jana; Castillo, Regina; Benites, Carlos; Caballero, Patricia; Cáceres, Carlos F

    2016-01-01

    Introduction As a group, transwomen in Peru have the highest prevalence of HIV (>20%) in the country, but they have little access to HIV prevention, testing and care services. Until recently, Peru's national HIV programme did not recognize transwomen and had remained essentially static for decades. This changed in December 2014, when the Ministry of Health expressed its commitment to improve programming for transwomen and to involve transwomen organizations by prioritizing the development of a “Targeted Strategy Plan of STIs/HIV/AIDS Prevention and Comprehensive Care for Transwomen.” Discussion A policy dialogue between key stakeholders – Peru's Ministry of Health, academic scientists, civil society, transgender leaders and international agencies – created the conditions for a change in Peru's national HIV policy for transwomen. Supported by the effective engagement of all sectors, the Ministry of Health launched a plan to provide comprehensive HIV prevention and care for transwomen. The five-year plan includes new national guidelines for HIV prevention, care and support, and country-level investments in infrastructure and equipment. In addition to new biomedical strategies, the plan also incorporates several strategies to address structural factors that contribute to the vulnerability of transwomen. We identified three key factors that created the right conditions for this change in Peru's HIV policy. These factors include (1) the availability of solid evidence, based on scientific research; (2) ongoing efforts within the transwomen community to become better advocates of their own rights; and (3) a dialogue involving honest discussions between stakeholders about possibilities of changing the nation's HIV policy. Conclusions The creation of Peru's national plan for HIV prevention and care for transwomen shows that long-term processes, focused on human rights for transwomen in Peru, can lead to organizational and public-policy change. PMID:27431469

  12. Professional advancement of women in health care management: a conceptual model.

    Science.gov (United States)

    Madsen, M K; Blide, L A

    1992-11-01

    Ragins and Sundstrom suggest three major conclusions based on power and gender differences within organizations. The first is that power develops or detracts as individuals progress along their career track. HIM professionals who accept the challenges that changing roles bring can also develop a new sensitivity to the value of power as a tool. They can use their negotiating skills to avoid being placed in work roles that result in a decrease in power. The second difference between men and women within organizations is that obstacles often impede women's career paths more than men's. Perceptions by women and men of a woman as homemaker and mother create serious conflicts when jobs are demanding and time intensive. Lastly, Ragins and Sundstrom suggest that career progression is influenced by both intrinsic factors (personal and professional) and extrinsic factors (organizational and interpersonal). The interaction between these factors is often driven by gender differences allowing men to progress and succeed, whereas women remain beneath the glass ceiling. HIM professionals, like other women health professionals, are graduating from advanced programs in health care and business administration at a greater rate than ever before in the history of this country. Not all these graduates will be able to acquire top-level administrative positions in the traditional health care institutions (e.g., hospitals). Therefore, if they wish to advance, they may have to move to nontraditional work settings. This is especially true for HIM professionals. The expanding computerized environment in traditional and nontraditional health care settings presents great potential for the development of new roles and responsibilities that have not been identified as male roles. HIM professionals and women in other health care professions who aspire to advance to upper administrative positions in traditional and nontraditional settings must be willing to take the risks inherent in assuming

  13. Differential Patient-Caregiver Opinions of Treatment and Care For Advanced Lung Cancer Patients

    OpenAIRE

    Zhang, Amy Y.; Zyzanski, Stephen J.; Siminoff, Laura A.

    2010-01-01

    This study examined the differences of opinion between cancer patients and caregivers with regard to treatment and care decisions. 184 advanced lung cancer patients and 171 primary caregivers were recruited as a convenience sample from clinics in Cleveland, Ohio. A telephone interview was conducted to collect data using a semi-structured questionnaire. Nonparametric tests and regression analysis were performed. The findings showed that patients and caregivers reported significant disagreement...

  14. Improving medical graduates' training in palliative care: advancing education and practice

    Directory of Open Access Journals (Sweden)

    Head BA

    2016-02-01

    Full Text Available Barbara A Head,1 Tara J Schapmire,1 Lori Earnshaw,1 John Chenault,2 Mark Pfeifer,1 Susan Sawning,3 Monica A Shaw,3 1Division of General Internal Medicine, Palliative Care and Medical Education, University of Louisville School of Medicine, 2Kornhouser Health Sciences Library, University of Louisville, 3Undergraduate Medical Education Office, University of Louisville School of Medicine, Louisville, KY, USA Abstract: The needs of an aging population and advancements in the treatment of both chronic and life-threatening diseases have resulted in increased demand for quality palliative care. The doctors of the future will need to be well prepared to provide expert symptom management and address the holistic needs (physical, psychosocial, and spiritual of patients dealing with serious illness and the end of life. Such preparation begins with general medical education. It has been recommended that teaching and clinical experiences in palliative care be integrated throughout the medical school curriculum, yet such education has not become the norm in medical schools across the world. This article explores the current status of undergraduate medical education in palliative care as published in the English literature and makes recommendations for educational improvements which will prepare doctors to address the needs of seriously ill and dying patients. Keywords: medical education, palliative care, end-of-life care

  15. Toward Optimal End-of-Life Care for Patients with Advanced Chronic Obstructive Pulmonary Disease: Insights from a Multicentre Study

    OpenAIRE

    Rocker, Graeme M; Dodek, Peter M; Heyland, Daren K; for the Canadian Researchers at the End of Life Network

    2008-01-01

    BACKGROUND: Understanding patients’ needs and perspectives is fundamental to improving end-of-life (EOL) care. However, little is known of what quality care means to patients who have advanced lung disease.OBJECTIVES: To describe ratings of importance and satisfaction with elements of EOL care, informational needs, decision-making preferences, obstacles to a preferred location of death, clinical outcomes, and health care use before and during an index hospital admission for patients who have ...

  16. Ministry of Advanced Education and Labour Market Development 2009/10-2011/12 Service Plan Update

    Science.gov (United States)

    Ministry of Advanced Education and Labour Market Development, 2009

    2009-01-01

    The Ministry of Advanced Education and Labour Market Development's overarching purpose is to position British Columbia to meet the competitive challenges of the twenty-first century through better aligning labour market supply and demand. In the six months since the Ministry issued its February 2009 service plan and the subsequent re-election of…

  17. 75 FR 6689 - Sustainable Communities Planning Grant Program Advance Notice and Request for Comment

    Science.gov (United States)

    2010-02-10

    ... URBAN DEVELOPMENT Sustainable Communities Planning Grant Program Advance Notice and Request for Comment... Housing and Communities, Department of Housing and Urban Development, 451 7th Street, SW., Room 10180... decisions, and increase State, regional and local capacity to incorporate livability, sustainability,...

  18. Advanced reactors transition fiscal year 1995 multi-year program plan WBS 7.3

    International Nuclear Information System (INIS)

    This document describes in detail the work to be accomplished in FY-1995 and the out years for the Advanced Reactors Transition (WBS 7.3). This document describes specific milestones and funding profiles. Based upon the Fiscal Year 1995 Multi-Year Program Plan, DOE will provide authorization to perform the work outlined in the FY 1995 MYPP. Following direction given by the US Department of Energy (DOE) on December 15, 1993, Advanced Reactors Transition (ART), previously known as Advanced Reactors, will provide the planning and perform the necessary activities for placing the Fast Flux Test Facility (FFTF) in a radiologically and industrially safe shutdown condition. The DOE goal is to accomplish the shutdown in approximately five years. The Advanced Reactors Transition Multi-Year Program Plan, and the supporting documents; i.e., the FFTF Shutdown Program Plan and the FFTF Shutdown Project Resource Loaded Schedule (RLS), are defined for the life of the Program. During the transition period to achieve the Shutdown end-state, the facilities and systems will continue to be maintained in a safe and environmentally sound condition. Additionally, facilities that were associated with the Office of Nuclear Energy (NE) Programs, and are no longer required to support the Liquid Metal Reactor Program will be deactivated and transferred to an alternate sponsor or the Decontamination and Decommissioning (D and D) Program for final disposition, as appropriate

  19. A Study on planning of the international collaboration foundation for the Advanced Nuclear Technology Development Project

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Moon Hee; Kim, H. R.; Kim, H. J. and others

    2005-03-15

    Korea has participated in the international collaboration programs for the development of future nuclear energy systems driven by the countries holding advanced nuclear technology and Korea and U.S. have cooperated in the INERI. This study aimed mainly at developing the plan for participation in the collaborative development of the Gen IV, searching the participation strategy for INERI and the INPRO, and the international cooperation in these programs. Contents and scope of the study for successful achievement are as follows; Investigation and analysis of international and domestic trends related to advanced nuclear technologies, Development of the plan for collaborative development of the Gen IV and conducting the international cooperation activities, Support for the activities related to I-NERI between Korea and U.S. and conducting the international cooperation, International cooperation activities for the INPRO. This study can be useful for planning the research plan and setting up of the strategy of integrating the results of the international collaboration and the domestic R and D results by combining the Gen IV and the domestic R and D in the field of future nuclear technology. Futhermore, this study can contribute to establishing the effective foundation and broadening the cooperation activities not only with the advanced countries for acquisition of the advanced technologies but also with the developing countries for the export of the domestic nuclear energy systems.

  20. 42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Health information technology implementation... CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.338 Health information technology implementation advance planning...

  1. A Study on planning of the international collaboration foundation for the Advanced Nuclear Technology Development Project

    International Nuclear Information System (INIS)

    Korea has participated in the international collaboration programs for the development of future nuclear energy systems driven by the countries holding advanced nuclear technology and Korea and U.S. have cooperated in the INERI. This study aimed mainly at developing the plan for participation in the collaborative development of the Gen IV, searching the participation strategy for INERI and the INPRO, and the international cooperation in these programs. Contents and scope of the study for successful achievement are as follows; Investigation and analysis of international and domestic trends related to advanced nuclear technologies, Development of the plan for collaborative development of the Gen IV and conducting the international cooperation activities, Support for the activities related to I-NERI between Korea and U.S. and conducting the international cooperation, International cooperation activities for the INPRO. This study can be useful for planning the research plan and setting up of the strategy of integrating the results of the international collaboration and the domestic R and D results by combining the Gen IV and the domestic R and D in the field of future nuclear technology. Futhermore, this study can contribute to establishing the effective foundation and broadening the cooperation activities not only with the advanced countries for acquisition of the advanced technologies but also with the developing countries for the export of the domestic nuclear energy systems

  2. Differential patient-caregiver opinions of treatment and care for advanced lung cancer patients.

    Science.gov (United States)

    Zhang, Amy Y; Zyzanski, Stephen J; Siminoff, Laura A

    2010-04-01

    This study examined the differences of opinion between cancer patients and caregivers with regard to treatment and care decisions. 184 advanced lung cancer patients and 171 primary caregivers were recruited as a convenience sample from hospitals in Cleveland, Ohio. A telephone interview was conducted to collect data using a semi-structured questionnaire. Nonparametric tests and regression analysis were performed. The findings showed that patients and caregivers reported significant disagreement on three main issues: trade-off between treatment side effects and benefits; reporting treatment side effects to physicians, and hospice care. Caregivers were more concerned about patient's quality of life and more willing to discuss hospice issues than were patients (p caregivers (p caregiver disagreement about treatment and care decisions and its significant adverse impact on both patients and caregivers. PMID:20137849

  3. Beta Test Plan for Advanced Inverters Interconnecting Distributed Resources with Electric Power Systems

    Energy Technology Data Exchange (ETDEWEB)

    Hoke, A.; Chakraborty, S.; Basso, T.; Coddington, M.

    2014-01-01

    This document provides a preliminary (beta) test plan for grid interconnection systems of advanced inverter-based DERs. It follows the format and methodology/approach established by IEEE Std 1547.1, while incorporating: 1. Upgraded tests for responses to abnormal voltage and frequency, and also including ride-through. 2. A newly developed test for voltage regulation, including dynamic response testing. 3. Modified tests for unintentional islanding, open phase, and harmonics to include testing with the advanced voltage and frequency response functions enabled. Two advanced inverters, one single-phase and one three-phase, were tested under the beta test plan. These tests confirmed the importance of including tests for inverter dynamic response, which varies widely from one inverter to the next.

  4. Menu planning in long-term care: toward resident-centred menus.

    Science.gov (United States)

    Ducak, Kate; Keller, Heather H

    2011-01-01

    Factors that influence the menu planning process in Ontario long-term care (LTC) homes were studied, as were key informants' perspectives on how this process could be improved to promote resident-centred menus. Key informants were interviewed by telephone to obtain qualitative data through standardized open-ended questions. The key informants (n=35) were randomly selected nutrition managers of Ontario LTC homes. Selected registered dietitians from the Ontario Long-Term Care Action Group also participated (n=5). Descriptive thematic analysis was completed on data provided. Three over arching themes emerged from the data as drivers in the menu planning process: resource limitations, Ontario Ministry of Health and Long-Term Care standards, and the accommodation of diverse and evolving preferences. Challenges involving resources include insufficient food labour and raw food funding, the workload involved with altering menus, and providing food items for special diets or preferences. In terms of ministry standards, participants reported barriers to complying with rotation and portion standards. Other common obstacles within LTC homes include accommodating personal preferences, cultural preferences, and therapeutic diets. Ontario LTC homes face numerous challenges in the planning of menus for residents, regardless of a home's size, location, or profit status. Suggestions are aimed at improving the menu planning process and providing high-quality, palatable, and culturally appropriate food in these homes so that menus are resident-centred. PMID:21645428

  5. Implementing the Affordable Care Act: choosing an essential health benefits benchmark plan.

    Science.gov (United States)

    Corlette, Sabrina; Lucia, Kevin W; Levin, Max

    2013-03-01

    To improve the adequacy of private health insurance, the Affordable Care Act requires insurers to cover a minimum set of medical benefits, known as "essential health benefits." In implementing this requirement, states were asked to select a "benchmark plan" to serve as a reference point. This issue brief examines state action to select an essential health benefits benchmark plan and finds that 24 states and the District of Columbia selected a plan. All but five states will have a small-group plan as their benchmark. Each state, whether or not it made a benchmark selection, will have a set of essential health benefits that reflects local, employer-based health insurance coverage currently sold in the state. States adopted a variety of approaches to selecting a benchmark, including intergov­ernmental collaboration, stakeholder engagement, and research on benchmark options. PMID:23547335

  6. Care at home of the patient with advanced multiple sclerosis--part 2.

    Science.gov (United States)

    Reitman, Nancy Clayton

    2010-05-01

    Clinicians caring for patients with advanced MS have choices of different options and approaches. Whatever path is chosen, interventions must incorporate the wishes and capabilities of the patient and be supported by the care team, usually led by the nurse. As the work of the great psychologist Abraham Maslow has shown, in his famous "hierarchy of needs," the basic levels of needs must be met before the highest self-actualization can be accomplished (Maslow, 1943). This is equally true in the nursing care of very ill patients, as authors Zalenski and Raspa write: "The five levels of the hierarchy of needs as adapted to palliative care are: (1) distressing symptoms, such as pain or dyspnea; (2) fears for physical safety, of dying or abandonment; (3) affection, love and acceptance in the face of devastating illness; (4) esteem, respect, and appreciation for the person; (5) self-actualization and transcendence. Maslow's modified hierarchy of palliative care needs could be utilized to provide a comprehensive approach for the assessment of patients' needs and the design of interventions to achieve goals that start with comfort and potentially extend to the experience of transcendence."(Zalenski & Raspa, 2006, p.1120). PMID:20463509

  7. Is advanced life support better than basic life support in prehospital care? A systematic review

    Directory of Open Access Journals (Sweden)

    Ryynänen Olli-Pekka

    2010-11-01

    Full Text Available Abstract Background - Prehospital care is classified into ALS- (advanced life support and BLS- (basic life support levels according to the methods used. ALS-level prehospital care uses invasive methods, such as intravenous fluids, medications and intubation. However, the effectiveness of ALS care compared to BLS has been questionable. Aim - The aim of this systematic review is to compare the effectiveness of ALS- and BLS-level prehospital care. Material and methods - In a systematic review, articles where ALS-level prehospital care was compared to BLS-level or any other treatment were included. The outcome variables were mortality or patient's health-related quality of life or patient's capacity to perform daily activities. Results - We identified 46 articles, mostly retrospective observational studies. The results on the effectiveness of ALS in unselected patient cohorts are contradictory. In cardiac arrest, early cardiopulmonary resuscitation and defibrillation are essential for survival, but prehospital ALS interventions have not improved survival. Prehospital thrombolytic treatment reduces mortality in patients having a myocardial infarction. The majority of research into trauma favours BLS in the case of penetrating trauma and also in cases of short distance to a hospital. In patients with severe head injuries, ALS provided by paramedics and intubation without anaesthesia can even be harmful. If the prehospital care is provided by an experienced physician and by a HEMS organisation (Helicopter Emergency Medical Service, ALS interventions may be beneficial for patients with multiple injuries and severe brain injuries. However, the results are contradictory. Conclusions - ALS seems to improve survival in patients with myocardial infarction and BLS seems to be the proper level of care for patients with penetrating injuries. Some studies indicate a beneficial effect of ALS among patients with blunt head injuries or multiple injuries. There is

  8. Efficacy of a self-management plan in exacerbations for patients with advanced COPD

    Directory of Open Access Journals (Sweden)

    Sánchez-Nieto JM

    2016-08-01

    Full Text Available Juan Miguel Sánchez-Nieto,1,2 Rubén Andújar-Espinosa,3 Roberto Bernabeu-Mora,1,2 Chunshao Hu,1 Beatriz Gálvez-Martínez,1 Andrés Carrillo-Alcaraz,1 Carlos Federico Álvarez-Miranda,3 Olga Meca-Birlanga,1 Eva Abad-Corpa4 1Division of Pneumology, Hospital Morales Meseguer, 2University of Murcia, 3Division of Pneumology, Hospital Arrixaca, Murcia, 4Department of Professional Development Unit, Murcia, Spain Background: Self-management interventions improve different outcome variables in various chronic diseases. Their role in COPD has not been clearly established. We assessed the efficacy of an intervention called the self-management program on the need for hospital care due to disease exacerbation in patients with advanced COPD.Methods: Multicenter, randomized study in two hospitals with follow-up of 1 year. All the patients had severe or very severe COPD, and had gone to either an accident and emergency (A&E department or had been admitted to a hospital at least once in the previous year due to exacerbation of COPD. The intervention consisted of a group education session on the main characteristics of the disease, an individual training session on inhalation techniques, at the start and during the 3rd month, and a written action plan containing instructions for physical activity and treatment for stable phases and exacerbations. We determined the combined number of COPD-related hospitalizations and emergency visits per patient per year. Secondary endpoints were number of patients with visits to A&E and the number of patients hospitalized because of exacerbations, use of antibiotics and corticosteroids, length of hospital stay, and all-cause mortality.Results: After 1 year, the rate of COPD exacerbations with visits to A&E or hospitalization had decreased from 1.37 to 0.89 (P=0.04 and the number of exacerbations dropped from 52 to 42 in the group of patients who received the intervention. The numbers of patients hospitalized, at 19 (40

  9. Planning for the integration of the digital library, clinical decision support, and evidence at the point of care.

    Science.gov (United States)

    Schwartz, Linda Matula; Iobst, Barbara

    2008-01-01

    Integrating knowledge-based resources at the point of care is an important opportunity for hospital library involvement. In the progression of an IAIMS planning grant, the digital library is recognized as pivotal to the success of information domain integration throughout the institution. The planning process, data collection, and evolution of the planning project are discussed. PMID:18844088

  10. Clinical Practice Guidance for Radiotherapy Planning After Induction Chemotherapy in Locoregionally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: The use of induction chemotherapy (IC) for locoregionally advanced head-and-neck cancer is increasing. The response to IC often causes significant alterations in tumor volume and location and shifts in normal anatomy. Proper determination of the radiotherapy (RT) targets after IC becomes challenging, especially with the use of conformal and precision RT techniques. Therefore, a consensus conference was convened to discuss issues related to RT planning and coordination of care for patients receiving IC. Methods and Materials: Ten participants with special expertise in the various aspects of integration of IC and RT for the treatment of locoregionally advanced head-and-neck cancer, including radiation oncologists, medical oncologists, and a medical physicist, participated. The individual members were assigned topics for focused, didactic presentations. Discussion was encouraged after each presentation, and recommendations were formulated. Results: Recommendations and guidelines emerged that emphasize up-front evaluation by all members of the head-and-neck management team, high-quality baseline and postinduction planning scans with the patient in the treatment position, the use of preinduction target volumes, and the use of full-dose RT, even in the face of a complete response. Conclusion: A multidisciplinary approach is strongly encouraged. Although these recommendations were provided primarily for patients treated with IC, many of these same principles apply to concurrent chemoradiotherapy without IC. A rapid response during RT is quite common, requiring the development of two or more plans in a sizeable fraction of patients, and suggesting the need for similar guidance in the rapidly evolving area of adaptive RT.

  11. Use of a hand-held computer observational tool to improve communication for care planning and psychosocial well-being

    OpenAIRE

    Corazzini, Kirsten; Rapp, Carla Gene; McConnell, Eleanor S.; Anderson, Ruth A.

    2009-01-01

    Staff development nurses in long-term care are challenged to implement training programs that foster quality unlicensed assistive personnel (UAP) care and improve the transfer of their observations to licensed nursing staff for care planning. This study describes the outcomes of a program where UAP recorded behavioral problems of residents to inform care. Findings suggest staff development nurses who aim to improve UAP reporting without simultaneously targeting licensed nursing staff behavior...

  12. Coaching Family Caregivers to Become Better Problem Solvers When Caring for Persons with Advanced Cancer.

    Science.gov (United States)

    Dionne-Odom, J Nicholas; Lyons, Kathleen D; Akyar, Imatullah; Bakitas, Marie A

    2016-01-01

    Family caregivers of persons with advanced cancer often take on responsibilities that present daunting and complex problems. Serious problems that go unresolved may be burdensome and result in negative outcomes for caregivers' psychological and physical health and affect the quality of care delivered to the care recipients with cancer, especially at the end of life. Formal problem-solving training approaches have been developed over the past several decades to assist individuals with managing problems faced in daily life. Several of these problem-solving principles and techniques were incorporated into ENABLE (Educate, Nurture, Advise, Before Life End), an "early" palliative care telehealth intervention for individuals diagnosed with advanced cancer and their family caregivers. A hypothetical case resembling the situations of actual caregiver participants in ENABLE that exemplifies the complex problems that caregivers face is presented, followed by presentation of an overview of ENABLE's problem-solving key principles, techniques, and steps in problem-solving support. Though more research is needed to formally test the use of problem-solving support in social work practice, social workers can easily incorporate these techniques into everyday practice. PMID:27143574

  13. Measuring and monitoring quality of care in family planning: are we ignoring negative experiences?

    OpenAIRE

    Reichenbach, Laura

    2016-01-01

    Shannon Harris,1 Laura Reichenbach,2 Karen Hardee2 1Public Health Consultant, Seattle, WA, USA; 2The Evidence Project, Population Council, Washington, DC, USA Abstract: Despite decades of emphasis on quality of care, qualitative research continues to describe incidents of poor quality client–provider interactions in family planning provision. Using an emerging framework on disrespect and abuse (D and A) in maternal health services, we reviewed the global published literature for qu...

  14. Measuring and monitoring quality of care in family planning: are we ignoring negative experiences?

    OpenAIRE

    Harris S; Reichenbach L; Hardee K

    2016-01-01

    Shannon Harris,1 Laura Reichenbach,2 Karen Hardee2 1Public Health Consultant, Seattle, WA, USA; 2The Evidence Project, Population Council, Washington, DC, USA Abstract: Despite decades of emphasis on quality of care, qualitative research continues to describe incidents of poor quality client–provider interactions in family planning provision. Using an emerging framework on disrespect and abuse (D and A) in maternal health services, we reviewed the global published literature for quanti...

  15. Connection, Regulation, and Care Plan Innovation: A Case Study of Four Nursing Homes

    OpenAIRE

    Colón-Emeric, Cathleen S.; Lekan-Rutledge, Deborah; Utley-Smith, Queen; Ammarell, Natalie; Bailey, Donald; Piven, Mary L.; Corazzini, Kirsten; Anderson, Ruth A.

    2006-01-01

    We describe how connections among nursing home staff impact the care planning process using a complexity science framework. We completed six-month case studies of four nursing homes. Field observations (n = 274), shadowing encounters (n = 69), and in-depth interviews (n = 122) of 390 staff at all levels were conducted. Qualitative analysis produced a conceptual/thematic description and complexity science concepts were used to produce conceptual insights. We observed that greater levels of sta...

  16. The establishment of master plan for developing advanced I and C technology -The development of advanced instrumentation and control technology-

    International Nuclear Information System (INIS)

    Although several organizations are performing their tasks making efforts to develop new digital technology for application to existing nuclear power plants as well as new plants of the future, their projects are similar to each other and have possibilities of redundant investment. Therefore, KAERI have established a Master Plan to define the suitable work-scope of each Instrumentation and Control (I and C) development project and proceed its development items continuously. Furthermore, in the project, several kinds of advanced technology for application of computer science and digital electronics were studied to obtain better reliability of the I and C systems and reduce opertor's burden. For establishing the Master Plan, functions of I and C system of NPPs were surveyed. Especially EPRI URD was deeply analyzed for setting up a basis of the foreign countries were referred for the Master Plan. For the new technology survey, fault-tolerant control technology and control system performance analysis methods were studied. Requirements of alarm and information system as well as technology of I and C network system of NPPs were also established to introduce the advantages of commercial distributed control system. (Author)

  17. In consumer-directed health plans, a majority of patients were unaware of free or low-cost preventive care.

    Science.gov (United States)

    Reed, Mary E; Graetz, Ilana; Fung, Vicki; Newhouse, Joseph P; Hsu, John

    2012-12-01

    Consumer-directed health plans are plans with high deductibles that typically require patients to bear no out-of-pocket costs for preventive care, such as annual physicals or screening tests, in order to ease financial barriers and encourage patients to seek such care. We surveyed people in California who had a consumer-directed health plan and found that fewer than one in five understood that their plan exempted preventive office visits, medical tests, and screenings from their deductible, meaning that this care was free or had a modest copayment. Roughly one in five said that they had delayed or avoided a preventive office visit, test, or screening because of cost. Those who were confused about the exemption were significantly more likely to report avoiding preventive visits because of cost concerns. Special efforts to educate consumers about preventive care cost-sharing exemptions may be necessary as more health plans, including Medicare, adopt this model. PMID:23213148

  18. The Role of Health Care Provider Goals, Plans, and Physician Orders for Life-Sustaining Treatment (POLST) in Preparing for Conversations About End-of-Life Care.

    Science.gov (United States)

    Russell, Jessica

    2016-09-01

    The Physician Orders for Life-Sustaining Treatment (POLST) is a planning tool representative of an emerging paradigm aimed at facilitating elicitation of patient end-of-life care preferences. This study assessed the impact of the POLST document on provider goals and plans for conversations about end-of-life care treatment options. A 2 (POLST: experimental, control) × 3 (topic of possible patient misunderstanding: cardiopulmonary resuscitation, medical intervention, artificially administered nutrition) experimental design was used to assess goals, plan complexity, and strategies for plan alterations by medical professionals. Findings suggested that the POLST had little impact on plan complexity or reaction time with initial plans. However, preliminary evidence suggested that the utility of the POLST surfaced with provider responses to patient misunderstanding, in which differences in conditions were identified. Significant differences in goals reported as most important in driving conversational engagement emerged. Implications for findings are discussed. PMID:27442346

  19. Award-Winning CARES/Life Ceramics Durability Evaluation Software Is Making Advanced Technology Accessible

    Science.gov (United States)

    1997-01-01

    Products made from advanced ceramics show great promise for revolutionizing aerospace and terrestrial propulsion and power generation. However, ceramic components are difficult to design because brittle materials in general have widely varying strength values. The CARES/Life software developed at the NASA Lewis Research Center eases this by providing a tool that uses probabilistic reliability analysis techniques to optimize the design and manufacture of brittle material components. CARES/Life is an integrated package that predicts the probability of a monolithic ceramic component's failure as a function of its time in service. It couples commercial finite element programs--which resolve a component's temperature and stress distribution - with reliability evaluation and fracture mechanics routines for modeling strength - limiting defects. These routines are based on calculations of the probabilistic nature of the brittle material's strength.

  20. An agent based manufacturing scheduling module for Advanced Planning and Scheduling

    OpenAIRE

    Attri, Hitesh

    2005-01-01

    A software agents based manufacturing scheduling module for Advanced Planning and Scheduling (APS) is presented. The problem considered is scheduling of jobs with multiple operations, distinct operation processing times, arrival times, and due dates in a job shop environment. Sequence dependent setups are also considered. The additional constraints of material and resource availability are also taken into consideration. The scheduling is to be considered in integration with production plannin...

  1. Optimization of time distribution for studying the course modules on advanced training of health care administrators

    Directory of Open Access Journals (Sweden)

    Dorovskaya A.l.

    2015-06-01

    Full Text Available The research objective is rational (optimal time management in studying the course modules on Advanced Training of Health Care Administrators. Materials and methods. We conducted expert survey of 73 healthcare administrators from medical organizations of Saratov region. Branch-and-bound method was used for rescheduling the educational program. Results. Both direct and inverse problems have been solved. The direct one refers to time distribution for each module of the advanced Training of Healthcare Administrators course so that the total score is maximum and each module is marked not lower than "satisfactory". The inverse one resulted in achieving minimal time characteristics for varieties of average score. Conclusion. The offered approach allows to solve problems of managing time given for education.

  2. Impact of cut-off probability on emergency planning zone sizing for advanced light water reactors

    International Nuclear Information System (INIS)

    In 1997, NRC performed an evaluation of emergency planning for the evolutionary and advanced light water reactors, and indicated that no changes to emergency planning (EP) requirements were warranted in the existing technical framework. How- ever, NRC also recognized if the lower probability of severe accidents or the longer time period between accident initiation and release of radioactive material was considered, the changes to EP requirements for advanced light water reactors might be warranted and the emergency planning zone (EPZ) sizing might be reduced. This means that if the accidents which probabilities are lower than a cut-off probability are not considered, there may be a significant impact on the EPZ sizing. AP1000 was selected as an example in this study and the probable impacts of different cut-off probabilities were studied by using MACCS code in accordance with the NUREG-0396 method. The results show that, only if the cut-off probability is higher than the occurrence probability of the accident which has relatively serious consequence and high probability, there will be a significant impact on the EPZ sizing for the advanced light water reactor. (authors)

  3. Developing a national dissemination plan for collaborative care for depression: QUERI Series

    Directory of Open Access Journals (Sweden)

    Rubenstein Lisa V

    2008-12-01

    Full Text Available Abstract Background Little is known about effective strategies for disseminating and implementing complex clinical innovations across large healthcare systems. This paper describes processes undertaken and tools developed by the U.S. Department of Veterans Affairs (VA Mental Health Quality Enhancement Research Initiative (MH-QUERI to guide its efforts to partner with clinical leaders to prepare for national dissemination and implementation of collaborative care for depression. Methods An evidence-based quality improvement (EBQI process was used to develop an initial set of goals to prepare the VA for national dissemination and implementation of collaborative care. The resulting product of the EBQI process is referred to herein as a "National Dissemination Plan" (NDP. EBQI participants included: a researchers with expertise on the collaborative care model for depression, clinical quality improvement, and implementation science, and b VA clinical and administrative leaders with experience and expertise on how to adapt research evidence to organizational needs, resources and capacity. Based on EBQI participant feedback, drafts of the NDP were revised and refined over multiple iterations before a final version was approved by MH-QUERI leadership. 'Action Teams' were created to address each goal. A formative evaluation framework and related tools were developed to document processes, monitor progress, and identify and act upon barriers and facilitators in addressing NDP goals. Results The National Dissemination Plan suggests that effectively disseminating collaborative care for depression in the VA will likely require attention to: Guidelines and Quality Indicators (4 goals, Training in Clinical Processes and Evidence-based Quality Improvement (6 goals, Marketing (7 goals, and Informatics Support (1 goal. Action Teams are using the NDP as a blueprint for developing infrastructure to support system-wide adoption and sustained implementation of

  4. Using Micro-Synchrophasor Data for Advanced Distribution Grid Planning and Operations Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, Emma [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Kiliccote, Sila [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); McParland, Charles [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Roberts, Ciaran [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2014-07-01

    This report reviews the potential for distribution-grid phase-angle data that will be available from new micro-synchrophasors (µPMUs) to be utilized in existing distribution-grid planning and operations analysis. This data could augment the current diagnostic capabilities of grid analysis software, used in both planning and operations for applications such as fault location, and provide data for more accurate modeling of the distribution system. µPMUs are new distribution-grid sensors that will advance measurement and diagnostic capabilities and provide improved visibility of the distribution grid, enabling analysis of the grid’s increasingly complex loads that include features such as large volumes of distributed generation. Large volumes of DG leads to concerns on continued reliable operation of the grid, due to changing power flow characteristics and active generation, with its own protection and control capabilities. Using µPMU data on change in voltage phase angle between two points in conjunction with new and existing distribution-grid planning and operational tools is expected to enable model validation, state estimation, fault location, and renewable resource/load characterization. Our findings include: data measurement is outstripping the processing capabilities of planning and operational tools; not every tool can visualize a voltage phase-angle measurement to the degree of accuracy measured by advanced sensors, and the degree of accuracy in measurement required for the distribution grid is not defined; solving methods cannot handle the high volumes of data generated by modern sensors, so new models and solving methods (such as graph trace analysis) are needed; standardization of sensor-data communications platforms in planning and applications tools would allow integration of different vendors’ sensors and advanced measurement devices. In addition, data from advanced sources such as µPMUs could be used to validate models to improve

  5. Validity, reliability and responsiveness to change of the Italian palliative care outcome scale:A multicenter study of advanced cancer patients Cancer palliative care

    OpenAIRE

    COSTANTINI, MASSIMO; Rabitti, Elisa; Beccaro, Monica; Fusco, Flavio; Peruselli, Carlo; La Ciura, Pietro; Valle, Alessandro; Suriani, Cinzia; Berardi, Maria Alejandra; Valenti, Danila; Mosso, Felicita; Morino, Piero; Zaninetta, Giovanni; Tubere, Giorgio; Piazza, Massimo

    2016-01-01

    Background There is an increasing requirement to assess outcomes, but few measures have been tested for advanced medical illness. We aimed to test the validity, reliability and responsiveness of the Palliative care Outcome Scale (POS), and to analyse predictors of change after the transition to palliative care. Methods Phase 1: multicentre, mixed method study comprising cognitive and qualitative interviews with patients and staff, cultural refinement and adaption. Phase 2: consecutive cancer ...

  6. A protocol for an exploratory phase I mixed-methods study of enhanced integrated care for care home residents with advanced dementia: the Compassion Intervention

    OpenAIRE

    Elliott, M.; Harrington, J.; Moore, K.; Davis, S.; Kupeli, N.; Vickerstaff, V.; Gola, A; Candy, B; Sampson, E. L.; Jones, L.

    2014-01-01

    Introduction In the UK approximately 700 000 people are living with, and a third of people aged over 65 will die with, dementia. People with dementia may receive poor quality care towards the end of life. We applied a realist approach and used mixed methods to develop a complex intervention to improve care for people with advanced dementia and their family carers. Consensus on intervention content was achieved using the RAND UCLA appropriateness method and mapped to sociological theories of p...

  7. Learning to plan? A critical fiction about the facilitation of professional and practice development plans in primary care.

    Science.gov (United States)

    Elwyn, Glyn; Hocking, Paul; Burtonwood, Ann; Harry, Karan; Turner, Arthur

    2002-11-01

    A shift from continuing medical education towards professional and organisational development policies, coupled with the introduction of accountability frameworks (clinical governance), has generated interest in professional and practice development plans (PPDPs) in general practice. The problems of implementing this change in an independent contractor-based service remain unexplored and the aims of this study were to focus on the facilitator's experience of the issues that hampered or fostered development in general practice. Facilitators of PPDPs were asked to document their experience of supporting 12 practices in an all Wales feasibility study. In order to maintain organisational anonymity while reporting accurate accounts of the obstacles encountered, a method known as critical fiction was employed. This method allowed the authors to write detailed reflective accounts that were then fictionalised. The culture of general practice reflects the development of an independent contractor service that has developed into partnerships that employ some professionals (practice nurses, managers and administrative staff) and collaborate with others in variable arrangements (community nurses, health visitors, midwives and others). Developing organisation-wide systems in so-called 'primary health care teams' is a difficult exercise, given the ethos of autonomous decision-making processes and the lack of experience of 'whole systems' approaches in primary care. The potential for multiprofessional synergy and the evidence that systematic changes lead to sustained health care improvements are well established. But the implementation issues of these concepts have not been addressed. Existing educational policies are based in uniprofessional paradigms and the protected time requirements and funding streams required for PPDPs have not been clarified. PMID:12487843

  8. Are Marketplace Plans Affordable? Consumer Perspectives from the Commonwealth Fund Affordable Care Act Tracking Survey, March-May 2015.

    Science.gov (United States)

    Collins, Sara R; Gunja, Munira; Rasmussen, Petra W; Doty, Michelle M; Beutel, Sophie

    2015-09-01

    Most employers who provide health insurance to employees subsidize their premiums and provide a comprehensive benefit package. Before the Affordable Care Act, people who lacked health insurance through a job and purchased it on their own paid the full cost of their plans, which often came with skimpy benefit packages and high deductibles. Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March--May 2015, indicate that the law's tax credits have made premium costs in health plans sold through the marketplaces roughly comparable to employer plans, at least for people with low and moderate incomes. At higher incomes, the phase-out of the subsidies means that adults in marketplace plans have higher premium costs than those in employer plans. Overall, larger shares of adults in marketplace plans reported deductibles of $1,000 or more, compared with those in employer plans, though these differences were narrower among low-and moderate-income adults. PMID:26445739

  9. Tamoxifen compared to best supportive care in advanced hepatocelluar carcinoma: A retrospective matched-cohort study

    International Nuclear Information System (INIS)

    Hepatocelluar carcinoma (HCC) is a common cancer worldwide as well as in Egypt with hepatitis B and C, alcohol and aflatoxins being the commonest risk factors. Tamoxifen was initially reported to confer a marginal survival benefit in advanced HCC. However, later reports declined any benefit. Objective: To study the impact of tamoxifen on overall survival (OS) compared to best supportive care (BSC) in Egyptian patients with advanced HCC. Methods: This retrospective matched-cohort study was conducted at Tanta Cancer Center (TCC), Egypt where 116 advanced HCC cases treated with tamoxifen were compared to TNM stage and Child-Pugh class matched 116 HCC cases who received BSC. Results: The median OS in the tamoxifen group was 9.3 months (95% confidence interval [Cl], 6.7- 11.9 months) compared to 8.7 months (95%CI, 6.8-10.6) in the BSC group (p = 0.758). With univariate analyses, it was shown that absence of fatigue, Child-Pugh class A, single tumors, less advanced tumors (T2), and absence of metastases (M0), had significantly better OS than their counterparts. Multivariate analysis showed that absence of fatigue, Child-Pugh class A and T2 tumors were independent prognostic factors affecting OS. Tamoxifen produced partial response and clinical stabilization in one% and 16% of cases, respectively. The median PFS with tamoxifen was 7.2 months (95%CI, 5.2-9.5). Conclusions: Tamoxifen did not show any OS advantage in Egyptian patients with advanced HCC. Use of this drug is discouraged

  10. Comprehensive Care Plan Development Using Resident Assessment Instrument Framework: Past, Present, and Future Practices

    Directory of Open Access Journals (Sweden)

    Mary Ellen Dellefield

    2015-10-01

    Full Text Available Development of the comprehensive care plan (CCP is a requirement for nursing homes participating in the federal Medicare and Medicaid programs, referred to as skilled nursing facilities. The plan must be developed within the context of the comprehensive interdisciplinary assessment framework—the Resident Assessment Instrument (RAI. Consistent compliance with this requirement has been difficult to achieve. To improve the quality of CCP development within this framework, an increased understanding of complex factors contributing to inconsistent compliance is required. In this commentary, we examine the history of the comprehensive care plan; its development within the RAI framework; linkages between the RAI and registered nurse staffing; empirical evidence of the CCP’s efficacy; and the limitations of extant standards of practices in CCP development. Because of the registered nurse’s educational preparation, professional practice standards, and licensure obligations, the essential contributions of professional nurses in CCP development are emphasized. Recommendations for evidence-based micro and macro level practice changes with the potential to improve the quality of CCP development and regulatory compliance are presented. Suggestions for future research are given.

  11. Treatment planning structure and process in the United States: a 'patterns of care' study

    International Nuclear Information System (INIS)

    Purpose: To conduct a study of the structure and process of treatment planning in the United States. Methods and Materials: A Patterns of Care treatment planning consensus committee developed a survey form that was used to gather data for 106 items relating to the structure and process of treatment planning. These questions were general in nature and not specific to any particular disease site. Seventy-three facilities were randomly selected for site visits from the 1321 radiation therapy facilities in the United States: 21 academic, 26 hospital, and 26 free-standing. During the site visit the facility physicist, assisted by the site-visit physicist, completed the form. Results: Twenty-nine percent of facilities have cobalt-60 machines; 25% have 4 MV linacs; 75% have photon energies in the range of 5-8 MV; and less than 10% have energies greater than 20 MV. Academic facilities led hospital and free-standing facilities by about 30 percentage points in the availability of all electron energies (88 vs. 58%, approximately, in the range 4-13 MeV and scaling downward to about 60 vs. 30% at the highest energies). The national averages for the availability of Cs-137, Ir-192, and I-125 were 87, 73, and 44%, respectively. Computerized tomography (CT) scanning is not available or not used in 15% of hospital and free-standing facilities. Ninety-six percent of facilities have treatment planning computers; at 10% of facilities physicians do not participate in treatment planning. The estimated national averages of facilities having formal quality assurance (QA) programs for treatment planning systems, simulators, film processors, and blocking systems are 44, 79, 62, and 55%, respectively. Sixty-three percent of facilities obtain independent machine calibrations. Conclusion: This is the first patterns of treatment planning study carried out in the United States and the results reported here will establish a baseline for future studies. The present study has identified some

  12. Planning for interprofessional change in primary health care: exploring the use of the Interprofessional Resource Centre

    Directory of Open Access Journals (Sweden)

    Patterson C

    2013-05-01

    Full Text Available Christine Patterson,1 Heather Arthur,1,2 Gladys Peachey,1 Julie Vohra,1 David Price,3 Dave Pearson,4 Rob Mariani51School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; 2Heart and Stroke Foundation of Ontario/Michael G DeGroote Endowed Chair in Cardiovascular Nursing Research, McMaster University, Hamilton, ON, Canada; 3Department of Family Medicine, McMaster University, Hamilton, ON, Canada; 4Central West Local Health Integration Network, Brampton, ON, Canada; 5Ascentum Consulting, Ottawa, ON, CanadaImportance: Resources to support change are needed for solo practitioners who are transitioning to family health teams (FHTs which involve multiple health disciplines working together to provide team-based care.Objective: The purpose of this project was: (1 to explore the use of an online resource, the Interprofessional Resource Centre (IRC, when planning for interprofessional change and; (2 to explore the experience of planning interprofessional change.Design and setting: Six FHTs organized under the structure of one Local Health Integrated Network (LHIN in Ontario, Canada.Intervention: Participants in six FHTs were directed to the IRC to support planning interprofessional change. In addition, two of the six FHTs participated in pilot site meetings with investigators where they received in-person support to apply the information from the IRC to an interprofessional activity.Results: Pilot site participants reported the IRC was useful for planning, but they cited lack of time to use it as a key barrier. When planning for interprofessional change, providers experienced challenges with physician buy-in and team dynamics. As a strategy for change, providers would like to learn from other FHTs who have experienced success with interprofessional change; at the LHIN level, they saw a need for more educational opportunities. Participation was found to be low among those only receiving online support.Conclusion and

  13. Piloting an advanced methodology to analyse health care policy networks: The example of Belgrade, Serbia

    Directory of Open Access Journals (Sweden)

    Helmut Wenzel

    2015-11-01

    Full Text Available Aim: Political decisions usually emerge from the competing interests of politicians, voters, and special interest groups. We investigated the applicability of an advanced methodological concept to determine whether certain institutional positions in a cooperating network have influence on the decision-making procedures. To that end, we made use of the institutional network of relevant health care and health governance institutions, concentrated in Belgrade, Serbia. Methods: We used a Principal Component Analysis (PCA based on a combination of measures for centrality in order to evaluate the positions of 25 players in Belgrade‟s institutional network. Their directed links were determined by a simulated position approach employing the authors‟ long-term involvement. Software packages used consisted of Visone 2.9, UCINET 6, and KeyPlayer 1.44. Results: In our analysis, the network density score in Belgrade was 71%. The PCA revealed two dimensions: control and attractiveness. The Ministry of Health exerted the highest level of control but displayed a low attractiveness in terms of receiving links from important players. The National Health Insurance Fund had less control capacity but a high attractiveness. The National Institute of Public Health‟s position was characterized by a low control capacity and high attractiveness, whereas the National Drug Agency, the National Health Council, and Non-Governmental Organisations were no prominent players. Conclusions: The advanced methodologies used here to analyse the health care policy network in Belgrade provided consistent results indicating that the intended decentralization of the health care network in Belgrade may be incomplete, still with low participation of civil society representatives. With the present study we set the stage for a broad-range survey based data collection applying the methodology piloted in Belgrade.

  14. Palliative home care intervention to improve the quality of life of women with advanced breast cancer

    International Nuclear Information System (INIS)

    The quality of life is affected frequently observed in women with advanced breast cancer and is considered a leading indicator of effectiveness of palliative care. A descriptive, quasi-experimental study is presented ex-ante / ex-post, by applying open-ended interviews to explore the effects on the processes of adaptation of each patient and a self-administrable scale identified specific dimensions of quality of life, satisfaction with care and overall quality of life. The intervention was performed palliative home care to 52 women, according to the damages identified in the baseline diagnosis. The overall strategy included four steps: clinical and socio-demographic characterization of women; identification of the effects on the processes of adaptation by the theoretical model of Roy and dimensions of quality of life frequently affected, to design individually oriented actions on the drive shaft of Nursing Interventions Classification and evaluation of results intervention. The dimensions achieved higher frequency of involvement were: behavior, physical symptoms, pain interference and leisure activities, social life and family. Data were analyzed with qualitative methodologies and uni and multivariate statistical processing. After the intervention favorable changes in adaptive processes and dimensions of quality of life were observed; well as in the assessment of overall satisfaction with life. It was interesting that the dimensions of satisfaction assessed at the end of the intervention obtained an unfavorable assessment, outcome associated with sociodemographic variables. (author)

  15. Advancing the use of checklists for evaluating performance in health care.

    Science.gov (United States)

    Rosen, Michael A; Pronovost, Peter J

    2014-07-01

    Patients frequently do not receive recommended therapies because performance expectations are often unclear. Clinical guidelines provide exhaustive details and recommendations, but this information is not formatted in a way that supports decision making or bedside translation of therapies. When performance expectations are unclear, it is difficult for clinicians to assess their own or others' competence. Checklists offer hope because they codify interventions, remove ambiguity, and increase reliability of care processes. Schmutz and colleagues developed a robust methodology to create a checklist for evaluating clinical performance, which is described in this issue of Academic Medicine.In this commentary, the authors offer several points to consider as checklists become more prevalent in medical education and clinical practice. First, culture is a much larger part of the equation than the checklist; understanding what all stakeholders expect to gain will help engage checklist use. Second, the construction, validation, and maintenance of checklist evaluation tools is labor intensive, requiring innovative dissemination approaches to ensure maximum access and use of checklists. Third, integrated systems that evaluate technically specified and adaptive performance are needed because some aspects of clinical performance cannot be captured on a checklist. Fourth, checklists provide an opportunity to evaluate and improve an individual's performance concurrently with the context in which it is delivered. A tighter connection between education and training activities and process improvement strategies will accelerate improvements in safety and quality. Schmutz and colleagues have provided advancements in performance evaluation that will help health care achieve higher-quality and safer care. PMID:24826861

  16. Wound healing and nutrition: going beyond dressings with a balanced care plan.

    Science.gov (United States)

    Gruen, Douglas

    2010-09-01

    As the largest organ of the body, the human skin protects all subcutaneous tissues. Despite its many attributes, the skin is vulnerable to pressure ulcers. The number of pressure ulcers and venous leg ulcers is on the rise, but healing rates have not improved over the past decade. The reason may be a tendency to focus on one or two fundamentals of wound healing, but not on all 3 fundamentals equally. The 3 fundamentals of wound healing are (1) pressure relief and nursing care, (2) dressings, and (3) nutrition. Nutrition is the area that is most often overlooked, which commonly causes the care plan to be out of balance. In the United States, few clinicians would consider malnutrition to be an issue in the homecare and long-term care setting, yet nutritional status and risk for pressure ulcer formation are well documented and strongly correlated. Our aging population will continue to survive previously catastrophic events, only to present with pressure ulcers or the potential for developing pressure ulcers. Clinicians caring for residents with pressure ulcers must strike a balance between pressure relief, dressings, and nutrition. Functional gastrointestinal-tract impairments must be diagnosed and addressed. Wounds must be treated aggressively with high-protein calorically-balanced diets because wounds heal from the inside out. PMID:24527147

  17. The dangers of involving children as family caregivers of palliative home-based-care to advanced HIV/AIDS patients

    Directory of Open Access Journals (Sweden)

    S M Kang′ethe

    2010-01-01

    Full Text Available The aim of this research paper is to explore the dangers of involving children as family caregivers of palliative care and home-based-care to advanced HIV/AIDS patients, while its objective is to discuss the dangers or perfidiousness that minors especially the girl children face as they handle care giving of advanced HIV/AIDS patients. The article has relied on eclectic data sources. The research has foundminors disadvantaged by the following: being engulfed by fear and denied rights through care giving; being emotionally and physiologically overwhelmed; being oppressed and suppressed by caring duties; being at risk of contracting HIV/AIDS; and having their education compromised by care giving. The paper recommends: (1 strengthening and emphasizing on children′s rights; (2 maintaining gender balance in care giving; (3 implementation and domestication of the United Nations conventions on the rights of children; (4 community awareness on equal gender co participation in care giving; (5 and fostering realization that relying on child care giving is a negative score in fulfilling global Millennium Development Goals.

  18. 晚期肿瘤患者的临终关怀%Palliative Care for Patients with Advanced Malignant Tumor

    Institute of Scientific and Technical Information of China (English)

    苏芳

    2013-01-01

      [Objective] To explore the way of pal iative care and its significance related to patients with advanced malignant tumor. [Method]30 patients with advanced cancer hospitalized in our hospital were given basic nursing care, intravenous infusion care, pain care, and psychological care. [Results] Pal-liative care includes basic nursing care, intravenous infusion care, pain care and psychological care, improves the life quality of the patients. [Conclusion] Pal iative care needs the cooperation of the social health care workers, family members, together to help dying patients calm through life at the last minute, ful y emboding the noble health care professional ethics.%  [目的]探讨晚期肿瘤患者临终关怀的护理方式及其意义。[方法]对2012年1-12月在我科收住的30例晚期肿瘤患者开展基础护理、静脉输液护理、疼痛护理以及心理护理等临终关怀护理。[结果]加强基础护理、静脉输液护理、疼痛护理以及心理护理等临终关怀护理方式提高了患者的生活质量。[结论]临终关怀需要社会、医护人员、家属的共同配合,帮助晚期肿瘤患者平静度过人生最后一刻,充分体现了高尚医护职业道德。

  19. Patient Navigation Through the Cancer Care Continuum: An Overview

    OpenAIRE

    Hopkins, Janice; Mumber, Matthew P.

    2009-01-01

    Technologic advances, medical specialization, novel payment structures, and an increased scientific knowledge base have resulted in a health care system requiring trained experts to deliver guidance as patients complete care plans: Enter the concept of patient navigation.

  20. Advanced lung disease: quality of life and role of palliative care.

    Science.gov (United States)

    Gilbert, Christopher R; Smith, Cecilia M

    2009-02-01

    . Recognition and correction of nocturnal hypoxemia and other sleep disturbances should enhance quality of life in patients with restrictive lung disease; however, there is currently no evidence to support this claim. End-of-life care needs more attention by clinicians in the decision-making and preparatory phase. Physicians need to maintain their focus on quality-of-life issues as medical management shifts from curative therapies to comfort management therapies. Palliative care and hospice appear to be underused in patients with advanced diseases other than cancer. Because the only curative option for some end-stage restrictive lung diseases is lung transplantation, if transplantation is not an option, palliation of symptoms and hospice care may offer patients and families the opportunity to die with dignity and comfort. PMID:19170219

  1. DYNAMIC ADVANCED PLANNING AND SCHEDULING WITH FROZEN INTERVAL FOR NEW ORDERS

    Institute of Scientific and Technical Information of China (English)

    CHEN Kejia; JI Ping

    2007-01-01

    A dynamic advanced planning and scheduling (DAPS) problem is addressed where new Orders arrive on a continuous basis. A periodic policy with frozen interval is adopted to increase stability on the shop floor. A genetic algorithm is developed to find a schedule at each rescheduling point for both original Orders and new orders that both production idle time and penalties on tardiness and earliness of orders are minimized. The proposed methodology is tested on a small example to illustrate the effect of the frozen interval. The results indicate that the suggested approach can improve the schedule stability while retaining efficiency.

  2. Development plan for an advanced drilling system with real-time diagnostics (Diagnostics-While-Drilling)

    Energy Technology Data Exchange (ETDEWEB)

    FINGER,JOHN T.; MANSURE,ARTHUR J.; PRAIRIE,MICHAEL R.; GLOWKA,D.A.

    2000-02-01

    This proposal provides the rationale for an advanced system called Diagnostics-while-drilling (DWD) and describes its benefits, preliminary configuration, and essential characteristics. The central concept is a closed data circuit in which downhole sensors collect information and send it to the surface via a high-speed data link, where it is combined with surface measurements and processed through drilling advisory software. The driller then uses this information to adjust the drilling process, sending control signals back downhole with real-time knowledge of their effects on performance. The report presents background of related previous work, and defines a Program Plan for US Department of Energy (DOE), university, and industry cooperation.

  3. Recent advances in application of intelligent decision suport software systes for inspection planning in power plants

    International Nuclear Information System (INIS)

    Within the BE5935 joint project of the Commission of the European Communities and European industry a new concept of advanced multi-criteria decision making (MCDM) has been developed and applied onto several selected practical problems (bridges, offshore structures, power plants). The example in the area of power plants concerns the planning of periodic inspections (overhauls). The paper describes the concept as applied and customized for power plant related practical applications, and presents the results obtained in 1994 and early 1995. The results confirm the high relevance of the concept for the practice. (author). 6 refs., 1 figs., 4 tabs

  4. A decentralized model of palliative care for patients with advanced incurable cancer

    Directory of Open Access Journals (Sweden)

    Nancy Mineko Koseki

    2010-11-01

    Full Text Available Most cancer patients in Brazil are diagnosed in the disease advanced stages; therefore, survival rates are low, meaning that there is a large patient population in need of palliative care. Palliative care models in practice are based on those provided by cancer hospitals. The main limitation to this is their local range, whereas the demand is predominantly regional. The target of this study was to test a decentralized palliative care model based on local public health services and healthcare professionals for the assistance of gynecologic and/or breast cancer patients with incurable disease in partnership with the Center for the Integral Care of Women’s Health (Centro de Atenção Integral à Saúde da Mulher of the State University of Campinas (Universidade Estadual de Campinas. This was a qualitative descriptive study which followed the directives of a research in development. It was expected that the cities adopted the resolution corresponding to the primary treatment level, having Center for the Integral Care of Women’s Health as a reference center for the conditions demanding a higher complexity level of care. The cities which demonstrated interest and accepted the proposal were: Amparo, Atibaia, Indaiatuba, Mogi-Mirim, São João da Boa Vista and São João do Rio Pardo. Strategy for implementation included prior professionals qualification and accomplishment of specifc meetings in each city to seek political and strategic support for the implementation of these activities. Since data were collected through interviews, analysis included: the raw material preparation and description; reduction in data; decodification; vertical and cross analysis. The model was operational in the cities of: Amparo, Atibaia, Indaiatuba and São José do Rio Pardo. There was an increase in resolution and a positive perception of the biopsychosocial effects regarding patients and family members from the viewpoint of health care professionals and family

  5. Wild orangutan males plan and communicate their travel direction one day in advance.

    Directory of Open Access Journals (Sweden)

    Carel P van Schaik

    Full Text Available The ability to plan for the future beyond immediate needs would be adaptive to many animal species, but is widely thought to be uniquely human. Although studies in captivity have shown that great apes are capable of planning for future needs, it is unknown whether and how they use this ability in the wild. Flanged male Sumatran orangutans (Pongo abelii emit long calls, which females use to maintain earshot associations with them. We tested whether long calls serve to communicate a male's ever-changing predominant travel direction to facilitate maintaining these associations. We found that the direction in which a flanged male emits his long calls predicts his subsequent travel direction for many hours, and that a new call indicates a change in his main travel direction. Long calls given at or near the night nest indicate travel direction better than random until late afternoon on the next day. These results show that male orangutans make their travel plans well in advance and announce them to conspecifics. We suggest that such a planning ability is likely to be adaptive for great apes, as well as in other taxa.

  6. Inter-subject variability modulates phonological advance planning in the production of adjective-noun phrases

    Directory of Open Access Journals (Sweden)

    Violaine eMichel Lange

    2014-01-01

    Full Text Available The literature on advance phonological planning in adjective-noun phrases (NPs presents diverging results: while many experimental studies suggest that the entire NP is encoded before articulation, other results favour a span of encoding limited to the first word. Although cross-linguistic differences in the structure of adjective-noun phrases may account for some of these contrasting results, divergences have been reported even among similar languages and syntactic structures. Here we examined whether inter-individual differences account for variability in the span of phonological planning in the production of French NPs, where previous results indicated encoding limited to the first word. The span of phonological encoding is tested with the picture-word interference (PWI paradigm using phonological distractors related to the noun or to the adjective of the NPs. In Experiment 1, phonological priming effects were limited to the first word in adjective NPs whichever the position of the adjective (pre-nominal or post-nominal. Crucially, phonological priming effects on the second word interacted with speakers´ production speed suggesting different encoding strategies for participants. In Experiment 2, we tested this hypothesis further with a larger group of participants. Results clearly showed that slow and fast initialising participants presented different phonological priming patterns on the last element of adjective-noun phrases: while the first word was primed by a distractor for all speakers, only the slow speaker group presented a priming effect on the second element of the NP. These results show that the span of phonological encoding is modulated by inter-individual strategies: in experimental paradigms some speakers plan word by word whereas others encode beyond the initial word. We suggest that the diverging results reported in the literature on advance phonological planning may partly be reconciled in light of the present results.

  7. Corporate compliance plans in health care organizations: a top-down perspective.

    Science.gov (United States)

    Forgione, D A

    1998-01-01

    Recently, at an all-day professional meeting that was targeted at about 100 junior-level health care financial professionals, we covered a whole spectrum of subjects. We covered topics ranging from the Hill-Burton Act to Medicare managed care organizations (MCOs) and capitation; the Stark rules on physician self-referral; the financial incentives within various payment systems for physicians, hospitals, and other providers; Medicare fraud and abuse rules; and the need for well-designed corporate compliance plans. After responding to a number of the participants' questions, I could not help but be reminded of the students every semester who ask me, "Will this be on the test?" In other words, if there are no real teeth in the subject, then they have too many other urgent priorities demanding their attention to give the issue serious consideration. Perhaps this highlights the need for taking corporate compliance planning seriously--starting at the top levels of the organization. It is well documented that leadership attitudes filter downward in any organization. If change for the better is going to take place in the area of corporate compliance, it needs to begin with each of us as individuals, from the top down. PMID:9612741

  8. Editorial: Advances in healthcare provider and patient training to improve the quality and safety of patient care

    OpenAIRE

    Borycki, Elizabeth M

    2015-01-01

    This special issue of the Knowledge Management & E-Learning: An International Journal is dedicated to describing “Advances in Healthcare Provider and Patient Training to Improve the Quality and Safety of Patient Care.” Patient safety is an important and fundamental requirement of ensuring the quality of patient care. Training and education has been identified as a key to improving healthcare provider patient safety competencies especially when working with new technologies such as electronic ...

  9. Family planning: formal health care providers’ challenges in the district of Antananarivo Avaradrano

    Directory of Open Access Journals (Sweden)

    Barbara Elyan Edwige Vololonarivelo

    2013-06-01

    Full Text Available Background: Recorded contraceptive prevalence may not represent all the women using contraceptives. Nevertheless, it serves as a fundamental tool in decision-making at Ministry and international level. This study aims to determine the actual contraceptive prevalence and identify factors determining users’ positions about modern contraception and local services deliveries in the district of Antananarivo Avaradrano. Methods: A cross-sectional survey was conducted, where an interviewer-administered questionnaire has been used to collect data. Targeted female respondents aged 18-39 were asked about their contraceptive use, knowledge and information sources on family planning, perception of social support and perception on the local health care providers. Results: Contraceptive prevalence is underestimated. Moreover, it is higher among women aged 35 to 39 and those having two children or more, but lower among those who have reached university level of education. Women who are able to tell two benefits of family planning, informed by the community health agents (CHA, and deciding with their partners on contraception use are more likely to use contraceptives on a regular basis. Women complain on their poor relationship with health care providers and doubt about their real competence. Conclusions: This study demonstrates the evidence of an underestimation of contraceptive prevalence. The challenge is how to collect reliable data, thus recording systems have to be improved. Besides, government efforts in increasing contraceptive use ought to be targeted on adolescents and young people aged 20-25, the couple itself, health-care provider – woman relationship, and on the CHA’s activities. [Int J Res Med Sci 2013; 1(3.000: 204-211

  10. Palliative care in advanced gynecological cancers: Institute of palliative medicine experience

    Directory of Open Access Journals (Sweden)

    Sushmita Pathy

    2008-01-01

    Full Text Available Aim: To study the epidemiological profile, clinical symptoms and referral patterns of patients with gynecological malignancy. To evaluate pain symptoms, response to treatment and factors affecting management in patients with advanced gynecological malignancies. Methods: A retrospective analysis was performed of the gynecological malignancy cases registered at the Pain and Palliative Care Clinic, Calicut, over a 12-month period between January 2006 and December 2006.Patient characteristics, symptoms and response to treatment were evaluated in detail. Results: A total of 1813 patients registered, of which 64 had gynecological malignancies. Most of the cases were referred from the Oncology Department of the Calicut Medical College. Fifty-five percent of the patients were unaware of their diagnosis. Psychosocial issues and anxiety were observed in 48%. Insomnia was seen in 52% of the cases. Pain was the most common and most distressing symptom. Adequate pain relief was achieved in only 32% of the patients. Conclusions: The number of gynecological malignancy cases attending the Pain and Palliative Care Clinic is small. Pain is the most common and distressing symptom, with only 32% of the patients achieving adequate pain relief. Poor drug compliance, incomplete assessment of pain and the lack of awareness of morphine therapy were identified as the most common causes for poor pain control.

  11. Advances in Supportive Care for Late Effects of Head and Neck Cancer.

    Science.gov (United States)

    Murphy, Barbara A; Deng, Jie

    2015-10-10

    As the population of head and neck cancer survivors increases, it has become increasingly important for health care providers to understand and manage late complications of therapy. Functional deficits can be categorized as general health deficits resulting in frailty or debility, head and neck-specific functional deficits such as swallowing and speech, and musculoskeletal impairment as a result of tumor and treatment. Of critical importance is the growing data indicating that swallow therapy and physical therapy may prevent or ameliorate long-term functional deficits. Oral health complications of head and neck therapy may manifest months or years after the completion of treatment. Patients with hyposalivation are at high risk for dental caries and thus require aggressive oral hygiene regimens and routine dental surveillance. Swallowing abnormalities, xerostomia, and poor dentition may result in dietary adaptations that may cause nutritional deficiencies. Identification and management of maladaptive dietary strategies are important for long-term health. Follow-up with primary care physicians for management of comorbidities such as diabetes and hyperlipidemia may help to limit late vascular complications caused by radiation therapy. Herein, we review late effects of head and neck cancer therapy, highlighting recent advances. PMID:26351334

  12. Advanced Imaging and Receipt of Guideline Concordant Care in Women with Early Stage Breast Cancer

    Science.gov (United States)

    Buist, Diana S. M.; Gold, Laura S.; Zeliadt, Steven; Hunter Merrill, Rachel; Etzioni, Ruth; Ramsey, Scott D.; Sullivan, Sean D.; Kessler, Larry

    2016-01-01

    Objective. It is unknown whether advanced imaging (AI) is associated with higher quality breast cancer (BC) care. Materials and Methods. Claims and Surveillance Epidemiology and End Results data were linked for women diagnosed with incident stage I-III BC between 2002 and 2008 in western Washington State. We examined receipt of preoperative breast magnetic resonance imaging (MRI) or AI (defined as computed tomography [CT]/positron emission tomography [PET]/PET/CT) versus mammogram and/or ultrasound (M-US) alone and receipt of guideline concordant care (GCC) using multivariable logistic regression. Results. Of 5247 women, 67% received M-US, 23% MRI, 8% CT, and 3% PET/PET-CT. In 2002, 5% received MRI and 5% AI compared to 45% and 12%, respectively, in 2008. 79% received GCC, but GCC declined over time and was associated with younger age, urban residence, less comorbidity, shorter time from diagnosis to surgery, and earlier year of diagnosis. Breast MRI was associated with GCC for lumpectomy plus radiation therapy (RT) (OR 1.55, 95% CI 1.08–2.26, and p = 0.02) and AI was associated with GCC for adjuvant chemotherapy for estrogen-receptor positive (ER+) BC (OR 1.74, 95% CI 1.17–2.59, and p = 0.01). Conclusion. GCC was associated with prior receipt of breast MRI and AI for lumpectomy plus RT and adjuvant chemotherapy for ER+ BC, respectively. PMID:27525122

  13. Family-centred care during midface advancement with a rigid external device: what do families need?

    Science.gov (United States)

    Bredero-Boelhouwer, H; Joosten, K F M; van Veen-van der Hoek, M; Mathijssen, I M J

    2013-08-01

    Midface advancement with distraction osteogenesis using the rigid external device (RED) is an effective but invasive treatment to correct the hypoplastic midface. This study draws up an inventory of the stressors, needs and coping strategies of families during this treatment, to determine the best conditions for family-centred care. Data were collected by reviewing the patients' files and administering semi-structured interviews. The data were analysed using the software program Atlas.ti and were re-analysed by an independent researcher. Parents and patients were interviewed separately. Fourteen families participated. Four patients had an absolute indication for surgery. All families were eager to have the patient's facial appearance improved. Nevertheless, despite psychological counselling, they experienced stress when confronted with the changed facial appearance. Another stressor was weight loss. Six patients were in a state of acute malnutrition and needed supplementary feeding. We conclude that the best conditions for family-centred care should be aligned to the different phases of treatment. Leading up to surgery it is important to screen families' expectations regarding aesthetic, functional and social outcomes and to assess their capacity to cope with the long treatment and effects of changed facial appearance. Peer contact and psychosocial training to increase self-esteem are tools to enhance co-operation and satisfaction. During the distraction and stabilisation phase, we advise the monitoring of nutritional intake and weight. During all phases of treatment easy accessibility to the team is recommended. PMID:23664572

  14. Effectiveness of improvement plans in primary care practice accreditation: a clustered randomized trial.

    Directory of Open Access Journals (Sweden)

    Elvira Nouwens

    Full Text Available BACKGROUND: Accreditation of healthcare organizations is a widely used method to assess and improve quality of healthcare. Our aim was to determine the effectiveness of improvement plans in practice accreditation of primary care practices, focusing on cardiovascular risk management (CVRM. METHOD: A two-arm cluster randomized controlled trial with a block design was conducted with measurements at baseline and follow-up. Primary care practices allocated to the intervention group (n = 22 were instructed to focus improvement plans during the intervention period on CVRM, while practices in the control group (n = 23 could focus on any domain except on CVRM and diabetes mellitus. Primary outcomes were systolic blood pressure <140 mmHg, LDL cholesterol <2.5 mmol/l and prescription of antiplatelet drugs. Secondary outcomes were 17 indicators of CVRM and physician's perceived goal attainment for the chosen improvement project. RESULTS: No effect was found on the primary outcomes. Blood pressure targets were reached in 39.8% of patients in the intervention and 38.7% of patients in the control group; cholesterol target levels were reached in 44.5% and 49.0% respectively; antiplatelet drugs were prescribed in 82.7% in both groups. Six secondary outcomes improved: smoking status, exercise control, diet control, registration of alcohol intake, measurement of waist circumference, and fasting glucose. Participants' perceived goal attainment was high in both arms: mean scores of 7.9 and 8.2 on the 10-point scale. CONCLUSIONS: The focus of improvement plans on CVRM in the practice accreditation program led to some improvements of CVRM, but not on the primary outcomes. ClinicalTrials.gov NCT00791362.

  15. Quality control in health care: an experiment in radiotherapy planning for breast cancer patients after mastectomy

    International Nuclear Information System (INIS)

    Purpose: The importance of evaluating and improving quality in clinical practice is now generally acknowledged. In this study we estimated different sources of variation in radiotherapy planning for breast cancer patients after mastectomy and sought to test the applicability of a reproducibility and repeatability (R and R) study in a clinical context. Methods: Eleven radiation oncologists planned radiotherapy three times for three different kinds of breast cancer patients without knowing they were handling the same patient three times. Variation was divided into different components: physicians as operators, patients as parts, and repeated measurements as trials. Variation due to difference across trials (repeatability), that across the physicians (reproducibility), and that across the patients (variability) were estimated, as well as interactions between physicians and patients. Calculation was based on the sum of squares, and analysis was supported by various graphical presentations such as range charts and box plots. Results: Some parts of the planning process were characterized by higher and different kinds of variation than the others. Interphysician variation (i.e., reproducibility) was not high but there were some clearly outlying physicians. The highest variation was in repeatability (intraphysician variation). The major part of the variation was, however, that from patient to patient: 33% of the total in Parameter 1 and 85% of the total in Parameter 2. Conclusions: R and R studies are applicable and are needed to evaluate and improve quality in clinical practice. This kind of analysis provides opportunities to establish which kinds of patients require particularly careful attention, which points in the process are most critical for variation, which are the most difficult aspects for each physician and call for more careful description in documents, and which physicians need further training

  16. Communication About Sexuality in Advanced Illness Aligns With a Palliative Care Approach to Patient-Centered Care.

    Science.gov (United States)

    Leung, Margaret W; Goldfarb, Shari; Dizon, Don S

    2016-02-01

    Treatment-related sexual complications are common in cancer patients although rarely discussed in the palliative care setting. Sexuality is an important survivorship issue and remains relevant even in the terminal setting. There are multiple barriers in dialoguing about intimacy and sexual functioning from the patient and provider perspectives. Palliative care providers, while not expected to be sexual health experts, can provide comprehensive patient-centered care by including sexual health as part of their evaluation. They can explore how sexual dysfunction can impair functioning and utilize an interdisciplinary approach to manage symptoms. Palliative care providers can help patients identify their goals of care and explore what anticipated sexual changes and treat-related side effects are tolerable and intolerable to the patient's quality of life. Principles on addressing sexuality in the palliative setting and practical ways of incorporating sexual history into the palliative care assessment are provided. PMID:26769116

  17. Factors associated with the designation of a health care proxy and writing advance directives for patients suffering from haematological malignancies

    OpenAIRE

    Trarieux-Signol, Sophie; Moreau, Stéphane; Gourin, Marie-Pierre; Penot, Amélie; Edoux de Lafont, Geoffroy; Preux, Pierre-Marie; Bordessoule, Dominique

    2014-01-01

    Background During the last few decades, patients’ rights have been reinforced in many countries by acts of law. Measures now include health care proxies to uphold the doctor-patient relationship and advance directives for end-of-life patients. These could be relevant tools as early as the initial diagnosis of haematological malignancies because of the uncertain disease course. The aim of this research was to assess the factors associated with the designation of a proxy and writing advance dir...

  18. Planning of development strategy for establishment of advanced simulation of nuclear system

    International Nuclear Information System (INIS)

    In this product, the long term development plan in each technical area has been prosed with the plan of coupled code system. The consolidated code system for safety analysis has been proposing for future needs. The computing hardware needed for te advanced simulation is also proposing. The best approach for future safety analysis simulation capabilities may be a dual-path program. i. e. the development programs for an integrated analysis tool and multi-scale/multi-physic analysis tools, where the former aims at reducing uncertainty and the latter at enhancing accuracy. Integrated analysis tool with risk informed safety margin quantification It requires a significant extension of the phenomenological and geometric capabilities of existing reactor safety analysis software, capable of detailed simulations that reduce the uncertainties. Multi-scale, multi-physics analysis tools. Simplifications of complex phenomenological models and dependencies have been made in current safety analyses to accommodate computer hardware limitations. With the advent of modern computer hardware, these limitations may be removed to permit greater accuracy in representation of physical behavior of materials in design basis and beyond design basis conditions, and hence more accurate assessment of the true safety margins based on first principle methodology. The proposals can be utilized to develop the advanced simulation project and formulation of organization and establishment of high performance computing system in KAERI

  19. 2015 ACC Health Policy Statement on Cardiovascular Team-Based Care and the Role of Advanced Practice Providers.

    Science.gov (United States)

    Brush, John E; Handberg, Eileen M; Biga, Cathleen; Birtcher, Kim K; Bove, Alfred A; Casale, Paul N; Clark, Michael G; Garson, Arthur; Hines, Jerome L; Linderbaum, Jane A; Rodgers, George P; Shor, Robert A; Thourani, Vinod H; Wyman, Janet F

    2015-05-19

    The mission of the American College of Cardiology is "to transform cardiovascular care and improve heart health." Cardiovascular team-based care is a paradigm for practice that can transform care, improve heart health, and help meet the demands of the future. One strategic goal of the College is to help members successfully transition their clinical practices to the future, with all its complexity, challenges, and opportunities. The ACC's strategic plan is aligned with the triple aim of improved care, improved population health, and lower costs per capita. The traditional understanding of quality, access, and cost is that you cannot improve one component without diminishing the others. With cardiovascular team-based care, it is possible to achieve the triple aim of improving quality, access, and cost simultaneously to also improve cardiovascular health. Striving to serve the best interests of patients is the true north of our guiding principles. Cardiovascular team-based care is a model that can improve care coordination and communication and allow each team member to focus more on the quality of care. In addition, the cardiovascular team-based care model increases access to cardiovascular care and allows expansion of services to populations and geographic areas that are currently underserved. This document will increase awareness of the important components of cardiovascular team-based care and create an opportunity for more discussion about the most creative and effective means of implementing it. We hope that this document will stimulate further discussions and activities within the ACC and beyond about team-based care. We have identified areas that need improvement, specifically in APP education and state regulation. The document encourages the exploration of collaborative care models that should enable team members to optimize their education, training, experience, and talent. Improved team leadership, coordination, collaboration, engagement, and efficiency

  20. Where We Are Headed--and Why? A Step-by-Step Guide to Strategic Planning in Center-Based Child Care.

    Science.gov (United States)

    Ratekin, Cindy; Bess, Gary

    1995-01-01

    Argues that strategic planning by all involved in a child care center facilitates planning for the future. This planning includes representation of all parties concerned; attendance at planning events; equal participation; analysis of center's current status; planning sessions in places encouraging creativity; and a skilled, impartial facilitator.…

  1. Development of an interactive model for planning the care workforce for Alberta: case study

    Directory of Open Access Journals (Sweden)

    Bloom Judy

    2012-08-01

    Full Text Available Abstract Introduction In common with other jurisdictions, Alberta faces challenges in ensuring a balance in health worker supply and demand. As the provider organization with province-wide responsibility, Alberta Health Services needed to develop a forecasting tool to inform its position on key workforce parameters, in the first instance focused on modeling the situation for Registered Nurses, Licensed Practical Nurses and health care aides. This case study describes the development of the model, highlighting the choices involved in model development. Case description A workforce planning model was developed to test the effect of different assumptions (for instance about vacancy rates or retirement and different policy choices (for example about the size of intakes into universities and colleges, different composition of the workforce. This case study describes the choices involved in designing the model. The workforce planning model was used as part of a consultation process and to develop six scenarios (based on different policy choices. Discussion and evaluation The model outputs highlighted the problems with continuation of current workforce strategies and the impact of key policy choices on workforce parameters. Conclusions Models which allow for transparency of the underlying assumptions, and the ability to assess the sensitivity of assumptions and the impact of policy choices are required for effective workforce planning.

  2. An Assessment to Inform Pediatric Cancer Provider Development and Delivery of Survivor Care Plans.

    Science.gov (United States)

    Warner, Echo L; Wu, Yelena P; Hacking, Claire C; Wright, Jennifer; Spraker-Perlman, Holly L; Gardner, Emmie; Kirchhoff, Anne C

    2015-12-01

    Current guidelines recommend all pediatric cancer survivors receive a survivor care plan (SCP) for optimal health management, yet clinical delivery of SCPs varies. We evaluated oncology providers' familiarity with and preferences for delivering SCPs to inform the implementation of a future SCP program at our institution. From November 2013 to April 2014, oncology providers from the Primary Children's Hospital in Salt Lake City, UT, completed a survey (n=41) and a 45-min focus group (n=18). Participants reported their familiarity with and training in SCP guidelines, opinions on SCPs, and barriers to delivering SCPs. As a secondary analysis, we examined differences in survey responses between physicians and nurses with Fisher's exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Participants reported high familiarity with late effects of cancer treatment (87.8%) and follow-up care that cancer survivors should receive (82.5%). Few providers had delivered an SCP (oncologists 35.3% and nurses 5.0%; p=0.03). Barriers to providing SCPs included lack of knowledge (66.7%), SCP delivery is not expected in their clinic (53.9%), and no champion (48.7%). In qualitative comments, providers expressed that patient age variation complicated SCP delivery. Participants supported testing an SCP intervention program (95.1%) and felt this should be a team-based approach. Strategies for optimal delivery of SCPs are needed. Participants supported testing an SCP program to improve the quality of patient care. Team-based approaches, including nurses and physicians, that incorporate provider training on and support for SCP delivery are needed to improve pediatric cancer care. PMID:25893925

  3. Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center

    OpenAIRE

    Leppert, Wojciech; Majkowicz, Mikolaj; Forycka, Maria; Mess, Eleonora; Zdun-Ryzewska, Agata

    2014-01-01

    Aim of the study To assess quality of life (QoL) in cancer patients treated at home, at an in-patient palliative care unit (PCU), and at a day care center (DCC). Patients and methods QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL), the Edmonton Symptom Assessment System (ESAS), and the Karnofsky Perfor...

  4. Office of River Protection Advanced Low-Activity Waste Glass Research and Development Plan

    Energy Technology Data Exchange (ETDEWEB)

    Peeler, David K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Kim, Dong-Sang [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Vienna, John D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Schweiger, Michael J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Piepel, Gregory F. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-11-01

    The U.S. Department of Energy Office of River Protection (ORP) has initiated and leads an integrated Advanced Waste Glass (AWG) program to increase the loading of Hanford tank wastes in glass while meeting melter lifetime expectancies and process, regulatory, and product performance requirements. The integrated ORP program is focused on providing a technical, science-based foundation for making key decisions regarding the successful operation of the Hanford Tank Waste Treatment and Immobilization Plant (WTP) facilities in the context of an optimized River Protection Project (RPP) flowsheet. The fundamental data stemming from this program will support development of advanced glass formulations, key product performance and process control models, and tactical processing strategies to ensure safe and successful operations for both the low-activity waste (LAW) and high-level waste vitrification facilities. These activities will be conducted with the objective of improving the overall RPP mission by enhancing flexibility and reducing cost and schedule. The purpose of this advanced LAW glass research and development plan is to identify the near-term, mid-term, and longer-term research and development activities required to develop and validate advanced LAW glasses, property-composition models and their uncertainties, and an advanced glass algorithm to support WTP facility operations, including both Direct Feed LAW and full pretreatment flowsheets. Data are needed to develop, validate, and implement 1) new glass property-composition models and 2) a new glass formulation algorithm. Hence, this plan integrates specific studies associated with increasing the Na2O and SO3/halide concentrations in glass, because these components will ultimately dictate waste loadings for LAW vitrification. Of equal importance is the development of an efficient and economic strategy for 99Tc management. Specific and detailed studies are being implemented to understand the fate of Tc throughout

  5. The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians

    Directory of Open Access Journals (Sweden)

    Schopper Andrea

    2010-10-01

    Full Text Available Abstract Background Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation. In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008. Methods Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation. Results There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy. Conclusion A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward.

  6. Frequency and Correlates of Advance Planning Among Cognitively Impaired Older Adults

    Science.gov (United States)

    Lingler, Jennifer Hagerty; Hirschman, Karen B.; Garand, Linda; Dew, Mary Amanda; Becker, James T.; Schulz, Richard; DeKosky, Steven T.

    2009-01-01

    Objective To examine the prevalence and sociodemographic correlates of written advance planning among patients with or at risk for dementia-imposed decisional incapacity. Design Retrospective, cross-sectional. Setting University-based memory disorders clinic. Participants Persons with a consensus-based diagnosis of mild cognitive impairment (N = 112), probable or possible Alzheimer disease (AD; N = 549), and nondemented comparison subjects (N = 84). Intervention N/A. Measurements Semistructured interviews to assess durable power of attorney (DPOA) and living will (LW) status upon initial presentation for a dementia evaluation. Results Sixty-five percent of participants had a DPOA and 56% had a LW. Planning rates did not vary by diagnosis. European Americans (adjusted odds ratio = 4.75; 95% CI, 2.40-9.38), older adults (adjusted odds ratio = 1.05; 95% CI, 1.03-1.07) and college graduates (adjusted odds ratio = 2.06; 95% CI, 1.33-3.20) were most likely to have a DPOA. Findings were similar for LW rates. Conclusions Although a majority of persons with and at risk for the sustained and progressive decisional incapacity of AD are formally planning for the future, a substantial minority are not. PMID:18669942

  7. OPERATION OF ENTERPRISE RESOURCE PLANNING SYSTEM IMPLEMENTATION COMPATIBILITY TOWARDS TECHNICAL ADVANCEMENT

    Directory of Open Access Journals (Sweden)

    J. Venkatesh

    2013-01-01

    Full Text Available The Execution of ERP systems has been perplexing factor for many firms. Many establishments have accepted that the operation of ERP system is a massive hindrance until the flow of process is organized carefully. As information technology is booming its prerequisite for organizations to realize the prominence of technical advancement and compatibility in work environment. A complete review was done to ascertain the features and strategic aids of ERP enactments using the retorts from 120 firms. The respondents were approached with orderly framed questionnaires, thereby giving them ample time to come out with their own thoughts. The effects of this learning provide assistance for the vendors, higher officials and ERP specialists to be more competent in handling the execution of ERP with their inadequate possessions there by augmenting the business. It acts a pathway for the concerns to realize their potent and extend their business platform.

  8. Health Care System Measures to Advance Preconception Wellness: Consensus Recommendations of the Clinical Workgroup of the National Preconception Health and Health Care Initiative.

    Science.gov (United States)

    Frayne, Daniel J; Verbiest, Sarah; Chelmow, David; Clarke, Heather; Dunlop, Anne; Hosmer, Jennifer; Menard, M Kathryn; Moos, Merry-K; Ramos, Diana; Stuebe, Alison; Zephyrin, Laurie

    2016-05-01

    Preconception wellness reflects a woman's overall health before conception as a strategy to affect health outcomes for the woman, the fetus, and the infant. Preconception wellness is challenging to measure because it attempts to capture health status before a pregnancy, which may be affected by many different service points within a health care system. The Clinical Workgroup of the National Preconception Health and Health Care Initiative proposes nine core measures that can be assessed at initiation of prenatal care to index a woman's preconception wellness. A two-stage web-based modified Delphi survey and a face-to-face meeting of key opinion leaders in women's reproductive health resulted in identifying seven criteria used to determine the core measures. The Workgroup reached unanimous agreement on an aggregate of nine preconception wellness measures to serve as a surrogate but feasible assessment of quality preconception care within the larger health community. These include indicators for: 1) pregnancy intention, 2) access to care, 3) preconception multivitamin with folic acid use, 4) tobacco avoidance, 5) absence of uncontrolled depression, 6) healthy weight, 7) absence of sexually transmitted infections, 8) optimal glycemic control in women with pregestational diabetes, and 9) teratogenic medication avoidance. The focus of the proposed measures is to quantify the effect of health care systems on advancing preconception wellness. The Workgroup recommends that health care systems adopt these nine preconception wellness measures as a metric to monitor performance of preconception care practice. Over time, monitoring these baseline measures will establish benchmarks and allow for comparison within and among regions, health care systems, and communities to drive improvements. PMID:27054935

  9. Technology Alignment and Portfolio Prioritization (TAPP): Advanced Methods in Strategic Analysis, Technology Forecasting and Long Term Planning for Human Exploration and Operations, Advanced Exploration Systems and Advanced Concepts

    Science.gov (United States)

    Funaro, Gregory V.; Alexander, Reginald A.

    2015-01-01

    The Advanced Concepts Office (ACO) at NASA, Marshall Space Flight Center is expanding its current technology assessment methodologies. ACO is developing a framework called TAPP that uses a variety of methods, such as association mining and rule learning from data mining, structure development using a Technological Innovation System (TIS), and social network modeling to measure structural relationships. The role of ACO is to 1) produce a broad spectrum of ideas and alternatives for a variety of NASA's missions, 2) determine mission architecture feasibility and appropriateness to NASA's strategic plans, and 3) define a project in enough detail to establish an initial baseline capable of meeting mission objectives ACO's role supports the decision­-making process associated with the maturation of concepts for traveling through, living in, and understanding space. ACO performs concept studies and technology assessments to determine the degree of alignment between mission objectives and new technologies. The first step in technology assessment is to identify the current technology maturity in terms of a technology readiness level (TRL). The second step is to determine the difficulty associated with advancing a technology from one state to the next state. NASA has used TRLs since 1970 and ACO formalized them in 1995. The DoD, ESA, Oil & Gas, and DoE have adopted TRLs as a means to assess technology maturity. However, "with the emergence of more complex systems and system of systems, it has been increasingly recognized that TRL assessments have limitations, especially when considering [the] integration of complex systems." When performing the second step in a technology assessment, NASA requires that an Advancement Degree of Difficulty (AD2) method be utilized. NASA has used and developed or used a variety of methods to perform this step: Expert Opinion or Delphi Approach, Value Engineering or Value Stream, Analytical Hierarchy Process (AHP), Technique for the Order of

  10. Exploring motivations to seek and undergo prosthodontic care: an empirical approach using the Theory of Planned Behavior construct

    OpenAIRE

    Vieira AH; Leles CR

    2014-01-01

    Antonio Hélio Vieira, Cláudio Rodrigues Leles Department of Prevention and Oral Rehabilitation, School of Dentistry, Federal University of Goias, Goiania, Goias, Brazil Abstract: Motivations for seeking and undergoing prosthodontic care are poorly understood and are not often explored for clinical purposes when determining treatment need and understanding the factors related to the demand for health care and effective use. This article uses the Theory of Planned Behavi...

  11. Efficacy of an Intervention Based on the Theory of Planned Behavior on Foot Care Performance in Type II Diabetic Patients

    OpenAIRE

    Beiranvand; Asadizaker; Fayazi; Yaralizadeh

    2015-01-01

    Background It is known that health education on foot care is a common strategy for preventing diabetic foot and reducing the rate of lower limb amputation. Objectives To evaluate the efficacy of an intervention based on the theory of planned behavior for improving foot care in patients with type II diabetes in 2013 in Ahvaz, Iran. Patients and Methods In this clinical trial, 69 pat...

  12. Using machine learning algorithms to guide rehabilitation planning for home care clients

    Directory of Open Access Journals (Sweden)

    Hirdes John P

    2007-12-01

    Full Text Available Abstract Background Targeting older clients for rehabilitation is a clinical challenge and a research priority. We investigate the potential of machine learning algorithms – Support Vector Machine (SVM and K-Nearest Neighbors (KNN – to guide rehabilitation planning for home care clients. Methods This study is a secondary analysis of data on 24,724 longer-term clients from eight home care programs in Ontario. Data were collected with the RAI-HC assessment system, in which the Activities of Daily Living Clinical Assessment Protocol (ADLCAP is used to identify clients with rehabilitation potential. For study purposes, a client is defined as having rehabilitation potential if there was: i improvement in ADL functioning, or ii discharge home. SVM and KNN results are compared with those obtained using the ADLCAP. For comparison, the machine learning algorithms use the same functional and health status indicators as the ADLCAP. Results The KNN and SVM algorithms achieved similar substantially improved performance over the ADLCAP, although false positive and false negative rates were still fairly high (FP > .18, FN > .34 versus FP > .29, FN. > .58 for ADLCAP. Results are used to suggest potential revisions to the ADLCAP. Conclusion Machine learning algorithms achieved superior predictions than the current protocol. Machine learning results are less readily interpretable, but can also be used to guide development of improved clinical protocols.

  13. Survivorship care planning in a comprehensive cancer center using an implementation framework.

    Science.gov (United States)

    Garcia, Sofia F; Kircher, Sheetal M; Oden, Megan; Veneruso, Aubri; McKoy, June M; Pearman, Timothy; Penedo, Frank J

    2016-05-01

    Cancer survivorship care plans (SCPs) have been recommended to improve clinical care and patient outcomes. Research is needed to establish their efficacy and identify best practices. Starting in 2015, centers accredited by the American College of Surgeons Commission on Cancer must deliver SCPs to patients completing primary cancer treatment with curative intent. We describe how we established routine SCP delivery at the Robert H Lurie Comprehensive Cancer Center in Chicago, Illinois, using the Quality Implementation Framework. We evaluated local practices, gathered clinician and patient stakeholder input, developed customized SCP templates within the electronic health record (EHR), and implemented 2 complementary delivery models. Clinician interviews (n = 41) and survey responses (n = 12), along with input from patients (n = 68) and a patient advisory board (n = 15), indicated support for SCPs and survivorship services. To promote feasible implementation and leverage existing workflows, we harmonized 2 SCP delivery models: integrated care within clinics where patients received treatment, and referral to a centralized survivorship clinic. We are implementing SCP delivery with prominent disease sites and will extend services to survivors of other cancers in the future. We developed four electronic disease-specific SCP templates for breast, colorectal, lung, and prostate cancers and a fifth, generic template that can be used for other malignancies. The templates reduced free-text clinician entry by auto-populating 20% of the fields from existing EHR data, and using drop-down menus for another 65%. Mean SCP completion time is 12 minutes (range, 10-15; n = 64). We designed our framework to facilitate ongoing evaluation of implementation and quality improvement. Funding/sponsorship Robert H Lurie Comprehensive Cancer Center, the Coleman Foundation, and the Lynn Sage Cancer Research Foundation. PMID:27258051

  14. Consumer-directed health plans: are medical and health savings accounts viable options for financing American health care?

    Science.gov (United States)

    Masri, Maysoun Demachkie; Oetjen, Reid M; Campbell, Claudia

    2010-01-01

    When Americans voted in November 2008, many had the presidential candidates' positions on health care reform in mind. Health savings accounts, which are high deductible health plans coupled with a tax-protected savings account, are 1 type of consumer-directed health plan (CDHP) that gained strong support from the Bush administration. Despite evidence of the effectiveness of CDHPs in constraining costs in other countries, the Obama health plan contains no mention of their role in future US health reform. This article seeks to provide the reader with a better understanding of how CDHPs can help to improve the use of health resources and reduce national health care expenditures by exploring the history and previous research on several types of consumer-directed plans and by providing a comparative analysis of the use of CDHPs in other countries. PMID:20686396

  15. Planned search for LIGO-GBM coincidence in the first advanced LIGO data run

    CERN Document Server

    Camp, Jordan; Briggs, Michael; Christensen, Nelson; Connaughton, Valerie; Singer, Leo; Shawhan, Peter; Veitch, John

    2015-01-01

    In the fall of 2015 the first scientific observing run (O1) of the advanced LIGO detectors will be conducted. Based on the recent commissioning progress at the LIGO Hanford and Livingston sites, the gravitational wave detector range for a neutron star binary inspiral is expected to be of order 60 Mpc. We describe here our planning for an O1 search for coincidence between a LIGO gravitational wave detection and a gamma-ray signal from the Fermi Gamma-ray Burst Monitor. Such a coincidence would constitute measurement of an electromagnetic counterpart to a gravitational wave signal, with significant corresponding scientific benefits, including revealing the central engine powering the gamma-ray burst, enhanced confidence in the event as a genuine astrophysical detection, and a determination of the relative speed of the photon and graviton.

  16. Advanced Simulation and Computing Fiscal Year 2016 Implementation Plan, Version 0

    Energy Technology Data Exchange (ETDEWEB)

    McCoy, M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Archer, B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Hendrickson, B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2015-08-27

    The Stockpile Stewardship Program (SSP) is an integrated technical program for maintaining the safety, surety, and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational capabilities to support these programs. The purpose of this IP is to outline key work requirements to be performed and to control individual work activities within the scope of work. Contractors may not deviate from this plan without a revised WA or subsequent IP.

  17. Financial Planning for Military Child Care Centers: A Guidebook Based on the Experiences of the Fort Lewis Child Care Center.

    Science.gov (United States)

    Office of the Assistant Secretary of Defense for Manpower and Reserve Affairs (DOD), Washington, DC.

    Good record keeping--along with a constant and detailed knowledge of expenses, income, profit, and loss--is the first step toward profitable management of a child care center. Good record keeping is especially important in a center that provides "drop-in" or occasional care because income may fluctuate greatly as a result of the variable number of…

  18. Advance Directives for End-of-Life Care and the Role of Health Education Specialists: Applying the Theory of Reasoned Action

    Science.gov (United States)

    Tremethick, Mary Jane; Johnson, Maureen K.; Carter, Mary R.

    2011-01-01

    Quality end-of-life care is subjective and based on individual values and beliefs. An advance directive provides a legal means of communicating these values and beliefs, as well as preferences in regards to end-of-life care when an individual is no longer able to make his or her desires known. In many nations, advance directives are underused…

  19. Advances in diagnosis, clinical care, research, and treatment in retinopathy of prematurity

    Directory of Open Access Journals (Sweden)

    Hartnett ME

    2016-05-01

    Full Text Available M Elizabeth Hartnett,1–3 Antonio Capone Jr4,5 1Vitreoretinal Surgery, John A. Moran Eye Center, 2Department of Ophthalmology, 3Department of Neurobiology and Anatomy, and Pediatrics, University of Utah, Salt Lake City, UT, 4Associated Retina Consultants, Royal Oak, 5Department of Ophthalmology, Oakland University William Beaumont Hospital School of Medicine, Auburn Hills, MI, USAThe appearance of retinopathy of prematurity (ROP has changed throughout the world and since the first description of “retrolental fibroplasia” in 1942. However, despite advances in neonatal care and the abilities to improve the survival of ever younger and smaller premature infants, ROP remains a leading cause of childhood blindness worldwide. We know that ROP is complex in that it is influenced by genetic predisposition, epigenetic regulation, and environmental risks. It is strongly associated with extreme degrees of prematurity, and the “phenotype” of ROP depends on resources available to support premature infants with adequate nutrition and regulation of oxygen, as examples. New studies also suggest that what is seen in the preterm infant retina may portend later neurodevelopmental outcomes. Therefore, we believe this is a needed time to revisit ROP and provide a thematic issue focused on ROP from several perspectives.

  20. Advances in the conceptualization and measurement of Health Care Empowerment: development and validation of the Health Care Empowerment inventory.

    Directory of Open Access Journals (Sweden)

    Mallory O Johnson

    Full Text Available The Health Care Empowerment Model offers direction for the investigation of patient-controlled engagement and involvement in health care. At the core of the model is the construct of Health Care Empowerment (HCE, for which there exist no validated measures. A set of 27 candidate self-report survey items was constructed to capture five hypothesized inter-related facets of HCE (informed, engaged, committed, collaborative, and tolerant of uncertainty. The full item set was administered to 644 HIV-infected persons enrolled in three ongoing research studies. Exploratory and confirmatory factor analyses resulted in a two factor solution comprising four items each on two subscales: (1 HCE: Informed, Committed, Collaborative, and Engaged HCE ICCE and (2 HCE Tolerance of Uncertainty (HCE TU. Subscale scores were evaluated for relationships with relevant constructs measured in the three studies, including depression, provider relationships, medication adherence, and HIV-1 viral load. Findings suggest the utility of this 8-item Health Care Empowerment Inventory (HCEI in efforts to measure, understand, and track changes in the ways in which individuals engage in health care.

  1. Advances in the conceptualization and measurement of Health Care Empowerment: development and validation of the Health Care Empowerment inventory.

    Science.gov (United States)

    Johnson, Mallory O; Rose, Carol Dawson; Dilworth, Samantha E; Neilands, Torsten B

    2012-01-01

    The Health Care Empowerment Model offers direction for the investigation of patient-controlled engagement and involvement in health care. At the core of the model is the construct of Health Care Empowerment (HCE), for which there exist no validated measures. A set of 27 candidate self-report survey items was constructed to capture five hypothesized inter-related facets of HCE (informed, engaged, committed, collaborative, and tolerant of uncertainty). The full item set was administered to 644 HIV-infected persons enrolled in three ongoing research studies. Exploratory and confirmatory factor analyses resulted in a two factor solution comprising four items each on two subscales: (1) HCE: Informed, Committed, Collaborative, and Engaged HCE ICCE) and (2) HCE Tolerance of Uncertainty (HCE TU). Subscale scores were evaluated for relationships with relevant constructs measured in the three studies, including depression, provider relationships, medication adherence, and HIV-1 viral load. Findings suggest the utility of this 8-item Health Care Empowerment Inventory (HCEI) in efforts to measure, understand, and track changes in the ways in which individuals engage in health care. PMID:23029184

  2. A treatment planning comparison of four target volume contouring guidelines for locally advanced pancreatic cancer radiotherapy

    International Nuclear Information System (INIS)

    Background and purpose: Contouring of target volumes varies significantly in radiotherapy of pancreatic ductal adenocarcinoma (PDAC). There is a lack of consensus as to whether elective lymph nodes (eLN’s) should be included or not in the planning target volume (PTV). In the present study we analyzed the dosimetric coverage of the eLN’s and organs at risk (OAR) by comparing four different contouring guidelines. Methods and materials: PTVs were delineated with (Oxford and RTOG guidelines) or without (Michigan and SCALOP guidelines) including the eLNs in eleven patients with PDAC. eLNs included the peripancreatic, paraaortic, paracaval, celiac trunk, superior mesenteric and portal vein clinical target volumes (CTVs). A 3D-CRT plan (50.40 Gy in 28 fractions) was performed to analyze and compare the dosimetric coverage of all eLNs and OAR between the 4 contouring guidelines. Results: The size of Oxford and RTOG PTVs was comparable and significantly larger than the SCALOP and Michigan PTVs. Interestingly the eLNs received a significant amount of incidental dose irradiation by PTV-based plans that only aimed to treat the tumor without the eLNs. The dosimetric coverage of eLN presented a large variability according to the respective contouring methods. The difference in the size of the 4 PTVs was reflected to the dose distribution at the OAR. Conclusions: Our study provides important information regarding the impact of different contouring guidelines on the dose distribution to the eLNs and the OAR in patients with locally advanced PDAC treated with radiotherapy

  3. Inverse Planned High-Dose-Rate Brachytherapy for Locoregionally Advanced Cervical Cancer: 4-Year Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Tinkle, Christopher L.; Weinberg, Vivian [Department of Radiation Oncology, University of California, San Francisco, California (United States); Chen, Lee-May [Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California (United States); Littell, Ramey [Gynecologic Oncology, The Permanente Medical Group, San Francisco, California (United States); Cunha, J. Adam M.; Sethi, Rajni A. [Department of Radiation Oncology, University of California, San Francisco, California (United States); Chan, John K. [Gynecologic Oncology, California Pacific Medical Center, San Francisco, California (United States); Hsu, I-Chow, E-mail: ichow.hsu@ucsf.edu [Department of Radiation Oncology, University of California, San Francisco, California (United States)

    2015-08-01

    Purpose: Evaluate the efficacy and toxicity of image guided brachytherapy using inverse planning simulated annealing (IPSA) high-dose-rate brachytherapy (HDRB) boost for locoregionally advanced cervical cancer. Methods and Materials: From December 2003 through September 2009, 111 patients with primary cervical cancer were treated definitively with IPSA-planned HDRB boost (28 Gy in 4 fractions) after external radiation at our institution. We performed a retrospective review of our experience using image guided brachytherapy. Of the patients, 70% had a tumor size >4 cm, 38% had regional nodal disease, and 15% had clinically evident distant metastasis, including nonregional nodal disease, at the time of diagnosis. Surgical staging involving pelvic lymph node dissection was performed in 15% of patients, and 93% received concurrent cisplatin-based chemotherapy. Toxicities are reported according to the Common Terminology Criteria for Adverse Events version 4.0 guidelines. Results: With a median follow-up time of 42 months (range, 3-84 months), no acute or late toxicities of grade 4 or higher were observed, and grade 3 toxicities (both acute and late) developed in 8 patients (1 constitutional, 1 hematologic, 2 genitourinary, 4 gastrointestinal). The 4-year Kaplan-Meier estimate of late grade 3 toxicity was 8%. Local recurrence developed in 5 patients (4 to 9 months after HDRB), regional recurrence in 3 (6, 16, and 72 months after HDRB), and locoregional recurrence in 1 (4 months after HDR boost). The 4-year estimates of local, locoregional, and distant control of disease were 94.0%, 91.9%, and 69.1%, respectively. The overall and disease-free survival rates at 4 years were 64.3% (95% confidence interval [CI] of 54%-73%) and 61.0% (95% CI, 51%-70%), respectively. Conclusions: Definitive radiation by use of inverse planned HDRB boost for locoregionally advanced cervical cancer is well tolerated and achieves excellent local control of disease. However, overall

  4. Improving Demand-oriented Quality Care in Family Planning--A Review of Practice and Experience in Family Planning Programme of Qianjiang, Hubei

    Institute of Scientific and Technical Information of China (English)

    Jia-yuan LIAO; Meng-ye PENG; Er-sheng GAO

    2003-01-01

    @@ With the mainstreaming being the demand from the people at reproductive age, we systematically analyzed the ideas and ways to implement quality care (QC) in family planning (FP) in Qianjiang, including advocating the conception of quality care, carrying out health education and counseling, strengthening capacity building of service system and reforming measurement of the evaluation and other aspects. The demand-oriented QC in FP has met personalized and verified demands from people of reproductive age satisfactorily, and kept the fertility rate at a lower level while uplifting satisfaction of the public. The demand-oriented QC in FP in Qianjiang county proved to be a successful and great worth practice.

  5. Reliability of a patient survey assessing cost-related changes in health care use among high deductible health plan enrollees

    Directory of Open Access Journals (Sweden)

    Galbraith Alison A

    2011-05-01

    Full Text Available Abstract Background Recent increases in patient cost-sharing for health care have lent increasing importance to monitoring cost-related changes in health care use. Despite the widespread use of survey questions to measure changes in health care use and related behaviors, scant data exists on the reliability of such questions. Methods We administered a cross-sectional survey to a stratified random sample of families in a New England health plan's high deductible health plan (HDHP with ≥ $500 in annualized out-of-pocket expenditures. Enrollees were asked about their knowledge of their plan, information seeking, behavior change associated with having a deductible, experience of delay in care due in part to cost, and hypothetical delay in care due in part to cost. Initial respondents were mailed a follow-up survey within two weeks of each family returning the original survey. We computed several agreement statistics to measure the test-retest reliability for select questions. We also conducted continuity adjusted chi-square, and McNemar tests in both the original and follow-up samples to measure the degree to which our results could be reproduced. Analyses were stratified by self-reported income. Results The test-retest reliability was moderate for the majority of questions (0.41 - 0.60 and the level of test-retest reliability did not differ substantially across each of the broader domains of questions. The observed proportions of respondents with delayed or foregone pediatric, adult, or any family care were similar when comparing the original and follow-up surveys. In the original survey, respondents in the lower-income group were more likely to delay or forego pediatric care, adult care, or any family care. All of the tests comparing income groups in the follow-up survey produced the same result as in the original survey. Conclusions In this population of HDHP beneficiaries, we found that survey questions concerning plan knowledge, information

  6. Editorial: Advances in healthcare provider and patient training to improve the quality and safety of patient care

    Directory of Open Access Journals (Sweden)

    Elizabeth M. Borycki

    2015-09-01

    Full Text Available This special issue of the Knowledge Management & E-Learning: An International Journal is dedicated to describing “Advances in Healthcare Provider and Patient Training to Improve the Quality and Safety of Patient Care.” Patient safety is an important and fundamental requirement of ensuring the quality of patient care. Training and education has been identified as a key to improving healthcare provider patient safety competencies especially when working with new technologies such as electronic health records and mobile health applications. Such technologies can be harnessed to improve patient safety; however, if not used properly they can negatively impact on patient safety. In this issue we focus on advances in training that can improve patient safety and the optimal use of new technologies in healthcare. For example, use of clinical simulations and online computer based training can be employed both to facilitate learning about new clinical discoveries as well as to integrate technology into day to day healthcare practices. In this issue we are publishing papers that describe advances in healthcare provider and patient training to improve patient safety as it relates to the use of educational technologies, health information technology and on-line health resources. In addition, in the special issue we describe new approaches to training and patient safety including, online communities, clinical simulations, on-the-job training, computer based training and health information systems that educate about and support safer patient care in real-time (i.e. when health professionals are providing care to patients. These educational and technological initiatives can be aimed at health professionals (i.e. students and those who are currently working in the field. The outcomes of this work are significant as they lead to safer care for patients and their family members. The issue has both theoretical and applied papers that describe advances in patient

  7. Patient-centered cancer treatment planning: improving the quality of oncology care. Summary of an Institute of Medicine workshop.

    Science.gov (United States)

    Balogh, Erin P; Ganz, Patricia A; Murphy, Sharon B; Nass, Sharyl J; Ferrell, Betty R; Stovall, Ellen

    2011-01-01

    The Institute of Medicine's National Cancer Policy Forum recently convened a workshop on patient-centered cancer treatment planning, with the aim of raising awareness about this important but often overlooked aspect of cancer treatment. A primary goal of patient-centered treatment planning is to engage patients and their families in meaningful, thorough interactions with their health care providers to develop an accurate, well-conceived treatment plan, using all available medical information appropriately while also considering the medical, social, and cultural needs and desires of the patient and family. A cancer treatment plan can be shared among the patient, family, and care team in order to facilitate care coordination and provide a roadmap to help patients navigate the path of cancer treatment. There are numerous obstacles to achieving patient-centered cancer treatment planning in practice. Some of these challenges stem from the patient and include patients' lack of assertiveness, health literacy, and numeracy, and their emotional state and concurrent illnesses. Others are a result of physician limitations, such as a lack of time to explain complex information and a lack of tools to facilitate treatment planning, as well as insensitivity to patients' informational, cultural, and emotional needs. Potential solutions to address these obstacles include better training of health care providers and patients in optimal communication and shared decision making, and greater use of support services and tools such as patient navigation and electronic health records. Other options include greater use of quality metrics and reimbursement for the time it takes to develop, discuss, and document a treatment plan. PMID:22128118

  8. Point-of-Care Technologies for the Advancement of Precision Medicine in Heart, Lung, Blood, and Sleep Disorders.

    Science.gov (United States)

    Bigelow, Mary Emma Gorham; Jamieson, Brian G; Chui, Chi On; Mao, Yufei; Shin, Kyeong-Sik; Huang, Tony Jun; Huang, Po-Hsun; Ren, Liqiang; Adhikari, Bishow; Chen, Jue; Iturriaga, Erin

    2016-01-01

    The commercialization of new point of care technologies holds great potential in facilitating and advancing precision medicine in heart, lung, blood, and sleep (HLBS) disorders. The delivery of individually tailored health care to a patient depends on how well that patient's health condition can be interrogated and monitored. Point of care technologies may enable access to rapid and cost-effective interrogation of a patient's health condition in near real time. Currently, physiological data are largely limited to single-time-point collection at the hospital or clinic, whereas critical information on some conditions must be collected in the home, when symptoms occur, or at regular intervals over time. A variety of HLBS disorders are highly dependent on transient variables, such as patient activity level, environment, time of day, and so on. Consequently, the National Heart Lung and Blood Institute sponsored a request for applications to support the development and commercialization of novel point-of-care technologies through small businesses (RFA-HL-14-011 and RFA-HL-14-017). Three of the supported research projects are described to highlight particular point-of-care needs for HLBS disorders and the breadth of emerging technologies. While significant obstacles remain to the commercialization of such technologies, these advancements will be required to achieve precision medicine. PMID:27602308

  9. Development of a web-based pharmaceutical care plan to facilitate collaboration between healthcare providers and patients

    NARCIS (Netherlands)

    Geurts, Marlies M E; Ivens, Martijn; van Gelder, Egbert; de Gier, Johan J

    2013-01-01

    BACKGROUND: In medication therapy management there is a need for a tool to document medication reviews and pharmaceutical care plans (PCPs) as well as facilitate collaboration and sharing of patient data between different healthcare providers. Currently, pharmacists and general practitioners (GPs) h

  10. Old-age Care Modes and Facility Planning Based on the Concept of “Continuum of Care”

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    Through the comparative analysis on the theories and practical experience of the development of old-age care (OAC) in both China and other countries,and based on the interview and questionnaire survey in Zhejiang Province and Hangzhou City,this paper proposes the research and analysis framework for the old-age service system,i.e.,"OAC mode-OAC service system-OAC facility system." The paper argues that,oriented by OAC mode of "taking community-and home-based care as the main body and institution-based care as supplement," China should build an OAC facility system and planning thoughts that take "continuum of care" as concept and long-term care system as core.Taking Zhejiang Province and Hangzhou City as examples,the paper conducts the optimization research on current OAC facilities planning in terms of hierarchical system,scale,and differentiation,so as to formulate more systematic and operable planning standards for OAC facilities.

  11. A vision of long-term care. To care for tomorrow's elderly, hospitals must plan now, not react later.

    Science.gov (United States)

    Kodner, D L

    1989-12-01

    In the next two decades, rapid, fundamental changes will take place in the way we finance, organize, and provide long-term care services. Because the elderly make up such a large portion of the patient population, America's hospitals should be concerned--and involved. There are six keys to the future of long-term care: a sharp increase in elderly population, a new generation of elderly, restrained government role, intergenerational strains, growing corporate concern, and the rise of "gerotechnology." These trends and countertrends will result in a new look in the long-term care landscape. By the year 2010, changes will include a true public-private financing system, provider reimbursement on the basis of capitation and prospective payment, coordinated access to services, dominant alternative delivery systems, a different breed of nursing homes, fewer staffing problems, patient-centered care, a new importance in housing, and an emphasis on prevention. For hospitals, this future vision of long-term care means that significant opportunities will open up to meet the needs of the elderly-at-risk and to achieve a competitive position in the burgeoning elderly care industry. PMID:10313396

  12. Planning of Nursing Home Care Services in Jordan: Its Reality and Challenges

    Directory of Open Access Journals (Sweden)

    Hasan Salih Suliman Al-Qudah

    2011-09-01

    Full Text Available United Nations Principles for Older Persons acknowledge five rights to elderly or older persons, these rights are the right of "independence, care, self, fulfillment, dignity, participation.The demographic Indication witnessed increasing trends in population pyramid at developed countries on aging rates world wide, especially in most of developing countries. So in order to address this growing dilemma at our civilized world its proved at statistics surveys, on current research work as it will try to expose to efforts the plans made by many Jordanian Civil &Governmental initiatives for facing this category for the purpose of providing high standards services at both health and social care services for elderly people and to help them reaching a self-realization, and to encourage them in developing their potential through resources available in different aspects of the community educationally, culturally, spiritually and even through recreational activities.The present study aims to identify current capabilities that available in serving elderly people at two main Nursing Home Centers in Jordan located in Amman. Its limitation to only two most serving accommodated numbers of elder's Nursing Home centers the first is: White Beds Society and the second is: Centre for Princess Muna older women Nursing homes / Orthodox Charity as both are largest and oldest of Nursing homes centers serving elderly.The research concluded many numerous results most important are: There shall specialized cooperation bodies in charge of deals with other institutions working in the field of aging society, as of governmental organizations, hospitals, accredited qualified manpower to deal with this deer category of our society.secondly. Assist homes for elderly in budgetary provisions of adequate budget to them.

  13. Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction

    Directory of Open Access Journals (Sweden)

    Gausvik C

    2015-01-01

    Full Text Available Christian Gausvik,1 Ashley Lautar,2 Lisa Miller,2 Harini Pallerla,3 Jeffrey Schlaudecker4,5 1University of Cincinnati College of Medicine, 2The Christ Hospital, Cincinnati, OH, USA; 3Department of Family and Community Medicine, 4Division of Geriatric Medicine, University of Cincinnati, Cincinnati, OH, USA; 5Geriatric Medicine Fellowship Program, University of Cincinnati/The Christ Hospital, Cincinnati, OH, USA Abstract: Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR on an acute care for the elderly (ACE unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer

  14. Advancing adolescent health and health services in Saudi Arabia: exploring health-care providers' training, interest, and perceptions of the health-care needs of young people

    Directory of Open Access Journals (Sweden)

    AlBuhairan FS

    2014-09-01

    Full Text Available Fadia S AlBuhairan,1–3 Tina M Olsson3,4 1Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 4School of Social Work, Lund University, Lund, Sweden Background: Adolescent health is regarded as central to global health goals. Investments made in adolescent health and health services protect the improvements witnessed in child health. Though Saudi Arabia has a large adolescent population, adolescent health-care only began to emerge in recent years, yet widespread uptake has been very limited. Health-care providers are key in addressing and providing the necessary health-care services for adolescents, and so this study was conducted with the aim of identifying opportunities for the advancement of knowledge transfer for adolescent health services in Saudi Arabia. Methods: This Web-based, cross-sectional study was carried out at four hospitals in Saudi Arabia. Physicians and nurses were invited to participate in an online survey addressing their contact with adolescent patients, and training, knowledge, and attitudes towards adolescent health-care. Results: A total of 232 professionals participated. The majority (82.3% reported sometimes or always coming into contact with adolescent patients. Less than half (44%, however, had received any sort of training on adolescent health during their undergraduate or postgraduate education, and only 53.9% reported having adequate knowledge about the health-care needs of adolescents. Nurses perceived themselves as having more knowledge in the health-care needs of adolescents and reported feeling more comfortable in communicating with adolescents as compared with physicians. The majority of participants were interested in gaining further skills and knowledge in adolescent health-care and agreed or strongly agreed that adolescents have

  15. The Child Care Transition: A league table of early childhood education and care in economically advanced countries

    OpenAIRE

    Peter Adamson

    2008-01-01

    A great change is coming over childhood in the world's richest countries. Today's rising generation is the first in which a majority are spending a large part of early childhood in some form of out-of-home child care. At the same time, neuroscientific research is demonstrating that loving, stable, secure, and stimulating relationships with caregivers in the earliest months and years of life are critical for every aspect of a child’s development. Taken together, these two developments confront...

  16. RISMC advanced safety analysis working plan: FY2015 - FY2019. Light Water Reactor Sustainability Program

    Energy Technology Data Exchange (ETDEWEB)

    Szilard, Ronaldo H; Smith, Curtis L

    2014-09-01

    In this report, the Advanced Safety Analysis Program (ASAP) objectives and value proposition is described. ASAP focuses on modernization of nuclear power safety analysis (tools, methods and data); implementing state-of-the-art modeling techniques (which include, for example, enabling incorporation of more detailed physics as they become available); taking advantage of modern computing hardware; and combining probabilistic and mechanistic analyses to enable a risk informed safety analysis process. The modernized tools will maintain the current high level of safety in our nuclear power plant fleet, while providing an improved understanding of safety margins and the critical parameters that affect them. Thus, the set of tools will provide information to inform decisions on plant modifications, refurbishments, and surveillance programs, while improving economics. The set of tools will also benefit the design of new reactors, enhancing safety per unit cost of a nuclear plant. As part of the discussion, we have identified three sets of stakeholders, the nuclear industry, the Department of Energy (DOE), and associated oversight organizations. These three groups would benefit from ASAP in different ways. For example, within the DOE complex, the possible applications that are seen include the safety of experimental reactors, facility life extension, safety-by-design in future generation advanced reactors, and managing security for the storage of nuclear material. This report provides information in five areas: (1) A value proposition (“why is this important?”) that will make the case for stakeholder’s use of the ASAP research and development (R&D) products; (2) An identification of likely end users and pathway to adoption of enhanced tools by the end-users; (3) A proposed set of practical and achievable “use case” demonstrations; (4) A proposed plan to address ASAP verification and validation (V&V) needs; and (5) A proposed schedule for the multi-year ASAP.

  17. RISMC advanced safety analysis project plan: FY2015 - FY2019. Light Water Reactor Sustainability Program

    International Nuclear Information System (INIS)

    In this report, the Advanced Safety Analysis Program (ASAP) objectives and value proposition is described. ASAP focuses on modernization of nuclear power safety analysis (tools, methods and data); implementing state-of-the-art modeling techniques (which include, for example, enabling incorporation of more detailed physics as they become available); taking advantage of modern computing hardware; and combining probabilistic and mechanistic analyses to enable a risk informed safety analysis process. The modernized tools will maintain the current high level of safety in our nuclear power plant fleet, while providing an improved understanding of safety margins and the critical parameters that affect them. Thus, the set of tools will provide information to inform decisions on plant modifications, refurbishments, and surveillance programs, while improving economics. The set of tools will also benefit the design of new reactors, enhancing safety per unit cost of a nuclear plant. As part of the discussion, we have identified three sets of stakeholders, the nuclear industry, the Department of Energy (DOE), and associated oversight organizations. These three groups would benefit from ASAP in different ways. For example, within the DOE complex, the possible applications that are seen include the safety of experimental reactors, facility life extension, safety-by-design in future generation advanced reactors, and managing security for the storage of nuclear material. This report provides information in five areas: (1) A value proposition (@@@why is this important?@@@) that will make the case for stakeholder's use of the ASAP research and development (R&D) products; (2) An identification of likely end users and pathway to adoption of enhanced tools by the end-users; (3) A proposed set of practical and achievable @@use case@@@ demonstrations; (4) A proposed plan to address ASAP verification and validation (V&V) needs; and (5) A proposed schedule for the multi-year ASAP.

  18. The Effects of Guided Careful Online Planning on Complexity, Accuracy and Fluency in Intermediate EFL Learners' Oral Production: The Case of English Articles

    Science.gov (United States)

    Ahmadian, Mohammad Javad

    2012-01-01

    The purpose of the study reported in this article was twofold: First, to see whether guided careful online planning assists intermediate learners of English as a foreign language (EFL) in accurate oral production of English articles ("an/a" and "the"); and, second, to see whether guided careful online planning has any effects on global complexity…

  19. A descriptive study of point-of-care reference resource use by advanced practice RNs in Texas.

    Science.gov (United States)

    Bischoff, Whitney Rogers; Hinojosa, Rogelio H

    2013-11-01

    This descriptive study replicates and extends previous research on advanced practice RNs and the (1) reference resources available to them at the point of care, (2) resources they use to inform their clinical practice, and (3) resources they are accessing from handheld electronic devices such as PDAs, smartphones, and tablet computers during practice. These elements formed the purpose of the current study. A sample of advanced practice RNs from Texas Public Health Region 11 was surveyed. Available resources were current journals appropriate to setting and current clinical guidelines. These advanced practice RNs "always or frequently" based their professional practice on personal experience of caring for patients/clients over time, information learned in college/university, and information learned about each patient/client as an individual. Responses for Hispanic respondents as well as electronic device users were similar. Content and features accessed daily by handheld computer devices were reference materials, e-mail, address/phonebook, Internet access other than e-mail, calendar/date book, alarm/reminder, calculator, and memo pad. Software installed on handheld devices and used daily included drug references, medical text/reference book, medical math/formula calculator, practice guidelines, and language translator/dictionary. Respondents who did not report using handheld devices at work were older, had more years in advanced practice nursing, and were more likely to work in a hospital, birthing center, or institution such as a prison, school, or military facility. There was no difference in resource or electronic device use by Hispanic advanced practice RNs. Electronic resources for practice are growing and being used by advanced practice RNs. Consideration should be given to incorporating evaluation and implementation of electronic clinical resources into advanced practice RN educational programs. Future research should include greater detail about the origin of

  20. Planned neck dissection after weekly docetaxel and concurrent radiotherapy for advanced oropharyngeal cancer

    International Nuclear Information System (INIS)

    Small oropharyngeal carcinomas with advanced neck metastases (stage N2 or greater) are common. Patients with small T with large N oropharyngeal carcinoma have high rates of local control but lower rates of regional control when treated with chemoradiotherapy. Clinical assessment after chemoradiotherapy cannot ensure the absence of neck disease. In the last 5 years, we have treated patients with T1-2 with N2-3 oropharyngeal carcinoma with weekly docetaxel radiotherapy followed by planned neck dissection (PND). Our objectives were to clarify the pathologically complete response (CR) rate of neck metastasis after weekly docetaxel radiotherapy, to identify the clinical predictor of residual neck disease, and to determine the mobidity of planned neck dissection. After chemoradiotherapy, all 12 patients had a complete response at the primary site. We conducted 15 neck dissections. Of these, 6 (40%) had positive nodes. The pathological CR rate of neck metastasis was 58.3%, whereas overall 2-year neck control rate was 91.7%. These findings lend support to the role of PND after chemoradiotherapy in N2-3 neck disease. After chemoradiotherapy, clinical parameters including TN status, feasibility of chemoradiotherapy, largest lymph node size or size reduction in MRI, did not identify patients with residual neck disease. We conducted selective neck dissection (SND) in 80% of patients. SND as PND appears to be appropriate in this group of patients because of the low incidence of complications. A further cohort study including the comparison of PND nonenforcement group is necessary to clarify the validity of the addition of PND in weekly docetaxel radiotherapy. (author)

  1. International Forum for the Advancement of Diabetes Research and Care, April 29–30, 2011, Athens, Greece

    OpenAIRE

    Bolli, Geremia B.; Deeb, Larry C.; Garg, Satish K.; Leahy, John L.; Mazze, Roger S.; Owens, David R; Riddle, Matthew C.; Southerland, Phil; Strock, Ellie S.

    2011-01-01

    The International Forum for the Advancement of Diabetes Research and Care brought together distinguished international experts in diabetes to discuss diverse trends and emerging issues in diabetes therapy and management. The plenary sessions on the first day focused on trends in insulin therapy, the role of glucagon-like peptide-1 receptor agonists in diabetes treatment, the relationship between diabetes and cardiovascular risk, and the challenges associated with the development of clinically...

  2. Planning a pharmacy-led medical mission trip, part 3: development and implementation of an elective medical missions advanced pharmacy practice experience (APPE) rotation.

    Science.gov (United States)

    Brown, Dana A; Ferrill, Mary J

    2012-01-01

    With an increasing number of new pharmacy schools/colleges and expansion of existing ones, pharmacy schools/colleges are often in need of elective rotation experiences as part of the final year advanced pharmacy practice experience (APPE) program. Offering a medical missions elective APPE in either a domestic or international setting is a unique opportunity to expose pharmacy students to direct patient care. APPE students can be involved in triaging patients, compounding and dispensing medications, and providing patient education. As part of this APPE, pharmacy students are expected to complete projects such as formulary development, case presentations, book club discussions, journal reflections, manuscript preparations, and trip logistics planning. An elective APPE focused on medical missions facilitates the learning process and promotes the emergence of team leaders and leadership skills in general. PMID:22739719

  3. Learning to plan? A critical fiction about the facilitation of professional and practice development plans in primary care.

    NARCIS (Netherlands)

    Elwyn, G.; Hocking, P.; Burtonwood, A.; Harry, K.; Turner, A.

    2002-01-01

    A shift from continuing medical education towards professional and organisational development policies, coupled with the introduction of accountability frameworks (clinical governance), has generated interest in professional and practice development plans (PPDPs) in general practice. The problems of

  4. A model plan for the uninsured: delivering quality and affordability in a limited benefit managed care safety net program in Flint, Michigan.

    Science.gov (United States)

    Creech, Constance J; Kornblau, Barbara; Strugar-Fritsch, Donna

    2012-02-01

    This paper presents the background and multiyear outcome data for a limited benefit safety-net care program in Michigan. It is a possible solution for policymakers and hospital/clinic administrators to consider when evaluating plans to provide primary care for the 30 million uninsured Americans who will be affected by the Affordable Care Act. PMID:22643481

  5. Daily Care

    Science.gov (United States)

    ... to Know Online Tools Enhancing Daily Life Daily Plan Activities Communication Food & Eating Music & Art Personal Care Incontinence Bathing ... Tweet Email | Print Create a Daily Routine Daily Plan Activities Communication Food/Eating Get Tips on Personal Care Bathing ...

  6. Defining Advancement Career Paths and Succession Plans: Critical Human Capital Retention Strategies for High-Performing Advancement Divisions

    Science.gov (United States)

    Croteau, Jon Derek; Wolk, Holly Gordon

    2010-01-01

    There are many factors that can influence whether a highly talented staff member will build a career within an institution or use it as a stepping stone. This article defines and explores the notions of developing career paths and succession planning and why they are critical human capital investment strategies in retaining the highest performers…

  7. Advanced energy design and operation technologies research: Recommendations for a US Department of Energy multiyear program plan

    Energy Technology Data Exchange (ETDEWEB)

    Brambley, M.R.; Crawley, D.B.; Hostetler, D.D.; Stratton, R.C.; Addision, M.S.; Deringer, J.J.; Hall, J.D.; Selkowitz, S.E.

    1988-12-01

    This document describes recommendations for a multiyear plan developed for the US Department of Energy (DOE) as part of the Advanced Energy Design and Operation Technologies (AEDOT) project. The plan is an outgrowth of earlier planning activities conducted for DOE as part of design process research under the Building System Integration Program (BSIP). The proposed research will produce intelligent computer-based design and operation technologies for commercial buildings. In this document, the concept is explained, the need for these new computer-based environments is discussed, the benefits are described, and a plan for developing the AEDOT technologies is presented for the 9-year period beginning FY 1989. 45 refs., 37 figs., 9 tabs.

  8. Barriers to shared decision making in mental health care:qualitative study of the Joint Crisis Plan for psychosis

    OpenAIRE

    Farrelly, Simone; Lester, Helen; Rose, Diana; Birchwood, Max; Marshall, Max; Waheed, Waquas; Henderson, R. Claire; Szmukler, George; Thornicroft, Graham

    2016-01-01

    BackgroundDespite increasing calls for shared decision making (SDM), the precise mechanisms for its attainment are unclear. Sharing decisions in mental health care may be especially complex. Fluctuations in service user capacity and significant power differences are particular barriers.Objective and designWe trialled a form of facilitated SDM that aimed to generate patients' treatment preferences in advance of a possible relapse. The ‘Joint Crisis Plan’ (JCP) intervention was trialled in four...

  9. Sustainable practice improvements: impact of the Comprehensive Advanced Palliative Care Education (CAPCE) program.

    Science.gov (United States)

    Harris, Diane; Hillier, Loretta M; Keat, Nancy

    2007-01-01

    This paper describes an education program designed to improve palliative care practice through the development of workplace hospice palliative care resources (PCRs), and its impact on knowledge transfer and longer-term changes to clinical practice. Evaluation methods included pre- and post-program questionnaires, and a survey of learners' (n=301) perceptions of program learning strategies. Interviews (n=21) were conducted with a purposeful sample of PCRs and representatives from their work sites. Ratings of the sessions indicated that they were relevant to learners' clinical practice. At follow up, the majority of learners (83%) continued to serve as PCRs. Many positive effects were identified, including enhanced pain and symptom management, staff education, and development of care policies and guidelines. Management support, particularly the prioritization of palliative care and staff development, were factors facilitating sustained implementation. These findings highlight the importance of multimodal learning strategies and supportive work environments in the development of PCRs to enhance palliative care practice. PMID:18251444

  10. Long-term survival results of a randomized phase III trial of vinflunine plus best supportive care versus best supportive care alone in advanced urothelial carcinoma patients after failure of platinum-based chemotherapy

    DEFF Research Database (Denmark)

    Bellmunt, J; Fougeray, R; Rosenberg, J E;

    2013-01-01

    To compare long-term, updated overall survival (OS) of patients with advanced transitional cell carcinoma of the urothelium (TCCU) treated with vinflunine plus best supportive care (BSC) or BSC alone, after failure of platinum-based chemotherapy.......To compare long-term, updated overall survival (OS) of patients with advanced transitional cell carcinoma of the urothelium (TCCU) treated with vinflunine plus best supportive care (BSC) or BSC alone, after failure of platinum-based chemotherapy....

  11. Advancing patient-centered care through transformative educational leadership: a critical review of health care professional preparation for patient-centered care

    Directory of Open Access Journals (Sweden)

    Lévesque MC

    2013-07-01

    Full Text Available Martine C Lévesque,1,2 Richard Bruce Hovey,2,3 Christophe Bedos2,4 1Faculté de médecine, Université de Montréal, Montréal, QC, Canada; 2Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, QC, Canada; 3Faculty of Medicine, University of Calgary, Calgary, AB, Canada; 4Département de médecine sociale et préventive, Faculté de médicine, Université de Montréal, Montréal, QC, Canada Abstract: Following a historical brief on the development of patient-centered care (PCC, we discuss PCC's value and role in counterbalancing the evidence-based movement in health care. We in turn make a case for a philosophical shift in thinking about the PCC concept, one based on a consideration for how knowledge is produced, used, and valued within care provision processes. A “shared epistemology” foundation is presented, defined, and promoted as essential to the authentic and ethical realization of “shared decision making” between patient and health care provider, and, more generally, of PCC. In accordance with these views, this article critically reviews the literature on health care professional education for the development of PCC. We uncover the disturbing ways in which education frequently undermines the development of patient centeredness, despite curricular emphasis on professionalism and ethical PCC. We also establish the need to raise awareness of how dominant approaches to evaluating student or practitioner performance often fail to reinforce or promote patient centeredness. Finally, we identify successful and inspiring cases of teaching and learning experiences that have achieved perspective transformation on PCC and on new ways of providing care. The pertinence of adopting the theoretical foundations of adult transformative learning is argued, and a call to action is proposed to the leadership of health professional educators across all disciplines. Keywords: patient-centered care, health professional

  12. Morbidity of caesarean delivery: a comparative study between early and advanced stages of labour in an Indian tertiary care center

    Directory of Open Access Journals (Sweden)

    Amrutha Ramachandran

    2013-08-01

    Methods: A retrospective analysis of 131 women with singleton term pregnancies who underwent emergency caesarean section. The study was done in a tertiary care teaching hospital in India. In this study advanced labour was defined as one with cervical dilatation 8 cm or more at the time of caesarean section. The primary outcome variables were a maternal composite morbidity and a neonatal composite morbidity. Categorical data were compared using chi square test or Fischer’s exact test. Results: 73 women (56% underwent caesarean delivery in the early labour and 58(44% in advanced labour. 12/73 (16.4% patients in early stage of labour had at least one maternal complication (Composite maternal morbidity compared to 18/58 (31% women who had caesarean in advanced stage (p = 0.048. Seven patients out of 73 in the early labour and 14/58 in the advanced labour (p = 0.024 had at least one neonatal complication (Composite neonatal morbidity. Conclusions: The morbidity of primary caesarean sections done in the advanced stage of labour is associated with increased maternal and neonatal morbidity compared to that done in the early stage. A larger study will be needed to establish the inference. [Int J Reprod Contracept Obstet Gynecol 2013; 2(4.000: 646-650

  13. Exploring motivations to seek and undergo prosthodontic care: an empirical approach using the Theory of Planned Behavior construct.

    Science.gov (United States)

    Vieira, Antonio Hélio; Leles, Cláudio Rodrigues

    2014-01-01

    Motivations for seeking and undergoing prosthodontic care are poorly understood and are not often explored for clinical purposes when determining treatment need and understanding the factors related to the demand for health care and effective use. This article uses the Theory of Planned Behavior construct to identify factors related to the motivations of edentulous subjects to seek and undergo prosthodontic treatment. The conceptual framework of the Theory of Planned Behavior includes attitude toward behavior, an individual's positive or negative evaluation of self-performance of the particular behavior; the subjective norm, an individual's perception of social normative pressures or relevant others' beliefs that he or she should or should not perform such behavior; and perceived behavioral control, or an individual's perceived ease or difficulty in performing the particular behavior, determined by the total set of accessible control beliefs. These components mediate a subject's intention and behavior toward an object and may also explain health-related behaviors, providing strong predictions across a range of health behaviors. This study suggests categories for each component of the Theory of Planned Behavior, based on clinical evidence and practical reasoning. Attitudes toward behavior include perceived consequences of no treatment, perceived potential benefits and risks of treatment, dental anxiety, previous experiences, and interpersonal abilities of the health care providers. The subjective norm includes the opinions of relevant others, advertisement, professionally defined normative need, perceived professional skills, and technical quality of care. Perceived behavioral control includes subject's time, availability and opportunity, treatment costs, subject's perceived need, and accessibility to dental care. This conceptual model represents a theoretical multidimensional model that may help clinicians better understand the patient's treatment behaviors and

  14. Research Infrastructure for the Advancement of Hydrologic Science: Planning Highlights and Update

    Science.gov (United States)

    Bales, R. C.

    2001-12-01

    In response to the need for research infrastructure in hydrologic sciences, a group of over 35 universities has formed a Consortium of Universities for the Advancement of Hydrologic Science, Inc. (CUAHSI). With support from the U.S. National Science Foundation, CUAHSI has initiated a science planning process aimed at building research infrastructure in three main areas: i) Long Term Hydrologic Observatories, to provide the consistent, integrated, long-term information from point to continental scales ii) a Hydrologic Information System program, to support the data, information, and analysis requirements of the community and iii) a Hydrologic Measurement Technology program to develop and operate state-of-the-art systems and provide support services for hydrologic research. Scientifically, this infrastructure initiative aims to support research to provide new understanding about priority questions in hydrologic and related sciences, including: i) spatial and temporal properties of precipitation and snow processes, ii) surface water generation and transport at scales from hectares to continental-scale basins, iii) linked water, carbon and other chemical cycles, and changes in response to varying temperature, precipitation and land-use patterns, iii) environmental stresses on aquatic and riparian ecosystems related to groundwater pumping and other perturbations, iv) basin-scale subsurface water and solute movement, particularly as related to patterns of precipitation, evapotranspiration and recharge, and v) feedback between regional evaporation and transpiration and patterns of precipitation and humidity. It has become apparent that the science infrastructure in hydrologic and related sciences is currently inadequate to meet many of these priority science questions and societal needs. Specifically, investments are needed to: i) maintain, supplement and upgrade existing field facilities, ii) establish measurement programs that can deliver consistent data over the long

  15. Providers’ Perspectives on Provision of Family Planning to HIV-Positive Individuals in HIV Care in Nyanza Province, Kenya

    Directory of Open Access Journals (Sweden)

    Sara J. Newmann

    2013-01-01

    Full Text Available Objective. To inform an intervention integrating family planning into HIV care, family planning (FP knowledge, attitudes and practices, and perspectives on integrating FP into HIV care were assessed among healthcare providers in Nyanza Province, Kenya. Methods. Thirty-one mixed-method, structured interviews were conducted among a purposive sample of healthcare workers (HCWs from 13 government HIV care facilities in Nyanza Province. Structured questions and case scenarios assessed contraceptive knowledge, training, and FP provision experience. Open-ended questions explored perspectives on integration. Data were analyzed descriptively and qualitatively. Results. Of the 31 HCWs interviewed, 45% reported previous FP training. Few providers thought long-acting methods were safe for HIV-positive women (19% viewed depot medroxyprogesterone acetate as safe and 36% viewed implants and intrauterine contraceptives as safe; fewer felt comfortable recommending them to HIV-positive women. Overall, providers supported HIV and family planning integration, yet several potential barriers were identified including misunderstandings about contraceptive safety, gendered power differentials relating to fertility decisions, staff shortages, lack of FP training, and contraceptive shortages. Conclusions. These findings suggest the importance of considering issues such as patient flow, provider burden, commodity supply, gender and cultural issues affecting FP use, and provider training in FP/HIV when designing integrated FP/HIV services in high HIV prevalence areas.

  16. Deep Assessment: A Novel Framework for Improving the Care of People with Very Advanced Alzheimer’s Disease

    Directory of Open Access Journals (Sweden)

    Gordon Lyons

    2015-01-01

    Full Text Available Best practice in understanding and caring for people with advanced Alzheimer’s disease presents extraordinary challenges. Their severe and deteriorating cognitive impairments are such that carers find progressive difficulty in authentically ascertaining and responding to interests, preferences, and needs. Deep assessment, a novel multifaceted framework drawn from research into the experiences of others with severe cognitive impairments, has potential to empower carers and other support professionals to develop an enhanced understanding of people with advanced Alzheimer’s disease and so deliver better calibrated care in attempts to maximize quality of life. Deep assessment uses a combination of techniques, namely, Behaviour State Observation, Triangulated Proxy Reporting, and Startle Reflex Modulation Measurement, to deliver a comprehensive and deep assessment of the inner states (awareness, preferences, likes, and dislikes of people who cannot reliably self-report. This paper explains deep assessment and its current applications. It then suggests how it can be applied to people with advanced Alzheimer’s disease to develop others’ understanding of their inner states and to help improve their quality of life. An illustrative hypothetical vignette is used to amplify this framework. We discuss the potential utility and efficacy of this technique for this population and we also propose other human conditions that may benefit from research using a deep assessment approach.

  17. Awareness and pattern of utilizing family planning services among women attending urban health care center Azizabad Sukkur

    International Nuclear Information System (INIS)

    To assess level of awareness and pattern of utilizing family planning services among women (15-49 years) of reproductive age at Urban Health Center, Azizabad Sukkur, Sindh. A cross-sectional study was conducted from April to June 2005 at Urban Health Care Center Azizabad Sukkur. Two hundred women of reproductive age group were interviewed by using a pre tested semi structured questionnaire visiting the health care center during the study period. Information was obtained after taking informed consent regarding socio demographic characteristics, knowledge, attitude and pattern of utilizing family planning services. The data was entered and analyzed by using statistical package SPSS version 13. About 75% of women and 42.5% husbands were found illiterate, 85% women were housewives, 69.5% were married before 18 years of age and 54% had nuclear family. Regarding desired number of children women responded one child (3%), 2-3 children (11%), 4-5 (37.5%), more than five children (36%), 5.5% said that children are God gifted and 7% did not answer. About 60% of women reported use of at least one contraceptive method and 40% had never used any contraceptive method. The women who received counseling from the health care provider were 48.5% and only 6% received information through media. Religious prohibition, shortage of female staff and cost of family planning contraceptive methods were the main reasons identified for not utilizing contraceptive methods. The unsatisfactory variables were long waiting hours at the center, non-availability of contraceptive, shortage of the female staff and cost. Limited number of women was aware and practice contraception in the area and utilization of family planning services were low. The efforts should be made for providing information to couple and improving quality of family planning services in the area. (author)

  18. Family Planning Supply Environment in Kinshasa, DRC: Survey Findings and Their Value in Advancing Family Planning Programming

    OpenAIRE

    Kayembe, Patrick; Babazadeh, Saleh; Dikamba, Nelly; Akilimali, Pierre; Hernandez, Julie; Binanga, Arsene; Bertrand, Jane T.

    2015-01-01

    A series of facility-based surveys that mapped all sites providing family planning services and that assessed readiness to provide services, using mobile phones, was feasible in a low-resource setting, contributing to mobilization of partners and increased donor support. Between 2012 and 2013, readiness to provide services increased from 44% of sites to 63%. Three factors most associated with productivity: type of facility (clinics more than hospitals or health centers), more years in operati...

  19. Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center

    Directory of Open Access Journals (Sweden)

    Leppert W

    2014-05-01

    Full Text Available Wojciech Leppert,1 Mikolaj Majkowicz,2 Maria Forycka,1 Eleonora Mess,3 Agata Zdun-Ryzewska2 1Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland; 2Department of Quality of Life Research, Gdansk Medical University, Gdansk, Poland; 3Palliative Care Nursing Department, Wroclaw Medical University, Wroclaw, Poland Aim of the study: To assess quality of life (QoL in cancer patients treated at home, at an in-patient palliative care unit (PCU, and at a day care center (DCC. Patients and methods: QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL, the Edmonton Symptom Assessment System (ESAS, and the Karnofsky Performance Status (KPS scale. Results: A total of 129 patients completed the study, with 51 patients treated at home, 51 patients treated at the PCU, and 27 patients at DCC. In the EORTC QLQ-C15-PAL, improvement in functional and symptom scales was observed except in physical functioning and fatigue levels; patients at DCC had a better physical functioning, global QoL, appetite, and fatigue levels. In the ESAS, improvement in all items was found except for drowsiness levels, which was stable in patients treated at DCC and deteriorated in home and PCU patients. Higher activity, better appetite and well-being, and less drowsiness were observed in patients treated at DCC. KPS was better in DCC patients compared to those treated at home and at the PCU; the latter group deteriorated. Conclusions: QoL improved in all patient groups, with better results in DCC patients and similar scores in those staying at home and at the PCU. Along with clinical assessment, baseline age, KPS, physical and emotional functioning may be considered when assigning patients to care at a DCC, PCU, or at home. Keywords: oncology, patient care

  20. Becoming Food Aware in Hospital: A Narrative Review to Advance the Culture of Nutrition Care in Hospitals

    Directory of Open Access Journals (Sweden)

    Celia Laur

    2015-06-01

    Full Text Available The Nutrition Care in Canadian Hospitals (2010–2013 study identified the prevalence of malnutrition on admission to medical and surgical wards as 45%. Nutrition practices in the eighteen hospitals, including diagnosis, treatment and monitoring of malnourished patients, were ad hoc. This lack of a systematic approach has demonstrated the need for the development of improved processes and knowledge translation of practices aimed to advance the culture of nutrition care in hospitals. A narrative review was conducted to identify literature that focused on improved care processes and strategies to promote the nutrition care culture. The key finding was that a multi-level approach is needed to address this complex issue. The organization, staff, patients and their families need to be part of the solution to hospital malnutrition. A variety of strategies to promote the change in nutrition culture have been proposed in the literature, and these are summarized as examples for others to consider. Examples of strategies at the organizational level include developing policies to support change, use of a screening tool, protecting mealtimes, investing in food and additional personnel (healthcare aides, practical nurses and/or diet technicians to assist patients at mealtimes. Training for hospital staff raises awareness of the issue, but also helps them to identify their role and how it can be modified to improve nutrition care. Patients and families need to be aware of the importance of food to their recovery and how they can advocate for their needs while in hospital, as well as post-hospitalization. It is anticipated that a multi-level approach that promotes being “food aware” for all involved will help hospitals to achieve patient-centred care with respect to nutrition.

  1. Implementation plan for automatic data processing equipment as part of the DYMAC advanced accountability system. Addendum 3 to applications of advanced accountability concepts in mixed oxide fabrication

    International Nuclear Information System (INIS)

    The Phase I study of the application of advanced accountability methods (DYMAC) in a uranium/plutonium mixed oxide facility was extended to include an implementation plan for the Automatic Data Processing System, as required by ERDA Manual Appendix 1830. The proposed system consists of a dual-control computer system with a minimum complement of peripheral equipment, which will be interfaced to the necessary measuring and display devices. Technical specifications for hardware and software system requirements are included, and cost estimates based on these specifications have been obtained

  2. Overcoming the challenges of conducting research with people who have advanced heart failure and palliative care needs.

    Science.gov (United States)

    Fitzsimons, Donna; Strachan, Patricia H

    2012-06-01

    Research on the palliative care needs of heart failure patients is scant and requires development to provide a sound evidence base for improved care; but there are distinct practical and ethical challenges in conducting research with this population. This paper presents an integrative review of the literature that aims to describe these challenges and discuss potential strategies by which they may be addressed. It is recognised that heart failure is a volatile condition making identification of the end of the life phase difficult. This leads to an array of other issues; firstly clinical teams tend to use this as a rationale for their failure to discuss palliative care issues with patients and families, making identification of the population difficult and research related communication challenging. Symptom volatility also creates methodological problems for researchers in deciding patients' eligibility, securing user involvement and contributes to sample attrition in research. There are also substantial ethical challenges for researchers in terms of gaining access and ensuring patient autonomy in this population. Acknowledgement of these issues and discussion of strategies by which they can be addressed has the potential to augment clinical research, develop practice and ultimately produce the much needed improvements in patient care required for those with advanced heart failure. PMID:21330214

  3. Montessori-based activities for long-term care residents with advanced dementia: effects on engagement and affect.

    Science.gov (United States)

    Orsulic-Jeras, S; Judge, K S; Camp, C J

    2000-02-01

    Sixteen residents in long-term care with advanced dementia (14 women; average age = 88) showed significantly more constructive engagement (defined as motor or verbal behaviors in response to an activity), less passive engagement (defined as passively observing an activity), and more pleasure while participating in Montessori-based programming than in regularly scheduled activities programming. Principles of Montessori-based programming, along with examples of such programming, are presented. Implications of the study and methods for expanding the use of Montessori-based dementia programming are discussed. PMID:10750318

  4. Building an advanced climate model: Program plan for the CHAMMP (Computer Hardware, Advanced Mathematics, and Model Physics) Climate Modeling Program

    Energy Technology Data Exchange (ETDEWEB)

    1990-12-01

    The issue of global warming and related climatic changes from increasing concentrations of greenhouse gases in the atmosphere has received prominent attention during the past few years. The Computer Hardware, Advanced Mathematics, and Model Physics (CHAMMP) Climate Modeling Program is designed to contribute directly to this rapid improvement. The goal of the CHAMMP Climate Modeling Program is to develop, verify, and apply a new generation of climate models within a coordinated framework that incorporates the best available scientific and numerical approaches to represent physical, biogeochemical, and ecological processes, that fully utilizes the hardware and software capabilities of new computer architectures, that probes the limits of climate predictability, and finally that can be used to address the challenging problem of understanding the greenhouse climate issue through the ability of the models to simulate time-dependent climatic changes over extended times and with regional resolution.

  5. The development and application of a simulation approach to advanced manufacturing systems planning

    OpenAIRE

    Mills, R. I.

    1987-01-01

    In the competitive field of metalworking industry, the planning of manufacturing systems so as to maximise their performance is crucial. The relatively new field of Flexible Manufacturing Systems presents a new set of planning challenges to the production engineer. This is due to the integrated nature of the these systems and the resultant effects upon their performance. This thesis presents a structured approach to the planning of materials flow within these systems and ...

  6. Focus on care policy for children and adolescents: federal public budget and analysis of multiannual plans

    Directory of Open Access Journals (Sweden)

    Ana Carolina Vidigal

    2013-12-01

    Full Text Available This article discuss the government planning, expressed in the multiannual plans, and to know what is being planned for the Treatment Politic for Children and Adolescents, assuming the priority contained in the Statute of Children and Adolescents, enabling control of what is being planned and the demand for its implementation. Therefore, the objective of analyzing the Multiannual Plan for the years 2004 to 2007 and from 2008 to 2011 the Federal Government, with the scope to identify how the attendance policy to children and adolescents are being treated in government planning. For the research we opted for an approach that allows joint basic research quantitative and qualitative perspective of data integration. We performed a literature search on the public budget, then it was also used to document research, public documents related to the federal budget. The results presented in this article was that Pluriannual Plans from 2004 to 2007 and from 2008 to 2011 found themselves the focus on children and adolescents, primarily in the Social Assistance and Education Policy, whereas in the area of education the focus is on the two largest plans, thereby presenting government's intentions regarding this segment and how they will be met. There are no plans in both a call and differential priority to children and adolescents, but these appear included through programs targeted to Basic Education and Income Transfer Programs linked to Social Assistance.

  7. A novel test of planning ability: great apes can plan step-by-step but not in advance of action.

    Science.gov (United States)

    Tecwyn, Emma C; Thorpe, Susannah K S; Chappell, Jackie

    2013-11-01

    The ability to identify an appropriate sequence of actions or to consider alternative possible action sequences might be particularly useful during problem solving in the physical domain. We developed a new 'paddle-box' task to test the ability of different ape species to plan an appropriate sequence of physical actions (rotating paddles) to retrieve a reward from a goal location. The task had an adjustable difficulty level and was not dependent on species-specific behaviours (e.g. complex tool use). We investigated the planning abilities of captive orangutans (Pongo pygmaeus) and bonobos (Pan paniscus) using the paddle-box. In experiment 1, subjects had to rotate one or two paddles before rotating the paddle with the reward on. Subjects of both species performed poorly, though orangutans rotated more non-food paddles, which may be related to their greater exploratory tendencies and bolder temperament compared with bonobos. In experiment 2 subjects could always rotate the paddle with the reward on first and still succeed, and most subjects of both species performed appropriate sequences of up to three paddle rotations to retrieve the reward. Poor performance in experiment 1 may have been related to subjects' difficulty in inhibiting the prepotent response to act on the reward immediately. PMID:24153327

  8. How Can Public Health Approaches and Perspectives Advance Hearing Health Care?

    Science.gov (United States)

    Reavis, Kelly M; Tremblay, Kelly L; Saunders, Gabrielle

    2016-01-01

    This commentary explores the role of public health programs and themes on hearing health care. Ongoing engagement within the hearing professional community is needed to determine how to change the landscape and identify important features in the evolution of population hearing health care. Why and how to leverage existing public health programs and develop new programs to improve hearing health in older individuals is an important topic. Hearing professionals are encouraged to reflect on these themes and recommendations and join the discussion about the future of hearing science on a population level. PMID:27232072

  9. Can Individualized Health Care Plans Help Increase Continence in Children with Dysfunctional Elimination Syndrome?

    Science.gov (United States)

    Boisclair-Fahey, Anne

    2009-01-01

    School-age children with dysfunctional elimination syndrome (DES) do not always have school support for their treatment plans, including an every 2-hr voiding schedule. The objective of this study was to increase school support of treatment plans by allowing access to bathrooms, thereby improving continence. An eight-question survey about bathroom…

  10. Advanced Monitoring Is Associated with Fewer Alarm Events During Planned Moderate Procedure-Related Sedation: A 2-Part Pilot Trial

    Science.gov (United States)

    Lenart, John; Malkin, Mathew; Meineke, Minhthy N.; Qoshlli, Silvana; Neumann, Monica; Jacobson, J. Paul; Kruger, Alison; Ching, Jeffrey; Hassanian, Mohammad; Um, Michael

    2016-01-01

    BACKGROUND: Diagnostic and interventional procedures are often facilitated by moderate procedure-related sedation. Many studies support the overall safety of this sedation; however, adverse cardiovascular and respiratory events are reported in up to 70% of these procedures, more frequently in very young, very old, or sicker patients. Monitoring with pulse oximetry may underreport hypoventilation during sedation, particularly if supplemental oxygen is provided. Capnometry may result in false alarms during sedation when patients mouth breathe or displace sampling devices. Advanced monitor use during sedation may allow event detection before complications develop. This 2-part pilot study used advanced monitors during planned moderate sedation to (1) determine incidences of desaturation, low respiratory rate, and deeper than intended sedation alarm events; and (2) determine whether advanced monitor use is associated with fewer alarm events. METHODS: Adult patients undergoing scheduled gastroenterology or interventional radiology procedures with planned moderate sedation given by dedicated sedation nurses under the direction of procedural physicians (procedural sedation team) were monitored per standard protocols (electrocardiography blood pressure, pulse oximetry, and capnometry) and advanced monitors (acoustic respiratory monitoring and processed electroencephalograpy). Data were collected to computers for analysis. Advanced monitor parameters were not visible to teams in part 1 (standard) but were visible to teams in part 2 (advanced). Alarm events were defined as desaturation—Spo2 ≤92%; respiratory depression, acoustic respiratory rate ≤8 breaths per minute, and deeper than intended sedation, indicated by processed electroencephalograpy. The number of alarm events was compared. RESULTS: Of 100 patients enrolled, 10 were excluded for data collection computer malfunction or consent withdrawal. Data were analyzed from 90 patients (44 standard and 46 advanced

  11. IRS Ruling Advances Mich. Tuition Plan but Could Quash Other States' Programs.

    Science.gov (United States)

    Jaschik, Scott

    1988-01-01

    Governor Blanchard of Michigan announced that the IRS planned to allow parents to participate in the state's prepaid-tuition program without paying additional federal income tax. A broader ruling will take additional time to formulate. The federal government is considering a national plan to allow tax breaks for college savings. (MLW)

  12. End-of-life costs of medical care for advanced stage cancer patients

    Directory of Open Access Journals (Sweden)

    Kovačević Aleksandra

    2015-01-01

    Full Text Available Background/Aim. Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia. Methods. A retrospective, indepth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care, hospital outpatient and hospital inpatient care. Results. Exactly 114 patients were analyzed, out of whom a high percent (48.25% had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR and the lowest (4.00 EUR ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs, followed by oncology medical care (21%, radiation therapy and interventional radiology (11%, surgery (9%, imaging diagnostics (9% and laboratory costs (8%. Conclusion. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients’ quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency. [Projekat Ministarstva nauke

  13. Turning the Lens Inward: Cultural Competence and Providers' Values in Health Care Decision Making

    Science.gov (United States)

    Chettih, Mindy

    2012-01-01

    The population of older adults in the United States is growing in size and diversity, presenting challenges to health care providers and patients in the context of health care decision making (DM), including obtaining informed consent for treatment, advance care planning, and deliberations about end-of-life care options. Although existing…

  14. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings – Guideline of the German Society for Hospital Hygiene (DGKH

    Directory of Open Access Journals (Sweden)

    Külpmann, Rüdiger

    2016-02-01

    Full Text Available Since the publication of the first “Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems in hospitals” ( in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section “Ventilation and air conditioning technology” attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

  15. Commentary on "a roadmap for the prevention of dementia II. Leon Thal Symposium 2008." Innovations in care that advance Alzheimer's disease drug development.

    Science.gov (United States)

    Foster, Norman L; Andersen, Troy C; Zamrini, Edward Y

    2009-03-01

    Advancing the development of drugs for the prevention and treatment of Alzheimer's disease (AD) is dependent on the ability of investigators to identify, recruit, and retain appropriate subjects in clinical trials. Innovations in care that link primary-care providers with AD researchers can help overcome barriers to early, specific diagnosis and access to research studies. Collaborative care provides a new paradigm for the mutual benefit of patients, providers, and AD research. Recommendations to achieve this goal include funding clinical centers of excellence in AD, linked with community physicians to utilize clinical care and initial evaluations as early entry points for patients into AD research, and funding mini-fellowships for community physicians. Reimbursement for dementia care should be expanded to include periodic cognitive assessments for at-risk individuals, medically directed dementia education, and diagnostic imaging and biomarkers. These innovations can simultaneously improve the translation of research advances, and benefit AD research. PMID:19328451

  16. Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan : ASC software quality engineering practices Version 3.0.

    Energy Technology Data Exchange (ETDEWEB)

    Turgeon, Jennifer L.; Minana, Molly A.; Hackney, Patricia; Pilch, Martin M.

    2009-01-01

    The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in the US Department of Energy/National Nuclear Security Agency (DOE/NNSA) Quality Criteria, Revision 10 (QC-1) as 'conformance to customer requirements and expectations'. This quality plan defines the SNL ASC Program software quality engineering (SQE) practices and provides a mapping of these practices to the SNL Corporate Process Requirement (CPR) 001.3.6; 'Corporate Software Engineering Excellence'. This plan also identifies ASC management's and the software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals. This SNL ASC Software Quality Plan establishes the signatories commitments to improving software products by applying cost-effective SQE practices. This plan enumerates the SQE practices that comprise the development of SNL ASC's software products and explains the project teams opportunities for tailoring and implementing the practices.

  17. The Moses Mabhida Medical Plan: medical care planning and execution at a FIFA2010 stadium; the Durban experience

    Directory of Open Access Journals (Sweden)

    Timothy C Hardcastle

    2010-12-01

    Full Text Available Timothy C Hardcastle1,2, Mergan Naidoo3,4, Sanjay Samlal5,6, Morgambery Naidoo5,6, Timothy Larsen5,6, Muzi Mabasu5,6,7, Sibongiseni Ngema6,81Inkosi Albert Luthuli Hospital, Mayville, South Africa; 2Department of Surgery, University of KwaZulu-Natal, Durban, South Africa; 3Wentworth Hospital, Durban, South Africa; 4Department of Family Medicine, University of KwaZulu-Natal, Durban, South Africa; 5Emergency Medical Rescue Service, KwaZulu-Natal, South Africa; 6Department of Health, KwaZulu-Natal, South Africa; 7EMRS 2010 Planning Committee, KwaZulu-Natal, South Africa; 8School of Public Administration and Development Management, University of KwaZulu-Natal, Durban, South AfricaAim: This paper aims to outline the medical services provided at the Moses Mabhida Stadium, Durban, South Africa for the Fédération Internationale de Football Association (FIFA 2010 Soccer World Cup and audit the clinical services delivered to persons seeking medical assistance.Methods: Descriptive report of the medical facilities at the Moses Mabhida Stadium including the staff deployment. Retrospective data review of medical incident reports from the Stadium Medical Team.Results: Medical staffing exceeded the local norms and was satisfactory to provide rapid intervention for all incoming patients. Senior medical presence decreased the transport to hospital rate (TTHR. A total of 316 spectators or support staff were treated during the seven matches played at the stadium. The majority of patients were male (60%, mostly of local origin, with mostly minor complaints that were treated and discharged (88.2% Green codes. The most common complaints were headache, abdominal disorders, and soft-tissue injuries. One fatality was recorded. The patient presentation rate (PPR was 0.66/10,000 and the TTHR was overall 4.1% of all treated patients (0.027/10,000 spectators.Conclusion: There was little evidence to guide medical planning for staffing from the FIFA governing body. Most

  18. Directors' duty of care to monitor information systems in HMOs: some lessons from the Oxford Health Plan.

    Science.gov (United States)

    O'Byrne, M E

    This paper examines the legal and strategic issues raised by the use of information systems in health maintenance organizations (HMOs) and other managed care organizations. Given the critical nature of information systems to an HMO's business success and regulatory compliance, the large financial investment HMOs make in their systems, and the widely publicized concerns over the year 2000 "millennium bug" problem, information systems are appropriately a matter of concern to an HMO's board of directors. The recent experience of Oxford Health Plans, Inc. offers a case study in the apparent failure of the directors to monitor adequately the in-house development of an information system. The systems disaster which this corporation suffered in 1997 led to a dramatic drop in stock price, from which the company has yet to recover, as well as intense scrutiny by state and federal regulators and countless shareholder derivative actions against the directors. Corporate directors are subject to the fiduciary duty of care. Despite statutes in some states requiring directors to act prudently, state courts almost always apply the standard of gross negligence. As a result, even when directors act without due deliberation in their decision, it is rare that a court will find them to have failed in their duty of care. The business and regulatory community may find otherwise, however, when directors fail to evaluate information systems options carefully and the business suffers as a result. PMID:11187367

  19. Ethical Dilemmas in Hospice and Palliative Care Units for Advanced Cancer Patients

    Directory of Open Access Journals (Sweden)

    Beyhan Bag

    2013-02-01

    Full Text Available Ethical dilemmas that face heathcare team members referring patients to hospice programs include the ability of clinicians to predict accurately a patient bad prognosis. They affect day-to-day patient management in palliative care programs including healthcare team members concern over the use of morphine because possible respiratory depression in the patient, the question of providing enteral or parenteral nutritional support to patients who refuse to eat and the question of providing parenteral fluids to patients who are unable to take fluids during the terminal phrases of illness. A final ethical dilemma concerns the methodology for quality of life research in palliative care. Understanding and resolving these ethical dilemmas is an important factor determining the quality of the caring for the patient. The ethical dilemmas that are discussed in the article likely to occur in this period can be prevented through his/her participation in the decisions concerning his or her treatment. [Archives Medical Review Journal 2013; 22(1.000: 65-79

  20. Exploring motivations to seek and undergo prosthodontic care: an empirical approach using the Theory of Planned Behavior construct

    Directory of Open Access Journals (Sweden)

    Vieira AH

    2014-09-01

    Full Text Available Antonio Hélio Vieira, Cláudio Rodrigues Leles Department of Prevention and Oral Rehabilitation, School of Dentistry, Federal University of Goias, Goiania, Goias, Brazil Abstract: Motivations for seeking and undergoing prosthodontic care are poorly understood and are not often explored for clinical purposes when determining treatment need and understanding the factors related to the demand for health care and effective use. This article uses the Theory of Planned Behavior construct to identify factors related to the motivations of edentulous subjects to seek and undergo prosthodontic treatment. The conceptual framework of the Theory of Planned Behavior includes attitude toward behavior, an individual’s positive or negative evaluation of self-performance of the particular behavior; the subjective norm, an individual’s perception of social normative pressures or relevant others’ beliefs that he or she should or should not perform such behavior; and perceived behavioral control, or an individual’s perceived ease or difficulty in performing the particular behavior, determined by the total set of accessible control beliefs. These components mediate a subject’s intention and behavior toward an object and may also explain health-related behaviors, providing strong predictions across a range of health behaviors. This study suggests categories for each component of the Theory of Planned Behavior, based on clinical evidence and practical reasoning. Attitudes toward behavior include perceived consequences of no treatment, perceived potential benefits and risks of treatment, dental anxiety, previous experiences, and interpersonal abilities of the health care providers. The subjective norm includes the opinions of relevant others, advertisement, professionally defined normative need, perceived professional skills, and technical quality of care. Perceived behavioral control includes subject’s time, availability and opportunity, treatment costs

  1. 42 CFR 441.102 - Plan of care for institutionalized recipients.

    Science.gov (United States)

    2010-10-01

    ... days after approval of the State plan provision for services in institutions for mental disease; and... SPECIFIC SERVICES Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases §...

  2. The choice of optimal radiotherapy technique for locally advanced maxillary carcinoma using 3d treatment planning system

    Directory of Open Access Journals (Sweden)

    Mileusnić Dušan

    2004-01-01

    Full Text Available Aim. To compare the isodose distribution of three radiotherapy techniques for locally advanced maxillary sinus carcinoma and analyze the potential of three-dimensional (3D conformal radiotherapy planning in order to determine the optimal technique for target dose delivery, and spare uninvolved healthy tissue structures. Methods. Computed tomography (CT scans of fourteen patients with T3-T4, N0, M0 maxillary sinus carcinoma were acquired and transferred to 3D treatment planning system (3D-TPS. The target volume and uninvolved dose limiting structures were contoured on axial CT slices throughout the volume of interest combining three variants of treatment plans (techniques for each patient: 1. A conventional two-dimensional (2D treatment plan with classically shaped one anterior two lateral opposite fields and two types of 3D conformal radiotherapy plans were compared for each patient. 2. Three-dimensional standard (3D-S plan one anterior + two lateral opposite coplanar fields, which outlines were shaped with multileaf collimator (MLC according to geometric information based on 3D reconstruction of target volume and organs at risk as seen in the beam eye's view (BEV projection. 3. Three-dimensional non-standard (3D-NS plan: one anterior + two lateral noncoplanar fields, which outlines were shaped in the same manner as in 3D-S plans. The planning parameters for target volumes and the degree of neurooptic structures and parotid glands protection were evaluated for all three techniques. Comparison of plans and treatment techniques was assessed by isodose distribution, dose statistics and dose-volume histograms. Results. The most enhanced conformity of the dose delivered to the target volume was achieved with 3D-NS technique, and significant differences were found comparing 3D-NS vs. 2D (Dmax: p<0,05 Daver: p<0,01; Dmin: p<0,05; V90: p<0,05, and V95: p<0,01, as well as 3D-NS vs. 3D-S technique (Dmin: p<0,05; V90: p<0,05, and V95: p<0,01, while there

  3. Durable mechanical circulatory support in advanced heart failure: a critical care cardiology perspective.

    Science.gov (United States)

    Lala, Anuradha; Mehra, Mandeep R

    2013-11-01

    Though cardiac transplantation for advanced heart disease patients remains definitive therapy for patients with advanced heart failure, it is challenged by inadequate donor supply, causing durable mechanical circulatory support (MCS) to slowly become a new primary standard. Selecting appropriate patients for MCS involves meeting a number of prespecifications as is required in evaluation for cardiac transplant candidacy. As technology evolves to bring forth more durable smaller devices, selection criteria for appropriate MCS recipients will likely expand to encompass a broader, less sick population. The "Holy Grail" for MCS will be a focus on clinical recovery and explantation of devices rather than the currently more narrowly defined indications of bridge to transplantation or lifetime device therapy. PMID:24188222

  4. Advanced perception, navigation and planning for autonomous in-water ship hull inspection

    OpenAIRE

    Hover, Franz S.; Eustice, Ryan M.; Kim, Ayoung; Englot, Brendan J.; Johannsson, Hordur; Kaess, Michael; Leonard, John Joseph

    2013-01-01

    Inspection of ship hulls and marine structures using autonomous underwater vehicles has emerged as a unique and challenging application of robotics. The problem poses rich questions in physical design and operation, perception and navigation, and planning, driven by difficulties arising from the acoustic environment, poor water quality and the highly complex structures to be inspected. In this paper, we develop and apply algorithms for the central navigation and planning problems on ship hull...

  5. Outcome of neoadjuvant chemotherapy in locally advanced breast cancer: A tertiary care centre experience

    OpenAIRE

    Tapesh Bhattacharyya; Suresh C Sharma; Budhi Singh Yadav; Rajinder Singh; Gurpreet Singh

    2014-01-01

    Background: Introduction of neoadjuvant chemotherapy (NACT) has dramatically changed the management of locally advanced breast cancer (LABC). However, very few randomized trials of NACT have been carried out specifically in LABC patients in our country. In this retrospective analysis, we presented our experience with NACT in LABC patients. Materials and Methods: Medical records of 148 patients of stage III LABC patients treated with NACT, followed by surgery and radiotherapy from January 2006...

  6. Advances and Future Directions for Tuberous Sclerosis Complex Research: Recommendations From the 2015 Strategic Planning Conference.

    Science.gov (United States)

    Sahin, Mustafa; Henske, Elizabeth P; Manning, Brendan D; Ess, Kevin C; Bissler, John J; Klann, Eric; Kwiatkowski, David J; Roberds, Steven L; Silva, Alcino J; Hillaire-Clarke, Coryse St; Young, Lisa R; Zervas, Mark; Mamounas, Laura A

    2016-07-01

    On March 10 to March 12, 2015, the National Institute of Neurological Disorders and Stroke and the Tuberous Sclerosis Alliance sponsored a workshop in Bethesda, Maryland, to assess progress and new opportunities for research in tuberous sclerosis complex with the goal of updating the 2003 Research Plan for Tuberous Sclerosis (http://www.ninds.nih.gov/about_ninds/plans/tscler_research_plan.htm). In addition to the National Institute of Neurological Disorders and Stroke and Tuberous Sclerosis Alliance, participants in the strategic planning effort and workshop included representatives from six other Institutes of the National Institutes of Health, the Department of Defense Tuberous Sclerosis Complex Research Program, and a broad cross-section of basic scientists and clinicians with expertise in tuberous sclerosis complex along with representatives from the pharmaceutical industry. Here we summarize the outcomes from the extensive premeeting deliberations and final workshop recommendations, including (1) progress in the field since publication of the initial 2003 research plan for tuberous sclerosis complex, (2) the key gaps, needs, and challenges that hinder progress in tuberous sclerosis complex research, and (3) a new set of research priorities along with specific recommendations for addressing the major challenges in each priority area. The new research plan is organized around both short-term and long-term goals with the expectation that progress toward specific objectives can be achieved within a five to ten year time frame. PMID:27267556

  7. [Oncologic after-care--a patient-oriented concept. Basic diagnostic plan for pediatric oncology patients].

    Science.gov (United States)

    Duffner, U; Sauter, S; Bergsträsser, E; Brandis, M; Niemeyer, C

    1995-01-01

    With intensive treatment many children and young adults with cancer can be cured of their disease. Therefore, the recognition of late effects of therapy will become increasingly important. Future concepts of follow-up care in pediatric oncology will have to serve two purposes: First, to determine the status of the malignant disease with early diagnosis of relapse and second, to recognize relevant side effects of treatment. We present a comprehensive approach of follow-up care which is primarily based on the definition of risk criteria for the development of relevant organ toxicity after different treatment modalities. For each patient a standardized summary of therapy delivered is documented. According to the definition of the risk criteria an individualized schedule for follow-up is decided upon. We hope that this structured concept will result in appropriate patient care while keeping the diagnostic efforts and costs limited. PMID:7564151

  8. Human-centered design of a cyber-physical system for advanced response to Ebola (CARE).

    Science.gov (United States)

    Dimitrov, Velin; Jagtap, Vinayak; Skorinko, Jeanine; Chernova, Sonia; Gennert, Michael; Padir, Taşkin

    2015-08-01

    We describe the process towards the design of a safe, reliable, and intuitive emergency treatment unit to facilitate a higher degree of safety and situational awareness for medical staff, leading to an increased level of patient care during an epidemic outbreak in an unprepared, underdeveloped, or disaster stricken area. We start with a human-centered design process to understand the design challenge of working with Ebola treatment units in Western Africa in the latest Ebola outbreak, and show preliminary work towards cyber-physical technologies applicable to potentially helping during the next outbreak. PMID:26737868

  9. Contemporary theories and contemporary nursing--advancing nursing care for those who are marginalized.

    Science.gov (United States)

    Davis, K; Glass, N

    1999-06-01

    This paper critiques the topic of postmodernism and how it is represented in nursing and social science literature. This critique classified the debates into three identifiable constructs, those being: dissatisfaction; fragmentation and integration. The authors propose a solution from the integration debate by putting forward the notion of an 'integrated postmodern turn'. The 'solution' is situated within feminism and draws on modernist and postmodernist theory. The integrated model is grounded in nursing clinical examples which demonstrate the usefulness and workability of this approach when caring for those who are marginalized by nurses because of their ethnicity, gender, cultural and/or spiritual beliefs. PMID:11096793

  10. Human Papillomavirus Vaccination Coverage Among Female Adolescents in Managed Care Plans - United States, 2013.

    Science.gov (United States)

    Ng, Judy; Ye, Faye; Roth, Lindsey; Sobel, Katherine; Byron, Sepheen; Barton, Mary; Lindley, Megan; Stokley, Shannon

    2015-10-30

    Human papillomavirus (HPV) is the most common sexually transmitted infection, with a reported 79 million persons aged 15–59 years in the United States currently infected with HPV, and approximately 14 million new cases diagnosed each year. Although most HPV infections are asymptomatic, transient, and do not cause disease, persistent HPV infection can lead to cervical, vulvar, vaginal, anal, penile, and oropharyngeal cancer. In the United States, approximately 27,000 HPV-attributable cancers occur each year. HPV vaccination is an effective primary prevention strategy that can reduce many of the HPV infections that lead to cancer, and is routinely recommended for adolescents aged 11–12 years. To determine whether the recommended HPV vaccination series is currently being administered to adolescents with health insurance, CDC and the National Committee for Quality Assurance (NCQA) assessed 2013 data from the Healthcare Effectiveness Data and Information Set (HEDIS). The HEDIS HPV Vaccine for Female Adolescents performance measure evaluates the proportion of female adolescent members in commercial and Medicaid health plans who receive the recommended 3-dose HPV vaccination series by age 13 years. In 2013, in the United States, the median HPV vaccination coverage levels for female adolescents among commercial and Medicaid plans were 12% and 19%, respectively (ranges = 0%–34% for commercial plans; 5%–52% for Medicaid plans). Improving HPV vaccination coverage and understanding of what health plans might do to support HPV vaccination are needed, including understanding the barriers to, and facilitators for, vaccination coverage. PMID:26513219

  11. Planning for End-of-Life Care: Findings from the Canadian Study of Health and Aging

    Science.gov (United States)

    Garrett, Douglas D.; Tuokko, Holly; Stajduhar, Kelli I.; Lindsay, Joan; Buehler, Sharon

    2008-01-01

    Steps involved in formalizing end-of-life care preferences and factors related to these steps are unclear in the literature. Using data from the third wave of the Canadian Study of Health and Aging (CSHA-3), we examined the relations between demographic and health predictors, on the one hand, and three outcomes, on the other (whether participants…

  12. Menu Planning, Food Consumption, and Sanitation Practices in Day Care Facilities.

    Science.gov (United States)

    Kuratko, Connye N.; Martin, Ruth E.; Lan, William Y.; Chappell, James A.; Ahmad, Mahassen

    2000-01-01

    In 102 day care centers, data were collected on nutritional content of menus, compliance with guidelines, children's food consumption, and safety/sanitation. Although menus exceeded recommended daily allowances, quantities of food were below recommendations. No menu components were consumed by more than 65% of children. Sanitation problems were…

  13. 42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services.

    Science.gov (United States)

    2010-10-01

    ... professional roles: (i) A doctor of medicine or osteopathy (who is an employee or under contract with the hospice). (ii) A registered nurse. (iii) A social worker. (iv) A pastoral or other counselor. (2) If the... supervise the care and services. The hospice must designate a registered nurse that is a member of...

  14. Hazards of Immobility: Bedsores. Adult Residential Care Home, Lesson Plan No. 5.

    Science.gov (United States)

    Lin, Kathleen

    Developed as part of a 104-hour course on adult residential care homes (ARCHs), this 50-minute lesson is designed to enable a student to: (1) define a bedsore; (2) list and describe three major causes of bedsores; (3) identify potential bedsore sites in the back-lying, side-lying, and sitting positions; and (4) calculate the risk for developing…

  15. 78 FR 69418 - Patient Protection and Affordable Care Act; Exchanges and Qualified Health Plans, Quality Rating...

    Science.gov (United States)

    2013-11-19

    ... safety, prevention, population health, patient engagement, patient experience, and efficient resource use... Department of Health and Human Services (the Secretary) holds primary responsibility for establishing the... performance data for the QRS in general topics, such as clinical effectiveness of care, patient safety,...

  16. Multiplexed lateral flow biosensors: Technological advances for radically improving point-of-care diagnoses.

    Science.gov (United States)

    Li, Jia; Macdonald, Joanne

    2016-09-15

    Lateral flow biosensors are a leading technology in point-of-care diagnostics due to their simplicity, rapidness and low cost. Their primacy in this arena continues through technological breakthroughs such as multiplexing: the detection of more than one biomarker in a single assay. Multiplexing capacity is critical for improving diagnostic efficiency, enhancing the diagnostic precision for specific diseases and reducing diagnostic cost. Here we review, for the first time, the various types and strategies employed for creating multiplexed lateral flow biosensors. These are classified into four main categories in terms of specific application or multiplexing level, namely linear, parameter, spatial and conceptual. We describe the practical applications and implications for each approach and compare their advantages and disadvantages. Importantly, multiplexing is still subject to limitations of the traditional lateral flow biosensor, such as sensitivity and specificity. However, by pushing the limitations of the traditional medium into the multiplex arena, several technological breakthroughs are emerging with novel solutions that further expand the utility of lateral flow biosensing for point-of-care applications. PMID:27125840

  17. Improved VMAT planning for head and neck tumors with an advanced optimization algorithm

    International Nuclear Information System (INIS)

    In this study, the ''Progressive Resolution Optimizer PRO3'' (Varian Medical Systems) is compared to the previous version PRO2'' with respect to its potential to improve dose sparing to the organs at risk (OAR) and dose coverage of the PTV for head and neck cancer patients. Materials and Methods For eight head and neck cancer patients, volumetric modulated arc therapy (VMAT) treatment plans were generated in this study. All cases have 2-3 phases and the total prescribed dose (PD) was 60-72 Gy in the PTV. The study is mainly focused on the phase 1 plans, which all have an identical PD of 54 Gy, and complex PTV structures with an overlap to the parotids. Optimization was performed based on planning objectives for the PTV according to ICRU83, and with minimal dose to spinal cord, and parotids outside PTV. In order to assess the quality of the optimization algorithms, an identical set of constraints was used for both, PRO2 and PRO3. The resulting treatment plans were investigated with respect to dose distribution based on the analysis of the dose volume histograms. Results For the phase 1 plans (PD = 54 Gy) the near maximum dose D2% of the spinal cord, could be minimized to 22±5 Gy with PRO3, as compared to 32±12 Gy with PRO2, averaged for all patients. The mean dose to the parotids was also lower in PRO3 plans compared to PRO2, but the differences were less pronounced. A PTV coverage of V95% = 97±1% could be reached with PRO3, as compared to 86±5% with PRO2. In clinical routine, these PRO2 plans would require modifications to obtain better PTV coverage at the cost of higher OAR doses. Conclusion A comparison between PRO3 and PRO2 optimization algorithms was performed for eight head and neck cancer patients. In general, the quality of VMAT plans for head and neck patients are improved with PRO3 as compared to PRO2. The dose to OARs can be reduced significantly, especially for the spinal cord. These reductions are achieved with better

  18. Improved VMAT planning for head and neck tumors with an advanced optimization algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Klippel, Norbert; Schmuecking, Michael; Terribilini, Dario; Geretschlaeger, Andreas; Aebersold, Daniel M.; Manser, Peter [Bern University Hospital - Inselspital (Switzerland). Div. of Medical Radiation Physics and Dept. of Radiation Oncology

    2015-07-01

    In this study, the ''Progressive Resolution Optimizer PRO3'' (Varian Medical Systems) is compared to the previous version PRO2'' with respect to its potential to improve dose sparing to the organs at risk (OAR) and dose coverage of the PTV for head and neck cancer patients. Materials and Methods For eight head and neck cancer patients, volumetric modulated arc therapy (VMAT) treatment plans were generated in this study. All cases have 2-3 phases and the total prescribed dose (PD) was 60-72 Gy in the PTV. The study is mainly focused on the phase 1 plans, which all have an identical PD of 54 Gy, and complex PTV structures with an overlap to the parotids. Optimization was performed based on planning objectives for the PTV according to ICRU83, and with minimal dose to spinal cord, and parotids outside PTV. In order to assess the quality of the optimization algorithms, an identical set of constraints was used for both, PRO2 and PRO3. The resulting treatment plans were investigated with respect to dose distribution based on the analysis of the dose volume histograms. Results For the phase 1 plans (PD = 54 Gy) the near maximum dose D{sub 2%} of the spinal cord, could be minimized to 22±5 Gy with PRO3, as compared to 32±12 Gy with PRO2, averaged for all patients. The mean dose to the parotids was also lower in PRO3 plans compared to PRO2, but the differences were less pronounced. A PTV coverage of V{sub 95%} = 97±1% could be reached with PRO3, as compared to 86±5% with PRO2. In clinical routine, these PRO2 plans would require modifications to obtain better PTV coverage at the cost of higher OAR doses. Conclusion A comparison between PRO3 and PRO2 optimization algorithms was performed for eight head and neck cancer patients. In general, the quality of VMAT plans for head and neck patients are improved with PRO3 as compared to PRO2. The dose to OARs can be reduced significantly, especially for the spinal cord. These reductions are achieved

  19. Planning report for establishment of research infrastructure for national advanced radiation technology

    International Nuclear Information System (INIS)

    Establishment of research infrastructure and assistant of industry renovation is needed to achieve technology level-up in the all industry areas including plant engineering, material engineering, polymers, nondestructive tests, radioisotope tracer application, environment engineering, medical science, agriculture, sterilization, sprouting, biotechnology and aerospace, which would be the core motivation of our future industry. Especially for early settlement of research environment for the new RT-specialized national institute, Advanced Radiation Technology Institute (ARTI) in Jeongup, Chonbuk, Korea is essential. For this purpose, an intensive system construction is demanded including: 1) Area of establishment of the system assisting radiation technology advancement: It is expected that radioisotope production for industrial or medical uses and activation of the related researches and training of experts by manufacture, installation, and operation of 30 MeV cyclotron. It also can be contributed in the promotion of national radiation related science and technology by establishment of a basic and advanced analysis system. 2) Area of establishment of training and education system of RT experts. 3) Area of establishment of a system for technological assistance for industry and industry-university-institute network. Contribution to balanced regional development and promotion of national RT-based science through establishment of RT industry cluster with Advanced Radiation Technology Institute (ARTi) at Jeongup as the center figure

  20. 25 CFR 1001.9 - Selection criteria for tribes/consortia seeking advance planning grant funding.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Selection criteria for tribes/consortia seeking advance..., DEPARTMENT OF THE INTERIOR SELF-GOVERNANCE PROGRAM § 1001.9 Selection criteria for tribes/consortia seeking...., submit resumes and position descriptions of key staff or consultants to be used). (c) How will...

  1. Integrated Computer Aided Planning and Manufacture of Advanced Technology Jet Engines

    Directory of Open Access Journals (Sweden)

    B. K. Subhas

    1987-10-01

    Full Text Available This paper highlights an attempt at evolving a computer aided manufacturing system on a personal computer. A case study of an advanced technology jet engine component is included to illustrate various outputs from the system. The proposed system could be an alternate solution to sophisticated and expensive CAD/CAM workstations.

  2. Latest advances in confocal microscopy of skin cancers toward guiding patient care: a Mohs surgeon's review and perspective (Conference Presentation)

    Science.gov (United States)

    Nehal, Kishwer S.; Rajadhyaksha, Milind

    2016-02-01

    Latest advances in confocal microscopy of skin cancers toward guiding patient care: a Mohs surgeon's review and perspective About 350 publications worldwide have reported the ability of reflectance confocal microscopy (RCM) imaging to detect melanocytic skin lesions in vivo with specificity of 84-88% and sensitivity of 71-92%, and non-melanocytic skin lesions with specificity of 85-97% and sensitivity 100-92%. Lentigo maligna melanoma can be detected with sensitivity of 93% and specificity 82%. While the sensitivity is comparable to that of dermoscopy, the specificity is 2X superior, especially for lightly- and non-pigmented lesions. Dermoscopy combined with RCM imaging is proving to be both highly sensitive and highly specific. Recent studies have reported that the ratio of equivocal (i.e., would have been biopsied) lesions to detected melanomas dropped by ~2X when guided by dermoscopy and RCM imaging, compared to that with dermoscopy alone. Dermoscopy combined with RCM imaging is now being implemented to guide noninvasive diagnosis (to rule out malignancy and biopsy) and to also guide treatment, with promising initial impact: thus far, about 3,000 patients have been saved from biopsies of benign lesions. These are currently under follow-up monitoring. With fluorescence confocal microscopy (FCM) mosaicing, residual basal cell carcinomas can be detected in Mohs surgically excised fresh tissue ex vivo, with sensitivity of 94-97% and specificity 89-94%. FCM mosaicing is now being implemented for guiding Mohs surgery. To date, about 600 Mohs procedures have been performed, guided with mosaicing, and with pathology being performed in parallel to confirm the final outcome. These latest advances demonstrate the promising ability of RCM and FCM to guide patient care.

  3. 76 FR 77392 - Patient Protection and Affordable Care Act; Establishment of Consumer Operated and Oriented Plan...

    Science.gov (United States)

    2011-12-13

    ... bring meaningful resolution to the lack of consumer choice in the health insurance market. The commenter... program (CO-OP) to foster the creation of new consumer-governed, private, nonprofit health insurance issuers. In addition to improving consumer choice and plan accountability, the CO- OP program also...

  4. Nursing and philanthropy: a partnership to advance professional excellence and exceptional care.

    Science.gov (United States)

    Janney, Michelle A

    2014-01-01

    Michelle A. Janney, PhD, RN, NEA-BC, 2013 AONE President, Senior Vice President, and Wood-Prince Family Chief Nurse Executive at Northwestern Memorial Hospital, discusses the impact of engaging institutional leadership in nursing philanthropic and strategic priorities and the importance of developing a culture of philanthropy that permeates the organization and encourages participation from all levels. The article highlights key outcomes of Northwestern Memorial Hospital's collective efforts to build a culture of philanthropy that prioritizes nursing as consequential to the mission of the organization. The outcomes demonstrate how such a culture provides a critical platform for creating opportunities that enable nurses to be indispensable partners in a shared commitment to the highest-quality, scientifically driven, personalized care. PMID:25208145

  5. A prospective evaluation of Dignity Therapy in advanced cancer patients admitted to palliative care

    DEFF Research Database (Denmark)

    Houmann, Lise Jul; Chochinov, Harvey M; Kristjanson, Linda J;

    2014-01-01

    questionnaires were completed when patients received the generativity document (T1) and 2 weeks later (T2). Changes from baseline (T0) were measured in sense of dignity, Structured Interview for Symptoms and Concerns items, Patient Dignity Inventory, Hospital Anxiety and Depression Scale and European...... purpose, dignity and will to live. Quality of life decreased (mean = -9 (95% confidence interval: -14.54; -2.49)) and depression increased (mean = 0.31 (0.06; 0.57)) on one of several depression measures. At T2 (n = 31), sense of dignity (mean = -0.52 (-1.01; -0.02)) and sense of being a burden to others...... (mean = -0.26 (-0.49; -0.02)) improved. Patients with children and lower performance status, emotional functioning and quality of life were more likely to report benefit.Conclusions:This study adds to the growing body of evidence supporting Dignity Therapy as a valuable intervention in palliative care...

  6. Advanced Rain Analysis in order to Improve the Planning in Radiocommunications

    Czech Academy of Sciences Publication Activity Database

    Fišer, Ondřej

    Brusel : European Union, 2001, s. 13. [Minutes of the COST280 inaugural meeting. Brusel (BE), 18.06.2001-19.06.2001] Institutional research plan: CEZ:AV0Z3042911 Keywords : radiowave propagation * rain attenuation * rain type Subject RIV: DG - Athmosphere Sciences, Meteorology

  7. Advancing mission in the marketplace. Integrated strategic planning and budgeting helps a system remain accountable.

    Science.gov (United States)

    Smessaert, A H

    1992-10-01

    In the late 1980s Holy Cross Health System (HCHS), South Bend, IN, began to implement a revised strategic planning and budgeting process to effectively link the system's mission with its day-to-day operations. Leaders wanted a process that would help system employees internalize and act on the four major elements articulated in the HCHS mission statement: fidelity, excellence, empowerment, and stewardship. Representatives from mission, strategic planning, and finance from the corporate office and subsidiaries examined planning and budgeting methods. From the beginning, HCHS leaders decided that the process should be implemented gradually, with each step focusing on refining methodology and improving mission integration. As the process evolved. HCHS developed a sequence in which planning preceded budgeting. The system also developed a variety of educational and collaborative initiatives to help system employees adapt to the organization's change of direction. One critical aspect of HCHS's ongoing education is an ethical reflection process that helps participants balance ethical considerations by viewing an issue from three perspectives: social vision, multiple responsibility, and self-interest. PMID:10121477

  8. Benefits planning for advanced clinical information systems implementation at Allina hospitals and clinics.

    Science.gov (United States)

    Thompson, Douglas Ivan; Henry, Sharon; Lockwood, Linda; Anderson, Brian; Atkinson, Susan

    2005-01-01

    Allina Hospitals and Clinics is implementing an enterprise-wide information system with inpatient and ambulatory clinical documentation and orders, clinical decision support, and revenue cycle applications. Allina has adopted a rigorous approach to planning for and realizing the expected clinical and financial benefits from this investment. Allina's strategies include: Forming a benefits realization team with formal responsibility for analysis, education, facilitation, and measurement; Studying system design to consider requirements for benefits realization; Integrating cultural, organizational and process change plans with system implementation plans; Measuring benefits using a measurement framework that matches organizational reporting, enables multi-level sequential analysis and adjusts for bias in quantifying benefits; Assigning accountability for achieving benefits by matching every benefit with an individual and an operational group; system executives, hospital executives, and department managers are held accountable for benefits within their scope of responsibility, and expected financial benefits are part of their yearly budgets. This article describes Allina's approach for benefits planning, contrasting it with the typical provider's approach to benefits realization. It argues that this approach may greatly increase the likelihood of realizing the value of investments in integrated clinical and business IT PMID:15682677

  9. Advanced software development workstation: Object-oriented methodologies and applications for flight planning and mission operations

    Science.gov (United States)

    Izygon, Michel

    1993-01-01

    The work accomplished during the past nine months in order to help three different organizations involved in Flight Planning and in Mission Operations systems, to transition to Object-Oriented Technology, by adopting one of the currently most widely used Object-Oriented analysis and Design Methodology is summarized.

  10. Developing a national dissemination plan for collaborative care for depression: QUERI Series

    OpenAIRE

    Rubenstein Lisa V; Owen Richard R; Williams John W; Smith Jeffrey L; Chaney Edmund

    2008-01-01

    Abstract Background Little is known about effective strategies for disseminating and implementing complex clinical innovations across large healthcare systems. This paper describes processes undertaken and tools developed by the U.S. Department of Veterans Affairs (VA) Mental Health Quality Enhancement Research Initiative (MH-QUERI) to guide its efforts to partner with clinical leaders to prepare for national dissemination and implementation of collaborative care for depression. Methods An ev...

  11. Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries.

    LENUS (Irish Health Repository)

    Coffey, Alice

    2016-01-28

    Nurses\\' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses\\' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients\\' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.

  12. Two Case Studies Using Mock-Ups for Planning Adult and Neonatal Intensive Care Facilities

    Directory of Open Access Journals (Sweden)

    Sue Hignett

    2010-01-01

    Full Text Available This paper describes two case studies using a 5-step protocol to determine functional space requirements for cardiac and neonatal intensive care clinical activities. Functional space experiments were conducted to determine the spatial requirements (defined as the minimumsized rectangle to encompass the Link Analysis. The data were collected with multi-directional filming and analysed frame-by-frame to plot the movements between the nurses and other components in the space. The average clinical functional space for the adult critical care unit was 22.83m2 (excluding family and hygiene space and in-room storage. The average functional clinical space for neonatal intensive care unit was 13.5m2 (excluding circulation and storage. The use of the 5-step protocol is reviewed, with limitations in case study 1 addressed in case study 2. The findings from both case studies have been incorporated into government guidance and achieved knowledge transfer by being implemented in building design.

  13. Impact of Instruction and Feedback on Reflective Responses during an Ambulatory Care Advanced Pharmacy Practice Experience.

    Science.gov (United States)

    Teply, Robyn; Spangler, Mikayla; Klug, Laura; Tilleman, Jennifer; Coover, Kelli

    2016-06-25

    Objective. To investigate whether instruction and feedback on reflective responses are beneficial in developing pharmacy students to become more reflective practitioners. Methods. Students on an advanced pharmacy practice experience answered weekly reflection questions and were randomly assigned to either an intervention (received instruction and feedback on reflection) or control group. The final week's responses were de-identified and two blinded faculty members independently categorized them as reflective or nonreflective. The primary outcome measure was comparing the number of "reflective" responses in each group. Results. The responses were classified as reflective in 83.3% of students in the intervention group (n=18) compared to 37.5% of the control group (n=16). The odds that the response was categorized as reflective were 8.3 times higher in the intervention group. Conclusion. Providing instruction and feedback to students improved the likelihood that their work was reflective. PMID:27402984

  14. Cell Phone-Based and Adherence Device Technologies for HIV Care and Treatment in Resource-Limited Settings: Recent Advances.

    Science.gov (United States)

    Campbell, Jeffrey I; Haberer, Jessica E

    2015-12-01

    Numerous cell phone-based and adherence monitoring technologies have been developed to address barriers to effective HIV prevention, testing, and treatment. Because most people living with HIV and AIDS reside in resource-limited settings (RLS), it is important to understand the development and use of these technologies in RLS. Recent research on cell phone-based technologies has focused on HIV education, linkage to and retention in care, disease tracking, and antiretroviral therapy adherence reminders. Advances in adherence devices have focused on real-time adherence monitors, which have been used for both antiretroviral therapy and pre-exposure prophylaxis. Real-time monitoring has recently been combined with cell phone-based technologies to create real-time adherence interventions using short message service (SMS). New developments in adherence technologies are exploring ingestion monitoring and metabolite detection to confirm adherence. This article provides an overview of recent advances in these two families of technologies and includes research on their acceptability and cost-effectiveness when available. It additionally outlines key challenges and needed research as use of these technologies continues to expand and evolve. PMID:26439917

  15. Physical and Visual Accessibilities in Intensive Care Units: A Comparative Study of Open-Plan and Racetrack Units.

    Science.gov (United States)

    Rashid, Mahbub; Khan, Nayma; Jones, Belinda

    2016-01-01

    This study compared physical and visual accessibilities and their associations with staff perception and interaction behaviors in 2 intensive care units (ICUs) with open-plan and racetrack layouts. For the study, physical and visual accessibilities were measured using the spatial analysis techniques of Space Syntax. Data on staff perception were collected from 81 clinicians using a questionnaire survey. The locations of 2233 interactions, and the location and length of another 339 interactions in these units were collected using systematic field observation techniques. According to the study, physical and visual accessibilities were different in the 2 ICUs, and clinicians' primary workspaces were physically and visually more accessible in the open-plan ICU. Physical and visual accessibilities affected how well clinicians' knew their peers and where their peers were located in these units. Physical and visual accessibilities also affected clinicians' perception of interaction and communication and of teamwork and collaboration in these units. Additionally, physical and visual accessibilities showed significant positive associations with interaction behaviors in these units, with the open-plan ICU showing stronger associations. However, physical accessibilities were less important than visual accessibilities in relation to interaction behaviors in these ICUs. The implications of these findings for ICU design are discussed. PMID:27575795

  16. An ethnographic study of strategies to support discussions with family members on end-of-life care for people with advanced dementia in nursing homes

    OpenAIRE

    Saini, Geena; Sampson, Elizabeth L.; Davis, Sarah; Kupeli, Nuriye; Harrington, Jane; Leavey, Gerard; Nazareth, Irwin; Jones, Louise; Moore, Kirsten J.

    2016-01-01

    Background Most people with advanced dementia die in nursing homes where families may have to make decisions as death approaches. Discussions about end-of-life care between families and nursing home staff are uncommon, despite a range of potential benefits. In this study we aimed to examine practices relating to end-of-life discussions with family members of people with advanced dementia residing in nursing homes and to explore strategies for improving practice. Methods An ethnographic study ...

  17. Office of River Protection Advanced Low-Activity Waste Glass Research and Development Plan

    International Nuclear Information System (INIS)

    The U.S. Department of Energy Office of River Protection (ORP) has initiated and leads an integrated Advanced Waste Glass (AWG) program to increase the loading of Hanford tank wastes in glass while meeting melter lifetime expectancies and process, regulatory, and product performance requirements. The integrated ORP program is focused on providing a technical, science-based foundation for making key decisions regarding the successful operation of the Hanford Tank Waste Treatment and Immobilization Plant (WTP) facilities in the context of an optimized River Protection Project (RPP) flowsheet. The fundamental data stemming from this program will support development of advanced glass formulations, key product performance and process control models, and tactical processing strategies to ensure safe and successful operations for both the low-activity waste (LAW) and high-level waste vitrification facilities. These activities will be conducted with the objective of improving the overall RPP mission by enhancing flexibility and reducing cost and schedule.

  18. Office of River Protection Advanced Low-Activity Waste Glass Research and Development Plan

    Energy Technology Data Exchange (ETDEWEB)

    Kruger, A. A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Peeler, D. K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Kim, D. S. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Vienna, J. D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Piepel, G. F. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Schweiger, M. J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-11-23

    The U.S. Department of Energy Office of River Protection (ORP) has initiated and leads an integrated Advanced Waste Glass (AWG) program to increase the loading of Hanford tank wastes in glass while meeting melter lifetime expectancies and process, regulatory, and product performance requirements. The integrated ORP program is focused on providing a technical, science-based foundation for making key decisions regarding the successful operation of the Hanford Tank Waste Treatment and Immobilization Plant (WTP) facilities in the context of an optimized River Protection Project (RPP) flowsheet. The fundamental data stemming from this program will support development of advanced glass formulations, key product performance and process control models, and tactical processing strategies to ensure safe and successful operations for both the low-activity waste (LAW) and high-level waste vitrification facilities. These activities will be conducted with the objective of improving the overall RPP mission by enhancing flexibility and reducing cost and schedule.

  19. Strategic Management. Strategic Plan for SCHOTT Advanced Optics' entrance into the laser market

    OpenAIRE

    Laguna De Paco, Ignacio

    2009-01-01

    The following pages contain a strategic recommendation for SCHOTT AG, a Germanbased multinational, to enter the market of optical materials and components for laser applications. The company, through its Business Unit “Advanced Materials” is currently successfully supplying optical materials and components made of glass to several markets. Is there a profitable opportunity for the company to join the Laser Market now? This Thesis’ aim is to answer that question by following ...

  20. FY05-FY06 Advanced Simulation and Computing Implementation Plan, Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    Baron, A L

    2004-07-19

    The Stockpile Stewardship Program (SSP) is a single, highly integrated technical program for maintaining the safety and reliability of the U.S. nuclear stockpile. The SSP uses past nuclear test data along with future non-nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program will require the continued use of current facilities and programs along with new experimental facilities and computational enhancements to support these programs. The Advanced Simulation and Computing program (ASC) is a cornerstone of the SSP, providing simulation capabilities and computational resources to support the annual stockpile assessment and certification, to study advanced nuclear weapon design and manufacturing processes, to analyze accident scenarios and weapons aging, and to provide the tools to enable stockpile life extension programs and the resolution of significant finding investigations (SFIs). This requires a balanced system of technical staff, hardware, simulation software, and computer science solutions.

  1. Continuing Care

    Science.gov (United States)

    ... Care Obesity at Midlife May Speed Alzheimer’s Onset Hello from my mom Easing the Behavior Problems of ... Managers Continuing Care FOR MORE ARTICLES CLICK HERE Hello from my mom Common Estate Planning Errors Alzheimer’s ...

  2. Detailed statistical analysis plan for the Danish Palliative Care Trial (DanPaCT)

    DEFF Research Database (Denmark)

    Johnsen, Anna Thit; Petersen, Morten Aagaard; Gluud, Christian;

    2014-01-01

    from being referred to 'early SPC'. DanPaCT is a multicenter, parallel-group, superiority clinical trial with 1:1 randomization. The planned sample size was 300 patients. The primary data collection for DanPaCT is finished. To prevent outcome reporting bias, selective reporting, and data-driven results......, we present a detailed statistical analysis plan (SAP) for DanPaCT here. RESULTS: This SAP provides detailed descriptions of the statistical analyses of the primary and secondary outcomes in DanPaCT. The primary outcome is the change in the patient's 'primary need'. The 'primary need' is a patient...... primary outcome, but each scale evaluated individually for all patients, and survival. The detailed description includes chosen significance levels, models for multiple imputations, sensitivity analyses and blinding. In addition, we discuss the patient-individualized primary outcome, blinding, missing...

  3. MOD* Lite: An Incremental Path Planning Algorithm Taking Care of Multiple Objectives.

    Science.gov (United States)

    Oral, Tugcem; Polat, Faruk

    2016-01-01

    The need for determining a path from an initial location to a target one is a crucial task in many applications, such as virtual simulations, robotics, and computer games. Almost all of the existing algorithms are designed to find optimal or suboptimal solutions considering only a single objective, namely path length. However, in many real life application path length is not the sole criteria for optimization, there are more than one criteria to be optimized that cannot be transformed to each other. In this paper, we introduce a novel multiobjective incremental algorithm, multiobjective D* lite (MOD* lite) built upon a well-known path planning algorithm, D* lite. A number of experiments are designed to compare the solution quality and execution time requirements of MOD* lite with the multiobjective A* algorithm, an alternative genetic algorithm we developed multiobjective genetic path planning and the strength Pareto evolutionary algorithm. PMID:25730837

  4. Advancing the argument for validity of the Alberta Context Tool with healthcare aides in residential long-term care

    Directory of Open Access Journals (Sweden)

    Cummings Greta G

    2011-07-01

    Full Text Available Abstract Background Organizational context has the potential to influence the use of new knowledge. However, despite advances in understanding the theoretical base of organizational context, its measurement has not been adequately addressed, limiting our ability to quantify and assess context in healthcare settings and thus, advance development of contextual interventions to improve patient care. We developed the Alberta Context Tool (the ACT to address this concern. It consists of 58 items representing 10 modifiable contextual concepts. We reported the initial validation of the ACT in 2009. This paper presents the second stage of the psychometric validation of the ACT. Methods We used the Standards for Educational and Psychological Testing to frame our validity assessment. Data from 645 English speaking healthcare aides from 25 urban residential long-term care facilities (nursing homes in the three Canadian Prairie Provinces were used for this stage of validation. In this stage we focused on: (1 advanced aspects of internal structure (e.g., confirmatory factor analysis and (2 relations with other variables validity evidence. To assess reliability and validity of scores obtained using the ACT we conducted: Cronbach's alpha, confirmatory factor analysis, analysis of variance, and tests of association. We also assessed the performance of the ACT when individual responses were aggregated to the care unit level, because the instrument was developed to obtain unit-level scores of context. Results Item-total correlations exceeded acceptable standards (> 0.3 for the majority of items (51 of 58. We ran three confirmatory factor models. Model 1 (all ACT items displayed unacceptable fit overall and for five specific items (1 item on adequate space for resident care in the Organizational Slack-Space ACT concept and 4 items on use of electronic resources in the Structural and Electronic Resources ACT concept. This prompted specification of two additional

  5. Earth Observing System (EOS) Advanced Microwave Sounding Unit-A (AMSU-A) Spares Program Plan

    Science.gov (United States)

    Chapman, Weldon

    1994-01-01

    This plan specifies the spare components to be provided for the EOS/AMSU-A instrument and the general spares philosophy for their procurement. It also address key components not recommended for spares, as well as the schedule and method for obtaining the spares. The selected spares list was generated based on component criticality, reliability, repairability, and availability. An alternative spares list is also proposed based on more stringent fiscal constraints.

  6. Improved Test Planning and Analysis Through the Use of Advanced Statistical Methods

    Science.gov (United States)

    Green, Lawrence L.; Maxwell, Katherine A.; Glass, David E.; Vaughn, Wallace L.; Barger, Weston; Cook, Mylan

    2016-01-01

    The goal of this work is, through computational simulations, to provide statistically-based evidence to convince the testing community that a distributed testing approach is superior to a clustered testing approach for most situations. For clustered testing, numerous, repeated test points are acquired at a limited number of test conditions. For distributed testing, only one or a few test points are requested at many different conditions. The statistical techniques of Analysis of Variance (ANOVA), Design of Experiments (DOE) and Response Surface Methods (RSM) are applied to enable distributed test planning, data analysis and test augmentation. The D-Optimal class of DOE is used to plan an optimally efficient single- and multi-factor test. The resulting simulated test data are analyzed via ANOVA and a parametric model is constructed using RSM. Finally, ANOVA can be used to plan a second round of testing to augment the existing data set with new data points. The use of these techniques is demonstrated through several illustrative examples. To date, many thousands of comparisons have been performed and the results strongly support the conclusion that the distributed testing approach outperforms the clustered testing approach.

  7. Development of advanced methods for planning electric energy distribution systems. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Goenen, T.; Foote, B.L.; Thompson, J.C.; Fagan, J.E.

    1979-10-01

    An extensive search was made for the identification and collection of reports published in the open literature which describes distribution planning methods and techniques. In addition, a questionnaire has been prepared and sent to a large number of electric power utility companies. A large number of these companies were visited and/or their distribution planners interviewed for the identification and description of distribution system planning methods and techniques used by these electric power utility companies and other commercial entities. Distribution systems planning models were reviewed and a set of new mixed-integer programming models were developed for the optimal expansion of the distribution systems. The models help the planner to select: (1) optimum substation locations; (2) optimum substation expansions; (3) optimum substation transformer sizes; (4) optimum load transfers between substations; (5) optimum feeder routes and sizes subject to a set of specified constraints. The models permit following existing right-of-ways and avoid areas where feeders and substations cannot be constructed. The results of computer runs were analyzed for adequacy in serving projected loads within regulation limits for both normal and emergency operation.

  8. The use of regional advance mitigation planning (RAMP) to integrate transportation infrastructure impacts with sustainability; a perspective from the USA

    International Nuclear Information System (INIS)

    Globally, urban areas are expanding, and their regional, spatially cumulative, environmental impacts from transportation projects are not typically assessed. However, incorporation of a Regional Advance Mitigation Planning (RAMP) framework can promote more effective, ecologically sound, and less expensive environmental mitigation. As a demonstration of the first phase of the RAMP framework, we assessed environmental impacts from 181 planned transportation projects in the 19 368 km2 San Francisco Bay Area. We found that 107 road and railroad projects will impact 2411–3490 ha of habitat supporting 30–43 threatened or endangered species. In addition, 1175 ha of impacts to agriculture and native vegetation are expected, as well as 125 crossings of waterways supporting anadromous fish species. The extent of these spatially cumulative impacts shows the need for a regional approach to associated environmental offsets. Many of the impacts were comprised of numerous small projects, where project-by-project mitigation would result in increased transaction costs, land costs, and lost project time. Ecological gains can be made if a regional approach is taken through the avoidance of small-sized reserves and the ability to target parcels for acquisition that fit within conservation planning designs. The methods are straightforward, and can be used in other metropolitan areas. (papers)

  9. Poor planning, communication lead to missteps in care of Ebola patient.

    Science.gov (United States)

    2015-11-01

    A panel of experts examining the diagnosis and care of Thomas Eric Duncan, a patient diagnosed with Ebola Virus Disease (EVD) in the United States in 2014, and the cases of two nurses who contracted EVD while caring for Duncan, has unveiled its findings along with recommendations to prevent many of the missteps that occurred during the crisis. While the independent panel was convened at the direction of Texas Health Resources, the parent company of Texas Health Presbyterian Hospital in Dallas, observers and the panel itself note that the findings should help hospitals, EDs, and communities across the country prepare for the next infectious disease event. The expert panel noted that ED personnel relied too heavily on the electronic medical record (EMR) to communicate with other members of the care team, and that important information, such as the patient's travel history, was not prioritized or highlighted in the EMR. Patient satisfaction and other operational objectives took precedence over patient safety during Duncan's ED visit, according to the expert panel's findings. The clinical team failed to pick up on changes in the patient's clinical status, missing an opportunity to re-evaluate Duncan and properly diagnosis him with EVD during his first visit to the ED. Confusion over the roles and responsibilities of local and federal health authorities, and inadequate preparation for an infectious disease event led to missteps. The expert panel suggests conducting practice drills that include all participating organizations, and hospital leaders should consider infectious disease threats as well as other types of disasters. PMID:26550674

  10. Wound Healing and Nutrition: Going Beyond Dressings With a Balanced Care Plan

    OpenAIRE

    Gruen, Douglas

    2010-01-01

    As the largest organ of the body, the human skin protects all subcutaneous tissues. Despite its many attributes, the skin is vulnerable to pressure ulcers. The number of pressure ulcers and venous leg ulcers is on the rise, but healing rates have not improved over the past decade. The reason may be a tendency to focus on one or two fundamentals of wound healing, but not on all 3 fundamentals equally. The 3 fundamentals of wound healing are (1) pressure relief and nursing care, (2) dressings, ...

  11. The Use of Computers for Clinical Care: A Case Series of Advanced U.S. Sites

    Science.gov (United States)

    Doolan, David F.; Bates, David W.; James, Brent C.

    2003-01-01

    Objective: To describe advanced clinical information systems in the context in which they have been implemented and are being used. Design: Case series of five U.S. hospitals, including inpatient, ambulatory and emergency units. Descriptive study with data collected from interviews, observations, and document analysis. Measurements: The use of computerized results, notes, orders, and event monitors and the type of decision support; data capture mechanisms and data form; impact on clinician satisfaction and clinical processes and outcomes; and the organizational factors associated with successful implementation. Results: All sites have implemented a wide range of clinical information systems with extensive decision support. The systems had been well accepted by clinicians and have improved clinical processes. Successful implementation required leadership and long-term commitment, a focus on improving clinical processes, and gaining clinician involvement and maintaining productivity. Conclusion: Despite differences in approach there are many similarities between sites in the clinical information systems in use and the factors important to successful implementation. The experience of these sites may provide a valuable guide for others who are yet to start, or are just beginning, the implementation of clinical information systems. PMID:12509360

  12. Advancing the quality of oncology nursing care: Interlink Community Cancer Nurses' model for reflective practice.

    Science.gov (United States)

    Howell, D; Pelton, B

    2001-01-01

    Since 1996, Interlink Community Cancer Nurses have been using reflective practice as a team to share knowledge and experience amongst peers. The use of reflective practice enables the nurse to examine decision-making in patient situations and uncover the knowledge and artistry that is embedded in nursing practice. This article describes how reflection is practised by specialist cancer nurses to advance the quality of caregiving. The use of a structured framework for reflection which incorporates ways of knowing in nursing is an essential feature of the Interlink model for reflection. The development of a process for reflection within the Interlink program has at times been challenging. However, the Interlink nurses' experience with reflection is believed to be critical to the ongoing development of the program and the individual nurse. Interlink nurses have found that guided reflection, the creation of an environmental milieu for reflection and personal knowing, and self-evaluation are critical to the process of becoming a self-reflective practitioner. PMID:11842450

  13. Advance care directives and the position in Ireland: what lessons can Ireland learn from the United Kingdom, the United States and Europe?

    OpenAIRE

    Laura Donnellan

    2008-01-01

    An Advance care directive entitles a person to request in advance either the refusal of or consent to certain medical treatment if that person is not competent to consent or refuse at the time such refusal or consent is required.  The 2003 Law Reform Commission’s Consultation Paper on Law and the Elderly briefly mentioned advance directives.  However, the Paper decided to leave the issue to a future Paper that would give a more comprehensive analysis.  There is no Irish legislation on the mat...

  14. Fiscal year 1998 multi-year work plan. Advanced reactors transition program

    International Nuclear Information System (INIS)

    The mission of the Advanced Reactors Transition program is two-fold. First, the program is to maintain the Fast Flux Test Facility (FFTF) and the Fuels and Materials Examination Facility (FMEF) in Standby to support a possible future role in the tritium production strategy. Secondly, the program is to continue deactivation activities which do not conflict with the Standby directive. On-going deactivation activities include the processing of non-usable, irradiated, FFTF components for storage or disposal; deactivation of Nuclear Energy legacy test facilities; and deactivation of the Plutonium Recycle Test Reactor (PRTR) facility, 309 Building

  15. Advancing methodological thinking and practice for development-compatible climate policy planning

    DEFF Research Database (Denmark)

    Scrieciu, S. Şerban; Belton, Valerie; Chalabi, Zaid;

    2014-01-01

    There are growing calls for identifying climate mitigation and adaptation policy packages that would also support human development objectives at the national and regional levels. The literature on climate policy analysis and impact assessment continues to be driven by standard economics with its...... planning climate policy actions.We also argue that analytical tools drawing on economic thinking which embraces interdisciplinary analysis and deep uncertainty and avoids the fallacy of unique optimal solutions, may deliver more effective strategies for pushing economies onto the transformational pathways...

  16. Palliative Care in Lung Cancer.

    Science.gov (United States)

    Shinde, Arvind M; Dashti, Azadeh

    2016-01-01

    Lung cancer is the most common cancer worldwide and is the leading cause of cancer death for both men and women in the USA. Symptom burden in patients with advanced lung cancer is very high and has a negative impact on their quality of life (QOL). Palliative care with its focus on the management of symptoms and addressing physical, psychosocial, spiritual, and existential suffering, as well as medically appropriate goal setting and open communication with patients and families, significantly adds to the quality of care received by advanced lung cancer patients. The Provisional Clinical Opinion (PCO) of American Society of Clinical Oncology (ASCO) as well as the National Cancer Care Network's (NCCN) clinical practice guidelines recommends early integration of palliative care into routine cancer care. In this chapter, we will provide an overview of palliative care in lung cancer and will examine the evidence and recommendations with regard to a comprehensive and interdisciplinary approach to symptom management, as well as discussions of goals of care, advance care planning, and care preferences. PMID:27535397

  17. The search for the Holy Grail: combining decentralised planning and contracting mechanisms in the French health care system.

    Science.gov (United States)

    Bellanger, Martine M; Mossé, Philippe R

    2005-09-01

    France has recently adopted one of the least market-oriented models for reforming its health care system, where competition does not feature at all prominently in the overall policy design. This country has a strong tradition of top-down public administration, and health professionals, trade unions and the general public are all uneasy about the idea of introducing market forces and privatising public health provision. The main reforms discussed in this article were based on planning, rationalisation, cost-containment, efficiency and equity. However, some embryonic changes and emerging practices can be detected which might seem to relate to the 'new public management' approach, and which could also serve as a basis for future market initiatives. PMID:16161194

  18. Educating the Educator: Use of Advanced Bleeding Control Mechanisms in Athletic Training: A Shift in the Thought Process of Prehospital Care. Part 2: Hemostatic Agents

    Science.gov (United States)

    Payne, Ellen K.; Berry, David C.; Seitz, S. Robert

    2014-01-01

    In Part 1 of this series [see: EJ1044392], the concepts of hemorrhaging, shock, and controlling bleeding as they relate to athletic training and prehospital emergency care along with the use of tourniquets were presented for athletic training educators (ATEs) to teach the skill in the classroom. This article, Part 2 of advanced bleeding control,…

  19. Efficacy of misoprostol for the treatment of postpartum hemorrhage: current knowledge and implications for health care planning

    Directory of Open Access Journals (Sweden)

    Prata N

    2016-07-01

    Full Text Available Ndola Prata, Karen Weidert Bixby Center for Population, Health and Sustainability, School of Public Health, University of California at Berkeley, Berkeley, CA, USA Background: A myriad of interventions exist to treat postpartum hemorrhage (PPH, ranging from uterotonics and hemostatics to surgical and aortic compression devices. Nonetheless, PPH remains the leading cause of maternal mortality worldwide. The purpose of this article is to review the available evidence on the efficacy of misoprostol for the treatment of primary PPH and discuss implications for health care planning. Data and methods: Using PubMed, Web of Science, and GoogleScholar, we reviewed the literature on randomized controlled trials of interventions to treat PPH with misoprostol and non-randomized field trials with controls. We discuss the current knowledge and implications for health care planning, especially in resource-poor settings. Results: The treatment of PPH with 800 µg of misoprostol is equivalent to 40 IU of intravenous oxytocin in women who have received oxytocin for the prevention of PPH. The same dose might be an option for the treatment of PPH in women who did not receive oxytocin for the prevention of PPH and do not have access to oxytocin for treatment. Adding misoprostol to standard uterotonics has no additional benefits to women being treated for PPH, but the beneficial adjunctive role of misoprostol to conventional uterotonics is important in reducing intra- and postoperative hemorrhage during cesarean section. Conclusion: Misoprostol is an effective uterotonic agent in the treatment of PPH. Clinical guidelines and treatment protocols should be updated to reflect the current knowledge on the efficacy of misoprostol for the treatment of PPH with 800 µg sublingually. Keywords: PPH treatment, uterotonics, low-resource settings, cesarean section, retained placenta

  20. Care staff intentions to support adults with an intellectual disability to engage in physical activity: An application of the Theory of Planned Behaviour

    OpenAIRE

    Martin, Emma; McKenzie, Karen; Newman, Emily; Bowden, Keith; Morris, Paul Graham

    2011-01-01

    Researchers suggest that people with an intellectual disability (ID) undertake less physical activity than the general population and many rely, to some extent, on others to help them to access activities. The Theory of Planned Behaviour (TPB) model was previously found to significantly predict the intention of care staff to facilitate a healthy diet in those they supported. The present study examined whether the TPB was useful in predicting the intentions of 78 Scottish care staff to support...