WorldWideScience

Sample records for affairs medical centers

  1. Assessment of diabetic teleretinal imaging program at the Portland Department of Veterans Affairs Medical Center

    Directory of Open Access Journals (Sweden)

    Grace L. Tsan, OD

    2015-06-01

    Full Text Available We conducted a retrospective chart review of 200 diabetic patients who had teleretinal imaging performed between January 1, 2010, and January 1, 2011, at Portland Department of Veterans Affairs (VA Medical Center outpatient clinics to assess the effectiveness of the diabetic teleretinal imaging program. Twenty patients (10% had diabetic retinopathy. Ninety percent of the available teleretinal imaging studies were of adequate quality for interpretation. In accordance with local VA policy at that time, all teleretinal imaging patients should have been referred for a dilated retinal examination the following year. Image readers referred 97.5% of the patients to eye clinics for subsequent eye examinations, but the imagers scheduled appointments for only 80% of these patients. The redundancy rate, i.e., patients who had an eye examination within the past 6 mo, was 11%; the duplicate recall rate, i.e., patients who had a second teleretinal imaging performed within 1 yr of the eye examination, was 37%. Rates of timely diabetic eye examinations at clinics with teleretinal imaging programs, particularly when teleretinal imaging and eye clinics were colocated at the same community-based outpatient clinic, were higher than at those without a teleretinal imaging program. We concluded that the Portland VA Medical Center's teleretinal imaging program was successful in increasing the screening rate for diabetic retinopathy.

  2. Characteristics of ambulatory care clinics and pharmacists in Veterans Affairs medical centers. IMPROVE investigators. Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers.

    Science.gov (United States)

    Alsuwaidan, S; Malone, D C; Billups, S J; Carter, B L

    1998-01-01

    The type and extent of ambulatory care clinical pharmaceutical services in selected Veterans Affairs medical centers (VAMCs) were studied as part of a larger project. Questionnaires were sent to the 174 VAMCs to determine the extent of clinical pharmacy activity in ambulatory care clinics, characteristics of outpatient pharmacies and clinics, and characteristics of ambulatory care pharmacists in VAMCs and to identify sites for the IMPROVE (Impact of Managed Pharmaceutical Care on Resource Utilization and Outcomes in Veterans Affairs Medical Centers) project. Fifty VAMCs responded to the survey. There were 512 ambulatory care clinics within these VAMCs. There was some pharmacist coverage in 75% of the clinics. The highest pharmacist coverage was in walk-in refill, therapeutic drug monitoring, and anticoagulation clinics. Clinical pharmacists at 68% of the VAMCs had prescribing privileges in ambulatory care clinics. Clinical pharmacists managed 29.9% of the clinics. The types of clinics most commonly managed by pharmacists were therapeutic drug monitoring, anticoagulation, walk-in refill, and lipid clinics. Nurse practitioners or physician assistants also were providing primary care in 41% of the clinics. There were 242 ambulatory care clinical pharmacy specialists practicing in the 50 VAMCs. Of these, 41.3% had three years or less of ambulatory care experience. Most pharmacists were in the clinic five days per week. A Pharm.D. degree was the highest degree obtained for 76.9%. Ambulatory care pharmaceutical services are common in VAMCs and are being provided by numerous clinical pharmacists. PMID:9437478

  3. Preferences and Barriers to Care Following Psychiatric Hospitalization at Two Veterans Affairs Medical Centers: A Mixed Methods Study.

    Science.gov (United States)

    Pfeiffer, Paul N; Bowersox, Nicholas; Birgenheir, Denis; Burgess, Jennifer; Forman, Jane; Valenstein, Marcia

    2016-01-01

    Patient preferences and barriers to care may impact receipt of adequate mental health treatment following psychiatric hospitalization and could inform quality improvement initiatives. This study assessed preferences for a broad range of post-hospital services and barriers to counseling by surveying 291 patients and interviewing 25 patients who had recently been discharged from an inpatient psychiatric stay at one of the two Veterans Affairs Medical Centers. Individual counseling was the most frequently reported service that survey respondents preferred, but did not receive; whereas, open-ended survey responses and interviews also identified telephone follow-up "check-in" calls as a frequently preferred service. Difficulty with transportation was the most commonly cited barrier to counseling among survey respondents and in interviews; however, patients strongly preferred in-person counseling to telephone or internet-video alternatives. Increasing support from family and support from an individual Veteran peer were also perceived to be helpful in the majority of survey respondents. PMID:25779387

  4. AVTA Federal Fleet PEV Readiness Data Logging and Characterization Study for Department of Veterans Affairs. James J. Peters VA Medical Center, Bronx, NY

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    Schey, Stephen [Intertek Testing Services, North America, Phoenix, AZ (United States); Francfort, Jim [Idaho National Lab. (INL), Idaho Falls, ID (United States)

    2014-10-01

    This report focuses on the Department of Veterans Affairs, James J. Peters VA Medical Center (VA - Bronx) fleet to identify daily operational characteristics of select vehicles and report findings on vehicle and mission characterizations to support the successful introduction of PEVs into the agencies’ fleets. Individual observations of these selected vehicles provide the basis for recommendations related to electric vehicle adoption and whether a battery electric vehicle or plug-in hybrid electric vehicle (collectively referred to as PEVs) can fulfill the mission requirements.

  5. First six months of clinical usage of an ATM network link between two Veterans Affairs Medical Centers

    Science.gov (United States)

    Duerinckx, Andre J.; Gentili, Amilcare; El-Saden, Suzie; Harmon, Craig; Kenagy, John J.; Grant, Edward G.

    1998-07-01

    Purpose/Background: Asynchronous transfer mode (ATM) network technology has recently been used for high speed transmission of radiological images between hospitals and inside hospitals. However, the number of clinical sites which routinely use this technology is limited. The purpose of this study was to analyze the very early impact of an ATM link between a large tertiary referral center and small peripheral clinic on cost and clinical practice. Methodology: An ATM link using 155 bps (OC3) technology was installed between the West Los Angeles VA Medical Center and the Sepulveda VA, a large outpatient facility which provides full service radiological services. The West Los Angeles VA Medical Center is a large tertiary referral center with sub-specialist radiologist. The clinical impact of this ATM link between a large full-scale DICOM-3 compliant PACS system at the West LA VA on a smaller PACS system at the Sepulveda VA was evaluated. Results: The ability to freely exchange complicated MRI and CT studies between a tertiary referral center and a clinic could have a direct impact on patient care. Over the last six months, all and CT studies from Sepulveda VA were readily available via the ATM connection to all radiologists at the West LA VA. On average the workload at the Sepulveda VA in CT and MRI was about one tenth of the same workload at West LA VA, thus creating interesting possibilities for sharing or radiologist resources. Conclusions: Although our preliminary data and work loads have been too limited to draw any final conclusions yet, we feel that future results will show that the ability to provide immediate and fast interactive consultation between general radiologists in a large outpatient facility and sub- specialists at a tertiary referral center can have an impact upon the quality of patient care.

  6. Implementing Geriatric Resources for Assessment and Care of Elders Team Care in a Veterans Affairs Medical Center: Lessons Learned and Effects Observed.

    Science.gov (United States)

    Schubert, Cathy C; Myers, Laura J; Allen, Katie; Counsell, Steven R

    2016-07-01

    In a randomized clinical trial, Geriatric Resources for Assessment and Care of Elders (GRACE), a model of care that works in collaboration with primary care providers (PCPs) and patient-centered medical homes to provide home-based geriatric care management focusing on geriatric syndromes and psychosocial problems commonly found in older adults, improved care quality and reduced acute care use for high-risk, low-income older adults. To assess the effect of GRACE at a Veterans Affairs (VA) Medical Center (VAMC), veterans aged 65 and older from Marion County, Indiana, with PCPs from four of five VAMC clinics who were not on hospice or dialysis were enrolled in GRACE after discharge home from an acute hospitalization. After an initial home-based transition visit to GRACE enrollees, the GRACE team returned to conduct a geriatric assessment. Guided by 12 protocols and input from an interdisciplinary panel and the PCP, the GRACE team developed and implemented a veteran-centric care plan. Hospitalized veterans from the fifth clinic, who otherwise met enrollment criteria, served as a usual-care comparison group. Demographic, comorbidity, and usage data were drawn from VA databases. The GRACE and comparison groups were similar in age, sex, and burden of comorbidity, although predicted risk of 1-year mortality in GRACE veterans was higher. Even so, GRACE enrollment was associated with 7.1% fewer emergency department visits, 14.8% fewer 30-day readmissions, 37.9% fewer hospital admissions, and 28.5% fewer total bed days of care, saving the VAMC an estimated $200,000 per year after program costs during the study for the 179 veterans enrolled in GRACE. Having engaged, enthusiastic VA leadership and GRACE staff; aligning closely with the medical home; and accommodating patient acuity were among the important lessons learned during implementation. PMID:27305428

  7. Identification of methicillin-resistant Staphylococcus aureus within the Nation’s Veterans Affairs Medical Centers using natural language processing

    Directory of Open Access Journals (Sweden)

    Jones Makoto

    2012-07-01

    Full Text Available Abstract Background Accurate information is needed to direct healthcare systems’ efforts to control methicillin-resistant Staphylococcus aureus (MRSA. Assembling complete and correct microbiology data is vital to understanding and addressing the multiple drug-resistant organisms in our hospitals. Methods Herein, we describe a system that securely gathers microbiology data from the Department of Veterans Affairs (VA network of databases. Using natural language processing methods, we applied an information extraction process to extract organisms and susceptibilities from the free-text data. We then validated the extraction against independently derived electronic data and expert annotation. Results We estimate that the collected microbiology data are 98.5% complete and that methicillin-resistant Staphylococcus aureus was extracted accurately 99.7% of the time. Conclusions Applying natural language processing methods to microbiology records appears to be a promising way to extract accurate and useful nosocomial pathogen surveillance data. Both scientific inquiry and the data’s reliability will be dependent on the surveillance system’s capability to compare from multiple sources and circumvent systematic error. The dataset constructed and methods used for this investigation could contribute to a comprehensive infectious disease surveillance system or other pressing needs.

  8. Center for Homeland Defense and Security Homeland Security Affairs Journal

    OpenAIRE

    2015-01-01

    Homeland Security Affairs is the peer-reviewed online journal of the Center for Homeland Defense and Security (CHDS). The journal provides a forum to propose and debate strategies, policies and organizational arrangements to strengthen U.S. homeland security.

  9. Lean Six Sigma in health care and the challenge of implementation of Six Sigma methodologies at a Veterans Affairs Medical Center.

    Science.gov (United States)

    Pocha, Christine

    2010-01-01

    Six Sigma and Lean Thinking are quality initiatives initially deployed in industry to improve operational efficiency leading to better quality and subsequent cost savings. The financial rationale for embarking on this quality journey is clear; applying it to today's health care remains challenging. The cost of medical care is increasing at an alarming rate; most of these cost increases are attributed to an aging population and technological advances; therefore, largely beyond control. Furthermore, health care cost increases are caused by unnecessary operational inefficiency associated with the direct medical service delivery process. This article describes the challenging journey of implementing Six Sigma methodology at a tertiary care medical center. Many lessons were learned; however, of utmost importance were team approach, "buy in" of the stakeholders, and the willingness of team members to change daily practice and to adapt new and innovative ways how health care can be delivered. Six Sigma incorporated as part of the "company's or hospital's culture" would be most desirable but the learning curve will be steep. PMID:20924252

  10. Evaluation of the Significance of Pretreatment Liver Biopsy and Baseline Mental Health Disorder Diagnosis on Hepatitis C Treatment Completion Rates at a Veterans Affairs Medical Center

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    Joseph Kluck

    2013-01-01

    Full Text Available Objectives. This study was performed to define the overall treatment response rates and treatment completion rates among the population of Hepatitis C infected patients at an urban VA Medical Center. Additionally, we examined whether pretreatment liver biopsy is a positive predictor for treatment completion and if the presence of mental health disorders is a negative predictor for treatment completion. Methods. Retrospective chart review was performed on the 375 patients that were treated for HCV and met the study inclusion parameters between January 1, 2003 and April 1, 2008 at our institution. Clinical data was obtained from the computerized patient record system and was analyzed for respective parameters. Results. Sustained virological response was achieved in 116 (31% patients. 169 (45% patients completed a full treatment course. Also, 44% of patients who received a pre-treatment liver biopsy completed treatment versus 46% completion rates for patients who did not receive a pretreatment liver biopsy. Baseline ICD9 diagnosis of a mental health disorder was not associated with higher treatment discontinuation rates. Conclusions. In conclusion, pretreatment liver biopsy was not a positive predictor for treatment completion, and the presence of mental health disorders was not a negative predictor for treatment completion.

  11. Regulatory affairs for biomaterials and medical devices

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    Amato, Stephen F; Amato, B

    2014-01-01

    All biomaterials and medical devices are subject to a long list of regulatory practises and policies which must be adhered to in order to receive clearance. This book provides readers with information on the systems in place in the USA and the rest of the world. Chapters focus on a series of procedures and policies including topics such as commercialization, clinical development, general good practise manufacturing and post market surveillance.Addresses global regulations and regulatory issues surrounding biomaterials and medical devicesEspecially useful for smaller co

  12. Medical perspective on nuclear power; Council on Scientific Affairs

    International Nuclear Information System (INIS)

    This article summarizes a recent report of the Council on Scientific Affairs of the American Medical Association. Major issues summarized in this presentation include the role of and demand for electricity, and an overview of normal operations of nuclear power plants and the nuclear fuel cycle. Unplanned radiation releases from nuclear reactors and risks related to nuclear power are also addressed. Nine recommendations emphasize the safety of reactors, and the role of physicians in the nuclear power issue

  13. Female genital mutilation. Council on Scientific Affairs, American Medical Association.

    Science.gov (United States)

    1995-12-01

    Female genital mutilation is the medically unnecessary modification of female genitalia. Female genital mutilation typically occurs at about 7 years of age, but mutilated women suffer severe medical complications throughout their adult lives. Female genital mutilation most frequently occurs in Africa, the Middle East, and Muslim parts of Indonesia and Malaysia, and it is generally part of a ceremonial induction into adult society. Recent political and economic problems in these regions, however, have increased the numbers of students and refugees to the United States. Consequently, US physicians are treating an increasing number of mutilated patients. The Council on Scientific Affairs recommends that US physicians join the World Health Organization, the World Medical Association, and other major health care organizations in opposing all forms of medically unnecessary surgical modification of the female genitalia. PMID:7474278

  14. Satellite medical centers project

    Science.gov (United States)

    Aggarwal, Arvind

    2002-08-01

    World class health care for common man at low affordable cost: anywhere, anytime The project envisages to set up a national network of satellite Medical centers. Each SMC would be manned by doctors, nurses and technicians, six doctors, six nurses, six technicians would be required to provide 24 hour cover, each SMC would operate 24 hours x 7 days. It would be equipped with the Digital telemedicine devices for capturing clinical patient information and investigations in the form of voice, images and data and create an audiovisual text file - a virtual Digital patient. Through the broad band connectivity the virtual patient can be sent to the central hub, manned by specialists, specialists from several specialists sitting together can view the virtual patient and provide a specialized opinion, they can see the virtual patient, see the examination on line through video conference or even PCs, talk to the patient and the doctor at the SMC and controlle capturing of information during examination and investigations of the patient at the SMC - thus creating a virtual Digital consultant at the SMC. Central hub shall be connected to the doctors and consultants in remote locations or tertiary care hospitals any where in the world, thus creating a virtual hub the hierarchical system shall provide upgradation of knowledge to thedoctors in central hub and smc and thus continued medical education and benefit the patient thru the world class treatment in the smc located at his door step. SMC shall be set up by franchisee who shall get safe business opportunity with high returns, patients shall get Low cost user friendly worldclass health care anywhere anytime, Doctors can get better meaningful selfemplyment with better earnings, flexibility of working time and place. SMC shall provide a wide variety of services from primary care to world class Global consultation for difficult patients.

  15. The effect of pre-existing mental health comorbidities on the stage at diagnosis and timeliness of care of solid tumor malignances in a Veterans Affairs (VA) medical center

    International Nuclear Information System (INIS)

    There are limited data on the impact of mental health comorbidities (MHC) on stage at diagnosis and timeliness of cancer care. Axis I MHC affect approximately 30% of Veterans receiving care within the Veterans Affairs (VA) system. The purpose of this study was to compare stage at diagnosis and timeliness of care of solid tumor malignancies among Veterans with and without MHC. We performed a retrospective analysis of 408 charts of Veterans with colorectal, urothelial, and head/neck cancer diagnosed and treated at VA Connecticut Health Care System (VACHS) between 2008 and 2011. We collected demographic data, stage at diagnosis, medical and mental health co-morbidities, treatments received, key time intervals, and number of appointments missed. The study was powered to assess for stage migration of 15–20% from Stage I/II to Stage III/IV. There was no significant change in stage distribution for patients with and without MHC in the entire study group (p = 0.9442) and in each individual tumor type. There were no significant differences in the time intervals from onset of symptoms to initiation of treatment between patients with and without MHC (p = 0.1135, 0.2042 and 0.2352, respectively). We conclude that at VACHS, stage at diagnosis for patients with colorectal, urothelial and head and neck cancers did not differ significantly between patients with and without MHC. Patients with MHC did not experience significant delays in care. Our study indicates that in a medical system in which mental health is integrated into routine care, patients with Axis I MHC do not experience delays in cancer care

  16. Equine Medical Center director honored

    OpenAIRE

    Douglas, Jeffrey S.

    2004-01-01

    Nathaniel White, of Hamilton, Va., the Jean Ellen Shehan Professor and Director of the Marion duPont Scott Equine Medical Center in Leesburg, was awarded the American Association of Equine Practitioners' "Distinguished Service Award" during its recent annual meeting in Denver.

  17. Cartographic Encounters at the Bureau of Indian Affairs Geographic Information System Center of Calculation

    Science.gov (United States)

    Palmer, Mark H.

    2012-01-01

    The centering processes of geographic information system (GIS) development at the United States Bureau of Indian Affairs (BIA) was an extension of past cartographic encounters with American Indians through the central control of geospatial technologies, uneven development of geographic information resources, and extension of technically dependent…

  18. Kennedy Space Center Medical Operations and Medical Kit

    Science.gov (United States)

    Scarpa, Philip

    2011-01-01

    This slide presentation reviews the emergency medical operations at Kennedy Space center, the KSC launch and landing contingency modes, the triage site, the medical kit, and the medications available.

  19. Patient-Centered Medical Homes in 2016.

    Science.gov (United States)

    Tayloe, David T

    2016-01-01

    There is much information in the medical literature concerning the medical home concept. Each medical practice must utilize that literature to devise a system of care-a patient-centered medical home-that best meets the needs of patients, families, and practice staff. This article is Goldsboro Pediatrics' attempt to describe its system of care, its patient-centered medical home. PMID:27422953

  20. Medication adherence and glycemic control in patients with psychotic disorders in the Veterans Affairs healthcare system

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    Nelson LA

    2011-06-01

    Full Text Available Objective: To compare antihyperglycemic medication adherence and glycemic control between individuals with schizophrenia and related psychotic disorders and a nonpsychiatric comparison group.Methods: This was a retrospective medical record review. A total of 124 subjects with diabetes (62 patients with schizophrenia or a related psychotic disorder and 62 randomly selected, age-matched patients without a psychiatric illness receiving their medical and psychiatric care exclusively through the Kansas City Veterans Affairs healthcare system during 2008 were included in the study. Adherence to antihyperglycemic and antipsychotic medication was determined by refill records obtained through the computerized patient record system to calculate the cumulative mean gap ratio. Hemoglobin A1C values were utilized to compare glycemic control between groups and compared to glycemic goals established by diabetes treatment guidelines.Results: Antihyperglycemic medication adherence was poor for both groups as approximately 60% of the psychotic disorder group and 75% of the nonpsychiatric comparison group were without antihyperglycemic medication for greater than 30 days during the 12-month period but adherence did not differ between the groups (p=0.182. Antipsychotic adherent subjects (=80% adherent were more likely to be adherent to their antihyperglycemic medication (p=0.0003. There were no significant differences between groups in glycemic control.Conclusion: Antihyperglycemic medication adherence and glycemic control was less than optimal for both groups. There were no significant differences in antihyperglycemic medication adherence and glycemic control between patients with a psychotic disorder and those without a psychiatric illness.

  1. Communications and Collaboration Keep San Francisco VA Medical Center Project on Track

    International Nuclear Information System (INIS)

    This case study about energy saving performance contacts (ESPCs) presents an overview of how the Veterans Affairs Medical Center in San Francisco established an ESPC contract and the benefits derived from it. The Federal Energy Management Program instituted these special contracts to help federal agencies finance energy-saving projects at their facilities

  2. Person-centered medical interview

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    Đorđević, Veljko; Braš, Marijana; Brajković, Lovorka

    2012-01-01

    Abstract We are witnessing an unprecedented development of medical science and personalized medicine. However, technological superiority must not make us lose sight of the physical, psychological, social, and spiritual totality of the patient. The core of the medical profession has always been and will be the relationship between the health professional and the person seeking assistance. However, the traditional relationship between the physician and the patient has changed and is greatly imp...

  3. St. Luke's Medical Center: technologizing health care

    International Nuclear Information System (INIS)

    The computerization of the St. Luke's Medical Center improved the hospital administration and management, particularly in nuclear medicine department. The use of computer-aided X-ray simulator machine and computerized linear accelerator machine in diagnosing and treating cancer are the most recent medical technological breakthroughs that benefited thousands of Filipino cancer patients. 4 photos

  4. Reengineering Academic Medical Centers: Reengineering Academic Values?

    Science.gov (United States)

    Korn, David

    1996-01-01

    Discussion of academic medical centers (AMCs) looks at: change due to heavy federal funding in recent decades; adverse consequences, including deemphasis on education in favor of research and clinical service delivery, and discrepancies between AMC internal and external labor markets; and challenges to medical education in research, education, and…

  5. Developing physician leaders in academic medical centers.

    Science.gov (United States)

    Bachrach, D J

    1997-01-01

    While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management; intramurally conducted courses in leadership skill development, management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. While part one of this series, which appeared in Volume 43, No. 6 of Medical Group Management Journal addressed, "The changing role of physician leaders at academic medical centers," part 2 will examine as a case study the faculty leadership development program at the University of Texas M.D. Anderson Cancer Center. These two articles were prepared by the author from his research into, and the presentation of a thesis entitled. "The importance of leadership training and development for physicians in academic medical centers in an increasingly complex health care environment," prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in this College.* PMID:10164266

  6. Medical Center Farmers Markets: A Strategic Partner in the Patient-Centered Medical Home

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    Daniel R. George, PhD, MSc

    2013-08-01

    Full Text Available Background The number of medical center���based farmers markets has increased in the past decade, but little is known about how such organizations contribute to the preventive health goals of the patient-centered medical home. Community Context In 2010, we started a seasonal farmers market at Penn State Hershey Medical Center to help support the institution’s commitment to the medical home. Methods We obtained descriptive data on the farmers market from hospital and market records and tracking information on the market’s Facebook and Twitter sites. We computed summary measures to characterize how the market has begun to meet the 6 standards of the 2011 National Committee for Quality Assurance’s report on the medical home. Outcome During the 2010 and 2011 seasons, 146 medical center volunteers from 40 departments formed 23 interprofessional teams that spent an average of 551 volunteer hours per season at the market, providing health screenings (n = 695 and speaking to customers (n = 636 about preventive health. Fifty-five nonmedical community health partners provided 208 hours of service at the market alongside medical center staff. Market programming contributed to 5 regional preventive health partnerships and created opportunities for interprofessional mentoring, student leadership, data management, development of social media skills, and grant-writing experience. The market contributed to all 6 medical home standards outlined by the National Committee for Quality Assurance. Interpretation Medical center markets can support medical home standards. With systematic tracking of the health effects and integration with electronic medical health records, markets hold potential to contribute to comprehensive patient-centered care.

  7. Department of Veterans Affairs compensation and medical care benefits accorded to veterans with major limb loss

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    Jonathan D. Pruden, MPS

    2010-07-01

    Full Text Available Veterans injured in theaters of combat operations are eligible for benefits, including medical care and compensation.This article describes veterans with service-connected disabilityfor major lower- and/or upper-limb loss resulting from combat-field-associated injuries sustained in the Vietnam war, Operation Desert Shield/Operation Desert Storm, and OperationIraqi Freedom/Operation Enduring Freedom (OIF/OEF. Using the Department of Veterans Affairs (VA Compensation and Pension Mini-Master file, we identified 2,690 veterans who in August 2007 received compensation for loss of one or more limbs. More than 97% sustained their injuries in Vietnam;most were young men who served in the U.S. Army or Marine Corps. All but 5% had at least 50% combined service-connected disability and nearly half had a 100% rating. In addition to limb loss, one of the most prevalent compensable conditions was posttraumatic stress disorder, present in 46% of OIF/OEF and 20% of Vietnam veterans. Of these veterans, 82% visited VA outpatient clinics in 2007, although only 4% were hospitalized. A special obligation exists to those who have sustained serious injuries related to combat; this responsibilityextends for the life of the servicemember and beyond to his or her spouse and dependents.

  8. [Medical education centers: strategies and purpose].

    Science.gov (United States)

    Binetti, P

    1999-01-01

    The introduction of new didactic guidelines, for the graduate degrees in medicine and allied disciplines, is secondary to the new needs of the National Health Care System, and in part to the significant developments of science. It is not easy to meet this challenge. It is likewise not easy to channel coherently the required changes, with respect to the scientific, clinical and didactic goals. Paradoxically the same institutions that are in such great need of transformation, are also a significant part of the existing problem. In many countries, schools of medicine have developed centers for medical education that are geared toward the development and growth of students, teachers-tutors, and patients alike. Medical education has become more global, in an attempt to meet much needed communication needs, from both ends, teachers and students, as well as the recipients of care, patients. One major goal of such centers is the introduction of innovative didactic activities. There is indeed a new tendency toward the development of methodological tracks aiming at the acquisition and consolidation of a deeper and broader cultural knowledge. Amongst these initiatives there is the introduction of an evaluation of the teaching delivered, as well as the development of a multidisciplinary approach to didactics. The latter, is a prerequisite of an effective training directed toward the development of the concept of "team approach", whose ultimate goal is patient care. In Italy, at the Università Campus Biomedico, in Rome, one of the first of such centers of medical education has been developed. Its goal is to be both a learning organization, as well as a center for both research and clinical services. PMID:10687267

  9. Teaching in a Patient-Centered Medical Home

    OpenAIRE

    Hotelling, Barbara A.

    2011-01-01

    Teaching Lamaze International classes in a patient-centered medical home allows the childbirth educator the best environment for giving evidence-based information and empowering parents to give birth their way. Patient-centered medical home facilities and providers practice evidence-based care and adhere to the principles of family-centered maternity care. In patient-centered medical homes, women can expect to give birth using the Lamaze Healthy Birth Practices and to fully participate in the...

  10. Jackson Park Hospital Green Building Medical Center

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    William Dorsey; Nelson Vasquez

    2010-03-31

    Jackson Park Hospital completed the construction of a new Medical Office Building on its campus this spring. The new building construction has adopted the City of Chicago's recent focus on protecting the environment, and conserving energy and resources, with the introduction of green building codes. Located in a poor, inner city neighborhood on the South side of Chicago, Jackson Park Hospital has chosen green building strategies to help make the area a better place to live and work. The new green building houses the hospital's Family Medicine Residency Program and Specialty Medical Offices. The residency program has been vital in attracting new, young physicians to this medically underserved area. The new outpatient center will also help to allure needed medical providers to the community. The facility also has areas designated to women's health and community education. The Community Education Conference Room will provide learning opportunities to area residents. Emphasis will be placed on conserving resources and protecting our environment, as well as providing information on healthcare access and preventive medicine. The new Medical Office Building was constructed with numerous energy saving features. The exterior cladding of the building is an innovative, locally-manufactured precast concrete panel system with integral insulation that achieves an R-value in excess of building code requirements. The roof is a 'green roof' covered by native plantings, lessening the impact solar heat gain on the building, and reducing air conditioning requirements. The windows are low-E, tinted, and insulated to reduce cooling requirements in summer and heating requirements in winter. The main entrance has an air lock to prevent unconditioned air from entering the building and impacting interior air temperatures. Since much of the traffic in and out of the office building comes from the adjacent Jackson Park Hospital, a pedestrian bridge connects the two

  11. The development of a telemedical cancer center within the Veterans Affairs Health Care System: a report of preliminary clinical results.

    Science.gov (United States)

    Billingsley, Kevin G; Schwartz, David L; Lentz, Susan; Vallières, Eric; Montgomery, R Bruce; Schubach, William; Penson, David; Yueh, Bevan; Chansky, Howard; Zink, Claudia; Parayno, Darla; Starkebaum, Gordon

    2002-01-01

    In order to optimize the delivery of multidisciplinary cancer care to veterans, our institution has developed a regional cancer center with a telemedical outreach program. The objectives of this report are to describe the organization and function of the telemedical cancer center and to report our early clinical results. The Veterans Affairs Health Care System is organized into a series of integrated service networks that serve veterans within different areas throughout the United States. Within Veterans Integrated Service Network 20 (Washington, Alaska, Idaho, Oregon) we have developed a regional cancer center with telemedicine links to four outlying facilities within the service area. The telemedical outreach effort functions through the use of a multidisciplinary telemedicine tumor board. The tumor board serves patients in outlying facilities by providing comprehensive, multidisciplinary consultation for the complete range of malignancies. For individuals who do require referral to the cancer center, the tumor board serves to coordinate the logistical and clinical details of the referral process. This program has been in existence for 1 year. During that time 85 patients have been evaluated in the telemedicine tumor board. Sixty-two percent of the patients were treated at their closest facility; 38% were referred to the cancer center for treatment and/or additional diagnostic studies. The patients' diagnoses included the entire clinical spectrum of malignant disease. Preliminary clinical results demonstrate the program is feasible and it improves access to multidisciplinary cancer care. Potential benefits include improved referral coordination and minimization of patient travel and treatment delays. PMID:12020412

  12. The new reality: academic medical centers partner with the community.

    Science.gov (United States)

    Scott, K

    1996-11-01

    As academic medical centers face a price-sensitive market dominated by managed care, their survival, says Association of American Medical Colleges' Robert Dickler, will depend on the combination of strategies they use in response. HSL looks at three centers' solution--building alliances to secure patient bases, focusing on expanding primary care capabilities, and downsizing and reorganizing for greater cost savings. PMID:10162189

  13. Professional Quality of Life of Veterans Affairs Staff and Providers in a Patient-Centered Care Environment.

    Science.gov (United States)

    Locatelli, Sara M; LaVela, Sherri L

    2015-01-01

    Changes to the work environment prompted by the movement toward patient-centered care have the potential to improve occupational stress among health care workers by improving team-based work activities, collaboration, and employee-driven quality improvement. This study was conducted to examine professional quality of life among providers at patient-centered care pilot facilities. Surveys were conducted with 76 Veterans Affairs employees/providers at facilities piloting patient-centered care interventions, to assess demographics, workplace practices and views (team-based environment, employee voice, quality of communication, and turnover intention), and professional quality of life (compassion satisfaction, burnout, and secondary traumatic stress).Professional quality-of-life subscales were not related to employee position type, age, or gender. Employee voice measures were related to lower burnout and higher compassion satisfaction. In addition, employees who were considering leaving their position showed higher burnout and lower compassion satisfaction scores. None of the work practices showed relationships with secondary traumatic stress. PMID:26218000

  14. Medication wrong route administration: a poisons center-based study

    OpenAIRE

    Bloch-Teitelbaum, Alexandra; Lüde, Saskia; Rauber-Lüthy, Christine; Kupferschmidt, Hugo; Russmann, Stefan; Kullak-Ublick, Gerd A.; Ceschi, Alessandro

    2013-01-01

    OBJECTIVES: To describe clinical effects, circumstances of occurrence, management and outcomes of cases of inadvertent administration of medications by an incorrect parenteral route. METHODS: Retrospective single-center consecutive review of parenteral route errors of medications, reported to our center between January 2006 and June 2010. We collected demographic data and information on medications, route and time of administration, severity of symptoms/signs, treatment, and outcome. RE...

  15. The Development of the Patient Transfer Center at Ochsner Medical Center

    OpenAIRE

    Hulefeld, Michael

    2009-01-01

    Transfers are a major source of patients for the Ochsner Medical Center. To facilitate transfers, a “transfer center” was developed. This article describes the rationale for this center, how it was developed, and the results of its implementation.

  16. Lessons learned: mobile device encryption in the academic medical center.

    Science.gov (United States)

    Kusche, Kristopher P

    2009-01-01

    The academic medical center is faced with the unique challenge of meeting the multi-faceted needs of both a modern healthcare organization and an academic institution, The need for security to protect patient information must be balanced by the academic freedoms expected in the college setting. The Albany Medical Center, consisting of the Albany Medical College and the Albany Medical Center Hospital, was challenged with implementing a solution that would preserve the availability, integrity and confidentiality of business, patient and research data stored on mobile devices. To solve this problem, Albany Medical Center implemented a mobile encryption suite across the enterprise. Such an implementation comes with complexities, from performance across multiple generations of computers and operating systems, to diversity of application use mode and end user adoption, all of which requires thoughtful policy and standards creation, understanding of regulations, and a willingness and ability to work through such diverse needs. PMID:19382736

  17. Equine medical center sees more owners selecting equine elective surgery

    OpenAIRE

    Musick, Marjorie

    2007-01-01

    A greater number of owners are choosing to have elective surgeries, typically defined as non-emergency procedures, performed on their horses at Virginia Tech's Marion duPont Scott Equine Medical Center.

  18. Equine Medical Center Appoints Veterinary Advisory Board Members

    OpenAIRE

    Nadjar, Ann

    2003-01-01

    A Veterinary Advisory Board, comprised of Virginia- and Maryland-based equine practitioners, has been established to help the Marion duPont Scott Equine Medical Center continue its quest to provide excellence in equine healthcare for the region.

  19. Jackson Park Hospital Green Building Medical Center

    Energy Technology Data Exchange (ETDEWEB)

    Dorsey, William [Jackson Park Hospital Foundation, Chicago, IL (United States); Vasquez, Nelson [Jackson Park Hospital Foundation, Chicago, IL (United States)

    2010-05-01

    Jackson Park Hospital completed the construction of a new Medical Office Building on its campus this spring. The new building construction has adopted the City of Chicago's recent focus on protecting the environment, and conserving energy and resources, with the introduction of green building codes. Located in a poor, inner city neighborhood on the South side of Chicago, Jackson Park Hospital has chosen green building strategies to help make the area a better place to live and work.

  20. A simulation model for emergency medical services call centers

    NARCIS (Netherlands)

    Buuren, M. van; Kommer, G.J.; Mei, R.D. van der; Bhulai, S.

    2015-01-01

    In pre-hospital health care the call center plays an important role in the coordination of emergency medical services (EMS). An EMS call center handles inbound requests for EMS and dispatches an ambulance if necessary. The time needed for triage and dispatch is part of the total response time to the

  1. A Multivariate Hierarchical Bayesian Framework for Healthcare Predictions with Application to Medical Home Study in The Department of Veteran Affairs

    OpenAIRE

    Issac Shams; Saeede Ajorlou; Kai Yang

    2014-01-01

    Recently the patient centered medical home (PCMH) model has become a popular approach to deliver better care to patients. Current research shows that the most important key for succession of this method is to make balance between healthcare supply and demand. Without such balance in clinical supply and demand, issues such as excessive under and over utilization of physicians, long waiting time for receiving the appropriate treatment, and non continuity of care will eliminate many advantages o...

  2. The Center for Healthy Weight: an academic medical center response to childhood obesity

    OpenAIRE

    Robinson, T N; Kemby, K M

    2012-01-01

    Childhood obesity represents a worldwide medical and public health challenge. Academic medical centers cannot avoid the effects of the obesity epidemic, and must adopt strategies for their academic, clinical and public policy responses to childhood obesity. The Center for Healthy Weight at Stanford University and Lucile Packard Children's Hospital at Stanford provides an example and model of one such strategy. The design provides both breadth and depth through six cores: Research, Patient Car...

  3. Report of VA Medical Training Programs

    Data.gov (United States)

    Department of Veterans Affairs — The Report of VA Medical Training Programs Database is used to track medical center health services trainees and VA physicians serving as faculty. The database also...

  4. Effectively implementing FDA medication alerts utilizing patient centered medical home clinical pharmacists.

    Science.gov (United States)

    Arenz, Barbara J; Diez, Heidi L; Bostwick, Jolene R; Kales, Helen C; Zivin, Kara; Dalack, Gregory W; Fluent, Tom E; Standiford, Connie J; Stano, Claire; Mi Choe, Hae

    2016-03-01

    FDA medication alerts can be successfully implemented within patient centered medical home (PCMH) clinics utilizing clinical pharmacists. Targeted selection of high-risk patients from an electronic database allows PCMH pharmacists to prioritize assessments. Trusting relationships between PCMH clinical pharmacists and primary care providers facilitates high response rates to pharmacist recommendations. This health system approach led by PCMH pharmacists provides a framework for proactive responses to FDA safety alerts and medication related quality measure improvement. PMID:27001101

  5. A simulation model for emergency medical services call centers

    OpenAIRE

    Buuren, van, R.; Kommer, G.J.; Mei,, H.; Bhulai, Sandjai

    2015-01-01

    In pre-hospital health care the call center plays an important role in the coordination of emergency medical services (EMS). An EMS call center handles inbound requests for EMS and dispatches an ambulance if necessary. The time needed for triage and dispatch is part of the total response time to the request, which, in turn, is an indicator for the quality of EMS. Calls entering an efficient EMS call center must have short waiting times, centralists should perform the triage efficiently and th...

  6. Equine medical center offers new ophthalmology service for horses

    OpenAIRE

    Lee, Kate

    2008-01-01

    Virginia Tech's Marion duPont Scott Equine Medical Center has added an ophthalmology service through an alliance with Scottsdale, Ariz., based Eye Care for Animals. The new offering, which became available on March 4, is provided by Dr. Gwendolyn Lynch, a board certified veterinary ophthalmologist and associate doctor at Eye Care for Animals Leesburg, Va., location.

  7. The Ambulatory Diagnostic and Treatment Center: A Unique Model for Educating Medical Trainees and Providing Expedited Care.

    Science.gov (United States)

    Serrao, Richard A; Orlander, Jay D

    2016-05-01

    In this article, the authors reexamine the Ambulatory Diagnostic and Treatment Center (ADTC) model, which uniquely combines the education of trainees with the care of referred patients at one Veterans Affairs medical center. As an ambulatory clinic with an inpatient mind-set, the ADTC uses a series of closely spaced outpatient appointments that are longer than typical ambulatory visits, offering a VIP-level of evaluation with the patient-centered goal of expedited diagnosis and treatment. Faculty triage patients by weighing factors such as urgency, educational value, complexity, and instability of diseases in conjunction with the resources, availability, and appropriateness of other services within the medical center.The ADTC's unique focus on the education of trainees in comparison with other clinical rotations is evident in the ratio of learning to patient care. This intensive training environment expects postgraduate year 2 and 3 internal medicine residents and fourth-year medical students to read, reflect, and review literature daily. This mix of education and care delivery is ripe for reexploration in light of recent calls for curriculum reform amidst headlines exposing delays in veterans' access to care.A low-volume, high-intensity clinic like the ADTC can augment the clinical services provided by a busy primary care and subspecialty workforce without losing its emphasis on education. Other academic health centers can learn from this model and adapt its structure in settings where accountable care organizations and education meet. PMID:26839944

  8. Best practice in unbilled account management: one medical center's story.

    Science.gov (United States)

    Menaker, Debra; Miller, Joshua

    2016-02-01

    After implementing its new electronic health record, a large metropolitan academic medical center (AMC) decided to optimize its supporting business systems, beginning with billing. By identifying problems and taking the following corrective actions immediately, the AMC significantly reduced the number and average age of its unbilled accounts: Realigning system automation to improve routing efficiency. Facilitating interdisciplinary collaboration to better identify and correct the root causes of issues. Ensuring transparent data reporting by setting up different ways of viewing the underlying information. PMID:26999975

  9. Extending Medical Center Computer Application to Rural Health Clinics

    OpenAIRE

    Gottfredson, Douglas K.

    1983-01-01

    A paper entitled “A COMPUTER DATA BASE FOR CLINICIANS, MANAGERS AND RESEARCHERS,” presented during the 1981 SCAMC, described the Salt Lake VA Medical Center computer system. Since that time, two Rural Health Clinics each about 150 miles from Salt Lake City were established by the SL VAMC to reduce traveling distances and improve services for Veterans. Although many existing computer applications were available with no modifications, additional software was needed to support unique needs of th...

  10. Landscape of Medication Management in the Minnesota Patient-Centered Medical Home (PCMH)

    OpenAIRE

    Donald L. Uden, PharmD, FCCP; Jody L. Lounsbery, PharmD, BCPS; Jean Moon, PharmD, BCACP; Margaret L. Wallace, PharmD, BCACP

    2013-01-01

    Purpose: To describe the landscape of medication management within the patient-centered medical homes (PCMH) in the state of Minnesota. Methods: An electronic survey of care coordinators within PCMHs certified with the Department of Health in state of Minnesota was conducted. The survey and follow up were distributed by the Minnesota Department of Health. At the time the survey was distributed, there were 161 certified PCMHs in the state. Results: The final analysis included 21 respondents. S...

  11. Understanding and improving inpatient mortality in academic medical centers.

    Science.gov (United States)

    Behal, Raj; Finn, Jeannine

    2009-12-01

    The purpose of this article is to describe factors contributing to potentially preventable mortality in academic medical centers and the organizational characteristics associated with success in reducing mortality. Sixteen U.S. academic medical centers that wished to improve risk-adjusted inpatient mortality rates requested a consultation that included interviews with physicians, nurses, and hospital leaders; review of medical records; and evaluation of systems and processes of care. The assessments took place on-site; they identified key factors contributing to preventable mortality, and each hospital received specific recommendations. Changes in observed mortality and in the ratio of observed to expected mortality were measured from 2002 to final follow-up in 2007. Evaluations determined each hospital's success factors and key barriers to improvement. The key factors contributing to preventable mortality were delays in responding to deteriorating patients, suboptimal critical care, hospital-acquired infections, postoperative complications, medical errors, and community issues such as the availability of hospice care. Of the 16 hospitals, 12 were able to reduce their mortality index. The five hospitals that had the greatest improvement in mortality were the only hospitals with a broad level of engagement among hospital and physician leaders, including the department chairs. In the hospitals whose performance did not improve, the department chairs were not engaged in the process. The academic medical centers that focused on mortality reduction and had engagement of physicians, especially department chairs, were able to achieve meaningful reductions in hospital mortality. The necessary ingredients for achieving meaningful improvement in clinical outcomes included good data, a sound method for change, and physician leadership. PMID:19940569

  12. Medical waste management in Jordan: A study at the King Hussein Medical Center

    International Nuclear Information System (INIS)

    As in many other developing countries, the generation of regulated medical waste (RMW) in Jordan has increased significantly over the last few decades. Despite the serious impacts of RMW on humans and the environment, only minor attention has been directed to its proper handling and disposal. This study was conducted in the form of a case study at one of Jordan's leading medical centers, namely, the King Hussein Medical Center (KHMC). Its purpose was to report on the current status of medical waste management at KHMC and propose possible measures to improve it. In general, it was found that the center's administration was reasonably aware of the importance of medical waste management and practiced some of the measures to adequately handle waste generated at the center. However, it was also found that significant voids were present that need to be addressed in the future including efficient segregation, the use of coded and colored bags, better handling and transfer means, and better monitoring and tracking techniques, as well as the need for training and awareness programs for the personnel

  13. Succession planning in an academic medical center nursing service.

    Science.gov (United States)

    Barginere, Cynthia; Franco, Samantha; Wallace, Lynne

    2013-01-01

    Succession planning is of strategic importance in any industry. It ensures the smooth transition from leader to leader and the ability of the organization to maintain the forward momentum as well as meet its operational and financial goals. Health care and nursing are no exception. In the complex and challenging world of health care today, leadership is critical to an organization's success and leadership succession is a key strategy used to ensure continuity of leadership and development of talent from within the organization. At Rush University Medical Center, a 667-bed academic medical center providing tertiary care to adults and children, the need for a focus on succession planning for the nursing leadership team is apparent as key leaders come to the end of their careers and consider retirement. It has become apparent that to secure the legacy and continue the extraordinary history of nursing excellence, care must be taken to grow talent from within and take the opportunity to leverage the mentoring opportunities before the retirement of many key leaders. To ensure a smooth leadership transition, nursing leadership and human resources partner at Rush University Medical Center to implement a systematic approach to leadership succession planning. PMID:23222756

  14. An academic medical center under prolonged rocket attack--organizational, medical, and financial considerations.

    Science.gov (United States)

    Bar-El, Yaron; Michaelson, Moshe; Hyames, Gila; Skorecki, Karl; Reisner, Shimon A; Beyar, Rafael

    2009-09-01

    The Rambam Medical Center, the major academic health center in northern Israel, serving a population of two million and providing specialized tertiary care, was exposed to an unprecedented experience during the Second Lebanon War in the summer of 2006. For more than one month, it was subjected to continuous rocket attacks, but it continued to provide emergency and routine medical services to the civilian population and also served the military personnel who were evacuated from the battlefront. To accomplish the goals of serving the population while itself being under fire, the Rambam Medical Center had to undertake major organizational decisions, which included maximizing safety within the hospital by shifting patients and departments, ensuring that the hospital was properly fortified, managing the health professional teams' work schedules, and providing needed services for the families of employees. The Rambam Medical Center's Level I trauma center expertise included multidisciplinary teams and extensive collaborations; modern imaging modalities usually reserved for peacetime medical practice were frequently used. The function of the hospital teams during the war was efficient and smooth, based on the long-term actions taken to prepare for disasters and wartime conditions. Routine hospital services continued, although at 60% of normal occupancy. Financial losses incurred were primarily due to the decrease in revenue-generating activity. The two most important components of managing the hospital under these conditions are (1) the ability to arrive at prompt and meaningful decisions with respect to the organizational and medical hospital operations and (2) the leadership and management of the professional staff and teams. PMID:19707058

  15. From the Sidelines to Center Stage: Sidekick No More? The European Commission in Justice and Home Affairs

    Directory of Open Access Journals (Sweden)

    Emek M. Ucarer

    2001-05-01

    Full Text Available Cooperation in Justice and Home Affairs (JHA an issue area that includes matters of asylum, immigration, police and judicial cooperation is a relatively new policy arena for the European Union. The level and quality of the collective thinking on these issues have improved since the mid-1980s. JHA cooperation was formally endorsed in Maastricht and revisited during the 1996 IGC, resulting in new institutional frameworks within which discussions now occur. Throughout this period, the European Commission has seen its involvement in the decision-making enhanced. Its efforts as an actor began with a humble Task Force with which the Commission attempted to steer EU's policies on asylum and immigration, as well as police and judicial cooperation. After Amsterdam, and particularly as a result of the Commission's restructuring following the resignation of the Santer Commission, the Commission's institutional capacities as well as its charge vis-à-vis the treaties has changed quite remarkably. This paper reviews the Commission's role in JHA as an institutional actor and will evaluate its agency and emerging autonomy in these fields. It argues that the Commission has a stronger constitutional and institutional basis from which to work, bolstered by the increased propensity by member states to delegate to the Commission and enhanced by the creation of the Directorate General for Justice and Home Affairs. While improvements in the Commission's position vis-à-vis the immediate aftermath of Maastricht are visible, challenges remain nonetheless which constrain the Commissions ability to act as a competence-maximizing institution with formal agenda-setting powers.

  16. Gunma University Heavy Ion Medical Center. Evolution of carbon therapy

    International Nuclear Information System (INIS)

    Cancer treatments with high energy carbon beams have been initiated at Gunma University Heavy Ion Medical Center, GHMC, in March of this year. Aiming the wide spread of the carbon therapy, the grand design of the facility and a variety of R and D studies were conducted by HIMAC group of National Institute of Radiological Sciences, NIRS, in collaboration with Gunma University. The design concepts of the facility include the high reliability, high efficiency, and low construction and operation cost. The success of the facility will open up new era of the carbon therapy. (author)

  17. Forensic neuropsychological evaluations in an academic medical center.

    Science.gov (United States)

    Schwarz, Lauren; Schrift, Michael; Pliskin, Neil

    2009-01-01

    Within the expanding field of clinical neuropsychology, the subspecialty of forensic neuropsychology has developed. Currently, there is considerable diversity within the discipline as to how practitioners approach test selection, reports, and number of hours billed. How individuals handle these issues is subject to debate, but what is clear is that there are no specific guidelines as to how to conduct these evaluations. The current study provides an introduction to the issues faced by clinical neuropsychologists completing forensic evaluations. In addition, the authors present how the relevant issues are addressed in one neuropsychology service housed within a university-affiliated academic medical center. PMID:19333065

  18. Case study: a data warehouse for an academic medical center.

    Science.gov (United States)

    Einbinder, J S; Scully, K W; Pates, R D; Schubart, J R; Reynolds, R E

    2001-01-01

    The clinical data repository (CDR) is a frequently updated relational data warehouse that provides users with direct access to detailed, flexible, and rapid retrospective views of clinical, administrative, and financial patient data for the University of Virginia Health System. This article presents a case study of the CDR, detailing its five-year history and focusing on the unique role of data warehousing in an academic medical center. Specifically, the CDR must support multiple missions, including research and education, in addition to administration and management. Users include not only analysts and administrators but clinicians, researchers, and students. PMID:11452578

  19. An Integrated Model of Care: A Visit to The SPARK Center, a Program of Boston Medical Center

    Science.gov (United States)

    Griest, Christa

    2010-01-01

    This article features The SPARK Center, a program of Boston Medical Center, located in Mattapan, Massachusetts. The Center has pioneered a whole-child approach to address the multi-dimensional needs of Boston's most at-risk children, recognizing that vulnerable children need more than educational supports to flourish. The Center's integrated model…

  20. Patient-Centered Medical Home in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Ortiz G

    2011-10-01

    Full Text Available Gabriel Ortiz1, Len Fromer21Pediatric Pulmonary Services, El Paso, TX; 2Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USAAbstract: Chronic obstructive pulmonary disease (COPD is a progressive and debilitating but preventable and treatable disease characterized by cough, phlegm, dyspnea, and fixed or incompletely reversible airway obstruction. Most patients with COPD rely on primary care practices for COPD management. Unfortunately, only about 55% of US outpatients with COPD receive all guideline-recommended care. Proactive and consistent primary care for COPD, as for many other chronic diseases, can reduce hospitalizations. Optimal chronic disease management requires focusing on maintenance rather than merely acute rescue. The Patient-Centered Medical Home (PCMH, which implements the chronic care model, is a promising framework for primary care transformation. This review presents core PCMH concepts and proposes multidisciplinary team-based PCMH care strategies for COPD.Keywords: Patient-Centered Medical Home, chronic care model, chronic obstructive pulmonary disease, patient education, physician assistants, nurse practitioners

  1. Photodynamic research at Baylor University Medical Center Dallas, Texas

    Science.gov (United States)

    Gulliya, Kirpal S.; Matthews, James Lester; Sogandares-Bernal, Franklin M.; Aronoff, Billie L.; Judy, Millard M.

    1993-03-01

    We received our first CO2 laser at Baylor University Medical Center in December 1974, following a trip to Israel in January of that year. Discussion with the customs office of the propriety of charging an 18% import tax lasted for nine months. We lost that argument. Baylor has been using lasers of many types for many procedures since that time. About ten years ago, through the kindness of Tom Dougherty and Roswell Park, we started working with photodynamic therapy, first with hematoporphyrin I and later with dihematoporphyrin ether (II). In February 1984, we were invited to a conference at Los Alamos, New Mexico, U.S.A. on medical applications of the free electron laser as part of the Star Wars Program. A grant application from Baylor was approved that November, but funding did not start for many months. This funding contributed to the development of a new research center as part of Baylor Research Institute. Many of the projects investigated at Baylor dealt with applications of the free electron laser (FEL), after it became available. A staff was assembled and many projects are still ongoing. I would like to outline those which are in some way related to photodynamic therapy.

  2. Publications in academic medical centers: technology-facilitated culture clash.

    Science.gov (United States)

    Berner, Eta S

    2014-05-01

    Academic culture has a set of norms, expectations, and values that are sometimes tacit and sometimes very explicit. In medical school and other health professions educational settings, probably the most common norm includes placing a high value on peer-reviewed research publications, which are seen as the major evidence of scholarly productivity. Other features of academic culture include encouraging junior faculty and graduate students to share their research results at professional conferences and lecturing with slides as a major way to convey information. Major values that faculty share with journal editors include responsible conduct of research and proper attribution of others' words and ideas. Medical school faculty also value technology and are often quick to embrace technological advances that can assist them in their teaching and research. This article addresses the effects of technology on three aspects of academic culture: education, presentations at professional meetings, and research publications.The technologies discussed include online instruction, dissemination of conference proceedings on the Internet, plagiarism-detection software, and new technologies deployed by the National Center for Biotechnology Information, the home of PubMed. The author describes how the ease of deploying new technologies without faculty changing their norms and behavior in the areas of teaching and research can lead to conflicts of values among key stakeholders in the academic medical community, including faculty, journal editors, and professional associations. The implications of these conflicts and strategies for managing them are discussed. PMID:24667517

  3. A special issue on the patient-centered medical home.

    Science.gov (United States)

    Blount, Alexander

    2010-12-01

    This special issue on the Patient-Centered Medical Home (PCMH) reflects its times. At the present time, the PCMH is an aspirational model with a few pilots functioning well around the country. How long the current period of idealism, fueled by the energy of early adopters, the consensus of diverse stakeholders, and the dollars of the Affordable Care Act will continue is anybody's guess. Representing the thinking of some of the best minds in the field, the articles in this issue have an aspirational and idealistic tone as much as a descriptive and analytic one. A year ago the balance would have been tipped more toward idealism and model building and a year from now it would, in all likelihood, tip more toward model description and analysis. The authors in this volume have been personally responsible for helping to move behavioral health to a more central position in the PCMH model. PMID:21299276

  4. Wilms′ Tumor Experience at King Hussein Medical Center

    Directory of Open Access Journals (Sweden)

    Haddadin Isam

    2000-01-01

    Full Text Available This is a retrospective study designed to find out the clinical profile of children with Wilms′ tumor admitted to King Hussein Medical Center over a 6.5-year period. There were 26 patients (eight males and 18 females with a median age of three years (range 1-8 years, at the time of diagnosis. Twenty children went into complete remission for a period ranging from 4-80 months (mean 46 months. Six children relapsed locally or with distant metastasis. All the six children with relapse died because of progressive disease. The overall relapse free survival was 77% for all stages (100%, 90%, 66.6%, 0% and 100% for stage I, II, III, IV and V respectively. This is similar to the international figures for stage I & II but is still behind for stage III & IV.

  5. An academic medical center's response to widespread computer failure.

    Science.gov (United States)

    Genes, Nicholas; Chary, Michael; Chason, Kevin W

    2013-01-01

    As hospitals incorporate information technology (IT), their operations become increasingly vulnerable to technological breakdowns and attacks. Proper emergency management and business continuity planning require an approach to identify, mitigate, and work through IT downtime. Hospitals can prepare for these disasters by reviewing case studies. This case study details the disruption of computer operations at Mount Sinai Medical Center (MSMC), an urban academic teaching hospital. The events, and MSMC's response, are narrated and the impact on hospital operations is analyzed. MSMC's disaster management strategy prevented computer failure from compromising patient care, although walkouts and time-to-disposition in the emergency department (ED) notably increased. This incident highlights the importance of disaster preparedness and mitigation. It also demonstrates the value of using operational data to evaluate hospital responses to disasters. Quantifying normal hospital functions, just as with a patient's vital signs, may help quantitatively evaluate and improve disaster management and business continuity planning. PMID:24352930

  6. Medication therapy management clinic: perception of healthcare professionals in a University medical center setting

    Directory of Open Access Journals (Sweden)

    Shah M

    2013-09-01

    Full Text Available Objective: To determine the overall perception and utilization of the pharmacist managed medication therapy management (MTM clinic services, by healthcare professionals in a large, urban, university medical care setting.Methods: This was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application. Results: Sixty-two healthcare professionals (32% completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as ‘excellent’, 44% as ‘good’, 5% as ‘fair’, and 0% stated ‘poor’. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise.Conclusion: In a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with in-depth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management.

  7. Implementation of an RFID Medical Center Allocation and Picking up Process Support Cloud System

    Directory of Open Access Journals (Sweden)

    Chih-Sheng Chen

    2013-05-01

    Full Text Available In this study, the expendable medical supplies warehouse of the Medical Center can be seen as a logistics center. The users act as the front-end clients and the medical material is a cargo. The concept combines RFID, PDA technology and cloud computing to design and implement the system. The main purpose of the system is to reduce the errors when the operating personnel distribute the expendable medical supplies.

  8. Implementation of an RFID Medical Center Allocation and Picking up Process Support Cloud System

    OpenAIRE

    Chih-Sheng Chen; Min-Hsuan Fan

    2013-01-01

    In this study, the expendable medical supplies warehouse of the Medical Center can be seen as a logistics center. The users act as the front-end clients and the medical material is a cargo. The concept combines RFID, PDA technology and cloud computing to design and implement the system. The main purpose of the system is to reduce the errors when the operating personnel distribute the expendable medical supplies.

  9. Nonstandard Programs: the University of Pittsburgh Medical Center's next frontier in graduate medical education.

    Science.gov (United States)

    Kroboth, Frank J; Zerega, W Dennis; Patel, Rita M; Barnes, Barbara E; Webster, Marshall W

    2011-02-01

    The University of Pittsburgh Medical Center has seen continuous growth in the number and types of graduate training programs not accredited by the Accreditation Council for Graduate Medical Education (ACGME), the American Board of Medical Specialties, or the American Osteopathic Association. For the purposes of ensuring best educational products and of controlling unrecognized competition with our accredited programs, a sequential process of centralized oversight of these nonstandard programs was undertaken. The first step involved programs whose fellows were hired and tracked like accredited fellows (i.e., not instructors). The basic process began with consensus among leadership, writing of policy with consultation as necessary, establishment of a registry of programs and graduates, and a committee to allow sharing of best practices and dissemination of policy. The second step applied the same process to instructor-level programs. Whereas the previous group of programs was made subject to ACGME regulations, more latitude in duty hours and progressive responsibility were allowed for instructor programs. The final step, in progress, is extending a similar but modified approach to short-duration clinical experiences and observerships. The outcomes of these efforts have been the creation of a centralized organizational structure, policies to guide this structure, an accurate registry of a surprising number of training programs, and a rolling record of all graduates from these programs. Included in the process is a mechanism that ensures that core program directors and department chairs specifically review the impact of new programs on core programs before allowing their creation. PMID:21169779

  10. Juvenile DermatomyositisKing Hussein Medical Center Experience

    Directory of Open Access Journals (Sweden)

    Zeyad Habahbeh

    2014-04-01

    Full Text Available Background: Juvenile dermatomyositis (JDM is an uncommon, often chronic, and potentially serious childhood systemic autoimmune vasculopathy affecting primarily skin and muscles. It is characterized by pathognomonic rash, and symmetrical proximal muscle weakness. Objective: In this retrospective study, we reviewed the clinical, laboratory profiles, treatment and outcome of Jordanian children diagnosed with JDM in the past 8 years in a tertiary facility in Amman, Jordan. Methods: Sixteen (16 JDM patients, diagnosed based on criteria of Bohan and Peter, and have attended the pediatric rheumatology clinic in King Hussein Medical Center, from January 2006 to September 2013, were recruited. Their medical records were studied for clinical and biochemical profile, radiological and electrophysiological data were studied as well. Treatment and outcome were also reviewed. Results: Our cohort includes 16 patients, 9(56 % males, and 7 (44% females (M: F 1.3:1, their age ranges between 2 to 9 years, with average age at diagnosis of 5.4 years. Time to diagnosis varies from 2 months to 12 months, and averages at 4.6 months. Proximal muscle weakness was present at time of diagnosis in 14(87.5 % cases. Cutaneous signs in form of either poikiloderma in malar distribution, Gottron’s sign and /or heliotrope sign were apparent in all the 16(100% patients at time of diagnosis, periungual erythema was evident in 10(63% patients while abnormal nailbed capillaries pattern was only reported in 6(38% cases. Skin and soft tissue calcification, crusting and ulceration were seen in 3(19 % patients. Serum Lactate dehydrogenase, (LDH was elevated in 94% and creatininine phosphokinase (CPK in 88%. Elevated SGOT (AST was seen in almost all subjects, while ESR was high in 14 (87.5% patients. All patients treated with corticosteroids and methotrexate (MTX. Two (12.5% patients died in our series, complete remission was achieved in 4(25% of patients, while partial remission was

  11. A model for training medical student innovators: the Harvard Medical School Center for Primary Care Abundance Agents of Change program

    OpenAIRE

    David B. Duong; Sullivan, Erin E.; Myechia Minter-Jordan; Lindsay Giesen; Andrew L. Ellner

    2016-01-01

    Background: In 2013, the Harvard Medical School Center for Primary Care established the Abundance Agents of Change (AoC) program to promote interprofessional learning and innovation, increase partnership between 15 academic and community health centers (CHCs) in Boston's most under-served communities, and increase medical student interest in primary care careers. Methods: The AoC is modeled in the form of a ‘grants challenge’, offering $20,000 to interprofessional student teams to develop an ...

  12. What do clinicians want? Interest in integrative health services at a North Carolina academic medical center

    OpenAIRE

    Eadie Dee; Dirkse Deborah; Kemper Kathi J; Pennington Melissa

    2007-01-01

    Abstract Background Use of complementary medicine is common, consumer driven and usually outpatient focused. We wished to determine interest among the medical staff at a North Carolina academic medical center in integrating diverse therapies and services into comprehensive care. Methods We conducted a cross sectional on-line survey of physicians, nurse practitioners and physician assistants at a tertiary care medical center in 2006. The survey contained questions on referrals and recommendati...

  13. An Academic Medical Center Experience with a Computerized Hospital Information System: The First Four Years

    OpenAIRE

    Reynolds, Robert E.; Heller, Edward E.

    1980-01-01

    Rush-Presbyterian-St. Luke's Medical Center (RPSLMC) obtained and implemented an on-line, real time medical information system (MIS), SPECTRA 2000, in 1976 in its branch hospital, the Sheridan Road Pavilion. After several years of successful operation and minor modifications, the system was evaluated with regard to installing it throughout the rest of the RPSLMC. A group of specified enhancements were outlined to make the system suitable to the needs of the large academic medical center. Impl...

  14. 76 FR 59407 - Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and...

    Science.gov (United States)

    2011-09-26

    ... Scientific and Medical Literature and Information on Non-Standardized Allergenic Extracts in the Diagnosis... scientific and medical literature and information concerning the use of non-standardized allergenic extracts... ``Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and...

  15. Measuring, Evaluating, and Mapping the Electromagnetic Field Levels in Turgut Ozal Medical Center Building and Environment

    OpenAIRE

    Karadağ, Teoman; ABBASOV, Teymuraz; Karadağ, Müge Otlu

    2014-01-01

    Objectives: To take measurements for electromagnetic field levels in the range of 5Hz-8GHz frequency at Turgut Ozal Medical Center, Inonu University, a medical center visited by over 500.000 patients every year, and analysing the results. Material and Methods: Two Wavecontrol MonitEM, continuous electromagnetic field measurement stations have been used to observe the values of electrical field levels at 100kHz-8GHz and GSM and 3G frequencies inside and outside the medical center in differ...

  16. A model for training medical student innovators: the Harvard Medical School Center for Primary Care Abundance Agents of Change program

    OpenAIRE

    David B. Duong; Sullivan, Erin E.; Minter-Jordan, Myechia; Giesen, Lindsay; Andrew L. Ellner

    2016-01-01

    Background: In 2013, the Harvard Medical School Center for Primary Care established the Abundance Agents of Change (AoC) program to promote interprofessional learning and innovation, increase partnership between 15 academic and community health centers (CHCs) in Boston’s most under-served communities, and increase medical student interest in primary care careers.Methods: The AoC is modeled in the form of a ‘grants challenge’, offering $20,000 to interprofessional student teams to develop an i...

  17. Development of a Patient-Centered Antipsychotic Medication Adherence Intervention

    Science.gov (United States)

    Pyne, Jeffrey M.; Fischer, Ellen P.; Gilmore, LaNissa; McSweeney, Jean C.; Stewart, Katharine E.; Mittal, Dinesh; Bost, James E.; Valenstein, Marcia

    2014-01-01

    Objective: A substantial gap exists between patients and their mental health providers about patient's perceived barriers, facilitators, and motivators (BFMs) for taking antipsychotic medications. This article describes how we used an intervention mapping (IM) framework coupled with qualitative and quantitative item-selection methods to…

  18. Medical emergency center for radiation injuries in Zagreb, Croatia

    International Nuclear Information System (INIS)

    The paper presents the way how radiation injuries due to a radiation accident can be treated. Several degrees of action will be provided in case of a NPP-Krsko nuclear accident. Medical treatment will be done in the Centre for Radiation Medicine and Protection in Clinical Hospital Centre Zagreb. (rieger)

  19. Marion duPont Scott Equine Medical Center uses innovative lameness treatment

    OpenAIRE

    Lee, Kate

    2009-01-01

    Virginia Tech's Marion duPont Scott Equine Medical Center is now offering an equine lameness therapy that prevents further degeneration of the affected joint and offers a longer-lasting benefit than traditional steroid treatment.

  20. Marion duPont Scott Equine Medical Center offers treatments for upper respiratory disease

    OpenAIRE

    Musick, Marjorie

    2008-01-01

    At Virginia Tech's Marion duPont Scott Equine Medical Center, a variety of treatments are available for correcting disorders of the upper respiratory system and improving the odds of performance success.

  1. Medication Practices at Center Of Hospital and Nursing Home Proposals: Discharge and Pharmacy Requirements to Change

    OpenAIRE

    Barlas, Stephen

    2016-01-01

    Rules proposed by the Centers for Medicare and Medicaid Services would change discharge policies at hospitals and long-term care facilities and update conditions of participation with a focus on medication reconciliation and pharmacist responsibilities.

  2. Medication Practices at Center Of Hospital and Nursing Home Proposals: Discharge and Pharmacy Requirements to Change.

    Science.gov (United States)

    Barlas, Stephen

    2016-04-01

    Rules proposed by the Centers for Medicare and Medicaid Services would change discharge policies at hospitals and long-term care facilities and update conditions of participation with a focus on medication reconciliation and pharmacist responsibilities. PMID:27069341

  3. New equine surgeon joins Marion duPont Scott Equine Medical Center

    OpenAIRE

    Douglas, Jeffrey S.

    2005-01-01

    Curry Keoughan has joined the Virginia-Maryland Regional College of Veterinary Medicine's Marion duPont Scott Equine Medical Center as a clinical assistant professor. He will work primarily with lameness and surgery services.

  4. Data Center Strategy to Increase Medical Information Sharing in Hospital Information Systems

    Directory of Open Access Journals (Sweden)

    Karim Zarour

    2013-05-01

    Full Text Available The sharing of medical information among healthcare providers is a key factor in improving any health care system. By providing opportunities for sharing and exchanging information and knowledge, data center, agent and ontology play a very important role in the field of medical informatics. In this paper, we propose a design of architecture and data center for the development of a Hospital information system (HIS based on agents and ontology.

  5. ANALISIS STRATEGI PEMASARAN PELAYANAN SKIN MEDICAL CENTER DI RUMAH SAKIT PKU MUHAMMADIYAH YOGYAKARTA

    OpenAIRE

    Endri Hariyanti; . Rosyidah

    2013-01-01

    Background: Service center medical skin is a new service PKU Muhammadiyah Hospital in Yogyakarta, the necessary research to find out the marketing strategy plan that will be used PKU Muhammadiyah Hospital in Yogyakarta. The marketing strategies of medical skin care center that will be researched to see of the marketing mix, consisting of product, price, place, promotion, people, processes and Physical evidence, from the marketing mix in the analysis using the SWOT analysis to determine the ri...

  6. Selecting a commercial clinical information system: an academic medical center's experience.

    OpenAIRE

    Wong, E.T.; Abendroth, T. W.

    1994-01-01

    Choosing a commercial clinical information system to meet the information needs of patient care, research, education, administration, finance, and ongoing changes of the healthcare system of an academic medical center is a challenging task. For the past six months, The Milton S. Hershey Medical Center undertook this task through (i) establishing a task force, (ii) assessing end-user information needs, (iii) understanding future institutional development and strategies, (iv) conceptualizing th...

  7. Trend of knowledge production of research centers in the field of medical sciences in iran.

    Science.gov (United States)

    Falahat, K; Eftekhari, Mb; Habibi, E; Djalalinia, Sh; Peykari, N; Owlia, P; Malekafzali, H; Ghanei, M; Mojarrab, Sh

    2013-01-01

    Establishment of medical research centers at universities and health-related organizations and annually evaluation of their research activities was one of the strategic policies which followed by governmental organization in last decade in order to strengthening the connections between health research system and health system. The aim of this study is to scrutinize the role of medical research centers in medical science production in Iran. This study is a cross sectional which has been performed based on existing reports on national scientometrics and evaluation results of research performance of medical research centers between years 2001 to 2010. During last decade number of medical research centers increased from 53 in 2001 to 359 in 2010. Simultaneous scientific output of medical research centers has been increased especially articles indexed in ISI (web of science). Proper policy implementation in the field of health research system during last decades led to improving capacity building and growth knowledge production of medical science in recent years in Iran. The process embedding research into the health systems requires planning up until research products improves health outcomes and health equity in country. PMID:23865017

  8. Trend of Knowledge Production of Research Centers in the Field of Medical Sciences in Iran

    Directory of Open Access Journals (Sweden)

    P Owlia

    2013-01-01

    Full Text Available Establishment of medical research centers at universities and health-related organizations and annually evaluation of their research activities was one of the strategic policies which followed by governmental organization in last decade in order to strengthening the connections between health research system and health system. The aim of this study is to scrutinize the role of medical research centers in medical science production in Iran. This study is a cross sectional which has been performed based on existing reports on national scientometrics and evaluation results of research performance of medical research centers between years 2001 to 2010. During last decade number of medical research centers increased from 53 in 2001 to 359 in 2010. Simultaneous scientific output of medical research centers has been increased especially articles indexed in ISI (web of science. Proper policy implementation in the field of health research system during last decades led to improving capacity building and growth knowledge production of medical science in recent years in Iran. The process embedding research into the health systems requires planning up until research products improves health outcomes and health equity in country.

  9. DOE Center of Excellence in Medical Laser Applications. Final report, December 1, 1994--November 30, 1997

    Energy Technology Data Exchange (ETDEWEB)

    Jacques, S.L.

    1998-01-01

    An engineering network of collaborating medical laser laboratories are developing laser and optical technologies for medical diagnosis and therapy and are translating the engineering into medical centers in Portland OR, Houston TX, and Galveston TX. The Center includes the University of Texas M.D. Anderson Cancer Center, the University of Texas-Austin, Texas A and M University, Rice University, the University Texas Medical Branch-Galveston, Oregon Medical Laser Center (Providence St. Vincent Medical Center, Oregon Health Sciences University, and Oregon Graduate Institute, Portland, OR), and the University of Oregon. Diagnostics include reflectance, fluorescence, Raman IR, laser photoacoustics, optical coherence tomography, and several new video techniques for spectroscopy and imaging. Therapies include photocoagulation therapy, laser welding, pulsed laser ablation, and light-activated chemotherapy of cancer (photodynamic therapy, or PDT). Medical applications reaching the clinic include optical monitoring of hyperbilirubinemia in newborns, fluorescence detection of cervical dysplasia, laser thrombolysis of blood clots in heart attack and brain stroke, photothermal coagulant of benign prostate hyperplasia, and PDT for both veterinary and human cancer. New technologies include laser optoacoustic imaging of breast tumors and hemorrhage in head trauma and brain stroke, quality control monitoring of dosimetry during PDT for esophageal and lung cancer, polarization video reflectometry of skin cancer, laser welding of artificial tissue replacements, and feedback control of laser welding.

  10. Early Clinical Experiences for Second-Year Student Pharmacists at an Academic Medical Center

    OpenAIRE

    McLaughlin, Jacqueline E.; Amerine, Lindsey B.; Chen, Sheh-Li; Luter, David N.; Arnall, Justin; Smith, Shayna; Roth, Mary T.; Rodgers, Philip T.; Williams, Dennis M.; Pinelli, Nicole R.

    2015-01-01

    Objective. To examine student outcomes associated with the Student Medication and Reconciliation Team (SMART) program, which was designed to provide second-year student pharmacists at the University of North Carolina (UNC) Eshelman School of Pharmacy direct patient care experience at UNC Medical Center.

  11. Preparing an Academic Medical Center to Manage Patients Infected with Ebola: Experiences of a University Hospital

    OpenAIRE

    Schultz, Ch.; Koenig, KL; Alassaf, W

    2015-01-01

    © 2015 Society for Disaster Medicine and Public Health, Inc. As Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population's health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered t...

  12. Equipment for nuclear medical centers, production capabilities of Rosatom enterprises

    Science.gov (United States)

    Gavrish, Yu. N.; Koloskov, S. A.; Smirnov, V. P.; Strokach, A. P.

    2015-12-01

    Analysis of the capabilities of the State Corporation Rosatom enterprises on the development and production of diagnostic and therapeutic equipment for nuclear medicine centers is presented. Prospects of the development of accelerator equipment for the production of a wide range of radioisotope products are shown, and the trends of its development are determined. A comparative analysis of the technical parameters of domestic tomographs and devices for brachytherapy with foreign counterparts is given.

  13. Equipment for nuclear medical centers, production capabilities of Rosatom enterprises

    Energy Technology Data Exchange (ETDEWEB)

    Gavrish, Yu. N., E-mail: gavrish@luts.niiefa.spb.su [JSC Efremov Institute of Electrophysical Apparatus (Russian Federation); Koloskov, S. A. [JSC Scientific Research Institute of Technical Physics and Automation (Russian Federation); Smirnov, V. P. [JSC Science and Innovation (Russian Federation); Strokach, A. P. [JSC Efremov Institute of Electrophysical Apparatus (Russian Federation)

    2015-12-15

    Analysis of the capabilities of the State Corporation Rosatom enterprises on the development and production of diagnostic and therapeutic equipment for nuclear medicine centers is presented. Prospects of the development of accelerator equipment for the production of a wide range of radioisotope products are shown, and the trends of its development are determined. A comparative analysis of the technical parameters of domestic tomographs and devices for brachytherapy with foreign counterparts is given.

  14. What do clinicians want? Interest in integrative health services at a North Carolina academic medical center

    Directory of Open Access Journals (Sweden)

    Eadie Dee

    2007-02-01

    Full Text Available Abstract Background Use of complementary medicine is common, consumer driven and usually outpatient focused. We wished to determine interest among the medical staff at a North Carolina academic medical center in integrating diverse therapies and services into comprehensive care. Methods We conducted a cross sectional on-line survey of physicians, nurse practitioners and physician assistants at a tertiary care medical center in 2006. The survey contained questions on referrals and recommendations in the past year and interest in therapies or services if they were to be provided at the medical center in the future. Results Responses were received from 173 clinicians in 26 different departments, programs and centers. There was strong interest in offering several specific therapies: therapeutic exercise (77%, expert consultation about herbs and dietary supplements (69%, and massage (66%; there was even stronger interest in offering comprehensive treatment programs such as multidisciplinary pain management (84%, comprehensive nutritional assessment and advice (84%, obesity/healthy lifestyle promotion (80%, fit for life (exercise and lifestyle program, 76%, diabetes healthy lifestyle promotion (73%; and comprehensive psychological services for stress management, including hypnosis and biofeedback (73%. Conclusion There is strong interest among medical staff at an academic health center in comprehensive, integrated services for pain, obesity, and diabetes and in specific services in fitness, nutrition and stress management. Future studies will need to assess the cost-effectiveness of such services, as well as their financial sustainability and impact on patient satisfaction, health and quality of life.

  15. Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China

    OpenAIRE

    Qing, Yunbo; Hu, Guijie; Chen, Qingyun; Peng, Hailun; Li, Kailan; Wei, Jinling; Yi, Yanhua

    2015-01-01

    Purpose: To produce competent undergraduate-level medical doctors for rural township health centers (THCs), the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs) starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China. Methods: An internet-ba...

  16. Perceptions of personal health risks by medical and non-medical workers in a university medical center : a survey study

    NARCIS (Netherlands)

    Listyowardojo, Tita Alissa; Nap, Raoul E.; Johnson, Addie

    2010-01-01

    Background: Health care workers (HCWs) are faced with many work-related choices which may depend on how they perceive risk, such as whether or not to comply with safety regulations. Little research has investigated risk perception in medical workers in comparison with non-medical workers and the ext

  17. Attitudes towards primary care career in community health centers among medical students in China

    OpenAIRE

    Zhang, Lingling; Bossert, Thomas; Mahal, Ajay; Hu, Guoqing; Guo, Qing; Liu, Yuanli

    2016-01-01

    Background Very few of the primary care doctors currently working in China’s community health centers have a college degree (issued by 5-year medical schools). How to attract college graduates to community services in the future, therefore, has major policy relevance in the government’s ongoing efforts to reform community health care and fill in the long-absent role of general physicians in China. This paper examined medical school students’ attitudes towards working in communities and the fa...

  18. Suggested Minimum Data Set for Speech Therapy Centers Affiliated to Tabriz University of Medical Sciences

    OpenAIRE

    Damanabi, Shahla; Abdolnejad, Shawbo; Karimi, Gelavizh

    2015-01-01

    Background: The minimum data considered as a conceptual framework, based on the achievement of effectiveness indicators and it ensures to access of precise and clear health data. The aims of the present study were identified and proposed a data element set of speech therapy centers affiliated with Tabriz University of Medical Sciences. Material and Methods: This study that was cross – sectional type, performed in 9 speech therapy clinic from medical university in 2014. Firstly, the minimum da...

  19. A Human-Centered Approach to Medical Informatics for Medical Students, Residents, and Practicing Clinicians.

    Science.gov (United States)

    Stahlhut, Richard W.; Gosbee, John W.; Gardner-Bonneau, Daryle J.

    1997-01-01

    Describes development of a curriculum in medical information science that focuses on practical problems in clinical medicine rather than details of information technology. Design was guided by identification of six key clinical challenges that must be addressed by practitioners in the near future and by examination of past failures of informatics…

  20. ANALISIS STRATEGI PEMASARAN PELAYANAN SKIN MEDICAL CENTER DI RUMAH SAKIT PKU MUHAMMADIYAH YOGYAKARTA

    Directory of Open Access Journals (Sweden)

    Endri Hariyanti

    2013-04-01

    Full Text Available Background: Service center medical skin is a new service PKU Muhammadiyah Hospital in Yogyakarta, the necessary research to find out the marketing strategy plan that will be used PKU Muhammadiyah Hospital in Yogyakarta. The marketing strategies of medical skin care center that will be researched to see of the marketing mix, consisting of product, price, place, promotion, people, processes and Physical evidence, from the marketing mix in the analysis using the SWOT analysis to determine the right strategy. Method: The study was descriptive qualitative research. The subjects in this study were the Director of Medical Services, Marketing Manager, one Marketing staff, dermatologist and six patients. The instrument used a form of interview guidelines and the type of recorder. Data analysis Used SWOT analysis. Results: (1 Aspects of the product; Products used in cooperation with Ristra because Ristra is a product that has been certified legal, so safe to use MUI emergency. (2 Aspects of the price, price is still relatively cheap because they still get the discount. (3 Aspects of the place; PKU Muhammadiyah Hospital in Yogyakarta strategically located alongside the highway easily accessible by any transportation making it easier for patients to come to the skin medical center. (4 Promotion: Promotion is not maximized, not broad market area just around the DIY. (5 People; trained human resources, good, loyal and work according to the procedure, Consumers who feel happy and satisfied with the services provided at the medical center skin. (6 Physical evidence; facilities and infrastructure such as physical buildings, medical equipment provided by hospital and has been standard. (7 Process: The process of medical skin care center for treatment tailored to the criteria that will be used in patient care, marketing process of the skin as support medical center for promotional material. Conclusion: The PKU Muhammadiyah Hospital in Yogyakarta in cooperation

  1. Results of an Institutional LGBT Climate Survey at an Academic Medical Center.

    Science.gov (United States)

    Chester, Sean D; Ehrenfeld, Jesse M; Eckstrand, Kristen L

    2014-12-01

    The purpose of this study was to characterize the climate and culture experienced by lesbian, gay, bisexual, and transgender (LGBT) employees and students at one large academic medical center. An anonymous, online institutional climate survey was used to assess the attitudes and experiences of LGBT employees and students. There were 42 LGBT and 14 non-LGBT survey participants. Results revealed that a surprisingly large percentage of LGBT individuals experienced pressure to remain "closeted" and were harassed despite medical center policies of non-discrimination. Continuing training, inclusive policies and practices, and the development of mechanisms to address LGBT-specific harassment are necessary for improving institutional climate. PMID:26789861

  2. Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home

    OpenAIRE

    O’Donnell, Alison J.; Bogner, Hillary R.; Cronholm, Peter F.; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F. de Vries; Kaye, Elise M.; Gabbay, Robert

    2016-01-01

    Introduction: Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in ...

  3. Implementing RECONSIDER, a diagnostic prompting computer system, at the Georgetown University Medical Center.

    OpenAIRE

    Broering, N C; Corn, M; Ayers, W R; Mistry, P

    1988-01-01

    RECONSIDER, a computer program for diagnostic prompting developed at the University of California, San Francisco, has been implemented at the Georgetown University Medical Center as part of the Integrated Academic Information Management System Model Development grant project supported by the National Library of Medicine. The system is available for student use in the Biomedical Information Resources Center of the Dahlgren Memorial Library. Instruction on use of the computer system is provided...

  4. [Urgency and acuity judgment systems before medical care (emergency telephone consultation center #7119, JTAS etc.)].

    Science.gov (United States)

    Ishikawa, Hideki; Yoshida, Masashi; Sakamoto, Tetsuya

    2016-02-01

    Currently growing the demand of the emergency medical care in Japan, sharing the concept about medical urgency is needed in the whole society in order to maintain the emergency medical systems as social resources. The present conditions and challenges are outlined: Emergency Telephone Consultation Center in Tokyo Fire Department (established in June 2007) and on-site triage as representatives of "pre-hospital urgency determination systems", and JTAS (Japan Triage and Acuity System, introduced in April 2012) as a representative of "in-hospital, pre-examination urgency determination systems". PMID:26915257

  5. [Medical fault or professional negligence? Case studies in two recovery nutrition centers in Niger].

    Science.gov (United States)

    Halidou Doudou, M; Manzo, M L; Guero, D

    2014-12-01

    In developing countries such as Niger, the risk of medical malpractice is ubiquitous in health, jeopardizing patient safety. The aim of this work was to contribute to patients' safety and respect of code of ethics and conduct in the exercise of the medical profession. The reported cases involved two children under 5 years who were admitted to nutrition rehabilitation centers, died as a result of medical malpractice. In Niger, there are no statistics on this phenomenon and a few cases found have always been considered "accident" or "fate." The establishment of an observatory collections of such information should improve their frequency, consequences and propose a prevention plan. PMID:25449444

  6. Top 10 Lessons Learned from Electronic Medical Record Implementation in a Large Academic Medical Center

    OpenAIRE

    Rizer, Milisa K.; Kaufman, Beth; Sieck, Cynthia J.; Hefner, Jennifer L; McAlearney, Ann Scheck

    2015-01-01

    Electronic medical record (EMR) implementation efforts face many challenges, including individual and organizational barriers and concerns about loss of productivity during the process. These issues may be particularly complex in large and diverse settings with multiple specialties providing inpatient and outpatient care. This case report provides an example of a successful EMR implementation that emphasizes the importance of flexibility and adaptability on the part of the implementation team...

  7. Undergoing Transformation to the Patient Centered Medical Home in Safety Net Health Centers: Perspectives from the Front Lines

    Science.gov (United States)

    Quinn, Michael T.; Gunter, Kathryn E.; Nocon, Robert S.; Lewis, Sarah E.; Vable, Anusha M.; Tang, Hui; Park, Seo-Young; Casalino, Lawrence P.; Huang, Elbert S.; Birnberg, Jonathan; Burnet, Deborah L.; Summerfelt, W. Thomas; Chin, Marshall H.

    2013-01-01

    Objectives Safety Net Health Centers (SNHCs), which include Federally Qualified Health Centers (FQHCs) provide primary care for underserved, minority and low income patients. SNHCs across the country are in the process of adopting the Patient Centered Medical Home (PCMH) model, based on promising early implementation data from demonstration projects. However, previous demonstration projects have not focused on the safety net and we know little about PCMH transformation in SNHCs. Design This qualitative study characterizes early PCMH adoption experiences at SNHCs. Setting and Participants We interviewed 98 staff,(administrators, providers, and clinical staff) at 20 of 65 SNHCs, from five states, who were participating in the first of a five-year PCMH collaborative, the Safety Net Medical Home Initiative. Main Measures We conducted 30-45 minute, semi-structured telephone interviews. Interview questions addressed benefits anticipated, obstacles encountered, and lessons learned in transition to PCMH. Results Anticipated benefits for participating in the PCMH included improved staff satisfaction and patient care and outcomes. Obstacles included staff resistance and lack of financial support for PCMH functions. Lessons learned included involving a range of staff, anticipating resistance, and using data as frequent feedback. Conclusions SNHCs encounter unique challenges to PCMH implementation, including staff turnover and providing care for patients with complex needs. Staff resistance and turnover may be ameliorated through improved healthcare delivery strategies associated with the PCMH. Creating predictable and continuous funding streams may be more fundamental challenges to PCMH transformation. PMID:23914423

  8. [Current aspects of war surgery. From the trauma center to precarious medical care].

    Science.gov (United States)

    Houdelette, P

    1997-01-01

    War, said Carl von Clausewitz, is a cameleon. In this century, each armed conflict has proved to be unique, particularly in its medical aspects, with its own features and teaching its won lessons. As recent events show, no conflict is a fact of the past. Medical care delivered to war casualties depend on the circumstances of the war, on the medical resources available, but also on the price that cultures or circumstances place on it. Everything separates these two paradigms; on the one hand the "precious" casualty of western armies whose medical support is organized in a concept (forward medical and surgical care, ultra-rapid medical evacuation) tailored to each case, and as close as possible to the medical care of a civilian trauma patient whose models remains the North-American ballistic wound managed in trauma centers; on the other hand, civilian victims, in large numbers, in poor and disorganized countries, often abandoned to their own fate or sorted by "epidemiological" triage, which guarantees a distribution, as efficient as possible, of limited medical care. In war, advanced medical care and precarious medicine may work side by side according to two logics which do not exclude one another and constantly improve. PMID:9297902

  9. Three-Year Experience of an Academic Medical Center Ombuds Office.

    Science.gov (United States)

    Raymond, John R; Layde, Peter M

    2016-03-01

    An ombuds is an individual who informally helps people or groups (visitors) resolve disputes and/or interpersonal conflicts as an alternative to formal dispute resolution mechanisms within an organization. Ombuds are nearly ubiquitous in many governmental, business, and educational settings but only recently have gained visibility at medical schools. Medical schools in the United States are increasingly establishing ombuds offices as part of comprehensive conflict management systems to address concerns of faculty, staff, students, and others. As of 2015, more than 35 medical schools in the United States have active ombuds Web pages. Despite the growing number of medical schools with ombuds offices, the literature on medical school ombuds offices is scant. In this article, the authors review the first three years of experience of the ombuds office at the Medical College of Wisconsin, a freestanding medical and graduate school with a large physician practice. The article is written from the perspective of the inaugural ombuds and the president who initiated the office. The authors discuss the rationale for, costs of, potential advantages of, and initial reactions of faculty, staff, and administration to having an ombuds office in an academic medical center. Important questions relevant to medical schools that are considering an ombuds office are discussed. The authors conclude that an ombuds office can be a useful complement to traditional approaches for conflict management, regulatory compliance, and identification of systemic issues. PMID:26675192

  10. Benchmarking in Student Affairs.

    Science.gov (United States)

    Mosier, Robert E.; Schwarzmueller, Gary J.

    2002-01-01

    Discusses the use of benchmarking in student affairs, focusing on issues related to student housing. Provides examples of how benchmarking has influenced administrative practice at many institutions. (EV)

  11. Journey toward a Patient-Centered Medical Home: Readiness for Change in Primary Care Practices

    OpenAIRE

    Wise, Christopher G; Alexander, Jeffrey A.; Green, Lee A.; Cohen, Genna R.; Koster, Christina R

    2011-01-01

    Context: Information is limited regarding the readiness of primary care practices to make the transformational changes necessary to implement the patient-centered medical home (PCMH) model. Using comparative, qualitative data, we provide practical guidelines for assessing and increasing readiness for PCMH implementation.

  12. Marion duPont Scott Equine Medical Center offers new treatment for lameness

    OpenAIRE

    Musick, Marjorie

    2006-01-01

    The Virginia-Maryland Regional College of Veterinary Medicine's Marion duPont Scott Equine Medical Center has begun offering a new therapy for treating lameness associated with osteoarthritis and cartilage damage in horses, a problem that affects all segments of the equine industry.

  13. Which Sexual Abuse Victims Receive a Forensic Medical Examination?: The Impact of Children's Advocacy Centers

    Science.gov (United States)

    Walsh, Wendy A.; Cross, Theodore P.; Jones, Lisa M.; Simone, Monique; Kolko, David J.

    2007-01-01

    Objective: This study examines the impact of Children's Advocacy Centers (CAC) and other factors, such as the child's age, alleged penetration, and injury on the use of forensic medical examinations as part of the response to reported child sexual abuse. Methods: This analysis is part of a quasi-experimental study, the Multi-Site Evaluation of…

  14. Examining Health Information Technology Implementations: Case of the Patient-Centered Medical Home

    Science.gov (United States)

    Behkami, Nima A.

    2012-01-01

    It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to…

  15. The History of SHSAAMc: Student Health Services at Academic Medical Centers

    Science.gov (United States)

    Veeser, Peggy Ingram; Hembree, Wylie; Bonner, Julia

    2008-01-01

    This article presents an historical review of the organization known as Student Health Services at Academic Medical Centers (SHSAAMc). The authors discuss characteristics of health service directors as well as the history of meetings, discussion, and leadership. The focus of the group is the healthcare needs of health professions students at…

  16. Developing a Sustainable Research Culture in an Independent Academic Medical Center

    Science.gov (United States)

    Joyce, Jeffrey N.

    2013-01-01

    Independent academic medical centers (IAMC) are challenged to develop and support a research enterprise and maintain primary goals of healthcare delivery and financial solvency. Strategies for promoting translational research have been shown to be effective at institutions in the top level of federal funding, but not for smaller IAMCs. The…

  17. Marion duPont Scott Equine Medical Center announces Tuesday Talks schedule

    OpenAIRE

    Lee, Kate

    2008-01-01

    Virginia Tech's Marion duPont Scott Equine Medical Center has announced its 2009-10 Tuesday Talks schedule. This series of free lectures is designed to provide veterinarians, horse owners, and horse professionals with valuable insight and practical advice related to a wide array of equine health care topics.

  18. Equine medical center's isolation unit is valuable tool in battle against infectious diseases

    OpenAIRE

    Musick, Marjorie

    2007-01-01

    Whether it is Equine Herpesvirus-1, Potomac Horse Fever or Strangles, infectious diseases in horses have appeared frequently in recent news headlines. Fortunately, the Marion duPont Scott Equine Medical Center in Leesburg, Va., is on the frontlines in the battle against infectious diseases within the equine population.

  19. Crossing the Great Divide: Adoption of New Technologies, Therapeutics and Diagnostics at Academic Medical Centers

    Science.gov (United States)

    DeMonaco, Harold J.; Koski, Greg

    2007-01-01

    The role of new technology in healthcare continues to expand from both the clinical and financial perspectives. Despite the importance of innovation, most academic medical centers do not have a clearly defined process for technology assessment. Recognizing the importance of new drugs, diagnostics and procedures in the care of patients and in the…

  20. Program review of the USDA Center for Medical, Agricultural and Veterinary Entomology

    Science.gov (United States)

    The USDA-ARS Center for Medical, Agricultural and Veterinary Entomology (CMAVE) has a history that starts in 1932 in Orlando to develop methods to control mosquitoes, including malaria vectors under conditions simulating those of the south Pacific jungles, and other insects affecting man and animals...

  1. Developing physician leaders in academic medical centers. Part 1: Their changing role.

    Science.gov (United States)

    Bachrach, D J

    1996-01-01

    While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management, intramurally conducted courses in leadership skill development; management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. This article article was prepared by the author from research into and presentation of a thesis entitled. "The Importance of Leadership Training And Development For Physicians In Academic Medical Centers In An Increasingly Complex Healthcare Environment, " prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in the College (ACHE). Part 2 will appear in the next issue of the Journal. PMID:10162876

  2. The Role of Human Resource Management in Iranian SMEs; in the Case of Medical Imaging Centers

    Directory of Open Access Journals (Sweden)

    Amirhossein Akhavan

    2010-05-01

    Full Text Available Human Resource Management (HRM faces difficulties in small businesses which derive from the small size and absence of adequate financial resources. Many authors have investigated the changed version of HRM in small enterprises which is some deal different with HRM in large enterprises. But in Iran researches are not interested in investigating human resource management in the field of small businesses and this encouraged me to perform this research. At first, this study has reviewed HRM policies and practices in small and medium enterprises (SMEs in the world. Then Iranian medical imaging centers have been selected as knowledge SMEs and some related managerial information has been collected from them by observation and interview. The obtained findings are about the role that HRM plays in today Iranian SMEs in the case of medical imaging centers. In this chapter the type of Human Resource Management which is accomplished in medical imaging enterprises in Iran is discovered and you can find the mistakes performed by their managers. These findings are analyzed based on literatures. In the conclusion part, some differences between western and Iranian models are proved and the study concludes that most of the owner managers in medical imaging centers in Iran could not execute HRM practices, even if they knew them or not. At last, some key points are presented as final recommendations to Iranian medical imaging SMEs in order to help them to improve their efficiency in the future.

  3. Preparing Academic Medical Centers for the Clinical Learning Environment Review: Alliance of Independent Academic Medical Centers National Initiative IV Outcomes and Evaluation

    Science.gov (United States)

    Wehbe-Janek, Hania; Markova, Tsveti; Polis, Rachael L.; Peters, Marguerite; Liu, Yang

    2016-01-01

    Background: Driven by changes to improve quality in patient care and population health while reducing costs, evolvement of the health system calls for restructuring health professionals' education and aligning it with the healthcare delivery system. In response to these changes, the Accreditation Council for Graduate Medical Education's Clinical Learning Environment Review (CLER) encourages the integration of health system leadership, faculty, and residents in restructuring graduate medical education (GME). Innovative approaches to achieving this restructuring and the CLER objectives are essential. Methods: The Alliance of Independent Academic Medical Centers National Initiative (NI) IV provided a multiinstitutional learning collaborative focused on supporting GME redesign. From October 2013 through March 2015, participants conducted relevant projects, attended onsite meetings, and participated in teleconferences and webinars addressing the CLER areas. Participants shared best practices, resources, and experiences. We designed a pre/post descriptive study to examine outcomes. Results: Thirty-three institutions completed NI IV, and at its conclusion, the majority reported greater CLER readiness compared with baseline. Twenty-two (88.0%) institutions reported that NI IV had a great impact on advancing their efforts in the CLER area of their project focus, and 15 (62.5%) reported a great impact in other CLER focus areas. Opportunities to share progress with other teams and the national group meetings were reported to contribute to teams' success. Conclusion: The NI IV learning collaborative prepared institutions for CLER, suggesting successful integration of the clinical and educational enterprises. We propose that national learning collaboratives of GME-sponsoring health systems enable advancement of their education mission, leading ultimately to better healthcare outcomes. This learning model may be generalizable to newfound programs for academic medical centers

  4. Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience

    Directory of Open Access Journals (Sweden)

    Linda Thomas-Hemak

    2015-02-01

    Full Text Available Purpose. The effect of patient centered medical home (PCMH curriculum interventions on residents’ self-reported and demonstrated knowledge, skills and attitudes in PCMH competency arenas (KSA is lacking in the literature. This study aimed to assess the impact of PCMH curricular innovations on the KSA of Internal Medicine residents. Methods. Twenty four (24 Internal Medicine residents—12 Traditional (TR track residents and 12 Teaching Health Center (THC track residents—began training in Academic Year (AY 2011 at the Wright Center for Graduate Medical Education (WCGME. They were followed through AY2013, covering three years of training. PCMH curricular innovations were focally applied July 2011 until May 2012 to THC residents. These curricular innovations were spread program-wide in May 2012. Semi-annual, validated PCMH Clinician Assessments assessing KSA were started in AY2011 and were completed by all residents. Results. Mean KSA scores of TR residents were similar to those of THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than TR residents for most KSA. After program-wide implementation of PCMH innovations, mean scores of TR residents for all KSA improved and most became equalized to those of THC residents. Globally improved KSA scores of THC and TR residents were maintained through May 2014, with the majority of improvements above baseline and reaching statistical significance. Conclusions. PCMH curricular innovations inspired by Health Resources and Services Administration (HRSA’s Teaching Health Center funded residency program expansion quickly and consistently improved the KSA of Internal Medicine residents.

  5. Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center

    Directory of Open Access Journals (Sweden)

    Salih Bin Salih

    2013-01-01

    Full Text Available Objective: The objective of this study was to assess the prevalence of polypharmacy (PP and the associated factors in medical outpatients. Materials and Methods: A cross-sectional, observational, descriptive study was carried out in adult medical outpatients attending internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 1 March 2009 to 31 December 2009. PP was defined as the concomitant use of ≥5 medications daily. The number of medications being currently taken by patient was recorded. Effect of patients′ age, gender, educational level, number of prescribers, disease load and disease type on PP was assessed by multivariate analysis using Statistical Package for Social Sciences Incorporated (SPSS Inc Version 18. Results: Out of 766 patients included in the study, 683 (89% had PP. The mean number of prescribed medications, oral pills and doses was 8.8, 9.6 and 12.1, respectively. Factors significantly associated with PP included age (≥61 years, disease load and the number of prescribers. Gender had no impact on PP while education beyond primary education significantly decreased PP. Hypertension, diabetes mellitus and dyslipidemia alone and as a cluster increased PP. Conclusion: We found an extremely high level of PP in medical outpatients at our tertiary care center. The impact of PP on medication compliance and control of underlying diseases in Saudi Arabia is unknown and needs to be studied at different levels of care.

  6. A management plan for hospitals and medical centers facing radiation incidents

    Directory of Open Access Journals (Sweden)

    Fereshteh Davari

    2015-01-01

    Full Text Available Background: Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. Materials and Methods: In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. Results: We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. Conclusion: With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

  7. Towards Interactive Medical Content Delivery Between Simulated Body Sensor Networks and Practical Data Center.

    Science.gov (United States)

    Shi, Xiaobo; Li, Wei; Song, Jeungeun; Hossain, M Shamim; Mizanur Rahman, Sk Md; Alelaiwi, Abdulhameed

    2016-10-01

    With the development of IoT (Internet of Thing), big data analysis and cloud computing, traditional medical information system integrates with these new technologies. The establishment of cloud-based smart healthcare application gets more and more attention. In this paper, semi-physical simulation technology is applied to cloud-based smart healthcare system. The Body sensor network (BSN) of system transmit has two ways of data collection and transmission. The one is using practical BSN to collect data and transmitting it to the data center. The other is transmitting real medical data to practical data center by simulating BSN. In order to transmit real medical data to practical data center by simulating BSN under semi-physical simulation environment, this paper designs an OPNET packet structure, defines a gateway node model between simulating BSN and practical data center and builds a custom protocol stack. Moreover, this paper conducts a large amount of simulation on the real data transmission through simulation network connecting with practical network. The simulation result can provides a reference for parameter settings of fully practical network and reduces the cost of devices and personnel involved. PMID:27562482

  8. A new concept for medical imaging centered on cellular phone technology.

    Directory of Open Access Journals (Sweden)

    Yair Granot

    Full Text Available According to World Health Organization reports, some three quarters of the world population does not have access to medical imaging. In addition, in developing countries over 50% of medical equipment that is available is not being used because it is too sophisticated or in disrepair or because the health personnel are not trained to use it. The goal of this study is to introduce and demonstrate the feasibility of a new concept in medical imaging that is centered on cellular phone technology and which may provide a solution to medical imaging in underserved areas. The new system replaces the conventional stand-alone medical imaging device with a new medical imaging system made of two independent components connected through cellular phone technology. The independent units are: a a data acquisition device (DAD at a remote patient site that is simple, with limited controls and no image display capability and b an advanced image reconstruction and hardware control multiserver unit at a central site. The cellular phone technology transmits unprocessed raw data from the patient site DAD and receives and displays the processed image from the central site. (This is different from conventional telemedicine where the image reconstruction and control is at the patient site and telecommunication is used to transmit processed images from the patient site. The primary goal of this study is to demonstrate that the cellular phone technology can function in the proposed mode. The feasibility of the concept is demonstrated using a new frequency division multiplexing electrical impedance tomography system, which we have developed for dynamic medical imaging, as the medical imaging modality. The system is used to image through a cellular phone a simulation of breast cancer tumors in a medical imaging diagnostic mode and to image minimally invasive tissue ablation with irreversible electroporation in a medical imaging interventional mode.

  9. Discharge against medical advice in a pediatric emergency center in the State of Qatar

    Directory of Open Access Journals (Sweden)

    Hala Abdulateef

    2012-05-01

    Full Text Available Objective: The objective of this study was to analyze cases that had left the Pediatric Emergency Center Al Sadd, Doha (PEC against medical advice, with the aim of developing policies to help reduce this occurrence. Methodology: All patients that were admitted to the main PEC observation room for treatment and/or investigation and subsequently left against medical advice from February 18, 2007 to June 18, 2007, were followed by a phone call, and a questionnaire, which was completed by the departmental patient representative. Results: 99,133 patients attended the facility during the study period. Of those, 106 left the facility against medical advice. Ninety-four guardians were successfully contacted. 90% of the cases were in children below 2 years of age. In 87% of the cases the mother was the main decision maker for leaving against medical advice. Domestic obligations were the leading cause of DAMA (discharge against medical advice, reported in 45% of the cases. Respondents reported that the consequences of DAMA were well explained by medical staff before they left the facility however, they had not met with the departmental patient representative during their stay. Conclusion:As the majority of DAMA cases occurred in infants, medical staff should address the concerns of this group early on in the course of treatment. Maintaining communication and providing support, in particular for mothers of higher risk groups may help to reduce the rate of DAMA cases.

  10. United States academic medical centers: priorities and challenges amid market transformation.

    Science.gov (United States)

    Thompson, Irene M; Anason, Barbara

    2012-01-01

    United States academic medical centers (AMCs) have upheld their long-standing reputation for excellence by teaching and training the next generation of physicians, supporting medical research, providing world-class medical care, and offering breakthrough treatments for highly complex medical cases. In recent years, the pace and direction of change reshaping the American health care industry has created a set of new and profound challenges that AMC leaders must address in order to sustain their institutions. University HealthSystem Consortium (UHC) is an alliance of 116 leading nonprofit academic medical centers and 276 of their affiliated hospitals, all of which are focused on delivering world-class patient care. Formed in 1984, UHC fosters collaboration with and among its members through its renowned programs and services in the areas of comparative data and analytics, performance improvement, supply chain management, strategic research, and public policy. Each year, UHC surveys the executives of its member institutions to understand the issues they view as most critical to sustaining the viability and success of their organizations. The results of UHC's most recent 2011 member survey, coupled with a 2012 Strategic Health Perspectives Harris Interactive presentation, based in parton surveys of major health care industry stakeholders reveal the most important and relevant issues and opportunities that hospital leaders face today, as the United States health care delivery system undergoes a period of unprecedented transformation. PMID:23484431

  11. Development of a longitudinal integrated clerkship at an academic medical center

    Directory of Open Access Journals (Sweden)

    Ann Poncelet

    2011-04-01

    Full Text Available In 2005, medical educators at the University of California, San Francisco (UCSF, began developing the Parnassus Integrated Student Clinical Experiences (PISCES program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants’ career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

  12. A model for training medical student innovators: the Harvard Medical School Center for Primary Care Abundance Agents of Change program

    Directory of Open Access Journals (Sweden)

    David B. Duong

    2016-06-01

    Full Text Available Background: In 2013, the Harvard Medical School Center for Primary Care established the Abundance Agents of Change (AoC program to promote interprofessional learning and innovation, increase partnership between 15 academic and community health centers (CHCs in Boston's most under-served communities, and increase medical student interest in primary care careers. Methods: The AoC is modeled in the form of a ‘grants challenge’, offering $20,000 to interprofessional student teams to develop an innovative solution that addresses a healthcare delivery need identified by CHCs. The program's initial two years were characterized by a four-stage process which included working with CHCs and crafting a request for proposals, forming interprofessional 20 student teams comprising students from across and outside of Harvard University, training students using a systems-based innovation curriculum, and performing program evaluation. Results: Our evaluation data from cohorts 1 and 2 of the AoC program demonstrate that we succeeded in training students as innovators and members of interprofessional teams. We also learned valuable lessons regarding creating better alignment with CHC priorities, extending the program cycle from 12 to 18 months, and changing the way funding is disbursed to 25 students, which will be incorporated in later versions of the program. Conclusions: Based on our experience and evaluation data, we believe that this program is a replicable way to train students as innovators and members of interprofessional teams to address the current complex healthcare environment.

  13. Medical diplomacy and global mental health: from community and national institutions to regional centers of excellence.

    Science.gov (United States)

    Aggarwal, Neil Krishan; Kohrt, Brandon A

    2013-12-01

    We explore how regional medical diplomacy can increase funding for global mental health initiatives. Interventions for infectious diseases have dominated medical diplomacy by focusing on security concerns. The global mental health movement has adopted similar strategies, but unsuccessfully since mental illnesses do not cause international epidemics. Instead, realpolitik arguments may increase funding by prioritizing economic productivity and regional diplomacy based on cultural ties to advance mental health services and research at the community level. In South Asia, initiatives to train personnel and provide refugee services offer a foundation for regional centers of excellence. This model can be expanded elsewhere. PMID:23918068

  14. A renewed Medication Adherence Alliance call to action: harnessing momentum to address medication nonadherence in the United States

    OpenAIRE

    Zullig, Leah

    2016-01-01

    Leah L Zullig,1,2 Bradi B Granger,3 Hayden B Bosworth,1–4 On behalf of the Medication Adherence Alliance 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 2Division of General Internal Medicine, Department of Medicine, Duke University, 3Duke Heart Center Nursing Research Program, School of Nursing, Duke University, 4Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA The problem: Nonadherence to prescript...

  15. Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care.

    Science.gov (United States)

    Simon, Melissa A; Samaras, Athena T; Nonzee, Narissa J; Hajjar, Nadia; Frankovich, Carmi; Bularzik, Charito; Murphy, Kara; Endress, Richard; Tom, Laura S; Dong, XinQi

    2016-01-01

    Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients' interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus-community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented. PMID:27594792

  16. Positioning academic medical centers and teaching hospitals to thrive in the next decade.

    Science.gov (United States)

    Morris, D E

    1985-06-01

    Market share for academic medical centers and teaching hospitals will decline over the next five years necessitating new strategies to ensure growth and profitability. These types of institutions are, however, in a strong position to compete and gain market share locally by building a defensible competitive advantage. This article offers three avenues for increasing market share: networking, brand name product differentiation, and business diversification. PMID:10271804

  17. Public sector unions shaping hospital privatization: the creation of Boston Medical Center

    OpenAIRE

    Lydia Savage

    2004-01-01

    In this paper the author examines, through a case study of a hospital merger in Boston, MA, the ways in which a locally scaled union strategy can shape privatization. She first examines recent economic changes in the US hospital industry, which have resulted in a record number of mergers, closures, and conversions. A case study of the merger between a public hospital, Boston City Hospital, and a private hospital, Boston University Hospital, into the private, nonprofit, Boston Medical Center i...

  18. Implementation of Epic Beaker Clinical Pathology at an academic medical center

    OpenAIRE

    Krasowski, Matthew D.; Joseph D Wilford; Wanita Howard; Susan K Dane; Scott R Davis; Karandikar, Nitin J.; Blau, John L; Bradley A Ford

    2016-01-01

    Background: Epic Beaker Clinical Pathology (CP) is a relatively new laboratory information system (LIS) operating within the Epic suite of software applications. To date, there have not been any publications describing implementation of Beaker CP. In this report, we describe our experience in implementing Beaker CP version 2012 at a state academic medical center with a go-live of August 2014 and a subsequent upgrade to Beaker version 2014 in May 2015. The implementation of Beaker CP was concu...

  19. Aligning Incentives in Orthopaedics: Opportunities and Challenges—the Case Medical Center Experience

    OpenAIRE

    Marcus, Randall E.; Zenty, Thomas F.; Adelman Esq., Harlin G.

    2009-01-01

    For 30 years, the orthopaedic faculty at Case Western Reserve University worked as an independent private corporation within University Hospitals Case Medical Center (Hospital). However, by 2002, it became progressively obvious to our orthopaedic practice that we needed to modify our business model to better manage the healthcare regulatory changes and decreased reimbursement if we were to continue to attract and retain the best and brightest orthopaedic surgeons to our practice. In 2002, our...

  20. Sports hernia: the experience of Baylor University Medical Center at Dallas

    OpenAIRE

    Preskitt, John T.

    2011-01-01

    Groin injuries in high-performance athletes are common, occurring in 5% to 28% of athletes. Athletic pubalgia syndrome, or so-called sports hernia, is one such injury that can be debilitating and sport ending in some athletes. It is a clinical diagnosis of chronic, painful musculotendinous injury to the medial inguinal floor occurring with athletic activity. Over the past 12 years, we have operated on >100 patients with this injury at Baylor University Medical Center at Dallas. These patients...

  1. Comparison of patient outcomes in academic medical centers with and without value analysis programs

    Directory of Open Access Journals (Sweden)

    Murray AS

    2012-09-01

    Full Text Available Adrienne S Murray, Michael Griswold, Imran Sunesara, Ed SmithUniversity of Mississippi Health Care, University of Mississippi Medical Center, Jackson, MS, USABackground: Value analysis is the science of balancing the mandate to deliver high-quality clinical outcomes with the necessity to drive down costs in order to thrive in the challenging economics of health care. This study compared average length of stay, direct cost, morbidity, and mortality across the cardiology, cardiovascular, neuroscience, and orthopedic service lines, in academic medical centers with and without value analysis programs (VAPs. The basic question was, “Do academic medical centers with VAPs have lower average length of stay, better morbidity and mortality rates, and lower overall supply costs?”Methods and results: The clinical data base/resource manager (CDB/RM of the University HealthSystem Consortium was utilized as secondary data for this study. Reports from the CDB/RM were generated from 2006 to 2011. Continuous variable differences across VAP status were examined using Wilcoxon two-sample tests. Primary analyses used multilevel linear mixed model methods to estimate the effects of VAPs on primary outcomes (average length of stay, cost, morbidity, mortality. Association components of the linear mixed models incorporated random effects at the hospital level and robust, Huber-White, standard errors were calculated. There was no significant difference for average length of stay, direct cost, morbidity, and mortality between academic medical centers with and without VAPs. However, outcomes were not noted to be substantially worse.Conclusion: Numerous case studies reveal that aggressively active VAPs do decrease hospital cost. Also, this study did not find a negative impact on patient care. Further studies are needed to explore the benefits of value analysis and its effect on patient outcomes.Keywords: value analysis, average length of stay, morbidity, mortality

  2. Improving small purchase operations at the National Naval Medical Center Bethesda, Maryland

    OpenAIRE

    Kuhn, Gregory T.

    1990-01-01

    This research was accomplished to perform a management problem analysis study of the Procurement Department at the National Naval Medical Center, Bethesda, MD. The goal of this research was to develop an organizational plan to increase small purchase productivity, improve quality of purchase documentation and strengthen customer service through improved utilization of personnel resources, increased levels of training, increased utilization of efficient procurement techniques and automation. R...

  3. The Uses of the Smartphone for Doctors: An Empirical Study from Samsung Medical Center

    OpenAIRE

    Choi, Jong Soo; Yi, Byoungkee; PARK, Jong Hwan; Choi, Kyesook; Jung, Jaegon; Park, Seung Woo; Rhee, Poong-Lyul

    2011-01-01

    Objectives In healthcare, mobile computing made possible by smartphones is becoming an important tool among healthcare professionals. However, currently there is very little research into the effectiveness of such applications of technology. This study aims to present a framework for a smartphone application to give doctors mobile access to patient information, then review the consequences of its use and discuss its future direction. Methods Since 2003 when Samsung Medical Center introduced i...

  4. Scheduled telephone visits in the veterans health administration patient-centered medical home

    OpenAIRE

    Sperber, Nina R; King, Heather A.; Steinhauser, Karen; Ammarell, Natalie; Danus, Susanne; Powers, Benjamin J

    2014-01-01

    Background The Veterans Health Administration (VHA) patient-centered medical home model, Patient Aligned Care Teams (PACT), includes telephone visits to improve care access and efficiency. Scheduled telephone visits can replace in-person care for some focused issues, and more information is needed to understand how this mode can best work for primary care. We conducted a study at the beginning of PACT implementation to elicit stakeholder views on this mode of healthcare delivery, including po...

  5. Television spots win national award. Part of OSF Saint Francis Medical Center's branding effort.

    Science.gov (United States)

    Rees, Tom

    2004-01-01

    "Miracles in Medicine," a series of award-winning television spots, was produced for OSF Saint Francis Medical Center, Peoria, Ill., by The Roberts Group, Inc., Waukesha, Wis. They are an integral part of a broader branding campaign, launched in May 2003, that includes newspaper, radio, and outdoor elements. The spots were deemed so successful, the branding effort was expanded to include Children's Hospital of Illinois. PMID:15162576

  6. Prototyping an institutional IAIMS/UMLS information environment for an academic medical center.

    OpenAIRE

    Miller, P. L.; Paton, J A; Clyman, J. I.; Powsner, S M

    1992-01-01

    The paper describes a prototype information environment designed to link network-based information resources in an integrated fashion and thus enhance the information capabilities of an academic medical center. The prototype was implemented on a single Macintosh computer to permit exploration of the overall "information architecture" and to demonstrate the various desired capabilities prior to full-scale network-based implementation. At the heart of the prototype are two components: a diverse...

  7. Impact of sham-controlled vertebroplasty trials on referral patterns at two academic medical centers

    OpenAIRE

    Lindsey, Sara S.; Kallmes, David F.; Opatowsky, Michael J.; Broyles, Elizabeth A.; Layton, Kennith F.

    2013-01-01

    Debate persists regarding the merit of vertebroplasty following publication of blinded vertebroplasty trials in 2009, one of which was the Investigational Vertebroplasty Efficacy and Safety Trial (INVEST). This study was performed to determine whether referring physicians at two academic medical centers were aware of the trial results and to assess if this awareness prompted a change in their treatment of osteoporotic fractures. E-mail surveys were distributed to physicians within the Mayo Cl...

  8. Do medical marijuana centers behave like locally undesirable land uses? Implications for the geography of health and environmental justice

    OpenAIRE

    Boggess, Lyndsay; Perez, Deanna; Cope, Kathryn; Root, Carl; Stretesky, Paul

    2014-01-01

    As of 2013, medical marijuana is legal in 20 states and the District of Columbia, but few studies have investigated the consequences of the retail centers that sell the drug. We draw upon the social construction literature to frame our research and help us determine whether medical marijuana centers in Denver, Colorado (USA) are considered locally undesirable land uses (LULUs). The geography of health and environmental justice frameworks lead us to hypothesize that marijuana centers are more ...

  9. Incorporating the principles of the patient- centered medical home into a student-run free clinic

    Directory of Open Access Journals (Sweden)

    Riddle MC

    2014-09-01

    Full Text Available Megan C Riddle,1,* Jiahui Lin,3,* Jonathan B Steinman,2 Joshua D Salvi,2 Margaret M Reynolds,3 Anne S Kastor,3,† Christina Harris,4 Carla Boutin-Foster3 1Department of Psychiatry and Behavioral Sciences, University of Washington, 2Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD–PhD Program, 3Department of Internal Medicine, Weill Cornell Medical College, New York, NY, 4Department of Medicine, Division of General Internal Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, LA, USA *These authors contributed equally to this work †Anne S Kastor passed away on July 5, 2013. Abstract: As the health care delivery landscape changes, medical schools must develop creative strategies for preparing future physicians to provide quality care in this new environment. Despite the growing prominence of the patient-centered medical home (PCMH as an effective model for health care delivery, few medical schools have integrated formal education on the PCMH into their curricula. Incorporating the PCMH model into medical school curricula is important to ensure that students have a comprehensive understanding of the different models of health care delivery and can operate effectively as physicians. The authors provide a detailed description of the process by which the Weill Cornell Community Clinic (WCCC, a student-run free clinic, has integrated PCMH principles into a service-learning initiative. The authors assessed patient demographics, diagnoses, and satisfaction along with student satisfaction. During the year after a PCMH model was adopted, 112 students and 19 licensed physicians volunteered their time. A review of the 174 patients seen from July 2011 to June 2012 found that the most common medical reasons for visits included management of hypertension, hyperlipidemia, diabetes, gastrointestinal conditions, arthritis, anxiety, and depression. During the year after the adoption of the PCMH model, 87

  10. Implementation of Patient-Centered Medical Homes in Adult Primary Care Practices.

    Science.gov (United States)

    Alexander, Jeffrey A; Markovitz, Amanda R; Paustian, Michael L; Wise, Christopher G; El Reda, Darline K; Green, Lee A; Fetters, Michael D

    2015-08-01

    There has been relatively little empirical evidence about the effects of patient-centered medical home (PCMH) implementation on patient-related outcomes and costs. Using a longitudinal design and a large study group of 2,218 Michigan adult primary care practices, our study examined the following research questions: Is the level of, and change in, implementation of PCMH associated with medical surgical cost, preventive services utilization, and quality of care in the following year? Results indicated that both level and amount of change in practice implementation of PCMH are independently and positively associated with measures of quality of care and use of preventive services, after controlling for a variety of practice, patient cohort, and practice environmental characteristics. Results also indicate that lower overall medical and surgical costs are associated with higher levels of PCMH implementation, although change in PCMH implementation did not achieve statistical significance. PMID:25861803

  11. Analysis of 10-Year Training Results of Medical Students Using the Microvascular Research Center Training Program.

    Science.gov (United States)

    Onoda, Satoshi; Kimata, Yoshihiro; Sugiyama, Narushi; Tokuyama, Eijiro; Matsumoto, Kumiko; Ota, Tomoyuki; Thuzar, Moe

    2016-06-01

    Background In this article, we reviewed the training results of medical students using the Microvascular Research Center Training Program (MRCP), and proposed an ideal microsurgical training program for all individuals by analyzing the training results of medical students who did not have any surgical experience. Methods As of 2015, a total of 29 medical students completed the MRCP. In the most recent 12 medical students, the number of trials performed for each training stage and the number of rats needed to complete the training were recorded. Additionally, we measured the operating time upon finishing stage 5 for the recent six medical students after it became a current program. Results The average operating time upon finishing stage 5 for the recent six medical students was 120 minutes ± 11 minutes (standard deviation [SD]). The average vascular anastomosis time (for the artery and vein) was 52 minutes ± 2 minutes (SD). For the most recent 12 medical students, there was a negative correlation between the number of trials performed in the non-rat stages (stages 1-3) and the number of rats used in the rat stages (stages 4-5). Conclusion Analysis of the training results of medical students suggests that performing microsurgery first on silicon tubes and chicken wings saves animals' lives later during the training program. We believe that any person can learn the technique of microsurgery by performing 7 to 8 hours of training per day over a period of 15 days within this program setting. PMID:26636888

  12. Public affairs plan

    International Nuclear Information System (INIS)

    The purpose of the Uranium Mill Tailings Remedial Action (UMTRA) Project Public Affairs Plan is to establish goals for the fiscal year (FY) 1996 UMTRA Project public affairs program and to identify specific activities to be conducted during the year. It describes the roles of various agencies involved in the public affairs program and defines the functions of the UMTRA Project Technical Assistance Contractor (TAC) Public Affairs Department. It replaces the FY 1995 Public Affairs Plan (DOE/AL/62350-154). The plan also describes the US Department of Energy's (DOE) plans to keep stakeholders and other members of the public informed about UMTRA Project policies, plans, and activities, and provide opportunities for stakeholders and interested segments of the public to participate in UMTRA Project decision-making processes. The plan applies to the UMTRA Project Team; the DOE Grand Junction Projects Office (GJPO); the DOE Albuquerque Operations Office, Office of Public Affairs (OPA); the TAC; the UMTRA Project Remedial Action Contractor (RAC); and other cooperating agencies

  13. The Tulane University Medical Center/Columbia partnership: opportunities and challenges for pathology.

    Science.gov (United States)

    Krause, J R; Salmon, B C; Gerber, M A

    1996-01-01

    A joint venture between the largest health-care corporation in the country (Columbia/HCA) and Tulane University Hospital/Clinic was established about 1 year ago. Early indications are that the partnership is successful and mutually beneficial. For Tulane University Medical Center, the joint venture provides financial stability and support for academic centers of excellence. Tulane University Hospital/Clinic will become the referral center for complicated cases from the regional Columbia hospitals. The Tulane University Hospital laboratories are positioned to become the regional referral laboratory for esoteric testing. For the pathologists of the regional Columbia hospitals, the opportunity beckons to form a group of equal partners that will contract with Columbia to provide laboratory services at Columbia hospitals and to consolidate the laboratories in the New Orleans division. Columbia has brought corporate expertise, capital, and opportunities for cost-saving economies of scale to the partnership. Quality and cost-effectiveness of patients care will be emphasized as will research on clinical outcomes. This model of corporate/academic partnership represents a new option for academic medical centers around the country as they respond to the rapid changes in the health-care environment. PMID:10162016

  14. Strom Thurmond Biomedical Research Center at the Medical Univesity for South Carolina Charleston, South Carolina

    Energy Technology Data Exchange (ETDEWEB)

    1994-02-01

    The Department of Energy (DOE) has prepared an Environmental Assessment (EA) evaluating the proposed construction and operation of the Strom Thurmond Biomedical Research Center (Center) at the Medical University of South Carolina (MUSC), Charleston, SC. The DOE is evaluating a grant proposal to authorize the MUSC to construct, equip and operate the lower two floors of the proposed nine-story Center as an expansion of on-going clinical research and out-patient diagnostic activities of the Cardiology Division of the existing Gazes Cardiac Research Institute. Based on the analysis in the EA, the DOE has determined that the proposed action does not constitute a major federal action significantly affecting the quality of the human environment within the meaning of the NEPA. Therefore, the preparation of an Environmental Impact Statement is not required.

  15. Contingency Operations Support to NASA Johnson Space Center Medical Operations Division

    Science.gov (United States)

    Stepaniak, Philip; Patlach, Bob; Swann, Mark; Adams, Adrien

    2005-01-01

    The Wyle Laboratories Contingency Operations Group provides support to the NASA Johnson Space Center (JSC) Medical Operations Division in the event of a space flight vehicle accident or JSC mishap. Support includes development of Emergency Medical System (EMS) requirements, procedures, training briefings and real-time support of mishap investigations. The Contingency Operations Group is compliant with NASA documentation that provides guidance in these areas and maintains contact with the United States Department of Defense (DOD) to remain current on military plans to support NASA. The contingency group also participates in Space Operations Medical Support Training Courses (SOMSTC) and represents the NASA JSC Medical Operations Division at contingency exercises conducted worldwide by the DOD or NASA. The events of September 11, 2001 have changed how this country prepares and protects itself from possible terrorist attacks on high-profile targets. As a result, JSC is now considered a high-profile target and thus, must prepare for and develop a response to a Weapons of Mass Destruction (WMD) incident. The Wyle Laboratories Contingency Operations Group supports this plan, specifically the medical response, by providing expertise and manpower.

  16. Cryoablation for the treatment of drug refractory symptomatic atrial fibrillation: A regional medical center experience.

    Directory of Open Access Journals (Sweden)

    Robert Tonks, MD; Hiba-tul-kareem Sayed, MD; Ashley Adams, BA; William T. Smith, MD, FACC

    2016-02-01

    Full Text Available Introduction: PVI is an effective, guideline-based treatment for drug refractory symptomatic AF. Balloon cryoablation has been shown to be a safe and effective method for PVI. In the STOP-AF trial, data was produced from practitioners performing PVI with significant experience at high volume centers. This study evaluates the effectiveness and safety of treating symptomatic, drug refractory AF with PVI via cryoablation after implementation in a regional medical center. Method: This represents a retrospective analysis of outcomes after cryoablation treatment for AF in 71 patients over 354.7 +/- 164.4 days. Reported and recorded episodes of AF were categorized into a representative percent of AF “burden” for each 90 day period. Primary effectiveness and safety end points paralleled those of the STOP-AF trial. Results: Patients undergoing cryoablation had a 91% reduction of AF burden at 6 months following the procedure with an event-free survival rate of 45.5 % at a mean follow up of 12 months. The mean burden reduction was 3.21% per quarter. Anti-arrhythmic and anticoagulant medication use was reduced by 14.3% and 26.8% respectively. Significant complications included one report of pulmonary vein stenosis, one report of pseudoaneurysm and 5.5% of patients had transient pericarditis or pericardial effusion following the procedure. Conclusion: The results of this study were comparable to those of the high volume multi-center STOP-AF trial. PVI via cryoablation is a safe and effective alternative treatment of drug refractory symptomatic AF in the setting of a regional medical center. Abbreviations: Atrial fibrillation (AF, pulmonary vein isolation (PVI

  17. Finding Common Ground: Interprofessional Collaborative Practice Competencies in Patient-Centered Medical Homes.

    Science.gov (United States)

    Swihart, Diana

    2016-01-01

    The patient-centered medical home model is predicated on interprofessional collaborative practice and team-based care. While information on the roles of various providers is increasingly woven into the literature, the competencies of those providers have been generally profession-specific. In 2011, the Interprofessional Education Collaborative comprising the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Dental Education Association, the Association of American Medical Colleges, and the Association of Schools of Public Health sponsored an expert panel of their members to identify and develop 4 domains of core competencies needed for a successful interprofessional collaborative practice: (1) Values/Ethics for Interprofessional Practice; (2) Roles/Responsibilities; (3) Interprofessional Communication; and (4) Teams and Teamwork. Their findings and recommendations were recorded in their Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. This article explores these 4 domains and how they provide common ground for team-based care within the context of the medical home model approach to patient-centered primary care. PMID:26938181

  18. Implementing a New Chart in the Radiotherapy Unit at Rambam Medical Center

    International Nuclear Information System (INIS)

    The Radiotherapy chart is the paper form used by the multi-disciplinary team of the Radiotherapy [RT] Unit to convey information and register treatment orders. The chart is a major tool which helps the medical and para-medical staff to provide the correct treatment to the patient and to assure that every step is performed appropriately and approved. For this reason, the RT chart is one of the quality assurance tools used in the Unit. In the last decade, the RT chart used at Rambam Medical Center was very simple, 4 pages long, designed by the staff members themselves. Several errors in delivering RT led to a decision to involve the Research Center for Work Safety and Human Engineering at Technion. This group conducted a human factors and safety analysis study in the RT Unit. After both general and focused analyses, the group recommended redesigning the RT chart which plays an important role as an information and guiding map, affecting the quality of treatment and the patient's health and safety

  19. Analysis of the Service Quality of Medical Centers Using Servqual Model (Case:Shaheed Rahnemoon Hospital

    Directory of Open Access Journals (Sweden)

    H Zare Ahmadabadi

    2007-07-01

    Full Text Available Introduction: Many organizations, especially service oriented ones, relative to their goals and mission, have a special view towards quality phenomena and its management. Methods: This paper analyzes medical service quality in one case; The internal section of Shaheed Rahnemoon Hospital Based on the basis of gap analysis model and Servqual technique. A questionnaire was designed and applied to measure expectations and perceptions of patients and personnel of the hospital. Results: On application of non-parametric statistical tests, we propose certain recommendations. These tests drive on five conceptual dimensions of service quality including intangibility, responsiveness, reliability, assurance and empathy. Results show that patients in this section were satisfied from the service provider’s responsiveness, but there are significant differences between expectations and perceptions in other dimensions. Conclusion: The service quality analysis models are useful for managers of medical centers to distinguish gaps between the two sides of service representation; patients and medical centers personnel. Ultimately, they can reinforce strengths and control weaknesses.

  20. Public affairs plan

    International Nuclear Information System (INIS)

    The purpose of the Uranium Mill Tailings Remedial Action (UMTRA) Project Public Affairs Plan is to establish goals for the Fiscal Year 1995 UMTRA public affairs program and identify specific activities to be conducted during the year. It also describes the roles of various agencies involved in the conduct of the public affairs program and defines the functions of the Technical Assistance Contractor (TAC) Public Affairs Department. It integrates and replaces the Public Participation Plan (DOE/AL/62350-47D) and Public Information Plan (DOE/AL/623590-71). The plan describes the US Department of Energy's (DOE) plans to keep stakeholders and other members of the public informed about project policies, plans, and activities, and provide opportunities for stakeholders and interested segments of the public to participate in project decision-making processes. The plan applies to the UMTRA Project Office; the DOE Albuquerque Operations Office, Office of Intergovernmental and External Affairs (OIEA); the UMTRA TAC; the UMTRA Remedial Action Contractor (RAC); and other cooperating agencies

  1. Meeting changing conditoins at the Rhode Island Medical Center cogeneration plant

    International Nuclear Information System (INIS)

    The Rhode Island Department of Mental Health, Retardation and Hospitals is one state department in Rhode Island whose basic function is to provide services to seriously disabled individuals throughout the state. Savings in operating expenses from the Rhode Island Medical Center Central Power Plant have accruded to provide operating funds for the major programs. Operating under a Director who reports to the Governor of Rhode Island, the Department has three major divisions, approximately 2500 employees, and a budget of 200 million dollars. Its operations extend throughout the state and the major focus for hospital or institutional levels of care reside in three major locations, the Dr. U.E. Zambarano Memorial Hospital in northern Rhode Island, the Dr. Joseph Ladd Center in southern Rhode Island, and the Rhode Island Medical Center in the middle of the state. Besides these institution-based operations, the Department sponsors a wide range of rehabilitative programming in the community other through direct operations of facilities such as group homes or through contracts with private non-profit providers of service

  2. Detecting Postpartum Depression in Referents to Medical and Health Centers in Hamadan City

    Directory of Open Access Journals (Sweden)

    F. Shobeiri

    2007-10-01

    Full Text Available Introduction & Objective: Pregnancy and childbirth are significant developmental excitable for most women. Physical, intrapersonal and relational adaptations are needed to adjust successfully to pregnancy and delivery. Postpartum depression is a serious psychiatric disorder and the adverse impact on infants has been noted. The purpose of this study was to detect postpartum depression in referents to medical and health centers in Hamadan city.Materials & Methods: A descriptive and cross-sectional study involving 400 women completed the Beck Depression Inventory (BDI within 2-8 weeks of delivery was conducted in urban health centers in Hamadan city, Iran. Data were collected through interviews with women in the clinics in the health centers. Data processing and statistical analysis were performed using SPSS 10.0.Results: The results revealed that majority of women (68.0% were considered normal. Depression was detected in 32.0% of women. Out of these 19.0, 4.0 and 9.0% were mild, moderate and severe depression, respectively. There were statistically significant differences between postpartum depression and age, number of delivery, education, job and husband's job (P=0.000.Conclusion: Nearly 32.0% of selected women had depression. Therefore, it is important for medical personnel to be well versed in the course and treatment of postpartum depression. Post partum depression should be screened and treated as early as possible for several reasons. It can cause significant suffering for the woman who experiences it, and it can have deleterious consequences for the newborn.

  3. Establishment of exposure dose assessment laboratory in National Radiation Emergency Medical Center (NREMC)

    International Nuclear Information System (INIS)

    As unclear industry grown, 432 of the nuclear power plants are operating and 52 of NPPs are under construction currently. Increasing use of radiation or radioisotopes in the field of industry, medical purpose and research such as non-destructive examination, computed tomography and x-ray, etc. constantly. With use of nuclear or radiation has incidence possibility for example the Fukushima NPP incident, the Goiania accident and the Chernobyl Nuclear accident. Also the risk of terror by radioactive material such as Radiological Dispersal Device(RDD) etc. In Korea, since the 'Law on protection of nuclear facilities and countermeasure for radioactive preparedness was enacted in 2003, the Korean institute of Radiological and Medical Sciences(KIRAMS) was established for the radiation emergency medical response in radiological disaster due to nuclear accident, radioactive terror and so on. Especially National Radiation Emergency Medical Center(NREMC) has the duty that is protect citizens from nuclear, radiological accidents or radiological terrors through the emergency medical preparedness. The NREMC was established by the 39-article law on physical protection of nuclear material and facilities and measures for radiological emergencies. Dose assessment or contamination survey should be performed which provide the radiological information for medical response. For this reason, the NREMC establish and re-organized dose assessment system based on the existing dose assessment system of the NREMC recently. The exposure dose could be measured by physical and biological method. With these two methods, we can have conservative dose assessment result. Therefore the NREMC established the exposure dose assessment laboratory which was re-organized laboratory space and introduced specialized equipment for dose assessment. This paper will report the establishment and operation of exposure dose assessment laboratory for radiological emergency response and discuss how to enhance

  4. [Professionalism in healthcare organizations--a unique model in the Assuta Medical Centers Network].

    Science.gov (United States)

    Shemer, Joshua; Abadi-Korek, Ifat

    2015-04-01

    "Medical professionalism signifies a set of values, behaviors, and relationships that underpin the trust the public has in doctors". Healthcare organizations and medical schools are expected to ensure that their employees and graduates possess these values, behaviors and skills. The importance of maintaining professionalization within the organization led the Assuta Medical Centers Network to establish a School of Professionalism in January 2014. All of the employees within Assuta are scheduled to participate in a training program focused on Professionalism in Healthcare. Training includes a unique, interactive teaching initiative facilitated by leaders chosen from among Assuta employees. Each training class comprises heterogeneous sets of employees from all divisions within the organization (medical, administrative, support employees etc.). Until February 2015, a total of 1,225 workers participated in this program. This novel intervention initiative is being evaluated and assessed in order to understand how the trainees perceive professionalism before and after the interventions; to observe changes in their attitudes, behaviors and skills following the training; and to assess short and long-term outcomes as this program progresses over the years. PMID:26065223

  5. Individual radiation load monitoring in the medical and technical staff of a regional dosimetric center

    International Nuclear Information System (INIS)

    The structure of radiological procedures over the last decade underwent substantial changes that influenced the working conditions of the medical and technical staff of photofluorographic departments. Radiodiagnostic equipment became more powerful. To find a solution to urgent problems of individual dosimetric monitoring there should be organized regional dosimetric centers using methods of thermoluminescent dosimetry. According to the data obtained, the levels of occupational irradiation of the medical and technical staff of photofluorotraphic departments, have a clear tendency to a decrease, and Din most cases do not exceed 0.1 of the MP. Mathematical approximation of the density of annual dose distribution has revealed the stabilization of their maximum and a gradual decrease that attests to the standardization of the working conditions. A collective dose for the staff-members of photofluorographic departments in 1979 was 290 man/rem

  6. Putting patients first: a novel patient-centered model for medical enterprise success.

    Science.gov (United States)

    Dhawan, Naveen

    2014-01-01

    This article introduces a new way of viewing patient-customers. It encourages a greater emphasis on patients' needs and the importance of considering dimensions of the patient experience to better serve them. It also draws from examples in the general business world as they can be applied to medical enterprises. The author introduces a model that directs all business activities toward the end consumer with an underlying guidance by patient needs. A business is advised to understand its customer, design a patient-directed vision, and focus on creating a unique customer experience. The article delineates key action items for physicians and administrators that will allow them to better meet their patient-customers' needs and develop loyalty. By practicing a patient-centered approach and following these guidelines, one may ensure greater success of the medical enterprise. PMID:25108980

  7. Chelation research at the Institute of Environmental Medicine, New York University Medical Center

    International Nuclear Information System (INIS)

    Chelation research should be continued in order to improve the effectiveness and safety of this mode of decontamination therapy. At the New York University Medical Center we are evaluating various treatment procedures using Na3(Zn-DTPA) and Na3(CA-DTPA) for removing americium, curium, and plutonium from the baboon, an animal whose blood and urine chemistries are similar to those of man. It has been determined, thus far, that the treatment schedules presently recommended for man may not be optimal

  8. Multidisciplinary Teams and Obesity: Role of the Modern Patient-Centered Medical Home.

    Science.gov (United States)

    Bernstein, Kevin M; Manning, Debra A; Julian, Regina M

    2016-03-01

    With the growing obesity epidemic, it is difficult for individual primary care providers to devote the time and effort necessary to achieve meaningful weight loss for significant numbers of patients. A variety of health care professionals provide value and evidence-based care that is effective in treating obesity and other preventable diseases. Multidisciplinary collaboration between primary care physicians and other trained health professionals within patient-centered medical homes offers an effective approach to sustainable behavioral treatment options for individuals who are obese or overweight. PMID:26896199

  9. Late diagnosis of HIV infection at two academic medical centers: 1994–2004

    OpenAIRE

    Jean-Jacques, M.; Walensky, R.P.; Aaronson, W.H.; Chang, Y.; Freedberg, K.A.

    2008-01-01

    Over the last decade, there has been increased attention to the role of earlier HIV testing in the United States. Our objective was to determine if this has translated into changes in the proportion of inpatients with advanced disease at the time of initial HIV diagnosis. We identified inpatients discharged with a new diagnosis of HIV infection or AIDS between 1994 and 2004 at two academic medical centers. We examined trends in initial CD4 count at diagnosis over three time periods: 1994–1996...

  10. Spreading a patient-centered medical home redesign: a case study.

    Science.gov (United States)

    Hsu, Clarissa; Coleman, Katie; Ross, Tyler R; Johnson, Eric; Fishman, Paul A; Larson, Eric B; Liss, David; Trescott, Claire; Reid, Robert J

    2012-01-01

    Health care leaders and policymakers are turning to the patient-centered medical home (PCMH) model to contain costs, improve the quality of care, and create a more positive primary care work environment. We describe how Group Health, an integrated delivery system, developed and implemented a PCMH intervention that included standardized structural and practice level changes. This intervention was spread to a diverse set of 26 primary care practices in 14 months using Lean Management principles. Group Health's experience provides valuable insights that can be used to improve the design and implementation of future PCMH models. PMID:22415283

  11. Conjoined twins: three cases in one tertiary medical center and literature review.

    Science.gov (United States)

    Kongling, L; Shi, X; Yao, Q

    2014-01-01

    Conjoined twins are so rare that most obstetricians will not be personally exposed to such cases during their professional lifetimes. The authors report three cases including one of dicephalic parapagus conjoined twins and two thoracopagus conjoined twins in the present tertiary medical center, and discuss the diagnosis and management details. They also review the incidence, embryological, diagnostic, obstetrical, and prognostic aspects of conjoined twins. Regular antenatal visits and serial ultrasound scanning are crucial for early diagnosis of conjoined twins, optimal obstetric management and perinatal preparation still remain challenging, and multidisciplinary cooperation is urgently needed. PMID:25864269

  12. A decade of offering a Healing Enhancement Program at an academic medical center.

    Science.gov (United States)

    Cutshall, Susanne M; Rodgers, Nancy J; Dion, Liza J; Dreyer, Nikol E; Thomley, Barbara S; Do, Alexander; Wood, Christina; Pronk, Susan C; Bauer, Brent A

    2015-11-01

    An increased focus has been given to improving the patient experience in health care. This focus has included placing value in a patient-centric, holistic approach to patient care. In the past decade, the Healing Enhancement Program was developed at 1 large medical center to address this focus through implementation of such integrative medicine services as massage, acupuncture, and music therapy to holistically address the pain, anxiety, and tension that hospitalized patients often experience. We describe the development and growth of this program over the past decade. PMID:26573445

  13. Maternal mortality in the American University of Beirut Medical Center (AUBMC) 1971-1982.

    Science.gov (United States)

    Mashini, I; Mroueh, A; Hadi, H

    1984-08-01

    Maternal deaths were reviewed at the American University of Beirut Medical Center (AUBMC) during an 11-year period, 1971-1982. There were 35,058 live births and 45 deaths making a maternal mortality rate of 128 per 100,000 live births. Hemorrhage, sepsis and toxemia were the main direct obstetric causes of death. The most important indirect causes were cerebrovascular accidents and heart disease. In this review, an analytic discussion of the direct and indirect causes of maternal death in Lebanon are presented and preventive measures are discussed. PMID:6152795

  14. Prevalence of the microbiologic flora in contact lens wearers at the Puerto Rico Medical Center.

    Science.gov (United States)

    Izquierdo, N; Díaz Mendoza, S; Townsend, W; Carro, J

    1991-03-01

    The prevalence of microbioogic flora was determined in a convenience sample of contact lens wearers at the Puerto Rico Medical Center, ophthalmology clinics obtaining cultures from the conjunctival fornices. Gram positive bacterial prevalence was 100% in the control group, as well as in rigid gas permeable lens wearers. In the soft contact lens group, gram positive bacterial prevalence was 94.7%. On the other hand prevalence of Gram negative bacteria is null in the soft contact lens wearer population, being only 2.5% in control group, and 45.5% for Rigid Gas Permeable wearers. These contact lens wearers were using different disinfection systems. PMID:1854385

  15. Proposed finding of no significant impact for the Sakakawea Medical Center coal-fired heating plant

    Energy Technology Data Exchange (ETDEWEB)

    1994-07-01

    The Department of Energy (the Department) has prepared an environmental assessment (Assessment) (DOE/EA-0949) to identify and evaluate the potential environmental impacts of a proposed action at the Sakakawea Medical Center (the Center) in Hazen, North Dakota. The proposed action would replace the existing No. 2 fuel oil-fired boilers supplemented by electric reheat with a new coal-fired hot water heating plant, using funds provided from a grant under the Institutional Conservation Program. Based on the analysis in DOE/EA-0949, the Department has determined that the proposed action is not a major federal action significantly affecting the quality of the human environment, within the meaning of the National Environmental Policy Act (NEPA) of 1969, as amended. Therefore, preparation of an Environmental Impact Statement is not required, and the Department is issuing this Finding of No Significant Impact (Finding).

  16. The Citizen Health System (CHS): a modular medical contact center providing quality telemedicine services.

    Science.gov (United States)

    Maglaveras, Nicos; Chouvarda, Ioanna; Koutkias, Vassilis G; Gogou, George; Lekka, Irini; Goulis, Dimitrios; Avramidis, Avram; Karvounis, Charalambos; Louridas, George; Balas, E Andrew

    2005-09-01

    In the context of the Citizen Health System (CHS) project, a modular Medical Contact Center (MCC) was developed, which can be used in the monitoring, treatment, and management of chronically ill patients at home, such as diabetic or congestive heart failure patients. The virtue of the CHS contact center is that, using any type of communication and telematics technology, it is able to provide timely and preventive prompting to the patients, thus, achieving better disease management. In this paper, we present the structure of the CHS system, describing the modules that enable its flexible and extensible architecture. It is shown, through specific examples, how quality of healthcare delivery can be increased by using such a system. PMID:16167689

  17. Celebrities in International Affairs

    DEFF Research Database (Denmark)

    Richey, Lisa Ann; Budabin, Alexandra Cosima

    2016-01-01

    that celebrities are acting as other elite actors in international affairs: investing considerable capital into processes that are highly political. It traces the emergence and practices of the elite politics of celebrities in North-South relations, an evolution made possible by recent changes in aid...... practices, media, and NGOs, then considers exemplary cases of Angelina Jolie in Burma, Ben Affleck in the Democractic Republic of Congo, and Madonna in Malawi. These celebrity practices as diplomats, experts, and humanitarians in international affairs illustrate the diverse and contradictory forms of...

  18. Hurley Medical Center report makes fund-raising look like fun. Hackensack, CMH use styles suited to their donors.

    Science.gov (United States)

    Botvin, J D

    2000-01-01

    Myriad elements go into making a great fund-raising publication. Judges singled out three reports with content and design clearly aimed at thanking supporters and stimulating the flow of contributions. They are: Hurley Medical Center, Grand Rapids, Mich., first place; Hackensack University Medical Center, Hackensack, N.J., second place; and Clinton Memorial Healthcare Regional Health System Foundation, Wilmington, Ohio, third place. PMID:11188143

  19. Development of an activity-based costing model for implementing capitation at Naval Medical Center San Diego

    OpenAIRE

    Jones, Ives C.

    1996-01-01

    The purpose of this research is to develop a financial model for Naval Medical Center San Diego for the calculation of an appropriate capitation rate under capitation budgeting. The current cost accounting system at Naval Medical Center San Diego and records of the Military Expense and Reporting System and the Uniform Management Report were analyzed to determine their usefulness in providing the information for and implementing capitation budgeting. An accounting model based on the principles...

  20. The Dispersal of High Risk Sexual Behaviors in Different Occupations of People Referred to Council Center of Shiraz Medical University

    OpenAIRE

    Pezhman Bagheri; Hossain Faramarzi

    2012-01-01

    Background: High risk sexual behaviors endanger young people and adolescents to HIV infection and other sexual diseases. The objective of this study was to assess the dispersal of high risk sexual behaviors in different in our referred patients to council center of Shiraz medical university.Materials and Method: This descriptive, cross sectional study was done between 2004-2009 years on referred people to council center of Shiraz medical university by census method.Results: Maximum prevalence...

  1. Hochschuldidaktische Qualifizierung in der Medizin: I. Bestandsaufnahme [Faculty Development Initiatives in Medical Education in German-Speaking Countries: I. State of Affairs

    Directory of Open Access Journals (Sweden)

    Lammerding-Köppel, Maria

    2006-11-01

    Full Text Available [english] In recent years, quality management of educational skills of medical teachers has gained increasing relevance, predominantly triggered by rising external pressure. Meanwhile, a consensus is reached that a professional training in pedagogical methods and didactic skills is essential for medical teachers in UGME and PGME. A series of three articles intends to provide not only a brief overview, but also detailed argumentative support concerning pedagogical aspects of medical education, the conceptual design and the implementation of faculty development programs in medical education. Additionally the important topic of how the effectiveness of staff development programs can be demonstrated will be addressed. The goal of the first article is to outline the present situation, conditions and recognition of teacher's training programs in German-speaking countries. At present, a variety of faculty development programs and activities have been designed and implemented. These activities include e.g. non-structured short courses and lectures, workshops and seminars of one to six days, as well as longitudinal programs up to national, two-year postgraduate programs to achieve the degree of a "Master of Medical Education" in Swiss and Germany. Compared to the international situation, in Germany is a lack of a mandatory basic program for all teaching staff members, which systematically provides a broad range of teaching and learning strategies for diverse settings. Only one regional faculty development program has been established so far in the federal state of Baden-Wurttemberg, which has been certified as "Medical Education Qualification, Step I and II" by the federal state ministry responsible for higher education. Two comparable programs are on the way in the federal states of Bavaria and North-Rhine-Westfalia. [german] Maßgeblich unter dem wachsenden externen Druck hat die didaktische Qualifizierung in den medizinischen Fakultäten an Bedeutung

  2. Learning from Primary Health Care Centers in Nepal: reflective writings on experiential learning of third year Nepalese medical students

    OpenAIRE

    Dhital, Rolina; Subedi, Madhusudan; Prasai, Neeti; Shrestha, Karun; Malla, Milan; Upadhyay, Shambhu

    2015-01-01

    Background Medical education can play important role in cultivating the willingness among the medical students to work in underprivileged areas after their graduation. Experiential learning through early exposure to primary health care centers could help students better understand the opportunities and challenges of such settings. However, the information on the real experiences and reflections of medical students on the rural primary health care settings from low-income countries like Nepal ...

  3. Information technology leadership in academic medical centers: a tale of four cultures.

    Science.gov (United States)

    Friedman, C P

    1999-07-01

    Persons and groups within academic medical centers bring consistent and predictable viewpoints to planning and decision making. The varied professional and academic cultures of these individuals appear to account primarily for the diversity of their viewpoints. Understanding these professional cultures can help leaders achieve some predictability in the complex environments for which they are responsible. Leaders in information technology in particular, in order to be successful, must become part-time anthropologists, immersing themselves in the varied workplaces of their constituents to understand the work they do and the cultures that have grown up around this work. Only in this way will they be able to manage the challenges that arise continuously as the technology and the needs it can address change over time. In this article, the author briefly describes the concept of culture, portrays four specific professional cultures that typically coexist in academic medical centers, and argues that understanding these cultures is absolutely critical to effective management and use of information resources. PMID:10429588

  4. A Journey through Meaningful Use at a Large Academic Medical Center: Lessons of Leadership, Administration, and Technical Implementation

    OpenAIRE

    Unger, Melissa D.; Aldrich, Alison M; Hefner, Jennifer L.; Rizer, Milisa K.

    2014-01-01

    Successfully reporting meaningful use of electronic health records to the Centers for Medicare and Medicaid Services can be a challenging process, particularly for healthcare organizations with large numbers of eligible professionals. This case report describes a successful meaningful use attestation process undertaken at a major academic medical center. It identifies best practices in the areas of leadership, administration, communication, ongoing support, and technological implementation.

  5. New faculty member at Virginia Tech's Marion duPont Scott Equine Medical Center specializes in equine surgery, reproduction, dentistry

    OpenAIRE

    Lee, Kate

    2010-01-01

    Dr. James A. Brown has joined Virginia Tech's Marion duPont Scott Equine Medical Center as a clinical assistant professor of equine surgery. He will perform both elective and emergency surgery, and he will instruct residents and veterinary students at the center.

  6. Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China

    Directory of Open Access Journals (Sweden)

    Yunbo Qing

    2015-07-01

    Full Text Available Purpose: To produce competent undergraduate-level medical doctors for rural township health centers (THCs, the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China. Methods: An internet-based self-administered questionnaire survey was conducted with medical students in Guangxi province. Multinomial logistic regression was used to identify factors related to the attitudes toward work in a rural township health center. Results: Among 4,669 medical students, 1,523 (33% had a positive attitude and 2,574 (55% had a neutral attitude toward working in THCs. Demographic characteristics, personal job concerns, and knowledge of THCs were associated with the choice of a career in THCs. The factors related to a positive attitude included the following: three-year program, a rural-oriented medical program, being male, an expectation of working in a county or township, a focus on medical career development, some perceived difficulty of getting a job, having family support, sufficient knowledge of THCs, optimism toward THC development, seeking lower working pressure, and a lower expected monthly salary. Conclusion: Male students in a three-year program or a rural-oriented tuition-waived medical education program were more likely to work in THCs. Selecting medical students through interviews to identify their family support and intentions to work in THCs would increase recruitment and retention. Establishing favorable policies and financial incentives to improve living conditions and the social status of rural physicians is necessary.

  7. A Three-Year Experience of Medical Thoracoscopy at A Tertiary Care Center of Himalayan Region

    Directory of Open Access Journals (Sweden)

    Rakhee Sodhi

    2016-03-01

    Full Text Available Introduction: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases. Despite its proven role in diagnostic and therapeutic purposes, it is infrequently used, which could be because of cost of equipment and lack of training. We analyzed our initial 3 years record of thoracoscopy at Himalayan Institute of Medical Sciences, a tertiary care center in Himalayan region of north India. Materials and Methods: This cross-sectional study was to analyze our experience of medical thoracoscopy which was started in Jan 2011 at our center. All patients who underwent thoracoscopy during the period between Jan 2011 to Dec 2013 were included in the study. Thoracoscopy was performed for diagnosis of undiagnosed pleural effusions. Clinical, radiological, cytological & histopathological data of the patients were collected prospectively and analysed. Results: The diagnostic yield for a pleuroscopic pleural biopsy in our study was 87.23% (41/47. Malignancy was diagnosed histopathologically in 70.2% (33/47 patients (both primary & metastatic pleural carcinoma and tuberculosis in 10.6% (5/47. There was no mortality related to procedure. Only three patients had minor complications like subcutaneous emphysema which was mild and resolved by second post-procedure day. Pain at intercostal drain site was observed in some patients. Conclusion: Thoracoscopy is an easy outpatient procedure and an excellent diagnostic tool for pleural effusion of uncertain etiology. It has low complication rate even in settings where the procedure is just started. It should be included in the armamentarium of tools for management of pleural effusion.

  8. Epidemiological, Clinical and Paraclinical Study of Hydatid Cysts in Three Educational Medical Centers in 10 Years

    Directory of Open Access Journals (Sweden)

    Simindokht Shoaee

    2016-01-01

    Full Text Available Background: Echinococcosis or hydatidosis, caused by the larval stage of Echinococcus granulosus (E. granulosus, is an important public health problem in many areas of the world  and  Iran is a country of endemic situation for hydatidosis In the present study, we evaluated epidemiological, complications and clinical characteristics of hydatidosis at three University Medical Centers in Tehran over a 10-year period.Materials and Methods: This is a descriptive cross-sectional study performed in patients with hydatid cysts. Information about age, gender, number of cysts, organ involvement, morbidity and mortality and relapse were collected from medical records of hydatid patients. Paraclinic information such as CT Scan, MRI, ultrasound, complete blood count, pathological diagnosis and complication of disease were collected.Results: Overall, 81 patients, 35 (43.2% male and 46 (56.8% female, who were diagnosed as having hydatid cyst by clinical and radiological findings, with pathologic documentation were studied in three university medical center registries over a 10-year period (2003- 2012 in Tehran. Fourteen patients (17% of cases had complications resulting from this disease. Patients' age ranged from 5 to 86 years, and the peak prevalence of the disease was between 20 and 40 (34% of cases.Conclusion: Iran  is a country of endemic situation for hydatidosis. Prevalence rate of hydatidosis in Iran was reported to be 0.61-2 in 100000 populations. The highest  rate of infection and complications were in patients of 20-40 years age. Clinical examination revealed that abdominal pain was the most common complaint and was present in 51.7% of the cases. Other most common complain were cough, abdominal mass, dyspnea, icterus, chest pain, dyspepsia, back pain and seizure; and it was result of occupying effect of cysts in organs. This is similar with previous studies in Iran

  9. ANALISIS TINGKAT KEPUASAN PELANGGAN POLI UMUM DI MAJAPAHIT MEDICAL CENTER (MMC LAMONGAN

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    Gurendro Putro

    2012-09-01

    Full Text Available Costumer satisfaction is one of the costumer loyaiity factors. After seeing health-service-data in MMC Lamongan shows that general polyclinic has tendency for decreasing visitors about -165 from 2003 until 2006. From those data, need to do research about satisfaction of health service in general polyclinic MMC Lamongan. Design research has cross sectional observation characteristic by use satisfaction theory from Dabholkar that's composed offive points, there are physical aspect, reliability, personal interaction, problem solving, and policy. The research's result shows that costumer satisfaction of medical service has strong value in physical aspect and problem solving. In the other hand, costumer satisfaction in supporting-and-non-supporting medical service has strong value in personal interaction. All customers have loyaiity in MMC Lamongan's service. The conclusion shows customer satisfaction is one of the important aspect for increase health service quality, so it's expected costumer always use meritorious service given by MMC Lamongan.   Keywords : satisfaction, general polyclinic, majapahit medical center

  10. How psoriasis patients perceive, obtain, and use biologic agents: Survey from an academic medical center.

    Science.gov (United States)

    Kamangar, Faranak; Isip, Leah; Bhutani, Tina; Dennis, Madison; Heller, Misha M; Lee, Eric S; Nie, Hong; Liao, Wilson

    2013-02-01

    The availability of new biologic agents for the treatment of psoriasis provides hope for improved quality of life outcomes. However, the way patients come to use biologics, the potential barriers they encounter, and their attitudes towards using these medications are still not well studied. Here, we conducted a survey of 106 psoriasis patients at an academic medical center to discern patient attitudes towards biologics. We found that most patients learn of biologics through their physician and perform follow-up research using the Internet. Most patients did not find it difficult to make the decision to start a biologic. Difficulty in obtaining biologics was associated with age less than 55 (p = 0.01), lower income level (p = 0.007), and lack of insurance (p = 0.04). Patients were found to have high satisfaction and compliance rates on biologics. Of patients who missed a dose of their biologic, this was mainly due to logistical reasons such as not having the medication or forgetting to take it, rather than being depressed or overwhelmed. Patients with lower income levels had increased cut backs in personal expenses due to co-payments (p = 0.001). Among respondents, the mean annual out-of-pocket expense for a biologic was $557.12 per year, with a range of $0-7000. PMID:22007699

  11. Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas.

    Science.gov (United States)

    Barclift, Songhai C; Brown, Elizabeth J; Finnegan, Sean C; Cohen, Elena R; Klink, Kathleen

    2016-05-01

    Background The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained. Objective The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program. Methods Geographic locations of the training sites were collected and characterized as Health Professional Shortage Area, Medically Underserved Area, Population, or rural areas, and were compared with the distribution of Centers for Medicare and Medicaid Services (CMS)-funded training positions. Results More than half of the teaching health centers (57%) are located in states that are in the 4 quintiles with the lowest CMS-funded resident-to-population ratio. Of the 109 training sites identified, more than 70% are located in federally designated high-need areas. Conclusions The THCGME program is a model that funds residency training in community-based ambulatory settings. Statute suggests, but does not explicitly require, that training take place in underserved settings. Because the majority of the 109 clinical training sites of the 60 funded programs in 2014-2015 are located in federally designated underserved locations, the THCGME program deserves further study as a model to improve primary care distribution into high-need communities. PMID:27168895

  12. Human-centered design of the human-system interfaces of medical equipment: thyroid uptake system

    International Nuclear Information System (INIS)

    Technology plays an important role in modern medical centers, making healthcare increasingly complex, relying on complex technical equipment. This technical complexity is particularly noticeable in the nuclear medicine. Poorly design human-system interfaces can increase the risks for human error. The human-centered approach emphasizes the development of the equipment with a deep understanding of the users activities, current work practices, needs and abilities of the users. An important concept of human-centered design is that the ease-of-use of the equipment can be ensured only if users are actively incorporated in all phases of the life cycle of design process. Representative groups of users are exposed to the equipment at various stages in development, in a variety of testing, evaluation and interviewing situations. The users feedback obtained is then used to refine the design, with the result serving as input to the next interaction of design process. The limits of the approach are that the users cannot address any particular future needs without prior experience or knowledge about the equipment operation. The aim of this paper is to present a methodological framework that contributes to the design of the human-system interfaces, through an approach related to the users and their activities. A case study is described in which the methodological framework is being applied in development of new human-system interfaces of the thyroid uptake system. (author)

  13. Human-centered design of the human-system interfaces of medical equipment: thyroid uptake system

    Energy Technology Data Exchange (ETDEWEB)

    Monteiro, Jonathan K.R.; Farias, Marcos S.; Santos, Isaac J.A. Luquetti, E-mail: luquetti@ien.gov.br [Instituto de Engenharia Nuclear (IEN/CNEN-RJ), Rio de Janeiro, RJ (Brazil); Monteiro, Beany G. [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil). Dept. de Desenho Industrial

    2013-07-01

    Technology plays an important role in modern medical centers, making healthcare increasingly complex, relying on complex technical equipment. This technical complexity is particularly noticeable in the nuclear medicine. Poorly design human-system interfaces can increase the risks for human error. The human-centered approach emphasizes the development of the equipment with a deep understanding of the users activities, current work practices, needs and abilities of the users. An important concept of human-centered design is that the ease-of-use of the equipment can be ensured only if users are actively incorporated in all phases of the life cycle of design process. Representative groups of users are exposed to the equipment at various stages in development, in a variety of testing, evaluation and interviewing situations. The users feedback obtained is then used to refine the design, with the result serving as input to the next interaction of design process. The limits of the approach are that the users cannot address any particular future needs without prior experience or knowledge about the equipment operation. The aim of this paper is to present a methodological framework that contributes to the design of the human-system interfaces, through an approach related to the users and their activities. A case study is described in which the methodological framework is being applied in development of new human-system interfaces of the thyroid uptake system. (author)

  14. House Committee on Veterans' Affairs

    Science.gov (United States)

    ... form Search Sign up to receive email updates House Committee on Veterans' Affairs About Chair Membership Hearing ... Investigations (O&I) Meet the Committee The 114th House Committee on Veterans’ Affairs Meet the Chairman The ...

  15. The role of the pharmacist in patient-centered medical home practices: current perspectives

    Directory of Open Access Journals (Sweden)

    Lewis NJW

    2014-06-01

    Full Text Available Nancy JW Lewis,1 Leslie A Shimp,2 Stuart Rockafellow,2 Jeffrey M Tingen,2 Hae Mi Choe,3 Marie A Marcelino21Private consultancy practice, Rochester Hills, MI, USA; 2Clinical, Social and Administrative Department, University of Michigan College of Pharmacy, Ann Arbor, MI, USA; 3Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USAAbstract: Patient-centered medical homes (PCMHs are the centerpiece of primary care transformation in the US. They are intended to improve care coordination and communication, enhance health care quality and patient experiences, and lower health care costs by linking patients to a physician-led interdisciplinary health care team. PCMHs are widely supported by health care associations, payers, and employers. Health care accreditation organizations have created performance measures that promote the adoption of PCMH core attributes. Public and private payers are increasingly providing incentives and bonuses related to performance measure status. Evidence-based prescription, medication adherence, medication use coordination, and systems to support medication safety are all necessary components of PCMHs. Pharmacists have unique knowledge and skills that can complement the care provided by other PCMH team members. Their experience in drug therapy assessments, medication therapy management, and population health has documented benefits, both in terms of patient health outcomes and health care costs. Through collaborative care, pharmacists can assist physicians and other prescribers in medication management and thus improve prescriber productivity and patient access to care. Pharmacists are engaged in PCMHs through both employment and contractual arrangements. While some pharmacists serve a unique PCMH, others work within practice networks that serve practices within a geographical area. Financial support for pharmacist-provided services includes university funding, external grant funding

  16. The Critical Role of Clerks in the Patient-Centered Medical Home.

    Science.gov (United States)

    Solimeo, Samantha L; Stewart, Greg L; Rosenthal, Gary E

    2016-07-01

    Research evaluating the effectiveness, function, and implementation of patient-centered medical homes (PCMHs) has found major socioprofessional transformations and contributions of primary care physicians and, to a lesser degree, nurses. Our longitudinal ethnographic research with teams implementing PCMH in Veterans Health Administration (VHA) primary care identifies the important but largely underutilized contributions of clerks to PCMH outcomes. Although the relationship of high-performing clerical staff to patient satisfaction is widely acknowledged, PCMH can be further enhanced by enabling clerks to use administrative tasks as conduits for investing in long-term personalized relationships with patients that foster trust in the PCMH and the broader health care organization. Such relationships are engendered through the care-coordination activities clerks perform, which may be bolstered by organizational investment in clerks as skilled health care team members. PMID:27401428

  17. Development of scanning irradiation in Gunma University Heavy Ion Medical Center

    International Nuclear Information System (INIS)

    Spot scanning irradiation system of carbon ion beam has been developed in Gunma University Heavy Ion Medical Center. During 2013, the beam size and position was stabilized with the use of a pattern-excited steering magnet and optimization of the optic parameters. After these improvement, 3-dimensional spherical field uniform irradiation was carried out based on the measurement of pencil beam profile and depth-dose distribution. The irradiated dose distribution agreed with the calculation within 3%. An experiment of rotating energy absorber has been carried out to suppress the range variation in the extraction period. In order to improve the dose linearity and reproducibility in the low dose region less than 1Gy, the response of I/V converter circuit was improved from 3kHz to 50kHz. After these improvement, the uniform box irradiation was utilized routinely for the animal (mice) experiment from April 2014. (author)

  18. The Patient-Centered Medical Home: Preparation of the Workforce, More Questions than Answers.

    Science.gov (United States)

    Reynolds, P Preston; Klink, Kathleen; Gilman, Stuart; Green, Larry A; Phillips, Russell S; Shipman, Scott; Keahey, David; Rugen, Kathryn; Davis, Molly

    2015-07-01

    As American medicine continues to undergo significant transformation, the patient-centered medical home (PCMH) is emerging as an interprofessional primary care model designed to deliver the right care for patients, by the right professional, at the right time, in the right setting, for the right cost. A review of local, state, regional and national initiatives to train professionals in delivering care within the PCMH model reveals some successes, but substantial challenges. Workforce policy recommendations designed to improve PCMH effectiveness and efficiency include 1) adoption of an expanded definition of primary care, 2) fundamental redesign of health professions education, 3) payment reform, 4) responsiveness to local needs assessments, and 5) systems improvement to emphasize quality, population health, and health disparities. PMID:25707941

  19. Implementation of Epic Beaker Clinical Pathology at an academic medical center

    Directory of Open Access Journals (Sweden)

    Matthew D Krasowski

    2016-01-01

    Full Text Available Background: Epic Beaker Clinical Pathology (CP is a relatively new laboratory information system (LIS operating within the Epic suite of software applications. To date, there have not been any publications describing implementation of Beaker CP. In this report, we describe our experience in implementing Beaker CP version 2012 at a state academic medical center with a go-live of August 2014 and a subsequent upgrade to Beaker version 2014 in May 2015. The implementation of Beaker CP was concurrent with implementations of Epic modules for revenue cycle, patient scheduling, and patient registration. Methods: Our analysis covers approximately 3 years of time (2 years preimplementation of Beaker CP and roughly 1 year after using data summarized from pre- and post-implementation meetings, debriefings, and the closure document for the project. Results: We summarize positive aspects of, and key factors leading to, a successful implementation of Beaker CP. The early inclusion of subject matter experts in the design and validation of Beaker workflows was very helpful. Since Beaker CP does not directly interface with laboratory instrumentation, the clinical laboratories spent extensive preimplementation effort establishing middleware interfaces. Immediate challenges postimplementation included bar code scanning and nursing adaptation to Beaker CP specimen collection. The most substantial changes in laboratory workflow occurred with microbiology orders. This posed a considerable challenge with microbiology orders from the operating rooms and required intensive interventions in the weeks following go-live. In postimplementation surveys, pathology staff, informatics staff, and end-users expressed satisfaction with the new LIS. Conclusions: Beaker CP can serve as an effective LIS for an academic medical center. Careful planning and preparation aid the transition to this LIS.

  20. Nurses and Psychologists Advancing the Patient-Centered Medical Home Model.

    Science.gov (United States)

    Corso, Kent A; Gage, Donna

    2016-01-01

    As America experiences the largest health care revolution of the past 50 years, clinicians and administrators are refocusing their attention on the goals of the Quadruple Aim. Motivation and capabilities among stakeholders vary as practical tools and an adequate workforce remain elusive. At the same time, the patient-centered medical home (PCMH) model is spreading rapidly but demonstrating variable results. Positive PCMH outcomes seem to reflect high-quality teamwork. A primary care physician shortage is looming, and increasing numbers of health professionals are being pushed into the PCMH, mandated to provide "integrated" care. Even now, the majority of our Graduate Medical Education programs do not train clinicians in team-based workflow models and interaction skills. Consequently, PCMH teams will only optimize and realize the model's true potential if they learn to coordinate, communicate, and collaborate effectively. This means all PCMH staff members achieve solid teamwork skills and work at the top of their license. The authors discuss resources for improving coordination, communication, and collaboration among members of PCMH teams, and strategies for including other professionals. PMID:27259123

  1. Factors related to complications among adult patients with intellectual disabilities hospitalized at an academic medical center.

    Science.gov (United States)

    Ailey, Sarah H; Johnson, Tricia J; Fogg, Louis; Friese, Tanya R

    2015-04-01

    People with intellectual disabilities (ID) represent a small but important group of hospitalized patients who have higher rates of complications than do patients without ID hospitalized for the same reasons. Complications are potentially avoidable conditions, such as healthcare-acquired infections, healthcare-acquired skin breakdown, falls, and medication errors and reactions. Addressing factors related to complications can focus efforts to improve hospital care. The purpose of this exploratory study was to analyze data from reviews of academic medical center charts (N  =  70) about complications and to examine patient and hospitalization characteristics in relation to complications among adult patients (age ≥ 18 years) with ID hospitalized for nonpsychiatric reasons. Adults with ID tended to be twice as likely to have complications (χ2  =  2.893, df  =  1, p  =  .09) if they had a surgical procedure and were nearly four times as likely to have complications (χ2  =  6.836, df  =  1, p  =  .009) if they had multiple chronic health conditions (three of the following: history of cerebral palsy, autism spectrum symptoms, aggressive behavior, respiratory disorder, and admission through the emergency department). Findings suggest preliminary criteria for assessing risk for complications among hospitalized people with ID and the need for attention to their specific needs when hospitalized. PMID:25860449

  2. Training Residents to Work in a Patient-Centered Medical Home: What Are the Outcomes?

    Science.gov (United States)

    Hasley, Peggy B; Simak, Deborah; Cohen, Elan; Buranosky, Raquel

    2016-05-01

    Background The patient-centered medical home (PCMH) provides a setting to enhance resident training in systems-based practice. Few studies have addressed the impact of PCMHs on resident knowledge and confidence. Objective The goal of this study was to evaluate resident knowledge, confidence, behavior, and patient outcomes in a PCMH. Methods Our curriculum emphasized patient panel report card interpretation, a telephone medicine curriculum, and interdisciplinary team-based care of chronic medical conditions. We measured resident satisfaction, knowledge, and confidence. Patient outcomes included hemoglobin A1c (HbA1c) and blood pressures. Prescores and postscores were compared using paired t tests for continuous measures and McNemar's test for binary measures. Results A total of 154 residents were eligible for the curriculum. All residents participated in the curriculum, though not all residents completed the evaluation. Completion rates for paired pre-post knowledge and confidence surveys were 38% and 37%, respectively. Nearly 80% (69 of 87) of residents indicated that the curriculum was above average or outstanding. Our evaluation revealed very small immediate improvements in knowledge and confidence. No significant improvement in patients' HbA1cs or blood pressures occurred after the curriculum. Conclusions Explicit training to work in a PCMH was feasible and resulted in high levels of resident satisfaction and immediate small improvements in knowledge and confidence. PMID:27168892

  3. Virtual microscopy in medical research: Open European Nephrology Science Center (OpEN.SC)

    Science.gov (United States)

    Schrader, Thomas; Beil, Michael; Schmidt, Danilo; Dietel, Manfred; Lindemann, Gabriela

    2007-03-01

    The amount and heterogeneity of data in biomedical research, notably in transnational research, requires new methods for the collection, presentation and analysis of information. Important data from laboratory experiments as well as patient trials are available as images. Thus, the integration and processing of image data represent a crucial component of information systems in biomedical research. The Charité Medical School in Berlin has established a new information service center for kidney diseases and transplantation (Open European Nephrology Science Centre - OpEN.SC) together with the German Research Agency (DFG). The aims of this project are (i) to improve the availability of raw data, (ii) to establish an infrastructure for clinical trials, (iii) to monitor the occurrence of rare disease patterns and (iv) to establish a quality assurance system. Major diagnostic procedures in medicine are based on the processing and analysis of image data. In diagnostic pathology, the availability of automated slide scanners provide the opportunity to digitize entire microscopic slides. The processing, presentation and analysis of these image data are called virtual microscopy. The integration of this new technology into the OpEN.SC system and the link to other heterogeneous data of individual patients represent a major technological challenge. Thus, new ways in communication between clinical and scientific partners have to be established and will be promoted by the project. The technological basis of the repository are web services for a scalable and adaptable system. HL7 and DICOM are considered the main medical standards of communication.

  4. Radiation safety knowledge of medical center radiology technologists in southern Taiwan

    International Nuclear Information System (INIS)

    People who live in Taiwan are getting more and more afraid of radiation. Sometimes the phobia results from distorted knowledge. Radiology technologists, in one hand, are more well-educated in radiation and, in the other hand, have more chance to expose to radiation when they are operating radiation producing medical instruments in their daily life. So we are interested in whether they have enough knowledge to protect themselves. We pick up the radiology technology board examination to make the questionnaire for this study. The population is the radiology technologists who work at department of diagnostic radiology, of radiation therapy and nuclear medicine in medical centers. Statistics is then used to see the relationship between knowledge and the factors including gender, age and career period. Based on statistics, we find out that there is significant correlation between the knowledge with age or education level. Elder or lower education level ones has worse knowledge. Continued education may be highly recommended for radiology technologists to avoid occupational radiation injury. (author)

  5. Evaluation of tumor registry validity in Samsung medical center radiation oncology department

    International Nuclear Information System (INIS)

    A tumor registry system for the patients treated by radiotherapy at Samsung Medical Center since the opening of a hospital at 1994 was employed. In this study, the tumor registry system was introduced and the validity of the tumor registration was analyzed. The tumor registry system was composed of three parts: patient demographic, diagnostic, and treatment information. All data were input in a screen using a mouse only. Among the 10,000 registered cases in the tumor registry system until Aug, 2002, 199 were randomly selected and their registration data were compared with the patients' medical records. Total input errors were detected in 15 cases (7.5%). There were 8 error items in the part relating to diagnostic information: tumor site 3, pathology 2, AJCC staging 2 and performance status 1. In the part relating to treatment information there were 9 mistaken items: combination treatment 4, the date of initial treatment 3 and radiation completeness 2. According to the assignment doctor, the error ratio was consequently variable. The doctors who did no double-checks showed higher errors than those that did (15.6%: 3.7%). Our tumor registry had errors within 2% for each item. Although the overall data quality was high, further improvement might be achieved through promoting sincerity, continuing training periodic validity tests and keeping double-checks. Also, some items associated with the hospital information system will be input automatically in the next step

  6. The proton therapy nozzles at Samsung Medical Center: A Monte Carlo simulation study using TOPAS

    Science.gov (United States)

    Chung, Kwangzoo; Kim, Jinsung; Kim, Dae-Hyun; Ahn, Sunghwan; Han, Youngyih

    2015-07-01

    To expedite the commissioning process of the proton therapy system at Samsung Medical Center (SMC), we have developed a Monte Carlo simulation model of the proton therapy nozzles by using TOol for PArticle Simulation (TOPAS). At SMC proton therapy center, we have two gantry rooms with different types of nozzles: a multi-purpose nozzle and a dedicated scanning nozzle. Each nozzle has been modeled in detail following the geometry information provided by the manufacturer, Sumitomo Heavy Industries, Ltd. For this purpose, the novel features of TOPAS, such as the time feature or the ridge filter class, have been used, and the appropriate physics models for proton nozzle simulation have been defined. Dosimetric properties, like percent depth dose curve, spreadout Bragg peak (SOBP), and beam spot size, have been simulated and verified against measured beam data. Beyond the Monte Carlo nozzle modeling, we have developed an interface between TOPAS and the treatment planning system (TPS), RayStation. An exported radiotherapy (RT) plan from the TPS is interpreted by using an interface and is then translated into the TOPAS input text. The developed Monte Carlo nozzle model can be used to estimate the non-beam performance, such as the neutron background, of the nozzles. Furthermore, the nozzle model can be used to study the mechanical optimization of the design of the nozzle.

  7. Cerebral angioplasty practice at major medical centers in the United States

    International Nuclear Information System (INIS)

    Concern has been expressed recently regarding the proliferation of angioplasty and/or stenting of cerebral vessels. However, little is known about the volume of angioplasties being performed or the number of experienced interventionalists. A questionnaire was mailed to directors of accredited radiology residency programs in the United States, to define the level of expertise available at teaching hospitals in terms of angioplasty and/or stenting. Of 200 programs surveyed, 111 responded (56 %). Of 111 program directors 47 (42 %) indicated that cerebral angioplasty was being performed at their center. The greatest experience is currently for angioplasty of post-subarachnoid hemorrhage vasospasm (mean 16 procedures performed) and the least experience for dilation of basilar artery atherosclerosis (mean five procedures performed). The reported stroke and/or death rate in centers performing angioplasty of the extracranial carotid system is 1.5 %. Comparisons with other medical specialties (e. g., cardiologists, neurologists, neurosurgeons) are necessary to determine the full scope of extracranial neurovascular procedures being performed and the corresponding complication rates. (orig.)

  8. Disruptive innovation in academic medical centers: balancing accountable and academic care.

    Science.gov (United States)

    Stein, Daniel; Chen, Christopher; Ackerly, D Clay

    2015-05-01

    Numerous academic medicine leaders have argued that academic referral centers must prepare for the growing importance of accountability-driven payment models by adopting population health initiatives. Although this shift has merit, execution of this strategy will prove significantly more problematic than most observers have appreciated. The authors describe how successful implementation of an accountable care health strategy within a referral academic medical center (AMC) requires navigating a critical tension: The academic referral business model, driven by tertiary-level care, is fundamentally in conflict with population health. Referral AMCs that create successful value-driven population health systems within their organizations will in effect disrupt their own existing tertiary care businesses. The theory of disruptive innovation suggests that balancing the push and pull of academic and accountable care within a single organization is achievable. However, it will require significant shifts in resource allocation and changes in management structure to enable AMCs to make the inherent difficult choices and trade-offs that will ensue. On the basis of the theories of disruptive innovation, the authors present recommendations for how academic health systems can successfully navigate these issues as they transition toward accountability-driven care. PMID:25517702

  9. The Proton Therapy Nozzles at Samsung Medical Center: A Monte Carlo Simulation Study using TOPAS

    CERN Document Server

    Chung, Kwangzoo; Kim, Dae-Hyun; Ahn, Sunghwan; Han, Youngyih

    2015-01-01

    To expedite the commissioning process of the proton therapy system at Samsung Medical Center (SMC), we have developed a Monte Carlo simulation model of the proton therapy nozzles using TOPAS. At SMC proton therapy center, we have two gantry rooms with different types of nozzles; a multi-purpose nozzle and a dedicated scanning nozzle. Each nozzle has been modeled in detail following the geometry information provided by the manufacturer, Sumitomo Heavy Industries, Ltd. For this purpose, novel features of TOPAS, such as the time feature or the ridge filter class, have been used. And the appropriate physics models for proton nozzle simulation were defined. Dosimetric properties, like percent depth dose curve, spread-out Bragg peak (SOBP), beam spot size, have been simulated and verified against measured beam data. Beyond the Monte Carlo nozzle modeling, we have developed an interface between TOPAS and the treatment planning system (TPS), RayStation. An exported RT plan data from the TPS has been interpreted by th...

  10. Structure and content of radiology reports, a quantitative and qualitative study in eight medical centers

    Energy Technology Data Exchange (ETDEWEB)

    Bosmans, Jan M.L. [Department of Radiology, Antwerp University Hospital (Belgium); Faculty of Medicine, Antwerp University (Belgium)], E-mail: jan.bosmans@uza.be; Weyler, Joost J. [Department of Epidemiology and Social Medicine, Antwerp University (Belgium); Parizel, Paul M. [Department of Radiology, Antwerp University Hospital (Belgium); Faculty of Medicine, Antwerp University (Belgium)

    2009-11-15

    Rationale and objectives: In order to determine how the quality of the radiology report can be improved, the variation in content, form and length of the report needs to be examined. The purpose of the present study was to investigate and compare the length and structure of radiology reports (reports of abdominal CT examinations) in eight hospitals in the Netherlands and Flanders, the Dutch speaking part of Belgium. Materials and methods: Eight hundred reports - 100 from each collaborating center - were collected. After exclusion of the reports that did not fulfill the criteria for a standard CT examination of the abdomen, 525 were retained for further study. The structure of each report was analyzed and the constituting parts (technical information, description of the findings, conclusion, advice, remark, note) were determined. The character and word count of the report and its constituting parts were measured and the results were grouped according to the country (Netherlands vs. Belgium/Flanders), the qualification of the radiologist (staff members vs. residents.) and the nature of the hospital (university medical centers vs. community hospitals). Results: Statistically significant differences were found between the Netherlands and Flanders, and between staff members and residents. The authors also found a wide variety in the lay-out and the overall content of the radiology report. Conclusion: While most of the differences we found are probably rooted in local tradition, a standard model for the radiology report in centers sharing the same language may be a means to avoid interpretation mistakes by referring physicians, and to promote better care.

  11. The Honolulu Liver Disease Cluster at the Medical Center: Its Mysteries and Challenges

    Directory of Open Access Journals (Sweden)

    Rolf Teschke

    2016-03-01

    Full Text Available In 2013, physicians at the Honolulu Queen’s Medical Center (QMC noticed that seven liver disease patients reported the use of OxyELITE Pro (OEP, a widely consumed dietary supplement (DS. Assuming a temporal association between OEP use and disease, they argued that OEP was the cause of this mysterious cluster. Subsequent reexamination, however, has revealed that this QMC cohort is heterogeneous and not a cluster with a single agent causing a single disease. It is heterogeneous because patients used multiple DS’s and drugs and because patients appeared to have suffered from multiple liver diseases: liver cirrhosis, liver failure by acetaminophen, hepatotoxicity by non-steroidal antiinflammatory drugs (NSAIDs, resolving acute viral hepatitis by hepatitis B virus (HBV, herpes simplex virus (HSV, and varicella zoster virus (VZV, and suspected hepatitis E virus (HEV. Failing to exclude these confounders and to consider more viable diagnoses, the QMC physicians may have missed specific treatment options in some of their patients. The QMC physicians unjustifiably upgraded their Roussel Uclaf Causality Assessment Method (RUCAM causality scores so that all patients would appear to be “probable” for OEP. However, subsequent RUCAM reassessments by our group demonstrated a lack of causality for OEP in the evaluated QMC cases. The QMC’s questionable approaches explain the extraordinary accumulation of suspected OEP cases at the QMC in Hawaii as single place, whereas similar cohorts were not published by any larger US liver center, substantiating that the problem is with the QMC. In this review article, we present and discuss new case data and critically evaluate upcoming developments of problematic regulatory assessments by the US Centers for Disease Control and Prevention (CDC, the Hawaii Department of Health (HDOH, and the Food and Drug Administration (FDA, as based on invalid QMC conclusions, clarifying now also basic facts and facilitating

  12. The Honolulu Liver Disease Cluster at the Medical Center: Its Mysteries and Challenges

    Science.gov (United States)

    Teschke, Rolf; Eickhoff, Axel

    2016-01-01

    In 2013, physicians at the Honolulu Queen’s Medical Center (QMC) noticed that seven liver disease patients reported the use of OxyELITE Pro (OEP), a widely consumed dietary supplement (DS). Assuming a temporal association between OEP use and disease, they argued that OEP was the cause of this mysterious cluster. Subsequent reexamination, however, has revealed that this QMC cohort is heterogeneous and not a cluster with a single agent causing a single disease. It is heterogeneous because patients used multiple DS’s and drugs and because patients appeared to have suffered from multiple liver diseases: liver cirrhosis, liver failure by acetaminophen, hepatotoxicity by non-steroidal antiinflammatory drugs (NSAIDs), resolving acute viral hepatitis by hepatitis B virus (HBV), herpes simplex virus (HSV), and varicella zoster virus (VZV), and suspected hepatitis E virus (HEV). Failing to exclude these confounders and to consider more viable diagnoses, the QMC physicians may have missed specific treatment options in some of their patients. The QMC physicians unjustifiably upgraded their Roussel Uclaf Causality Assessment Method (RUCAM) causality scores so that all patients would appear to be “probable” for OEP. However, subsequent RUCAM reassessments by our group demonstrated a lack of causality for OEP in the evaluated QMC cases. The QMC’s questionable approaches explain the extraordinary accumulation of suspected OEP cases at the QMC in Hawaii as single place, whereas similar cohorts were not published by any larger US liver center, substantiating that the problem is with the QMC. In this review article, we present and discuss new case data and critically evaluate upcoming developments of problematic regulatory assessments by the US Centers for Disease Control and Prevention (CDC), the Hawaii Department of Health (HDOH), and the Food and Drug Administration (FDA), as based on invalid QMC conclusions, clarifying now also basic facts and facilitating constructive

  13. Structure and content of radiology reports, a quantitative and qualitative study in eight medical centers

    International Nuclear Information System (INIS)

    Rationale and objectives: In order to determine how the quality of the radiology report can be improved, the variation in content, form and length of the report needs to be examined. The purpose of the present study was to investigate and compare the length and structure of radiology reports (reports of abdominal CT examinations) in eight hospitals in the Netherlands and Flanders, the Dutch speaking part of Belgium. Materials and methods: Eight hundred reports - 100 from each collaborating center - were collected. After exclusion of the reports that did not fulfill the criteria for a standard CT examination of the abdomen, 525 were retained for further study. The structure of each report was analyzed and the constituting parts (technical information, description of the findings, conclusion, advice, remark, note) were determined. The character and word count of the report and its constituting parts were measured and the results were grouped according to the country (Netherlands vs. Belgium/Flanders), the qualification of the radiologist (staff members vs. residents.) and the nature of the hospital (university medical centers vs. community hospitals). Results: Statistically significant differences were found between the Netherlands and Flanders, and between staff members and residents. The authors also found a wide variety in the lay-out and the overall content of the radiology report. Conclusion: While most of the differences we found are probably rooted in local tradition, a standard model for the radiology report in centers sharing the same language may be a means to avoid interpretation mistakes by referring physicians, and to promote better care.

  14. Impacts Of Counseling On Adherence To Prescribed Medications And Blood Pressure Of Hypertensive Patients In Four Indonesian Primary Health Centers

    OpenAIRE

    Nasution, Azizah; Khairunnisa; Tanjung, HR

    2016-01-01

    Objective: To analyze the impacts of pharmacist counseling on adherence to medications and reduction in systolic and diastolic blood pressures (SBP/DBP) of hypertensive outpatients. Methods: A retro-prospective cohort study was undertaken to evaluate the impacts of two-month period counseling on medication adherence and SBP/DBP of hypertensive patients (n=47) insured by Social Security Organizing Body in primary health centers (Medan Deli, Helvetia, Darussalam, and Teladan) in Medan. Incl...

  15. Revolution in Detection Affairs

    Energy Technology Data Exchange (ETDEWEB)

    Stern W.

    2013-11-02

    The detection of nuclear or radioactive materials for homeland or national security purposes is inherently difficult. This is one reason detection efforts must be seen as just one part of an overall nuclear defense strategy which includes, inter alia, material security, detection, interdiction, consequence management and recovery. Nevertheless, one could argue that there has been a revolution in detection affairs in the past several decades as the innovative application of new technology has changed the character and conduct of detection operations. This revolution will likely be most effectively reinforced in the coming decades with the networking of detectors and innovative application of anomaly detection algorithms.

  16. An approach to human-centered design of nuclear medical equipment: the system of caption of the thyroid

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Isaac J.A. Luquetti; Silva, Carlos Borges da; Santana, Marcos; Carvalho, Paulo Victor R.; Oliveira, Mauro Vitor de; Mol, Antonio Carlos Mol; Grecco, Claudio Henrique; Augusto, Silas Cordeiro [Instituto de Engenharia Nuclear (IEN) , Rio de Janeiro, RJ (Brazil)]. E-mail: luquetti@ien.gov.br; borges@ien.gov.br; msantana@ien.gov.br; paulov@ien.gov.br; mvitor@ien.gov.br; mol@ien.gov.br; grecco@ien.gov.br; silas@ien.gov.br

    2005-07-01

    Technology plays an important role in modern medical centers, making health care increasingly complex, relying on complex technical equipment. This technical complexity is particularly noticeable in the nuclear medicine and can increase the risks for human error. Human error has many causes such as performance shaping factors, organizational factors and user interface design. Poorly design human system interfaces of nuclear medical equipment can increase the risks for human error. If all nuclear medical equipment had been designed with good user interfaces, incidents and accidents could be reduced as well as he time required to learn how to use the equipment. Although some manufacturers of nuclear medical equipment have already integrate human factors principles in their products, there is still a need to steer the development of nuclear medical technology toward more human-centered approach. The aim of this paper is to propose a methodology that contributes to the design, development and evaluation of nuclear medical equipment and human system interface, towards a human-centered approach. This methodology includes the ergonomic approach, based on the operator activity analysis, together with human factors standards and guidelines, questionnaires and user based testing. We describe a case study in which this methodology is being applied in evaluation of the thyroid uptake system, getting essential information and data, that ill be used in development of a new system. (author)

  17. An approach to human-centered design of nuclear medical equipment: the system of caption of the thyroid

    International Nuclear Information System (INIS)

    Technology plays an important role in modern medical centers, making health care increasingly complex, relying on complex technical equipment. This technical complexity is particularly noticeable in the nuclear medicine and can increase the risks for human error. Human error has many causes such as performance shaping factors, organizational factors and user interface design. Poorly design human system interfaces of nuclear medical equipment can increase the risks for human error. If all nuclear medical equipment had been designed with good user interfaces, incidents and accidents could be reduced as well as he time required to learn how to use the equipment. Although some manufacturers of nuclear medical equipment have already integrate human factors principles in their products, there is still a need to steer the development of nuclear medical technology toward more human-centered approach. The aim of this paper is to propose a methodology that contributes to the design, development and evaluation of nuclear medical equipment and human system interface, towards a human-centered approach. This methodology includes the ergonomic approach, based on the operator activity analysis, together with human factors standards and guidelines, questionnaires and user based testing. We describe a case study in which this methodology is being applied in evaluation of the thyroid uptake system, getting essential information and data, that ill be used in development of a new system. (author)

  18. SU-E-P-01: An Informative Review On the Role of Diagnostic Medical Physicist in the Academic and Private Medical Centers

    International Nuclear Information System (INIS)

    Purpose: The role of physicist in the academic and private hospital environment continues to evolve and expand. This becomes more obvious with the newly revised requirements of the Joint Commission (JC) on imaging modalities and the continued updated requirements of ACR accreditation for medical physics (i.e., starting in June 2014, a physicists test will be needed before US accreditation). We provide an informative review on the role of diagnostic medical physicist and hope that our experience will expedite junior physicists in understanding their role in medical centers, and be ready to more opportunities. Methods: Based on our experience, diagnostic medical physicists in both academic and private medical centers perform several clinical functions. These include providing clinical service and physics support, ensuring that all ionizing radiation devices are tested and operated in compliance with the State and Federal laws, regulations and guidelines. We also discuss the training and education required to ensure that the radiation exposure to patients and staff is as low as reasonably achievable. We review the overlapping roles of medical and health physicist in some institutions. Results: A detailed scheme on the new requirements (effective 7/1/2014) of the JC is provided. In 2015, new standards for fluoroscopy, cone beam CT and the qualifications of staff will be phased in. A summary of new ACR requirements for different modalities is presented. Medical physicist have other duties such as sitting on CT and fluoroscopy committees for protocols design, training of non-radiologists to meet the new fluoroscopy rules, as well as helping with special therapies such as Yittrium 90 cases. Conclusion: Medical physicists in both academic and private hospitals are positioned to be more involved and prominent. Diagnostic physicists need to be more proactive to involve themselves in the day to day activities of the radiology department

  19. SU-E-P-01: An Informative Review On the Role of Diagnostic Medical Physicist in the Academic and Private Medical Centers

    Energy Technology Data Exchange (ETDEWEB)

    Weir, V [Baylor Health Care System, Dallas, TX (United States); Zhang, J [University of Kentucky, Lexington, KY (United States)

    2014-06-01

    Purpose: The role of physicist in the academic and private hospital environment continues to evolve and expand. This becomes more obvious with the newly revised requirements of the Joint Commission (JC) on imaging modalities and the continued updated requirements of ACR accreditation for medical physics (i.e., starting in June 2014, a physicists test will be needed before US accreditation). We provide an informative review on the role of diagnostic medical physicist and hope that our experience will expedite junior physicists in understanding their role in medical centers, and be ready to more opportunities. Methods: Based on our experience, diagnostic medical physicists in both academic and private medical centers perform several clinical functions. These include providing clinical service and physics support, ensuring that all ionizing radiation devices are tested and operated in compliance with the State and Federal laws, regulations and guidelines. We also discuss the training and education required to ensure that the radiation exposure to patients and staff is as low as reasonably achievable. We review the overlapping roles of medical and health physicist in some institutions. Results: A detailed scheme on the new requirements (effective 7/1/2014) of the JC is provided. In 2015, new standards for fluoroscopy, cone beam CT and the qualifications of staff will be phased in. A summary of new ACR requirements for different modalities is presented. Medical physicist have other duties such as sitting on CT and fluoroscopy committees for protocols design, training of non-radiologists to meet the new fluoroscopy rules, as well as helping with special therapies such as Yittrium 90 cases. Conclusion: Medical physicists in both academic and private hospitals are positioned to be more involved and prominent. Diagnostic physicists need to be more proactive to involve themselves in the day to day activities of the radiology department.

  20. Performance evaluation of Al-Zahra academic medical center based on Iran balanced scorecard model

    Science.gov (United States)

    Raeisi, Ahmad Reza; Yarmohammadian, Mohammad Hossein; Bakhsh, Roghayeh Mohammadi; Gangi, Hamid

    2012-01-01

    Background: Growth and development in any country's national health system, without an efficient evaluation system, lacks the basic concepts and tools necessary for fulfilling the system's goals. The balanced scorecard (BSC) is a technique widely used to measure the performance of an organization. The basic core of the BSC is guided by the organization's vision and strategies, which are the bases for the formation of four perspectives of BSC. The goal of this research is the performance evaluation of Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences, based on Iran BSC model. Materials and Methods: This is a combination (quantitative–qualitative) research which was done at Al-Zahra Academic Medical Center in Isfahan University of Medical Sciences in 2011. The research populations were hospital managers at different levels. Sampling method was purposive sampling in which the key informed personnel participated in determining the performance indicators of hospital as the BSC team members in focused discussion groups. After determining the conceptual elements in focused discussion groups, the performance objectives (targets) and indicators of hospital were determined and sorted in perspectives by the group discussion participants. Following that, the performance indicators were calculated by the experts according to the predetermined objectives; then, the score of each indicator and the mean score of each perspective were calculated. Results: Research findings included development of the organizational mission, vision, values, objectives, and strategies. The strategies agreed upon by the participants in the focus discussion group included five strategies, which were customer satisfaction, continuous quality improvement, development of human resources, supporting innovation, expansion of services and improving the productivity. Research participants also agreed upon four perspectives for the Al-Zahra hospital BSC. In the patients and community

  1. Human-centered risk management for medical devices - new methods and tools.

    Science.gov (United States)

    Janß, Armin; Plogmann, Simon; Radermacher, Klaus

    2016-04-01

    Studies regarding adverse events with technical devices in the medical context showed, that in most of the cases non-usable interfaces are the cause for use deficiencies and therefore a potential harm for the patient and third parties. This is partially due to the lack of suitable methods for interlinking usability engineering and human-centered risk management. Especially regarding the early identification of human-induced errors and the systematic control of these failures, medical device manufacturers and in particular the developers have to be supported in order to guarantee reliable design and error-tolerant human-machine interfaces (HMI). In this context, we developed the HiFEM methodology and a corresponding software tool (mAIXuse) for model-based human risk analysis. Based on a two-fold approach, HiFEM provides a task-type-sensitive modeling structure with integrated temporal relations in order to represent and analyze the use process in a detailed way. The approach can be used from early developmental stages up to the validation process. Results of a comparative study with the HiFEM method and a classical process-failure mode and effect analysis (FMEA) depict, that the new modeling and analysis technique clearly outperforms the FMEA. Besides, we implemented a new method for systematic human risk control (mAIXcontrol). Accessing information from the method's knowledge base enables the operator to detect the most suitable countermeasures for a respective risk. Forty-one approved generic countermeasure principles have been indexed as a resulting combination of root causes and failures in a matrix. The methodology has been tested in comparison to a conventional approach as well. Evaluation of the matrix and the reassessment of the risk priority numbers by a blind expert demonstrate a substantial benefit of the new mAIXcontrol method. PMID:26985681

  2. Rejecting conventional wisdom: how academic medical centers can regain their leadership positions.

    Science.gov (United States)

    Krauss, K; Smith, J

    1997-07-01

    Academic medical centers (i.e., medical schools and their principal hospitals) are following very similar strategies in attempts to secure their futures. It is likely that these undifferentiated strategies will fail, since most of them have been copied from the lower-cost, geographically better-positioned hospitals and health systems. Despite a wealth of innovative, entrepreneurial talent and the potential to reshape the world that AMCs live in, most AMCs are in reactive modes. Future directions and strategies are almost always shaped, forced, and justified by external pressures. The major problem with the strategic plans of most AMCs is that they are based on conventional industry wisdom. Strategic plans tend not to be analytically driven. The insight and understanding of those factors that drive the demand for AMCs' services and determine the performances of AMCs are lacking. The authors note some questions that are critical to the formulation of strategies for AMCs. For example, how can the research mission be changed from a cost-based to a value-based endeavor? Most AMCs cannot answer these questions, and if they do address them in the planning process, they do so superficially. Several examples of the factors that need to be understood are also given, such as patients' purposes and needs in seeking specialty care. Alternative strategies are listed, such as maintaining and exploiting the economic irrationality of the market rather than acting as if it were economically rational or forcing it to become so. Last, the authors outline the scope of the changes that are required and urge AMCs to reject conventional wisdom, determine their own unique situations, and work from there. PMID:9236466

  3. Child Injury in Israel: Emergency Room Visits to a Children's Medical Center

    Directory of Open Access Journals (Sweden)

    Michal Hemmo-Lotem

    2005-01-01

    Full Text Available The object of this study was to provide data for policy making and prevention program planning in Israel. The study examined all visits to the Department of Emergency Medicine at the Schneider Children's Medical Center in 1996 (41,279 visits in total. Approximately 22.6% of the emergency room patients were admitted following injury. Most (97% were unintentional injury. Approximately 42% of the patients were less than 4 years old and about 20% were 2 years old. In all age groups, the rate of boys was double. Approximately 92% were Jews. Despite this low rate of non-Jewish patients, however, they constituted 20% of later hospitalizations. The main injuries recorded were bruises and wounds from blunt objects, falls, motor vehicle–related accidents, and sport injuries. The most commonly injured body parts were the head and upper and lower limbs. In 82%, medical treatment was reported and 7% were hospitalized. In examining injuries over the year, there were no significant differences between the different months, but there were clusters of injuries around various holidays—bicycle and skateboard accidents at Rosh Hashanah, Yom Kippur, and Succoth; pedestrian accidents around Lag BaOmer; burns on Purim, Hannukkah, and Passover; and accidental poisoning around Passover. The findings gave an indication of the nature of the injured population groups. These data could be useful for prevention strategy, both on the level of physical injury as well as on the level of the times of the year, when the risk was higher. The data collected very strongly raise the urgent need for establishing a national surveillance system, which would allow tracking injury-related data with respect to young people throughout the country.

  4. Screening mammography in a health promotion center for 5 years : results of medical audits

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Hye [Miz Medi Hospital, Seoul (Korea, Republic of); Lee, Mi Ja [Health Promoting Center, Severance Hospital, Seoul (Korea, Republic of); Oh, Ki Keun; Lee, Kyong Sik [College of Medicine, Yonsei University, Seoul (Korea, Republic of)

    2000-05-01

    The purpose of this study was to perform a medical audit of the screening of mammographic results according to ACR BI-RADS Follow-Up and Outcome Monitoring and to evaluate the efficacy of screening mammography in the early detection of breast cancer. We reviewed the results of 15,300 mammographic examinations of 13,889 women aged 30-75 years who underwent mammography at least once at the Severance Health Promotion Center between 1994-1998. Women with abnormal mammographic findings were recalled for additional study and those with dense breast composition (3, 4) underwent additional ultrasound. All results were categorized on the basis of the ACR BI-RADS final assessment scale, 1-5. We reviewed the pathologic or follow-up results of all women in categories 4 and 5, and/or those in any category who took the films out of the health center. The recall rate was 13%. Biopsy or surgical consultation was recommended for 92 women and biopsy was performed in 52. Pathology revealed 17 cancers and 35 benign lesions. Positive predictive value 2 was found in 18.5% of cases, and positive predictive value 3 in 33%. The cancer detection rate was 1.2/1,000, and sensitivity was 89.5%. Invasive cancers smaller than 1 cm or in situ ductal cancers were found in eight of 17 cases (47%), while node-positive invasive cancers were found in nine of 14 cases (64%). Four of 17 mammographically detected cancers were palpated by a surgeon. In asymptomatic women, screening mammography is an effective method for the detection of early breast cancer. (author)

  5. Screening mammography in a health promotion center for 5 years : results of medical audits

    International Nuclear Information System (INIS)

    The purpose of this study was to perform a medical audit of the screening of mammographic results according to ACR BI-RADS Follow-Up and Outcome Monitoring and to evaluate the efficacy of screening mammography in the early detection of breast cancer. We reviewed the results of 15,300 mammographic examinations of 13,889 women aged 30-75 years who underwent mammography at least once at the Severance Health Promotion Center between 1994-1998. Women with abnormal mammographic findings were recalled for additional study and those with dense breast composition (3, 4) underwent additional ultrasound. All results were categorized on the basis of the ACR BI-RADS final assessment scale, 1-5. We reviewed the pathologic or follow-up results of all women in categories 4 and 5, and/or those in any category who took the films out of the health center. The recall rate was 13%. Biopsy or surgical consultation was recommended for 92 women and biopsy was performed in 52. Pathology revealed 17 cancers and 35 benign lesions. Positive predictive value 2 was found in 18.5% of cases, and positive predictive value 3 in 33%. The cancer detection rate was 1.2/1,000, and sensitivity was 89.5%. Invasive cancers smaller than 1 cm or in situ ductal cancers were found in eight of 17 cases (47%), while node-positive invasive cancers were found in nine of 14 cases (64%). Four of 17 mammographically detected cancers were palpated by a surgeon. In asymptomatic women, screening mammography is an effective method for the detection of early breast cancer. (author)

  6. The pattern of active pulmonary tuberculosis in adults at King Hussein Medical Center, Jordan

    International Nuclear Information System (INIS)

    To identify the pattern of the clinical, radiological, and diagnostic procedures of the diagnosed cases of active pulmonary tuberculosis (TB) patients presented to the Respiratory Medicine Division at King Hussein Medical Center over the last 10 years. This is a retrospective analysis of the medical records and chest radiographs of 137 active pulmonary TB patients who were diagnosed between March 1995 and October 2005. Patient's symptoms were recorded and analyzed. Radiological findings were assessed. Procedures used to identify Mycobacterium TB were identified. One hundred and thirty-seven patients medical records were retrieved and analyzed (84 males and 53 females). The mean age (range) was 48.43 +/- 14.65 (14-83) years. The most common presenting symptoms were cough (79%), weight loss (74%), and fatigue (69%). Other presenting complaints were fever (69%), excessive night sweating (55%), chest pain (41%) and dyspnea (39%). Thirty-one percent of the cohort presented with hemoptysis. Seventy-one patients had different types of opacities and infiltrates in their chest x-ray. Micro- or macro- nodular lung changes were reported in 22 (16%) patients. Lung cavitations and pleural effusions were present in 13% of the studied patients. In 7% of cases, bronchiectasis was noted as a sequelae of long-standing lung disease. The right lung was involved in 51% of cases; the left lung in 27% and bilateral lung involvement was noted in 22% of patients. The upper lobes were involved in 63%. Sputum for acid-fast bacilli (AFB) Z-Nielson stain and culture was positive in 51%, bronchial wash was positive in 27% of cases. The diagnosis was made by histopathological examination in 15% of cases. This study showed that active pulmonary TB patients vary in clinical presentation. The radiological manifestations of pulmonary TB are heterogeneous. Sputum for AFB remains an important, easy and inexpensive measure for TB diagnosis, but may not be always helpful in early diagnosis. Bronchoscopy

  7. 77 FR 5186 - Medical Foster Homes

    Science.gov (United States)

    2012-02-02

    ... representative of the medical foster home facility must agree upon the charge and payment procedures for medical... AFFAIRS 38 CFR Part 17 RIN 2900-AN80 Medical Foster Homes AGENCY: Department of Veterans Affairs. ACTION: Final rule. SUMMARY: This document amends the Department of Veterans Affairs (VA)...

  8. 76 FR 36955 - West Los Angeles VA Medical Center Veterans Programs Enhancement Act of 1998; Master Plan

    Science.gov (United States)

    2011-06-23

    ... addition, the campus serves as a center for medical research and education. We received 29 comments on the... support the mission of offering the highest quality health care, research, education and disaster response... just across the street from the Domiciliary, will include meditative gardens, tables for chess...

  9. Geospatial Modeling and Disease Insect Vector Management at the USDA-ARS Center for Medical, Agricultural, and Veterinary Entomology

    Science.gov (United States)

    Geospatial modeling at the Center for Medical, Agricultural and Veterinary Entomology (CMAVE) is used assist in the surveillance of insect vectors and in the management of insect transmitted diseases. The most recent Geospatial Modeling/Technology Transfer success involves the prediction of Rift Val...

  10. New Tools for Learning: A Case of Organizational Problem Analysis Derived from Debriefing Records in a Medical Center

    Science.gov (United States)

    Holzmann, Vered; Mischari, Shoshana; Goldberg, Shoshana; Ziv, Amitai

    2012-01-01

    Purpose: This article aims to present a unique systematic and validated method for creating a linkage between past experiences and management of future occurrences in an organization. Design/methodology/approach: The study is based on actual data accumulated in a series of projects performed in a major medical center. Qualitative and quantitative…

  11. The USDA-ARS Center for Medical, Agricultural and Veterinary Entomology: Developing new mosquito surveillance and control products

    Science.gov (United States)

    The Center for Medical, Agricultural and Veterinary Entomology (CMAVE), U.S. Department of Agriculture – Agricultural Research Service (USDA-ARS), conducts specific research directed at reducing or eliminating the harm caused by insects to humans, animals, and crops. CMAVE is an internationally ren...

  12. Frequency of enteric protozoan parasites among patients with gastrointestinal complaints in medical centers of Zahedan, Iran.

    Science.gov (United States)

    Haghighi, Ali; Khorashad, Alireza Salimi; Nazemalhosseini Mojarad, Ehsan; Kazemi, Bahram; Rostami Nejad, Mohammad; Rasti, Sima

    2009-05-01

    We investigated the prevalence of intestinal protozoan parasites in patients with gastrointestinal complaints in medical centers in Zahedan, Iran. A total of 1562 stool samples was examined from July 2004 to January 2006 using microscopy (direct smear, formalin-ether concentration), xenic culture and PCR techniques. Four hundred and twenty-seven (27.3%) of the patients were infected with one or more intestinal parasites. Giardia lamblia (10.1%), Entamoeba coli (10%), E. hartmanni (1.7%), Blastocystis hominis (2.2%), Chilomastix mesnili (1.7%), Trichomonas hominis (0.7%), E. histolytica/E. dispar (0.51%) and Iodamoeba butschlii (0.45%) were the most prevalent protozoa detected with microscopy. Of the eight microscopy-positive E. histolytica/E. dispar samples, six were identified as E. dispar by PCR/gel electrophoresis, whereas E. histolytica was not detected at all. Although Zahedan is an area with poor hygiene located in a tropical area near the border of Pakistan and Afghanistan, the prevalence of E. histolytica and E. dispar here compared with other parasites and infectious diseases is unexpectedly low. PMID:19084249

  13. Good Neighbors: Shared Challenges and Solutions Toward Increasing Value at Academic Medical Centers and Universities.

    Science.gov (United States)

    Clancy, Gerard P

    2015-12-01

    Academic medical centers (AMCs) and universities are experiencing increasing pressure to enhance the value they offer at the same time that they are facing challenges related to outcomes, controlling costs, new competition, and government mandates. Yet, rarely do the leaders of these academic neighbors work cooperatively to enhance value. In this Perspective the author, a former university regional campus president with duties in an AMC as an academic physician, shares his insights into the shared challenges these academic neighbors face in improving the value of their services in complex environments. He describes the successes some AMCs have had in generating revenues from new clinical programs that reduce the overall cost of care for larger populations. He also describes how several universities have taken a comprehensive approach to reduce overhead and administrative costs. The author identifies six themes related to successful value improvement efforts and provides examples of successful strategies used by AMCs and their university neighbors to improve the overall value of their programs. He concludes by encouraging leaders of AMCs and universities to share information about their successes in value improvements with each other, to seek additional joint value enhancement efforts, and to market their value improvements to the public. PMID:26266460

  14. Pharmaceutical speakers' bureaus, academic freedom, and the management of promotional speaking at academic medical centers.

    Science.gov (United States)

    Boumil, Marcia M; Cutrell, Emily S; Lowney, Kathleen E; Berman, Harris A

    2012-01-01

    Pharmaceutical companies routinely engage physicians, particularly those with prestigious academic credentials, to deliver "educational" talks to groups of physicians in the community to help market the company's brand-name drugs. Although presented as educational, and even though they provide educational content, these events are intended to influence decisions about drug selection in ways that are not based on the suitability and effectiveness of the product, but on the prestige and persuasiveness of the speaker. A number of state legislatures and most academic medical centers have attempted to restrict physician participation in pharmaceutical marketing activities, though most restrictions are not absolute and have proven difficult to enforce. This article reviews the literature on why Speakers' Bureaus have become a lightning rod for academic/industry conflicts of interest and examines the arguments of those who defend physician participation. It considers whether the restrictions on Speakers' Bureaus are consistent with principles of academic freedom and concludes with the legal and institutional efforts to manage industry speaking. PMID:22789048

  15. MIC Susceptility Testing of Nosocomial Infections at PICU in Children’s Medical Center, Iran

    Directory of Open Access Journals (Sweden)

    M Rezaei

    2006-05-01

    Full Text Available Background: The aim of this study was to determine the minimal inhibitory concentration (MIC of microorganisms causing nosocomial infections in the pediatric intensive care unit (PICU of the Children's Medical Center in Tehran. Methods: All patients with nosocomial infections in the PICU were enrolled in the study. Causative microoraganisms were coagulase positive, and coagulase negative Staphylococci and Pseudomonas aeruginosa. MIC of many antibiotics was determined by microbroth dilution according to NCCLS. Findings: Within a period of 18 months, thirty patients developed nosocomial infection including 17 cases with P.aeruginosa and 9 individuals with Staph aureus infection. The remaining 4 patients were involved with coagulase negative Staphylococci. The most common sources were respiratory tract, blood stream, wound and soft tissue. Multi-antimicrobial resistance (resistance to Amikacin, Ceftazidim, Imipenem and Ciprofloxacin was common among P. aeruginosa species All strains of Staph aureus were resistant to Methicillin (MRSA. These microorganisms were also resistant to clindamycin and ciprofloxacin in 88% of cases. Conclusion: Resistance to antimicrobial agents was high in our study, therefore routine MIC examination is necessary in PICU.

  16. Transformation of Care: Integrating the Registered Nurse Care Coordinator into the Patient-Centered Medical Home.

    Science.gov (United States)

    Biernacki, Pamela J; Champagne, Mary T; Peng, Shane; Maizel, David R; Turner, Barbara S

    2015-10-01

    The purpose of this quality improvement project was to implement and evaluate a care delivery model integrating the registered nurse care coordinator (RNCC) into a family practice that is certified as a patient-centered medical home (PCMH) by the National Committee for Quality Assurance. The initial target population was the 937 patients with diabetes in the family practice. A pre-post design was used to assess changes in patients' diabetic quality indicators after integrating the role of RNCC using existing staff. This 6-month project compared the following diabetic quality indicators: blood pressure post scores for A1c (P = .001, n = 790), foot exam (P = .001, n = 850), and microalbumin (P = .01, n = 850). Post intervention, patient and health care team satisfaction with the RNCC role was high (mean scores ≥3 on a 5-point Likert scale). Integrating the RNCC within a multidisciplinary team in the PCMH had a significant positive impact on diabetic quality indicators. Patient and health care team satisfaction with the RNCC role was high. PMID:25632926

  17. Commentary: The battle of Louisville: money, power, politics, and publicity at an academic medical center.

    Science.gov (United States)

    Halperin, Edward C

    2011-10-01

    In 2009, the entire clinical faculty of the Department of Neurosurgery of the University of Louisville School of Medicine elected to become employees of a nearby community hospital. This took place in the context of the financial burden of caring for the indigent, declining reimbursement, clinical demands for neurosurgical coverage of a level 1 trauma center, rising salaries for neurosurgeons, and competitive pressure on hospitals. The author, who was dean of the school of medicine at the time, would not accept the abrupt withdrawal of these clinicians from the faculty practice plan, single-point contracting, and academic governance of clinical work assignments. Politicians, the press, and accreditation bodies quickly weighed in as the university, the school, and the public good were placed in jeopardy. The motivations for this event-the community hospital defending its market share and physician recruitment and retention pipeline, the dean defending principles of academic governance and the faculty practice plan-and the responses of the participants offer an instructive case study for academic medical management. The author concludes that one might view the protagonists of this episode not as defenders of principles but, rather, as pawns in a larger drama playing out related to a perfect storm of economic and social pressures in American medicine. PMID:21955714

  18. Banner plans to issue new bonds to cover university of Arizona medical center purchase

    Directory of Open Access Journals (Sweden)

    Robbns RA

    2015-10-01

    Full Text Available No abstract available. Article truncated at 150 words. Modern Healthcare is reporting that Banner Health is issuing new bonds this week to refinance older debt (1. Banner financed the $1 billion purchase of the University of Arizona Health Network (UAHN including the University of Arizona Medical Center with a $700 million short-term loan from investment bank Mizuho in February. Banner is issuing $100 million in tax-exempt, fixed rate Series 2015A bonds. It is also planning to take on an additional $500 million in taxable and tax-exempt debt that will be used to replace the short-term loans associated with the purchase. Banner is focusing on how to improve the return on its UAHN investment, which has dragged down its earnings. UAHN's financial performance has deteriorated with an operating margin declining to -4.3% in fiscal 2014, down from -1.2% the previous fiscal year. Before that, UAHN was profitable, according to Banner Chief Financial Officer Dennis Dahlen. Banner reported an operating ...

  19. Sports hernia: the experience of Baylor University Medical Center at Dallas.

    Science.gov (United States)

    Preskitt, John T

    2011-04-01

    Groin injuries in high-performance athletes are common, occurring in 5% to 28% of athletes. Athletic pubalgia syndrome, or so-called sports hernia, is one such injury that can be debilitating and sport ending in some athletes. It is a clinical diagnosis of chronic, painful musculotendinous injury to the medial inguinal floor occurring with athletic activity. Over the past 12 years, we have operated on >100 patients with this injury at Baylor University Medical Center at Dallas. These patients have included professional athletes, collegiate athletes, competitive recreational athletes, and the occasional "weekend warrior." The repair used is an open technique using a lightweight polypropylene mesh. Patient selection is important, as is collaboration with other experienced and engaged sports health care professionals, including team trainers, physical therapists, team physicians, and sports medicine and orthopedic surgeons. Of the athletes who underwent surgery, 98% have returned to competition. After a minimum of 6 weeks for recovery and rehabilitation, they have usually returned to competition within 3 months. PMID:21566750

  20. Facilitators and Barriers to Care Coordination in Patient-centered Medical Homes (PCMHs) from Coordinators’ Perspectives

    Science.gov (United States)

    Friedman, Asia; Howard, Jenna; Shaw, Eric K.; Cohen, Deborah J.; Shahidi, Laleh; Ferrante, Jeanne M.

    2016-01-01

    Background Care coordinators are increasingly featured in patient-centered medical home (PCMH) projects, yet little research examines how coordinators themselves define and experience their role. This is the first study describing experiences of care coordinators across the US from their own perspectives. Methods This qualitative study used a 5-month private, online discussion forum to gather data from 25 care coordinators from PCMH practices representing diversity in practice size, setting, and type. Participants answered questions and interacted with one another, creating an online social learning collaborative while allowing for data collection for research. Results Coordinators identified barriers and facilitators in their work at the organization/system level, the interpersonal level, and the individual level. Some factors emerged as both barriers and facilitators, including the functionality of clinical information technology; the availability of community resources; interactions with clinicians and other health care facilities; interactions with patients; and self-care practices for mental health and wellness. Colocation and full integration into practices were other key facilitators, whereas excessive case loads and data management responsibilities were felt to be important barriers. Conclusions While all the barriers and facilitators were important to performing coordinators’ roles, relationship building materialized as key to effective care coordination, whether with clinicians, patients, or outside organizations. We discuss implications for practice and provide suggestions for further research. PMID:26769881

  1. Successful Resident Engagement in Quality Improvement: The Detroit Medical Center Story.

    Science.gov (United States)

    Hussain, Syed Ahmed; Arsene, Camelia; Hamstra, Corinne; Woehrlen, Tess H; Wiese-Rometsch, Wilhelmine; White, Suzanne R

    2016-05-01

    Background In 2014, the Detroit Medical Center launched a new program to engage residents and fellows in a strategy to deliver optimal care within 1 year, focusing on quality at an earlier stage of their careers and preparing them for working posttraining. Methods Residents from clinically relevant residency and fellowships programs were selected to be Resident Quality Directors. The project involved development of an interactive electronic health record (EHR) checklist to visually depict real time gaps in 40 process measures, while focusing on 14 areas related to stroke and venous thromboembolism (VTE) prophylaxis. We also implemented an incentive approach, using a pay-for-performance (P4P) model. Results The project included 800 residents led by 14 resident quality directors. We were able to achieve 100% resident participation. Prior compliance with VTE quality measures 6 months was 88.5%, with performance increasing to 94.2% (P system-wide quality performance on VTE prevention and stroke care process measures, which was facilitated by a interactive EHR-based checklist and linkage to P4P incentive payments. PMID:27168890

  2. The Incidence of Nosocomial Toxigenic Clostridium difficile Associated Diarrhea in Tehran Tertiary Medical Centers

    Directory of Open Access Journals (Sweden)

    Norakhoda Sadeghifard

    2010-10-01

    Full Text Available Clostridium difficile is the most common cause of nosocomial diarrhea. It is usually a consequence of antibiotic treatment, But sporadic cases can occur. This study was aimed to determine the frequency of the nosocomial Clostridium difficile (C. difficile associated diarrhea in Tehran University of Medical Sciences hospitals and study of antibacterial susceptibility of isolates. In this study a total of 942 stool samples from patients with nosocomial diarrhea that were hospitalized in Imam Khomeini hospital, Shariati hospital and Children clinical center were collected. The samples were cultured on a selective cycloserine cefoxitin fructose agar (CCFA and incubated in anaerobic conditions, at 37°C for 5 days. Isolates were characterized to species level by conventional biochemical tests. Bacterial cytotoxicity was assayed on tissue culture (vero. Antimicrobial sensitivity of isolated toxigenic C. difficile were investigated by kirby Beuer method (disk diffusion. Our findings show that, of the total patients, 57 toxigenic C. difficile (6.1% were isolated. Results of statistical analysis show significant differences between the rate of isolated toxigenic C. difficile and age group of patients (P

  3. [Using SWOT to analyze breastfeeding education results in a medical center].

    Science.gov (United States)

    Lee, Pei-Shan; Huang, Chiu-Mieh

    2005-08-01

    The breastfeeding rate within the first month after postpartum dropped from 95% in 1962 to 25% in 1989. As a result, the Department of Health, Executive Yuan, has made a lot of effort to promote a baby-friendly hospital policy since 2001, with the aim of increasing the breastfeeding rate. However, many studies have pointed out that the Department of Health is encountering difficulties when implementing this policy. This study is designed to use the Strengths, Weakness, Opportunities, and Threats (SWOT) Analysis to evaluate the development of breastfeeding education in a certain medical center. We divide those factors that influence the effect of this policy into extrinsic environmental factors and intrinsic environmental factors. The intrinsic environmental factors are the strengths and weaknesses of the baby-friendly hospital policy. The extrinsic environmental factors are the opportunities and threats. The SWOT Matrix is also applied to develop appropriate strategies to take the greatest possible advantage of opportunities available. With the SWOT approach, managers can not only readily extinguish intrinsic advantages from intrinsic disadvantages, but also recognize external opportunities and threats. Furthermore, it assists managers in resolving problems and turning adversity into opportunity. In providing the SWOT analysis, we hope clinical nursing staff will gain a better understanding of the baby-friendly hospital policy and deliver higher quality of health care for postpartum mothers, thus increasing the breastfeeding rate. PMID:16088785

  4. The Changing Landscape of Molecular Diagnostic Testing: Implications for Academic Medical Centers.

    Science.gov (United States)

    Rehm, Heidi L; Hynes, Elizabeth; Funke, Birgit H

    2016-01-01

    Over the last decade, the field of molecular diagnostics has undergone tremendous transformation, catalyzed by the clinical implementation of next generation sequencing (NGS). As technical capabilities are enhanced and current limitations are addressed, NGS is increasingly capable of detecting most variant types and will therefore continue to consolidate and simplify diagnostic testing. It is likely that genome sequencing will eventually serve as a universal first line test for disorders with a suspected genetic origin. Academic Medical Centers (AMCs), which have been at the forefront of this paradigm shift are now presented with challenges to keep up with increasing technical, bioinformatic and interpretive complexity of NGS-based tests in a highly competitive market. Additional complexity may arise from altered regulatory oversight, also triggered by the unprecedented scope of NGS-based testing, which requires new approaches. However, these challenges are balanced by unique opportunities, particularly at the interface between clinical and research operations, where AMCs can capitalize on access to cutting edge research environments and establish collaborations to facilitate rapid diagnostic innovation. This article reviews present and future challenges and opportunities for AMC associated molecular diagnostic laboratories from the perspective of the Partners HealthCare Laboratory for Molecular Medicine (LMM). PMID:26828522

  5. The Changing Landscape of Molecular Diagnostic Testing: Implications for Academic Medical Centers

    Directory of Open Access Journals (Sweden)

    Heidi L. Rehm

    2016-01-01

    Full Text Available Over the last decade, the field of molecular diagnostics has undergone tremendous transformation, catalyzed by the clinical implementation of next generation sequencing (NGS. As technical capabilities are enhanced and current limitations are addressed, NGS is increasingly capable of detecting most variant types and will therefore continue to consolidate and simplify diagnostic testing. It is likely that genome sequencing will eventually serve as a universal first line test for disorders with a suspected genetic origin. Academic Medical Centers (AMCs, which have been at the forefront of this paradigm shift are now presented with challenges to keep up with increasing technical, bioinformatic and interpretive complexity of NGS-based tests in a highly competitive market. Additional complexity may arise from altered regulatory oversight, also triggered by the unprecedented scope of NGS-based testing, which requires new approaches. However, these challenges are balanced by unique opportunities, particularly at the interface between clinical and research operations, where AMCs can capitalize on access to cutting edge research environments and establish collaborations to facilitate rapid diagnostic innovation. This article reviews present and future challenges and opportunities for AMC associated molecular diagnostic laboratories from the perspective of the Partners HealthCare Laboratory for Molecular Medicine (LMM.

  6. Should We Offer Medication to Reduce Breast Cancer Risk?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

    Science.gov (United States)

    Burns, Risa B; Schonberg, Mara A; Tung, Nadine M; Libman, Howard

    2016-08-01

    In November 2013, the U.S. Preventive Services Task Force issued a guideline on medications for risk reduction of primary breast cancer in women. Although mammography can detect early cases, it cannot prevent development of breast cancer. Tamoxifen and raloxifene are selective estrogen receptor modulators that have been shown to reduce the risk for estrogen receptor-positive breast cancer and are approved by the U.S. Food and Drug Administration (FDA) for this indication. However, neither medication reduces the risk for estrogen receptor-negative breast cancer or all-cause mortality. The Task Force concluded that postmenopausal women with an estimated 5-year risk for breast cancer of 3% or greater will probably have more net benefit than harm and recommends that clinicians engage in shared, informed decision making about these medications. The American Society of Clinical Oncology issued a practice guideline on use of pharmacologic interventions for breast cancer in 2013. It recommends that women aged 35 years or older at increased risk, defined as a 5-year absolute risk for breast cancer of 1.66% or greater, discuss breast cancer prevention medications with their primary care practitioner. The Society includes the aromatase inhibitor exemestane in addition to tamoxifen and raloxifene as a breast cancer prevention medication, although exemestane is not FDA approved for this indication. Here, an oncologist and an internist discuss how they would balance these recommendations and what they would suggest for an individual patient. PMID:27479221

  7. Student Affairs Capitalism and Early-Career Student Affairs Professionals

    Science.gov (United States)

    Lee, Jenny J.; Helm, Matthew

    2013-01-01

    This study explores student affairs capitalism as the alteration of professional practice towards the financial interests of institutions. Student affairs capitalism has the potential to create dynamics in which the interests of students become secondary to the institution's economic needs. This study examined this phenomenon from the…

  8. Center forTelehealth and Cybermedicine Research, University of New Mexico Health Sciences Center: a model of a telehealth program within an academic medical center.

    Science.gov (United States)

    Alverson, Dale C; Dion, Denise; Migliorati, Margaret; Rodriguez, Adrian; Byun, Hannah W; Effertz, Glen; Duffy, Veronica; Monge, Benjamin

    2013-05-01

    An overview of the Center for Telehealth and Cybermedicine Research at the University of New Mexico Health Sciences Center was presented along with several other national and international programs as part of the of a symposium-workshop on telehealth, "Sustaining and Realizing the Promise of Telemedicine," held at the University of Michigan Health System in Ann Arbor, MI, May 18-19, 2012 and hosted by the University of Michigan Telemedicine Resource Center and its Director, Rashid Bashshur. This article describes our Center, its business plan, and a view to the future. PMID:23317516

  9. Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system.

    Science.gov (United States)

    Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B

    2014-01-01

    The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills.Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment.Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers. PMID:24867551

  10. Medication Errors in Hospitals: A Study of Factors Affecting Nursing Reporting in a Selected Center Affiliated with Shahid Beheshti University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    HamidReza Mirzaee

    2015-10-01

    Full Text Available Background: Medication errors are mentioned as the most common important challenges threatening healthcare system in all countries worldwide. This study is conducted to investigate the most significant factors in refusal to report medication errors among nursing staff.Methods: The cross-sectional study was conducted on all nursing staff of a selected Education& Treatment Center in 2013. Data was collected through a teacher made questionnaire. The questionnaires’ face and content validity was confirmed by experts and for measuring its reliability test-retest was used. Data was analyzed by descriptive and analytic statistics. 16th  version of SPSS was also used for related statistics.Results: The most important factors in refusal to report medication errors respectively are: lack of reporting system in the hospital(3.3%, non-significance of reporting medication errors to hospital authorities and lack of appropriate feedback(3.1%, and lack of a clear definition for a medication error (3%. there was a significant relationship between the most important factors of refusal to report medication errors and work shift (p:0.002, age(p:0.003, gender(p:0.005, work experience(p<0.001 and employment type of nurses(p:0.002.Conclusion: Factors pertaining to management in hospitals as well as the fear of the consequences of reporting are two broad fields among the factors that make nurses not report their medication errors. In this regard, providing enough education to nurses, boosting the job security for nurses, management support and revising related processes and definitions are some factors that can help decreasing medication errors and increasing their report in case of occurrence.

  11. Evaluation of recombinant activated protein C for severe sepsis at a tertiary academic medical center

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    Anger KE

    2013-06-01

    Full Text Available Kevin E Anger,1 Jeremy R DeGrado,1 Bonnie C Greenwood,1 Steven A Cohen,2 Paul M Szumita1 1Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA; 2Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, USA Purpose: Early clinical trials of recombinant human activated protein C (rhAPC for severe sepsis excluded patients at high risk of bleeding. Recent literature suggests bleeding rates are higher in clinical practice and may be associated with worsened outcomes. Our objective was to evaluate baseline demographics; incidence, and risk factors for major bleeding; and mortality of patients receiving rhAPC for severe sepsis at our institution. Methods: A retrospective study was performed for all patients receiving rhAPC for treatment of severe sepsis at a tertiary academic medical center from January 2002 to June 2009. Demographic information, clinical variables, intensive care unit, and hospital outcomes were recorded. Results: Of the 156 patients that received rhAPC, 54 (34.6% did not meet institutional criteria for safe use at baseline due to bleeding precaution or contraindication. Twenty-three (14.7% patients experienced a major bleeding event. Multivariate analysis demonstrated baseline International Normalized Ratio ≥2.5 (odds ratio [OR] 3.68, 95% confidence interval [CI]: 1.28–10.56; P = 0.03 and platelet count ≤100 × 103/mm3 (OR 2.86, 95% CI: 1.07–7.67; P = 0.01 as significant predictors of a major bleed. Overall hospital mortality was 57.7%. Multivariate analysis demonstrated the presence of ≥3 organ dysfunctions (OR 2.46, 95% CI: 1.19–5.09; P < 0.05 and medical intensive care unit admission (OR 1.99, 95% CI: 1.00–3.98; P = 0.05 were independent variables associated with hospital mortality. Conclusion: Patients receiving rhAPC at our institution had higher APACHE II scores, mortality, and major bleeding events than published

  12. Functionally aberrant electrophysiological cortical connectivities in first episode medication-naive schizophrenics from three psychiatry centers

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    Dietrich Lehmann‡

    2014-08-01

    Full Text Available Functional dissociation between brain processes is widely hypothesized to account for aberrations of thought and emotions in schizophrenic patients. The typically small groups of analyzed schizophrenic patients yielded different neurophysiological findings, probably because small patient groups are likely to comprise different schizophrenia subtypes. We analyzed multichannel eyes-closed resting EEG from three small groups of acutely ill, first episode productive schizophrenic patients before start of medication (from three centers: Bern N=9; Osaka N=9; Berlin N=12 and their controls. Low resolution brain electromagnetic tomography (LORETA was used to compute intracortical source model-based lagged functional connectivity not biased by volume conduction effects between 19 cortical regions of interest (ROIs. The connectivities were compared between controls and patients of each group. Conjunction analysis determined six aberrant cortical functional connectivities that were the same in the three patient groups. Four of these six concerned the facilitating EEG alpha 1 frequency activity; they were decreased in the patients. Another two of these six connectivities concerned the inhibiting EEG delta frequency activity; they were increased in the patients. The principal orientation of the six aberrant cortical functional connectivities was sagittal; five of them involved both hemispheres. In sum, activity in the posterior brain areas of preprocessing functions and the anterior brain areas of evaluation and behavior control functions were compromised by either decreased coupled activation or increased coupled inhibition, common across schizophrenia subtypes in the three patient groups. These results of the analyzed three independent groups of schizophrenics support the concept of functional dissociation.

  13. Preliminary results of proton radiotherapy at the proton medical research center, Tsukuba

    International Nuclear Information System (INIS)

    The well-defined dose distribution possible to achieve with proton beams makes it feasible to deliver high doses to the tumor while reducing doses to the adjacent normal tissues. Clinical studies at Proton Medical Research Center (PMRC), University of Tsukuba, have been conducted to investigate the efficacy of high-energy proton beams in the treatment of a wide variety of human malignancies, especially for deep-seated tumors. So far, of 444 patients who received proton radiotherapy, 367 were treated with curative intent. The number of patients treated per year has often increased and the rate of each affection has changed over time. For example, the patients with primary liver cancer and bladder cancer have increased remarkably while the number of patients with esophageal cancer and lung cancer have been almost constant, while patients with uterus cancer and malignant glioma have recently decreased. Concerning the results of our studies, excellent local control and survival results have been obtained at many tumor sites. Local control rate and overall survival rate of primary liver cancer at 5 years were 90% and 41%, respectively. Those of esophageal cancer were 81% and 49%, non-small cell lung cancer 90% and 20%, and bladder cancer 78% and 67%, respectively. Furthermore, probability of morbidity related to proton radiotherapy was quite low (6% of all patients with malignant tumors). These results strongly indicate the potential advantage of proton beams in the treatment of deep-seated tumors, especially primary liver cancer, esophageal cancer, non-small cell lung cancer and bladder cancer. (author)

  14. A Reliable Billing Method for Internal Medicine Resident Clinics: Financial Implications for an Academic Medical Center

    Science.gov (United States)

    Kapa, Suraj; Beckman, Thomas J.; Cha, Stephen S.; Meyer, Joyce A.; Robinet, Charlotte A.; Bucher, Diane K.; Hardy, Jeanne M.; McDonald, Furman S.

    2010-01-01

    Background The financial success of academic medical centers depends largely on appropriate billing for resident-patient encounters. Objectives of this study were to develop an instrument for billing in internal medicine resident clinics, to compare billing practices among junior versus senior residents, and to estimate financial losses from inappropriate resident billing. Methods For this analysis, we randomly selected 100 patient visit notes from a resident outpatient practice. Three coding specialists used an instrument structured on Medicare billing standards to determine appropriate codes, and interrater reliability was assessed. Billing codes were converted to US dollars based on the national Medicare reimbursement list. Inappropriate billing, based on comparisons with coding specialists, was then determined for residents across years of training. Results Interrater reliability of Current Procedural Terminology components was excellent, with κ ranging from 0.76 for examination to 0.94 for diagnosis. Of the encounters in the study, 55% were underbilled by an average of $45.26 per encounter, and 18% were overbilled by an average of $51.29 per encounter. The percentages of appropriately coded notes were 16.1% for postgraduate year (PGY) 1, 26.8% for PGY-2, and 39.3% for PGY-3 residents (P < .05). Underbilling was 74.2% for PGY-1, 48.8% for PGY-2, and 42.9% for PGY-3 residents (P < .01). There was significantly less overbilling among PGY-1 residents compared with PGY-2 and PGY-3 residents (9.7% versus 24.4% and 17.9%, respectively; P < .05). Conclusions Our study reports a reliable method for assessing billing in internal medicine resident clinics. It exposed large financial losses, which were attributable to junior residents more than senior residents. The findings highlight the need for educational interventions to improve resident coding and billing. PMID:21975617

  15. Evaluation on antibiotic resistance of helicobacter pylori isolated from patients admitted to tooba medical center, Sari

    Directory of Open Access Journals (Sweden)

    Amin Talebi BezminAbadi

    2009-01-01

    Full Text Available (Received 17 March, 2009; Accepted 8 July, 2009AbstractBackground and purpose: Helicobacter pylori, which infect approximately one half of the world’s population, are an important risk factor in chronic gastritis, peptic ulcer disease, and gastric cancer. H. pylori eradication is now widely recommended as the most effective treatment of peptic ulcer disease. One of the most important reasons for treatment failure is H. pylori resistance to the antimicrobials usage in therapy. The aim of this study was to determine susceptibility patterns of H. pylori isolates in 6 routine anti-microbial agents in Northern Iran.Materials and methods: 125 patients from Tooba Medical Center in Sari with endoscopic evidence of dyspepsia complaints were used for obtaining gastric biopsies specimens. Biopsies were sent to the laboratory in thioglycolate broth (transport medium. Bacteria were primarily cultured on Columbia agar supplemented with 7% horse blood, 7% fetal calf serum. Urease, Catalase and Oxidase activities were used for H. pylori identification. Bacterial suspensions equivalent to 3 Mc. Farlands were spread on plates, along with antibiotic disks and placed in the diameter zone. Inhibition was measured after 3 days of incubation in micro-aerophilic condition.Results: H. pylori were isolated from 116(92.8% subjects, a total of 125 biopsy specimens. Resistance to metronidazole, amoxicillin, clarithromycin, tetracycline, furazolidone and ciprofloxacin were 71%, 35%, 25%, 9%, 24% and 25%, respectively. Multiple resistance (amoxicillin-clarithromycin-metronidazole were found in (65% of the isolates.Conclusion: Comparison of our data with previous results showed that prevalence of H. pylori resistance to clarithromycin, furazolidone and metronidazole has increased in Iran considerably. Resistance to amoxicillin in our study was too high in comparison with foreign studies. The present study demonstrates the need for continuous monitoring of the antimicrobial

  16. Medical SAS File (MDP)

    Data.gov (United States)

    Department of Veterans Affairs — The Medical SAS system provides a variety of SAS-formatted files containing medical data for use by VA staff. These files, and the ability to create user files, are...

  17. Effects of internal marketing on nurse job satisfaction and organizational commitment: example of medical centers in Southern Taiwan.

    Science.gov (United States)

    Chang, Ching-Sheng; Chang, Hsin-Hsin

    2007-12-01

    As nurses typically represent the largest percentage of employees at medical centers, their role in medical care is exceptionally important and becoming more so over time. The quality and functions of nurses impact greatly on medical care quality. The concept of internal marketing, with origins in the field of market research, argues that enterprises should value and respect their employees by treating them as internal customers. Such a marketing concept challenges traditional marketing methods, which focus on serving external customers only. The main objective of internal marketing is to help internal customers (employees) gain greater job satisfaction, which should promote job performance and facilitate the organization accomplishing its ultimate business objectives. A question in the medical service industry is whether internal marketing can similarly increase the job satisfaction of nurses and enhance their commitment to the organization. This study aimed to explore the relational model of nurse perceptions related to internal marketing, job satisfaction, and organizational commitment by choosing nurses from two medical centers in Southern Taiwan as research subjects. Of 450 questionnaire distributed, 300 valid questionnaires were returned, giving a response rate of 66.7%. After conducting statistical analysis and estimation using structural equation modeling, findings included: (1) job satisfaction has positive effects on organizational commitment; (2) nurse perceptions of internal marketing have positive effects on job satisfaction; and (3) nurse perceptions of internal marketing have positive effects on organizational commitment. PMID:18080971

  18. Clinical trials of boron neutron capture therapy [in humans] [at Beth Israel Deaconess Medical Center][at Brookhaven National Laboratory

    International Nuclear Information System (INIS)

    Assessment of research records of Boron Neutron Capture Therapy was conducted at Brookhaven National Laboratory and Beth Israel Deaconess Medical Center using the Code of Federal Regulations, FDA Regulations and Good Clinical Practice Guidelines. Clinical data were collected FR-om subjects' research charts, and differences in conduct of studies at both centers were examined. Records maintained at Brookhaven National Laboratory were not in compliance with regulatory standards. Beth Israel's records followed federal regulations. Deficiencies discovered at both sites are discussed in the reports

  19. New trends in medical and service robots human centered analysis, control and design

    CERN Document Server

    Chevallereau, Christine; Pisla, Doina; Bleuler, Hannes; Rodić, Aleksandar

    2016-01-01

    Medical and service robotics integrates several disciplines and technologies such as mechanisms, mechatronics, biomechanics, humanoid robotics, exoskeletons, and anthropomorphic hands. This book presents the most recent advances in medical and service robotics, with a stress on human aspects. It collects the selected peer-reviewed papers of the Fourth International Workshop on Medical and Service Robots, held in Nantes, France in 2015, covering topics on: exoskeletons, anthropomorphic hands, therapeutic robots and rehabilitation, cognitive robots, humanoid and service robots, assistive robots and elderly assistance, surgical robots, human-robot interfaces, BMI and BCI, haptic devices and design for medical and assistive robotics. This book offers a valuable addition to existing literature.

  20. An Analysis of Information Technology Adoption by IRBs of Large Academic Medical Centers in the United States.

    Science.gov (United States)

    He, Shan; Botkin, Jeffrey R; Hurdle, John F

    2015-02-01

    The clinical research landscape has changed dramatically in recent years in terms of both volume and complexity. This poses new challenges for Institutional Review Boards' (IRBs) review efficiency and quality, especially at large academic medical centers. This article discusses the technical facets of IRB modernization. We analyzed the information technology used by IRBs in large academic institutions across the United States. We found that large academic medical centers have a high electronic IRB adoption rate; however, the capabilities of electronic IRB systems vary greatly. We discuss potential use-cases of a fully exploited electronic IRB system that promise to streamline the clinical research work flow. The key to that approach utilizes a structured and standardized information model for the IRB application. PMID:25742664

  1. The Dispersal of High Risk Sexual Behaviors in Different Occupations of People Referred to Council Center of Shiraz Medical University

    Directory of Open Access Journals (Sweden)

    Pezhman Bagheri

    2012-04-01

    Full Text Available Background: High risk sexual behaviors endanger young people and adolescents to HIV infection and other sexual diseases. The objective of this study was to assess the dispersal of high risk sexual behaviors in different in our referred patients to council center of Shiraz medical university.Materials and Method: This descriptive, cross sectional study was done between 2004-2009 years on referred people to council center of Shiraz medical university by census method.Results: Maximum prevalence of high risk sexual behaviors observed in women’s barber (36%, unemployed individuals (9.51% and painters (8.53%; and the maximum referred pepole observed in drivers (28.81%, unemployed individuals (22.93% and school students (14.15%.Conclusions: Totally, according to our results, we can conclude that media and health ministry must be looking for different socio-economic groups and occupations providing special training structure

  2. Veterans Affairs Suicide Prevention Synthetic Dataset Metadata

    Data.gov (United States)

    Department of Veterans Affairs — The VA's Veteran Health Administration, in support of the Open Data Initiative, is providing the Veterans Affairs Suicide Prevention Synthetic Dataset (VASPSD). The...

  3. Veterans Affairs Suicide Prevention Synthetic Dataset

    Data.gov (United States)

    Department of Veterans Affairs — The VA's Veteran Health Administration, in support of the Open Data Initiative, is providing the Veterans Affairs Suicide Prevention Synthetic Dataset (VASPSD). The...

  4. Patient-Centered Pain Care Using Artificial Intelligence and Mobile Health Tools: Protocol for a Randomized Study Funded by the US Department of Veterans Affairs Health Services Research and Development Program

    OpenAIRE

    Piette, John D.; Krein, Sarah L; Striplin, Dana; Marinec, Nicolle; Kerns, Robert D.; Farris, Karen B.; Singh, Satinder; An, Lawrence; Heapy, Alicia A.

    2016-01-01

    Background Cognitive behavioral therapy (CBT) is one of the most effective treatments for chronic low back pain. However, only half of Department of Veterans Affairs (VA) patients have access to trained CBT therapists, and program expansion is costly. CBT typically consists of 10 weekly hour-long sessions. However, some patients improve after the first few sessions while others need more extensive contact. Objective We are applying principles from “reinforcement learning” (a field of artifici...

  5. Blood Culture Contamination in Children’s Medical Center of Tehran from April to July 2004

    Directory of Open Access Journals (Sweden)

    F Shhcheraghi

    2005-05-01

    Full Text Available Background: Blood culture is the criterion standard for identifying children with bacteremia. However, elevated false-positive rates are common and are associated with substantial health care costs. The aims of this prospective study were to: 1 determine the rate of blood culture contamination 2 determine variety and frequency of contaminant bacteria 3 compare the duration of hospital stay and antibiotic administration in patients with true bacteremia vs those have false positive blood culture. Materials and Methods: Cross-sectional study conducted April through July 2004 among patients aged 14 years or younger who were admitted at Doctor Garib Children Medical Center of Tehran and had a blood culture obtained as part of their care. Bacterial isolates were identified to species level and medical records were reviewed in all cases with a positive blood culture. A number of clinical and laboratory criteria were used to deciding whether a blood isolate is a pathogen or a contaminant. These include the identify of the micro-organism itself, clinical features such as fever and leukocytosis; the proportion of blood culture sets positive as a function of the number of sets obtained and to have an indwelling vascular catheter or prosthetic device. Results: During the study period, 2877 sets of blood culture were evaluated and the rates of positive blood cultures associated with significant bacteremia and contamination were 1.04% and 5.4% respectively. Among the positive blood cultures, over the 84% of isolates were due to contamination and only 15.95% of isolated strains associated with true infection. The frequency of isolated bacteria with respect to true infection and contamination are as following: S. Aureus (infect: 9.0%, contam: 0.0%, S. Epidemidis (infec: 0.0%, contam: 13.3%, Micrococcus sp. (infec: 0.0%, contam: 4.3%, pseudomonas and related species other than P. aeruginosa (infec: 2.1%, contam: 60.6%, viridans group of streptococci (infec: 1

  6. Health Habits of Employees in a Large Medical Center: Time Trends and Impact of a Worksite Wellness Facility

    OpenAIRE

    Abd Moain Abu Dabrh; Archana Gorty; Sarah M Jenkins; Mohammad Hassan Murad; Hensrud, Donald D.

    2016-01-01

    Worksite health interventions are not novel but their effect remains subject of debate. We examined employer-based wellness program to determine health habits trends, and compare prevalence estimates to national data. We conducted serial surveys (1996 and 2007–10) to employees of a large medical center that included questions measuring outcomes, including obesity, regular exercise, cardiovascular activity, and smoking status. Logistic regression models were estimated to compare data by member...

  7. Teaching About Culture and Health in Ontario Medical Schools: Learning about culture and health through patient-centered care

    OpenAIRE

    Hennen, B K; Blackman, N.

    1992-01-01

    Questionnaire surveys and on-site visits determined that culture and health are not a formal part of a curriculum for all students in any undergraduate or family medicine residency program in Ontario medical schools. Electives and other opportunities exist, but only some students benefit. Suggestions from the programs on how to improve such learning and make it universally available are noted. Patient-centered care is endorsed as a suitable model for learning about culture and health in the c...

  8. The Quality of Collaboration among Medical Research Centers, Universities, Health Executives and the Community in İran

    OpenAIRE

    Asefzadeh, Saeed

    2005-01-01

    A health research system is defined as a system for planning, coordinating, monitoring and managing health research resources and activities, and for promoting research aimed at effective and equitable national health development. This study was conducted to describe the quality of mutual collaboration among medical research centers, universities, executive organizations and the community. In this situation analysis qualitative methods were applied. In-depth interviews were held with the ...

  9. Impact of the Development of a Light Microscopy Shared Resource for the University of Rochester Medical Center: A Quantitative Assessment

    OpenAIRE

    Jepson, M.; Jordan, P.; Kasischke, K.; Brown, E.; Reed, A; Lentine, M.; Bushnell, T.; Puzas, E.; Callahan, L.M.

    2014-01-01

    The University of Rochester Medical Center (URMC) determined the need for a shared Light Microscopy facility to support researchers requiring high-end light microscopy for their research programs. URMC Shared Resource Laboratories (SRLs) represent a strategic investment in technology, targeted expertise, and space administration to systematically support and advance the research mission of the institution. Recognizing the need for centralized light microscopy resources to support the Universi...

  10. Safe medication management and use of narcotics in a Joint Commission International-accredited academic medical center hospital in the People's Republic of China.

    Science.gov (United States)

    Fang, Xu; Zhu, Ling-Ling; Pan, Sheng-Dong; Xia, Ping; Chen, Meng; Zhou, Quan

    2016-01-01

    Safe medication management and use of high-alert narcotics should arouse concern. Risk management experiences in this respect in a large-scale Joint Commission International (JCI)-accredited academic medical center hospital in the People's Republic of China during 2011-2015, focusing on organizational, educational, motivational, and information technological measures in storage, prescribing, preparing, dispensing, administration, and monitoring of medication are summarized. The intensity of use of meperidine in hospitalized patients in 2015 was one-fourth that in 2011. A 100% implementation rate of standard storage of narcotics has been achieved in the hospital since December 2012. A "Plan, Do, Check, Act" cycle was efficient because the ratio of number of inappropriate narcotics prescriptions to total number of narcotics prescriptions for inpatients decreased from August 2014 to December 2014 (28.22% versus 2.96%, P=0.0000), and it was controlled below 6% from then on. During the journey to good pain management ward accreditation by the Ministry of Health, People's Republic of China, (April 2012-October 2012), the medical oncology ward successfully demonstrated an increase in the pain screening rate at admission from 43.5% to 100%, cancer pain control rate from 85% to 96%, and degree of satisfaction toward pain nursing from 95.4% to 100% (all P-values person to 20.36 mg/person. A 100% implementation rate of independent double-check prior to narcotics dosing has been achieved since January 2013. From 2014 to 2015, the ratio of number of narcotics-related medication errors to number of discharged patients significantly decreased (6.95% versus 0.99%, P=0.0000). Taken together, continuous quality improvements have been achieved in safe medication management and use of narcotics by an integrated multidisciplinary collaboration during the journey to JCI accreditation and in the post-JCI accreditation era. PMID:27103812

  11. Autoverification in a core clinical chemistry laboratory at an academic medical center

    Directory of Open Access Journals (Sweden)

    Matthew D Krasowski

    2014-01-01

    Full Text Available Background: Autoverification is a process of using computer-based rules to verify clinical laboratory test results without manual intervention. To date, there is little published data on the use of autoverification over the course of years in a clinical laboratory. We describe the evolution and application of autoverification in an academic medical center clinical chemistry core laboratory. Subjects and Methods: At the institution of the study, autoverification developed from rudimentary rules in the laboratory information system (LIS to extensive and sophisticated rules mostly in middleware software. Rules incorporated decisions based on instrument error flags, interference indices, analytical measurement ranges (AMRs, delta checks, dilution protocols, results suggestive of compromised or contaminated specimens, and ′absurd′ (physiologically improbable values. Results: The autoverification rate for tests performed in the core clinical chemistry laboratory has increased over the course of 13 years from 40% to the current overall rate of 99.5%. A high percentage of critical values now autoverify. The highest rates of autoverification occurred with the most frequently ordered tests such as the basic metabolic panel (sodium, potassium, chloride, carbon dioxide, creatinine, blood urea nitrogen, calcium, glucose; 99.6%, albumin (99.8%, and alanine aminotransferase (99.7%. The lowest rates of autoverification occurred with some therapeutic drug levels (gentamicin, lithium, and methotrexate and with serum free light chains (kappa/lambda, mostly due to need for offline dilution and manual filing of results. Rules also caught very rare occurrences such as plasma albumin exceeding total protein (usually indicative of an error such as short sample or bubble that evaded detection and marked discrepancy between total bilirubin and the spectrophotometric icteric index (usually due to interference of the bilirubin assay by immunoglobulin (Ig M monoclonal

  12. Consolidated Copayment Processing Center (CCPC)

    Data.gov (United States)

    Department of Veterans Affairs — The Consolidated Copayment Processing Center (CCPC) database contains Veteran patient contact and billing information in order to support the printing and mailing...

  13. Epidemiology of sports injuries referring to Kashan University of Medical Sciences Trauma Research Center from 2005 to 2011

    Institute of Scientific and Technical Information of China (English)

    Mohammad Reza Sharif; Ali Akbarnejad; Alireza Moravveji; Rasool Hamayattalab; Mansour Sayyah

    2014-01-01

    Objective: Among the injury types, sports ones constitute a considerable proportion of patients who refer to the medical centers. This research was conducted to examine the frequency of sports-related injuries referring to Kashan University of Medical Sciences Trauma Research Center from 2005 to 2011. Methods: This was a retrospective research in which existing data from the data bank of Kashan University of Medical Sciences Trauma Research Center were employed. The data were extracted from the main source by SPSS version 16.0. Variables such as age, education, occupation and gender were analyzed. Results: The highest proportion of injuries was observed in students (59.4%) followed by workers (11.8%). Upper and lower extremities were most commonly injured. The most frequent injury was strain (35.4%), followed by sprain (27.7%). Conclusion: The results of this research showed that the majority of the sports trauma occurrs in students;therefore, they need more attention in regard to sports injuries. Preventive measures such as informing the coaches and teachers as well as increasing the students’ awareness about the injury risk can decrease the incidences of sports injuries.

  14. Final Report for The University of Texas at Arlington Optical Medical Imaging Section of Advanced Imaging Research Center

    Energy Technology Data Exchange (ETDEWEB)

    Khosrow Behbehani

    2013-02-26

    The goal of this project was to create state-of-the-art optical medical imaging laboratories for the Biomedical Engineering faculty and student researchers of the University of Texas at Arlington (UTA) on the campus of the University of Texas Southwestern Medical Center (UTSW). This has been successfully achieved. These laboratories provide an unprecedented opportunity for the bioengineers (from UTA) to bring about new breakthroughs in medical imaging using optics. Specifically, three major laboratories have been successfully established and state-of-the-art scientific instruments have been placed in the labs. As a result of this grant, numerous journal and conference publications have been generated, patents for new inventions have been filed and received, and many additional grants for the continuation of the research has been received.

  15. Patient-Centered Medical Home Adoption: Lessons Learned and Implications for Health Care System Reform.

    Science.gov (United States)

    Gurewich, Deborah; Cabral, Linda; Sefton, Laura

    2016-01-01

    Case studies of 8 primary care medical homes participating in a Massachusetts-based initiative were conducted to understand the approaches they used to operationalize medical home standards and associated barriers. All sites received their National Committee on Quality Assurance recognition as medical homes, yet varied considerably in how components were implemented. Despite this variation, they faced similar challenges to implementing and sustaining medical home standards. Variations and challenges strongly emerged in 4 areas: team-based care, scheduling and online access, identifying and managing high-risk patients, and organizing follow-up care. Our study offers insight into various pathways to medical home success, and notes areas for further study. PMID:27232687

  16. The evolution of integrative medical education:the influence of the University of Arizona Center for Integrative Medicine

    Institute of Scientific and Technical Information of China (English)

    Victoria Maizes; Randy Horwitz; Patricia Lebensohn; Hilary McClafferty; James Dalen; Andrew Weil

    2015-01-01

    The University of Arizona Center for Integrative Medicine (AzCIM) was founded in 1994 with a primary focus of educating physicians in integrative medicine (IM). Twenty years later, IM has become an international y recognized movement in medicine. With 40% of United States’ medical schools having membership in the Academic Consortium for Integrative Medicine and Health it is foreseeable that al medical students and residents wil soon receive training in the principles and practices of IM. The AzCIM has the broadest range and depth of IM educational programs and has had a major influence on integrative medical education in the United States. This review describes the fel owship, residency and medical student programs at AzCIM as wel as other significant national drivers of IM education; it also points out the chal enges faced in developing IM initiatives. The field of IM has matured with new national board certification in IM requiring fel owship training. Al ied health professional IM educational courses, as wel as integrative health coaching, assure that al members of the health care team can receive training. This review describes the evolution of IM education and wil be helpful to academic centers, health care institutions, and countries seeking to introduce IM initiatives.

  17. HMO development in an academic medical center: the rise and fall of a prepaid health program in New York city.

    Science.gov (United States)

    Bosch, S J; Deuschle, K W

    1993-08-01

    Through a documented case study the authors identify the critical factors that impede the introduction of prepaid medical care as part of education and practice within a prestigious and well established academic medical center. The inherent conflicts between individual fee-for-service practice and population-based prepaid practice and the resistance to innovations in medical care organization as they surfaced in that center, are presented. The need for a clear understanding of the complexities of HMO development and of an appreciation for the importance of a planning process in which all interested parties are involved, is emphasized. A clear commitment by policy makers, administrators and providers is highlighted as fundamental for the implementation of a system where practitioners are motivated to assume responsibility for the comprehensive care of a defined population that prepays for their services. The rewards as well as the difficulties for institutionalizing commitment to this form of health care delivery and impacting on medical education are discussed. PMID:8408749

  18. Judicial Affairs and the Future.

    Science.gov (United States)

    Pavela, Gary

    1996-01-01

    American colleges and universities will play an increasingly important role in revitalizing a national sense of identity and community. Judicial affairs offices can contribute to that process by helping students define and protect values essential to community life. (Author)

  19. Student Affairs and the Bicentennial

    Science.gov (United States)

    Dinniman, Andrew E.

    1974-01-01

    Student Affairs professionals have an active role to play in our nation's anniversary celebration, according to the author. In this article, he describes briefly some Bicentennial programs at different universities and colleges throughout the U.S. (Author/HMV)

  20. Collaborative Academic Training of Psychiatrists and Psychologists in VA and Medical School Settings

    Science.gov (United States)

    Scaturo, Douglas J.; Huszonek, John J.

    2009-01-01

    Objective: The authors review the background and contemporary strengths of Dean's Committee Veterans Affairs Medical Centers in the collaborative academic training of psychiatrists and psychologists. Methods: The authors discuss the problems and prospects of the current health care environment as it impacts the behavioral health treatment of…

  1. 78 FR 10608 - David Grant United States Air Force Medical Center Specialty Care Travel Reimbursement...

    Science.gov (United States)

    2013-02-14

    ... adequate clinical case mix of patients for approved Graduate Medical Education program functioning in the... currency and deployment capability through increased patient acuity and volume. Under this demonstration... on MTF productivity, provider currency in the identified specialties, and utilization of...

  2. Development of a Hospital-based Massage Therapy Course at an Academic Medical Center

    OpenAIRE

    Dion, Liza J.; Cutshall, Susanne M.; Rodgers, Nancy J.; Hauschulz, Jennifer L.; Dreyer, Nikol E.; Thomley, Barbara S.; Bauer, Brent

    2015-01-01

    Background: Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substanti...

  3. Enhanced Performance of Community Health Service Centers during Medical Reforms in Pudong New District of Shanghai, China: A Longitudinal Survey.

    Directory of Open Access Journals (Sweden)

    Xiaoming Sun

    Full Text Available The performance of community health service centers (CHSCs has not been well monitored and analysed since China's latest community health reforms in 2009. The aim of the current investigation was to evaluate the performing trends of the CHSCs and to analyze the main factors that could affect the performance in Pudong new district of Shanghai, China.A regional performance assessment indicator system was applied to the evaluation of Pudong CHSCs' performance from 2011 to 2013. All of the data were sorted out by a panel, and analyzed using descriptive statistics and a generalized estimating equation model.We found that the overall performance increased annually, with a growing number of CHSCs achieving high scores. Significant differences were observed in institutional management, public health services, basic medical services and comprehensive satisfaction during the period of three years. However, we found no differences in the service scores of Chinese traditional medicine (CTM. The investigation also demonstrated that the key factors affecting performance were the location, information system level, family GP program and medical association program rather than the size of the center. However, the medical association participation appeared to have a significant negative effect on performance.It can be concluded from the three-year investigation that the overall performance was improved, but that it could have been further enhanced, especially in institutional management and basic medical service; therefore, it is imperative that CHSCs undertake approaches such as optimizing the resource allocation and utilization, reinforcing the establishment of the information system level, extending the family GP program to more local communities, and promoting the medical association initiative.

  4. NHSC Jobs Center for Primary Care Medical, Dental and Mental Health Providers

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Health Service Corps (NHSC) Jobs Center is a tool designed to make data and information concerning NHSC job vacancies more readily available to our...

  5. Prevalence and Predictors of Self-Medication with Antibiotics in Al Wazarat Health Center, Riyadh City, KSA

    Directory of Open Access Journals (Sweden)

    Abdulrahman Al Rasheed

    2016-01-01

    Full Text Available Background. Antibiotics are responsible for most dramatic improvement in medical therapy in history. These medications contributed significantly to the decreasing mortality and morbidity when prescribed based on evidence of microbial infection. Objective. The aim of this study was to determine the prevalence and predictors of self-prescription with antibiotics in Al Wazarat Health Center, Riyadh City, Kingdom of Saudi Arabia. Material and Methods. Cross-sectional study was conducted in Al Wazarat Health Center between February 2014 and November 2014. Respondents were randomly selected using a multistage clustered random sampling technique. Data was entered into SPSS version 21 and analyzed. Descriptive statistics and multiple logistic regression models were applied. Results. A total of 681 patients have participated in this study with a response rate of 92%. The prevalence of self-prescription with antibiotics in Al Wazarat Health Center was 78.7%. Amoxicillin was the most used self-prescribed antibiotic with prevalence of (22.3%. Friend advice on self-prescription of antibiotics use (p=0.000 and pharmacy near to the participants (p=0.002 were the most common predictors for self-prescription with antibiotics. Conclusion. The level of self-prescribing antibiotics is relatively high among participants. Health education on the appropriate use of antibiotics is highly recommended. The proper use of treatment guidelines for antibiotic therapy will significantly reduce self-prescription with antibiotics.

  6. Improving diabetes medication adherence: successful, scalable interventions

    Directory of Open Access Journals (Sweden)

    Zullig LL

    2015-01-01

    Full Text Available Leah L Zullig,1,2 Walid F Gellad,3,4 Jivan Moaddeb,2,5 Matthew J Crowley,1,2 William Shrank,6 Bradi B Granger,7 Christopher B Granger,8 Troy Trygstad,9 Larry Z Liu,10 Hayden B Bosworth1,2,7,11 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Medicine, Duke University, Durham, NC, USA; 3Center for Health Equity Research and Promotion, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, PA, USA; 4Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; 5Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA; 6CVS Caremark Corporation; 7School of Nursing, Duke University, Durham, NC, USA; 8Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; 9North Carolina Community Care Networks, Raleigh, NC, USA; 10Pfizer, Inc., and Weill Medical College of Cornell University, New York, NY, USA; 11Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA Abstract: Effective medications are a cornerstone of prevention and disease treatment, yet only about half of patients take their medications as prescribed, resulting in a common and costly public health challenge for the US healthcare system. Since poor medication adherence is a complex problem with many contributing causes, there is no one universal solution. This paper describes interventions that were not only effective in improving medication adherence among patients with diabetes, but were also potentially scalable (ie, easy to implement to a large population. We identify key characteristics that make these interventions effective and scalable. This information is intended to inform healthcare systems seeking proven, low resource, cost-effective solutions to improve medication adherence. Keywords: medication adherence, diabetes mellitus, chronic disease, dissemination research

  7. Client-Centered Advocacy: Every Occupational Therapy Practitioner's Responsibility to Understand Medical Necessity.

    Science.gov (United States)

    Stover, Alyson D

    2016-01-01

    Occupational therapy practitioners must advocate for clients in multiple ways. The Occupational Therapy Practice Framework: Domain and Process as well as the Occupational Therapy Code of Ethics lend support to advocacy. Recognizing one's responsibility to provide advocacy for clients is different from knowing how to provide that advocacy. One aspect of health care affected by the Patient Protection and Affordable Care Act (ACA) is the definition and implementation of medical necessity. This article outlines some major concepts around medical necessity, particularly in relation to the passage of the ACA, and outlines guidance on how to advocate effectively to meet both individual and community needs. PMID:27548855

  8. Criterion validity of a competency-based assessment center in medical education – a 4-year follow-up study

    Directory of Open Access Journals (Sweden)

    Thomas Rotthoff

    2014-09-01

    Full Text Available Introduction: Core competencies have progressively gained importance in medical education. In other contexts, especially personnel selection and development, assessment centers (ACs are used to assess competencies, but there is only a limited number of studies on competency-based ACs in medical education. To the best of our knowledge, the present study provides the first data on the criterion-related validity of a competency-based AC in medical education. Methods: We developed an AC tailored to measure core competencies relevant to medical education (social-ethical, communicative, self, and teaching and tested its validity in n=30 first-year medical students using 3- to 4-year follow-up measures such as (a objective structured clinical examinations (OSCE on basic clinical skills (n=26, (b OSCE on communication skills (n=21, and (c peer feedback (n=18. The AC contained three elements: interview, group discussion, and role play. Additionally, a self-report questionnaire was provided as a basis for the interview. Results: Baseline AC average score and teaching competency correlated moderately with the communication OSCE average score (r=0.41, p=0.03, and r=0.38, p=0.04, respectively. Social-ethical competency in the AC showed a very strong convergent association with the communication OSCE average score (r=0.60, p0.05. Conclusion: The results showed that competency-based ACs can be used at a very early stage of medical training to successfully predict future performance in core competencies.

  9. 76 FR 71045 - Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and...

    Science.gov (United States)

    2011-11-16

    ... treatment of allergic disease that appeared in the Federal Register of September 26, 2011 (76 FR 59407). In... INFORMATION: I. Background In the Federal Register of September 26, 2011 (76 FR 59407), FDA published a notice... Scientific and Medical Literature and Information on Non-Standardized Allergenic Extracts in the...

  10. A Three Year Undergraduate Program (B.SC) in Medical Radiation Physics in the Ariel University Center of Samaria

    International Nuclear Information System (INIS)

    A three year undergraduate program (B.Sc.) in Medical Radiation Physics was established in the Ariel University Center of Samaria. The program was submitted to the Council of Higher Education (MALAG) in 2003 and was finally approved by the Council on October 2005. Registration for the first class was announced in January 2006. Studies started on October 2006. Of 24 candidates who applied, 16 were admitted. 12 of the 16 students completed their study duties in the first year. All of them started their second year studies in October 2007

  11. Molecular Epidemiology of CTX-M-Producing Escherichia coli Isolates at a Tertiary Medical Center in Western Pennsylvania▿

    OpenAIRE

    Sidjabat, Hanna E.; Paterson, David L.; Adams-Haduch, Jennifer M.; Ewan, Lindsay; Pasculle, Anthony W.; Muto, Carlene A.; Tian, Guo-Bao; Doi, Yohei

    2009-01-01

    A combination of phenotypic and genotypic methods was used to investigate 70 unique Escherichia coli clinical isolates identified as producing extended-spectrum β-lactamases (ESBLs) at a medical center in Pittsburgh, PA, between 2007 and 2008. Fifty-seven isolates (81%) produced CTX-M-type ESBLs, among which CTX-M-15 was predominant (n = 46). Isolates producing CTX-M-2, -9, -14, and -65 were also identified. One CTX-M-producing isolate coproduced CMY-2 cephalosporinase. Ten isolates (14%) pro...

  12. Management of ductal carcinoma in situ of the breast--experiences from National Naval Medical Center during last 10 years.

    OpenAIRE

    Park, S. T.; Hamilton, M.; Ghosh, B. C.

    1997-01-01

    Seventy-one ductal carcinoma in situ (DCIS) patients were reported to the tumor registry at the National Naval Medical Center between 1986 and 1995. This number represents 6.5% of all breast cancer patients. We did not include the patients with microinvasion or infiltrating ductal carcinoma with extensive DCIS in this study. After excluding 16 cases because of inaccessable clinical records, 55 cases of pure DCIS were analyzed. The mean age at presentation was 52.0 years (32 year-old to 74 yea...

  13. Physician Satisfaction in Practices That Transformed Into Patient-Centered Medical Homes: A Statewide Study in New York.

    Science.gov (United States)

    Richardson, Joshua E; Kern, Lisa M; Silver, Michael; Jung, Hye-Young; Kaushal, Rainu

    2016-07-01

    Patient-centered medical home (PCMH) transformation can significantly affect physicians' job satisfaction, which in turn can affect the quality of patient care. Between November 2012 and March 2013, the study team surveyed 159 community-based physicians in 159 practice sites that had experienced PCMH practice transformations in New York State. Of the 159 physicians, 121 responded (77% response rate) to the online survey. Nearly two thirds (60%) of physicians reported being somewhat or very satisfied overall with their practice after PCMH transformation. Overall satisfaction was lower than satisfaction with specific domains of practice: patient-centered care (82%), coordination of care (81%), access to care (79%), efficiency (76%), organizational culture (69%), and quality (69%). Although the physicians were moderately satisfied with care quality in their practices after PCMH transformation, their overall satisfaction was notably lower. The findings reveal a need to identify factors beyond quality for measuring physician satisfaction in PCMH transformed practices. PMID:25877964

  14. Can record and verify systems eliminate radiotherapy delivery errors? The Rambam Medical Center experience

    International Nuclear Information System (INIS)

    Full text: The use of record and verify (R and V) systems in radiotherapy departments has been well known for a long period of time. These tools, originally created for recording and verifying radiation field parameters, have developed into comprehensive systems that now allow for completely paper-less radiotherapy clinics. In the Radiotherapy Unit at Rambam Medical Center, 190 patients are treated daily (08:00- 19:00) with four linear accelerators (linacs). During the last two years, three of our accelerators (ELEKTA Precise, VARIAN 600C and VARIAN 1800) have been connected to the IMPAC MultiAccess system. Because of technology differences between the accelerators, the implementation and connection to the IMPAC system was not identical for the different linacs. However, in all cases, recording and verification of treatment parameters were possible. Twenty palliative patients are treated on a Varian 6-100 machine that was not connected to the IMPAC system because of its old technology and planned replacement. We also expected that administrative aspects, such as patient's treatment scheduling, would be improved. The implementation of the system was not meant to replace our 'paper' radiotherapy chart but to be used in parallel with it. As a result we expected an increase in the workload of the staff involved in the treatment planning and delivery process. Until the introduction of the system, the workflow of the patient's treatment parameters was as follows: I - Treatment dose is prescribed by the physician and written in the chart; II - Treatment plan is performed (2D or 3D), and all treatment parameters (setup and dosimetry) are defined/calculated by the technologist/physicist or dosimetrist and written in the chart; III - Treatment dosimetric parameters are checked by a senior physicist; IV - Treatment setup parameters are checked by a senior technologist; V - Treatment is delivered and manually recorded. In the above described process, we can find several weak

  15. Multidisciplinary HIS DICOM interfaces at the Department of Veterans Affairs

    Science.gov (United States)

    Kuzmak, Peter M.; Dayhoff, Ruth E.

    2000-05-01

    The U.S. Department of Veterans Affairs (VA) is using the Digital Imaging and Communications in Medicine (DICOM) standard to integrate image data objects from multiple systems for use across the healthcare enterprise. DICOM uses a structured representation of image data and a communication mechanism that allows the VA to easily acquire images from multiple sources and store them directly into the online patient record. The VA can obtain both radiology and non- radiology images using DICOM, and can display them on low-cost clinician's color workstations throughout the medical center. High-resolution gray-scale diagnostic quality multi-monitor workstations with specialized viewing software can be used for reading radiology images. The VA's DICOM capabilities can interface six different commercial Picture Archiving and Communication Systems (PACS) and over twenty different image acquisition modalities. The VA is advancing its use of DICOM beyond radiology. New color imaging applications for Gastrointestinal Endoscopy and Ophthalmology using DICOM are under development. These are the first DICOM offerings for the vendors, who are planning to support the recently passed DICOM Visible Light and Structured Reporting service classes. Implementing these in VistA is a challenge because of the different workflow and software support for these disciplines within the VA HIS environment.

  16. 3 CFR - Medicare Demonstration To Test Medical Homes in Federally Qualified Health Centers

    Science.gov (United States)

    2010-01-01

    ... health information technology and electronic health records. One of the key benefits health centers... improvement, access to care, communication with patients, and care management and coordination. These... any right or benefit, substantive or procedural, enforceable at law or in equity by any party...

  17. Latino Faculty Development in U.S. Medical Schools: A Hispanic Center of Excellence Perspective

    Science.gov (United States)

    Soto-Greene, Maria L.; Sanchez, Jorge; Churrango, Jose; Salas-Lopez, Debbie

    2005-01-01

    Traditionally, faculty development programs and fellowships have been shown to successfully address the developmental needs of individual faculty members. Despite positive results, there are very few programs targeted specifically toward career development for Latino and other minority faculty. The Hispanic Center of Excellence, as a Bureau of…

  18. Treatment Outcomes From a Specialist Model for Treating Tobacco Use Disorder in a Medical Center

    OpenAIRE

    Burke, Michael V; Jon O Ebbert; Schroeder, Darrell R.; McFadden, David D.; Hays, J Taylor

    2015-01-01

    Abstract Cigarette smoking causes premature mortality and multiple morbidity; stop smoking improves health. Higher rates of smoking cessation can be achieved through more intensive treatment, consisting of medication and extended counseling of patients, but there are challenges to integrating these interventions into healthcare delivery systems. A care model using a master-level counselor trained as a tobacco treatment specialist (TTS) to deliver behavioral intervention, teamed with a supervi...

  19. The Problem-Oriented Medical Synopsis: a patient-centered clinical information system.

    OpenAIRE

    Stitt, F W

    1993-01-01

    A clinical information system consists of four major components: the clinical database, decision support, data analysis (including outcomes), and the development system. We have created such a system using generally available database methodology. The clinical database, for record-keeping, is called the Problem-Oriented Medical Synopsis, and is quite an old system, originating in 1966. We describe the suitability of a problem-oriented model of clinical records management to the relational mod...

  20. Health Habits of Employees in a Large Medical Center: Time Trends and Impact of a Worksite Wellness Facility.

    Science.gov (United States)

    Abu Dabrh, Abd Moain; Gorty, Archana; Jenkins, Sarah M; Murad, Mohammad Hassan; Hensrud, Donald D

    2016-01-01

    Worksite health interventions are not novel but their effect remains subject of debate. We examined employer-based wellness program to determine health habits trends, and compare prevalence estimates to national data. We conducted serial surveys (1996 and 2007-10) to employees of a large medical center that included questions measuring outcomes, including obesity, regular exercise, cardiovascular activity, and smoking status. Logistic regression models were estimated to compare data by membership across years, considering p-values ≤ 0.01 as statistically significant. 3,206 employees responded (Response rates 59-68%). Obesity prevalence increased over time in members and nonmembers of the wellness facility, consistent with national trends. Members had a lower prevalence of cigarette smoking compared to nonmembers (overall year-adjusted odds ratio 0.66, P < 0.001). Further, employees had a lower prevalence of cigarette smoking (9.7 vs. 17.3% in 2010, P < 0.001) compared with national data. Wellness facility membership was associated with increased regular exercise and cardiovascular exercise (P < 0.001) compared to nonmembers. In summary, working in a medical center was associated with a decreased prevalence of cigarette smoking, but not with lower prevalence of obesity. Worksite wellness facility membership was associated with increased exercise and decreased cigarette smoking. Employer-based interventions may be effective in improving some health behaviors. PMID:26864205

  1. "ETIOLOGY AND ANTIBACTERIAL RESISTANCE OF BACTERIAL URINARY TRACT INFECTIONS IN CHILDREN’S MEDICAL CENTER, TEHRAN, IRAN"

    Directory of Open Access Journals (Sweden)

    M. Haghi-Ashteiani

    2007-06-01

    Full Text Available Urinary tract infection (UTI is a common bacterial illness in children. Knowledge of the antimicrobial resistance patterns of common uropathogens in children according to local epidemiology is essential for providing clinically appropriate, cost effective therapy for UTI. The aim of this study was to determine the distribution of urinary tract infections in a referral hospital, Children’s Medical Center, and determination of in vitro susceptibility of these organisms to antimicrobial agents. Of the 1231 bacterial isolates the most frequent isolates were Escherichia coli (38.66%, Klebsiella spp. (22.25%, Coagulase-negative staphylococci (10.1%, Pseudomonas spp. (8.7%, enterococci (8.28%, Enterobacter spp. (4.1%, staphylococcus aureus (3.24%, and proteus mirabilis (2.9%. Among Enterobacteriaceae, 79.80% of E. coli were amikacin-sensitive. Of Gram-positive cocci, 66.66% of staphylococcus aureus were vancomycin-sensitive. Our data show the original distribution of uropathogens from UTIs in children referred to Children’s Medical Center in Tehran and the emergence of multidrug resistant strains.

  2. Strong leadership and teamwork drive culture and performance change: Ohio State University Medical Center 2000-2006.

    Science.gov (United States)

    Sanfilippo, Fred; Bendapudi, Neeli; Rucci, Anthony; Schlesinger, Leonard

    2008-09-01

    Several characteristics of academic health centers have the potential to create high levels of internal conflict and misalignment that can pose significant leadership challenges. In September 2000, the positions of Ohio State University (OSU) senior vice president for health sciences, dean of the medical school, and the newly created position of chief executive officer of the OSU Medical Center (OSUMC) were combined under a single leader to oversee the OSUMC. This mandate from the president and trustees was modeled after top institutions with similar structures. The leader who assumed the role was tasked with improving OSUMC's academic, clinical, and financial performance. To achieve this goal, the senior vice president and his team employed the service value chain model of improving performance, based on the premise that leadership behavior/culture drives employee engagement/satisfaction, leading to customer satisfaction and improved organizational performance. Implementing this approach was a seven-step process: (1) selecting the right leadership team, (2) assessing the challenges and opportunities, (3) setting expectations for performance and leadership behavior, (4) aligning structures and functions, (5) engaging constituents, (6) developing leadership skills, and (7) defining strategies and tracking goals. The OSUMC setting during this period provides an observational case study to examine how these stepwise changes, instituted by strong leadership and teamwork, were able to make and implement sound decisions that drove substantial and measurable improvements in the engagement and satisfaction of faculty and staff; the satisfaction of students and patients; and academic, clinical, and financial performance. PMID:18728440

  3. Evaluation of interventional endoscopy unit efficiency metrics at a tertiary academic medical center

    OpenAIRE

    Yang, Dennis; Summerlee, Robert; Suarez, Alejandro L.; Perbtani, Yaseen; Williamson, J. Blair; Shrode, Charles W.; Gupte, Anand R.; Shailendra S. Chauhan; Draganov, Peter V; Forsmark, Chris E.; Wagh, Mihir S.

    2015-01-01

    Background and study aims: There is an increasing demand for interventional endoscopic services and the need to develop efficient endoscopic units. The aim of this study was to analyze performance data and define metrics to improve efficiency in a single academic interventional endoscopy center. ]Patients and methods: The prospective operations performance data (6-month period) of our interventional endoscopy unit (EU) was analyzed. First-case start time (FIRST) delay was defined as any time ...

  4. Office of International Affairs sponsors World Food Day telecast, canned food drive

    OpenAIRE

    Rich, Miriam Sommers

    2009-01-01

    Virginia Tech's Office of International Affairs will host the 2009 World Food Day teleconference on Oct. 16 from noon to 3 p.m. This year's broadcast will be held in the Cardinal Room at Squires Student Center.

  5. Carbon Monoxide Information Center

    Medline Plus

    Full Text Available ... Chairman Commissioners Contact Information Agency Reports Legislative Affairs Job Opportunities Inspector General Safety Guides Safety Education Centers OnSafety Blog Neighborhood Safety Network Community Outreach ...

  6. The Fetal Magnetic Resonance Imaging Experience in a Large Community Medical Center

    Directory of Open Access Journals (Sweden)

    Peter M Ghobrial

    2011-01-01

    Full Text Available Fetal magnetic resonance imaging (MRI continues to prove a useful problem solving tool for diagnostic and management decision making issues encountered in the antenatal period. In this paper, we attempt to review basic fetal MRI protocol considerations and demonstrate key imaging findings through multiple modalities, with pathologic correlation in several cases. A study of five fetal MRI cases, from our institution, were selected in order to highlight both the indications for, and benefits obtained from this advanced imaging technique. Fetal MRI proved useful in each case in better defining fetal anomalies, especially where ultrasound (due to drawbacks such as shadowing by pelvic bones was unable to be completely diagnostic. The more in-depth study made possible by MRI also helped with formulation of disease prognosis and estimation of survival chances of the fetus. Further, MRI as a diagnostic and prognostic tool has become more ubiquitous across the medical community. This imparts tangible benefit to patients, who are now able to find this service within arm′s reach. Whereas previously these patients were obligatorily referred up to 90 miles away from our centre for further medical work-up, now a large percentage can obtain their prenatal imaging and perinatal care locally. In addition, medical education benefits as new types of cases, those with pathology of the antenatal period, are retained for work-up and management in these large community settings. Cases from our institution exemplify these types of pathologies, from fetal chest masses to a syndromic presentation of bilateral renal agenesis.

  7. Marshall Space Flight Center Electromagnetic Compatibility Design and Interference Control (MEDIC) handbook

    Science.gov (United States)

    Clark, T. L.; McCollum, M. B.; Trout, D. H.; Javor, K.

    1995-06-01

    The purpose of the MEDIC Handbook is to provide practical and helpful information in the design of electrical equipment for electromagnetic compatibility (EMS). Included is the definition of electromagnetic interference (EMI) terms and units as well as an explanation of the basic EMI interactions. An overview of typical NASA EMI test requirements and associated test setups is given. General design techniques to minimize the risk of EMI and EMI suppression techniques at the board and equipment interface levels are presented. The Handbook contains specific EMI test compliance design techniques and retrofit fixes for noncompliant equipment. Also presented are special tests that are useful in the design process or in instances of specification noncompliance.

  8. Assessment of medical waste management at a primary health-care center in São Paulo, Brazil

    International Nuclear Information System (INIS)

    Highlights: ► Assessment of medical waste management at health-care center before/after intervention. ► Qualitative and quantitative results of medical waste management plan are presented. ► Adjustments to comply with regulation were adopted and reduction of waste was observed. ► The method applied could be useful for similar establishments. - Abstract: According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of São Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized. Total waste generation increased 9.8%, but it was possible to reduce the volume of non

  9. Medical Care Cost Recovery National Database (MCCR NDB)

    Data.gov (United States)

    Department of Veterans Affairs — The Medical Care Cost Recovery National Database (MCCR NDB) provides a repository of summary Medical Care Collections Fund (MCCF) billing and collection information...

  10. The Evaluation of Individuals who applied to Family Medicine Center for Medical Marriage Report

    Directory of Open Access Journals (Sweden)

    Bilge Yıldırım E

    2015-10-01

    Full Text Available Marriage is a spiritual and physical union of two people, supposed to last for a lifetime. According to Turkish Civil Law article 136, couples are obliged by municipal authorities to get a medical report in order to get permission to marry. In this context, although it varies among regions, some biochemical evaluations are required from couples at the time of admission. This study evaluates the laboratory parameters of the couples who admitted to outpatient clinic of Family Medicine at Istanbul Medeniyet University Göztepe Training and Research Hospital between years 2012-2013 in order to get medical report. Among 290 applicants evaluated 148 were women. There was no clinical or laboratory finding for VDRL, AntiHCV or radiological tuberculosis positivity. Two applicants had positivity for AntiHIV and 7 applicants had positive HBsAg. In accordance with these findings, the importance of giving counseling is obvious rather than only evaluating the health situations of these couples. It is obvious that efficient counseling provides the generation of a healthy population by helping the couples avoid genetically or sexually transmitted diseases. Therefore ‘to protect the unborn offspring and achieve a healthier population’ is both the responsibility and the ‘chance’ of the primary care system and the physician.

  11. Advancing LGBT Health at an Academic Medical Center: A Case Study.

    Science.gov (United States)

    Yehia, Baligh R; Calder, Daniel; Flesch, Judd D; Hirsh, Rebecca L; Higginbotham, Eve; Tkacs, Nancy; Crawford, Beverley; Fishman, Neil

    2015-12-01

    Academic health centers are strategically positioned to impact the health of lesbian, gay, bisexual and transgender (LGBT) populations by advancing science, educating future generations of providers, and delivering integrated care that addresses the unique health needs of the LGBT community. This report describes the early experiences of the Penn Medicine Program for LGBT Health, highlighting the favorable environment that led to its creation, the mission and structure of the Program, strategic planning process used to set priorities and establish collaborations, and the reception and early successes of the Program. PMID:26788778

  12. Accreditation the Education Development Centers of Medical-Sciences Universities: Another Step toward Quality Improvement in Education

    Directory of Open Access Journals (Sweden)

    M Mohagheghi

    2013-01-01

    Full Text Available Background: : In order to improve the quality of education in universities of medical sciences (UMS, and because of the key role of education development centers (EDCs, an accreditation scheme was developed to evaluate their performance.Method: A group of experts in the medical education field was selected based on pre-defined criteria by EDC of Ministry of Health and Medical education. The team, worked intensively for 6 months to develop a list of essential standards to assess the performance of EDCs. Having checked for the content validity of standards, clear and measurable indicators were created via consensus. Then, required information were collected from UMS EDCs; the first round of accreditation was carried out just to check the acceptability of this scheme, and make force universities to prepare themselves for the next factual round of accreditation.Results: Five standards domains were developed as the conceptual framework for defining main categories of indicators. This included: governing and leadership, educational planning, faculty development, assessment and examination and research in education. Nearly all of UMS filled all required data forms precisely with minimum confusion which shows the practicality of this accreditation scheme.Conclusion: It seems that the UMS have enough interest to provide required information for this accreditation scheme. However, in order to receive promising results, most of universities have to work intensively in order to prepare minimum levels in all required standards. However, it seems that in long term, implementation of a valid accreditation scheme plays an important role in improvement of the quality of medical education around the country.

  13. Veterans Affairs Central Cancer Registry (VACCR)

    Data.gov (United States)

    Department of Veterans Affairs — The Veterans Affairs Central Cancer Registry (VACCR) receives and stores information on cancer diagnosis and treatment constraints compiled and sent in by the local...

  14. Clinical skills training in undergraduate medical education using a student-centered approach

    DEFF Research Database (Denmark)

    Tolsgaard, Martin Grønnebæk

    2013-01-01

    professors. This study showed that student teachers performed as good as or even better than associate professors when teaching simple clinical skills. The second study of this thesis examined how complex clinical skills--such as patient management skills--develop with increasing levels of competence. The...... practicing in pairs significantly out-performed those training alone using RIME-based assessments and that dyad training significantly improved students' confidence in managing future patient encounters. The final study examined students' use of self-directed clinical encounter cards (CECs) based on the RIME......This thesis focuses on how to engage students in self-directed learning and in peer-learning activities to improve clinical skills training in undergraduate medical education. The first study examined the clinical skills teaching provided by student teachers compared to that provided by associate...

  15. Experience with a sustained policy of radiation exposure control and research in a medical center

    International Nuclear Information System (INIS)

    The development of a radiation protection policy and its implementation over a 27-yr period are described. Radiation uses included radionuclides and radiation generators for diagnosis, treatment and research. The original policy has been successfully applied and personnel radiation exposure has been controlled despite increasing radiation uses. The program included research and development on measurement and reduction of staff and patient exposure; the development of ionization chambers for different diagnostic energy ranges, including mammographic; a special 'flat' chamber for high energy therapy installation surveys; and the design of phantoms. A record of over 95% of the 'exposed population' with exposures below 0.5 rem/yr has been achieved, with maximum exposures substantially less than 2.0 rem. At the same time new procedures of improved quality have developed for uses of radiation. The achievement of radiation control has facilitated rather than inhibited medical uses of radiation. (author)

  16. Changes in Enterococcal and E coli populations and related antibiotic resistance from medical center to receiving environment

    Science.gov (United States)

    Petit, F.; Berthe, T.; Oberle, K.; Denamur, E.; Clermont, O.; Leclercq, R.; Cattoir, V.; Budzinski, H.

    2013-12-01

    The spread of antibiotic-resistant faecal bacteria and their corresponding genes in water environment, as a result of the overuse of antibiotics, have become an ecological and a public problem. The aim of this multidisciplinary research program (FLASH) -associating chemists, hydrologists, clinical and environmental microbiologists- was to determine to what extent the hospital effluent have an ecological impact on the downstream aquatic environment. For this purpose, fate of Escherichia coli (distribution of phylogenetic groups, antibiotic resistance, integrons- 342 strains) and Enterococci (diversity, antibiotic resistance, genes ermB, mefA, clonal complex 17- 235 strains ) was analyzed in water and sediments along a medical center - WWTP - river - estuary continuum, during a high epidemiologic period in the North west of France. A multi-residue chemical methodology was developed in order to detect low levels of 34 antibiotics in water. To link occurrence of antibiotic-resistant bacteria in water and antibiotic prescription, we use the data collection from the hospital and the antibiotics sales information. In the medical center, the main prescribed antibiotic (amoxicillin) was weakly found in effluents. Along the continuum, contamination of water by antibiotics decreased from 160μg.L-1 (cefotaxim) in hospital effluents to 1ng.L-1 (ofloxacin) in the river. These concentrations were too low to exert a selective pressure (mg.L-1) on antibiotic-resistant bacteria. In same samples, occurrences of antibiotic-resistant E. coli and those harboring a class 1 integrons decreased significantly (p-value water microcosm experiment (< 2days). Once in the estuary, E. coli and the corresponding antibiotic-resistance genes are submitted to the particle dynamics and are deposited on mudflats. Among Enterococcus populations, E. faecium was mainly isolated (from 89% to 98%). All E. faecium isolates from medical center effluents were multiply antibiotic-resistant, contained erm

  17. Clinical skills training in undergraduate medical education using a student-centered approach

    DEFF Research Database (Denmark)

    Tolsgaard, Martin Grønnebæk

    2013-01-01

    professors. This study showed that student teachers performed as good as or even better than associate professors when teaching simple clinical skills. The second study of this thesis examined how complex clinical skills--such as patient management skills--develop with increasing levels of competence. The...... practicing in pairs significantly out-performed those training alone using RIME-based assessments and that dyad training significantly improved students' confidence in managing future patient encounters. The final study examined students' use of self-directed clinical encounter cards (CECs) based on the RIME...... development initiatives are required before implementation in large and dispersed settings. In conclusion, this thesis demonstrated different aspects of student-centered approaches to clinical skills learning. Whereas self-directed learning is difficult in clinical clerkship, the experimental studies...

  18. Evaluation of a Worksite Diabetes Education Program at a Large Urban Medical Center.

    Science.gov (United States)

    Renda, Susan; Baernholdt, Marianne; Becker, Kathleen

    2016-01-01

    Evidence suggests that diabetes education can be delivered at the worksite to better support employees' diabetes self-management and improve productivity and health care costs. This study was conducted to address the feasibility of a diabetes worksite education program for employees at a large urban academic health care institution. The diabetes education program was delivered in the diabetes center at the institution, a resource that was previously underutilized by employees. Through collaboration with groups in the institution, 20 employees of diverse ethnicity participated in the worksite diabetes education program with positive outcomes: improved glycemic control measured (HbA1c), attainment of self-management goals, and satisfaction with the program. Work absences trended downward, but numbers of hospitalizations and emergency department visits were unchanged in the 3 months following education. Recommendations include replication of the study with more employee participation and program evaluation over a longer period of time to continue assessment of employees' educational needs. PMID:26458409

  19. Presentation and treatment of venomous snakebites at a northern academic medical center.

    Science.gov (United States)

    Cowles, Robert A; Colletti, Lisa M

    2003-05-01

    Poisonous snakebites are relatively rare in the United States. The incidence of venomous snakebites is comparatively high in the southern states compared with the northern states and reports of these accidents from northern states is particularly uncommon. We report the experience with treatment of venomous snakebites at the University of Michigan over a 25-year period from 1976 to 2001. Six cases were identified and are described in detail. All patients were male and all were bitten in the upper extremity by pit vipers. One patient suffered a moderate envenomation and was treated with antivenin. Four other cases of mild envenomation occurred and two of these cases required antivenin therapy. One case was considered to represent a "dry" bite and required only 24-hour observation. There were no severe envenomations and no mortalities. On short-term follow-up all patients recovered without sequelae. This report demonstrates that venomous snakebites can be treated effectively at low-volume centers. PMID:12769221

  20. Information Communication Technology (ICT) Shaping Student Affairs.

    Science.gov (United States)

    Broughton, Elizabeth

    This paper opens with the following questions: "How prepared are you as a student affairs professional for information communication technology (ICT)? Do you understand such concepts as portals, e-business, Napster, computer use policies, and wireless communication? Will student affairs be shaped by ICT or will student affairs help shape ICT on…

  1. A GUIDE TO UNDERSTANDING WORLD AFFAIRS.

    Science.gov (United States)

    ROGERS, WILLIAM C.

    WRITTEN IN EVERYDAY ENGLISH, THIS READING BOOK PRESENTS MANY FACTS AND IDEAS ABOUT WORLD AFFAIRS. CHAPTERS COVER INTERNATIONAL LIFE, POWER IN WORLD AFFAIRS, WAR AS INTERNATIONAL CONFLICT, THE MEANS AND VARIETIES OF ARMED CONFLICT, INTERNATIONAL CONFLICT SHORT OF WAR, THE ACCOMMODATION OF CONFLICT IN WORLD AFFAIRS, AND PEACE--WHAT IT IS AND HOW TO…

  2. 911 Call Center (PSAP) Service Areas, Homeland Security Infrastructure Program- public safety answer point boundaries, Published in 2008, 1:100000 (1in=8333ft) scale, Georgia Department of Community Affairs.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This 911 Call Center (PSAP) Service Areas dataset, published at 1:100000 (1in=8333ft) scale, was produced all or in part from Other information as of 2008. It is...

  3. Medical treatment for older people and people with disabilities: 1989 developments. National Legal Center Staff.

    Science.gov (United States)

    1990-01-01

    Pending before the United States Supreme Court are cases involving eligibility of children with disabilities for Supplemental Security Income (SSI) benefits and a guardian's authority to withhold nutrition and hydration from a permanently disabled but not terminally ill ward. The United States Commission on Civil Rights has issued a comprehensive report demonstrating evidence of current discrimination against infants with disabilities and examining current legal protections. In the federal courts, litigation continues in a case brought by parents on behalf of their infants with disabilities who were allegedly denied medical treatment on the basis of disability. State courts continue to examine the rights of competent and incompetent patients to forgo life-sustaining treatment, including nutrition and hydration. Discrimination against persons with AIDS or HIV continues to affect their access to health care. In 1989 forty states and the District of Columbia have "living will" legislation, and nine states have durable power of attorney for health care laws; however, the provisions of each vary from state to state. PMID:2138594

  4. Interactive radiopharmaceutical facility between Yale Medical Center and Brookhaven National Laboratory. Progress report, October 1976-June 1979

    International Nuclear Information System (INIS)

    DOE Contract No. EY-76-S-02-4078 was started in October 1976 to set up an investigative radiochemical facility at the Yale Medical Center which would bridge the gap between current investigation with radionuclides at the Yale School of Medicine and the facilities in the Chemistry Department at the Brookhaven National Laboratory. To facilitate these goals, Dr. Mathew L. Thakur was recruited who joined the Yale University faculty in March of 1977. This report briefly summarizes our research accomplishments through the end of June 1979. These can be broadly classified into three categories: (1) research using indium-111 labelled cellular blood components; (2) development of new radiopharmaceuticals; and (3) interaction with Dr. Alfred Wolf and colleagues in the Chemistry Department of Brookhaven National Laboratory

  5. Damping in quantum love affairs

    CERN Document Server

    Bagarello, Fabio

    2011-01-01

    In a series of recent papers we have used an operatorial technique to describe stock markets and, in a different context, {\\em love affairs} and their time evolutions. The strategy proposed so far does not allow any dumping effect. In this short note we show how, within the same framework, a strictly non periodic or quasi-periodic effect can be introduced in the model by describing in some details a linear Alice-Bob love relation with damping.

  6. Simplistic and complex thought in medicine: the rationale for a person-centered care model as a medical revolution

    Directory of Open Access Journals (Sweden)

    Reach G

    2016-04-01

    Full Text Available Gérard Reach1,2 1Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital AP-HP, 2EA 3412, Centre de Recherche en Nutrition Humaine Ile-de-France (CRNH-IDF, Paris 13 University, Sorbonne Paris Cité, Bobigny, France Abstract: According to the concept developed by Thomas Kuhn, a scientific revolution occurs when scientists encounter a crisis due to the observation of anomalies that cannot be explained by the generally accepted paradigm within which scientific progress has thereto been made: a scientific revolution can therefore be described as a change in paradigm aimed at solving a crisis. Described herein is an application of this concept to the medical realm, starting from the reflection that during the past decades, the medical community has encountered two anomalies that, by their frequency and consequences, represent a crisis in the system, as they deeply jeopardize the efficiency of care: nonadherence of patients who do not follow the prescriptions of their doctors, and clinical inertia of doctors who do not comply with good practice guidelines. It is proposed that these phenomena are caused by a contrast between, on the one hand, the complex thought of patients and doctors that sometimes escapes rationalization, and on the other hand, the simplification imposed by the current paradigm of medicine dominated by the technical rationality of evidence-based medicine. It is suggested therefore that this crisis must provoke a change in paradigm, inventing a new model of care defined by an ability to take again into account, on an individual basis, the complex thought of patients and doctors. If this overall analysis is correct, such a person-centered care model should represent a solution to the two problems of patients’ nonadherence and doctors’ clinical inertia, as it tackles their cause. These considerations may have important implications for the teaching and the practice of medicine. Keywords: person-centered

  7. Use of a data warehouse at an academic medical center for clinical pathology quality improvement, education, and research

    Directory of Open Access Journals (Sweden)

    Matthew D Krasowski

    2015-01-01

    Full Text Available Background: Pathology data contained within the electronic health record (EHR, and laboratory information system (LIS of hospitals represents a potentially powerful resource to improve clinical care. However, existing reporting tools within commercial EHR and LIS software may not be able to efficiently and rapidly mine data for quality improvement and research applications. Materials and Methods: We present experience using a data warehouse produced collaboratively between an academic medical center and a private company. The data warehouse contains data from the EHR, LIS, admission/discharge/transfer system, and billing records and can be accessed using a self-service data access tool known as Starmaker. The Starmaker software allows users to use complex Boolean logic, include and exclude rules, unit conversion and reference scaling, and value aggregation using a straightforward visual interface. More complex queries can be achieved by users with experience with Structured Query Language. Queries can use biomedical ontologies such as Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine. Result: We present examples of successful searches using Starmaker, falling mostly in the realm of microbiology and clinical chemistry/toxicology. The searches were ones that were either very difficult or basically infeasible using reporting tools within the EHR and LIS used in the medical center. One of the main strengths of Starmaker searches is rapid results, with typical searches covering 5 years taking only 1-2 min. A "Run Count" feature quickly outputs the number of cases meeting criteria, allowing for refinement of searches before downloading patient-identifiable data. The Starmaker tool is available to pathology residents and fellows, with some using this tool for quality improvement and scholarly projects. Conclusion: A data warehouse has significant potential for improving utilization of clinical pathology testing

  8. Commotio Cordis Caused by Violence in China: Epidemiological Characteristics Detected at the Tongji Forensic Medical Center.

    Science.gov (United States)

    Mu, Jiao; Chen, Zhenglian; Chen, Xinshan; Lin, Wei; Dong, Hongmei

    2015-12-01

    Commotio cordis (CC) is a recognized rare cause of sudden death in which an apparently minor blow to the chest causes ventricular fibrillation and cardiac arrest. CC diagnosis is still a challenge for forensic pathologists. A retrospective study of 9794 autopsy cases was conducted at the Department of Forensic Medicine, Tongji Medical College (DFM-TMC, China) from 1955 to 2014. A total of 39 cases (0.4%) were determined to be caused by CC. A male preponderance (male to female of 37:2) was found in the victims, whose age ranged from 13 to 47 years, including more than 85% individuals in their 10s and 20s. Most victims (27 cases, 69.2%) came from village. The highest rate of victims was found for middle school and college students (15 cases, 38.5%), followed by prisoners (11 cases, 28.2%), farmers (9 cases, 23.1%), workers (3 cases, 7.7%), and office staff (1 case, 2.6%). Chest blows were produced by fists (28 cases, 71.8%), feet (6 cases, 15.4%), knee (2 case, 5.1%), head (1 case, 2.6%), or objects (2 cases, 5.1%). Witness statements indicated that most victims collapsed after being impacted in the precordium. The autopsy findings were unremarkable except bruises, contusions, or subcutaneous hemorrhage in the anterior chest (13 cases), bleeding of intercostal muscles (5 cases), and disperse focal petechiae of the epicardium (11 cases). All CC cases in this study were caused by violent attacks and related to criminal processes. Correct diagnosis of CC due to violence has important implications in the judicial system. PMID:26705218

  9. Intravenous leiomyomatosis revisited: an experience of 14 cases at a single medical center.

    Science.gov (United States)

    Carr, Ryan J; Hui, Pei; Buza, Natalia

    2015-03-01

    Intravenous leiomyomatosis (IVL) is a rare neoplasm of smooth muscle origin with the capacity for distant vascular and/or organ extension. The primary lesion is typically found in the uterus, with the most common extrauterine sites being pelvic/broad ligament vessels, and less often inferior vena cava, right heart chambers, and pulmonary vasculature. Extrauterine involvement can result in direct mass effect or vascular obstruction with associated clinical sequelae. Fourteen cases of IVL were identified in our pathology archives over a 25-yr period. Patient medical records and gross pathologic findings were reviewed. Histologic and related immunohistochemical slides (smooth muscle actin, desmin, CD31, CD34, and CD10) were re-evaluated by 2 gynecologic pathologists to confirm the diagnosis using conventional diagnostic criteria. Patient age at initial diagnosis ranged from 35 to 64 yr (mean: 46.1 yr), with a median age of 45 yr. Four cases demonstrated extrauterine extension, 2 cases were associated with disease recurrence, and 1 case was found to be extrauterine in origin (i.e. arising from the broad ligament). In summary, our study represents the fourth largest IVL cohort in literature to date, and contains the first case of IVL arising from the broad ligament in the absence of a uterine mass. IVL is a rare and potentially underdiagnosed neoplastic condition of smooth muscle origin that may result in significant morbidity when extrauterine vasculature or organs are involved. A high index of suspicion must be maintained, as the histologic diagnosis may be particularly challenging in cases in which the intracaval/intracardiac portion of the tumor is removed before the uterine IVL diagnosis, or a significant interval of time has elapsed since the initial IVL diagnosis was made. Prompt diagnosis combined with surgical excision has been shown to portend an increased survival rate and good overall prognosis in such cases. PMID:25675187

  10. Duodenal Aspirates for Small Intestine Bacterial Overgrowth: Yield, PPIs, and Outcomes after Treatment at a Tertiary Academic Medical Center

    Directory of Open Access Journals (Sweden)

    Diana L. Franco

    2015-01-01

    Full Text Available Duodenal aspirates are not commonly collected, but they can be easily used in detection of small intestinal bacterial overgrowth (SIBO. Proton pump inhibitor (PPI use has been proposed to contribute to the development of SIBO. We aimed to determine the yield of SIBO-positive cultures detected in duodenal aspirates, the relationship between SIBO and PPI use, and the clinical outcomes of patients identified by this method. In a retrospective study, we analyzed electronic medical records from 1263 consecutive patients undergoing upper endoscopy at a tertiary medical center. Aspirates were collected thought out the third and fourth portions of the duodenum, and cultures were considered to be positive for SIBO if they produced more than 100,000 cfu/mL. Culture analysis of duodenal aspirates identified SIBO in one-third of patients. A significantly higher percentage of patients with SIBO use PPIs than patients without SIBO, indicating a possible association. Similar proportions of patients with SIBO improved whether or not they received antibiotic treatment, calling into question the use of this expensive therapy for this disorder.

  11. Duodenal Aspirates for Small Intestine Bacterial Overgrowth: Yield, PPIs, and Outcomes after Treatment at a Tertiary Academic Medical Center.

    Science.gov (United States)

    Franco, Diana L; Disbrow, Molly B; Kahn, Allon; Koepke, Laura M; Harris, Lucinda A; Harrison, M Edwyn; Crowell, Michael D; Ramirez, Francisco C

    2015-01-01

    Duodenal aspirates are not commonly collected, but they can be easily used in detection of small intestinal bacterial overgrowth (SIBO). Proton pump inhibitor (PPI) use has been proposed to contribute to the development of SIBO. We aimed to determine the yield of SIBO-positive cultures detected in duodenal aspirates, the relationship between SIBO and PPI use, and the clinical outcomes of patients identified by this method. In a retrospective study, we analyzed electronic medical records from 1263 consecutive patients undergoing upper endoscopy at a tertiary medical center. Aspirates were collected thought out the third and fourth portions of the duodenum, and cultures were considered to be positive for SIBO if they produced more than 100,000 cfu/mL. Culture analysis of duodenal aspirates identified SIBO in one-third of patients. A significantly higher percentage of patients with SIBO use PPIs than patients without SIBO, indicating a possible association. Similar proportions of patients with SIBO improved whether or not they received antibiotic treatment, calling into question the use of this expensive therapy for this disorder. PMID:25694782

  12. Helping cancer patients across the care continuum: the navigation program at the Queen's Medical Center.

    Science.gov (United States)

    Allison, Amanda L; Ishihara-Wong, Debra D M; Domingo, Jermy B; Nishioka, Jocelyn; Wilburn, Andrea; Tsark, JoAnn U; Braun, Kathryn L

    2013-04-01

    Research suggests that cancer patient navigation improves care, but few reports describe the variety of patients managed by a hospital-based navigation program. Differences in navigated patients by the intensity (low, medium, or high) of navigation services they received were examined. The 835 clients seen by the navigators in a hospital-based cancer center were first stratified by quarter and by four ethnic groups. Randomized selection from each group assured there would be equal representation for analysis of Hawaiians, Filipinos, Japanese, and Whites and even numbers over all time intervals. Five professionals extracted data from these case records on demographics, type/stage of cancer, diagnosis and treatment dates, barriers, and navigator actions. Clients had breast (30.0%), lung (15.8%), esophageal (6.7%), colon (5.8%), ovarian (4.2%), prostate (3.3%), and other cancers (34.2%). The median number of actions taken on behalf of a client was 4 (range 1-83), and the median number of days a case was open was 14 (range 1-216). High intensity cases (those receiving more assistance over longer periods of time) were more likely than low-intensity cases to need help with education and reassurance, transportation, care coordination, and covering costs. Although there were no demographic differences across intensity groups, Neighbor Island patients from Hawai'i, Maui, Moloka'i, Lana'i and Kaua'i were more likely to need help with arranging travel, care coordination, and costs associated with getting treatment (all at P=.05), and patients on public insurance were more likely to have stage 4 cancer (P=.001) and to need help with costs (P=.006). Findings suggest that this hospital-based navigation program is filling a real need of patients across the cancer care continuum. A triage protocol and an integrated data capture system could help improve the targeting and documentation of cancer patient navigation services. PMID:23795311

  13. Rating and Classification of Incident Reporting in Radiology in a Large Academic Medical Center.

    Science.gov (United States)

    Mansouri, Mohammad; Aran, Shima; Shaqdan, Khalid W; Abujudeh, Hani H

    2016-01-01

    The purpose of this article is to provide a rate of safety incident report of adverse events in a large academic radiology department and to share the various types that may occur. This is a Health Insurance Portability and Accountability Act compliant, institutional review board-approved study. Consent requirement was waived. All incident reports from April 2006-September 2012 were retrieved. Events were further classified as follows: diagnostic test orders, identity document or documentation or consent, safety or security or conduct, service coordination, surgery or procedure, line or tube, fall, medication or intravenous safety, employee general incident, environment or equipment, adverse drug reaction (ADR), skin or tissue, and diagnosis or treatment. Overall rates and subclassification rates were calculated. There were 10,224 incident reports and 4,324,208 radiology examinations (rate = 0.23%). The highest rates of the incident reports were due to diagnostic test orders (34.3%; 3509/10,224), followed by service coordination (12.2%; 1248/10,224) and ADR (10.3%; 1052/4,324,208). The rate of incident reporting was highest in inpatient (0.30%; 2949/970,622), followed by emergency radiology (0.22%; 1500/672,958) and outpatient (0.18%; 4957/2,680,628). Approximately 48.5% (4947/10,202) of incidents had no patient harm and did not affect the patient, followed by no patient harm, but did affect the patient (35.2%, 3589/10,202), temporary or minor patient harm (15.5%, 1584/10,202), permanent or major patient harm (0.6%, 62/10,202), and patient death (0.2%, 20/10,202). Within an academic radiology department, the rate of incident reports was only 0.23%, usually did not harm the patient, and occurred at higher rates in inpatients. The most common incident type was in the category of diagnostic test orders, followed by service coordination, and ADRs. PMID:27020256

  14. Is video review of patient encounters an effective tool for medical student learning? A review of the literature

    OpenAIRE

    Hammoud MM; Morgan HK; Edwards ME; Lyon JA; White C.

    2012-01-01

    Maya M Hammoud1, Helen K Morgan1, Mary E Edwards2, Jennifer A Lyon2, Casey White31Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA; 2Health Sciences Center Libraries, University of Florida, Gainesville, FL, USA; 3Graduate Medical Education, Faculty Affairs and Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USAPurpose: To determine if video review of student performance during patient encounters is an ...

  15. Performance of three prognostic models in patients with cancer in need of intensive care in a medical center in China.

    Directory of Open Access Journals (Sweden)

    XueZhong Xing

    Full Text Available The aim of this study was to evaluate the performance of Acute Physiology and Chronic Health Evaluation II (APACHE II, Simplified Acute Physiology Score 3 (SAPS 3, and Acute Physiology and Chronic Health Evaluation IV (APACHE IV in patients with cancer admitted to intensive care unit (ICU in a single medical center in China.This is a retrospective observational cohort study including nine hundred and eighty one consecutive patients over a 2-year period.The hospital mortality rate was 4.5%. When all 981 patients were evaluated, the area under the receiver operating characteristic curve (AUROC, 95% Confidential Intervals of the three models in predicting hospital mortality were 0.948 (0.914-0.982, 0.863 (0.804-0.923, and 0.873 (0.813-0.934 for SAPS 3, APACHE II and APACHE IV respectively. The p values of Hosmer-Lemeshow statistics for the models were 0.759, 0.900 and 0.878 for SAPS 3, APACHE II and APACHE IV respectively. However, SAPS 3 and APACHE IV underestimated the in-hospital mortality with standardized mortality ratio (SMR of 1.5 and 1.17 respectively, while APACHE II overestimated the in-hospital mortality with SMR of 0.72. Further analysis showed that discrimination power was better with SAPS 3 than with APACHE II and APACHE IV whether for emergency surgical and medical patients (AUROC of 0.912 vs 0.866 and 0.857 or for scheduled surgical patients (AUROC of 0.945 vs 0.834 and 0.851. Calibration was good for all models (all p > 0.05 whether for scheduled surgical patients or emergency surgical and medical patients. However, in terms of SMR, SAPS 3 was both accurate in predicting the in-hospital mortality for emergency surgical and medical patients and for scheduled surgical patients, while APACHE IV and APACHE II were not.In this cohort, we found that APACHE II, APACHE IV and SAPS 3 models had good discrimination and calibration ability in predicting in-hospital mortality of critically ill patients with cancer in need of intensive care. Of

  16. Prevalence of ductal carcinoma insitu of the breast in Tehran university medical centers: evaluation of 2244 cases

    Directory of Open Access Journals (Sweden)

    Omranipour R

    2009-10-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Detection rate of Ductal Carcinoma Insitu of the breast (DCIS have increased rapidly over the past decade, which is generally attributed to the widespread use of screening mammography. The aim of this study was to evaluate the prevalence of ductal carcinoma in situ in patients who had been referred to Tehran university medical centers."n"nMethods: In a retrospective study, medical records of the patients with diagnosis of breast cancer in 3 teaching hospitals of Tehran University of Medical Sciences (Cancer Institute, Sina and Shariati Hospitals between 1994-2003 were reviewed and records with ductal carcinoma in situ were selected and analyzed."n"nResults: Between 2244 medical records of breast cancer 23 patients had DCIS (1.02%. Mean age was 47.3 years just one patient had been detected by screening mammography and others had clinical symptoms. 48% of patients had mass with mean size of 3.3cm. All had undergone open biopsy (four incisional, 19 excisional. Treatment included 65.2% modified radical mastectomy, 30.4% lumpectomy with axillary dissections and 3.8% lumpectomy alone. Nine patients had radiotherapy after surgery and ten took tamoxifen as hormonal therapy. Two patients (8.6% in lumpectomy group

  17. 77 FR 20887 - Proposed Information Collection (National Acquisition Center Customer Response Survey) Activity...

    Science.gov (United States)

    2012-04-06

    ... solicits comments on the information needed to measure customer satisfaction with delivered products and... AFFAIRS Proposed Information Collection (National Acquisition Center Customer Response Survey) Activity...: Department of Veterans Affairs (VA) National Acquisition Center Customer Response Survey, VA Form 0863....

  18. A qualidade de vida de jovens portadores de espinha bífida do Children's National Medical Center – Washington DC The quality of life of adolescents with spina bifida at the Children's National Medical Center – Washington DC

    Directory of Open Access Journals (Sweden)

    Ana Helena Rotta Soares

    2006-09-01

    Full Text Available O presente artigo tem como objetivo explorar a qualidade de vida de jovens portadores de espinha bífida atendidos no Children's National Medical Center em Washington DC. A pesquisa baseia-se em uma perspectiva qualitativa que utiliza como referencial teórico central a "Teoria do estigma" e as discussões conceituais sobre as dimensões de qualidade de vida. Foram entrevistados 15 jovens do serviço acima citado, sendo que 8 deles participaram de um grupo focal construído através das questões levantadas durante entrevistas. Os discursos dos jovens em questão refletem a necessidade de categorias mais englobantes que não remetam a uma pulverização da experiência de vida. Evidenciou-se uma estrutura de desigualdade nas interações entre saudáveis e deficientes, e reproduzida pelos próprios jovens. Os resultados demonstram que o estigma se encontra presente em todas as dimensões da vida dos sujeitos, interferindo na inserção social, construção subjetiva do jovem e sua auto-estima, reforçando o papel do portador de deficiência como uma "não-pessoa". Embora a categoria sexualidade não seja priorizada em outros instrumentos para esta população, o tema se faz presente e central na discussão da experiência da vida dos mesmos.The present article explores the quality of life of adolescents with spina bifida at the Children's National Medical Center in Washington DC. The research is based on a qualitative perspective that utilizes the "Theory of stigma" as the central theoretical framework, in addition to the discussions of the concept of quality of life and its dimensions. Fifteen adolescents were interviewed at the above institution, eight of which then participated in a focal group structured through issues that emerged during this previous phase. The discourses reflected the need for more encompassing categories for quality of life that do not pulverize the life experience. The adolescent's discourses demonstrate an inequality

  19. Safety-evaluation report related to the renewal of the operating license for the research reactor at the Omaha Veterans Administration Medical Center (Docket No. 50-131)

    International Nuclear Information System (INIS)

    This Safety Evaluation Report for the application filed by the Omaha Veterans Administration Medical Center (OVAMC) for a renewal of operating license number R-57 to continue to operate a research reactor has been prepared by the Office of Nuclear Reactor Regulation of the US Nuclear Regulatory Commission. This facility is owned and operated by the Veterans Administration and is located in its Medical Center in the city of Omaha, Nebraska. The staff concludes that TRIGA reactor facility can continue to be operated by OVAMC without endangering the health and safety of the public

  20. Elements of the patient-centered medical home associated with health outcomes among veterans: the role of primary care continuity, expanded access, and care coordination.

    Science.gov (United States)

    Nelson, Karin; Sun, Haili; Dolan, Emily; Maynard, Charles; Beste, Laruen; Bryson, Christopher; Schectman, Gordon; Fihn, Stephan D

    2014-01-01

    Care continuity, access, and coordination are important features of the patient-centered medical home model and have been emphasized in the Veterans Health Administration patient-centered medical home implementation, called the Patient Aligned Care Team. Data from more than 4.3 million Veterans were used to assess the relationship between these attributes of Patient Aligned Care Team and Veterans Health Administration hospitalization and mortality. Controlling for demographics and comorbidity, we found that continuity with a primary care provider was associated with a lower likelihood of hospitalization and mortality among a large population of Veterans receiving VA primary care. PMID:25180648

  1. Profile of substance abusers attending at de-addiction center of GMERS medical college, Dharpur-Patan, Gujarat, India: a cross sectional study

    OpenAIRE

    Suraj Khandhedia; Raval, Chintan M; Nilesh Thakor

    2015-01-01

    Background: Although the history of substance abuse is as old as mankind itself, recently it has become a global problem that is influenced by social, economic, political, and psychosocial factors. The objective of the study was to study the socio-demographic profile of patients attending at de-addiction center. Methods: The present cross sectional study was conducted at de-addiction center of GMERS Medical College, Dharpur-Patan, North Gujarat, India during December 2014 to July 2015. Aft...

  2. Revolution in nuclear detection affairs

    Energy Technology Data Exchange (ETDEWEB)

    Stern, Warren M. [Nonproliferation and National Security Department, Brookhaven National Laboratory, Upton, New York (United States)

    2014-05-09

    The detection of nuclear or radioactive materials for homeland or national security purposes is inherently difficult. This is one reason detection efforts must be seen as just one part of an overall nuclear defense strategy which includes, inter alia, material security, detection, interdiction, consequence management and recovery. Nevertheless, one could argue that there has been a revolution in detection affairs in the past several decades as the innovative application of new technology has changed the character and conduct of detection operations. This revolution will likely be most effectively reinforced in the coming decades with the networking of detectors and innovative application of anomaly detection algorithms.

  3. Simplistic and complex thought in medicine: the rationale for a person-centered care model as a medical revolution.

    Science.gov (United States)

    Reach, Gérard

    2016-01-01

    According to the concept developed by Thomas Kuhn, a scientific revolution occurs when scientists encounter a crisis due to the observation of anomalies that cannot be explained by the generally accepted paradigm within which scientific progress has thereto been made: a scientific revolution can therefore be described as a change in paradigm aimed at solving a crisis. Described herein is an application of this concept to the medical realm, starting from the reflection that during the past decades, the medical community has encountered two anomalies that, by their frequency and consequences, represent a crisis in the system, as they deeply jeopardize the efficiency of care: nonadherence of patients who do not follow the prescriptions of their doctors, and clinical inertia of doctors who do not comply with good practice guidelines. It is proposed that these phenomena are caused by a contrast between, on the one hand, the complex thought of patients and doctors that sometimes escapes rationalization, and on the other hand, the simplification imposed by the current paradigm of medicine dominated by the technical rationality of evidence-based medicine. It is suggested therefore that this crisis must provoke a change in paradigm, inventing a new model of care defined by an ability to take again into account, on an individual basis, the complex thought of patients and doctors. If this overall analysis is correct, such a person-centered care model should represent a solution to the two problems of patients' nonadherence and doctors' clinical inertia, as it tackles their cause. These considerations may have important implications for the teaching and the practice of medicine. PMID:27103790

  4. Evaluating the value of a web-based natural medicine clinical decision tool at an academic medical center

    Directory of Open Access Journals (Sweden)

    Karpa Kelly

    2011-10-01

    Full Text Available Abstract Background Consumer use of herbal and natural products (H/NP is increasing, yet physicians are often unprepared to provide guidance due to lack of educational training. This knowledge deficit may place consumers at risk of clinical complications. We wished to evaluate the impact that a natural medicine clinical decision tool has on faculty attitudes, practice experiences, and needs with respect to H/NP. Methods All physicians and clinical staff (nurse practitioners, physicians assistants (n = 532 in departments of Pediatrics, Family and Community Medicine, and Internal Medicine at our medical center were invited to complete 2 electronic surveys. The first survey was completed immediately before access to a H/NP clinical-decision tool was obtained; the second survey was completed the following year. Results Responses were obtained from 89 of 532 practitioners (16.7% on the first survey and 87 of 535 (16.3% clinicians on the second survey. Attitudes towards H/NP varied with gender, age, time in practice, and training. At baseline, before having an evidence-based resource available, nearly half the respondents indicated that they rarely or never ask about H/NP when taking a patient medication history. The majority of these respondents (81% indicated that they would like to learn more about H/NP, but 72% admitted difficulty finding evidence-based information. After implementing the H/NP tool, 63% of database-user respondents indicated that they now ask patients about H/NP when taking a drug history. Compared to results from the baseline survey, respondents who used the database indicated that the tool significantly increased their ability to find reliable H/NP information (P Conclusions Our results demonstrate healthcare provider knowledge and confidence with H/NP can be improved without costly and time-consuming formal H/NP curricula. Yet, it will be challenging to make providers aware of such resources.

  5. KNOWLEDGE AND BEHAVIOR REGARDING SWINE FLU AMONG INTERNS AT INDEX MEDICAL COLLEGE, HOSPITAL & RESEARCH CENTER, INDORE (M.P.

    Directory of Open Access Journals (Sweden)

    Shireen

    2014-03-01

    Full Text Available BACKGROUND: Swine flu is an acute respiratory disease, caused by a strain of influenza type A virus known as H1N1. On 11 June 2009, the World Health Organization (WHO raised its pandemic alert level to the highest one, from phase 5 which represent a strong signal that a pandemic is imminent to phase 6, which shows full global pandemic. OBJECTIVES: To determine student knowledge, awareness, attitude and behavior regarding swine flu and its vaccination at the Index Medical College, Hospital & Research Center, Indore (M.P. MATERIAL & METHODS: This was a cross sectional study, carried out during March- April 2013 among, 209 Interns posted in various department, at Index Medical College. SPSS version 20 was used for statistical analysis. Study population was interviewed through pre-tested and pre-designed questionnaire. RESULT: 98.3% of the study population had previously heard of Swine flu. Newspaper was major source of information regarding swine flu in 38.3% followed by TV. Running Nose as a most common symptom was known to 21.8% only. 60.1% believed that pork eating can spread this disease. Only 2.1% believed in Hand washing as a mode of prevention. CONCLUSION: The results reflected the importance of health education as a cornerstone element in improving KAP towards influenza A/H1N1 infection. The study thrones light on the need of continuous health education of students to improve their awareness, attitude and practice regarding prevention of A/H1N1 virus.

  6. Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads.

    Science.gov (United States)

    Philpot, Lindsey M; Stockbridge, Erica L; Padrón, Norma A; Pagán, José A

    2016-06-01

    Three out of 4 Medicare beneficiaries have multiple chronic conditions, and managing the care of this growing population can be complex and costly because of care coordination challenges. This study assesses how different elements of the patient-centered medical home (PCMH) model may impact the health care expenditures of Medicare beneficiaries with the most prevalent chronic disease dyads (ie, co-occurring high cholesterol and high blood pressure, high cholesterol and heart disease, high cholesterol and diabetes, high cholesterol and arthritis, heart disease and high blood pressure). Data from the 2007-2011 Medical Expenditure Panel Survey suggest that increased access to PCMH features may differentially impact the distribution of health care expenditures across health care service categories depending on the combination of chronic conditions experienced by each beneficiary. For example, having no difficulty contacting a provider after regular hours was associated with significantly lower outpatient expenditures for beneficiaries with high cholesterol and diabetes (n = 635; P = 0.038), but it was associated with significantly higher inpatient expenditures for beneficiaries with high blood pressure and high cholesterol (n = 1599; P = 0.015), and no significant differences in expenditures in any category for beneficiaries with high blood pressure and heart disease (n = 1018; P > 0.05 for all categories). However, average total health care expenditures are largely unaffected by implementing the PCMH features considered. Understanding how the needs of Medicare beneficiaries with multiple chronic conditions can be met through the adoption of the PCMH model is important not only to be able to provide high-quality care but also to control costs. (Population Health Management 2016;19:206-211). PMID:26440215

  7. Use of CAHPS® patient experience survey data as part of a patient-centered medical home quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Quigley DD

    2015-07-01

    Full Text Available Denise D Quigley,1 Peter J Mendel,1 Zachary S Predmore,2 Alex Y Chen,3 Ron D Hays41RAND Corporation, Santa Monica, CA, 2RAND Corporation, Boston, MA, 3AltaMed Health Services Corporation, 4Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USAObjective: To describe how practice leaders used Consumer Assessment of Healthcare Providers and Systems (CAHPS® Clinician and Group (CG-CAHPS data in transitioning toward a patient-centered medical home (PCMH.Study design: Interviews conducted at 14 primary care practices within a large urban Federally Qualified Health Center in California.Participants: Thirty-eight interviews were conducted with lead physicians (n=13, site clinic administrators (n=13, nurse supervisors (n=10, and executive leadership (n=2.Results: Seven themes were identified on how practice leaders used CG-CAHPS data for PCMH transformation. CAHPS® was used: 1 for quality improvement (QI and focusing changes for PCMH transformation; 2 to maintain focus on patient experience; 3 alongside other data; 4 for monitoring site-level trends and changes; 5 to identify, analyze, and monitor areas for improvement; 6 for provider-level performance monitoring and individual coaching within a transparent environment of accountability; and 7 for PCMH transformation, but changes to instrument length, reading level, and the wording of specific items were suggested.Conclusion: Practice leaders used CG-CAHPS data to implement QI, develop a shared vision, and coach providers and staff on performance. They described how CAHPS® helped to improve the patient experience in the PCMH model, including access to routine and urgent care, wait times, provider spending enough time and listening carefully, and courteousness of staff. Regular reporting, reviewing, and discussing of patient-experience data alongside other clinical quality and productivity measures at multilevels of the organization was critical in maximizing the

  8. Patient-Centered Pain Care Using Artificial Intelligence and Mobile Health Tools: Protocol for a Randomized Study Funded by the US Department of Veterans Affairs Health Services Research and Development Program

    Science.gov (United States)

    Krein, Sarah L; Striplin, Dana; Marinec, Nicolle; Kerns, Robert D; Farris, Karen B; Singh, Satinder; An, Lawrence; Heapy, Alicia A

    2016-01-01

    Background Cognitive behavioral therapy (CBT) is one of the most effective treatments for chronic low back pain. However, only half of Department of Veterans Affairs (VA) patients have access to trained CBT therapists, and program expansion is costly. CBT typically consists of 10 weekly hour-long sessions. However, some patients improve after the first few sessions while others need more extensive contact. Objective We are applying principles from “reinforcement learning” (a field of artificial intelligence or AI) to develop an evidence-based, personalized CBT pain management service that automatically adapts to each patient’s unique and changing needs (AI-CBT). AI-CBT uses feedback from patients about their progress in pain-related functioning measured daily via pedometer step counts to automatically personalize the intensity and type of patient support. The specific aims of the study are to (1) demonstrate that AI-CBT has pain-related outcomes equivalent to standard telephone CBT, (2) document that AI-CBT achieves these outcomes with more efficient use of clinician resources, and (3) demonstrate the intervention’s impact on proximal outcomes associated with treatment response, including program engagement, pain management skill acquisition, and patients’ likelihood of dropout. Methods In total, 320 patients with chronic low back pain will be recruited from 2 VA healthcare systems and randomized to a standard 10 sessions of telephone CBT versus AI-CBT. All patients will begin with weekly hour-long telephone counseling, but for patients in the AI-CBT group, those who demonstrate a significant treatment response will be stepped down through less resource-intensive alternatives including: (1) 15-minute contacts with a therapist, and (2) CBT clinician feedback provided via interactive voice response calls (IVR). The AI engine will learn what works best in terms of patients’ personally tailored treatment plans based on daily feedback via IVR about their

  9. Role of HIS/RIS DICOM interfaces in the integration of imaging into the Department of Veterans Affairs healthcare enterprise

    Science.gov (United States)

    Kuzmak, Peter M.; Dayhoff, Ruth E.

    1998-07-01

    The U.S. Department of Veterans Affairs is integrating imaging into the healthcare enterprise using the Digital Imaging and Communication in Medicine (DICOM) standard protocols. Image management is directly integrated into the VistA Hospital Information System (HIS) software and clinical database. Radiology images are acquired via DICOM, and are stored directly in the HIS database. Images can be displayed on low- cost clinician's workstations throughout the medical center. High-resolution diagnostic quality multi-monitor VistA workstations with specialized viewing software can be used for reading radiology images. DICOM has played critical roles in the ability to integrate imaging functionality into the Healthcare Enterprise. Because of its openness, it allows the integration of system components from commercial and non- commercial sources to work together to provide functional cost-effective solutions (see Figure 1). Two approaches are used to acquire and handle images within the radiology department. At some VA Medical Centers, DICOM is used to interface a commercial Picture Archiving and Communications System (PACS) to the VistA HIS. At other medical centers, DICOM is used to interface the image producing modalities directly to the image acquisition and display capabilities of VistA itself. Both of these approaches use a small set of DICOM services that has been implemented by VistA to allow patient and study text data to be transmitted to image producing modalities and the commercial PACS, and to enable images and study data to be transferred back.

  10. There is no "i" in teamwork in the patient-centered medical home: defining teamwork competencies for academic practice.

    Science.gov (United States)

    Leasure, Emily L; Jones, Ronald R; Meade, Lauren B; Sanger, Marla I; Thomas, Kris G; Tilden, Virginia P; Bowen, Judith L; Warm, Eric J

    2013-05-01

    Evidence suggests that teamwork is essential for safe, reliable practice. Creating health care teams able to function effectively in patient-centered medical homes (PCMHs), practices that organize care around the patient and demonstrate achievement of defined quality care standards, remains challenging. Preparing trainees for practice in interprofessional teams is particularly challenging in academic health centers where health professions curricula are largely siloed. Here, the authors review a well-delineated set of teamwork competencies that are important for high-functioning teams and suggest how these competencies might be useful for interprofessional team training and achievement of PCMH standards. The five competencies are (1) team leadership, the ability to coordinate team members' activities, ensure appropriate task distribution, evaluate effectiveness, and inspire high-level performance, (2) mutual performance monitoring, the ability to develop a shared understanding among team members regarding intentions, roles, and responsibilities so as to accurately monitor one another's performance for collective success, (3) backup behavior, the ability to anticipate the needs of other team members and shift responsibilities during times of variable workload, (4) adaptability, the capability of team members to adjust their strategy for completing tasks on the basis of feedback from the work environment, and (5) team orientation, the tendency to prioritize team goals over individual goals, encourage alternative perspectives, and show respect and regard for each team member. Relating each competency to a vignette from an academic primary care clinic, the authors describe potential strategies for improving teamwork learning and applying the teamwork competences to academic PCMH practices. PMID:23524923

  11. Assessment of medical waste management at a primary health-care center in São Paulo, Brazil.

    Science.gov (United States)

    Moreira, A M M; Günther, W M R

    2013-01-01

    According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of São Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized. Total waste generation increased 9.8%, but it was possible to reduce the volume of non-recyclable materials (11%) and increase the volume of recyclable materials (4%). It was also possible to segregate organic waste (7%), which was forwarded for production of compost. The rate of infectious waste generation in critical areas decreased from 0.021 to 0.018 kg/procedure. Many improvements have been observed, and now the PHC complies with most of legal requirements

  12. The Research of Spatial-Temporal Analysis and Decision-Making Assistant System for Disabled Person Affairs Based on Mapworld

    Science.gov (United States)

    Zhang, J. H.; Yang, J.; Sun, Y. S.

    2015-06-01

    This system combines the Mapworld platform and informationization of disabled person affairs, uses the basic information of disabled person as center frame. Based on the disabled person population database, the affairs management system and the statistical account system, the data were effectively integrated and the united information resource database was built. Though the data analysis and mining, the system provides powerful data support to the decision making, the affairs managing and the public serving. It finally realizes the rationalization, normalization and scientization of disabled person affairs management. It also makes significant contributions to the great-leap-forward development of the informationization of China Disabled Person's Federation.

  13. The Phenomenon of Collaboration: A Phenomenologic Study of Collaboration between Family Medicine and Obstetrics and Gynecology Departments at an Academic Medical Center

    Science.gov (United States)

    Brown, David R.; Brewster, Cheryl D.; Karides, Marina; Lukas, Lou A.

    2011-01-01

    Collaboration is essential to manage complex real world problems. We used phenomenologic methods to elaborate a description of collaboration between two departments at an academic medical center who considered their relationship to represent a model of effective collaboration. Key collaborative structures included a shared vision and commitment by…

  14. 5 years of experience implementing a methicillin-resistant Staphylococcus aureus search and destroy policy at the largest university medical center in the Netherlands

    NARCIS (Netherlands)

    M.C. Vos (Margreet); M.D. Behrendt (Myra); D.C. Melles (Damian); F.P.N. Mollema (Femke); W. de Groot (Woutrinus); G. Parlevliet (Gerard); A. Ott (Alewijn); D. Horst-Kreft (Deborah); A.F. van Belkum (Alex); H.A. Verbrugh (Henri)

    2009-01-01

    textabstractOBJECTIVE: To evaluate the effectiveness of a rigorous search and destroy policy for controlling methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization. DESIGN: Hospital-based observational follow-up study. SETTING: Erasmus University Medical Center Rotterdam, a 1,2

  15. An Evaluation of a Voluntary Academic Medical Center Website Designed to Improve Access to Health Education among Consumers: Implications for E-Health and M-Health

    Science.gov (United States)

    Harris-Hollingsworth, Nicole Rosella

    2012-01-01

    Academic Medical Centers across the United States provide health libraries on their web portals to disseminate health promotion and disease prevention information, in order to assist patients in the management of their own care. However, there is a need to obtain consumer input, consumer satisfaction, and to conduct formal evaluations. The purpose…

  16. Overview of Mosquito Research Programs at the United States Department of Agriculture - Agricultural Research Service, Center for Medical, Agricultural & Veterinary Entomology

    Science.gov (United States)

    The Center for Medical, Agricultural, and Veterinary Entomology (CMAVE), a U.S. Department of Agriculture – Agricultural Research Service laboratory, was established in World War II to produce products to protect military personnel against insect vector of disease. Currently the mission of CMAVE is ...

  17. Factors Associated With Failure to Complete Phase II Cardiac Rehabilitation: Survey Registry in Rajaie Cardiovascular Medical and Research Center

    Directory of Open Access Journals (Sweden)

    Bahieh Moradi

    2011-12-01

    Full Text Available Background: A significant proportion of patients who begin CR (cardiac rehabilitation do not complete the program. Objectives: The purpose of this study was to determine the predicting factors that interfere with adherence and completion of an outpatient CR program. Patients and Methods: A cross-sectional survey was conducted with all 128 patients who entered the CR program at the Rajaie Cardiovascular Medical and Research Center in Tehran, IR Iran, from March 2009 to March 2010. The demographic variables included age, sex, education, employment status, insurance status, and return to work. These variables were compared in patients who completed and did not complete phase II CR. The reason for CR incompletion was asked in follow-up phone interviews. Results: The most frequent clinical diagnosis among the patients enrolled in the CR program was coronary artery disease. 83.6% of patients who participated had a CABG or PCI procedure during the last year. CR participation increased when cardiac revascularization procedures were performed during the first hospitalization. 88 of the 128 patients dropped out, yielding a dropout rate of 68.7%, which was significantly (P < 0.01 higher than the same study in other countries. Sex and age did not predict the completion rate. As education increased, cardiac rehabilitation utilization and completion increased. Unemployed patients were less likely than employed patients to complete the program. Conclusions: Our data indicate a low rate of CR completion, with lower rates among unemployed, uninsured, and less educated patients.

  18. A framework for improving access and customer service times in health care: application and analysis at the UCLA Medical Center.

    Science.gov (United States)

    Duda, Catherine; Rajaram, Kumar; Barz, Christiane; Rosenthal, J Thomas

    2013-01-01

    There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics. PMID:23903937

  19. Management of a comprehensive radiation safety program in a major American University and affiliated academic medical center

    International Nuclear Information System (INIS)

    Duke University, which operates under eight radiation licenses issued by the State of North Carolina, consists of a leading medical center including extensive inpatient and outpatient facilities, a medical school, biomedical research labs, and an academic campus including two major accelerator facilities. The Nuclear Medicine and Radiation Oncology departments handle over 40,000 diagnostic and therapeutic procedures annually, including approximately 160 radioiodine therapeutic cases. In biomedical research labs, about 300 professors are authorized to use radioactive materials. Over 2,000 radiation workers are identified on campus. Over the past two years, we have transformed the existing radiation safety program into a more responsive and more accountable one. Simultaneously, the institutional 'culture' changed, and the Radiation Safety Division came to be viewed as a helpful ally by investigators. The purpose of this paper is to present our experiences that have made this transformation possible. Our initiatives included; (a) defining short-term and long-term goals; (b) establishing a definitive chain of authority; (c) obtaining an external review by a consultant Health Physicist; (d) improving existing radiation safety programs; (e) reorganizing the Radiation Safety Division, with creation of multidisciplinary professional staff positions; (f) implementing campus-wide radiation safety training, (g) increasing technician positions; (h) establishing monthly medical center radiation safety executive meeting. As a result progress made at the Divisional level includes; (a) culture change by recruiting professionals with academic credentials and recent college graduates; (b) implementing weekly staff meetings and monthly quality assurance meetings; (c) achieving academic prominence by publishing and presenting papers in national meetings; (d) senior staff achieving faculty appointments with academic departments; (e) senior staff participating in graduate student

  20. Disbursement of $65 million to the State of Texas for construction of a Regional Medical Technology Center at the former Superconducting Super Collider Site, Waxahachie, Texas

    International Nuclear Information System (INIS)

    As part of a settlement agreement between the US DOE and the State of Texas, DOE proposes to transfer $65 million of federal funds to the Texas National Research Laboratory Commission (TNLRC) for construction of the Regional Medical Technology Center (RMTC) to be located in Ellis County, Texas. The RMTC would be a state-of-the-art medical facility for proton cancer therapy, operated by the State of Texas in conjunction with the University of Texas Southwestern Medical Center. The RMTC would use the linear accelerator assets of the recently terminated DOE Superconducting Super Collider Project to accelerate protons to high energies for the treatment of cancer patients. The current design provides for treatment areas, examination rooms, support laboratories, diagnostic imaging equipment, and office space as well as the accelerators (linac and synchrotron) and beam steering and shaping components. The potential environmental consequences of the proposed action are expected to be minor

  1. Are patient-centered care values as reflected in teaching scenarios really being taught when implemented by teaching faculty? A discourse analysis on an Indonesian medical school's curriculum

    Directory of Open Access Journals (Sweden)

    Claramita Mora

    2011-04-01

    Full Text Available Abstract Background According to The Indonesian Medical Council, 2006, Indonesian competence-based medical curriculum should be oriented towards family medicine. We aimed to find out if the educational goal of patient-centered care within family medicine (comprehensive care and continuous care were adequately transferred from the expected curriculum to implemented curriculum and teaching process. Methods Discourse analysis was done by 3 general practitioners of scenarios and learning objectives of an Indonesian undergraduate medical curriculum. The coders categorized those sentences into two groups: met or unmet the educational goal of patient-centered care. Results Text analysis showed gaps in patient-centered care training between the scenarios and the learning objectives which were developed by both curriculum committee and the block planning groups and the way in which the material was taught. Most sentences in the scenarios were more relevant to patient-centered care while most sentences in the learning objectives were more inclined towards disease-perspectives. Conclusions There is currently a discrepancy between expected patient-centered care values in the scenario and instructional materials that are being used.

  2. 76 FR 59741 - Bureau of International Labor Affairs; Office of Trade and Labor Affairs; National Advisory...

    Science.gov (United States)

    2011-09-27

    ... through the Bureau of International Labor Affairs (ILAB) that will be included in the second Biennial... statements in response to this notice to Paula Church Albertson, Office of Trade and Labor Affairs, ILAB,...

  3. 78 FR 13897 - Bureau of International Labor Affairs; Office of Trade and Labor Affairs; Labor Affairs Council...

    Science.gov (United States)

    2013-03-01

    ...: International Labor Affairs Bureau (ILAB), U.S. Department of Labor. ACTION: Notice of Public Session Meeting...), the International Labor Affairs Bureau (ILAB) of the U.S. Department of Labor gives notice of the..., 2013, from 9:00 a.m. to 11:30 a.m. ILAB requests those interested in attending provide their...

  4. Thirty Years of Pancreas Transplantation at Leiden University Medical Center : Long-Term Follow-Up in a Large Eurotransplant Center

    NARCIS (Netherlands)

    Kopp, Wouter H; Verhagen, Merel J J; Blok, Joris J; Huurman, Volkert A L; de Fijter, Johan W; de Koning, Eelco J; Putter, Hein; Baranski, Andzrej G; Schaapherder, Alexander F M; Braat, Andries E; Ringers, Jan

    2015-01-01

    BACKGROUND: An overview of 30 years of pancreas transplantation at a high volume center. Analysis of patient survival- and graft survival-associated risk factors. METHODS: All pancreas transplantations performed in our center from January 1, 1984, till December 31, 2012, were evaluated. Covariates i

  5. A descriptive study of prevalence, pattern and attitude of self-medication among second professional medical students in a tertiary care center

    Directory of Open Access Journals (Sweden)

    Vineeta Sawhney

    2015-06-01

    Conclusion: Our study showed that self-medication is widely practiced among students, easy availability of medicine probably being the cause. Educating the students regarding advantages and disadvantages of self-medication is necessary to create awareness. [Int J Basic Clin Pharmacol 2015; 4(3.000: 542-546

  6. Characteristics and trends of pediatric traumatic brain injuries treated at a large pediatric medical center in China, 2002-2011.

    Directory of Open Access Journals (Sweden)

    Jianbo Shao

    Full Text Available BACKGROUND: Pediatric traumatic brain injuries (TBIs have not been well studied in China. This study investigated characteristics and trends of hospitalized TBIs sustained by Chinese children. METHODS AND FINDINGS: We analyzed 2002-2011 hospitalized TBI patients (0-17 years of age treated at a large pediatric medical center in China. TBIs were defined using the International Classification of Diseases, Tenth Revision (ICD-10 codes. We examined age patterns across external causes of TBIs. We reported the trend of traffic-related TBIs for each year from 2002 to 2011. Of 4,230 TBI patients, 67.1% (95% CI: 65.4%-68.8% were city residents and 28.8% (95% CI: 26.3%-31.3% came from rural villages. Males had disproportionately more TBIs than females (65.2% vs. 34.8%. Falls, struck by/against objects, and traffic collisions were the top three external causes of TBIs for all age groups. Falls were the leading cause of TBI for all ages but peaked at 2 years of age. There were 125 TBIs in 0-2 year olds (5.9% of all TBIs in this age group that were caused by suspected child abuse. Suspected child abuse was significantly more likely to occur in 0-1 year olds. The proportion of traffic -related TBIs increased significantly from 12.99% in 2002 to 19.68% in 2008 but dropped each subsequent year until it reached a level of 8.91% in 2011. CONCLUSIONS: Our study confirms that falls, struck by/against objects and traffic collisions are the top external causes of TBIs in Chinese children. When compared with national data from the developed countries, gender patterns are similar, but the ranking of external causes is different. This is the first study to highlight the important role of suspected child abuse in causing TBIs in infants in China. TBIs caused by child abuse warrant further research and government attention as a social and medical problem in China.

  7. Evaluating the Imbalance Between Increasing Hemodialysis Patients and Medical Staff Shortage After the Great East Japan Earthquake: Report From a Hemodialysis Center Near the Fukushima Nuclear Power Plants.

    Science.gov (United States)

    Koshiba, Takaaki; Nishiuchi, Takamitsu; Akaihata, Hidenori; Haga, Nobuhiro; Kojima, Yoshiyuki; Kubo, Hajime; Kasahara, Masato; Hayashi, Masayuki

    2016-04-01

    The Great East Japan Earthquake in 2011 caused an unprecedented imbalance between an increasing number of hemodialysis patients and medical staff shortage in the Sousou area, the site of the Fukushima nuclear power plants. In 2014, capacity of our hemodialysis center reached a critical limit due to such an imbalance. We attempted to evaluate the effort of medical staff to clarify to what extent their burden had increased post-disaster. The ratio of total dialysis sessions over total working days of medical staff was determined as an approximate indicator of effort per month. The mean value of each year was compared. Despite fluctuations of the ratio, the mean value did not differ from 2010 to 2013. However, the ratio steadily increased in 2014, and there was a significant increase in the mean value. This proposed indicator of the effort of medical staff appears to reflect what we experienced, although its validity must be carefully examined in future studies. PMID:26935477

  8. Professional Competencies for Student Affairs Practice

    Science.gov (United States)

    Munsch, Patty; Cortez, Lori

    2014-01-01

    The purpose of this chapter is to explore the integration of the ACPA/NASPA Professional Competency Areas for Student Affairs Practitioners (ACPA/NASPA, 2010) on community college campuses. The competencies provide specific skill sets for a broad range of student affairs practice areas that should be met by professionals throughout their careers.…

  9. Intellectual and Political Hygiene: The "Sokal Affair."

    Science.gov (United States)

    Slack, Jennifer Daryl; Semati, M. Mehdi

    1997-01-01

    Analyzes coverage of the "Sokal Affair", in which physicist Alan Sokal submitted a fraudulent article and then criticized the journal for publishing it. Examines the four currents that overdetermined the Sokal Affair: antliberalism, anti-intellectualism, debates among the left about what constitutes a legitimate left, and the often-perceived…

  10. Factors influencing medical student attrition and their implications in a large multi-center randomized education trial.

    Science.gov (United States)

    Kalet, A; Ellaway, R H; Song, H S; Nick, M; Sarpel, U; Hopkins, M A; Hill, J; Plass, J L; Pusic, M V

    2013-08-01

    Participant attrition may be a significant threat to the generalizability of the results of educational research studies if participants who do not persist in a study differ from those who do in ways that can affect the experimental outcomes. A multi-center trial of the efficacy of different computer-based instructional strategies gave us the opportunity to observe institutional and student factors linked to attrition from a study and the ways in which they altered the participation profile. The data is from a randomized controlled trial conducted at seven US medical schools investigating the educational impact of different instructional designs for computer-based learning modules for surgical clerks. All students undertaking their surgical clerkships at the participating schools were invited participate and those that consented were asked to complete five study measures during their surgery clerkship. Variations in study attrition rates were explored by institution and by participants' self-regulation, self-efficacy, perception of task value, and mastery goal orientation measured on entry to the study. Of the 1,363 invited participants 995 (73 %) consented to participate and provided baseline data. There was a significant drop in the rate of participation at each of the five study milestones with 902 (94 %) completing at least one of two module post-test, 799 (61 %) both module post-tests, 539 (36 %) the mid-rotation evaluation and 252 (25 %) the final evaluation. Attrition varied between institutions on survival analysis (p self-regulated, self-efficacious and higher achievers than their peers who drop out and as such do not represent the class as a whole. PMID:22869047

  11. Heterotopic pancreas: a clinicopathological study of 184 cases from a single high-volume medical center in China.

    Science.gov (United States)

    Zhang, Yifen; Sun, Xitai; Gold, Jason S; Sun, Qi; Lv, Ying; Li, Qiang; Huang, Qin

    2016-09-01

    Heterotopic pancreas (HP) is often an incidental finding during operative or endoscopic procedures and described in case reports and small series in the literature. Large clinicopathological studies with a systematic analysis remain lacking. Herein, we identified 184 (0.18%; 184/99 544) consecutive histology-proven HP cases of 89 770 surgical resections and 9774 upper endoscopic biopsies carried out at a single medical center in China. Each case was diagnosed by unequivocal identification of pancreatic acini at a location outside the pancreas. The patients' median age was 49 years (range, 14-82) with a slight female predominance (male/female ratio, 0.94). Clinical presentation at diagnosis was nonspecific. Preoperatively, most (54.9%; 101/184) HP lesions were misdiagnosed. Only 26 HP lesions (14.1%) were correctly diagnosed, all in the stomach except for 1 in the duodenum; 57 (31%) were detected during operative procedures for other conditions. The most frequent location of HP was, in descending order, the stomach (97; 52.7%), small intestine (48; 26%), lesser and greater curvature omentum (18; 10%), spleen and hilar region (5; 2.7%), porta hepatis (2; 1%), gallbladder (1; 0.5%), peridistal esophageal tissue (4; 2.2%), and mesentery (7; 3.8%). The size of HP varied from smaller than 0.5 cm (35.3%), 0.6 to 1 cm (34.8%), to larger than 1.1 cm (29.9%). Because of difficulty in preoperative diagnosis, careful workup for upper gastrointestinal diseases with HP as a differential diagnosis may increase the chance of accurate diagnosis and appropriate patient management. PMID:27195908

  12. Sonography in Children with Acute Abdominal Pain: 5 Years Experience in Only Children Medical Center in Khorasan

    Directory of Open Access Journals (Sweden)

    S. A. Alamdaran

    2008-01-01

    Full Text Available Background/Objective: acute abdominal pain is one important dilemma in pediatric patients. The purpose of this paper is to present our experience about diagnostic value of sonography in children with acute abdominal pain."nPatients and Methods: During a period of 5 years (march 2002 to march 2007; we studied clinical, sonographical and surgical data of more than 5000 children with acute abdominal pain in only children medical center in khorasan at Dr. Sheikh Children hospital."nResults: Approximately in more than 90% children with acute abdominal pain, mesenteric lymphadenitis [enlarged mesenteric lymph nodes (≥4mm and/or mural thickening of the terminal ileum (≥8mm] and gastroenteritis (enlarged mesenteric lymph nodes with generalize thickened bowel wall were sonographic diagnosis. In all this patients, sonographic diagnosis was documented with clinical course and outcome, except in three that pelvic appendicitis was final surgical diagnosis. "nAppendicitis, intussusception and bowel obstruction [mainly due to inflammatory or tumoral mass] were uncommon causes. The rare sonographic diagnoses were peritonitis in 8, malrotation (abnormal mesenteric vessels position in 3, pancratitis in 3, diaphragmatic hernia with gastric volvulus (abnormal mesenteric vessels position in 2, ovarian torsion in 2, pylonephritis in 1, mechel diveticulitis in 1. Final clinical and surgical diagnosis in three patients with peritonitis diagnosis was gastroenteritis. In children with acute abdominal pain, there was normal sonography report only in few cases. "nConclusion: common and uncommon causes of acute abdominal pain in children are limited and in almost all of these patients, sonographic diagnosis is completely reliable.

  13. SU-E-J-137: Image Registration Tool for Patient Setup in Korea Heavy Ion Medical Accelerator Center

    Energy Technology Data Exchange (ETDEWEB)

    Kim, M; Suh, T [Department of Biomedical Engineering, Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul (Korea, Republic of); Cho, W [Borame Medical Center, Seoul National University Hospital, Seoul, Seoul (Korea, Republic of); Jung, W [Korea Institute of Radiological & Medical Sciences, Seoul, Seoul (Korea, Republic of)

    2015-06-15

    Purpose: A potential validation tool for compensating patient positioning error was developed using 2D/3D and 3D/3D image registration. Methods: For 2D/3D registration, digitally reconstructed radiography (DRR) and three-dimensional computed tomography (3D-CT) images were applied. The ray-casting algorithm is the most straightforward method for generating DRR. We adopted the traditional ray-casting method, which finds the intersections of a ray with all objects, voxels of the 3D-CT volume in the scene. The similarity between the extracted DRR and orthogonal image was measured by using a normalized mutual information method. Two orthogonal images were acquired from a Cyber-Knife system from the anterior-posterior (AP) and right lateral (RL) views. The 3D-CT and two orthogonal images of an anthropomorphic phantom and head and neck cancer patient were used in this study. For 3D/3D registration, planning CT and in-room CT image were applied. After registration, the translation and rotation factors were calculated to position a couch to be movable in six dimensions. Results: Registration accuracies and average errors of 2.12 mm ± 0.50 mm for transformations and 1.23° ± 0.40° for rotations were acquired by 2D/3D registration using an anthropomorphic Alderson-Rando phantom. In addition, registration accuracies and average errors of 0.90 mm ± 0.30 mm for transformations and 1.00° ± 0.2° for rotations were acquired using CT image sets. Conclusion: We demonstrated that this validation tool could compensate for patient positioning error. In addition, this research could be the fundamental step for compensating patient positioning error at the first Korea heavy-ion medical accelerator treatment center.

  14. SU-E-J-137: Image Registration Tool for Patient Setup in Korea Heavy Ion Medical Accelerator Center

    International Nuclear Information System (INIS)

    Purpose: A potential validation tool for compensating patient positioning error was developed using 2D/3D and 3D/3D image registration. Methods: For 2D/3D registration, digitally reconstructed radiography (DRR) and three-dimensional computed tomography (3D-CT) images were applied. The ray-casting algorithm is the most straightforward method for generating DRR. We adopted the traditional ray-casting method, which finds the intersections of a ray with all objects, voxels of the 3D-CT volume in the scene. The similarity between the extracted DRR and orthogonal image was measured by using a normalized mutual information method. Two orthogonal images were acquired from a Cyber-Knife system from the anterior-posterior (AP) and right lateral (RL) views. The 3D-CT and two orthogonal images of an anthropomorphic phantom and head and neck cancer patient were used in this study. For 3D/3D registration, planning CT and in-room CT image were applied. After registration, the translation and rotation factors were calculated to position a couch to be movable in six dimensions. Results: Registration accuracies and average errors of 2.12 mm ± 0.50 mm for transformations and 1.23° ± 0.40° for rotations were acquired by 2D/3D registration using an anthropomorphic Alderson-Rando phantom. In addition, registration accuracies and average errors of 0.90 mm ± 0.30 mm for transformations and 1.00° ± 0.2° for rotations were acquired using CT image sets. Conclusion: We demonstrated that this validation tool could compensate for patient positioning error. In addition, this research could be the fundamental step for compensating patient positioning error at the first Korea heavy-ion medical accelerator treatment center

  15. Profiles of attendees in voluntary counseling and testing centers of a medical college hospital in coastal Karnataka

    Directory of Open Access Journals (Sweden)

    Jayarama S

    2008-01-01

    Full Text Available Research Question: What are the socio-demographic profile and risk behavior pattern of seropositive attendees in the voluntary counseling and testing center (VCTC? Study Design: Retrospective study. Setting: VCTC in the outpatient complex of Kasturba Medical College Hospital, Mangalore, Karnataka. Subjects: Records pertaining to all the 539 and 330 seropositive attendees during the years 2005 and 2006, respectively, were included in the study besides data from 2001 onwards in order to assess the time trend of human immunodeficiency virus (HIV. Study Variables: Age, sex, marital status, religion, educational status, occupation, place of residence and pattern of risk behavior in relation to HIV/AIDS. Statistical Analysis: Analysis was done with SPSS version 11. Statistical test and Chi-square was done, and P < 0.05 was considered statistically significant. Results: The time trend of VCTC attendees reveals a gradual increase except in 2006 showing a sharp decline. Seropositives were around 20% between 2001 and April 2007 with a sharp increase in 2006, i.e., 33.64%. Male seropositivity constituted 60-63%; 81-91% of seropositive attendees belonged to the age group of 15-50 years; 58-70% were married. Only about 3% were illiterates and 20-25% constituted 6 th -12 th pass-outs. With regard to occupational profile, about 17-27% were housewives, 19-21% were laborers/hotel workers and 7% were entrepreneurs. About 45% were from urban area and nearly one-third hailing from other districts in the border of Karnataka. About 25% were exposed to commercial sex workers; another 21-23% were involved in premarital sex and nearly 38% were indulging in heterosexual activities.

  16. Molecular identification of adenovirus causing respiratory tract infection in pediatric patients at the University of Malaya Medical Center

    Directory of Open Access Journals (Sweden)

    AbuBakar Sazaly

    2010-07-01

    Full Text Available Abstract Background There are at least 51 adenovirus serotypes (AdV known to cause human infections. The prevalence of the different human AdV (HAdV serotypes varies among different regions. Presently, there are no reports of the prevalent HAdV types found in Malaysia. The present study was undertaken to identify the HAdV types associated primarily with respiratory tract infections (RTI of young children in Malaysia. Methods Archived HAdV isolates from pediatric patients with RTI seen at the University of Malaya Medical Center (UMMC, Kuala Lumpur, Malaysia from 1999 to 2005 were used. Virus isolates were inoculated into cell culture and DNA was extracted when cells showed significant cytopathic effects. AdV partial hexon gene was amplified and the sequences together with other known HAdV hexon gene sequences were used to build phylogenetic trees. Identification of HAdV types found among young children in Malaysia was inferred from the phylograms. Results At least 2,583 pediatric patients with RTI sought consultation and treatment at the UMMC from 1999 to 2005. Among these patients, 48 ( Conclusions HAdV-1 and HAdV-2 were the most common HAdV isolated from pediatric patients who sought treatment for RTI at the UMMC from 1999 to 2005. HAdV-B, mainly HAdV-3, was recovered from ~22% of the patients. These findings provide a benchmark for future studies on the prevalence and epidemiology of HAdV types in Malaysia and in the region.

  17. Clinical characteristics and prognostic factors of splenic abscess: A review of 67 cases in a single medical center of Taiwan

    Institute of Scientific and Technical Information of China (English)

    Kuo-Chin Chang; Chuan-Mo Lee; Tsung-Hui Hu; Seng-Kee Chuah; Chi-Sin Changchien; Tung-Lung Tsai; Sheng-Nan Lu; Yi-Chun Chiu; Yaw-Sen Chen; Chih-Chi Wang; Jui-Wei Lin

    2006-01-01

    AIM: To analyze 67 cases of splenic abscess in a medical center of Taiwan during a period of 19 years.METHODS: From January 1986 to December 2004, a total of 67 patients with splenic abscess were enrolled for the retrospective study. The clinical characteristics,underlying diseases, organism spectra, therapeutic methods, APACHE Ⅱ scores, and mortality rates were analyzed.RESULTS: There were 41 males and 26 females with the mean age of 54.1± 14.1 years. Multiple splenic abscesses (MSA) account for 28.4% and solitary splenic abscess in 71.6% of the patients. Twenty-six of sixtyseven patients (35.8%) had extrasplenic abscesses, with leading site of liver (34.6%). Microbiological cultures were positive in 58 patients (86.6%), with 71.8% in blood culture and 93.5% in abscess culture. Gram negative bacillus (GNB) infection predominated (55.2%),with leading pathogen ofKlebsiella pneumoniae (22.4%),followed by gram positive coccus (GPC) infection (31%).Splenectomy was performed in 26 patients (38.8%),percutaneous drainage or aspiration in 21 (31.3%),and antibiotic therapy alone in 20 patients (29.9%).Eventually, 12 of 67 patients expired (17.9 %). By statistics, spleen infected with GNB was likely to develop multiple abscesses compared with infection with GPC(P=0.036). Patients with GNB infection (P= 0.009) andmultiple abscesses (P= 0.011) experienced a higher mortality rate than patients with GPC infection and solitary abscess. The mean APACHE Ⅱ score of 12 expired patients (16.3 ±3.2) was significantly higher than that of the 55 survivals (7.2 ± 3.8) (P< 0.001).CONCLUSION: MSA, GNB infection, and high APACHEⅡ scores are poor prognostic factors. Early surgical intervention should be encouraged when these risk factors are present.

  18. Development of a patient positioning error compensation tool for Korea Heavy-Ion Medical Accelerator Treatment Center

    Science.gov (United States)

    Kim, Min-Joo; Suh, Tae-Suk; Cho, Woong; Jung, Won-Gyun

    2015-07-01

    In this study, a potential validation tool for compensating for the patient positioning error was developed by using 2D/3D and 3D/3D image registration. For 2D/3D registration, digitallyreconstructed radiography (DRR) and three-dimensional computed tomography (3D-CT) images were applied. The ray-casting algorithm is the most straightforward method for generating DRR, so we adopted the traditional ray-casting method, which finds the intersections of a ray with all objects, voxels of the 3D-CT volume in the scene. The similarity between the extracted DRR and the orthogonal image was measured by using a normalized mutual information method. Two orthogonal images were acquired from a Cyber-knife system from the anterior-posterior (AP) and right lateral (RL) views. The 3D-CT and the two orthogonal images of an anthropomorphic phantom and of the head and neck of a cancer patient were used in this study. For 3D/3D registration, planning CT and in-room CT images were applied. After registration, the translation and the rotation factors were calculated to position a couch to be movable in six dimensions. Registration accuracies and average errors of 2.12 mm ± 0.50 mm for transformations and 1.23 ° ± 0.40 ° for rotations were acquired by using 2D/3D registration with the anthropomorphic Alderson-Rando phantom. In addition, registration accuracies and average errors of 0.90 mm ± 0.30 mm for transformations and 1.00 ° ± 0.2 ° for rotations were acquired by using CT image sets. We demonstrated that this validation tool could compensate for patient positioning errors. In addition, this research could be a fundamental step in compensating for patient positioning errors at the Korea Heavy-ion Medical Accelerator Treatment Center.

  19. Assessment of preclinical students’ academic motivation before and after a three-day academic affair program

    OpenAIRE

    Aung MN; Somboonwong J; Jaroonvanichkul V; Wannakrairot P

    2015-01-01

    Myo Nyein Aung,1 Juraiporn Somboonwong,2 Vorapol Jaroonvanichkul,1 Pongsak Wannakrairot3 1Medical Education Unit, 2Quality Management Division and Department of Physiology, 3Academic Affairs Division, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandBackground: Medical students’ motivation is an important driving factor for academic performance, and therefore medical teachers and educators are often highly interested in this topic. This study evaluated the impact of an ac...

  20. Do Patient-Centered Medical Home Access and Care Coordination Measures Reflect the Contribution of All Team Members? A Systematic Review.

    Science.gov (United States)

    Annis, Ann M; Harris, Marcelline; Robinson, Claire H; Krein, Sarah L

    2016-01-01

    Patient-Centered Medical Home (PCMH) evaluations have primarily focused on primary care providers and not on the primary care team. This systematic literature review examined the extent to which access and care coordination measures in PCMH reflect the involvement of associate care providers (ACPs), which include registered and licensed practical nurses, nursing and medical assistants, clerks, pharmacists, social workers, and dietitians. Among 42 studies, few measures specified ACP roles or linked ACP care to outcomes. Increasing attention on team-based care emphasizes a vital need to reframe measures within a team context. PMID:27219827

  1. Contribution of the Medical Radiology Research Center, Russian Academy of Medical Sciences, to liquidation of radionuclide contamination aftereffects in the Kaluga Region that resulted from the Chernobyl power plant accident

    International Nuclear Information System (INIS)

    Specialists from the Medical Radiology Research Center, have been participating in liquidation of the Chernobyl power plant accident aftereffects since May-June, 1986. The basic trends of their work are mass dosimetric studies of the population of the contaminated areas, annual prophylactic check-ups of children and adolescents, pregnant and nursing women and other adults of high-risk groups (agricultural workers, patients with chronic diseases), development of recommendations for health and prophylactic measures in the districts under observation, treatment of patients from these regions, who are in need of a specialized care, at the clinic of the Center

  2. Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life

    OpenAIRE

    Christine Ritchie; Robin Andersen; Jessica Eng; Garrigues, Sarah K.; Gina Intinarelli; Helen Kao; Suzanne Kawahara; Kanan Patel; Lisa Sapiro; Anne Thibault; Erika Tunick; Barnes, Deborah E.

    2016-01-01

    Introduction The Geriatric Resources for the Assessment and Care of Elders (GRACE) program has been shown to decrease acute care utilization and increase patient self-rated health in low-income seniors at community-based health centers. Aims To describe adaptation of the GRACE model to include adults of all ages (named Care Support) and to evaluate the process and impact of Care Support implementation at an urban academic medical center. Setting 152 high-risk patients (≥5 ED visits or ≥2 hosp...

  3. Home Improvement in HIV Primary Care: Investigating the Patient-Centered Medical Home Model for People Living with HIV/AIDS.

    Science.gov (United States)

    Friedman, Erin Gael; Crowley, Megan; Howard, Kim Ammann; Pavel, M Paoloma

    2015-10-01

    This article details the processes and findings of a 3-year demonstration project implementing population health management and the Patient-Centered Medical Home (PCMH) model in 3 community health centers in Alameda County, California. The article provides a first look at the PCMH Continuum, a tool for aiding staff in conceptualizing and implementing complex organizational change. Findings of the project evaluation also are shared, comprising a road map for other organizations looking to implement population health management, panel management, and PCMH. The article reflects on lessons learned and best practices from the demonstration project. PMID:25867483

  4. Survival of male patients with spinal cord injury after cardiac arrest in Department of Veterans Affairs hospital: Pilot study

    Directory of Open Access Journals (Sweden)

    Deborah Caruso, MD

    2014-11-01

    Full Text Available Survivability characteristics after cardiopulmonary resuscitation in the population with spinal cord injury (SCI are unclear but may be useful for advanced care planning discussions with patients. Retrospective evaluation from records of all SCI patients over 10 yr at a Department of Veterans Affairs medical center who experienced in-hospital cardiac arrest was performed. Demographic data and other common measurements were recorded. Thirty-six male subjects were identified, and only two patients survived to discharge (5.5% survival rate, both of whom were admitted for nonacute issues and were asymptomatic shortly before the cardiac arrest. The mean age at the time of cardiopulmonary arrest was 62.4 yr, with a mean time from cardiac arrest to death of 3.02 d. No significant demographic parameters were identified. Overall, SCI likely portends worse outcome for acutely ill patients in the situation of a cardiac arrest. Conclusions are limited by sample size.

  5. 342 Epidemiology of Atopic Dermatitis in the Allergy Service of a Third Level Medical Center

    OpenAIRE

    Sanchez-Gallardo, Luis Rafael

    2012-01-01

    Background The creation of an Allergy service was required because of the high frequency of allergic diseases among paediatric population in the general consultation of a third level medical centre. Objective The purpose of this study is to report the cases of Atopic Dermatitis (AD) in the Allergy service from a Third level medical centre since its creation in July 2005. Methods This is a descriptive, retrospective, transversal study from July 2005 to February 2011. Selected medical records o...

  6. 328 Epidemiology of Asthma Cases in the Allergy Service of a Third Level Medical Center. Six Year Expirience

    OpenAIRE

    Sanchez-Gallardo, Luis Rafael

    2012-01-01

    Background The creation of an Allergy service was required because of the high frequency of allergic diseases among paediatric population in the general consultation of a third level medical centre. Objective The purpose of this study is to report the cases of asthma diagnosed in the Allergy service from a Third level medical centre since its creation in July 2005. Methods This is a descriptive, retrospective, transversal study from July 2005 to February 2011. Selected medical records of pati...

  7. If you feed them, they will come: A prospective study of the effects of complimentary food on attendance and physician attitudes at medical grand rounds at an academic medical center

    Directory of Open Access Journals (Sweden)

    Litin Scott C

    2007-07-01

    Full Text Available Abstract Background Evidence suggests that attendance at medical grand rounds at academic medical centers is waning. The present study examined whether attendance at medical grand rounds increased after providing complimentary food to attendees and also assessed attendee attitudes about complimentary food. Methods In this prospective, before-and-after study, attendance at medical grand rounds was monitored from September 25, 2002, to June 2, 2004, using head counts. With unrestricted industry (eg, pharmaceutical financial support, complimentary food was provided to medical grand rounds attendees beginning June 4, 2003. Attendance was compared during the pre-complimentary food and complimentary food periods. Attitudes about the complimentary food were assessed with use of a survey administered to attendees at the conclusion of the study period. Results The mean (± SD overall attendance by head counts increased 38.4% from 184.1 ± 90.4 during the pre-complimentary food period to 254.8 ± 60.5 during the complimentary food period (P Conclusion Providing free food may be an effective strategy for increasing attendance at medical grand rounds.

  8. Safe medication management and use of narcotics in a Joint Commission International-accredited academic medical center hospital in the People’s Republic of China

    OpenAIRE

    Fang X; Zhu LL; Pan SD; Xia P; Chen M; Zhou Q

    2016-01-01

    Xu Fang,1,2 Ling-ling Zhu,3 Sheng-dong Pan,4 Ping Xia,4 Meng Chen,5 Quan Zhou51Office of Hospital Administration, 2Office of Party and Administration Council, 3Geriatric VIP Care Ward, Division of Nursing, 4Division of Medical Administration, 5Department of Pharmacy, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of ChinaAbstract: Safe medication management and use of high-alert narcotics should arouse concern. Ris...

  9. Air Quality Monitoring of the Post-Operative Recovery Room and Locations Surrounding Operating Theaters in a Medical Center in Taiwan

    OpenAIRE

    Tang, Chin-Sheng; Wan, Gwo-Hwa

    2013-01-01

    To prevent surgical site infection (SSI), the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH), and carbon dioxide (CO2), suspended particulate matter (PM), and bacteri...

  10. The impact of a regional patient-centered medical home initiative on cost of care among commercially insured population in the US

    OpenAIRE

    Maeng DD; Sciandra JP; Tomcavage JF

    2016-01-01

    Daniel Dukjae Maeng, Joann P Sciandra, Janet F Tomcavage Geisinger Health System, Danville, PA, USAAbstract: The impact of a patient-centered medical home (PCMH) in reducing total cost of care remains a subject of debate, particularly among the non-elderly adult population. This study examines a 6-year experience of a large integrated regional health care delivery system in the US implementing PCMH among its commercially insured population. A regional health plan's claims data from 2008 t...

  11. The impact of a regional patient-centered medical home initiative on cost of care among commercially insured population in the US

    OpenAIRE

    Maeng, Daniel

    2016-01-01

    Daniel Dukjae Maeng, Joann P Sciandra, Janet F Tomcavage Geisinger Health System, Danville, PA, USAAbstract: The impact of a patient-centered medical home (PCMH) in reducing total cost of care remains a subject of debate, particularly among the non-elderly adult population. This study examines a 6-year experience of a large integrated regional health care delivery system in the US implementing PCMH among its commercially insured population. A regional health plan's claims data from 20...

  12. Prevalence and correlates of HIV-risky sexual behaviors among students attending the Medical and Social Welfare Center of the University of Maroua, Cameroon

    OpenAIRE

    Noubiap, Jean Jacques N; Nansseu, Jobert Richie N; Ndoula, Shalom Tchokfe; Wang, Binhuan; Jingi, Ahmadou M; Bigna, Jean Joel R; Aminde, Leopold N.; Youmbi, Rosette Amélie; Fokom-Domgue, Joël

    2015-01-01

    Background Data on sexual behaviors in Cameroonian youths are needed to design and implement effective preventive strategies against HIV/AIDS. This study aimed at assessing sociodemographic and religious factors associated with sexual behaviors among university students in Cameroon. Methods In 2011, 411 university students were surveyed by a self-administered questionnaire at the Medical and Social Welfare Center of the University of Maroua. Logistic regression analyses were used to determine...

  13. Conflations of Marital Status and Sanity: Implicit Heterosexist Bias in Psychiatric Diagnosis in Physician-Dictated Charts at a Midwestern Medical Center

    OpenAIRE

    Metzl, Jonathan M.; McClelland, Sara I.; Bergner, Erin

    2016-01-01

    This paper discusses the role of gender role conformity in psychiatric determinants of well-being after of the depathologization of homosexuality from the DSM. In order to examine the heterosexualizing of sanity in U.S. psychiatric and popular cultures, we analyze archived psychiatrist-dictated patient charts from outpatient psychiatric clinics from a Midwestern medical center (n = 45). We highlight ways physicians deployed heteronormative gender expectations to describe and treat women’s and...

  14. Knowledge, Attitude, and Performance of Radiographers about the Principles of Radiation Protection and Following Protective Standards in Medical Imaging Centers of Hospitals in Fasa in 2015

    OpenAIRE

    Reza Alipoor; Ghazal Mousavian; Ali Abbasnezhad; Seyede Farnaz Mousavi; Gholamhasan Haddadi

    2016-01-01

    Background & Objectives: Although ionizing radiation is effective in the diagnosis of illnesses, it is dangerous from the perspective of protection for patients and radiographers working in radiology sections. Therefore, knowledge, understanding, and application of radiation protection can play an important role. The aim of this study is to assess the knowledge, attitude, and practice of the radiation protection principles in radiation workers in medical imaging centers and hospitals in Fasa,...

  15. Ten years trend in maternal mortality at Kilimanjaro Christian Medical Center Tanzania, 2003–2012: A descriptive retrospective tertiary hospital based study

    OpenAIRE

    Eusebious W. Maro; Neema R. Mosha; Michael Johnson Mahande; Joseph Obure; Gileard Masenga

    2016-01-01

    Objective: To determine the trend, causes and characteristics of maternal deaths in a tertiary hospital in Northern Tanzania. Methods: A descriptive retrospective review of hospital based maternal death data that occurred at Kilimanjaro Christian Medical Center (KCMC) between the years 2003–2012. Descriptive statistics were used to summarize the socio-demographic characteristics, causes and risk factors for maternal deaths using STATA version 12. Yearly maternal mortality ratio (MMR) was c...

  16. Cytogenetic and Clinical Features in Children Suspected With Congenital Abnormalities in 1 Medical Center of Zhejiang Province From 2011 to 2014

    OpenAIRE

    Mao, Shujiong; Sun, Liying; Tu, Miaoying; Zou, Chaochun; Wang, Xiumin

    2015-01-01

    Abstract This study aimed to investigate the detection rate of chromosome abnormalities in children suspected with congenital disorders in 1 single center, identify any differences according to different classification criteria, and try to enlighten the medical professionals what clinical features should be transferred for cytogenetic analysis. From January 1, 2011 to March 31, 2014, children who were suspected with chromosomal disorders were included. All the cytogenetic analyses were perfor...

  17. Stereotactic Body Radiotherapy for Medically Inoperable Lung Cancer: Prospective, Single-Center Study of 108 Consecutive Patients

    International Nuclear Information System (INIS)

    Purpose: To present the results of stereotactic body radiotherapy (SBRT) for medically inoperable patients with Stage I non–small-cell lung cancer (NSCLC) and contrast outcomes in patients with and without a pathologic diagnosis. Methods and Materials: Between December 2004 and October 2008, 108 patients (114 tumors) underwent treatment according to the prospective research ethics board-approved SBRT protocols at our cancer center. Of the 108 patients, 88 (81.5%) had undergone pretreatment whole-body [18F]-fluorodeoxyglucose positron emission tomography/computed tomography. A pathologic diagnosis was unavailable for 33 (28.9%) of the 114 lesions. The SBRT schedules included 48 Gy in 4 fractions or 54–60 Gy in 3 fractions for peripheral lesions and 50–60 Gy in 8–10 fractions for central lesions. Toxicity and radiologic response were assessed at the 3–6-month follow-up visits using conventional criteria. Results: The mean tumor diameter was 2.4-cm (range, 0.9–5.7). The median follow-up was 19.1 months (range, 1–55.7). The estimated local control rate at 1 and 4 years was 92% (95% confidence interval [CI], 86–97%) and 89% (95% CI, 81–96%). The cause-specific survival rate at 1 and 4 years was 92% (95% CI, 87–98%) and 77% (95% CI, 64–89%), respectively. No statistically significant difference was found in the local, regional, and distant control between patients with and without pathologically confirmed NSCLC. The most common acute toxicity was Grade 1 or 2 fatigue (53 of 108 patients). No toxicities of Grade 4 or greater were identified. Conclusions: Lung SBRT for early-stage NSCLC resulted in excellent local control and cause-specific survival with minimal toxicity. The disease-specific outcomes were comparable for patients with and without a pathologic diagnosis. SBRT can be considered an option for selected patients with proven or presumed early-stage NSCLC.

  18. WORK EXPERIENCE OF THE OPERA TIVE INFORMATION SUPPORT SERVICE FOR SCIENTIFIC RESEARCH A T THE MEDICAL RADIOLOGICAL RESEARCH CENTER NAMED AFTER A.F . TSYB – BRANCH OF THE FEDERAL STATE BUDGET INSTITUTION "NATIONAL MEDICAL RESEARCH RADIOLOGICAL CENTER” OF T

    Directory of Open Access Journals (Sweden)

    N. P. Savina

    2015-01-01

    Full Text Available Abstract:The Operative Information Support Service for Scientific Research of the Medical Radiological Research Center named after A. F. Tsyb — Branch of the FSBI «National Medical Research Radiological Center” of the RF Health Ministry presented a report on providing off-budget support for scientific activities over the period from 1993 to 2014 using domestic and foreign information resources. The dynamics of employee activities in institutional sectors with aim to receive financial support for fundamental and applied scientific research on a competitive and non-competitive basis was given. The analysis of the obtained data indicated that a multi-channeling in off-budget funding was formed. It also showed to some extent a situation at the open market of grants in the field of medical radiology, radiobiology, and radiation epidemiology among leading investors in intellectual products.

  19. Repositorien: Der grüne Weg zu Open Access Publishing aus der Perspektive der International Association of Scientific, Technical & Medical Publishers (STM: 10 Fragen von Bruno Bauer an Barbara Kalumenos, Director of Public Affairs bei STM / Repository: The Green Road to Open Access Publishing and the International Association of Scientific, Technical & Medical Publishers' (STM point of view: 10 questions to Barbara Kalumenos, Director of Public Affairs at STM, by Bruno Bauer

    Directory of Open Access Journals (Sweden)

    Bauer, Bruno

    2009-06-01

    Full Text Available Advocates of Open Access call to substitute the established scholarly publication model, in particular subscriptions and licences, by an Open Access Publishing model. Scholarly papers should be immediately accessible without paying and leave the copyright to the author.At the beginning the Open Access movement focused on and demanded for the publication of original scientific articles in Open Access journals. Meanwhile they moved on to support a form of secondary publication, the self-archiving of sholarly papers in institutional repositories. The current interview with Barbara Kalumenos gives an account of the International Association of Scientific, Technical & Medical Publishers (STM; http://www.stm-assoc.org/ and their point of view towards Open Access. The interview hits the Golden Road as well as the Green Road to open access and their costs. Preconditions for a paradigm shift towards Open Access Publishing are brought up and prospects of sholarly publishing in 2020 were discussed with a look on libraries and their possible role within this setting.

  20. Improvements in self-efficacy for engaging in patient-centered communication following a course in peer-supervision and communication for medical students

    DEFF Research Database (Denmark)

    Lassesen, Berit; O Connor, Maja; Kjær, Louise Binow;

    Department of Psychology and Behavioral Science, Aarhus University, Aarhus, Denmark; 3Center for Medical Education, Aarhus University, Aarhus, Denmark.; belas@clu.au.dk Aim: The aim was to evaluate the outcome of a training course in peer-supervision and communication with the aim of improving medical......ID: 170 Individual Paper Berit Lassesen1, Maja O’Connor2, Louise Binnow Kjær3, Anne-Mette Mørcke3, Robert Zachariae2, 1Aarhus Universitet, School of Business and Social Science, Denmark; 2Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital and...... a course in peer-supervision and communication completed a pre-course questionnaire package including: 1) The Patient-Centeredness Self-Efficacy Questionnaire (PCSEQ), 2) Course-Related Motivation to Learn (CRML), 3) Course-Related Self-Efficacy (CRSE), and 4) the Medical Student Well-Being Index...

  1. [The role of a day care center for sick children in the convalescent stage to enable female medical practitioners to successfully continue their careers].

    Science.gov (United States)

    Kizuki, Noyuri

    2013-11-01

    From my experience of child rearing difficulties, when I decided to start a private practice, I planned to have a day care center for sick children in the convalescent stage in the same building to help working mothers, especially those employed in the provision of critical medical services to the community. Financial support was obtained from the city where the clinic exists, and the facility was built that satisfied the requirements of this purpose. I believe that the female surgeons are an especially important personnel resource of Japan's medical services, because surgeons are decreasing in number these days. However, sometimes, qualified medical practitioners, such as surgeons, have to give up their careers because of the difficulty of raising children and working at the same time, especially when their children become ill. The number of these types of day care centers should be increasing, along with necessary support systems to be established immediately, so that female professionals, most particularly in medical facilities, can continue successful careers. PMID:24358733

  2. Establishing the need and identifying goals for a curriculum in medical business ethics: a survey of students and residents at two medical centers in Missouri

    OpenAIRE

    Kraus, Elena M; Bakanas, Erin; Gursahani, Kamal; DuBois, James M.

    2014-01-01

    Background In recent years, issues in medical business ethics (MBE), such as conflicts of interest (COI), Medicare fraud and abuse, and the structure and functioning of reimbursement systems, have received significant attention from the media and professional associations in the United States. As a result of highly publicized instances of financial interests altering physician decision-making, major professional organizations and government bodies have produced reports and guidelines to encou...

  3. Mind-body skills groups for medical students: reducing stress, enhancing commitment, and promoting patient-centered care

    OpenAIRE

    Gordon, James S.

    2014-01-01

    Background For several decades, psychological stress has been observed to be a significant challenge for medical students. The techniques and approach of mind-body medicine and group support have repeatedly demonstrated their effectiveness at reducing stress and improving the quality of the education experience. Discussion Mind-Body Skills Groups provide medical students with practical instruction in and scientific evidence for a variety of techniques that reduce stress, promote self-awarenes...

  4. 77 FR 38398 - Agency Information Collection (National Acquisition Center Customer Response Survey) Activities...

    Science.gov (United States)

    2012-06-27

    ... AFFAIRS Agency Information Collection (National Acquisition Center Customer Response Survey) Activities Under OMB Review AGENCY: Office of Acquisition and Logistics, Department of Veterans Affairs. ACTION... review and comment. The PRA submission describes the nature of the information collection and...

  5. Electron nuclear double resonance study of photostimulated luminescence active centers in CsBr:Eu2+ medical imaging plates

    International Nuclear Information System (INIS)

    CsBr:Eu2+ needle image plates exhibit an electron-paramagnetic-resonance (EPR) spectrum at room temperature (RT), whose intensity is correlated with the photostimulated luminescence sensitivity of the plate. This EPR spectrum shows a strong temperature dependence: At RT it is owing to a single Eu2+ (S =7/2) center with axial symmetry, whereas at T1H nuclei close to the central Eu2+ ions in the centers. Analysis of the angular dependence of the ENDOR spectra allows to propose models for these centers, providing an explanation for the observed difference in intensity between the spectral components and for their temperature dependence.

  6. A study on the Rate of Knowledge, Attitude and Practice of Medical Students towards Method of Medical Records Documentation at Mazandaran University of Medical Sciences Affiliated Therapeutic and Teaching Centers 2003

    Directory of Open Access Journals (Sweden)

    A. Balaghafari

    2005-01-01

    Full Text Available Background and Objectives: History, clinical findings, procedures undertaken, and patients response to treatment are written in clinical records, hence their contents are indicators of physicians’ evaluation. If clinical records are provided precisely, clear and systematized, they indicate the clinical thinking of the staff and facilitate patients diagnosis process. These records have an important role in coordinating professional staff involved in patient care. Since the physicians and medical students are involved more in medical records documentation than the other hospital staff, thus, a study on their knowledge, attitude and practice towards the principles of medical records documentation is undertaken.Materials and Methods: This is a descriptive study, which is done about the rate of knowledge, attitude and practice of 207 Medical students of Mazandaran University of Medical Sciences in university hospitals. Descriptive and inferential statistical analytic methods were used for the collected data. For comparison of the hospitals, regarding observing designed principals in the completion of medical files, according to the filled questionnaires the minimum and maximum score designated as 1-5 which is very poor to excellent. Then the mean score was calculated and considered for the comparison of hospitals. For the determination of the relationship between knowledge, attitude, and practice, β Kendall’s Tau Test was used.Results: The majority of the participants had low knowledge (77.8% about medical records documentation. Most of them did not have good attitude (54.1 about completion of medical records and significance and value of medical records documentation in treatment, education, and research.Conclusion: Results indicate that incompletion of medical records at the university affiliated hospitals are due to lack of awareness of the students towards the method of medical records documentation. In addition, not considering the

  7. Putting Descartes before the Horse: Opportunities for Advancing the Student Affairs Link with Academic Affairs.

    Science.gov (United States)

    Lamarid, Lucas

    1999-01-01

    Article challenges the division between student and academic affairs and encourages a view of learning and reason in a more holistic and integrated fashion. Outlines the historical factors for the separation of student and academic affairs and offers the programs instituted at Bellarmine College as examples of effective collaboration between…

  8. Carbon Monoxide Information Center

    Medline Plus

    Full Text Available ... an Unsafe Product Consumers Businesses Contact CPSC Website Design Feedback Consumers: Español Businesses: Español , 中文 , Tiếng Việt ... Chairman Commissioners Contact Information Agency Reports Legislative Affairs Job Opportunities Inspector General Safety Guides Safety Education Centers ...

  9. Invasive amebiasis and ameboma formation presenting as a rectal mass: An uncommon case of malignant masquerade at a western medical center

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    A 54-year-old man presented with rectal pain and bleeding secondary to ulcerated, necrotic rectal and cecal masses that resembled colorectal carcinoma upon colonoscopy. These masses were later determined to be benign amebomas caused by invasive Entamoeba histolytica, which regressed completely with medical therapy. In Western countries, the occurrence of invasive protozoan infection with formation of amebomas is very rare and can mistakenly masquerade as a neoplasm. Not surprisingly, there have been very few cases reported of this clinical entity within the United States. Moreover, we report a patient that had an extremely rare occurrence of two synchronous lesions, one involving the rectum and the other situated in the cecum. We review the current literature on the pathogenesis of invasive E. Histolytica infection and ameboma formation, as well as management of this rare disease entity at a western medical center.

  10. Working out and inculcation organizing measures of accreditation of Health. Care primary units institutions activity — rural medical centers (RMC)

    OpenAIRE

    Yusupaliev Bakhodir Kahramonovich

    2015-01-01

    The developed system of self — estimation of therapeutic-prophylactic institutions can be used for any type level of Healthcare institutions, as it gives the opportunity to motivate the process of medical help administration, to receive objective marks based on the facts and it is directed to increase in formativeness of the institutions of Healthcare on existing problems, demanding the solutions.

  11. The MMPI-2 Symptom Validity Scale (FBS) Not Influenced by Medical Impairment: A Large Sleep Center Investigation

    Science.gov (United States)

    Greiffenstein, Manfred F.

    2010-01-01

    The Symptom Validity Scale (Minnesota Multiphasic Personality Inventory-2-FBS [MMPI-2-FBS]) is a standard MMPI-2 validity scale measuring overstatement of somatic distress and subjective disability. Some critics assert the MMPI-2-FBS misclassifies too many medically impaired persons as malingering symptoms. This study tests the assertion of…

  12. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center

    OpenAIRE

    Sunil Kumar Garg

    2015-01-01

    Bodybuilding is the use of progressive resistance exercise to control and develop one′s musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

  13. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center.

    Science.gov (United States)

    Garg, Sunil Kumar

    2015-04-01

    Bodybuilding is the use of progressive resistance exercise to control and develop one's musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects. PMID:25878431

  14. UNC Health Systems and Blue Cross and Blue Shield of North Carolina patient-centered medical home collaborative.

    Science.gov (United States)

    Bradley, Don; Rubinow, David R

    2011-01-01

    UNC Health Systems and Blue Cross and Blue Shield of North Carolina have entered into a joint venture that is designed to improve patient outcomes and experience and to control medical costs for patients with chronic conditions. This commentary reviews the impetus for, and the anticipated outcomes of, the model practice. PMID:21901922

  15. Non-doctor consultations and self-medication practices in patients seen at a tertiary dental center in Ibadan

    Directory of Open Access Journals (Sweden)

    Happy Adeyinka Adedapo

    2011-01-01

    Conclusion: Self-medication practices were quite high in this study, and these practices were also prevalent among the educated people. Drug control enforcement needs to be intensified and dental public health education needs to be given greater priority in the overall public health campaigns.

  16. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Garg

    2015-01-01

    Full Text Available Bodybuilding is the use of progressive resistance exercise to control and develop one′s musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

  17. Bridging the Gap: The Role of the Patient-Centered Medical Home in Reducing Time to Follow-Up After Hospital Discharge.

    Science.gov (United States)

    Hearld, Larry R; Hearld, Kristine R; Budhwani, Henna

    2016-01-01

    Poor transitions in care represent opportunities for improvement. The purpose of this study was to examine whether early follow-up by patients discharged from a hospital varied as a function of patient-centered medical home (PCMH) capacity. The PCMH capacity was not significantly associated with early follow-up; however, higher levels of capacity were associated with early follow-up among patients with more chronic conditions. Policy makers and practitioners should consider how the PCMH may be targeted to maximize its potential to improve transitions in care for these patients and ways it may be modified to improve transitions for other types of patients. PMID:27232682

  18. Epidemiology and Risk Factors for Isolation of Escherichia coli Producing CTX-M-Type Extended-Spectrum β-Lactamase in a Large U.S. Medical Center

    OpenAIRE

    Hayakawa, Kayoko; Gattu, Sureka; Marchaim, Dror; Bhargava, Ashish; Palla, Mohan; Alshabani, Khaled; Gudur, Uma Mahesh; Pulluru, Harish; Bathina, Pradeep; Sundaragiri, Pranathi Rao; Sarkar, Moumita; Kakarlapudi, Hari; Ramasamy, Balaji; Nanjireddy, Priyanka; Mohin, Shah

    2013-01-01

    A case-case-control study was conducted to identify independent risk factors for recovery of Escherichia coli strains producing CTX-M-type extended-spectrum β-lactamases (CTX-M E. coli) within a large Southeastern Michigan medical center. Unique cases with isolation of ESBL-producing E. coli from February 2010 through July 2011 were analyzed by PCR for blaCTX-M, blaTEM, and blaSHV genes. Patients with CTX-M E. coli were compared to patients with E. coli strains not producing CTX-M-type ESBLs ...

  19. Analyzing the Models of Medical Data Center on Cloud Computing%云计算实现医学数据中心的模型分析

    Institute of Scientific and Technical Information of China (English)

    张杰敏

    2011-01-01

    A new classification framework for the models of the medical data center was proposed in this paper, in the framework, the models of the medical data center were divided into some categories which are the Decentralization, the Centralization, the Distribution based on B/S or C/S and the Centralizing on cloud particularly by the trends and the truth. As the development of cloud computing, the public data center based on the cloud may be construct rather than private data center. The cloud computer in essence is the implementation of the abstract and the encapsulation for a higher level. For the cloud computing, everything is services and services is everything.%本文通过解析当前医院信息化实际情况,首次将医学数据中心模型划分为分体式、大集中式、B/S、C/S混合分布式.并依据对医学数据中心模型发展趋势的分析,提出云式医学数据中心模型.通过对分体式、大集中式和B/S、C/S混合分布式的综合分析,指出云式医学教据中心将成为主流模型.本文认为云计算本质上是对软件设计理论中最根本的抽象和封装概念在大范围、高层次上的延续实现,其核心是公共数据中心,首次提出创建云计算公共数据中心应遵循的宗旨是“一切是服务,服务是一切”.

  20. A Model for Protective Behavior Against the Harmful Effects of Radiation for Radiological Technologists in Medical Radiological Technologists in Medical Centers

    International Nuclear Information System (INIS)

    Protective behavior of radiological technologists against radiation exposure is important to achieve reduction of the patient doses without compromising medical achievements. This study attempts to provide a basic model for the sophisticated intervention strategy that increases the level of the protective behavior of the technologists. The model was applied to real situations in Korea to demonstrate its utility. The results of this study are summarized as follows: First, the protective environment showed the highest relationship in the factors considered, r=0.637 (p<0.01). Secondly, the important factors were protective environment in environment characteristics, expectation for the protective behavior 0.228 (p<0.001), self efficacy 0.142 (p<0.001), and attitude for the protective behavior 0.178 (p<0.001) in personal characteristics, and daily patient -0.112 (p<0.001) and number of the participation in the education session for the protective behavior 0.074 (p<0.05). Thirdly, the final protective behavior model by a path analysis method had direct influence on the attitude 0.171 (p<0.01) and environment 0.405 (p<0.01) for the protective behavior, self efficacy 0.122 (p<0.01), expectation for the protective behavior 0.16 (p<0.01), and self-efficacy in the specialty of projects 0.154 (p<0.01). The acceptance of the model determined by the absolute fit index (GFI), 0.969, and by the incremental fit index (CFI), 0.943, showed very significant levels. Value of 2/df that is a factor applied to verify the acceptance of the model was 37, which implies that the result can be accepted in the desirable range. In addition, the parsimonious fit index configured by AGFI (0.890) and TLI (0.852) was also considered as a scale that accepts the model in practical applications. In case of the establishment of some specific intervention strategies based on the protective behavior model against harmful radiation effects proposed in this study, the strategy will provide an effective way

  1. Pattern and Predictors of Medication Dosing Errors in Chronic Kidney Disease Patients in Pakistan: A Single Center Retrospective Analysis

    Science.gov (United States)

    Saleem, Ahsan; Masood, Imran

    2016-01-01

    Background Chronic kidney disease (CKD) alters the pharmacokinetic and pharmacodynamic response of various drugs and increases the risk of toxicity. The data regarding the pattern and predictors of medication dosing errors is scare from the developing countries. Therefore, the present study was conducted to assess the pattern and predictors of medication dosing errors in CKD patients in a tertiary care setting in Pakistan. Methods A retrospective study design was employed and medical charts of all those CKD patients who had an eGFR ≤60ml/min/1.73m2, hospitalization ≥24 hours, and admitted in the nephrology unit during January 2013 to December 2014 were assessed. Descriptive statistics and the logistic regression analysis were done using IBM SPSS version 20. Results In total, 205 medical charts were assessed. The mean age of patients was 38.64 (±16.82) years. Overall, 1534 drugs were prescribed to CKD patients, of which, nearly 34.0% drugs required dose adjustment. Among those drugs, only 41.8% were properly adjusted, and the remaining 58.2% were unadjusted. The logistic regression analysis revealed that the medication dosing errors were significantly associated with the CKD stages, i.e. stage 4 (OR 0.054; 95% CI [0.017–0.177]; p <0.001) and stage 5 (OR 0.098; 95% CI [0.040–0.241]; p <0.001), the number of prescribed medicines ≥ 5 (OR 0.306; 95% CI [0.133–0.704]; p 0.005), and the presence of a comorbidity (OR 0.455; 95% CI [0.226–0.916]; p 0.027) such as the hypertension (OR 0.453; 95% CI [0.231–0.887]; p 0.021). Conclusions It is concluded that more than half drugs prescribed to CKD patients requiring dose adjustment were unadjusted. The predictors of medication dosing errors were the severe-to-end stages of chronic kidney disease, the presence of a comorbidity such as hypertension, and a higher number of prescribed medicines. Therefore, attention should be paid to these risk factors. PMID:27367594

  2. Gap analysis: transition of health care from Department of Defense to Department of Veterans Affairs.

    Science.gov (United States)

    Randall, Marjorie J

    2012-01-01

    This study examined the effectiveness of Public Law 110-181, "National Defense Authorization Act of Fiscal Year 2008, Title XVI-Wounded Warriors Matter," as it relates to health care for returning Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) combat veterans. Specifically, it examined the gap between the time an OEF/OIF combat service member left active service and subsequently obtained health care within the Veteran Affairs (VA) Healthcare System, and which factors influenced or impeded the veteran from obtaining health care sooner. Data were collected from 376 OEF/OIF combat veterans who sought health care at the Nashville or Murfreesboro VA Medical Centers. A questionnaire was designed exclusively for this study. The average time gap for an OEF/OIF combat veteran to transition from Department of Defense to VA health care was 3.83 months (SD 7.17). Twenty-six percent of respondents reported there were factors that impeded them from coming to the VA sooner. Factors included lack of knowledge about VA benefits, transportation/distance, perceptions of losing military career, seeking help as sign of weakness, and VA reputation. The study provided some evidence to support that Department of Defense and VA are meeting mandates for providing seamless transition of health care set forth by "Public Law 110-181, National Defense Authorization Act of Fiscal Year 2008." PMID:22338972

  3. Prostate cancer risk factors: a UK population based case-control study centered on chronic diseases, medications, sunlight and diet

    OpenAIRE

    Robinson, Fredie

    2012-01-01

    Background: Prostate cancer risk has been associated with several environmental factors but there is little information to indicate the effects of timing and of lifetime exposures that may add to the risk. This thesis aims to investigate the association of six main areas that may contribute to prostate cancer risk (1) body shape & fat distribution, (2) chronic diseases/conditions (diabetes mellitus, hypertension, ischaemic heart diseases and hypercholesterolemia), (3) statin medications (4) p...

  4. Duodenal Aspirates for Small Intestine Bacterial Overgrowth: Yield, PPIs, and Outcomes after Treatment at a Tertiary Academic Medical Center

    OpenAIRE

    Franco, Diana L.; Disbrow, Molly B.; Allon Kahn; Laura M. Koepke; Harris, Lucinda A.; M. Edwyn Harrison; Crowell, Michael D; Ramirez, Francisco C.

    2015-01-01

    Duodenal aspirates are not commonly collected, but they can be easily used in detection of small intestinal bacterial overgrowth (SIBO). Proton pump inhibitor (PPI) use has been proposed to contribute to the development of SIBO. We aimed to determine the yield of SIBO-positive cultures detected in duodenal aspirates, the relationship between SIBO and PPI use, and the clinical outcomes of patients identified by this method. In a retrospective study, we analyzed electronic medical records from ...

  5. Listening in on difficult conversations: an observational, multi-center investigation of real-time conversations in medical oncology

    OpenAIRE

    Kimball, Brittany C; James, Katherine M; Yost, Kathleen J.; Fernandez, Cara A; Kumbamu, Ashok; Leppin, Aaron L; Robinson, Marguerite E; Geller, Gail; Roter, Debra L.; Larson, Susan M; Lenz, Heinz-Josef; Garcia, Agustin A.; Braddock, Clarence H.; Jatoi, Aminah; de Nuncio, María Luisa Zúñiga

    2013-01-01

    Background The quality of communication in medical care has been shown to influence health outcomes. Cancer patients, a highly diverse population, communicate with their clinical care team in diverse ways over the course of their care trajectory. Whether that communication happens and how effective it is may relate to a variety of factors including the type of cancer and the patient’s position on the cancer care continuum. Yet, many of the routine needs of cancer patients after initial cancer...

  6. Listening in on difficult conversations: an observational, multi-center investigation of real-time conversations in medical oncology

    OpenAIRE

    Kimball, Brittany C; James, Katherine M; Yost, Kathleen J.; Fernandez, Cara A; Kumbamu, Ashok; Leppin, Aaron L; Robinson, Marguerite E; Geller, Gail; Roter, Debra L.; Larson, Susan M; Lenz, Heinz-Josef; Garcia, Agustin A.; Braddock, Clarence H.; Jatoi, Aminah; de Nuncio, María Luisa Zúñiga

    2013-01-01

    Abstract Background The quality of communication in medical care has been shown to influence health outcomes. Cancer patients, a highly diverse population, communicate with their clinical care team in diverse ways over the course of their care trajectory. Whether that communication happens and how effective it is may relate to a variety of factors including the type of cancer and the patient’s position on the cancer care continuum. Yet, many of ...

  7. Community Essay: Implementation of the MediSend Program: a multidisciplinary medical surplus recovery initiative at an academic health science center

    Directory of Open Access Journals (Sweden)

    Biruh Workeneh

    2007-01-01

    Full Text Available As a second year medical student my focus was narrowly on navigating and absorbing the enormous amount of information that I needed to pass my courses—it was not one year at a time, rather it was one course at a time. This changed when I became a student leader and met phenomenal individuals, like my co-author, who introduced the idea of medical surplus recovery to me, as well as Martin Lazar, who founded MediSend/International. The world was not simply going to wait while I struggled to finish medical school, and if I wanted to make a difference I had to jump in. In the article below we describe the MediSend Program, a student-conceived, student-driven effort to collect medical, dental, and educational surplus at the University of Texas Health Science Center at Houston. The students that helped and continue to help craft the MediSend Program have realized that they are not only important constituents of higher education, but they play a vital role in shaping university priorities. In the process, the MediSend Program has provided an uncommon learning experience, one that incorporates the values of compassion and altruism with environmental preservation and equitable resource distribution. I am no longer a student and consider my participation in sustainable solutions a duty, a sensibility that was shaped during my tenure in medical school. Sustainability should be a universal guiding principle in healthcare education and practice, as well as other disciplines, because it is the key to human survival.

  8. A Patient-Centered Primary Care Practice Approach Using Evidence-Based Quality Improvement: Rationale, Methods, and Early Assessment of Implementation

    OpenAIRE

    Rubenstein, Lisa V.; Stockdale, Susan E.; Sapir, Negar; Altman, Lisa; Dresselhaus, Timothy; Salem-Schatz, Susanne; Vivell, Susan; Ovretveit, John; Hamilton, Alison B.; Yano, Elizabeth M

    2014-01-01

    ABSTRACT BACKGROUND Healthcare systems and their primary care practices are redesigning to achieve goals identified in Patient-Centered Medical Home (PCMH) models such as Veterans Affairs (VA)’s Patient Aligned Care Teams (PACT). Implementation of these models, however, requires major transformation. Evidence-Based Quality Improvement (EBQI) is a multi-level approach for supporting organizational change and innovation spread. OBJECTIVE To describe EBQI as an approach for promoting VA’s PACT a...

  9. Investigating the Prevalence of Pervasive Developmental Disorders According to Sex in a Sample of Iranian Children Referred to Medical-Rehabilitation Centers and Psychiatrics Clinics

    Directory of Open Access Journals (Sweden)

    K. Khushabi

    2006-04-01

    Full Text Available Introduction & Objective: According to significance of pervasive developmental disorders (PDD in children and the increasing rate of its prevalence in referred patients to clinic in recent years and due to absence of any report about the rate of PPD in our country, this study was carried out. The aim of this study was to determine the prevalence of PPD in a sample of Iranian children who referred to medical and rehabilitation centers.Materials & Methods: 248 children who referred to three medical-rehabilitation centers were participated in the research. Accessible sampling with diagnosis of PDD based on DSM-IV criteria was chosen. The obtained data were analyzed using descriptive statistics methods such as percent and frequency distribution. Results: Autistics disorder was most prevalent among pervasive developmental disorders. In this research Autistic disorder (proportion 4/1 to 1, Asperger disorder (proportion 3 to 1 and childhood disintegrative disease were more prevalent in boys than girls. Ret disorders was observed only in girls and pervasive developmental disease (NOS was seen in both sexes. Conclusion: The results showed that pervasive developmental disorders are 4 times more prevalent in boys than girls and the findings of this research were consistent with those of previous studies.

  10. A study on organizational culture, structure and information technology as three KM enablers: A case study in five Iranian medical and healthcare research centers

    Directory of Open Access Journals (Sweden)

    Mahdi Iran-nejad-parizi

    2013-01-01

    Full Text Available This study investigates organizational structure, culture, and information technology as knowledge management (KM infrastructural capabilities, and compares their significance and status quo in five medical research centers in Tehran, Iran. Objectives of this research were pursued by employing two statistical methods, regression analysis and Friedman test. Included in the study were 135 people (researchers and support staff from five medical and healthcare research centers of Tehran. A survey questionnaire including 23 questions was utilized to examine organizational structure, culture and information technology indicators. And another 12 questions examined KM effectiveness. The Friedman test indicated that in terms of their status quo, the three studied KM enablers are at different conditions, with organizational culture having the best (mean rank=1.79 and IT the worst (mean rank=2.14 status. Moreover, it was revealed by regression analysis that organizational structure is believed to have the most significant impact (Beta= 0.397 on the effectiveness of knowledge management initiatives, while information technology gained the least perceived impact (Beta= 0.176.

  11. Provider perceptions of the social work environment and the state of pediatric care in a downsized urban public academic medical center.

    Science.gov (United States)

    Tataw, David Besong

    2011-05-01

    The author's purpose through this study was to document and analyze health provider perceptions of their social work environment and the state of pediatric care at Los Angeles County King/Drew Hospital and Medical Center in 2000, after the restructuring and downsizing of the hospital and its community clinics. The research results showed nurses and physicians reporting that both the quality of pediatric care and the provider social work environment were poor. Negative factors in the social work environment included: low employee morale, poorly staffed clinical teams, lack of professional autonomy, perceptions of low quality of care for pediatric patients, and interpersonal issues of poor communication and collaboration among providers. Providers also perceived a non-supportive work environment, sense of powerlessness, poor quality of work, lack of goal clarity from leadership, lack of fairness in leadership behavior, and an organizational leadership that is abandoning its core mission and values, thereby making it difficult for providers to carry out their professional functions. The author's findings in this study suggest a relationship between intra-role conflict, social employment environment and quality of care at King/Drew Medical Center in 2000. Lessons for practice are presented. PMID:21660823

  12. Commercialization as a recommended approach to hospital restructuring. Case study of Łańcut Medical Center

    Directory of Open Access Journals (Sweden)

    Wiktor Patena

    2015-10-01

    Full Text Available Our society is on the brink of health care system reorganization and implementation of new medical technology. Hospitals have to be a core component of the medical revolution so they have to be prepared for the upcoming leap in their development. If Poland wants to be a pioneer in providing new medical solutions, the current ineffective system has to be changed. The necessary action should be taken to deal with the financial problems Polish hospitals have faced for over 20 years. The current structure of hospitals - SPZOZ, is old-fashioned and cannot adapt to a turbulent social and economic environment. The hospitals should be commercialized and restructured. Being capitalized companies will give incentives and new tools to deal with financial problems. The article presents an example of the commercialized hospital in Łańcut. We make the observations that commercialization increases: a hospital’s profitability, its employment productivity, its capital investment spending and leverage. The case proves that the transformation of hospitals to capital companies proposed by the Ministry of Health may be an appropriate approach and it does work once a reasonable management board is in charge. However, the legal structure alteration should be treated as the first step in the overall restructuring process. The article highlights the problem of managers of Polish hospitals who do not only struggle with financial shortages, but barely know which business model they should follow after commercialization to successfully run the restructuring process. Having examined the LMC the authors are crafting a prelude to the overall research on already commercialized hospitals to find an appropriate business model.

  13. The Relationship between Wife Abuse and Mental Health in Women Experiencing Domestic Violence referred to the Forensic Medical Center of Shiraz

    Directory of Open Access Journals (Sweden)

    Arezoo Shayan

    2015-03-01

    Full Text Available Background and Objectives: Neglecting women's health and the domestic violence prevailing against them can cause a variety of mental and even physical diseases that threaten the health of the family. Disruptions in the life pattern of women and mothers have adverse health effects for both the family and the entire society. The present study was conducted to investigate the relationship between wife abuse and mental health in female victims of domestic violence referred to the Forensic Medical Center of Shiraz. Materials and Methods: The present cross-sectional, descriptive, analytical study was conducted over three months in 2013 on 197 women with abusive husbands referred to the Forensic Medical Center of Shiraz. The study data collection tools included a demographic information questionnaire, the General Health Questionnaire (GHQ-28 and a standard violence against women questionnaire. Cronbach's alpha was measured to assess the data collection tools' reliability. Data were analyzed in SPSS-18. Results: The mean age of the study subjects was reported as 30.42±6.72. More than 50 percent of the women had been victim to domestic violence and suffered from disorders in all the aspects of general health (P<0.05. There was a positive relationship between domestic violence and all the aspects of general health. In other words, violence of any kind was a predictor of general health disorders (P<0.05. Domestic violence was found to have the greatest effect on the incidence of depression and anxiety. Conclusion: The present study revealed the psychological consequences of wife abuse and violence against women and confirmed the damaging effect of violence on women's mental health. In addition to imposing heavy costs on the society for providing healthcare and medications, mental health disorders in women are also a burden for the family life and the children's upbringing.

  14. Undergraduate Consumer Affairs Program Needs: Employers' Perspectives

    Science.gov (United States)

    Morrison, Kathryn; Saboe-Wounded Head, Lorna; Cho, Soo Hyun

    2012-01-01

    Forty-six Consumer Affairs (CA) internship supervisors were surveyed to identify critical knowledge and skills demonstrated by interns and to examine the importance of knowledge and skills needed in the workplace from the supervisors' perspectives.The knowledge and skills measured were identified through program goals. Results revealed that CA…

  15. Orienting Mid-Level Student Affairs Professionals

    Science.gov (United States)

    Mather, Peter C.; Bryan, Stephen P.; Faulkner, William O.

    2009-01-01

    Mid-level managers comprise a large proportion of student affairs organizations. They are often the most overlooked when it comes to professional orientation and institutional introduction when entering new positions. Accordingly, information is presented from the professional literature that speaks to the characteristics and unique needs of this…

  16. Rethinking the Introduction to Student Affairs Course.

    Science.gov (United States)

    Manning, Kathleen

    1993-01-01

    Discusses theoretical and philosophical foundations that can be used to structure Introduction to Student Affairs course within graduate program. Describes the model course as being divided into two segments: liberation theology and liberal arts. Sees liberal arts segment as being further subdivided into philosophy, history, psychology,…

  17. Assessment of preclinical students’ academic motivation before and after a three-day academic affair program

    OpenAIRE

    Aung, Myo Nyein

    2015-01-01

    Myo Nyein Aung,1 Juraiporn Somboonwong,2 Vorapol Jaroonvanichkul,1 Pongsak Wannakrairot3 1Medical Education Unit, 2Quality Management Division and Department of Physiology, 3Academic Affairs Division, Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandBackground: Medical students’ motivation is an important driving factor for academic performance, and therefore medical teachers and educators are often highly interested in this topic. This study evaluated the impact of a...

  18. Medical Identity

    DEFF Research Database (Denmark)

    Musaeus, Peter

    2015-01-01

    Purpose: To examine philosophical stances underpinning medical identity and assess the conceptual relationship between physician, medical practice and culture. Argument: Medical identity is about the ideals and moral positions that physicians take when justifying themselves. Medical identity is the...... hedonistic versus sentimentalist approaches to medical identity. The sociocultural philosophical analysis of medical identity can shed light on what it means conceptually for a physician to harbor beliefs associated with him/her being taken to be an autonomous professional. It is important because it touches...... on the meaning of being a compassionate, good and skilled physician, making its relevance to person-centered medicine self-evident. Conclusion: Medical identity should be analyzed with reference to literature, philosophy and medical practice in order for the physician to exercise a reflective...

  19. Vancomycin and Five Broad-spectrum Antibiotic Utilization Evaluation in an Educational Medical Center in One Year

    Directory of Open Access Journals (Sweden)

    SiminDokht Shoaei

    2015-10-01

    Full Text Available  Background: Antibiotics can be life saving if they are used correctly, and can have unwanted side effects specially resistance with incorrect use. Unfortunately in fear of no response, physicians use broad spectrum antibiotics meticulously. In this Drug Utilization Evaluation (DUE, improper use of Vancomycin and five broad-spectrum antibiotics are studied to find faults and solution for this problem. Methods:This descriptive cross-sectional study performed during the March of 2012 to March of 2013.DUE of Imipenem, Meropenem, Piperacillin-Tazobactam, Cefepime, Ciprofloxacin and Vancomycin was done in 6 wards of Imam Hossein Hospital in Tehran. Demographic, clinical, laboratory, imaging and treatment data were looked for in medical records of 686 patients. Evaluation was done by three infectious disease specialist based on reference text book of Mandell’s Principles and Practice of Infectious Diseases 2010 and IDSA Guidelines. Results:This study showed 38.5% of prescriptions were correct and the remained 61.5% were incorrect with different faults predominantly incorrect overuse in 51.1%.Ciprofloxacin was the most common incorrect used drug in 74.8% cases and Piperacillin-Tazobactam with 48.7% cases had the least common incorrect use. There was no fault in prescription of antibiotics observing age and sex (pregnancy, breast feeding factors. Conclusions:Our results reveal a significant high level of the inappropriate use of Antibiotics mostly as overuse and empirically without culture results. It is needed to establish continuing medical education (CME courses and a locally conformable guideline of antibiotic use based on antibiogram results.

  20. Alzheimer's Disease Medications

    Science.gov (United States)

    ... Referral Center Alzheimer's Disease Education and Referral Center Alzheimer's Disease Education and Referral Center Home About Alzheimer’s ... Plan National Alzheimer's Project Act (NAPA) About ADEAR Alzheimer's Disease Medications Fact Sheet Treatment for Mild to ...

  1. Emergency Medicine for medical students world wide!

    DEFF Research Database (Denmark)

    Perinpam, Larshan; Thi Huynh, Anh-Nhi

    2015-01-01

    A guest blog from Larshan Perinpam (President of ISAEM) and Anh-Nhi Thi Huynh (Vice president of external affairs, ISAEM) - http://blogs.bmj.com/emj/2015/04/17/emergency-medicine-for-medical-students-world-wide/......A guest blog from Larshan Perinpam (President of ISAEM) and Anh-Nhi Thi Huynh (Vice president of external affairs, ISAEM) - http://blogs.bmj.com/emj/2015/04/17/emergency-medicine-for-medical-students-world-wide/...

  2. Public Affairs-Management von Großunternehmen

    OpenAIRE

    Siedentopp, Jan

    2012-01-01

    More and more companies are actively representing their interests to politicians and the public – so-called public affairs. The author examines 102 large companies, based on an innovative empirical design from quantitative and qualitative methods. Topics such as public affairs strategies, work and organization of public affairs departments, as well as effects on the overall strategy of the company are requested. A valid measurement model for determining the degree of public affairs of a compa...

  3. ACTING OF THE MEDICAL GENETIC ADVISORY CENTER IN THE EARLY DETECTION AND PREVENTION OF PERSONS WITH PSHYCHOPHYSICAL DISORDERS IN THEIR DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    M. KJAEVA-PEJKOVSKA

    1997-03-01

    Full Text Available There had been a great dedication on the prevention of the acquired disease in the past. The well known are eugenetic advisory centers in which people could get information for a given inherited disease, later so called genetic advisory centers. Their work, besides is based on the principles of informing the patients for the difficulties, importance and prognoses of determined inherited disease. This activity, which is the highest achievement in the medical genetics, can be called genetic information, which is very important for regular treatment of every patient.The accurate etiological diagnosis is an essential precondition for giving the genetic information, assessment of the risk, the eventual treatment, as for the prenatal diagnosis e.i. prevention of congenital malformations.The genetic consulting is applicable in all possible phenotype manifestations of the breaking genes, regardless to the categorical custody of the examinees with retards in their development. In fact, that’s a summary of standards which are applicable in the basic prevention in disabilities in the psycho-physical development, whose reasons are genetically determined. Preventive activities are mostly used with mentally retarded as a result of the frequent intercession of the psychological disorders all together in different syndromes and diseases.The genetic consulting activities of the Center for Mental Health for children and adolescents in Skopje are based on the appliance of the following methodology: fortification of the risk for the appearance of inherited anomalies; explanation and assessment of the established risk in the concrete family situation, assurance of adequate assistance concerning the accurate and practical assessment of the risk and preparation of rational plan for subsequent treatment and decisions; consequent observation of the situations and evaluation of achieved results etc. In that way, the acting of medical-genetic advising center in the

  4. Student Affairs as Perceived Through Abraham Maslow's Hierarchy of Needs.

    Science.gov (United States)

    Nowacki, Steven

    The needs of human behavior are explored and correlated to the various departments within Student Affairs in an effort to show how Student Affairs can satisfy those needs. Maslow's Hierarchy of needs is briefly explained and related to the following Student Affairs departments: Financial Aid, Student Management, Career Development and Placement,…

  5. Clinical trial of neutron capture therapy for brain tumors at New England Medical Center and the Massachusetts Institute of Technology

    International Nuclear Information System (INIS)

    A proposal is submitted that is based on the conclusions of a NCT expert panel recently convened at BNL by the Department of Energy to evaluate the status of NCT and to recommend what preclinical tasks should be accomplished prior to a clinical study being undertaken. The proposal is for two years of preclinical research and preparations, followed in the third year by a pilot clinical trial of ten patients with grade-IV astrocytoma brain tumors, for whom the prognosis with existing treatment modalities is less than a 5% three-year survival rate. Preclinical tasks would include modifying the MIT Nuclear Reactor medical facility to produce an epithermal as well as the existing and highly thermalized neutron treatment beam; characterizing the transport behavior of these beams in both physical and mathematical models of the human head, and developing a treatment planning scheme for NCT; further development of the neutron-induced alpha-autoradiography track-etch method for measuring macro- and micro-distributions of B-10 uptake in tissues and blood; investigations into the B-10 cellular uptake pattern of human tumors; and examination of the nature of endothelial cell vascular damage in B-10-containing animals undergoing irradiation with neutrons. With the successful completion of the above preclinical tasks we feel we will be in a position to embark in the third year on a pilot clinical evaluation

  6. Conflations of Marital Status and Sanity: Implicit Heterosexist Bias in Psychiatric Diagnosis in Physician-Dictated Charts at a Midwestern Medical Center.

    Science.gov (United States)

    Metzl, Jonathan M; McClelland, Sara I; Bergner, Erin

    2016-06-01

    This paper discusses the role of gender role conformity in psychiatric determinants of well-being after of the depathologization of homosexuality from the DSM. In order to examine the heterosexualizing of sanity in U.S. psychiatric and popular cultures, we analyze archived psychiatrist-dictated patient charts from outpatient psychiatric clinics from a Midwestern medical center (n = 45). We highlight ways physicians deployed heteronormative gender expectations to describe and treat women's and men's depressive illness and implicitly construed troubled female-male relationships and sexual encounters as indices of psychopathology. We theorize how evolving connections between the heteronormal and the psychiatric normal performed some of the same regulatory functions, as did the DSM, coding particular gender performances and partner choices as mentally healthy while relegating others to the realm of disease. Only here, focusing on the mainstream instead of the marginalized kept the ideological work of these scripts hidden from view. PMID:27354850

  7. Knowledge level of primary care physicians who works in Denizli city center and interns in Pamukkale University medical faculty about alzheimer disease

    Directory of Open Access Journals (Sweden)

    Ahmet Ergin

    2015-04-01

    Full Text Available AIM: Many communities in the world are rapidly ageing, with aging dementia seen in the elderly, incidence and prevalence of Alzheimer and #8217;s disease which is the most common cause of dementia is also increasing. Therefore, primary care physicians will need to play a more significant role on the diagnosis and management of Alzheimer diseases in near future. The aim of this study was to determine the level of awareness on Alzheimers disease among primary care physicians who works in Denizli city center and interns in the Medical Faculty in Pamukkale University. METHODS: This cross-sectional study was conducted on primary care physicians who works in Denizli city center and interns in the Medical Faculty in Pamukkale University. 93 (60.4% family physicians and 65 (89.0% interns, a total of 158 (69.6% people participated in the study. The University of Alabama Alzheimers Disease Knowledge Test which consists of 12 questions was used to determine Alzheimers disease knowledge score. Data are evaluated by descriptive statistics, and either Mann-Whitney U test or Kruskal-Wallis test was used to determine the statistical differences between numeric variables. RESULTS: The mean of Alzheimers disease knowledge score of family physicians and interns were 5.16+/-1.83 and 7.34+/-1.85, respectively (p <0.001. Interns who previously took any course on Alzheimers disease had a higher average score of 8.41+/-1.67 than that of those who did not take any course 5.07+/-1.95, (p=0.04. Previous course among family physicians did not make any difference (p=0.568. CONCLUSION: Alzheimers disease knowledge among primary care physicians and interns is insufficient. Authorities should take the necessary actions to improve this situatio [TAF Prev Med Bull 2015; 14(2.000: 131-136

  8. Assessment of mothers’ satisfaction with the care of maternal care in Specialized Educational-Medical Centers in obstetrics and gynecological disease in Northwest, Iran

    Directory of Open Access Journals (Sweden)

    Simin Taghavi

    2015-06-01

    Full Text Available Introduction: Patients satisfaction includes the assessment of healthcare which she/he received. This study aims at assessment of mothers’ satisfaction with the care of maternal care in Specialized Educational-Medical Centers in obstetrics and gynecological disease in Northwest, Iran. Methods: In an analytic-descriptive cross-sectional study, 1000 female patients who admitted in educational-medical centers of Northwest were studied during a 2 years period (2010-2012. They asked to fill a 34-item closed-answer questionnaire (ranking from very unsatisfied to very satisfied responses following their discharge. Validity of the questionnaire was improved by gynecologist’s experts comments, and reliability of the questionnaire were assessed by test-retest methods (α = 0.946. Results: The satisfaction score (satisfied or very satisfied responses were 61.2, 55.8, 61.8 and 59.5 percent for admitting process, primary care services, treatments and therapeutic interventions and overall, respectively. The satisfaction score for access to doctors was highest in the morning and lowest at the night shifts. The satisfaction score about the personnel’s behavior was lowest during the night shifts. The satisfaction score about the residents’ behavior was highest for the morning shifts. There was no significant difference between the three working shifts regarding psychological feelings, humanitarian respect, and issues like nutrition and private and public hygiene. There was a significant direct correlation between the mean score of satisfaction and patients’ age (Spearman’s rho = 0.117, P < 0.001. Conclusion: The satisfaction level of patients hospitalized in Northwest of Iran's Hospitals was intermediate. Planning new strategies in this regard with emphasis on the main limitations may improve the satisfaction rate in the future.

  9. 77 FR 56710 - Proposed Information Collection (Call Center Satisfaction Survey): Comment Request

    Science.gov (United States)

    2012-09-13

    ... AFFAIRS Proposed Information Collection (Call Center Satisfaction Survey): Comment Request AGENCY... techniques or the use of other forms of information technology. Title: VBA Call Center Satisfaction Survey... information needed from Veterans regarding their recent experience in contacting VA call centers....

  10. Cyberbullying 101: A Student Affairs Perspective

    OpenAIRE

    McKillop, Elizabeth D'Arcy

    2014-01-01

    Bullying and its negative effects within the K-12 educational sector are thoroughly researched problems. However, there is a relative lack of research on bullying and its most recent incarnation, cyberbullying, within United States higher education. The studies that do exist indicate that college-level cyberbullying is a problem on some U.S. campuses. The goal of my study was to explore the experiences of student affairs administrators in implementing policies and practices used to address c...

  11. ANALYSIS AND MANAGEMENT RISK IN INTERNATIONAL AFFAIRS

    OpenAIRE

    Lăpăduşi Mihaela Loredana; Căruntu Constantin

    2009-01-01

    The risk is one of the most controversial issues for all persons involved both in domestic and international world economic affairs. The need to analyze, understand and effectively manage risk is growing, the ultimate aim being to obtain a higher degree of successThe risk means exposure to an uncertain future, the opportunity to face danger or suffering a loss ( "Risk - possibility of loss or injury", Webster's, 1995) or the chance that things go wrong ( "Risk is the change that something wil...

  12. The revised Bethesda guidelines: extent of utilization in a university hospital medical center with a cancer genetics program

    Directory of Open Access Journals (Sweden)

    Mukherjee Aparna

    2010-11-01

    Full Text Available Abstract Background In 1996, the National Cancer Institute hosted an international workshop to develop criteria to identify patients with colorectal cancer who should be offered microsatellite instability (MSI testing due to an increased risk for Hereditary Nonpolyposis Colorectal Cancer (HNPCC. These criteria were further modified in 2004 and became known as the revised Bethesda Guidelines. Our study aimed to retrospectively evaluate the percentage of patients diagnosed with HNPCC tumors in 2004 who met revised Bethesda criteria for MSI testing, who were referred for genetic counseling within our institution. Methods All HNPCC tumors diagnosed in 2004 were identified by accessing CoPath, an internal database. Both the Tumor Registry and patients' electronic medical records were accessed to collect all relevant family history information. The list of patients who met at least one of the revised Bethesda criteria, who were candidates for MSI testing, was then cross-referenced with the database of patients referred for genetic counseling within our institution. Results A total of 380 HNPCC-associated tumors were diagnosed at our institution during 2004 of which 41 (10.7% met at least one of the revised Bethesda criteria. Eight (19.5% of these patients were referred for cancer genetic counseling of which 2 (25% were seen by a genetics professional. Ultimately, only 4.9% of patients eligible for MSI testing in 2004 were seen for genetic counseling. Conclusion This retrospective study identified a number of barriers, both internal and external, which hindered the identification of individuals with HNPCC, thus limiting the ability to appropriately manage these high risk families.

  13. Hepatitis B Virus Vaccination Coverage in Medical, Nursing, and Paramedical Students: A Cross-Sectional, Multi-Centered Study in Greece.

    Science.gov (United States)

    Papagiannis, Dimitrios; Tsimtsiou, Zoi; Chatzichristodoulou, Ioanna; Adamopoulou, Maria; Kallistratos, Ilias; Pournaras, Spyros; Arvanitidou, Malamatenia; Rachiotis, George

    2016-01-01

    Students of health professions are at high risk of hepatitis B Virus (HBV) infection during their clinical training. The aim of this cross-sectional, multi-centered study was to investigate the HBV vaccination coverage in Greek medical, nursing, and paramedical students, to look into their attitudes towards the importance of vaccines and to reveal reasons associated with not being vaccinated. A self-completed, anonymous questionnaire was distributed to 2119 students of health professions in Greece, during the academic year 2013-2014. The HBV vaccination coverage of students was high (83%), being higher among medical students (88.1%, vs. 81.4% among nursing and 80.1% among paramedical students; p vaccinated during childhood. In addition, 30% of the unvaccinated students declared fear over HBV safety. Our results indicate that the healthcare students achieved higher reported immunization rates compared to the currently serving healthcare workers, but also to the students of the last decade. The fact that nursing and paramedical students have lower coverage figures underlines the importance of targeted interventions for the different subgroups of healthcare students in terms of educational programs and screening for HBV markers in order to increase HBV vaccination uptake. PMID:26999171

  14. Academic Medical Centers Forming Accountable Care Organizations and Partnering With Community Providers: The Experience of the Johns Hopkins Medicine Alliance for Patients.

    Science.gov (United States)

    Berkowitz, Scott A; Ishii, Lisa; Schulz, John; Poffenroth, Matt

    2016-03-01

    Academic medical centers (AMCs)--which include teaching hospital(s) and additional care delivery entities--that form accountable care organizations (ACOs) must decide whether to partner with other provider entities, such as community practices. Indeed, 67% (33/49) of AMC ACOs through the Medicare Shared Savings Program through 2014 are believed to include an outside community practice. There are opportunities for both the AMC and the community partners in pursuing such relationships, including possible alignment around shared goals and adding ACO beneficiaries. To create the Johns Hopkins Medicine Alliance for Patients (JMAP), in January 2014, Johns Hopkins Medicine chose to partner with two community primary care groups and one cardiology practice to support clinical integration while adding approximately 60 providers and 5,000 Medicare beneficiaries. The principal initial interventions within JMAP included care coordination for high-risk beneficiaries and later, in 2014, generating dashboards of ACO quality measures to facilitate quality improvement and early efforts at incorporating clinical pathways and Choosing Wisely recommendations. Additional interventions began in 2015.The principal initial challenges JMAP faced were data integration, generation of quality measure reports among disparate electronic medical records, receiving and then analyzing claims data, and seeking to achieve provider engagement; all these affected timely deployment of the early interventions. JMAP also created three regional advisory councils as a forum promoting engagement of local leadership. Network strategies among AMCs, including adding community practices in a nonemployment model, will continue to require thoughtful strategic planning and a keen understanding of local context. PMID:26535867

  15. Safety and efficacy of thromboprophylaxis with fondaparinux in elderly acutely ill medical patients with renal impairment: a retrospective single center study

    Directory of Open Access Journals (Sweden)

    Federico Silvestri

    2013-12-01

    Full Text Available The majority of acutely ill medical patients are elderly with some degree of renal impairment. In this setting, venous thromboembolism (VTE is one of the leading causes of morbidity and mortality and, to reduce this risk, a correct thromboprophylaxis is needed. The aim of this single center retrospective study was to assess the safety and efficacy of fondaparinux in elderly acutely ill medical patients with renal impairment. All patients aged 60 years or over, bedridden for at least four days, with a creatinine clearance (CrCl of 50 mL/min or under, and who had received fondaparinux during hospitalization were evaluated and followed for up to 90 days after discharge. A total of 125 patients were evaluated (34.4% males; median age was 83.0 years. Median duration of thromboprophylaxis was 9.0 days. Forty-one (32.8% patients were treated with fondaparinux 1.5 mg daily, 84 (67.2% with 2.5 mg daily. Inappropriately high doses of fondaparinux were used in 77 patients with CrCl 20-50 mL/min, in 12 patients with CrCl below 20 mL/min, in 14 patients with prothrombin time (PT ratio over 1.2, in 8 patients with PT ratio over 1.5, and in 3 patients with thrombocytopenia. No episodes of VTE or of major bleeding were recorded while there were 6 episodes (2.4% of minor bleeding. Both dosages of fondaparinux showed similar safety and efficacy. Twenty-six patients (20.8% died; no cause of death was related to fondaparinux. In conclusion, in elderly acutely ill hospitalized medical patients with renal impairment, prophylaxis with fondaparinux 2.5 or 1.5 mg daily is safe and effective in preventing VTE without increasing bleeding risk.

  16. The Survey of knowledge and attitude of pregnant women referred to Medical Centers of Qom towards type of delivery

    Directory of Open Access Journals (Sweden)

    Amir Kasaian

    2007-01-01

    Full Text Available Introduction: Vaginal delivery is the best method of delivery. Regarding to recent data (1382 33% of deliveries were carried out using cesarean method in Iran. Increasing of cesarean percentage is probably due to negative attitude about vaginal delivery and low knowledge about cesarean side effects. This research is aimed to determine knowledge and attitude of pregnant women about type of delivery. Methods: This descriptive study was conducted on 136 pregnant women attended to eight health centers in Qom during Jun to August of 2003. The tool for data collection was questionnaire including, demographic obstetrical and gynecological factors and some questions about knowledge and attitude about vaginal and cesarean delivery. The questionnaire was provided by counseling with experts in midwifery and gynecology and its reliability was confirmed by test and retest. Data were analyzed using descriptive statistics, ², Man Whitney and Kruskal Wallis. Results: The levels of knowledge in the pregnant women about type of delivery, in 40.4% were average and in 59.6% were good. In this study 94.1% of women toward vaginal delivery and 63.2% toward cesarean delivery had positive atitudes, 5.9% of subjects toward vaginal delivery and 36% toward cesarean had indifferent attitude. Significant statistical difference was observed between the level of knowledge and attitude of cesarean delivery (P< 0.0001, but no significant statistical difference was observed between the level of knowledge and attitude of vaginal delivery (P=0.19. Conclusion: According to the result there was significant relationship between knowledge and attitude toward cesarean delivery. Education strategies are suggested for improvement knowledge and positive attitude toward methods of delivery. It can decrease interest of pregnant women toward cesarean delivery.

  17. Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts.

    Science.gov (United States)

    Mikesell, Lisa; Bromley, Elizabeth; Young, Alexander S; Vona, Pamela; Zima, Bonnie

    2016-06-01

    Shared decision making (SDM) interventions aim to improve client autonomy, information sharing, and collaborative decision making, yet implementation of these interventions has been variably perceived. Using interviews and focus groups with clients and clinicians from mental health clinics, we explored experiences with and perceptions about decision support strategies aimed to promote SDM around psychotropic medication treatment. Using thematic analysis, we identified themes regarding beliefs about participant involvement, information management, and participants' broader understanding of their epistemic expertise. Clients and clinicians highly valued client-centered priorities such as autonomy and empowerment when making decisions. However, two frequently discussed themes revealed complex beliefs about what that involvement should look like in practice: (a) the role of communication and information exchange and (b) the value and stability of clinician and client epistemic expertise. Complex beliefs regarding these two themes suggested a dynamic and reflexive approach to information management. Situating these findings within the Theory of Motivated Information Management, we discuss implications for conceptualizing SDM in mental health services and adapt Siminoff and Step's Communication Model of Shared Decision Making (CMSDM) to propose a Communication-centered Epistemic Model of Shared Decision Making (CEM-SDM). PMID:26529605

  18. Current State Of Proton And Carbon-Ion Radiotherapy At The Hyogo Ion Beam Medical Center (HIBMC)

    Science.gov (United States)

    Murakami, Masao; Demizu, Yusuke; Niwa, Yasue; Fujii, Osamu; Terashima, Kazuki; Mima, Masayuki; Miyawaki, Daisuke; Sasaki, Ryohei; Hishikawa, Yoshio; Abe, Mitsuyuki

    2011-06-01

    HIBMC is the world's first facility to be able to use both proton (PRT) and carbon-ion radiotherapy (CiRT). The medically dedicated synchrotron can accelerate protons up to 230 MeV and carbon ions up to 320 MeV. From April 2001 to March 2010, the facility treated 3275 patients, with 2487 patients treated using PRT and 788 using CiRT. Particle radiotherapy was delivered to patients suffering from malignant tumors originating in the head and neck (502 patients), lungs (330), liver (539), prostate (1283), and the bone & soft tissue (130). The clinical results are as follows: (1) H & N tumors: The 2-year overall survival (OS) rates of patients with olfactory neuroblastoma, mucoepidermoid cancer, adenoid cystic cancer, adenocarcinoma, squamous cell carcinoma, and malignant melanoma was 100%, 86%, 78%, 78%, 66%, and 62%, respectively. (2) Lung cancer: For all 80 patients, the 3-year OS rate was 75% (Stage IA: 74%; Stage IB: 76%) and local control (LC) rate was 82% (IA: 87%; IB: 77%). Grade 3 pulmonary toxicity was observed in only 1 patient. These results are comparable to those obtained by surgery, and indicate proton therapy and carbon-ion therapy are safe and effective for stage I lung cancer. (3) Liver cancer: The 5-year LC rate for 429 tumor patient was 90%, and the 5-year OS rate for 364 patients was 38%. These results seem equivalent to those obtained by surgery or radio-frequency ablation. (4) Prostate cancer: In 290 patients treated by proton radiotherapy, five patients died from other disease in the median follow-up period of 62 months. Biochemical disease-free survival and OS rate at 5 years was 88.2% and 96.5%, respectively. Our proton radiotherapy showed excellent OS and biochemical disease-free survival rates with minimum late morbidities. PRT VS CiRT: From our retrospective analysis, it seems that there is no significant difference in the LC and OS rate in H&N, lung and liver cancer between PRT and CiRT.

  19. Current State Of Proton And Carbon-Ion Radiotherapy At The Hyogo Ion Beam Medical Center (HIBMC)

    International Nuclear Information System (INIS)

    HIBMC is the world's first facility to be able to use both proton (PRT) and carbon-ion radiotherapy (CiRT). The medically dedicated synchrotron can accelerate protons up to 230 MeV and carbon ions up to 320 MeV. From April 2001 to March 2010, the facility treated 3275 patients, with 2487 patients treated using PRT and 788 using CiRT. Particle radiotherapy was delivered to patients suffering from malignant tumors originating in the head and neck (502 patients), lungs (330), liver (539), prostate (1283), and the bone and soft tissue (130). The clinical results are as follows: (1) H and N tumors: The 2-year overall survival (OS) rates of patients with olfactory neuroblastoma, mucoepidermoid cancer, adenoid cystic cancer, adenocarcinoma, squamous cell carcinoma, and malignant melanoma was 100%, 86%, 78%, 78%, 66%, and 62%, respectively. (2) Lung cancer: For all 80 patients, the 3-year OS rate was 75%(Stage IA: 74%; Stage IB: 76%) and local control (LC) rate was 82%(IA: 87%; IB: 77%). Grade 3 pulmonary toxicity was observed in only 1 patient. These results are comparable to those obtained by surgery, and indicate proton therapy and carbon-ion therapy are safe and effective for stage I lung cancer. (3) Liver cancer: The 5-year LC rate for 429 tumor patient was 90%, and the 5-year OS rate for 364 patients was 38%. These results seem equivalent to those obtained by surgery or radio-frequency ablation. (4) Prostate cancer: In 290 patients treated by proton radiotherapy, five patients died from other disease in the median follow-up period of 62 months. Biochemical disease-free survival and OS rate at 5 years was 88.2% and 96.5%, respectively. Our proton radiotherapy showed excellent OS and biochemical disease-free survival rates with minimum late morbidities. PRT VS CiRT: From our retrospective analysis, it seems that there is no significant difference in the LC and OS rate in H and N, lung and liver cancer between PRT and CiRT.

  20. From traditional to patient-centered learning: curriculum change as an intervention for changing institutional culture and promoting professionalism in undergraduate medical education.

    Science.gov (United States)

    Christianson, Charles E; McBride, Rosanne B; Vari, Richard C; Olson, Linda; Wilson, H David

    2007-11-01

    The authors reframe a curriculum change from a traditional lecture-based to an integrated patient-centered approach as an intervention for changing the culture and hidden curriculum of an institution in ways that promote professionalism. Within this context, the authors articulate some of the inherent process and relational factors brought about by these curricular changes that are essential elements of this intervention process. In 1998 the University of North Dakota School of Medicine and Health Sciences (UNDSMHS) introduced a new preclinical patient-centered learning (PCL) curriculum for first- and second-year medical students. Case-based, small-group learning forms the critical foundation of the PCL process, and an integrated basic and clinical science didactic component supports this process. At the student level, the case-based PCL process generates innovative opportunities for professionalism education from the explicitly articulated formal content that arises naturally from the cases, but more importantly from the implicit values inherent to the PCL small-group process itself--humanism, accountability, pursuit of excellence, and altruism. Further, the organizational changes necessary for the transformation to the PCL curriculum required process changes at student, faculty, and administrative levels that have resulted in a cultural shift toward relationship centeredness within the institution. The authors describe the evolution and structure of the PCL curriculum at UNDSMHS and how this curricular transformation has served as an intervention that promotes professionalism and institutional culture change through (1) processes at the student level that present new opportunities for professionalism education, and (2) processes at student, faculty, administrative, and institutional levels that have created an institutional culture that supports, models, and promotes relationship-centered professional values. PMID:17971696

  1. An assessment of technology-based service encounters & network security on the e-health care systems of medical centers in Taiwan

    Directory of Open Access Journals (Sweden)

    Chang Ching

    2008-04-01

    Full Text Available Abstract Background Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enhanced service efficiency and quality under the restraint of healthcare cost control. The electronic medical record system and the online appointment system are the core features in employing e-health care systems in the technology-based service encounters. Methods This study implemented the Service Encounters Evaluation Model, the European Customer Satisfaction Index, the Attribute Model and the Overall Affect Model for model inference. A total of 700 copies of questionnaires from two authoritative southern Taiwan medical centers providing the electronic medical record system and the online appointment system service were distributed, among which 590 valid copies were retrieved with a response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural Relationship Model (LISREL 8.54 to analyze and evaluate the data. Results The findings are as follows: (1 Technology-based service encounters have a positive impact on service quality, but not patient satisfaction; (2 After experiencing technology-based service encounters, the cognition of the service quality has a positive effect on patient satisfaction; and (3 Network security contributes a positive moderating effect on service quality and patient satisfaction. Conclusion It revealed that the impact of electronic workflow (online appointment system service on service quality was greater than electronic facilities (electronic medical record systems in technology-based service encounters. Convenience and

  2. Hospitals - MEDICAL_CARE_FACILITIES_MHMP_IN: Medical Care Facilities in Indiana, derived from Essential Facilities Data of the Multi-Hazard Mitigation Planning Data (The Polis Center, Point Shapefile)

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — MEDICAL_CARE_FACILITIES_MHMP_IN.SHP is a point shapefile that shows medical care facilities in Indiana. MEDICAL_CARE_FACILITIES_MHMP_IN.SHP was derived from the...

  3. Peking University Center of Medical Genetics (PUCMG): a comprehensive medical genetics program in China%中国医学遗传综合项目基地--北京大学医学遗传中心

    Institute of Scientific and Technical Information of China (English)

    Nanbert ZHONG

    2006-01-01

    @@ Medical genetics, as an important component in the advanced medical practice, has touched in variant aspects of clinical aspects. Globally, in both developed and developing countries, medical genetics is playing more and more important roles in dealing with the public healthcare. Being a medical specialty performing diagnosis and intervention for genetic disorders, the medical genetics has bridged the clinical practice and basic medical sciences. It is derived, but different, from human genetics. The difference of which is that the medical genetics provides clinical service for medical professionals and patients; however, the human genetics focuses on investigation of genetic principles.

  4. Sacco e Vanzetti: caso giudiziario o affaire?

    Directory of Open Access Journals (Sweden)

    Flavia Tudini

    2013-08-01

    Full Text Available This article focus on maybe the most striking judicial case in America during the early twenieth century. The Sacco and Vanzetti case. There is a widespead awareness about the crime they were accused for, the trial phases and their tragic end, but what about the defensive strategies adopted by their lawyers? The analisys of this theme and the involvement of the pubblic opinion demostrates how this jucidial case bacame an affaire, with a disrupting international eco, underestimated even by U.S. authorities. The pubblic opinion will elevate the two anarchists, crushed by injustice and the political trial, to icons of political struggle against the system.

  5. The so-called nuclear waste affair

    International Nuclear Information System (INIS)

    The so-called nuclear waste affair has placed the Hanau nuclear fuel company NUKEM and its daughter Transnuklear in the centre of public discussions about nuclear safety. The disclosed and alleged irregularities have led to preliminary investigation by the public prosecutor, a parliamentary inquiry commission has been set in, and the Hanau companies have been re-organised by order of the state: Transnuklear has been dissolved, and NUKEM will discontinue fuel element fabrication. The article in hand explains the foundation and the history of the NUKEM company and its daughter companies in order to reveal the significance of the current events. (orig./DG)

  6. PS1-38: Building a Patient-centered Medical Home: Patient Perspectives from a Survey in an Integrated Healthcare System

    Science.gov (United States)

    Forjuoh, Samuel; Miller, Sarah; Reis, Michael

    2014-01-01

    Background/Aims As healthcare evolves to meet growing demand, it is crucial to maintain quality patient-centered care. In our quest to build a viable Patient-Centered Medical Home (PCMH) in our ambulatory care setting, we conducted this study to assess our patients’ perspectives on patient-centeredness in our integrated healthcare system. Methods Surveys were administered to all consenting English-speaking patients and accompanying relatives ages = 18 at 4 Family Medicine clinics. The questionnaire consisted primarily of Likert-type items with 5 choices ranging from strongly agree to strongly disagree on relationships within healthcare, communication with providers, access to providers, and coordination of care, along with basic demographics. Results Of 316 patients approached, 204 (64.6%) returned completed surveys. Mean age was 47.4 (SD = 16.0; range 18–89); 67% were female, 84.4% white, 11.8% black, and 12.8% Hispanic. Majority were married (57.0%), employed (60.2%), had college education (69.4%), and reported an annual income of <$60,000 (68.7%). The vast majority expressed believe that their healthcare team treats them with courtesy and respect (96.1%), trust their healthcare team with their medical care (93.6%), feel their healthcare provider communicates with them clearly using understandable language (95.6%) and listens to their questions, answering them directly (96%). Also the vast majority believe they play an active role in their healthcare (95.5%) and think it is important to be proactive in their healthcare (97%). Comparatively lower percentages of positive responses were noted when asked if the patient would like to use the Internet for filling prescriptions, making appointments, or communicating with their healthcare team (52%), if their provider inquires about their health goals (61.9%), and if their provider takes their health goals into account when developing a treatment plan (69.4%). Conclusions In order to move towards a more PCMH

  7. Commercial Crew Medical Ops

    Science.gov (United States)

    Heinbaugh, Randall; Cole, Richard

    2016-01-01

    Provide commercial partners with: center insight into NASA spaceflight medical experience center; information relative to both nominal and emergency care of the astronaut crew at landing site center; a basis for developing and sharing expertise in space medical factors associated with returning crew.

  8. Designing Student Affairs Organizational Structures: Perceptions of Senior Student Affairs Officers

    Science.gov (United States)

    Kuk, Linda; Banning, James H.

    2009-01-01

    Student affairs organizations have become complex entities and serve as a critical link to student success and the quality of the overall educational experience in collegiate institutions. Over time, new programs and services have been added to the array of existing programs and services with little attention focused on how these organizations…

  9. Student Affairs Case Management: Merging Social Work Theory with Student Affairs Practice

    Science.gov (United States)

    Adams, Sharrika D.; Hazelwood, Sherry; Hayden, Bruce

    2014-01-01

    Case management is a functional area in higher education and student affairs that emerged after the mass shootings at Virginia Tech in 2007. Although new to higher education, case management emerged from established social work practice. This article compares social work theory and case management standards with a new case management model for…

  10. Diagnosis of hepatobiliary disease by Technetium-99m-HIDA and BIDA cholecystography in 210 patients treated at ''Soroka Medical Center'' between 1977 - 1979

    International Nuclear Information System (INIS)

    Cholescintigraphy experience with Tc99m-HIDA and BIDA in 210 patients with gallbladder disease treated at the Soroka Medical Center between the years 1977 - 1979 is described. In this work the utility of the method in both acute and chronic cholecystitis and hepatobiliary disease in the presence of jaundice up to 26 mg% of Bilirubin is demosntrated. Four patients were diagnosed as suffering from Atresia of biliary duct. The most common findings in our series are: all normal gallbladders exhibited filling; absence of visualization indicated gallbladder disease and/or cystic duct obstruction; visualization of the gallbladder after a fatty meal-induced emptying excluded an obstructed cystic duct and acute cholecystitis; a definite diagnosis of hepato-cellular disease, partial and complete obstruction, is possible in jaundiced patients with hyperbilirubinemia. No diagnostic failures due to too low concentration of the tracer in the biliary tract, were observed. Radiation exposure is somewhat greater than in cholecystography and cholangiography. Cholescintigraphy is a suitable complementary or alternative investigation to intravenous cholangiography, especially when poor excretion of the contrast medium or adverse reaction impair the result of the latter. In some of our cases this method proved to be the first choice non invasive procedure, especially in cases with high serum bilirubin up to 26 mg%. (B.G.)

  11. Relationship Between Sleep Disorder and Pregnancy Depression in Primigravidae Referring to Health– Treatment Centers of Ahvaz Jundishapur University of Medical Sciences in 2010

    Directory of Open Access Journals (Sweden)

    ٍE Parsaie Rad

    2011-09-01

    Full Text Available Introduction: Sleep is an organized behavior which is repeated every day as a vital necessity, and based on biological rhythm. Sleep disorders are common problems in pregnancy that it seems to have emotional and psychological consequences in pregnant women. This study investigated the relationship between sleep disorders and depression during pregnancy among primigravidae. Methods: This cross-sectional, analytical study was conducted on 70 primigravidae with gestational age between 36 and 40 weeks, singleton without known disease. Subjects were selected by multi-stage sampling method in Health– Treatment centers of Ahvaz Jundishapour University of Medical Sciences. After filling demographic, Winefield & Tiggemann multidimensional support scale, ENRICH marital satisfaction scale and ISI questionnaires, subjects were classified into two groups: with and without sleep disorders. Then they were evaluated for depression by Beck questionnaire. Using SPSS(ver. 17, data was analyzed by T-test for quantitative variables, and chi square and Fisher test for qualitative variables, and Mann-Whitney test for ordinal variables. Results: Findings showed that the severity of sleep disorders is related to depression in pregnancy(p=0.01. There was a statistically significant relationship between difficulty falling asleep, sleep continuation, early awakening, and disruption of daily activities with depression during pregnancy(p= 0.03, 0.008, 0.03, and 0.001, respectively. Conclusion: With regard to the results, education about healthy sleep and suitable consultation during pregnancy is recommended in order to prevent mental complications and to achieve a safe pregnancy

  12. Calculations of doses for the personnel wrapped up in the radiological accident of the Specialties Hospital of the National Medical Center ''Siglo XXI''

    International Nuclear Information System (INIS)

    In this work the methodology used by the National Commission of Nuclear Safety and Safeguards for the determination of the internal dose due to the ingestion of coffee with I-131 for the personnel of the service of nuclear medicine of the Hospital of Specialties of the National Medical Center ''Siglo XXI'' of the Mexican Institute of the Social Insurance (IMSS), that was poured in the coffeepot of the service by a deliberate act before mentioned, is presented. Three different techniques were used to determine the initial activity incorporated starting from the measurements of retained activity in thyroid for 6 people of the service of nuclear medicine; the techniques employee provided consistent results. Using the results of the technique of the best estimator, it was applied the proposed methodology by the International Commission of Radioprotection in its publication 30 to determine the absorbed doses by the personnel involved in the accident, with which the Commission determines the administrative consequences to those that it should be held the personnel and the directive of the service of nuclear medicine of the one nosocome. (Author)

  13. Monte Carlo modeling of 6 MV photon beam produced by the elekta precise linear accelerator of Tripoli medical center using beamnrc/dosexyznrc

    International Nuclear Information System (INIS)

    The 6MV photon beam production by the Elekta Line accelerateur of Tripoli of medical center (TMC) was modeled using Beamnrc and Dosexyzne Monte Carlo codes. The Beamnrc code was used to model the accelerator head and generate phase files. The phase space files were then used as input to the Dosexyzne code to simulate octogenarian deth dose and beam profiles. simulation were first stared using nominal provided by the vendor, a field size of 10x10cm2 and Source to surface distance (SSD) of 100 cm. simulation were compared with experimental data and energy tuning procedures were applied to validate the model. Energy tuning procedures indicated that the nominal energy of 6 MV and a FWHM of the Gaussian distribution of the source of 0.35 cm were the optimal energy and FWHM for the model. The depth of maximum dose at 6 MV was found to be 1.5 cm. The percentage relative differences between calculated and experimental Pdd(s) ranged from 0.5% to 3% for field size of 10cm2 and reached a value of 8% at depths greater than 20cm, The model was later used to calculate PDD(s) and beam profile and output factors for different field size ranging from 3x3cm2 to 25x25cm2. Calculated output factors were in good agreement with experimental values (the percentage relative differences ranged from 1% to 4%). (Author)

  14. The Frequency of blaVIM, blaIMP, blaKPC and blaNDM Carbapenemase Genes in Clinical Isolates of Klebsiella Pneumoniae in Kermanshah Medical Centers

    Directory of Open Access Journals (Sweden)

    A Zare

    2015-11-01

    Full Text Available Background: Carbapenemase genes have been spread among strains of Klebsiella pneumoniae that make them resistant to carbapenems. Hence, the present study aimed to study the prevalence of carbapenmase genes within K. pneumoniae isolates in Kermanshah medical centers. Methods: Sixty isolates of K. pneumoniae were collected and identified using API kit. Then, antibiotic susceptibility of isolates was determined using a disk diffusion method. The carbapenems-resistant isolates were screened for carbapenemases production using the Modified Hodge Test (MHT. The carbapenemase genes of blaVIM, blaIMP, KPC and blaNDM were detected by PCR test . Results: Out of 60 isolates, 4 isolates were resistant to carbapenem antibiotics, but only one isolate was demonstrated to be positive for carbapenemases by MHT phenotypic testing. The gene of blaVIM was detected in three isolates by PCR, though other genes were not found in the isolates. Within the isolates, 6.67% and 100% were resistant to carbapenem and ampicillin, respectively. Conclusion: The study findings revealed that dissemination rate of carbapenemase genes was not reported to be high among isolates of K. pneumoniae in Kermanshah. Only blaVIM gene was probably more frequent than other tested genes. Since most isolates examined in this study were susceptible to carbapenem antibiotics, these antibiotics are still regarded as effective drugs against infections caused by K. pneumoniae.

  15. Connecting Hispanic Women in Baltimore to the Mercy Medical Center Sexual Assault Forensic Examiners/Forensic Nurse Examiners Program: A Preliminary Assessment of Service Utilization and Community Awareness.

    Science.gov (United States)

    Adams, Margaret; Fitzgerald, Sheila; Holbrook, Debra

    2016-01-01

    Sexual violence and gender-based violence represent a major public health problem causing significant negative mental, physical, and social outcomes for victims. The rapidly growing population of Hispanic women in Baltimore are both more vulnerable to sexual assault and less able to access postassault services. In an effort to assess service utilization and community awareness of the Mercy Medical Center Sexual Assault Forensic Examiners/Forensic Nurse Examiners Program, we conducted a retrospective chart review of 2,322 women who were seen by the program between 2010 and 2013 and found that only 2.5% of the women were identified as Hispanic, about half of what Baltimore City demographic data would predict. This exploratory pilot project, augmented by key informant interviews, reveals that Hispanic women are underutilizing sexual assault services. Multiple barriers exist for Hispanic women in obtaining victim services, including lack of awareness within the community that the services exist, cultural factors, language barriers, lack of awareness of legal rights, and a fear of deportation. PMID:27428791

  16. LEADER surveillance program results for 2006: an activity and spectrum analysis of linezolid using clinical isolates from the United States (50 medical centers).

    Science.gov (United States)

    Jones, Ronald N; Fritsche, Thomas R; Sader, Helio S; Ross, James E

    2007-11-01

    Surveillance for emerging linezolid resistance among commonly occurring Gram-positive pathogens in the United States began with the 2002 ZAAPS program and more recently (2004) expanded as the LEADER program. The 2006 LEADER program processed 5374 strains from 50 medical centers (100 per site) located within the 9 US census regions; species and number tested by broth microdilution (% linezolid susceptible) included Staphylococcus aureus (2913, >99.9), coagulase-negative staphylococci (CoNSs) (808, 98.4), enterococci (547, 97.4), Streptococcus pneumoniae (546, 100.0), viridans group streptococci (189, 100.0), and beta-hemolytic streptococci (371, 100.0). In addition to 1 linezolid-nonsusceptible S. aureus, 3 strains were daptomycin-nonsusceptible, 4 were quinupristin/dalfopristin-intermediate, 2 were vancomycin-intermediate (vancomycin MIC values, 4 mug/mL), and all were methicillin-resistant S. aureus. Among the linezolid-resistant isolates (1 S. aureus, 13 CoNSs, 3 Enterococcus faecalis, and 10 Enterococcus faecium isolates), all but 3 Staphylococcus epidermidis isolates had the G2567T mutation. Overall, 99.55% of the tested 2006 LEADER program isolates remained susceptible to linezolid at current Clinical and Laboratory Standards Institute breakpoints. PMID:17720350

  17. Air quality monitoring of the post-operative recovery room and locations surrounding operating theaters in a medical center in Taiwan.

    Directory of Open Access Journals (Sweden)

    Chin-Sheng Tang

    Full Text Available To prevent surgical site infection (SSI, the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH, and carbon dioxide (CO2, suspended particulate matter (PM, and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18% and traumatic surgery room (8%. The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers.

  18. Evaluation of Nurse-Physician Inter-Observer Agreement on Triage Categorization in the Emergency Department of a Taiwan Medical Center

    Directory of Open Access Journals (Sweden)

    Song-Seng Loke

    2002-07-01

    Full Text Available Background: To examine nurse-physician inter-observer agreement on triage categorizationand analyze their differences for future reference.Methods: A retrospective observational study was performed. Patients entering a3500-bed medical center emergency department (ED from July 1 to 31,1998 were randomly selected. We compared triage assignments made bynurses and 2 ED physicians, and examined them for inter-observer agreement(kappa-statistic within each illness category.Results: We found that the overall nurse-physician agreement on triage categorizationhad a £e-value of 0.32 (99% confidence interval, 0.27-0.37. The level ofinter-observer agreement was not consistent across all illness categories.Agreement was better when assigning critical patients, but it was poor whenassigning non-emergency patients.Conclusion: The overall nurse-physician agreement with triage categorization was poor.The lack of agreement on triage decision making has important implicationsfor EDs in which the priority of care is based on nursing triage categorization.Detailed chart recording and continued work is necessary to improvethe agreement between nurse-physician triage categorization.

  19. Antimicrobial Resistance of Nosocomial Strain of Acinetobacter baumannii in Children’s Medical Center of Tehran: A 6-Year Prospective Study

    Directory of Open Access Journals (Sweden)

    Setareh Soroush

    2010-05-01

    Full Text Available "nThere are increasing reports of emergence of multiple drug resistant (MDR Acinetobacter spp in the world; however there are a few reports in our country. 145 A. baumannii isolates from distinct wards and Children's Medical Center (CMC in Tehran were studied in order to find the profile of antibiotic resistance among them. 40.6% (59/145 of A. baumannii isolates were identified as MDR. Overall susceptibility rates to cotrimoxazole, chloramphenicole and ciprofloxacin were 23.4%, 16.9% and 20.1%, respectively. Frequency susceptibility rates to amikacin, kanamycin, gentamycin and tobramycin decreased gradually from 81.2%, 50%, 50% and 62.5% in 2002 to 25%, 15.6%, 28.1% and 25% in 2007 respectively. Overall susceptibility rates to cephalosporines cephalotin, ceftazidime, cefteriaxon, ceftizoxime and cefixime were 9.3%, 14.7%, 16.2%, 15.9% and 18%, respectively. Susceptibility to carbapenems was assessed only in 2007. The susceptibility rates of Imipenem and meropenem were shown to be 50% and 46.8%, respectively. Our data indicates that MDR A. baumannii strains are spreading and carbapenem resistance is becoming more common in Iran. Our findings also highlight the importance of clinicians' access to updated susceptibility data regarding A. baumannii in developing countries such as Iran.

  20. Radiation Therapy Improves Survival Outcome in Pancreatic Adenocarcinoma: Comparison of a 15-Year Institutional Experience at the University of Nebraska Medical Center with SEER Data

    International Nuclear Information System (INIS)

    Objectives. We examined the role of radiation therapy (RT) in pancreatic adenocarcinoma (PA) treatment through a 15-year retrospective analysis of patients treated at University of Nebraska Medical Center (UNMC) as well as those from the SEER database. Methods. A total of 561 patients diagnosed with PA at UNMC between 1995 and 2011 and 60,587 patients diagnosed between 1995 and 2009 from the SEER were included. Examined prognostic factors for overall survival (OS) were age, gender, race, stage, year of diagnosis, and treatment with surgery, chemotherapy (CT), or RT. Time to death was plotted by Kaplan-Meier method. A Cox proportional hazards model was used to evaluate prognostic factors for OS. Results. The median OS was 7.3 and 5 months for patients from UNMC and the SEER database, respectively. A Cox model of patients from UNMC showed that RT was associated with improved OS (HR 0.77,(Ρ =0.018) after adjusting for factors including age, race, gender, stage, year of diagnosis, having surgery, or having CT. Cox analysis of patients from the SEER showed similar results (HR 0.65, (Ρ0.0001). Conclusions. RT confers an independent survival advantage in patients being treated for PA which is apparent both at UNMC and through SEER data.

  1. RBE and OER within the spread-out Bragg peak for proton beam therapy. In vitro study at the Proton Medical Research Center at the University of Tsukuba

    International Nuclear Information System (INIS)

    There are few reports on the biological homogeneity within the spread-out Bragg peak (SOBP) of proton beams. Therefore, to evaluate the relative biological effectiveness (RBE) and the oxygen enhancement ratio (OER), human salivary gland tumor (HSG) cells were irradiated at the plateau position (position A) and three different positions within a 6-cm-wide SOBP (position B, 26 mm proximal to the middle; position C, middle; position D, 26 mm distal to the middle) using 155-MeV/n proton beams under both normoxic and hypoxic conditions at the Proton Medical Research Center, University of Tsukuba, Japan. The RBE to the plateau region (RBEplateau) and the OER value were calculated from the doses corresponding to 10% survival data. Under the normoxic condition, the RBEplateau was 1.00, 0.99 and 1.09 for positions B, C and D, respectively. Under the hypoxic condition, the RBEplateau was 1.10, 1.06 and 1.12 for positions B, C and D, respectively. The OER was 2.84, 2.60, 2.63 and 2.76 for positions A, B, C and D, respectively. There were no significant differences in either the RBEplateau or the OER between these three positions within the SOBP. In conclusion, biological homogeneity need not necessarily be taken into account for treatment planning for proton beam therapy at the University of Tsukuba. (author)

  2. The Concordance between Myocardial Perfusion Imaging and Coronary Angiography in Detecting Coronary Artery Disease: A Retrospective Study in a Tertiary Cardiac Center at King Abdullah Medical City

    Science.gov (United States)

    Aboul-Enein, Fatma; Alharthi, Hail T.

    2016-01-01

    Background. Coronary artery disease (CAD) is considered as the leading cause of the cardiovascular fatalities worldwide. CAD is diagnosed by many modalities of imaging such as myocardial perfusion imaging (MPI) and coronary angiography (CAG). Methods. A retrospective cross-sectional study was conducted that included all patients referred to the KAMC (King Abdullah Medical City) nuclear cardiology lab from its opening until the end of May 2014 (a period of 17 months). A total of 228 patient reports with a history of conducting either CAG or MPI or both were used in this study and statistically analyzed. Results. An analysis of the MPI results revealed that 78.5% of the samples were abnormal. On the other hand, 26.75% of the samples revealed that they were subjected to CAG and MPI. There was a significant and fair agreement between MPI and CAG by using all the agreement coefficients (kappa = 0.237, phi = 0.310, and P value = 0.043). The sensitivity, specificity, and accuracy of MPI with reference to CAG were 97.8%, 20%, and 78.69%, respectively. In addition, positive predictive and negative predictive values were 78.95% and 75%, respectively. Conclusion. In a tertiary referral center, there was a significant agreement between MPI and CAG and a high accuracy of MPI. MPI was a noninvasive diagnostic test that could be used as a gatekeeper for CAG. PMID:27429833

  3. Utilization of glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute myocardial infarction in a tertiary referral medical center in a developing country.

    Science.gov (United States)

    Abdallah, Mouhamad; Karrowni, Wassef; Dakik, Habib A

    2007-01-01

    We analyze the patterns of utilization of glycoprotein (GP) IIb/IIIa inhibitors in patients with non-ST-elevation myocardial infarction (NSTEMI) in a tertiary medical center in a developing country and we compare it to data from the national registry of myocardial infarction 4 (NRMI 4) in the USA. GP IIb/IIIa inhibitors were used in 28% of patients. The significant multivariate predictors of GP IIb/IIIa inhibitors utilization were Age or =4 (p=0.002), and the absence of congestive heart failure (p=0.01) or prior infarction (p=0.04). Our results show striking similarity to what has been reported by the NRMI 4 registry, in terms of the overall underutilization of GP IIb/IIIa inhibitors in NSTEMI patients, and particularly in elderly patients and women. These findings underscore the importance of initiating a worldwide campaign to educate physicians about the pivotal role of GP IIb/IIIa inhibitors in the management of patients with NSTEMI. PMID:16581145

  4. An Exploration of Ethical Dilemma Resolution by Student Affairs Professionals

    OpenAIRE

    Humphrey, Elaine

    2008-01-01

    This two-phase, sequential mixed methods study explored how student affairs professionals resolved professional ethical dilemmas. A student affairs professional was defined as an individual whose educational background and work experience are in student affairs. An ethical dilemma is defined as a situation in which two ethical principles are at odds rather than a simple matter of right versus wrong (Kitchener, 1985). A professional ethical dilemma is an ethical dilemma in the context of a per...

  5. Toward a Virtual Lifetime Electronic Record: the Department of Veterans Affairs experience with the Nationwide Health Information Network.

    Science.gov (United States)

    Bouhaddou, Omar; Bennett, Jamie; Teal, Jennifer; Pugh, Margaret; Sands, Melissa; Fontaine, Frank; Swall, Marie; Dhar, Sanjay; Mallia, Tony; Morgan, Brian; Cromwell, Tim

    2012-01-01

    Health information exchange is expected of all electronic health records (EHRs) in order to ensure safe, quality care coordination. The U.S. Department of Veterans Affairs (VA) has a long history of information exchange across VA facilities and with the U.S. Department of Defense (DoD). However, since a majority of VA and DoD patients receive a portion of their health care from the private sector, it is essential that both agencies enable health information exchange with private sector providers. This has been made possible by the use of the specifications and trust agreement developed by the Nationwide Health Information Network (NwHIN) initiative. Currently, VA has 12 medical centers exchanging information with the private sector and is evaluating the value of the exchange. The authors report on the success of these pilots as well as on the challenges, which include stricter technical specifications and a more efficient approach to patient identification (ID) matching and consent management. PMID:23304272

  6. THE SOCIAL AFFAIRS ARE THERE FOR YOU!

    CERN Multimedia

    2002-01-01

    We would like to remind you that the Social Affairs Service is a centre offering advice and support that can provide the following: Information and documentation (education for your children, language courses, child-minding facilities, health-related matters etc.). Information on social protection (illness, disability, handicap, retirement, death, etc.) and integration. Assistance in dealings with the authorities/services concerned. Consultations with a view to resolving problems of a personal, family or professional nature, such as problems of dependency (alcohol, drugs, relationship) or behavioural problems (stress, depression, eating disorders)... Support in facing new situations (maternity, divorce, bereavement, change of post, geographical isolation). Assistance with decision making relating to family, personal or professional matters. The team is at the disposal of all members of personnel, whatever their status, as well as to members of their family. Interviews with this service are CONFIDENTI...

  7. 77 FR 14707 - Vet Center Services

    Science.gov (United States)

    2012-03-13

    ... Records 64VA15, ``Readjustment Counseling Service Vet Center Program,'' most recently amended at 74 FR... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN92 Vet Center Services AGENCY: Department of Defense... (VA) proposes to establish in regulation the readjustment counseling currently provided in VA's...

  8. International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China

    Directory of Open Access Journals (Sweden)

    Chengquan Zhao

    2015-01-01

    Full Text Available Background: Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC and KingMed Diagnostics partnered to establish an international telepathology consultation service. Materials and Methods: This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014. Results: A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4% submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%, followed by bone/soft tissue (21.0% and gynecologic/breast (20.2% subspecialties. Average turnaround time (TAT per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7% where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered in 50.8% of cases. Conclusion: These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and

  9. 76 FR 44086 - Agency Information Collection (Report of Medical Examination for Disability Evaluation) Activity...

    Science.gov (United States)

    2011-07-22

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Agency Information Collection (Report of Medical Examination for Disability Evaluation) Activity.... 2900-0052.'' SUPPLEMENTARY INFORMATION: Title: Report of Medical Examination for Disability...

  10. Identification of Class-1 Integron and Various Β-Lactamase Classes among Clinical Isolates of Pseudomonas aeruginosa at Children's Medical Center Hospital

    Directory of Open Access Journals (Sweden)

    Hossein Fazeli

    2015-10-01

    Full Text Available Background: Pseudomonas aeruginosa is one of the most important oppor- tunistic pathogens responsible for various types of infections. Children suffer significant morbidity and mortality due to nosocomial infections. The aim of this study was to investigate the presence of Class-1 integron, blaBEL, blaPER, blaKPC, blaVIM, blaIMP and blaOXA-group-1  genes among P. aeruginosa isolates at Children's Medical Center Hospital in Iran and to determine phenotypic evi- dence of ESBL and MBL production.Methods: Antibiotic susceptibility tests were analyzed for 72 P. aeruginosa clinical isolates. Isolates were identified by using biochemical tests and con- firmed by PCR assay for oprL gene. ESBL and MBL producer isolates were identified  by phenotypic  tests (double disc synergy tests. Detection of β- lactamase genes and class-1 integron were performed by PCR method. Results: All of the isolates were susceptible to ceftazidime / clavulanate, me- ropenem, imipenem and ciprofloxacin. About 83.3% and 16.7% of isolates were  resistant  to  ceftazidime  and  amikacin  respectively.  Approximately,83.3% of isolates were considered as potential ESBL producers. None of the clinical isolates showed above β-lactamase genes. It seems that, the reason is the absence of class-1 integron in all of isolates. About 16.7% of strains were identified  as multidrug  resistant.  Fortunately,  all of the isolates were sus- ceptible to meropenem and imipenem which are effective against ESBL pro- ducing strains.Conclusion:  The absences of class-1 integron decreases the probability of acquired β-lactamase especially MBL. Thus, absolute susceptibility to carba- penems and ciprofloxacin among P. aeruginosa isolates in pediatric hospital has important implications for empirical antimicrobial therapy. It seems that these properties help to decrease mortality of nosocomial infections within children.

  11. Feasibility and safety of combined interventional procedures in elderly patients with complex cardiovascular diseases:experience of a single medical center

    Institute of Scientific and Technical Information of China (English)

    Caiyi LU; Haiyun WU; Shiwen WANG; Xinli WU; Qiao XUE; Taohong HU; Muyang YAN; Rui CHEN; Zhongren ZHAO

    2005-01-01

    Objectives:To report the clinical experience of combined interventional procedures in the treatment of elderly patients with coexisting two or more cardiovascular diseases in our medical center, and to assess the feasibility, safety and therapeutic efficacy of this management strategy. Methods : Patients were selected to the study if: 1) age >65 years; 2) with coexistence of two or more cardiovascular diseases which are indications for interventional therapy; 3) patients' general condition and organ functions allow the performance of combined multiple procedures; 4) the predicted procedure time is within 150 min; 5) the predicted contrast medium dosage is within 300 ml. The criteria we analyzed included procedural type, rocedural time, fluoroscopy time, dosage of contrast medium, success rates of the procedures, complications and in-hospital mortality. All patients were followed up for 30.4 ± 9.3 months,to determine the all-cause mortality, recurrence rates and adverse cardiac events. Results : From January 2000 to December 2004,combined interventional procedures were performed on 136 patients, with 2 procedures on 134 patients and 3 procedures on 2 patients.The mean procedure time was 115.4±11.6 min, the mean fluoroscopy time was 35.7±9.3 min, and the mean dosage of contrast medium used was 183.6±19.4 ml. Procedural success rate was 100%, no procedure related death or major complications occurred.Conclusion: Performed by a competent team, combined interventional procedures in elderly patients with multiple cardiovascular diseases were feasible and relatively safe.

  12. A qualidade de vida de jovens portadores de espinha bífida do Children's National Medical Center – Washington DC

    Directory of Open Access Journals (Sweden)

    Ana Helena Rotta Soares

    2006-09-01

    Full Text Available O presente artigo tem como objetivo explorar a qualidade de vida de jovens portadores de espinha bífida atendidos no Children's National Medical Center em Washington DC. A pesquisa baseia-se em uma perspectiva qualitativa que utiliza como referencial teórico central a "Teoria do estigma" e as discussões conceituais sobre as dimensões de qualidade de vida. Foram entrevistados 15 jovens do serviço acima citado, sendo que 8 deles participaram de um grupo focal construído através das questões levantadas durante entrevistas. Os discursos dos jovens em questão refletem a necessidade de categorias mais englobantes que não remetam a uma pulverização da experiência de vida. Evidenciou-se uma estrutura de desigualdade nas interações entre saudáveis e deficientes, e reproduzida pelos próprios jovens. Os resultados demonstram que o estigma se encontra presente em todas as dimensões da vida dos sujeitos, interferindo na inserção social, construção subjetiva do jovem e sua auto-estima, reforçando o papel do portador de deficiência como uma "não-pessoa". Embora a categoria sexualidade não seja priorizada em outros instrumentos para esta população, o tema se faz presente e central na discussão da experiência da vida dos mesmos.

  13. 78 FR 34702 - Foreign Affairs Policy Board Meeting Notice

    Science.gov (United States)

    2013-06-10

    ... From the Federal Register Online via the Government Publishing Office STATE DEPARTMENT Foreign..., 5 U.S.C. App., the Department of State announces a meeting of the Foreign Affairs Policy Board to take place on July 15, 2013, at the Department of State, Washington, DC. The Foreign Affairs...

  14. 78 FR 51266 - Foreign Affairs Policy Board Meeting Notice

    Science.gov (United States)

    2013-08-20

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF STATE Foreign..., 5 U.S.C. App., the Department of State announces a meeting of the Foreign Affairs Policy Board to take place on September 9, 2013, at the Department of State, Washington, DC. The Foreign Affairs...

  15. Preserving the History of a Student Affairs Association

    Science.gov (United States)

    Mann, B. J.

    2010-01-01

    The following is a brief overview regarding: the history and development of Student Affairs as it pertains to (a) preserving the history of a professional association, (b) value and benefits of a professional Student Affairs association, (c) establishing and assessing goals and (d) organizational development/change within a professional…

  16. Appreciative Inquiry and Student Affairs: A Positive Approach to Change

    Science.gov (United States)

    Lehner, Rachelle; Hight, Donna L.

    2006-01-01

    Appreciative Inquiry (AI) is an organization development (OD) philosophy that utilizes and builds on past successes, using these as positive momentum for future change. AI provides student affairs with an alternative and generative approach to improving their organizations' processes and culture. As student affairs professionals look to the future…

  17. College Student Concerns: Perceptions of Student Affairs Practitioners

    Science.gov (United States)

    Reynolds, Amy L.

    2013-01-01

    The purpose of this study was to increase awareness of the perceptions of student affairs professionals regarding the most frequent and challenging concerns facing college students today. Using the Delphi method, 159 entry-level and mid-level student affairs administrators from institutions across the country were surveyed about their perceptions…

  18. Helping Competencies of Student Affairs Professionals: A Delphi Study

    Science.gov (United States)

    Reynolds, Amy L.

    2011-01-01

    The purpose of this study was to gather student affairs professionals' perceptions of the knowledge and skills needed to effectively help students. Using the Delphi method, 159 entry-level and mid-level student affairs administrators from institutions across the United States were surveyed regarding their perceptions of the helping skills they use…

  19. Efficacy of Orientation for New Student Affairs Professionals

    Science.gov (United States)

    Dean, Laura A.; Saunders, Sue A.; Thompson, George F.; Cooper, Dianne L.

    2011-01-01

    New staff orientation is a strategy that can positively affect job satisfaction and productivity, especially for those beginning careers in student affairs. In this study, new student affairs professionals were surveyed to determine their perceptions about the content and efficacy of their orientation experiences. Despite literature encouraging…

  20. Enhancing the professionalisation of student affairs through assessment

    Directory of Open Access Journals (Sweden)

    Ann M. Gansemer-Topf

    2013-11-01

    Full Text Available The past decades have seen an increase in the attention and focus of student affairs workin Africa. As the profession works to strengthen its reputation and value within highereducation through conferences, organisations and publications, student affairs professionalscan also raise the stature of the profession through work on their individual campuses.Engaging in assessment may be one such opportunity. As a way to create a commonlanguage regarding student affairs assessment, this paper provides an overview of thedefinitions, types and purposes of assessment. The thought is that viewing assessment as anintegral, rather than ‘extra’ aspect of student affairs and incorporating these activities withintheir work, student affairs professionals will not only improve the effectiveness of theirwork with students but also can help legitimise the field as a profession.