WorldWideScience

Sample records for ambulatory care facilities

  1. Ambulatory Surgical Measures - Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  2. Ambulatory Care Database

    OpenAIRE

    Misener, Terry R.

    1983-01-01

    A six month project was undertaken to collect outpatient encounter data (demographic, workload, and diagnoses) at a community medical treatment facility. To capture data, the 13,000 patients seen each month, the clerical staff and primary care providers all completed portions of a “mark sense” form. Study results, lessons learned, and a conceptual plan for a future outpatient information system are reviewed.

  3. National Hospital Ambulatory Medical Care Survey

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect data on the utilization and provision of ambulatory care services in hospital...

  4. An overview of anesthetic procedures, tools, and techniques in ambulatory care

    Directory of Open Access Journals (Sweden)

    Messieha Z

    2015-01-01

    Full Text Available Zakaria Messieha Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA Abstract: Ambulatory surgical and anesthesia care (ASAC, also known as Same Day Surgery or Day Care in some countries, is the fastest growing segment of ambulatory surgical and anesthesia care. Over 50 million ambulatory surgical procedures are conducted annually comprising over 60% of all anesthesia care with an impressive track record of safety and efficiency. Advances in ambulatory anesthesia care have been due to newer generation of inhalation and intravenous anesthetics as well as airway management technology and techniques. Successful ambulatory anesthesia care relies on patient selection, adequate facilities, highly trained personnel and quality improvement policies and procedures. Favoring one anesthetic technique over the other should be patient and procedure-specific. Effective management of post-operative pain as well as nausea and vomiting are the final pieces in assuring success in ambulatory anesthesia care. Keywords: ambulatory anesthesia, out-patient anesthesia, Day-Care anesthesia

  5. National Ambulatory Medical Care Survey (NAMCS)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Ambulatory Medical Care Survey (NAMCS) is a national survey designed to meet the need for objective, reliable information about the provision and use...

  6. Ambulatory Medical Care Utilization Estimates for 2007

    Science.gov (United States)

    ... the caveats discussed in the ‘‘Methods’’ section. The relationship between characteristics of the patient’s ZIP Code and the choice of ambulatory care setting is shown in Table 5. For persons ...

  7. [A guide to good practice for information security in the handling of personal health data by health personnel in ambulatory care facilities].

    Science.gov (United States)

    Sánchez-Henarejos, Ana; Fernández-Alemán, José Luis; Toval, Ambrosio; Hernández-Hernández, Isabel; Sánchez-García, Ana Belén; Carrillo de Gea, Juan Manuel

    2014-04-01

    The appearance of electronic health records has led to the need to strengthen the security of personal health data in order to ensure privacy. Despite the large number of technical security measures and recommendations that exist to protect the security of health data, there is an increase in violations of the privacy of patients' personal data in healthcare organizations, which is in many cases caused by the mistakes or oversights of healthcare professionals. In this paper, we present a guide to good practice for information security in the handling of personal health data by health personnel, drawn from recommendations, regulations and national and international standards. The material presented in this paper can be used in the security audit of health professionals, or as a part of continuing education programs in ambulatory care facilities.

  8. Planning an ambulatory care joint venture.

    Science.gov (United States)

    Harpster, L M

    1988-01-01

    This article discusses ambulatory care joint ventures by hospitals and selected members of their medical staffs and emphasizes the resolution of problems in the early planning stages. Failure to follow an orderly and thoughtful planning process not only risks valuable resources of the venture partners, but also jeopardizes the working relationship between the hospital and its medical staff.

  9. Ambulatory Care Skills: Do Residents Feel Prepared?

    Directory of Open Access Journals (Sweden)

    Denise Bonds

    2002-10-01

    Full Text Available Objective: To determine resident comfort and skill in performing ambulatory care skills. Methods: Descriptive survey of common ambulatory care skills administered to internal medicine faculty and residents at one academic medical center. Respondents were asked to rate their ability to perform 12 physical exam skills and 6 procedures, and their comfort in performing 7 types of counseling, and obtaining 6 types of patient history (4 point Likert scale for each. Self-rated ability or comfort was compared by gender, status (year of residency, faculty, and future predicted frequency of use of the skill. Results: Residents reported high ability levels for physical exam skills common to both the ambulatory and hospital setting. Fewer felt able to perform musculoskeletal, neurologic or eye exams easily alone. Procedures generally received low ability ratings. Similarly, residents’ comfort in performing common outpatient counseling was also low. More residents reported feeling very comfortable in obtaining history from patients. We found little variation by gender, year of training, or predicted frequency of use. Conclusion: Self-reported ability and comfort for many common ambulatory care skills is low. Further evaluation of this finding in other training programs is warranted.

  10. Big Data and Ambulatory Care

    OpenAIRE

    Thorpe, Jane Hyatt; Gray, Elizabeth Alexandra

    2014-01-01

    Big data is heralded as having the potential to revolutionize health care by making large amounts of data available to support care delivery, population health, and patient engagement. Critics argue that big data's transformative potential is inhibited by privacy requirements that restrict health information exchange. However, there are a variety of permissible activities involving use and disclosure of patient information that support care delivery and management. This article presents an ov...

  11. Evaluation of Ambulatory Care Information Systems

    OpenAIRE

    Simborg, Donald W.; Whiting-O'Keefe, Quinn E.

    1980-01-01

    The central purpose of an ambulatory care information system is to communicate information to the practitioner to facilitate clinical decision making. The clinical decision can be considered the dependent output variable in a process having the information system, the patient, clinician characteristics, and the environment as the independent input variables. Evaluation approaches using patient outcomes are problematic because of the indirect relationship between the information system and pat...

  12. What Ambulatory Care Managers Need to Know About Examination Room Utilization Measurement and Analysis.

    Science.gov (United States)

    Klarich, Mark J; Rea, Ronald W; Lal, Tarun Mohan; Garcia, Angel L; Steffens, Fay L

    2016-01-01

    Demand for ambulatory care visits is projected to increase 22% between 2008 and 2025. Given this growth, ambulatory care managers need to proactively plan for efficient use of scarce resources (ie, space, equipment, and staff). One important component of ambulatory care space (the number of examination rooms) is dependent on multiple factors, including variation in demand, hours of operation, scheduling, and staff. The authors (1) outline common data collection methods, (2) highlight analysis and reporting considerations for examination room utilization, and (3) provide a strategic framework for short- and long-term decision making for facility design or renovation. PMID:27232683

  13. Redesigning ambulatory care business processes supporting clinical care delivery.

    Science.gov (United States)

    Patterson, C; Sinkewich, M; Short, J; Callas, E

    1997-04-01

    The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices--such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts--all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care. PMID:10181605

  14. Growing ambulatory care nurse leaders in a multigenerational workforce.

    Science.gov (United States)

    Moye, Janet P; Swan, Beth Ann

    2009-01-01

    Ambulatory care faces challenges in sustaining a nursing workforce in the future as newly licensed nurses are heavily recruited to inpatient settings and retirements will impact ambulatory care sooner than other areas. Building a diverse team by recruiting nurses of different ages (generations) and skills may result in a more successful and robust organization. Knowledge about generational characteristics and preferences will aid nurse leaders and recruiters in attracting high-quality, talented nurses. Nurses of Generations X and Y can increase their likelihood of success in ambulatory care by better understanding intergenerational issues. PMID:20050492

  15. [Interprofessional pill box management in an ambulatory care setting].

    Science.gov (United States)

    Abrecht, Loïc; Anchisi, Annick; Widmer, Daniel; Bugnon, Olivier; Du Pasquier, Sophie; Jotterand, Sébastien; Karlen, Martine; Herzig, Lilli

    2014-11-26

    Complex multimorbid patients are now more common in ambulatory care and the management of their medication more frequently needs interprofessional collaboration. This qualitative study explored health professional's main challenges when introducing, preparing and sharing the use of a pill box for a patient. Another objective of this study was to explore options for improving care in these situations.

  16. Transitioning the RN to Ambulatory Care: An Investment in Orientation.

    Science.gov (United States)

    Allen, Juliet Walshe

    2016-01-01

    Registered nurses (RNs) struggle when transitioning from the inpatient setting to the outpatient clinical environment because it results in a diverse skill-set shift. The RN, considered an outpatient revenue source, experiences a decrease in peer-to-peer relationships, changes in leadership responsibilities, and changes in workgroup dynamics (supervision of unlicensed clinical personnel who function under the direction of the physician, not the RN). Ambulatory organizations find themselves implementing clinical orientation programs that may not delineate the attributes of the RN. This diminishes their value while emphasizing the unlicensed technical skill set. Creating a core RN orientation program template is paramount for the transition of the RN to the ambulatory setting. The literature reveals several areas where improving the value of the RN will ultimately enhance recruitment and retention, patient care outcomes, and leverage the RN role within any organization. Eleven 30-minute in-depth telephone interviews were conducted in addition to 4 nurse observations to explore the lived experience of the RN in ambulatory care. The findings disclosed an overarching theme of nurse isolation and offered insightful underpinnings for the nurse leader as ambulatory growth continues and nurse leaders further endorse the RN presence in the ambulatory setting. PMID:26938183

  17. Interdisciplinary Shared Governance in Ambulatory Care: One Health System's Journey.

    Science.gov (United States)

    Powers, Sharon; Bacon, Cynthia Thornton

    2016-01-01

    The implementation of shared governance structures in acute care has illustrated the positive relationship between shared decision making and nurse empowerment and positive nurse and patient outcomes. Little is known, however, about interdisciplinary shared governance, and even less is known about shared governance in ambulatory care. This article details one health system's experience with the implementation of an interdisciplinary shared governance structure in ambulatory care over a 4-year period. The authors report lessons learned, positive health system outcomes that resulted including improved communication, better preparedness for accreditation visits, improved assessment of fall risk, and a streamlined documentation system. Also discussed are mechanisms to enhance sustainability of the structure and discussion of future opportunities and challenges. PMID:27259130

  18. Primary Care, Ambulatory Care, and Family Medicine: Overlapping But Not Synonymous

    Science.gov (United States)

    Reynolds, Robert E.

    1975-01-01

    Defines and depicts graphically the relationships between primary, secondary, and tertiary care functions (from least to most intensified phases of medical care); ambulatory care (care of sick or well people not confined to bed); and family medicine (an emerging medical discipline focusing on complete and longterm care of the family). (JT)

  19. Quality assurance in the ambulatory care setting.

    Science.gov (United States)

    Tyler, R D

    1989-01-01

    One of the most utilitarian developments in the field of quality assurance in health care has been the introduction of industrial concepts of quality management. These concepts, coupled with buyer demand for accountability, are bringing new perspectives to health care quality assurance. These perspectives provide a new view of quality assurance as a major responsibility and strategic opportunity for management; a competitive and marketable commodity; and a method of improving safety, effectiveness, and satisfaction with medical care.

  20. Use of extramural ambulatory care curricula in postgraduate medical training

    OpenAIRE

    Talwalkar, Jaideep S.; Satcher, D’Juanna; Turner, Teri L.; Sisson, Stephen D.; Fenick, Ada M.

    2015-01-01

    Introduction Extramural curricula developed for the purpose of sharing with other institutions have been designed to improve education on important topics in ambulatory care. We sought to assess the usage rates of these curricula among paediatric, internal medicine, and combined medicine-paediatrics residency programmes in the United States. Methods Surveys on aspects of trainee continuity clinic were sent to paediatric and medicine-paediatrics programme directors in 2012. Surveys contained a...

  1. Speak Up: Help Prevent Errors in Your Care: Ambulatory Care

    Science.gov (United States)

    ... role in making health care safe. That includes doctors, nurses and other health care professionals. Health care organizations ... embarrassed if you don't understand what your doctor, nurse or other health care professional tells you. • Don’ ...

  2. Ambulatory Surgical Facilities, Published in 2010, 1:2400 (1in=200ft) scale, Shawano County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Ambulatory Surgical Facilities dataset, published at 1:2400 (1in=200ft) scale, was produced all or in part from Published Reports/Deeds information as of 2010....

  3. AMBULATORY CARE SENSITIVE CONDITIONS: DIAGNOSTIC RELIABILITY IN SOUTHERN BRAZIL

    Directory of Open Access Journals (Sweden)

    Rafael Antoniazzi Abaid

    2014-12-01

    Full Text Available Introduction: Ambulatory Care Sensitive Conditions (ACSC are illnesses that could be prevented with adjusted ambulatorial care. ACSC have been used as indicator in effectiveness of the primary healthcare attention, through the evaluation of hospital admissions. However, we do not have studies to certify the reliability of diagnosis of ACSC in our country. Objective: To determine if the classification of ACSC from the main diagnostic field of the authorization of hospital internment (AHI is reliable. Methods: Transversal study carried through February of 2010 to January of 2011, in the city of Santa Cruz of Sul (RS. A random sample of 389 medical records was selected and evaluated by two medical appraisers. The main diagnosis in the AHI was compared with the classification in ACSC or not ACSC given for the appraisers after the study of each medical record. Kappa ratio agreement was used to calculate the reliability of the ACSC diagnostic. Results: The ratio of agreement between diagnosis from the AIH and CSAP assessment contained in the records was 92%, with a kappa coefficient of 0,784. Conclusions: The diagnostic of ACSC found in main diagnostic field of AHI showed agreement ratios over expected by chance, with kappa value equal to 0.784 and the correlation rated between substantial and almost perfect.

  4. Ambulatory Surgical Facilities, Identify the locations of Ambulatory Surgical Centers, Published in 2012, 1:2400 (1in=200ft) scale, Miami-Dade County, Information Technology Department.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Ambulatory Surgical Facilities dataset, published at 1:2400 (1in=200ft) scale, was produced all or in part from Other information as of 2012. It is described...

  5. Ambulatory Surgical Facilities, Licensed Ambulatory Sugery Centers, Published in 2007, 1:24000 (1in=2000ft) scale, State of California - Office of the State Chief Information Officer.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Ambulatory Surgical Facilities dataset, published at 1:24000 (1in=2000ft) scale, was produced all or in part from Published Reports/Deeds information as of...

  6. Translating caring theory across the continuum from inpatient to ambulatory care.

    Science.gov (United States)

    Tonges, Mary; McCann, Meghan; Strickler, Jeff

    2014-06-01

    While theory-based practice is a Magnet® characteristic, translating theories to practice remains challenging. As a result, theory-guided practice remains an ideal rather than a realized goal in many organizations. This article provides an overview of a research-derived caring theory, a translational model for theory-driven practice, implementation of a delivery model designed to translate theory across the acute and ambulatory care continuum, and resulting outcomes in oncology clinics and the emergency department.

  7. Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

    Directory of Open Access Journals (Sweden)

    Yvonne Ying Ru Ng

    2014-01-01

    Full Text Available Introduction. Ambulatory surgery is not commonly practiced in Asia. A 23-hour ambulatory (AS23 service was implemented at our institute in March 2004 to allow more surgeries to be performed as ambulatory procedures. In this study, we reviewed the impact of the AS23 service on breast cancer surgeries and reviewed surgical outcomes, including postoperative complications, length of stay, and 30-day readmission. Methods. Retrospective review was performed of 1742 patients who underwent definitive breast cancer surgery from 1 March 2004 to 31 December 2010. Results. By 2010, more than 70% of surgeries were being performed as ambulatory procedures. Younger women (P<0.01, those undergoing wide local excision (P<0.01 and those with ductal carcinoma-in situ or early stage breast cancer (P<0.01, were more likely to undergo ambulatory surgery. Six percent of patients initially scheduled for ambulatory surgery were eventually managed as inpatients; a third of these were because of perioperative complications. Wound complications, 30-day readmission and reoperation rates were not more frequent with ambulatory surgery. Conclusion. Ambulatory breast cancer surgery is now the standard of care at our institute. An integrated workflow facilitating proper patient selection and structured postoperativee outpatient care have ensured minimal complications and high patient acceptance.

  8. Ambulatory care training during core internal medicine residency training: the Canadian experience.

    OpenAIRE

    McLeod, P. J.; Meagher, T W

    1993-01-01

    OBJECTIVE: To determine the status of ambulatory care training of core internal medicine residents in Canada. DESIGN: Mail survey. PARTICIPANTS: All 16 program directors of internal medicine residency training programs in Canada. OUTCOME MEASURES: The nature and amount of ambulatory care training experienced by residents, information about the faculty tutors, and the sources and types of patients seen by the residents. As well, the program directors were asked for their opinions on the ideal ...

  9. [Ambulatory care nursing sites in Italy: results of a pilot study].

    Science.gov (United States)

    Alvaro, Rosaria; Venturini, Giulia; Tartaglini, Daniela; Vellone, Ercole; De Marinis, Maria Grazia

    2009-01-01

    The aim of this study was to map existing ambulatory care nursing sites in Italy, compare operational and organizational methodologies used, and evaluate visibility of the sites in health institutions and the community. Nurses' level of satisfaction with this work experience was also evaluated. The American Academy of Ambulatory Care Nursing and American Nurses Association definition of ambulatory care nursing (1997) was used to select sites for the study. Two hundred fifty ambulatory care sites meeting this definition were listed, most of which provide clinical and educational services to oncology and cardiology patients. Surgical sites provide treatment of surgical wounds and stomas. Results of the study show that ambulatory care nursing sites are not uniformly distributed across Italy and a greater concentration of sites can be found in northern Italy with respect to central and southern Italy. Nurses report having greater professional autonomy and an excellent level of satisfaction. All interviewed nurses attend specific training and continuing education courses. Ambulatory care sites are managed by nurses; medical consultations are requested when necessary and home assistance is assured through coordination with general practitioners. PMID:19629150

  10. Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions

    NARCIS (Netherlands)

    Freund, T.; Campbell, S.M.; Geissler, S.; Kunz, C.U.; Mahler, C.; Peters-Klimm, F.; Szecsenyi, J.

    2013-01-01

    PURPOSE: Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex c

  11. [Management and organization of ambulatory medical care in a district].

    Science.gov (United States)

    Schneider, K; Keune, H G; Miethe, D; Ringel, M; Szkibik, B

    1990-01-01

    An analysis is given of the management and organization of out-patient medical care in 15 districts and of the District Physician's responsibilities as well as the profile of a District Health Department. Compared to the situation of a decade ago, substantial changes in the territorial health organization have occurred (decentralization, formation of care areas, affiliation of small health facilities to bigger ones). The District Physician's scope of responsibility is increasingly determined by activities within the framework of the District Council, the proportion of organizational work has increased. In order to be able to fulfill his tasks the District Physician needs the support of a special Health Department. Skeleton regulations for out-patient medical care are necessary.

  12. Impact of an Elective Course in Community and Ambulatory Care Pharmacy Practices on Student Perception of Patient Care.

    Science.gov (United States)

    Barnes, Kelli D; Maguire, Michelle; Bennett, Marialice S

    2015-09-25

    Objective. To determine the impact of an elective course on students' perception of opportunities and of their preparedness for patient care in community and ambulatory pharmacy settings. Design. Each course meeting included a lecture and discussion to introduce concepts and active-learning activities to apply concepts to patient care or practice development in a community or ambulatory pharmacy setting. Assessment. A survey was administered to students before and after the course. Descriptive statistics were used to assess student responses to survey questions, and Wilcoxon signed rank tests were used to analyze the improvement in student responses with an alpha level set at 0.05. Students felt more prepared to provide patient care, develop or improve a clinical service, and effectively communicate recommendations to other health care providers after course completion. Conclusion. This elective course equipped students with the skills necessary to increase their confidence in providing patient care services in community and ambulatory settings. PMID:27168617

  13. Exploring the link between ambulatory care and avoidable hospitalizations at the Veteran Health Administration.

    Science.gov (United States)

    Pracht, Etienne E; Bass, Elizabeth

    2011-01-01

    This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable.

  14. Ambulatory Surgical Facilities, cruical infrastructures, Published in 2007, 1:100000 (1in=8333ft) scale, Marion County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Ambulatory Surgical Facilities dataset, published at 1:100000 (1in=8333ft) scale, was produced all or in part from Field Survey/GPS information as of 2007. It...

  15. Role Model Ambulatory Care Clinical Training Site in a Community-Based Pharmacy.

    Science.gov (United States)

    Magarian, Edward O.; And Others

    1993-01-01

    An interdisciplinary project provided ambulatory care clinical training for pharmacy and nursing students in community-based pharmacies, promoting early detection and medical follow-up of common health problems within the community. Students learned new clinical skills in patient health assessment, new diagnostic technologies, patient education…

  16. Integrated Clinical Geriatric Pharmacy Clerkship in Long Term, Acute and Ambulatory Care.

    Science.gov (United States)

    Polo, Isabel; And Others

    1994-01-01

    A clinical geriatric pharmacy clerkship containing three separate practice areas (long-term, acute, and ambulatory care) is described. The program follows the medical education clerkship protocol, with a clinical pharmacy specialist, pharmacy practice resident, and student. Participation in medical rounds, interdisciplinary conferences, and…

  17. Big data and ambulatory care: breaking down legal barriers to support effective use.

    Science.gov (United States)

    Thorpe, Jane Hyatt; Gray, Elizabeth Alexandra

    2015-01-01

    Big data is heralded as having the potential to revolutionize health care by making large amounts of data available to support care delivery, population health, and patient engagement. Critics argue that big data's transformative potential is inhibited by privacy requirements that restrict health information exchange. However, there are a variety of permissible activities involving use and disclosure of patient information that support care delivery and management. This article presents an overview of the legal framework governing health information, dispels misconceptions about privacy regulations, and highlights how ambulatory care providers in particular can maximize the utility of big data to improve care. PMID:25401945

  18. Quality of Ambulatory Care in Medicare Advantage HMOs and Traditional Medicare

    OpenAIRE

    Ayanian, John Z.; Landon, Bruce E.; Robert C. Saunders; Pawlson, L. Greg; Newhouse, Joseph P.

    2013-01-01

    To compare quality of care nationally between Medicare Advantage health maintenance organizations (HMOs) and traditional Medicare and determine how various types of Medicare HMOs differed in quality from traditional Medicare, we assessed performance measures of the quality of ambulatory care from the among beneficiaries matched by demographic characteristics within local areas during 2003-2009. HMO enrollees were consistently more likely than traditional Medicare beneficiaries to receive appr...

  19. Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center

    Directory of Open Access Journals (Sweden)

    Manulik S

    2016-08-01

    Full Text Available Stanisław Manulik,1 Joanna Rosińczuk,2 Piotr Karniej3 1Non-Public Health Care Institution, “Ambulatory of Cosmonauts” Ltd. Liability Company, 2Department of Nervous System Diseases, Faculty of Health Science, 3Department of Organization and Management, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland Introduction: Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services.Objectives: The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services.Materials and methods: The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected.Results: All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel.Conclusion: Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility. Keywords: health care service quality, patients’ expectations, qualitative priorities, outpatient health care facilities

  20. Hospitalization for ambulatory care sensitive conditions and the role of primary care in Italian regions.

    Directory of Open Access Journals (Sweden)

    Aldo Rosano

    2011-03-01

    Full Text Available Abstract
    Background: Hospitalization may often be prevented by timely and effective outpatient care either by preventing the onset of an illness, controlling an acute illness or managing a chronic disease with an appropriate follow-up. The objective of the study is to examine the variability of hospital admissions within Italian regions for Ambulatory Care Sensitive Conditions (ACSCs, and their relationship with primary care supply.
    Methods: Hospital discharge data aggregated at a regional level collected in 2005 were analysed by type of ACS conditions. Main outcome measures were regional hospital admission rates for ACSCs. Negative binomial models were used to analyse the association with individual risk factors (age and gender and regional risk factors (propensity to hospitalisation and prevalence of specific conditions.
    Non-parametric correlation indexes between standardised hospital admission rates and quantitative measures of primary care services were calculated.
    Results: ACSC admissions accounted for 6.6% of total admissions, 35.7% were classified as acute conditions and 64.3% as chronic conditions. Admission rates for ACSCs varied widely across Italian regions with different patterns for chronic and acute conditions. Southern regions showed significantly higher rates for chronic conditions and North-eastern regions for acute conditions. We found a significant negative association between the provision of ambulatory specialist services and standardised hospitalization rates
    (SHR for ACS chronic conditions (r=-0.50; p=0.02 and an inverse correlation among SHR for ACS acute conditions and the rate of GPs per 1,000 residents, although the latter was not statistically significant.
    Conclusions: In Italy, about 480,000 inpatient hospital admissions in 2005 were attributable to ACSCs. Even
    adjusting for potential confounders

  1. Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities. Final rule.

    Science.gov (United States)

    2016-05-01

    This final rule will amend the fire safety standards for Medicare and Medicaid participating hospitals, critical access hospitals (CAHs), long-term care facilities, intermediate care facilities for individuals with intellectual disabilities (ICF-IID), ambulatory surgery centers (ASCs), hospices which provide inpatient services, religious non-medical health care institutions (RNHCIs), and programs of all-inclusive care for the elderly (PACE) facilities. Further, this final rule will adopt the 2012 edition of the Life Safety Code (LSC) and eliminate references in our regulations to all earlier editions of the Life Safety Code. It will also adopt the 2012 edition of the Health Care Facilities Code, with some exceptions. PMID:27192728

  2. Clinical hypertension in Native American/span>s: a comparison of 1987 and 1992 rates from ambulatory care data.

    Science.gov (United States)

    Acton, K J; Preston, S; Rith-Najarian, S

    1996-01-01

    THE AUTHORS EXAMINED THE PREVALENCE of clinically diagnosed hypertension among all American Indian and Alaska Native outpatients served in Indian Health Service (IHS) facilities in fiscal year 1992, and compared these rates with a similar analysis done in 1987. In this report they provided data on that analysis as well as on the association between hypertension and diabetes. The 1992 overall estimated age-adjusted prevalence of clinically diagnosed hypertension in adults older than age 15 was 10.4%, compared with 10.9% in 1987, a small but significant decrease. Considerable variation exists in hypertension prevalence rates in American Indian communities as analyzed by IHS service area. This report represents an attempt to use ambulatory patient care data to demonstrate a means for ongoing surveillance of a chronic disease for the entire service population of the IHS. This comprehensive data set represents approximately 60% of the entire U.S. American Indian and Alaska Native population. Based on the ongoing nature of this ambulatory patient care data system, this model for hypertension surveillance permits a unique opportunity for longitudinal evaluation of quality improvement efforts for the American Indian and Alaska Native populations served by the IHS. PMID:8898769

  3. Marketing ambulatory care to women: a segmentation approach.

    Science.gov (United States)

    Harrell, G D; Fors, M F

    1985-01-01

    Although significant changes are occurring in health care delivery, in many instances the new offerings are not based on a clear understanding of market segments being served. This exploratory study suggests that important differences may exist among women with regard to health care selection. Five major women's segments are identified for consideration by health care executives in developing marketing strategies. Additional research is suggested to confirm this segmentation hypothesis, validate segmental differences and quantify the findings.

  4. Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings

    Directory of Open Access Journals (Sweden)

    Sen S

    2014-06-01

    Full Text Available Objective: To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC models in the inpatient, ambulatory, and community practice settings. Methods: TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models. Results: Pharmacists are an essential part of the multidisciplinary team and play a key role in providing care to patients as they move between health care settings or from a health care setting to home. Pharmacists can participate in many aspects of the inpatient, ambulatory care, and community pharmacy practice settings to implement and ensure optimal TOC processes. This article describes establishing the pharmacist’s TOC role and practicing within multiple health care settings. In these models, pharmacists focus on medication reconciliation, discharge counseling, and optimization of medications. Additionally, a checklist has been created to assist other pharmacists in developing the pharmacist’s TOC roles in a practice environment or incorporating more TOC elements in their practice setting. Conclusion: Optimizing the TOC process, reducing medication errors, and preventing adverse events are important focus areas in the current health care system, as emphasized by The Joint Commission and other health care organizations. Pharmacists have the unique opportunity and skillset to develop and participate in TOC processes that will enhance medication safety and improve patient care.

  5. Manager's leadership is the main skill for ambulatory health care plan success.

    Science.gov (United States)

    Marin, Gustavo Horacio; Silberman, Martin; Colombo, Maria Virginia; Ozaeta, Belen; Henen, Jaime

    2015-01-01

    To demonstrate effectiveness of ambulatory health care plan implementation among institutions and variables associated with the differences observed. Randomized selection of primary health care (PHC) centers was done. Leadership ability of the plan manager was explored. Univariate/bivariate analyses were performed to observe correlation between variables. Two groups of PHC centers were established according to the efficacy of plan implementation: high and low performance. Differences between groups were observed (592%-1023% more efficacy in controls and practices; P < .001). Leadership was responsible for the main differences observed. Leadership of manager for implementation of the health care plan was the major important variable to reach the best efficacy standards.

  6. Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings

    OpenAIRE

    Sen S.; Bowen JF; Ganetsky VS; Hadley D; Melody K; Otsuka S; Vanmali R; Thomas T

    2014-01-01

    Objective: To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC) models in the inpatient, ambulatory, and community practice settings. Methods: TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models. Results: Pharmacists are...

  7. AMBULATORY CARE - SENSITIVE CONDITIONS IN CHILDREN UNDER FIVE YEARS

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Araújo Figueiredo

    2013-05-01

    Full Text Available Objective:analyzethe extent to which the incidence rate of primary care sensitivehospitalizations in children under five years is influenced by the percentage of coverage of theprimary care.Methods:This was a cross-sectional ecological study that combines coverage ofprimary careand theambulatorycare-sensitiveconditionsin 2000 and 2010. We used data from theHospital Information System (HIS and the Information System of Primary Care (SIAB.Results:The data revealed that the increased coverage providedprimary carereductionrateofhospitalization diseases studied. In 2000 the reduction was greater for gastroenteritis (51% inchildren under 01 years and 30% in children 01-04 years in 2010 for respiratory diseases (51% inchildren under 01years and 33% in children aged 01-04 years.Conclusion:we found an association between the coverage ofprimary careand admission rates, however seem to affect othervariables, suggesting the need for further studies.

  8. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

    Science.gov (United States)

    Haas, Sheila A; Vlasses, Frances; Havey, Julia

    2016-01-01

    There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

  9. Health care in correctional facilities.

    OpenAIRE

    Thorburn, K M

    1995-01-01

    More than 1.3 million adults are in correctional facilities, including jails and federal and state prisons, in the United States. Health care of the inmates is an integral component of correctional management. Health services in correctional facilities underwent dramatic improvements during the 1970s. Public policy trends beginning in the early 1980s substantially affected the demographics and health status of jail and prison populations and threatened earlier gains in the health care of inma...

  10. The Role of Rural Health Clinics in Hospitalization Due to Ambulatory Care Sensitive Conditions: A Study in Nebraska

    Science.gov (United States)

    Zhang, Wanqing; Mueller, Keith J.; Chen, Li-Wu; Conway, Kevin

    2006-01-01

    Context: Hospitalization due to ambulatory care sensitive conditions (ACSCs) is often used as an indicator for measuring access to primary care. Rural health clinics (RHCs) provide basic primary care services for rural residents in health professional shortage areas (HPSAs). The relationship between RHCs and ACSCs is unclear. Purpose: The purpose…

  11. Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system

    Directory of Open Access Journals (Sweden)

    Tania Cristina Morais Santa Barbara Rehem

    2013-09-01

    Full Text Available OBJECTIVE: to estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. METHOD: the hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. RESULT: the sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. CONCLUSION: there are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

  12. [The social hygienic assessment of significance of diseases under organization of ambulatory polyclinic care].

    Science.gov (United States)

    Babenko, A I; Murakhovskiy, A G; Tomtchuk, A A; Bravve, Yu I

    2013-01-01

    The article presents the results of analysis of appealability of adult population of Omsk to municipal polyclinic on the subject of diseases. The coefficients of relative importance of different classes of diseases to determine the groups af their significance were calculated on the basis of integrated evaluation of common and primary morbidity and diseases of patients under dispensarization monitoring. The established character of formation of flows of appealabiliy of population on the subject of diseases is a basic one to determine demand in medical technologies and planning of activities of ambulatory polyclinic section of health care.

  13. Identifying consumer segments in health services markets: an application of conjoint and cluster analyses to the ambulatory care pharmacy market.

    Science.gov (United States)

    Carrol, N V; Gagon, J P

    1983-01-01

    Because of increasing competition, it is becoming more important that health care providers pursue consumer-based market segmentation strategies. This paper presents a methodology for identifying and describing consumer segments in health service markets, and demonstrates the use of the methodology by presenting a study of consumer segments in the ambulatory care pharmacy market.

  14. Marketing strategy adjustments in the ambulatory care center industry: implications for community pharmacy.

    Science.gov (United States)

    Phillips, J H

    1989-01-01

    Each stage of a product's life cycle requires marketing strategy modifications in response to changing demand levels. The purpose of this study was to investigate changes in ambulatory care center (ACC) operational characteristics indicative of product, market, and distribution channel adjustments that could have a competitive impact upon community pharmacy practice. A questionnaire was mailed to a national sample of 325 ACC managers. Evidence of new product feature additions includes increased emphasis on continued care and increased prevalence of prescription drug dispensing. Expansion into new market segments and distribution channels was demonstrated by increased participation in HMO and employer relationships. The observed adjustments in ACC marketing strategies present obvious challenges as well as less obvious opportunities for community pharmacy practice. PMID:10295634

  15. Evaluation of a career ladder program in an ambulatory care environment.

    Science.gov (United States)

    Nelson, Joan M; Cook, Paul F

    2008-01-01

    Clinical ladders, or career advancement systems, were designed to enhance professional development, provide a reward system for quality clinical performance, promote quality nursing practice, and improve job satisfaction among nurses. Most of the literature on RN clinical ladder programs is related to the acute care setting, where these programs originated; not much is known about their effectiveness in the ambulatory care environment. The RN Career Ladder at Kaiser Permanente of Colorado was begun by a Labor Management Partnership Committee in 2003, and awards financial incentives to RNs who demonstrate a commitment to continuing education, leadership activities, and program development on a local and regional level. In this study significantly more involvement in leadership, interdisciplinary, and quality improvement activities were found among career ladder nurses than non-career ladder nurses, regardless of their job role. It is not clear whether nursing leaders gravitate toward a career ladder or whether career ladder participation encourages increased participation in leadership activities. PMID:19330969

  16. Marketing strategy adjustments in the ambulatory care center industry: implications for community pharmacy.

    Science.gov (United States)

    Phillips, J H

    1989-01-01

    Each stage of a product's life cycle requires marketing strategy modifications in response to changing demand levels. The purpose of this study was to investigate changes in ambulatory care center (ACC) operational characteristics indicative of product, market, and distribution channel adjustments that could have a competitive impact upon community pharmacy practice. A questionnaire was mailed to a national sample of 325 ACC managers. Evidence of new product feature additions includes increased emphasis on continued care and increased prevalence of prescription drug dispensing. Expansion into new market segments and distribution channels was demonstrated by increased participation in HMO and employer relationships. The observed adjustments in ACC marketing strategies present obvious challenges as well as less obvious opportunities for community pharmacy practice.

  17. Perceived Stress, Multimorbidity, and Risk for Hospitalizations for Ambulatory Care-sensitive Conditions

    DEFF Research Database (Denmark)

    Prior, Anders; Vestergaard, Mogens; Davydow, Dimitry S;

    2016-01-01

    BACKGROUND: Psychiatric disorders are associated with an increased risk for ambulatory care-sensitive condition (ACSC)-related hospitalizations, but it remains unknown whether this holds for individuals with nonsyndromic stress that is more prevalent in the general population. OBJECTIVES......: To determine whether perceived stress is associated with ACSC-related hospitalizations and rehospitalizations, and posthospitalization 30-day mortality. RESEARCH DESIGN AND MEASURES: Population-based cohort study with 118,410 participants from the Danish National Health Survey 2010, which included data...... on Cohen's Perceived Stress Scale, followed from 2010 to 2014, combined with individual-level national register data on hospitalizations and mortality. Multimorbidity was assessed using health register information on diagnoses and drug prescriptions within 39 condition categories. RESULTS: Being...

  18. The Role of Ambulatory Care Pharmacists in an HIV Multidisciplinary Team within a Free and Bilingual Clinic

    OpenAIRE

    Ann M. Fugit, Pharm.D., BCPS; Sallie D. Mayer, Pharm.D., MBA, BCPS, CDE; Radha S. Vanmali, Pharm.D., BCACP

    2013-01-01

    Objective: Describe the role and integration of ambulatory care pharmacists in a Human Immunodeficiency Virus (HIV) clinic within a free and bilingual clinic with regards to types of interventions made during the patient-pharmacist visit. Design: Retrospective, single-centered, chart review. Setting: Free, bilingual clinic in Richmond, VA. Participants: Thirty-two adult patients with diagnosed HIV receiving care in the clinic between June 30, 2010 and January 26, 2011. Main Outcome Measure: T...

  19. The emerging primary care workforce: preliminary observations from the primary care team: learning from effective ambulatory practices project.

    Science.gov (United States)

    Ladden, Maryjoan D; Bodenheimer, Thomas; Fishman, Nancy W; Flinter, Margaret; Hsu, Clarissa; Parchman, Michael; Wagner, Edward H

    2013-12-01

    Many primary care practices are changing the roles played by the members of their health care teams. The purpose of this article is to describe some of these new roles, using the authors' preliminary observations from 25 site visits to high-performing primary care practices across the United States in 2012-2013. These sites visits, to practices using their workforce creatively, were part of the Robert Wood Johnson Foundation-funded initiative, The Primary Care Team: Learning From Effective Ambulatory Practices.Examples of these new roles that the authors observed on their site visits include medical assistants reviewing patient records before visits to identify care gaps, ordering and administering immunizations using protocols, making outreach calls to patients, leading team huddles, and coaching patients to set self-management goals. The registered nurse role has evolved from an emphasis on triage to a focus on uncomplicated acute care, chronic care management, and hospital-to-home transitions. Behavioral health providers (licensed clinical social workers, psychologists, or licensed counselors) were colocated and integrated within practices and were readily available for immediate consults and brief interventions. Physicians have shifted from lone to shared responsibility for patient panels, with other team members empowered to provide significant portions of chronic and preventive care.An innovative team-based primary care workforce is emerging. Spreading and sustaining these changes will require training both health professionals and nonprofessionals in new ways. Without clinical experiences that model this new team-based care and role models who practice it, trainees will not be prepared to practice as a team. PMID:24128622

  20. [Sexuality and Alzheimer's in care facilities].

    Science.gov (United States)

    Dupras, André; Boucher, Sonya

    2014-01-01

    Sexuality of people with Alzheimer's disease is often prohibited in care facilities because its manitestations are considered harmful for the residents and the facility. Ethics of welfare implemented in care facilities require respect for the emotional and sexual lives of residents. Restoring sexual desire in care facilities can be achieved by adopting a humanistic approach that focuses on the development and personal fulfilment of individuals in every sphere of their lives, including sexuality. PMID:25373262

  1. Assisted Living Facilities, care facilities, Published in 2006, Washoe County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Assisted Living Facilities dataset, was produced all or in part from Published Reports/Deeds information as of 2006. It is described as 'care facilities'. Data...

  2. Application of Porter's generic strategies in ambulatory health care: a comparison of managerial perceptions in two Israeli sick funds.

    Science.gov (United States)

    Torgovicky, Refael; Goldberg, Avishay; Shvarts, Shifra; Bar Dayan, Yosefa; Onn, Erez; Levi, Yehezkel; BarDayan, Yaron

    2005-01-01

    A number of typologies have been developed in the strategic management literature to categorize strategies that an organization can pursue at the business level. Extensive research has established Porter's generic strategies of (1) cost leadership, (2) differentiation, (3) differentiation focus, (4) cost focus, and (5) stuck-in-the-middle as the dominant paradigm in the literature. The purpose of the current study was to research competitive strategies in the Israeli ambulatory health care system, by comparing managerial perceptions of present and ideal business strategies in two Israeli sick funds. We developed a unique research tool, which reliably examines the gap between the present and ideal status managerial views. We found a relation between the business strategy and performance measures, thus strengthening Porter's original theory about the nonviability of the stuck-in-the-middle strategy, and suggesting the applicability Porter's generic strategies to not-for-profit institutes in an ambulatory health care system.

  3. Application of Porter's generic strategies in ambulatory health care: a comparison of managerial perceptions in two Israeli sick funds.

    Science.gov (United States)

    Torgovicky, Refael; Goldberg, Avishay; Shvarts, Shifra; Bar Dayan, Yosefa; Onn, Erez; Levi, Yehezkel; BarDayan, Yaron

    2005-01-01

    A number of typologies have been developed in the strategic management literature to categorize strategies that an organization can pursue at the business level. Extensive research has established Porter's generic strategies of (1) cost leadership, (2) differentiation, (3) differentiation focus, (4) cost focus, and (5) stuck-in-the-middle as the dominant paradigm in the literature. The purpose of the current study was to research competitive strategies in the Israeli ambulatory health care system, by comparing managerial perceptions of present and ideal business strategies in two Israeli sick funds. We developed a unique research tool, which reliably examines the gap between the present and ideal status managerial views. We found a relation between the business strategy and performance measures, thus strengthening Porter's original theory about the nonviability of the stuck-in-the-middle strategy, and suggesting the applicability Porter's generic strategies to not-for-profit institutes in an ambulatory health care system. PMID:15773250

  4. Application of three different sets of explicit criteria for assessing inappropriate prescribing in older patients: a nationwide prevalence study of ambulatory care visits in Taiwan

    OpenAIRE

    Chang, Chirn-Bin; Yang, Shu-yu; Lai, Hsiu-Yun; Wu, Ru-Shu; Liu, Hsing-Cheng; Hsu, Hsiu-Ying; Hwang, Shinn-Jang; Chan, Ding-Cheng (Derrick)

    2015-01-01

    Objective To investigate the national prevalence of potentially inappropriate medications (PIMs) prescribed in ambulatory care clinics in Taiwan according to three different sets of regional criteria and the correlates of PIM use. Design Cross-sectional study. Setting This analysis included older patients who visited ambulatory care clinics in 2009 and represented half of the older population included on the Taiwanese National Health Insurance Research Database. Participants We identified 1 1...

  5. A cluster randomized trial evaluating electronic prescribing in an ambulatory care setting

    Directory of Open Access Journals (Sweden)

    Quan Sherman

    2007-10-01

    Full Text Available Abstract Background Medication errors, adverse drug events and potential adverse drug events are common and serious in terms of the harms and costs that they impose on the health system and those who use it. Errors resulting in preventable adverse drug events have been shown to occur most often at the stages of ordering and administration. This paper describes the protocol for a pragmatic trial of electronic prescribing to reduce prescription error. The trial was designed to overcome the limitations associated with traditional study design. Design This study was designed as a 65-week, cluster randomized, parallel study. Methods The trial was conducted within ambulatory outpatient clinics in an academic tertiary care centre in Ontario, Canada. The electronic prescribing software for the study is a Canadian electronic prescribing software package which provides physician prescription entry with decision support at the point of care. Using a handheld computer (PDA the physician selects medications using an error minimising menu-based pick list from a comprehensive drug database, create specific prescription instructions and then transmit the prescription directly and electronically to a participating pharmacy via facsimile or to the physician's printer using local area wireless technology. The unit of allocation and randomization is by 'week', i.e. the system is "on" or "off" according to the randomization scheme and the unit of analysis is the prescription, with adjustment for clustering of patients within practitioners. Discussion This paper describes the protocol for a pragmatic cluster randomized trial of point-of-care electronic prescribing, which was specifically designed to overcome the limitations associated with traditional study design. Trial Registration This trial has been registered with clinicaltrials.gov (ID: NCT00252395

  6. Cost-effectiveness analysis of computerized ECG interpretation system in an ambulatory health care organization.

    Science.gov (United States)

    Carel, R S

    1982-04-01

    The cost-effectiveness of a computerized ECG interpretation system in an ambulatory health care organization has been evaluated in comparison with a conventional (manual) system. The automated system was shown to be more cost-effective at a minimum load of 2,500 patients/month. At larger monthly loads an even greater cost-effectiveness was found, the average cost/ECG being about $2. In the manual system the cost/unit is practically independent of patient load. This is primarily due to the fact that 87% of the cost/ECG is attributable to wages and fees of highly trained personnel. In the automated system, on the other hand, the cost/ECG is heavily dependent on examinee load. This is due to the relatively large impact of equipment depreciation on fixed (and total) cost. Utilization of a computer-assisted system leads to marked reduction in cardiologists' interpretation time, substantially shorter turnaround time (of unconfirmed reports), and potential provision of simultaneous service at several remotely located "heart stations."

  7. Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center

    OpenAIRE

    Rosińczuk,Joanna; Manulik,Stanisław; Karniej,Piotr

    2016-01-01

    Stanisław Manulik,1 Joanna Rosińczuk,2 Piotr Karniej3 1Non-Public Health Care Institution, “Ambulatory of Cosmonauts” Ltd. Liability Company, 2Department of Nervous System Diseases, Faculty of Health Science, 3Department of Organization and Management, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland Introduction: Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUA...

  8. Hospitalisations and costs relating to ambulatory care sensitive conditions in Ireland.

    LENUS (Irish Health Repository)

    Sheridan, A

    2012-03-08

    BACKGROUND: Ambulatory care sensitive conditions (ACSCs) are conditions for which the provision of timely and effective outpatient care can reduce the risks of hospitalisation by preventing, controlling or managing a chronic disease or condition. AIMS: The aims of this study were to report on ACSCs in Ireland, and to provide a baseline for future reference. METHODS: Using HIPE, via Health Atlas Ireland, inpatient discharges classified as ACSCs using definitions from the Victorian ACSC study were extracted for the years 2005-2008. Direct methods of standardisation allowed comparison of rates using the EU standard population as a comparison for national data, and national population as comparison for county data. Costs were estimated using diagnosis-related groups. RESULTS: The directly age-standardised discharge rate for ACSC-related discharges increased slightly, but non-significantly, from 15.40 per 1,000 population in 2005 to 15.75 per 1,000 population in 2008. The number of discharges increased (9.5%) from 63,619 in 2005 to 69,664 in 2008, with the estimated associated hospital costs increasing (31.5%) from 267.8 million in 2005 to 352.2 million in 2008. Across the country, there was considerable variation in the discharge rates for the Top-10 ACSCs for the years 2005-2008. Significantly lower rates of hospitalisation were observed in more urban areas including Cork, Dublin and Galway. The most common ACSC in 2008 was diabetes with complications (29.8%). CONCLUSIONS: The variation in rates observed indicates the scope of reducing hospitalisations and associated costs for ACSCs, across both adult\\'s and children\\'s services and particularly in relation to diabetes complications.

  9. Assisted Living Facilities - MO 2010 Long Term Care Facilities (SHP)

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — Long Term Care facilities (nursing homes) in Missouri - Data will not be made available for download via MSDIS. Interested parties should send an email inquiry to...

  10. Ambulatory Surgical Measures - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  11. Ambulatory Surgical Measures - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  12. Financial Health of Child Care Facilities Affects Quality of Care.

    Science.gov (United States)

    Brower, Mary R.; Sull, Theresa M.

    2003-01-01

    Contends that child care facility owners, boards of directors, staff, and parents need to focus on financial management, as poor financial health compromises the quality of care for children. Specifically addresses the issues of: (1) concern for providing high quality child care; (2) the connection between quality and money; and (3) strengthening…

  13. Evaluation of the Medical Care of Patients with Hypertension in an Emergency Department and in Ambulatory Hypertension Unit

    Directory of Open Access Journals (Sweden)

    Fernando Nobre

    2002-02-01

    Full Text Available OBJECTIVE: To evaluate the characteristics of the patients receiving medical care in the Ambulatory of Hypertension of the Emergency Department, Division of Cardiology, and in the Emergency Unit of the Clinical Hospital of the Ribeirão Preto Medical School. METHODS: Using a protocol, we compared the care of the same hypertensive patients in on different occasions in the 2 different places. The characteristics of 62 patients, 29 men with a mean age of 57 years, were analyzed between January 1996 and December 1997. RESULTS: The care of these patients resulted in different medical treatment regardless of their clinical features and blood pressure levels. Thus, in the Emergency Unit, 97% presented with symptoms, and 64.5% received medication to rapidly reduce blood pressure. In 50% of the cases, nifedipine SL was the elected medication. Patients who applied to the Ambulatory of Hypertension presenting with similar features, or, in some cases, presenting with similar clinically higher levels of blood pressure, were not prescribed medication for a rapid reduction of blood pressure at any of the appointments. CONCLUSION: The therapeutic approach to patients with high blood pressure levels, symptomatic or asymptomatic, was dependent on the place of treatment. In the Emergency Unit, the conduct was, in the majority of cases, to decrease blood pressure immediately, whereas in the Ambulatory of Hypertension, the same levels of blood pressure, in the same individuals, resulted in therapeutic adjustment with nonpharmacological management. These results show the need to reconsider the concept of hypertensive crises and their therapeutical implications.

  14. Integration of animals in residential care facilities

    OpenAIRE

    Bunderšek, Suzana

    2014-01-01

    The theoretical part of the thesis provides insight into the role animals play in different periods of a person’s life. The usefulness of human-animal interaction is demonstrated with a description of the ways of working with animals and the presentation of different animal species. The emphasis is put on children and minors placed in residential care facilities. While the advantages of introducing animals into residential care facilities are provided, the weaknesses and risks are also pointe...

  15. Supply sensitive services in Swiss ambulatory care: An analysis of basic health insurance records for 2003-2007

    Directory of Open Access Journals (Sweden)

    Künzi Beat

    2010-11-01

    Full Text Available Abstract Background Swiss ambulatory care is characterized by independent, and primarily practice-based, physicians, receiving fee for service reimbursement. This study analyses supply sensitive services using ambulatory care claims data from mandatory health insurance. A first research question was aimed at the hypothesis that physicians with large patient lists decrease their intensity of services and bill less per patient to health insurance, and vice versa: physicians with smaller patient lists compensate for the lack of patients with additional visits and services. A second research question relates to the fact that several cantons are allowing physicians to directly dispense drugs to patients ('self-dispensation' whereas other cantons restrict such direct sales to emergencies only. This second question was based on the assumption that patterns of rescheduling patients for consultations may differ across channels of dispensing prescription drugs and therefore the hypothesis of different consultation costs in this context was investigated. Methods Complete claims data paid for by mandatory health insurance of all Swiss physicians in own practices were analyzed for the years 2003-2007. Medical specialties were pooled into six main provider types in ambulatory care: primary care, pediatrics, gynecology & obstetrics, psychiatrists, invasive and non-invasive specialists. For each provider type, regression models at the physician level were used to analyze the relationship between the number of patients treated and the total sum of treatment cost reimbursed by mandatory health insurance. Results The results show non-proportional relationships between patient numbers and total sum of treatment cost for all provider types involved implying that treatment costs per patient increase with higher practice size. The related additional costs to the health system are substantial. Regions with self-dispensation had lowest treatment cost for primary care

  16. Optimization of preventive health care facility locations

    Directory of Open Access Journals (Sweden)

    McGregor S

    2010-03-01

    Full Text Available Abstract Background Preventive health care programs can save lives and contribute to a better quality of life by diagnosing serious medical conditions early. The Preventive Health Care Facility Location (PHCFL problem is to identify optimal locations for preventive health care facilities so as to maximize participation. When identifying locations for preventive health care facilities, we need to consider the characteristics of the preventive health care services. First, people should have more flexibility to select service locations. Second, each preventive health care facility needs to have a minimum number of clients in order to retain accreditation. Results This paper presents a new methodology for solving the PHCFL problem. In order to capture the characteristics of preventive health care services, we define a new accessibility measurement that combines the two-step floating catchment area method, distance factor, and the Huff-based competitive model. We assume that the accessibility of preventive health care services is a major determinant for participation in the service. Based on the new accessibility measurement, the PHCFL problem is formalized as a bi-objective model based on efficiency and coverage. The bi-objective model is solved using the Interchange algorithm. In order to accelerate the solving process, we implement the Interchange algorithm by building two new data structures, which captures the spatial structure of the PHCFL problem. In addition, in order to measure the spatial barrier between clients and preventive health care facilities accurately and dynamically, this paper estimates travelling distance and travelling time by calling the Google Maps Application Programming Interface (API. Conclusions Experiments based on a real application for the Alberta breast cancer screening program show that our work can increase the accessibility of breast cancer screening services in the province.

  17. The Role of Ambulatory Care Pharmacists in an HIV Multidisciplinary Team within a Free and Bilingual Clinic

    Directory of Open Access Journals (Sweden)

    Ann M. Fugit, Pharm.D., BCPS

    2013-01-01

    Full Text Available Objective: Describe the role and integration of ambulatory care pharmacists in a Human Immunodeficiency Virus (HIV clinic within a free and bilingual clinic with regards to types of interventions made during the patient-pharmacist visit. Design: Retrospective, single-centered, chart review. Setting: Free, bilingual clinic in Richmond, VA. Participants: Thirty-two adult patients with diagnosed HIV receiving care in the clinic between June 30, 2010 and January 26, 2011. Main Outcome Measure: Types of interventions documented during the patient-pharmacist visit, categorized as medication review, patient education, or adherence monitoring. Results: Total of 32 patients accounted for 55 patient-pharmacist visits and 296 interventions. The most common interventions were medication review (66.9%, patient education (23.3%, and adherence monitoring (9.8%. Post-hoc analysis suggests Hispanic patients are more likely to be diagnosed with Acquired Immune Deficiency Syndrome (AIDS (P = 0.01, have current or history of opportunistic infection (OI (P=0.01, and have current or history of OI prophylaxis (P = 0.03. Adherence monitoring was less common amongst the non-Hispanics (7.1% compared to the Hispanic sub-population (16.5%, (P = 0.04. Conclusion: The role of ambulatory care pharmacists in a free and bilingual clinic goes beyond adherence monitoring. Pharmacists can be a valuable part of the patient care team by providing medication review and patient education for HIV and other co-morbidities within free clinics. Further research is warranted to assess outcomes and to further explore the underlying barriers to early HIV diagnosis and adherence within the Hispanic population.

  18. Assisted Living Facilities - CARE_LONG_TERM_FACILITIES_ISDH_IN: Residential Care Facilities, Nursing Homes, and Hospices in Indiana in 2007 (Indiana State Department of Health, Point Shapefile)

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — CARE_LONG_TERM_FACILITIES_ISDH_IN is a point shapefile showing the locations of 86 residential care facilities, 525 long-term care facilities (nursing homes), and...

  19. Improving year-end transfers of care in academic ambulatory clinics: a survey of pediatric resident physician perceptions

    Directory of Open Access Journals (Sweden)

    Carlos F. Lerner

    2012-05-01

    Full Text Available Background: In resident primary care continuity clinics, at the end of each academic year, continuity of care is disrupted when patients cared for by the graduating class are redistributed to other residents. Yet, despite the recent focus on the transfers of care between resident physicians in inpatient settings, there has been minimal attention given to patient care transfers in academic ambulatory clinics. We sought to elicit the views of pediatric residents regarding year-end patient handoffs in a pediatric resident continuity clinic.Methods: Residents assigned to a continuity clinic of a large pediatric residency program completed a questionnaire regarding year-end transfers of care.Results: Thirty-one questionnaires were completed out of a total 45 eligible residents (69% response. Eighty seven percent of residents strongly or somewhat agreed that it would be useful to receive a written sign-out for patients with complex medical or social issues, but only 35% felt it would be useful for patients with no significant issues. Residents more frequently reported having access to adequate information regarding their new patients’ medical summary (53% and care plan (47% than patients’ functional abilities (30%, social history (17%, or use of community resources (17%. When rating the importance of receiving adequate sign-out in each those domains, residents gave most importance to the medical summary (87% of residents indicating very or somewhat important and plan of care (84%. Residents gave less importance to receiving sign-out regarding their patients’ functional abilities (71% social history (58%, and community resources (58%. Residents indicated that lack of access to adequate patient information resulted in additional work (80%, delays or omissions in needed care (56%, and disruptions in continuity of care (58%.Conclusions: In a single-site study, residents perceive that they lack adequate information during year-end patient transfers

  20. Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey

    Directory of Open Access Journals (Sweden)

    Mansfield Richard J

    2005-02-01

    Full Text Available Abstract Background Although shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting. Methods We performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000. Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection were examined. Results Shoulder pain was associated with an injury in one third (33.2% (230/692 of office visits in this population of US primary care physicians. Males, and younger adults (age ≤ 52 more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202 of visits. An x-ray was performed in 29.0% (164/566 of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound was infrequently performed (6.5%, 37/566. Physiotherapy was ordered in 23.9% (135/566 of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set. Conclusion These data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices.

  1. Association between community health center and rural health clinic presence and county-level hospitalization rates for ambulatory care sensitive conditions: an analysis across eight US states

    Directory of Open Access Journals (Sweden)

    Laditka Sarah B

    2009-07-01

    Full Text Available Abstract Background Federally qualified community health centers (CHCs and rural health clinics (RHCs are intended to provide access to care for vulnerable populations. While some research has explored the effects of CHCs on population health, little information exists regarding RHC effects. We sought to clarify the contribution that CHCs and RHCs may make to the accessibility of primary health care, as measured by county-level rates of hospitalization for ambulatory care sensitive (ACS conditions. Methods We conducted an ecologic analysis of the relationship between facility presence and county-level hospitalization rates, using 2002 discharge data from eight states within the US (579 counties. Counties were categorized by facility availability: CHC(s only, RHC(s only, both (CHC and RHC, and neither. US Agency for Healthcare Research and Quality definitions were used to identify ACS diagnoses. Discharge rates were based on the individual's county of residence and were obtained by dividing ACS hospitalizations by the relevant county population. We calculated ACS rates separately for children, working age adults, and older individuals, and for uninsured children and working age adults. To ensure stable rates, we excluded counties having fewer than 1,000 residents in the child or working age adult categories, or 500 residents among those 65 and older. Multivariate Poisson analysis was used to calculate adjusted rate ratios. Results Among working age adults, rate ratio (RR comparing ACS hospitalization rates for CHC-only counties to those of counties with neither facility was 0.86 (95% Confidence Interval, CI, 0.78–0.95. Among older adults, the rate ratio for CHC-only counties compared to counties with neither facility was 0.84 (CI 0.81–0.87; for counties with both CHC and RHC present, the RR was 0.88 (CI 0.84–0.92. No CHC/RHC effects were found for children. No effects were found on estimated hospitalization rates among uninsured populations

  2. Psychometric properties of the Persian version of the Ambulatory Care Learning Educational Environment Measure (ACLEEM questionnaire, Shiraz, Iran

    Directory of Open Access Journals (Sweden)

    Parvizi MM

    2016-09-01

    Full Text Available Mohammad Mahdi Parvizi,1,2 Mitra Amini,2 Mohammad Reza Dehghani,2 Peyman Jafari,3 Zahra Parvizi,1 1Health Policy Research Center, 2Quality Improvement in Clinical Education Research Center, 3Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Fars, Iran Purpose: Evaluation is the main component in design and implementation of educational activities and rapid growth of educational institution programs. Outpatient medical education and clinical training environment is one of the most important parts of training of medical residents. This study aimed to determine the validity and reliability of the Persian version of Ambulatory Care Learning Educational Environment Measure (ACLEEM questionnaire, as an instrument for assessment of educational environments in residency medical clinics. Materials and methods: This study was performed on 180 residents in Shiraz University of Medical Sciences, Shiraz, Iran, in 2014–2015. The questionnaire designers’ electronic permission (by email and the residents’ verbal consent were obtained before distributing the questionnaires. The study data were gathered using ACLEEM questionnaire developed by Arnoldo Riquelme in 2013. The data were analyzed using the SPSS statistical software, version 14, and MedCalc® software. Then, the construct validity, including convergent and discriminant validities, of the Persian version of ACLEEM questionnaire was assessed. Its internal consistency was also checked by Cronbach’s alpha coefficient. Results: Five team members who were experts in medical education were consulted to test the cultural adaptation, linguistic equivalency, and content validity of the Persian version of the questionnaire. Content validity indexes were >0.9 in all items. In factor analysis of the instrument, the ­Kaiser–Meyer–Olkin index was 0.928 and Barlett’s sphericity test yielded the following results: X 2=6,717.551, df =1,225, and P ≤0.001. Besides, Cronbach

  3. Anesthesiologists' practice patterns for treatment of postoperative nausea and vomiting in the ambulatory Post Anesthesia Care Unit

    Directory of Open Access Journals (Sweden)

    Claybon Louis

    2006-06-01

    Full Text Available Abstract Background When patients are asked what they find most anxiety provoking about having surgery, the top concerns almost always include postoperative nausea and vomiting (PONV. Only until recently have there been any published recommendations, mostly derived from expert opinion, as to which regimens to use once a patient develops PONV. The goal of this study was to assess the responses to a written survey to address the following questions: 1 If no prophylaxis is administered to an ambulatory patient, what agent do anesthesiologists use for treatment of PONV in the ambulatory Post-Anesthesia Care Unit (PACU?; 2 Do anesthesiologists use non-pharmacologic interventions for PONV treatment?; and 3 If a PONV prophylaxis agent is administered during the anesthetic, do anesthesiologists choose an antiemetic in a different class for treatment? Methods A questionnaire with five short hypothetical clinical vignettes was mailed to 300 randomly selected USA anesthesiologists. The types of pharmacological and nonpharmacological interventions for PONV treatment were analyzed. Results The questionnaire was completed by 106 anesthesiologists (38% response rate, who reported that on average 52% of their practice was ambulatory. If a patient develops PONV and received no prophylaxis, 67% (95% CI, 62% – 79% of anesthesiologists reported they would administer a 5-HT3-antagonist as first choice for treatment, with metoclopramide and dexamethasone being the next two most common choices. 65% (95% CI, 55% – 74% of anesthesiologists reported they would also use non-pharmacologic interventions to treat PONV in the PACU, with an IV fluid bolus or nasal cannula oxygen being the most common. When PONV prophylaxis was given during the anesthetic, the preferred PONV treatment choice changed. Whereas 3%–7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% (95% confidence intervals, 18% – 36% of practitioners would re

  4. Psychometric properties of the Persian version of the Ambulatory Care Learning Educational Environment Measure (ACLEEM) questionnaire, Shiraz, Iran

    Science.gov (United States)

    Parvizi, Mohammad Mahdi; Amini, Mitra; Dehghani, Mohammad Reza; Jafari, Peyman; Parvizi, Zahra

    2016-01-01

    Purpose Evaluation is the main component in design and implementation of educational activities and rapid growth of educational institution programs. Outpatient medical education and clinical training environment is one of the most important parts of training of medical residents. This study aimed to determine the validity and reliability of the Persian version of Ambulatory Care Learning Educational Environment Measure (ACLEEM) questionnaire, as an instrument for assessment of educational environments in residency medical clinics. Materials and methods This study was performed on 180 residents in Shiraz University of Medical Sciences, Shiraz, Iran, in 2014–2015. The questionnaire designers’ electronic permission (by email) and the residents’ verbal consent were obtained before distributing the questionnaires. The study data were gathered using ACLEEM questionnaire developed by Arnoldo Riquelme in 2013. The data were analyzed using the SPSS statistical software, version 14, and MedCalc® software. Then, the construct validity, including convergent and discriminant validities, of the Persian version of ACLEEM questionnaire was assessed. Its internal consistency was also checked by Cronbach’s alpha coefficient. Results Five team members who were experts in medical education were consulted to test the cultural adaptation, linguistic equivalency, and content validity of the Persian version of the questionnaire. Content validity indexes were >0.9 in all items. In factor analysis of the instrument, the Kaiser–Meyer–Olkin index was 0.928 and Barlett’s sphericity test yielded the following results: X2=6,717.551, df =1,225, and P≤0.001. Besides, Cronbach’s alpha coefficient of ACLEEM questionnaire was 0.964. Cronbach’s alpha coefficients were also >0.80 in all the three domains of the questionnaire. Overall, the Persian version of ACLEEM showed excellent convergent validity and acceptable discriminant validity, except for the clinical training domain

  5. Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care

    DEFF Research Database (Denmark)

    Thomsen, Linda Aagaard; Winterstein, Almut G; Søndergaard, Birthe;

    2007-01-01

    -months, and the pADE incidence was 5.6 per 1000 person-months (1.1-10.1). The median ADE preventability rate was 21% (11-38%). The median incidence of ADEs requiring hospital admission was 0.45 (0.10-13.1) per 1000 person-months, and the median incidence of pADEs requiring hospital admission was 4.5 per 1000 person....../pADE incidence, (2) clinical outcomes, (3) associated drug groups, and/or (4) underlying medication errors were included. Study country, year and design, sample size, follow-up time, ADE/pADE identification method, proportion of ADEs/pADEs and ADEs/pADEs requiring hospital admission, and frequency distribution...... of adverse outcome, associated drug groups, or medication errors were extracted. DATA SYNTHESIS: Twenty-nine studies met inclusion criteria: 14 were ambulatory-based and 15 were hospital-based. Seven studies enrolled only elderly patients. The median ADE incidence was 14.9 (range 4.0-91.3) per 1000 person...

  6. Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies.

    Directory of Open Access Journals (Sweden)

    Sima Berendes

    2011-04-01

    Full Text Available BACKGROUND: In developing countries, the private sector provides a substantial proportion of primary health care to low income groups for communicable and non-communicable diseases. These providers are therefore central to improving health outcomes. We need to know how their services compare to those of the public sector to inform policy options. METHODS AND FINDINGS: We summarised reliable research comparing the quality of formal private versus public ambulatory health care in low and middle income countries. We selected studies against inclusion criteria following a comprehensive search, yielding 80 studies. We compared quality under standard categories, converted values to a linear 100% scale, calculated differences between providers within studies, and summarised median values of the differences across studies. As the results for for-profit and not-for-profit providers were similar, we combined them. Overall, median values indicated that many services, irrespective of whether public or private, scored low on infrastructure, clinical competence, and practice. Overall, the private sector performed better in relation to drug supply, responsiveness, and effort. No difference between provider groups was detected for patient satisfaction or competence. Synthesis of qualitative components indicates the private sector is more client centred. CONCLUSIONS: Although data are limited, quality in both provider groups seems poor, with the private sector performing better in drug availability and aspects of delivery of care, including responsiveness and effort, and possibly being more client orientated. Strategies seeking to influence quality in both groups are needed to improve care delivery and outcomes for the poor, including managing the increasing burden of non-communicable diseases.

  7. The influence of distance on ambulatory care use, death, and readmission following a myocardial infarction.

    OpenAIRE

    Piette, J. D.; Moos, R.H.

    1996-01-01

    OBJECTIVE: To examine whether patients admitted for treatment of a myocardial infarction (MI) who live farther from their source of care are less likely to be followed in an outpatient clinic, and whether patients who receive follow-up care are less likely to die or to have a subsequent acute care admission. DATA SOURCE: Department of Veterans Affairs (VA) databases to identify a national sample of 4,637 MI patients discharged in 1992, their use of care, and vital status within the subsequent...

  8. Finding falls in ambulatory care clinical documents using statistical text mining

    Science.gov (United States)

    McCart, James A; Berndt, Donald J; Jarman, Jay; Finch, Dezon K; Luther, Stephen L

    2013-01-01

    Objective To determine how well statistical text mining (STM) models can identify falls within clinical text associated with an ambulatory encounter. Materials and Methods 2241 patients were selected with a fall-related ICD-9-CM E-code or matched injury diagnosis code while being treated as an outpatient at one of four sites within the Veterans Health Administration. All clinical documents within a 48-h window of the recorded E-code or injury diagnosis code for each patient were obtained (n=26 010; 611 distinct document titles) and annotated for falls. Logistic regression, support vector machine, and cost-sensitive support vector machine (SVM-cost) models were trained on a stratified sample of 70% of documents from one location (dataset Atrain) and then applied to the remaining unseen documents (datasets Atest–D). Results All three STM models obtained area under the receiver operating characteristic curve (AUC) scores above 0.950 on the four test datasets (Atest–D). The SVM-cost model obtained the highest AUC scores, ranging from 0.953 to 0.978. The SVM-cost model also achieved F-measure values ranging from 0.745 to 0.853, sensitivity from 0.890 to 0.931, and specificity from 0.877 to 0.944. Discussion The STM models performed well across a large heterogeneous collection of document titles. In addition, the models also generalized across other sites, including a traditionally bilingual site that had distinctly different grammatical patterns. Conclusions The results of this study suggest STM-based models have the potential to improve surveillance of falls. Furthermore, the encouraging evidence shown here that STM is a robust technique for mining clinical documents bodes well for other surveillance-related topics. PMID:23242765

  9. 40 CFR 160.43 - Test system care facilities.

    Science.gov (United States)

    2010-07-01

    ... GOOD LABORATORY PRACTICE STANDARDS Facilities § 160.43 Test system care facilities. (a) A testing... testing facility shall have a number of animal rooms or other test system areas separate from those... sanitary storage of waste before removal from the testing facility. Disposal facilities shall be...

  10. Quality and correlates of medical record documentation in the ambulatory care setting

    OpenAIRE

    Simon Steven R; Kleinman Kenneth P; Soto Carlos M

    2002-01-01

    Abstract Background Documentation in the medical record facilitates the diagnosis and treatment of patients. Few studies have assessed the quality of outpatient medical record documentation, and to the authors' knowledge, none has conclusively determined the correlates of chart documentation. We therefore undertook the present study to measure the rates of documentation of quality of care measures in an outpatient primary care practice setting that utilizes an electronic medical record. Metho...

  11. Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy

    Directory of Open Access Journals (Sweden)

    Forastiere Francesco

    2009-12-01

    Full Text Available Abstract Background A relationship between quality of primary health care and preventable hospitalizations has been described in the US, especially among the elderly. In Europe, there has been a recent increase in the evaluation of Ambulatory Care Sensitive Conditions (ACSC as an indicator of health care quality, but evidence is still limited. The aim of this study was to determine whether income level is associated with higher hospitalization rates for ACSC in adults in a country with universal health care coverage. Methods From the hospital registries in four Italian cities (Turin, Milan, Bologna, Rome, we identified 9384 hospital admissions for six chronic conditions (diabetes, hypertension, congestive heart failure, angina pectoris, chronic obstructive pulmonary disease, and asthma among 20-64 year-olds in 2000. Case definition was based on the ICD-9-CM coding algorithm suggested by the Agency for Health Research and Quality - Prevention Quality Indicators. An area-based (census block income index was used for each individual. All hospitalization rates were directly standardised for gender and age using the Italian population. Poisson regression analysis was performed to assess the relationship between income level (quintiles and hospitalization rates (RR, 95% CI separately for the selected conditions controlling for age, gender and city of residence. Results Overall, the ACSC age-standardized rate was 26.1 per 10.000 inhabitants. All conditions showed a statistically significant socioeconomic gradient, with low income people being more likely to be hospitalized than their well off counterparts. The association was particularly strong for chronic obstructive pulmonary disease (level V low income vs. level I high income RR = 4.23 95%CI 3.37-5.31 and for congestive heart failure (RR = 3.78, 95% CI = 3.09-4.62. With the exception of asthma, males were more vulnerable to ACSC hospitalizations than females. The risks were higher among 45-64 year

  12. Hotel-based ambulatory care for complex cancer patients: a review of the University College London Hospital experience.

    Science.gov (United States)

    Sive, Jonathan; Ardeshna, Kirit M; Cheesman, Simon; le Grange, Franel; Morris, Stephen; Nicholas, Claire; Peggs, Karl; Statham, Paula; Goldstone, Anthony H

    2012-12-01

    Since 2005, University College London Hospital (UCLH) has operated a hotel-based Ambulatory Care Unit (ACU) for hematology and oncology patients requiring intensive chemotherapy regimens and hematopoietic stem cell transplants. Between January 2005 and 2011 there were 1443 patient episodes, totaling 9126 patient days, with increasing use over the 6-year period. These were predominantly for hematological malignancy (82%) and sarcoma (17%). Median length of stay was 5 days (range 1-42), varying according to treatment. Clinical review and treatment was provided in the ACU, with patients staying in a local hotel at the hospital's expense. Admission to the inpatient ward was arranged as required, and there was close liaison with the inpatient team to preempt emergency admissions. Of the 523 unscheduled admissions, 87% occurred during working hours. An ACU/hotel-based treatment model can be safely used for a wide variety of cancers and treatments, expanding hospital treatment capacity, and freeing up inpatient beds for those patients requiring them. PMID:22591143

  13. Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center

    Science.gov (United States)

    Manulik, Stanisław; Rosińczuk, Joanna; Karniej, Piotr

    2016-01-01

    Introduction Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services. Objectives The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services. Materials and methods The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected. Results All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel. Conclusion Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility.

  14. Ambulatory Diagnosis and Management of Obstructive Sleep Apnea: Screening Questionnaires, Diagnostic Tests, and the Care Team.

    Science.gov (United States)

    McEvoy, R Doug; Chai-Coetzer, Ching Li; Antic, Nick A

    2016-09-01

    Obstructive sleep apnea has increased in prevalence in recent years and despite the expansion in sleep medicine services there is a significant unmet burden of disease. This burden presents a challenge to specialists and requires a reappraisal of service delivery, including a move toward lower-cost, simplified methods of diagnosis and treatment, an expansion of the sleep apnea workforce to include suitably trained and equipped primary care physicians and nurses, and the incorporation of chronic disease management principles that link patients to relevant community resources and empower them through new technologies to engage more fully in their own care. PMID:27542873

  15. Development and Implementation of an Ambulatory Integrated Care Pathway for Major Depressive Disorder and Alcohol Dependence.

    Science.gov (United States)

    Awan, Saima; Samokhvalov, Andriy V; Aleem, Nadia; Hendershot, Christian S; Irving, Julie Anne; Kalvik, Anne; Lefebvre, Lisa; Le Foll, Bernard; Quilty, Lena; Voore, Peter

    2015-12-01

    Integrated care pathways (ICPs) provide an approach for delivering evidence-based treatment in a hospital setting. This column describes the development and pilot implementation in a clinical setting of an ICP for patients with concurrent major depressive disorder and alcohol dependence at the Centre for Addiction and Mental Health (CAMH), an academic tertiary care hospital, in Toronto, Canada. The ICP methodology includes evidence reviews, knowledge translation, process reengineering, and change management. Pilot results indicate high patient satisfaction, evidence of symptom improvement, and excellent retention. PMID:26278235

  16. Improving the quality of palliative care for ambulatory patients with lung cancer

    DEFF Research Database (Denmark)

    von Plessen, Christian; Aslaksen, Aslak

    2005-01-01

    and energy in organisational aspects of care that could be better used in direct interaction with patients. DESIGN: Quality improvement study using direct observation and run and flow charts, and focus group meetings with patients and families regarding perceptions of the clinic and with staff regarding...... satisfaction with working conditions. SETTING: Thoracic oncology outpatient clinic at a Norwegian university hospital where patients receive chemotherapy and complementary palliative care. KEY MEASURES FOR IMPROVEMENT: Waiting time and time wasted during consultations; calmer working situation at the clinic...

  17. Research on the effects of pharmacist-patient communication in institutions and ambulatory care sites, 1969-1994.

    Science.gov (United States)

    De Young, M

    1996-06-01

    Research on the effects of pharmacist-patient communication that appeared in the pharmacy literature between 1969 and 1994 is reviewed. The terms patients education and patient counseling were used in identifying relevant research. Many authors used these terms interchangeably; also, the terms counseling and consultation often were not clearly defined. Studies of pharmacists' history-taking in institutional settings and of other communication with patients in ambulatory care settings were examined by decade. The research questions, theories, methods, results, and limitations were analyzed. More than 30 studies examined the effect of pharmacists' communication on patient outcomes, primarily knowledge and medication compliance; generally, the results suggested that pharmacists' communication led to increased knowledge and compliance. A few researchers raised concerns about patients' knowledge as an indicator of effective communication by pharmacists, and in the 1980s a few suggested that better medication compliance could be associated with the time and attention given to patients rather than the informational content of the interaction. Little was reported about the communication theories or models on which the studies were based, and there was little indication in most studies that patients' ideas about their therapy were considered. Often, the numbers of patients and pharmacists were small, and the pharmacists may have had training or motivation exceeding that of the average practitioner. In studies of pharmacists' versus physicians' history-taking, the physicians were not well described; their involvement and their approach may not have been comparable to those of the pharmacists. Before 1990, a few researchers had examined outcomes such as pulmonary function and control of diabetes. In the 1990s, more researchers looked at outcomes such as medication-related problems and use of health care resources. The research indicated that pharmacists can increase patients

  18. Clinical Preventive Services for Patients at Risk for Cardiovascular Disease, National Ambulatory Medical Care Survey, 2005-2006

    Directory of Open Access Journals (Sweden)

    Paula W. Yoon, ScD, MPH

    2011-03-01

    Full Text Available IntroductionClinical preventive services can detect diseases early, when they are most treatable, but these services may not be provided as recommended. Assessing the provision of services to patients at risk for cardiovascular disease (CVD could help identify disparities and areas for improvement.MethodsWe used data on patient visits (n = 21,261 from the National Ambulatory Medical Care Survey, 2005-2006, and classified patients with hypertension, hyperlipidemia, obesity, or diabetes as being at risk for CVD. We assessed differences in the provision of preventive services offered to patients who were and who were not at risk for CVD. Further, for those at risk, we compared the demographic characteristics of those who had and who had not been offered services.ResultsPatients at risk for CVD received significantly more preventive services compared with those not at risk. For patients at risk for CVD, aspirin therapy was more likely to be recommended to those aged 65 years or older than those aged 45 to 64 years and to men than women. Cholesterol screening was more likely for men and was less likely for patients with Medicare/Medicaid or no insurance than for patients who were insured. Rates of counseling for diet and nutrition, weight reduction, and exercise were low overall, but younger patients received these services more than older patients did.ConclusionPatients at risk for CVD are not all receiving the same level of preventive care, suggesting the need to clarify clinical practice guidelines and provide clinicians with education and support for more effective lifestyle counseling.

  19. A Break-Even Analysis of Optimum Faculty Assignment for Ambulatory Primary Care Training.

    Science.gov (United States)

    Xakellis, George C.; And Others

    1996-01-01

    A computer simulation was developed to estimate the number of medical residents one or two faculty teachers could supervise in a university-based primary medical care teaching clinic. With no non-teaching tasks, it was shown that two teachers could supervise 11 residents, while one teacher was able to supervise only three residents under similar…

  20. A force field evaluation tool for telephone service in ambulatory health care.

    Science.gov (United States)

    da Silva, V L; Steinberg, B

    1991-10-01

    The tool presented here is useful in analyzing the constraints and capabilities of a health care telephone service. It also provides a systematic method for assessing systems problems. As part of our analysis, we recommended that the manager implement the following steps. First, the manager determines whether the driving force on the unit is continuity of care by an individual provider or consistency of response. This focus directly affects how the unit's telephone service can be best organized (i.e., decentralized or centralized) and clarifies the factors most needed for success. For example, to function effectively and efficiently, a centralized phone service needs strong provider-endorsed protocols. Second, the manager should carefully examine neutral constraint factors to determine methods to transform these constraints into capabilities, such as planning for extra staff or office hours (or both) during influenza season. Planning for extra hours or staff depends largely on whether budget and resource planning is done in advance and whether value is placed on customer access and satisfaction during peak demand periods. The manager must next determine whether the service delivery format (centralized or decentralized) is consistent with the force field analysis findings. If the findings are not consistent, can the analysis present a compelling argument for using the opposite approach? Finally, the manager must create a plan of action for minimizing the constraints revealed and maximizing existing capabilities to achieve the overall goal of excellent phone service. The process of analysis and creating a plan of action is an excellent opportunity to involve staff, providers, and administrators in efforts to achieve better health care telephone service for all customers. PMID:10112997

  1. 40 CFR 792.43 - Test system care facilities.

    Science.gov (United States)

    2010-07-01

    ... CONTROL ACT (CONTINUED) GOOD LABORATORY PRACTICE STANDARDS Facilities § 792.43 Test system care facilities. (a) A testing facility shall have a sufficient number of animal rooms or other test system areas, as... different tests. (b) A testing facility shall have a number of animal rooms or other test system...

  2. Uses of ambulatory health/mental health utilization data in organized health care settings.

    Science.gov (United States)

    Burns, B J; Goldberg, I D; Hankin, J; Hoeper, E W; Jacobson, A M; Regier, D A

    1982-01-01

    A follow-up assessing uses of findings from NIMH-supported research on health and mental health services utilization in organized health care settings revealed a range of applications across the study sites. The research, conducted primarily for national policy purposes, had an impact on study sites in the following areas: clinician perceptions and attitudes about mental health services provided; program directions; fiscal policy; and further related research. Research team composition and dissemination of study findings are discussed in relation to the applications made. PMID:10260970

  3. Influenza-like-illness and clinically diagnosed flu: disease burden, costs and quality of life for patients seeking ambulatory care or no professional care at all.

    Directory of Open Access Journals (Sweden)

    Joke Bilcke

    Full Text Available This is one of the first studies to (1 describe the out-of-hospital burden of influenza-like-illness (ILI and clinically diagnosed flu, also for patients not seeking professional medical care, (2 assess influential background characteristics, and (3 formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011-2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever, a longer duration of illness, more use of medication (especially antibiotics and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5-6 symptoms over a 6-day period; required 1.6 physician visits and 86-91% took medication. An average episode amounted to €51-€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries.

  4. Influenza-like-illness and clinically diagnosed flu: disease burden, costs and quality of life for patients seeking ambulatory care or no professional care at all.

    Science.gov (United States)

    Bilcke, Joke; Coenen, Samuel; Beutels, Philippe

    2014-01-01

    This is one of the first studies to (1) describe the out-of-hospital burden of influenza-like-illness (ILI) and clinically diagnosed flu, also for patients not seeking professional medical care, (2) assess influential background characteristics, and (3) formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011-2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever), a longer duration of illness, more use of medication (especially antibiotics) and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5-6 symptoms over a 6-day period; required 1.6 physician visits and 86-91% took medication. An average episode amounted to €51-€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries. PMID:25032688

  5. Influenza-Like-Illness and Clinically Diagnosed Flu: Disease Burden, Costs and Quality of Life for Patients Seeking Ambulatory Care or No Professional Care at All

    Science.gov (United States)

    Bilcke, Joke; Coenen, Samuel; Beutels, Philippe

    2014-01-01

    This is one of the first studies to (1) describe the out-of-hospital burden of influenza-like-illness (ILI) and clinically diagnosed flu, also for patients not seeking professional medical care, (2) assess influential background characteristics, and (3) formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011–2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever), a longer duration of illness, more use of medication (especially antibiotics) and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5–6 symptoms over a 6-day period; required 1.6 physician visits and 86–91% took medication. An average episode amounted to €51–€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries. PMID:25032688

  6. Overview of hospitalizations by ambulatory care sensitive conditions in the municipality of Cotia, Brazil

    Directory of Open Access Journals (Sweden)

    Renata Laszlo Torres

    2014-08-01

    Full Text Available Objective To describe the profile of Hospitalizations by Amulatory Care Sensitive Conditions (HACSC, in the Municipality of Cotia, from 2008 to 2012. Method ecological, exploratory, longitudinal study with a quantitative approach. Data on HACSC, by age group and sex, were obtained from the Department of the Unified Health System. For data analysis descriptive statistics were used. Results During the period, there were 46,676 admissions, excluding deliveries, 7,753 (16.61% by HACSC. The main causes were cerebrovascular diseases, 16.96%, heart failure, 15.50%, hypertension, 10.80% and infection of the kidney and urinary tract, 10.51%. Regarding gender, HACSC occurred predominantly in males. There was a greater number of HACSC at extreme age ranges, especially in the elderly. Conclusion Chronic diseases predominate among the leading causes of HACSC and there was no significant difference between sex.

  7. 42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient hospital services, nursing facility... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... section 1903(i)(4) of the Act and subpart H of part 456 of this chapter. (b) Nursing facility...

  8. Ambulatory electrocardiology.

    Science.gov (United States)

    Romero, Iñaki

    2013-01-01

    About 50 years ago, Norman Jefferis Holter invented a device that opened the possibility of recording heart activity over long periods of time. This invention, together with the rapid developments in electronics, has enabled a revolutionary change in the diagnosis and management of cardiac diseases. Ambulatory cardiac monitors have decreased in size to the point of becoming wearable or implantable and are able to monitor heart activity for months or even years. In addition, new telecommunication systems allow clinicians to remotely access cardiac events and to respond within a short period of time. Novel advances in computing and algorithm development are expanding the clinical applications of ambulatory devices with more complex automatic interpretation of the electrocardiographic signal. This article reviews the state of the art of these techniques from both clinical and technical approaches, covering a historic perspective up to today, and discusses current applications, challenges, and future directions. PMID:23422020

  9. 21 CFR 58.43 - Animal care facilities.

    Science.gov (United States)

    2010-04-01

    ... testing facility shall have a sufficient number of animal rooms or areas, as needed, to assure proper: (1... (4) routine or specialized housing of animals. (b) A testing facility shall have a number of animal... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Animal care facilities. 58.43 Section 58.43...

  10. Brand Name and Generic Proton Pump Inhibitor Prescriptions in the United States: Insights from the National Ambulatory Medical Care Survey (2006–2010

    Directory of Open Access Journals (Sweden)

    Andrew J. Gawron

    2015-01-01

    Full Text Available Introduction. Proton pump inhibitors (PPI are one of the most commonly prescribed medication classes with similar efficacy between brand name and generic PPI formulations. Aims. We determined demographic, clinical, and practice characteristics associated with brand name PPI prescriptions at ambulatory care visits in the United States. Methods. Observational cross sectional analysis using the National Ambulatory Medical Care Survey (NAMCS of all adult (≥18 yrs of age ambulatory care visits from 2006 to 2010. PPI prescriptions were identified by using the drug entry code as brand name only or generic available formulations. Descriptive statistics were reported in terms of unweighted patient visits and proportions of encounters with brand name PPI prescriptions. Global chi-square tests were used to compare visits with brand name PPI prescriptions versus generic PPI prescriptions for each measure. Poisson regression was used to determine the incidence rate ratio (IRR for generic versus brand PPI prescribing. Results. A PPI was prescribed at 269.7 million adult ambulatory visits, based on 9,677 unweighted visits, of which 53% were brand name only prescriptions. In 2006, 76.0% of all PPI prescriptions had a brand name only formulation compared to 31.6% of PPI prescriptions in 2010. Visits by patients aged 25–44 years had the greatest proportion of brand name PPI formulations (57.9%. Academic medical centers and physician-owned practices had the greatest proportion of visits with brand name PPI prescriptions (58.9% and 55.6% of visits with a PPI prescription, resp.. There were no significant differences in terms of median income, patient insurance type, or metropolitan status when comparing the proportion of visits with brand name versus generic PPI prescriptions. Poisson regression results showed that practice ownership type was most strongly associated with the likelihood of receiving a brand name PPI over the entire study period. Compared to

  11. Society for Ambulatory Anesthesia

    Science.gov (United States)

    ... Webinars Publications & Resources Clinical Practice Guidelines SAMBA Link Digital ... We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, encourages research ...

  12. "My Favourite Day Is Sunday": Community Perceptions of (Drug-Resistant Tuberculosis and Ambulatory Tuberculosis Care in Kara Suu District, Osh Province, Kyrgyzstan.

    Directory of Open Access Journals (Sweden)

    Doris Burtscher

    Full Text Available Kyrgyzstan is one of the 27 high multidrug-resistant tuberculosis (MDR-TB burden countries listed by the WHO. In 2012, Médecins Sans Frontières (MSF started a drug-resistant tuberculosis (DR-TB project in Kara Suu District. A qualitative study was undertaken to understand the perception of TB and DR-TB in order to improve the effectiveness and acceptance of the MSF intervention and to support advocacy strategies for an ambulatory model of care.This paper reports findings from 63 interviews with patients, caregivers, health care providers and members of communities. Data was analysed using a qualitative content analysis. Validation was ensured by triangulation and a 'thick' description of the research context, and by presenting deviant cases.Findings show that the general population interprets TB as the 'lungs having a cold' or as a 'family disease' rather than as an infectious illness. From their perspective, individuals facing poor living conditions are more likely to get TB than wealthier people. Vulnerable groups such as drug and alcohol users, homeless persons, ethnic minorities and young women face barriers in accessing health care. As also reported in other publications, TB is highly stigmatised and possible side effects of the long treatment course are seen as unbearable; therefore, people only turn to public health care quite late. Most patients prefer ambulatory treatment because of the much needed emotional support from their social environment, which positively impacts treatment concordance. Health care providers favour inpatient treatment only for a better monitoring of side effects. Health staff increasingly acknowledges the central role they play in supporting DR-TB patients, and the importance of assuming a more empathic attitude.Health promotion activities should aim at improving knowledge on TB and DR-TB, reducing stigma, and fostering the inclusion of vulnerable populations. Health seeking delays and adherence problems will

  13. Optimizing anesthesia techniques in the ambulatory setting

    NARCIS (Netherlands)

    E. Galvin

    2007-01-01

    textabstractAmbulatory surgery refers to the process of admitting patients, administering anesthesia and surgical care, and discharging patients home following an appropriate level of recovery on the same day. The word ambulatory is derived from the latin word ambulare, which means ''to walk''. This

  14. Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study

    OpenAIRE

    Brennan, Aline; Jackson, Arthur; Horgan, Mary; Bergin, Colm J; Browne, John P

    2015-01-01

    BACKGROUND: It is anticipated that demands on ambulatory HIV services will increase in coming years as a consequence of the increased life expectancy of HIV patients on highly active anti-retroviral therapy (HAART). Accurate cost data are needed to enable evidence based policy decisions be made about new models of service delivery, new technologies and new medications. METHODS: A micro-costing study was carried out in an HIV outpatient clinic in a single regional centre in the south of Irelan...

  15. The Relative Impacts of Design Effects and Multiple Imputation on Variance Estimates: A Case Study with the 2008 National Ambulatory Medical Care Survey

    Directory of Open Access Journals (Sweden)

    Lewis Taylor

    2014-03-01

    Full Text Available The National Ambulatory Medical Care Survey collects data on office-based physician care from a nationally representative, multistage sampling scheme where the ultimate unit of analysis is a patient-doctor encounter. Patient race, a commonly analyzed demographic, has been subject to a steadily increasing item nonresponse rate. In 1999, race was missing for 17 percent of cases; by 2008, that figure had risen to 33 percent. Over this entire period, single imputation has been the compensation method employed. Recent research at the National Center for Health Statistics evaluated multiply imputing race to better represent the missing-data uncertainty. Given item nonresponse rates of 30 percent or greater, we were surprised to find many estimates’ ratios of multiple-imputation to single-imputation estimated standard errors close to 1. A likely explanation is that the design effects attributable to the complex sample design largely outweigh any increase in variance attributable to missing-data uncertainty.

  16. Hospitals, care facility attribute, Published in 2006, Washoe County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Hospitals dataset, was produced all or in part from Published Reports/Deeds information as of 2006. It is described as 'care facility attribute'. Data by this...

  17. Antibiotic use and resistance in long term care facilities

    NARCIS (Netherlands)

    Buul, L.W. van; Steen, J.T. van der; Veenhuizen, R.B.; Achterberg, W.P.; Schellevis, F.G.; Essink, R.T.G.M.; Benthem, B.H. van; Natsch, S.S.; Hertogh, C.M.P.M.

    2012-01-01

    INTRODUCTION: The common occurrence of infectious diseases in nursing homes and residential care facilities may result in substantial antibiotic use, and consequently antibiotic resistance. Focusing on these settings, this article aims to provide a comprehensive overview of the literature available

  18. Access to public dental care facilities in Chandigarh

    Directory of Open Access Journals (Sweden)

    Himbala Verma

    2012-01-01

    Conclusions: Dental health care access and only limited dental facilities were available in most of the dental clinics in Chandigarh. Self-reported dental problem was low, and people ignored their dental problems.

  19. Antibiotic use and resistance in long term care facilities.

    NARCIS (Netherlands)

    Buul, L.W. van; Steen, J.T. van der; Veenhuizen, R.B.; Achterberg, W.P.; Schellevis, F.G.; Essink, R.T.G.M.; Benthem, B.H.B. van; Natsch, S.; Hertogh, C.M.P.M.

    2012-01-01

    Introduction: The common occurrence of infectious diseases in nursing homes and residential care facilities may result in substantial antibiotic use, and consequently antibiotic resistance. Focusing on these settings, this article aims to provide a comprehensive overview of the literature available

  20. EMS Stations, care facility attribute, Published in 2006, Washoe County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This EMS Stations dataset, was produced all or in part from Published Reports/Deeds information as of 2006. It is described as 'care facility attribute'. Data by...

  1. 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...

  2. 7 CFR 15b.38 - Health care facilities.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 1 2010-01-01 2010-01-01 false Health care facilities. 15b.38 Section 15b.38... ACTIVITIES RECEIVING FEDERAL FINANCIAL ASSISTANCE Other Aid, Benefits, or Services § 15b.38 Health care... material concerning waivers of rights or consent to treatment shall take such steps as are necessary...

  3. Standards for Psychological Services in Long-Term Care Facilities.

    Science.gov (United States)

    Morrow-Howell, Nancy; Lichtenberg, Peter A.; Smith, Michael; Frazer, Deborah; Molinari, Victor; Rosowsky, Erlene; Crose, Royda; Stillwell, Nick; Kramer, Nanette; Hartman-Stein, Paula; Qualls, Sara; Salamon, Michael; Duffy, Michael; Parr, Joyce; Gallagher-Thompson, Dolores

    1998-01-01

    Describes the development of standards for psychological practice in long-term care facilities. The standards, which were developed by Psychologists in Long-Term Care, address provider characteristics, methods of referral, assessment practices, treatment, and ethical issues. Offers suggestions for use of the standards. (MKA)

  4. Influenza in long-term care facilities: preventable, detectable, treatable.

    Science.gov (United States)

    Mossad, Sherif B

    2009-09-01

    Influenza in long-term care facilities is an ever more challenging problem. Vaccination of residents and health care workers is the most important preventive measure. Although vaccine efficacy has been questioned, the preponderance of data favors vaccination. Antiviral resistance complicates postexposure chemoprophylaxis and treatment. Factors that limit the choice of antiviral agents in this patient population include limited vaccine supplies and impaired dexterity and confusion in long-term care residents. PMID:19726556

  5. Why caretakers bypass Primary Health Care facilities for child care - a case from rural Tanzania

    OpenAIRE

    Kahabuka Catherine; Kvåle Gunnar; Moland Karen; Hinderaker Sven

    2011-01-01

    Abstract Background Research on health care utilization in low income countries suggests that patients frequently bypass PHC facilities in favour of higher-level hospitals - despite substantial additional time and financial costs. There are limited number of studies focusing on user's experiences at such facilities and reasons for bypassing them. This study aimed to identify factors associated with bypassing PHC facilities among caretakers seeking care for their underfive children and to expl...

  6. Winning market positioning strategies for long term care facilities.

    Science.gov (United States)

    Higgins, L F; Weinstein, K; Arndt, K

    1997-01-01

    The decision to develop an aggressive marketing strategy for its long term care facility has become a priority for the management of a one-hundred bed facility in the Rocky Mountain West. Financial success and lasting competitiveness require that the facility in question (Deer Haven) establish itself as the preferred provider of long term care for its target market. By performing a marketing communications audit, Deer Haven evaluated its present market position and created a strategy for solidifying and dramatizing this position. After an overview of present conditions in the industry, we offer a seven step process that provides practical guidance for positioning a long term care facility. We conclude by providing an example application. PMID:10179063

  7. Ambulatory and Community-Based Services

    OpenAIRE

    Thomas, Fred

    1999-01-01

    The shift in the site of service delivery from inpatient and institutional to ambulatory and community settings has been prompted by concerns over cost and the prospect for improving the quality of life. In response to these concerns, Medicare has implemented several demonstrations that emphasize ambulatory and community-based services. In this issue, articles are presented on four demonstrations, which focus on the extent to which coordinated care models reduce health care costs, and the cos...

  8. Measuring the diffusion of palliative care in long-term care facilities – a death census

    OpenAIRE

    Santos-Eggimann Brigitte; Paroz Sophie

    2009-01-01

    Abstract Background The dissemination of palliative care for patients presenting complex chronic diseases at various stages has become an important matter of public health. A death census in Swiss long-term care facilities (LTC) was set up with the aim of monitoring the frequency of selected indicators of palliative care. Methods The survey covered 150 LTC facilities (105 nursing homes and 45 home health services), each of which was asked to complete a questionnaire for every non-accidental d...

  9. Diagnosis of prostate cancer in patients with persistently elevated PSA and tumor-negative biopsy in ambulatory care. Performance of MR imaging in a multi-reader environment

    International Nuclear Information System (INIS)

    Purpose: False-negative results are obtained in approx. 20 % of prostate cancer (PCa) patients (pts) at initial systematic transrectal biopsy (Bx), in particular when digital rectal examination (DRE) or transrectal ultrasound (TRUS) is negative. The aim of this study was to assess whether MR endorectal imaging of the prostate in a multi-reader ambulatory care setting may assist in patient selection for re-biopsy. Materials and Methods: 115 consecutive pts with persistent PSA elevation, negative Bx, DRE and TRUS were examined using T2w axial and coronal and T1w axial sequences for tumor diagnosis. MR images were prospectively read as tumor-suspicious or tumor-negative by the MR radiologist on duty. Additionally, a retrospective readout of a prostate MR expert and an abdominal imaging fellowship-trained radiologist was performed to evaluate the effect of the reader's experience on tumor detection. Imaging findings were compared to the results of the repeat Bx (61 pts) or the clinical course of at least two years. Results: For the prospective reading, the sensitivity of MRI was 83 %, the specificity was 69 %, the PPV was 33 % and the NPV was 96 %. ROC analysis revealed a significantly better performance of the prostate MR imaging expert compared to the abdominal imaging radiologist (area under ROC 0.88 vs. 0.66, p < 0.001). Based on the prospective reading, a pre-test probability for PCa of 17.4 % as in our study can be reduced to 5 % when obtaining a tumor-negative result in MRI. Conclusion: MR imaging in a multi-reader ambulatory care setting assists in patient selection for re-biopsy. Reducing the post-test probability for PCa to 5 % allows for further follow-up instead of re-biopsy in MR tumor-negative patients. Specific training and experience improve tumor detection in prostate MR imaging. (orig.)

  10. Diagnosis of prostate cancer in patients with persistently elevated PSA and tumor-negative biopsy in ambulatory care. Performance of MR imaging in a multi-reader environment

    Energy Technology Data Exchange (ETDEWEB)

    Scheidler, J. [Radiologisches Zentrum Muenchen-Pasing, Muenchen (Germany); Weoeres, I.; Scharf, M.; Siebels, M. [Urologische Gemeinschaftspraxis Pasing (Germany); Brinkschmidt, C. [Gemeinschaftspraxis Pathologie, Starnberg (Germany); Zeitler, H.; Heuck, A. [Radiologisches Zentrum Muenchen (Germany); Panzer, S. [Unfallklinik Murnau (Germany). Radiologie

    2012-02-15

    Purpose: False-negative results are obtained in approx. 20 % of prostate cancer (PCa) patients (pts) at initial systematic transrectal biopsy (Bx), in particular when digital rectal examination (DRE) or transrectal ultrasound (TRUS) is negative. The aim of this study was to assess whether MR endorectal imaging of the prostate in a multi-reader ambulatory care setting may assist in patient selection for re-biopsy. Materials and Methods: 115 consecutive pts with persistent PSA elevation, negative Bx, DRE and TRUS were examined using T2w axial and coronal and T1w axial sequences for tumor diagnosis. MR images were prospectively read as tumor-suspicious or tumor-negative by the MR radiologist on duty. Additionally, a retrospective readout of a prostate MR expert and an abdominal imaging fellowship-trained radiologist was performed to evaluate the effect of the reader's experience on tumor detection. Imaging findings were compared to the results of the repeat Bx (61 pts) or the clinical course of at least two years. Results: For the prospective reading, the sensitivity of MRI was 83 %, the specificity was 69 %, the PPV was 33 % and the NPV was 96 %. ROC analysis revealed a significantly better performance of the prostate MR imaging expert compared to the abdominal imaging radiologist (area under ROC 0.88 vs. 0.66, p < 0.001). Based on the prospective reading, a pre-test probability for PCa of 17.4 % as in our study can be reduced to 5 % when obtaining a tumor-negative result in MRI. Conclusion: MR imaging in a multi-reader ambulatory care setting assists in patient selection for re-biopsy. Reducing the post-test probability for PCa to 5 % allows for further follow-up instead of re-biopsy in MR tumor-negative patients. Specific training and experience improve tumor detection in prostate MR imaging. (orig.)

  11. Sound & Vibration 20 Design Guidelines for Health Care Facilities

    CERN Document Server

    Tocci, Gregory; Cavanaugh, William

    2013-01-01

    Sound, vibration, noise and privacy have significant impacts on health and performance. As a result, they are recognized as essential components of effective health care environments. However, acoustics has only recently become a prominent consideration in the design, construction, and operation of healthcare facilities owing to the absence, prior to 2010, of clear and objective guidance based on research and best practices. Sound & Vibration 2.0 is the first publication to comprehensively address this need. Sound & Vibration 2.0 is the sole reference standard for acoustics in health care facilities and is recognized by: the 2010 FGI Guidelines for the Design and Construction of Health Care Facilities (used in 60 countries); the US Green Building Council’s LEED for Health Care (used in 87 countries); The Green Guide for Health Care V2.2; and the International Code Council (2011). Sound & Vibration 2.0 was commissioned by the Facility Guidelines Institute in 2005, written by the Health Care Acous...

  12. Strategic Facilities Planning: A Focus On Health Care

    Directory of Open Access Journals (Sweden)

    Ellen D. Hoadley

    2011-01-01

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

  13. Processo de cuidar do idoso em Diálise Peritoneal Ambulatorial Contínua no domicílio Proceso de cuidar del anciano, que hace Diálisis Peritoneal Ambulatorial Contínua en el domicilio Home care for the elderly undergoing Continuous Ambulatory Peritoneal Dialysis

    Directory of Open Access Journals (Sweden)

    Daniele Favaro Ribeiro

    2009-12-01

    DPAC.Objectives: To describe the elders with end stage renal disease (ESRD undergoing continuous ambulatory peritoneal dialysis (CAPD, their caregivers, and the care the caregivers provide to the elders. Methods: This was a qualitative study with 9 caregivers. Data were collected through oral history. Data analysis consisted of thematic content analysis. Results: The sample consisted of 5 male and 4 female elders and all them were dependent on caregivers to change the dialysis collection bag. The mean age of the participants was 70 years. Among the caregivers, 8 of them were female with a mean age of 41.5 years and they provided 8 hours of care to the elders daily. The main theme emerging from the content analysis was "home care for the elderly undergoing continuous ambulatory peritoneal dialysis." Conclusion: Caregivers need support for the development of knowledge and skills to deal with the elders' demand of care, particularly in regard to the management of CAPD.

  14. Why caretakers bypass Primary Health Care facilities for child care - a case from rural Tanzania

    Directory of Open Access Journals (Sweden)

    Kahabuka Catherine

    2011-11-01

    Full Text Available Abstract Background Research on health care utilization in low income countries suggests that patients frequently bypass PHC facilities in favour of higher-level hospitals - despite substantial additional time and financial costs. There are limited number of studies focusing on user's experiences at such facilities and reasons for bypassing them. This study aimed to identify factors associated with bypassing PHC facilities among caretakers seeking care for their underfive children and to explore experiences at such facilities among those who utilize them. Methods The study employed a mixed-method approach consisting of an interviewer administered questionnaires and in-depth interviews among selected care-takers seeking care for their underfive children at Korogwe and Muheza district hospitals in north-eastern Tanzania. Results The questionnaire survey included 560 caretakers. Of these 30 in-depth interviews were conducted. Fifty nine percent (206/348 of caretakers had not utilized their nearer PHC facilities during the index child's sickness episode. The reasons given for bypassing PHC facilities were lack of possibilities for diagnostic facilities (42.2%, lack of drugs (15.5%, closed health facility (10.2%, poor services (9.7% and lack of skilled health workers (3.4%. In a regression model, the frequency of bypassing a PHC facility for child care increased significantly with decreasing travel time to the district hospital, shorter duration of symptoms and low disease severity. Findings from the in-depth interviews revealed how the lack of quality services at PHC facilities caused delays in accessing appropriate care and how the experiences of inadequate care caused users to lose trust in them. Conclusion The observation that people are willing to travel long distances to get better quality services calls for health policies that prioritize quality of care before quantity. In a situation with limited resources, utilizing available resources to

  15. Urgent Care Facilities, Trauma Care Facilities - name, address, certification level, contact info, email address, Published in 2007, Iowa Dept. of Public Health.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Urgent Care Facilities dataset, was produced all or in part from Published Reports/Deeds information as of 2007. It is described as 'Trauma Care Facilities -...

  16. Facility charter and quality of care for board and care residents.

    Science.gov (United States)

    Castle, Nicholas G

    2004-01-01

    In this investigation structure, process, and outcome measures of quality in for-profit and not-for-profit board and care homes are compared. We find one structural measure (providing nursing care), three process measures (food quality, staff treat residents with respect, and staff verbally abuse residents), and two outcomes measures (cleanliness of the facility and complaints to Ombudsman) to be significant. Moreover, the directions of these effects are all consistent, with for-profit facilities rated more poorly that not-for-profit facilities. These results are discussed emphasizing their implications for efficient and effective resident care.

  17. Ambulatory spine surgery: a survey study.

    Science.gov (United States)

    Baird, Evan O; Brietzke, Sasha C; Weinberg, Alan D; McAnany, Steven J; Qureshi, Sheeraz A; Cho, Samuel K; Hecht, Andrew C

    2014-08-01

    Study Design Cross-sectional study. Objective To assess the current practices of spine surgeons performing ambulatory surgery in the United States. Methods An electronic survey was distributed to members of the International Society for the Advancement of Spine Surgery. Data were initially examined in a univariate manner; variables with a p value ambulatory spine surgery, and 49.1% were investors in an ambulatory surgery center. Surgeon investors in ambulatory surgery centers were more likely to perform procedures of increased complexity than noninvestors, though limited data precluded a statistical correlation. Surgeons in private practice were more likely to perform ambulatory surgery (94.3%; p = 0.0176), and nonacademic surgeons were both more likely to invest in ambulatory surgery centers (p = 0.0024) and perform surgery at least part of the time in a surgery center (p = 0.0039). Conclusions Though the numbers were too few to calculate statistical significance, there was a trend toward the performance of high-risk procedures on an ambulatory basis being undertaken by those with investment status in an ambulatory center. It is possible that this plays a role in the decision to perform these procedures in this setting versus that of a hospital, where a patient may have better access to care should a complication arise requiring emergent assessment and treatment by a physician. This decision should divest itself of financial incentives and focus entirely on patient safety.

  18. Managing facility risk: external threats and health care organizations.

    Science.gov (United States)

    Reid, Daniel J; Reid, William H

    2014-01-01

    Clinicians and clinical administrators should have a basic understanding of physical and financial risk to mental health facilities related to external physical threat, including actions usually viewed as "terrorism" and much more common sources of violence. This article refers to threats from mentally ill persons and those acting out of bizarre or misguided "revenge," extortionists and other outright criminals, and perpetrators usually identified as domestic or international terrorists. The principles apply both to relatively small and contained acts (such as a patient or ex-patient attacking a staff member) and to much larger events (such as bombings and armed attack), and are relevant to facilities both within and outside the U.S. Patient care and accessibility to mental health services rest not only on clinical skills, but also on a place to practice them and an organized system supported by staff, physical facilities, and funding. Clinicians who have some familiarity with the non-clinical requirements for care are in a position to support non-clinical staff in preventing care from being interrupted by external threats or events such as terrorist activity, and/or to serve at the interface of facility operations and direct clinical care. Readers should note that this article is an introduction to the topic and cannot address all local, state and national standards for hospital safety, or insurance providers' individual facility requirements. PMID:24733720

  19. Assisted Living Facilities, Licensed Health Care Facilities - long term care facility type identified in attributes, Published in 2007, Iowa Dept. of Public Health.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Assisted Living Facilities dataset, was produced all or in part from Published Reports/Deeds information as of 2007. It is described as 'Licensed Health Care...

  20. Antimicrobial use in long-term-care facilities

    NARCIS (Netherlands)

    Nicolle, LE; Bentley, DW; Garibaldi, R; Neuhaus, EG; Smith, PW

    2000-01-01

    There is intense antimicrobial use in long-term-care facilities (LTCFs), and studies repeatedly document that much of this use is inappropriate. The current crisis in antimicrobial resistance, which encompasses the LTCF, heightens concerns of antimicrobial use. Attempts to improve antimicrobial use

  1. Housekeeper in Health Care Facilities. Student Manual [and] Instructor Key.

    Science.gov (United States)

    Scott, Jane

    This packet contains a student manual and instructor key for a course in housekeeping for health care facilities in secondary health occupations programs. The student manual is divided into six units: (1) introduction to housekeeping; (2) interpersonal relations; (3) infection control and safety; (4) general cleaning procedures; (5) cleaning areas…

  2. Household health care facility utilization in the Philippines.

    Science.gov (United States)

    Russo, G; Herrin, A N; Pons, M C

    This paper presents probit estimates of household utilization of health care facilities in the Philippines. Using household data from the 1987 National Health Survey and supply data from the Department of Health, separate probit equations are estimated for each of the four major types of facilities in the Philippines: Public hospitals, private hospitals, major rural health units and barangay (village) health stations. The probability that a household will utilize services from these facilities is estimated as a function of socioeconomic, demographic and supply variables. The results indicate substantial differences in utilization patterns by income class. Households in the highest income quartile are approximately twice as likely (0.451 versus 0.236) to utilize private hospital services vis-à-vis households in the lowest income quartile, ceteris paribus. The results also indicate substantial substitution between public and private services. An increase in the availability of private hospital beds significantly reduces the probability that a household will utilize government facilities. PMID:10050192

  3. A record review of reported musculoskeletal pain in an Ontario long term care facility

    Directory of Open Access Journals (Sweden)

    Humphreys B Kim

    2006-03-01

    Full Text Available Abstract Background Musculoskeletal (MSK pain is one of the leading causes of chronic health problems in people over 65 years of age. Studies suggest that a high prevalence of older adults suffer from MSK pain (65% to 80% and back pain (36% to 40%. The objectives of this study were: 1. To investigate the period prevalence of MSK pain and associated subgroups in residents of a long-term care (LTC facility. 2. To describe clinical features associated with back pain in this population. 3. To identify associations between variables such as age, gender, cognitive status, ambulatory status, analgesic use, osteoporosis and osteoarthritis with back pain in a long-term care facility. Methods A retrospective chart review was conducted using a purposive sampling approach of residents' clinical charts from a LTC home in Toronto, Canada. All medical records for LTC residents from January 2003 until March 2005 were eligible for review. However, facility admissions of less than 6 months were excluded from the study to allow for an adequate time period for patient medical assessments and pain reporting/charting to have been completed. Clinical data was abstracted on a standardized form. Variables were chosen based on the literature and their suggested association with back pain and analyzed via multivariate logistic regression. Results 140 (56% charts were selected and reviewed. Sixty-nine percent of the selected residents were female with an average age of 83.7 years (51–101. Residents in the sample had a period pain prevalence of 64% (n = 89 with a 40% prevalence (n = 55 of MSK pain. Of those with a charted report of pain, 6% (n = 5 had head pain, 2% (n = 2 neck pain, 21% (n = 19 back pain, 33% (n = 29 extremity pain and 38% (n = 34 had non-descriptive/unidentified pain complaint. A multivariate logistic regression analysis revealed that osteoporosis was the only significant association with back pain from the variables studied (P = 0.001. Conclusion

  4. Natural course of care dependency in residents of long-term care facilities: prospective follow-up study

    OpenAIRE

    Caljouw, Monique AA; Cools, Herman JM; Gussekloo, Jacobijn

    2014-01-01

    Background Insight in the natural course of care dependency of vulnerable older persons in long-term care facilities (LTCF) is essential to organize and optimize individual tailored care. We examined changes in care dependency in LTCF residents over two 6-month periods, explored the possible predictive factors of change and the effect of care dependency on mortality. Methods A prospective follow-up study in 21 Dutch long-term care facilities. 890 LTCF residents, median age 84 (Interquartile r...

  5. Nonlicensed employee turnover in a long-term care facility.

    Science.gov (United States)

    Gaddy, T; Bechtel, G A

    1995-06-01

    The purpose of this study was to analyze nonlicensed employee turnover in a long-term care facility using Maslow's hierarchy of needs as a framework. During exit interviews, a convenience sample of 34 employees completed an attitudes and beliefs survey regarding their work environment. Findings were mixed; 39.6 percent of the employees stated positive personal relationships were a strength of the organization, although 24.3 percent resigned because of personal/staff conflicts. Financial concerns were not a major factor in their resignations. The study suggests that decreasing nonlicensed employee stress and increasing their personal satisfaction with patient care may decrease employee turnover.

  6. Management considerations in the care of elderly heart failure patients in long-term care facilities.

    Science.gov (United States)

    Heckman, George A; Boscart, Veronique M; McKelvie, Robert S

    2014-07-01

    Heart failure, a condition that affects up to 20% of older persons residing in long-term care facilities, is an important cause of morbidity, health service utilization and death. Effective and interprofessional heart failure care processes could potentially improve care, outcomes and quality of life and delay decline or hospital admission. This article reviews the clinical aspects of heart failure, and the challenges to the diagnosis and management of this condition in long-term care residents who are frail and are affected by multiple comorbidities.

  7. Antibiotic use and resistance in long term care facilities.

    OpenAIRE

    Buul, L.W. van; Steen, J.T. van der; Veenhuizen, R.B.; Achterberg, W.P.; Schellevis, F.G.; Essink, R.T.G.M.; Benthem, B.H.B. van; Natsch, S.; Hertogh, C.M.P.M.

    2012-01-01

    Introduction: The common occurrence of infectious diseases in nursing homes and residential care facilities may result in substantial antibiotic use, and consequently antibiotic resistance. Focusing on these settings, this article aims to provide a comprehensive overview of the literature available on antibiotic use, antibiotic resistance, and strategies to reduce antibiotic resistance. Methods: Relevant literature was identified by conducting a systematic search in the MEDLINE and EMBASE dat...

  8. The 'wise list'- a comprehensive concept to select, communicate and achieve adherence to recommendations of essential drugs in ambulatory care in Stockholm.

    Science.gov (United States)

    Gustafsson, Lars L; Wettermark, Björn; Godman, Brian; Andersén-Karlsson, Eva; Bergman, Ulf; Hasselström, Jan; Hensjö, Lars-Olof; Hjemdahl, Paul; Jägre, Ingrid; Julander, Margaretha; Ringertz, Bo; Schmidt, Daniel; Sjöberg, Susan; Sjöqvist, Folke; Stiller, Carl-Olav; Törnqvist, Elisabeth; Tryselius, Rolf; Vitols, Sigurd; von Bahr, Christer

    2011-04-01

    The aim was to present and evaluate the impact of a comprehensive strategy over 10 years to select, communicate and achieve adherence to essential drug recommendations (EDR) in ambulatory care in a metropolitan healthcare region. EDRs were issued and launched as a 'Wise List' by the regional Drug and Therapeutics Committee in Stockholm. This study presents the concept by: (i) documenting the process for selecting, communicating and monitoring the impact of the 'Wise List'; (ii) analysing the variation in the number of drug substances recommended between 2000 and 2010; (iii) assessing the attitudes to the 'Wise List' among prescribers and the public; (iv) evaluating the adherence to recommendations between 2003 and 2009. The 'Wise List' consistently contained 200 drug substances for treating common diseases. The drugs were selected based on their efficacy, safety, suitability and cost-effectiveness. The 'Wise List' was known among one-third of a surveyed sample of the public in 2002 after initial marketing campaigns. All surveyed prescribers knew about the concept and 81% found the recommendations trustworthy in 2005. Adherence to recommendations increased from 69% in 1999 to 77% in 2009. In primary care, adherence increased from 83% to 87% from 2003 to 2009. The coefficient of variation (CV%) decreased from 6.1% to 3.8% for 156 healthcare centres between these years. The acceptance of the 'Wise List' in terms of trust among physicians and among the public and increased adherence may be explained by clear criteria for drug recommendations, a comprehensive communication strategy, electronic access to recommendations, continuous medical education and involvement of professional networks and patients.

  9. Ambulatory surgery center market share and rates of outpatient surgery in the elderly.

    Science.gov (United States)

    Hollenbeck, Brent K; Hollingsworth, John M; Dunn, Rodney L; Zaojun Ye; Birkmeyer, John D

    2010-12-01

    Relative to outpatient surgery in hospital settings, ambulatory surgery centers (ASCs) are more efficient and associated with a lower cost per case. However, these facilities may also spur higher overall procedure utilization and thus lead to greater overall health care costs. The authors used the State Ambulatory Surgery Database from the State of Florida to identify Medicare-aged patients undergoing 4 common ambulatory procedures in 2006, including knee arthroscopy, cystoscopy, cataract removal, and colonoscopy. Hospital service areas (HSAs) were characterized according to ASC market share, that is, the proportion of residents undergoing outpatient surgery in these facilities. The authors then examined relationships between ASC market share and rates of each procedure. Age-adjusted rates of ambulatory surgery ranged from 190.5 cases per 1000 to 320.8 cases per 1000 in HSAs with low and high ASC market shares, respectively (P < .01). For all 4 procedures, adjusted rates of procedures were significantly higher in HSAs with the highest ASC market share. The greatest difference, both in relative and absolute terms, was observed for patients undergoing cystoscopy. In areas of high ASC market share, the age-adjusted rate of cystoscopy was nearly 3-fold higher than in areas with low ASC market share (34.5 vs 11.9 per 1000 population; P < .01). The presence of an ASC is associated with higher utilization of common outpatient procedures in the elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear.

  10. Atención médica ambulatoria en México: el costo para los usuarios Ambulatory medical care in Mexico: the cost for users

    Directory of Open Access Journals (Sweden)

    Armando Arredondo

    1999-01-01

    Full Text Available Objetivo. Analizar los resultados de la Encuesta Nacional de Salud II (ENSA-II, en lo relativo a los costos del proceso de búsqueda y obtención de la atención médica ambulatoria en diferentes instituciones del sector público y privado. Material y métodos. La informacion se obtuvo a partir de los indicadores de costos de la atención médica que notificó la población de estudio de la ENSA-II. Los costos para el bolsillo del consumidor fueron la variable dependiente, y las independientes, la condición de aseguramiento y el ingreso económico. La significancia de los niveles de variación se identificó aplicando la prueba de Duncan. Resultados. Los costos en todo el país, en dólares estadunidenses, fueron: transporte, $ 2.20; consulta general, $ 7.90; medicamentos, $ 9.60, y estudios de diagnóstico, $13.6. El costo promedio total de la atención ambulatoria fue de $ 22.70. Los hallazgos empíricos permiten sugerir una nueva propuesta de análisis de los costos en salud, tanto directos como indirectos, en que incurren los consumidores de servicios de salud; dichos costos representan una carga importante en relación con el ingreso familiar, situación que se agudiza en el caso de la población no asegurada. Conclusiones. La incorporación de la perspectiva económica en el análisis de los problemas de los sistemas de salud, no debe limitarse a los costos de producción de servicios en que incurren los proveedores, sobre todo si lo que se busca es resolver los problemas de equidad y accesibilidad que actualmente caracterizan a la oferta de servicios médicos en México.Objective. To analyze the results of the National Health Survey (ENSA-II as to the costs generated by the search and obtainment of ambulatory medical attention in various intitutions of the private and public health sector. Material and methods. Information was raised from the health care cost indicators reported by the study population of the ENSA-II. The dependent

  11. Degree of Ambulatory Disability: Effects on Rural Siblings' Social Development.

    Science.gov (United States)

    Chamberlain, Theresa Nowak; Ross-Reynolds, Jane

    1993-01-01

    Interviews with 22 mothers of children with ambulatory disability and 33 nondisabled siblings showed no differences in sibling's child care responsibilities, general home responsibilities, or independence related to severity of the ambulatory disability. A difference in the amount of social activity, reported by mothers, was not confirmed by…

  12. Factors influencing oral health in long term care facilities.

    Science.gov (United States)

    MacEntee, M I; Weiss, R; Waxler-Morrison, N E; Morrison, B J

    1987-12-01

    In a stratified random sample of 41 long term care (LTC) facilities in Vancouver, 653 residents were chosen to investigate oral health needs and demands for treatment. All of the 603 dentists in the same area were questioned to assess their interest in attending the residents of the institutions. The information from each source was reviewed to identify factors influencing the oral health services to this predominantly elderly and medically compromised population. The majority (60%) of the residents were edentulous and they made infrequent demands on dentists. Two-thirds of those interviewed said that there was nothing wrong with their mouths, but most of those who were aware of a problem wanted it treated, preferably within the institution. They complained about loose or uncomfortable dentures most frequently, and many were dissatisfied with previous dental treatment. The oral mucosal lesions seen on examination were usually symptomless and associated with poor hygiene, while structurally defective dentures and deep carious lesions were not uncommon. The responding 334 dentists indicated that they enjoyed treating elderly patients, 19% had attended an LTC facility, usually to provide an emergency service, and 37% were willing to provide this service if asked. Interest, however, in the service was curtailed by pressures from private practice, concerns about inadequate training and the small demand and poor conditions in the facilities. Although the demand for treatment was not extensive from the residents, they did have problems that were not receiving care. PMID:3121247

  13. Measuring the diffusion of palliative care in long-term care facilities – a death census

    Directory of Open Access Journals (Sweden)

    Santos-Eggimann Brigitte

    2009-01-01

    Full Text Available Abstract Background The dissemination of palliative care for patients presenting complex chronic diseases at various stages has become an important matter of public health. A death census in Swiss long-term care facilities (LTC was set up with the aim of monitoring the frequency of selected indicators of palliative care. Methods The survey covered 150 LTC facilities (105 nursing homes and 45 home health services, each of which was asked to complete a questionnaire for every non-accidental death over a period of six months. The frequency of 4 selected indicators of palliative care (resort to a specialized palliative care service, the administration of opiates, use of any pain measurement scale or other symptom measurement scale was monitored in respect of the stages of care and analysed based on gender, age, medical condition and place of residence. Results Overall, 1200 deaths were reported, 29.1% of which were related to cancer. The frequencies of each indicator varied according to the type of LTC, mostly regarding the administration of opiate. It appeared that the access to palliative care remained associated with cancer, terminal care and partly with age, whereas gender and the presence of mental disorders had no effect on the indicators. In addition, the use of drugs was much more frequent than the other indicators. Conclusion The profile of patients with access to palliative care must become more diversified. Among other recommendations, equal access to opiates in nursing homes and in home health services, palliative care at an earlier stage and the systematic use of symptom management scales when resorting to opiates have to become of prime concern.

  14. Effect of Comorbid Depression on Outcomes in Diabetes and Its Relationship to Quality of Care and Patient Adherence: A Statewide Primary Care Ambulatory Research and Resources Consortium Study

    OpenAIRE

    Katerndahl, David; Calmbach, Walter L.; Becho, Johanna

    2012-01-01

    Objective: To determine whether current depression was associated with poorer quality of care and poorer patient adherence to treatment regimens and whether current depression was associated with patient diabetes outcomes independent of its relationships to quality of care and patient adherence among patients with diabetes.

  15. Awareness and use of Benzodiazepines in healthy volunteers and ambulatory patients visiting a tertiary care hospital: a cross sectional survey.

    Directory of Open Access Journals (Sweden)

    Mustafa Raoof

    Full Text Available BACKGROUND: Indiscriminate prescription of Benzodiazepines in Pakistan and subsequent availability over-the-counter without prescription is a major public health problem, requiring systematic inquiry through research. Additionally, there is limited data on the awareness and use of Benzodiazepines from developing countries making it impossible to devise meaningful health policies. METHODOLOGY/PRINCIPAL FINDINGS: This was an Observational, Cross-Sectional study. conducted at Aga Khan University. A total of 475 (58.5% males, 41.5% females people visiting a tertiary care hospital were interviewed by means of a structured questionnaire. The results showed that majority of population was aware of one or more Benzodiazepines (80.4% and 30.4% had used them at some point in life. 42.4% of the users had been using it for more than a year. Commonest reason for use was sleep disturbance. Frequency of usage was higher for females, married individuals, educated (>Grade12, high socioeconomic status and housewives. More (59% were prescribed than not and of them most by GP (58.5%. Only 36.5% of them were particularly told about the long-term addiction potential by the use of these drugs. CONCLUSION: Easy availability, access to re-fills without prescription and self prescription compounded with the lack of understanding of abuse potential of benzodiazepines constitutes a significant problem demanding serious consideration from health policy makers.

  16. Caring for patients with chronic kidney disease: a joint opinion of the ambulatory care and the nephrology practice and research networks of the American College of Clinical Pharmacy.

    Science.gov (United States)

    Zillich, Alan J; Saseen, Joseph J; Dehart, Renee M; Dumo, Peter; Grabe, Darren W; Gilmartin, Cheryl; Hachey, David M; Hudson, Joanna Q; Pruchnicki, Maria C; Joy, Melanie S

    2005-01-01

    An increasing number of patients are developing chronic kidney disease (CKD). Appropriate care for patients with CKD must occur in the earliest stages, preferably before CKD progresses to more severe stages. Therefore, recognition and treatment of CKD and its associated complications must occur in primary care settings. Patients with CKD often have comorbid conditions such as diabetes mellitus, hypertension, and dyslipidemia, creating specific considerations when treating these diseases. Also, these patients have CKD-related conditions, including anemia and renal osteodystrophy, that are not traditionally evaluated and monitored by the primary care practitioner. Collectively, many opportunities exist for pharmacists who practice in the primary care setting to improve the care of patients with CKD. PMID:15767229

  17. Systematic care for caregivers of people with dementia in the ambulatory mental health service: designing a multicentre, cluster, randomized, controlled trial

    Directory of Open Access Journals (Sweden)

    Adang Eddy

    2009-06-01

    Full Text Available Abstract Background Care for people with dementia and their informal caregivers is a challenging aim in healthcare. There is an urgent need for cost-effective support programs that prevent informal caregivers of people with dementia from becoming overburdened, which might result in a delay or decrease of patient institutionalization. For this reason, we have developed the Systematic Care Program for Dementia (SCPD. The SCPD consists of an assessment of caregiver's sense of competence and suggestions on how to deal with competence deficiencies. The efficiency of the SCPD will be evaluated in our study. Methods and design In our ongoing, cluster, randomized, single-blind, controlled trial, the participants in six mental health services in four regions of the Netherlands have been randomized per service. Professionals of the ambulatory mental health services (psychologists and social psychiatric nurses have been randomly allocated to either the intervention group or the control group. The study population consists of community-dwelling people with dementia and their informal caregivers (patient-caregiver dyads coming into the health service. The dyads have been clustered to the professionals. The primary outcome measure is the patient's admission to a nursing home or home for the elderly at 12 months of follow-up. This measure is the most important variable for estimating cost differences between the intervention group and the control group. The secondary outcome measure is the quality of the patient's and caregiver's lives. Discussion A novelty in the SCPD is the pro-active and systematic approach. The focus on the caregiver's sense of competence is relevant to economical healthcare, since this sense of competence is an important determinant of delay of institutionalization of people with dementia. The SCPD might be able to facilitate this with a relatively small cost investment for caregivers' support, which could result in a major decrease in

  18. Nontraumatic dental condition-related visits to emergency departments on weekdays, weekends and night hours: findings from the National Hospital Ambulatory Medical Care Survey

    Directory of Open Access Journals (Sweden)

    Okunseri C

    2013-09-01

    Full Text Available Christopher Okunseri,1 Elaye Okunseri,1 Melissa Christine Fischer,1 Saba Noori Sadeghi,1 Qun Xiang,2 Aniko Szabo21Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA; 2Division of Biostatistics, Institute of Health and Society, Medical College of Wisconsin, Milwaukee, WI, USAObjective: To determine whether the rates of nontraumatic dental condition (NTDC-related emergency department (ED visits are higher during the typical working hours of dental offices and lower during night hours, as well as the associated factors.Methods: We analyzed data from the National Hospital Ambulatory Medical Care Survey for 1997 through 2007 using multivariate binary and polytomous logistic regression adjusted for survey design to determine the effect of predictors on specified outcome variables.Results: Overall, 4,726 observations representing 16.4 million NTDC-related ED visits were identified. Significant differences in rates of NTDC-related ED visits were observed with 40%–50% higher rates during non-working hours and 20% higher rates on weekends than the overall average rate of 170 visits per hour. Compared with 19–33 year olds, subjects <18 years old had significantly higher relative rates of NTDC-related ED visits during nonworking hours [relative rate ratio (RRR = 1.6 to 1.8], whereas those aged 73 and older had lower relative rates during nonworking hours (RRR = 0.4; overall P = 0.0005. Compared with those having private insurance, Medicaid and self-pay patients had significantly lower relative rates of NTDC visits during nonworking and night hours (RRR = 0.6 to 0.7, overall P < 0.0003. Patients with a dental reason for visit were overrepresented during the night hours (RRR = 1.3; overall P = 0.04.Conclusion: NTDC-related visits to ED occurred at a higher rate during non-working hours and on weekends and were significantly associated with age, patient-stated reason for visit and payer type.Keywords: dental

  19. Ambulatory patient classifications and the regressive nature of medicare reform: is the reduction in outpatient health care reimbursement worth the price?

    International Nuclear Information System (INIS)

    Purpose: To evaluate the impact of the proposed Ambulatory Patient Classification (APC) system on reimbursement for hospital outpatient Medicare procedures at the Massachusetts General Hospital (MGH) Department of Radiation Oncology. Methods and Materials: Treatment and cost data for the MGH Department of Radiation Oncology for the fiscal year 1997 were analyzed. This represented 66,981 technical procedures and 41 CPT-4 codes. The cost of each procedure was calculated by allocating departmental costs to the relative value units (RVUs) for each procedure according to accepted accounting principles. Net reimbursement for each CPT-4 procedure was then calculated by subtracting its cost from the allowed 1998 Boston area Medicare reimbursement or from the proposed Boston area APC reimbursement. The impact of the proposed APC reimbursement system on changes in reimbursement per procedure and on volume-adjusted changes in overall net reimbursements per procedure was determined. Results: Although the overall effect of APCs on volume-adjusted net reimbursements for Medicare patients was projected to be budget-neutral, treatment planning revenues would have decreased by 514% and treatment delivery revenues would have increased by 151%. Net reimbursements for less complicated courses of treatment would have increased while those for treatment courses requiring more complicated or more frequent treatment planning would have decreased. Net reimbursements for a typical prostate interstitial implant and a three-treatment high-dose-rate intracavitary application would have decreased by 481% and 632%, respectively. Conclusion: The financial incentives designed into the proposed APC reimbursement structure could lead to compromises in currently accepted standards of care, and may make it increasingly difficult for academic institutions to continue to fulfill their missions of research and service to their communities. The ability of many smaller, low patient volume, high Medicare

  20. Pneumonia in older residents of long-term care facilities.

    Science.gov (United States)

    Furman, Christian Davis; Rayner, Abi V; Tobin, Elisabeth Pelcher

    2004-10-15

    Compared with community-dwelling persons, residents in long-term care facilities have more functional disabilities and underlying medical illnesses and are at increased risk of acquiring infectious diseases. Pneumonia is the leading cause of morbidity and mortality in this group. Risk factors include unwitnessed aspiration, sedative medication, and comorbidity. Recognition may be delayed because, in this population, pneumonia often presents without fever, cough, or dyspnea. Accurate identification of the etiologic agent is hampered because most patients cannot produce a suitable sputum specimen. It is difficult to distinguish colonization from infection. Colonization by Staphylococcus aureus and gram-negative organisms can result from aspiration of oral or gastric contents, which could lead to pneumonia. Aspiration of gastric contents also can produce aspiration pneumonitis. This condition is not infectious initially and may resolve without antibiotics. Antibiotics for the treatment of pneumonia should cover Streptococcus pneumoniae, Haemophilus influenzae, gram-negative rods, and S. aureus. Acceptable choices include quinolones or an extended-spectrum beta-lactam plus a macrolide. Treatment should last 10 to 14 days. Pneumonia is associated with significant mortality for up to two years. Dementia is related independently to the death rate within the first week after pneumonia, regardless of treatment. Prevention strategies include vaccination against S. pneumoniae and influenza on admission to the care facility. This article focuses on recent recommendations for the recognition of respiratory symptoms and criteria for the designation of probable pneumonia, and provides a guide to hospitalization, antibiotic use, and prevention.

  1. Improving patient satisfaction with ambulatory surgical care through quality control circle activities%开展品管圈活动提升门诊手术患者满意度

    Institute of Scientific and Technical Information of China (English)

    张健; 白晓霞

    2013-01-01

    Objective To explore the effect of quality control circle (QCC) activities on patient satisfaction with ambulatory surgical care.Methods The operating room nursing staff formed a QCC,delved into problems affecting patient satisfaction with ambulatory surgical care,and formulated solutions to the problems through brainstorming.They put forward improvement schemes and put them into practice.Results Patient overall satisfaction with ambulatory surgical care increased from (6.80 ± 0.57) points before QCC activities to (7.41±0.44) points after the activities,with significant difference found in the scores (P<0.01).Nurses' consciousness in participating nursing management,and job satisfaction were enhanced,and staff's enthusiasm,creativity,and initiative were fully exercised.Conclusion QCC activities help improve quality of ambulatory surgical care and patient satisfaction.%目的 探讨品管圈活动用于提升门诊手术患者满意度的效果.方法 由手术室一线护理人员组成品管圈小组,通过脑力激荡,讨论分析门诊手术患者满意度不高的原因,制订相应的整改措施并组织实施.结果 门诊手术患者总体满意度由活动前(6.80±0.57)分提高到活动后的(7.41±0.44)分,效果显著(P<0.01);护理人员参与护理管理的意识和工作满足感增强,护理人员的积极性、创造性、主动性得到充分发挥.结论 品管圈活动的开展,有利于提高门诊手术服务质量、提升门诊手术患者满意度.

  2. Cost of ambulatory care by mobile health clinic run by a Medical College in India for the year 2008-09

    Directory of Open Access Journals (Sweden)

    Aslesh Prabhakaran

    2014-01-01

    Full Text Available Background: The feasibility of using mobile health clinics (MHCs to deliver health services in urban poor areas has to be explored as the health needs of the residents are not sufficiently addressed by the existing primary health care delivery system in India. Objective: To estimate the cost of providing primary health care services and the out of pocket expenditure (OOPE incurred, while utilizing these services provided through the MHC based Urban Health Program of a Medical College in North India for the year 2008-2009. Materials and Methods: A cross-sectional study to estimate OOPE was conducted among 330 subjects selected from patients attending the mobile health care facility. For estimation of provider cost, 5 steps process involving identification of cost centres, measurement of inputs, valuing of inputs, assigning of inputs to cost centers, and estimation of unit cost were carried out. Results: Total annual cost of providing services under Urban Health Program in the year 2008-2009 was Rs. 7,691,943 Unit cost of providing outpatient curative care, antenatal care, and immunization were Rs. 107.74/visit, Rs. 388/visit and Rs. 66.14 per immunization, respectively. The mean OOPE incurred was Rs. 29.50/visit, while utilizing outpatient curative services and Rs. 88.70/visit for antenatal services. Conclusion: The MHC can be considered as a viable option to provide services to urban poor.

  3. The Perceived Needs and Availability of Eye Care Services for Older Adults in Long-term Care Facilities

    OpenAIRE

    Kergoat, Hélène; Boisjoly, Hélène; Freeman, Ellen E.; Monette, Johanne; Roy, Sylvie; Kergoat, Marie-Jeanne

    2014-01-01

    Background The objective was to evaluate the eye care services offered to older residents living in long-term care facilities (LTCFs). Methods A questionnaire targeting residents aged ≥65 years was sent to all LTCFs in Quebec. Questions related to the institution’s characteristics, demographic data related to residents, oculovisual health of residents and barriers to eye care, eye care services offered within and outside the institution, and degree of satisfaction regarding the eye care servi...

  4. Escuta psicanalítica de gestantes no contexto ambulatorial: uma experiência em grupos de fala = Psychoanalytic care of pregnant women in the context of an ambulatory: the experience of words group

    Directory of Open Access Journals (Sweden)

    Vilas Boas, Laís Macêdo

    2013-01-01

    Full Text Available A gestação é um momento de mudanças significativas na vida da mulher, permeado por afetos, fantasias e expectativas em relação ao parto e ao bebê. A existência de um espaço de fala, no qual a futura mãe possa de algum modo elaborar tais conteúdos psíquicos, pode auxiliar tanto no processo de construção do lugar materno, como na preparação para o parto e para a interação com o bebê. O presente trabalho é uma proposta de reflexão a partir da experiência que se desenvolve no chamado Grupo de Palavras – espaço de fala e partilha de experiências de gestantes sobre questões relativas à gravidez, criado na sala de espera de um ambulatório – com objetivo de discutir nuances do processo psíquico envolvido na construção do ser mãe e a possibilidade de elaboração de tal processo por meio da fala, bem como os desafios do trabalho de escuta psicanalítica no contexto ambulatorial

  5. Long-Term Care Facilities: A Cornucopia of Viral Pathogens

    Science.gov (United States)

    Falsey, Ann R.; Dallal, Gerard E.; Formica, Maria A.; Andolina, Gloria G.; Hamer, Davidson H.; Leka, Lynette L.; Meydani, Simin Nikbin

    2010-01-01

    Objectives To determine the frequency and types of respiratory viruses circulating in Boston long-term care facilities (LTCFs) during a 3-year period. Design Observational. Setting Thirty-three Boston-area LTCFs over a 3-year period. Participants Residents of long-term care who had previously participated in a trial of vitamin E supplementation and had paired serum samples available for viral analysis. Measurements Viral antibody titers to eight respiratory viruses (influenza A and B, respiratory syncytial virus (RSV), parainfluenza virus serotype three (PIV-3), PIV-2, human metapneumovirus (hMPV), and coronaviruses 229E and OC43) were measured using enzyme immunoassay at baseline and 53 weeks. Infection was defined as a more than quadrupling of viral titers. Clinical data on respiratory illnesses were collected throughout the study period. Results A total of 617 persons were enrolled in the trial. Of these, 382 (62%) had sera available for viral analysis. A total of 204 viral infections were documented in 157 subjects. Serological responses to all eight viruses were documented, with hMPV (12.8%) and coronavirus 229E (10.5%) being the most common and PIV-2 (2.4%) the least common. The occurrence of bronchitis (P = .007), pneumonia (P = .02), and any lower respiratory tract infection (P = .002) was significantly associated with having a viral diagnosis. Conclusion A wide range of respiratory viruses cocirculates in LTCFs and contributes to respiratory illness morbidity in these populations. PMID:18557966

  6. Oral health care in older people in long term care facilities : A systematic review of implementation strategies

    NARCIS (Netherlands)

    Weening-Verbree, L.; Huisman-de Waal, G.; van Dusseldorp, L.; van Achterberg, T.; Schoonhoven, L.

    2013-01-01

    Objectives: Oral hygiene is necessary to maintain oral health and quality of life. However, the oral hygiene and the oral health care of older people in long term care facilities are poor. This indicates that care is not in compliance with the available guidelines and protocols, and stresses the imp

  7. Planning an eLearning Dementia Care Program for Healthcare Teams in Long-Term Care Facilities: The Learners' Perspectives

    Science.gov (United States)

    MacDonald, Colla J.; Stodel, Emma J.; Coulson, Irene

    2004-01-01

    This paper presents a needs analysis conducted to obtain information concerning online dementia care training of healthcare workers in long-term care (LTC) facilities. The resulting information was used to guide the development of an online dementia care training program designed to facilitate the acquisition of skills and knowledge necessary for…

  8. Urgent Care Facilities, Urgent Care Facilities in Iredell County, NC, Published in 2007, 1:2400 (1in=200ft) scale, Iredell County GIS.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Urgent Care Facilities dataset, published at 1:2400 (1in=200ft) scale, was produced all or in part from Orthoimagery information as of 2007. It is described as...

  9. Care Facilities Licensed by LDHH, Geographic NAD83, LDHH (2006) [LDHH_care_facilities_06_07_full_LDHH_2006

    Data.gov (United States)

    Louisiana Geographic Information Center — A portion of the facilities licensed by the Louisiana Department of Health and Hospitals, Health Standards Section. This database includes Adult Day Cares, Adult...

  10. Development and implementation of the internal audit mechanisms to be used in the health care facilities.

    Science.gov (United States)

    Smeyanov, V; Tarasenko, S; Smeyanova, O

    2013-06-01

    Issues concerning the quality of care service improvement have become of national importance in the health-care system for both developed and developing countries. Internal audit is effective and efficient method to improve the quality of care in various health care facilities. Data from 452 outpatient cards of the case patients with arterial hypertension were analyzed, the level of awareness and patient compliance were defined. The stages of internal audit mechanisms implementation in the health care facilities were developed. As a result of medical records audit and awareness monitoring of patients with arterial hypertension ways to improve quality of medical care were defined.

  11. Assisted Living Facilities, Licensed Health Care Facilities - assisted living facility type identified in attributes, Published in 2007, Iowa Dept. of Public Health.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Assisted Living Facilities dataset, was produced all or in part from Published Reports/Deeds information as of 2007. It is described as 'Licensed Health Care...

  12. Communities Putting Prevention to Work: Results of an Obesity Prevention Initiative in Child Care Facilities

    Science.gov (United States)

    Natale, Ruby; Camejo, Stephanie; Sanders, Lee M.

    2016-01-01

    Obesity is a significant public health issue affecting even our youngest children. Given that a significant amount of young children are enrolled in child care, the goal of this project was to evaluate the effectiveness of a child care facility-based obesity prevention program. Over 1,000 facilities participated in the study. The intervention…

  13. 42 CFR 409.85 - Skilled nursing facility (SNF) care coinsurance.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Skilled nursing facility (SNF) care coinsurance. 409.85 Section 409.85 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... Coinsurance § 409.85 Skilled nursing facility (SNF) care coinsurance. (a) General provisions. (1) SNF...

  14. Differences in essential newborn care at birth between private and public health facilities in eastern Uganda

    Directory of Open Access Journals (Sweden)

    Peter Waiswa

    2015-03-01

    Full Text Available Background: In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. Objective: To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Design: Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. Results: The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007. Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (p<0.001. Women delivering in private facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities. Conclusions: In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was

  15. Helping You Choose Quality Hospice Care

    Science.gov (United States)

    ... Accreditation Accreditation Ambulatory Health Care Behavioral Health Care Critical Access Hospitals Home Care (+ Pharmacy) Hospital Laboratory Nursing Care Center International Accreditation Accreditation Top Spots What ...

  16. A new strategy for regulating long-term care facilities.

    Science.gov (United States)

    Ruchlin, H S

    1977-01-01

    This study analyzes the failure of current regulatory efforts to elicit an acceptable level of performance in long-term care facilities and proposes a strategy for correcting that failure. Seven factors are identified as being responsible for the failure of current regulatory efforts: inadequate financing, inadequate knowledge, bureaucratic apathy, legal constraints, political constraints, a fragmentation of agency responsibility, and a shortage of conforming beds. Public utility status, market regulation, and non-profit control are reviewed and rejected as alternatives to the current approach. A new strategy aimed at improving the regulatory process and environment is proposed. The process can be improved by adopting a program rather than taking a functional approach to agency organization; linking the inspection and rate-setting processes; creating a role for consumer groups in the inspection process; and exposing the process and results of regulation to public scrutiny. Five proposals are offered for improving the regulatory environment. These focus on eliminating barriers to entry, supporting alternatives to institutionalization, federalizing the Medicaid program, abandoning exclusive reliance on the medical model as the guide for regulatory standards, and changing the focus of regulation from structure-process to out-come.

  17. Older Residents' Perspectives of Long-Term Care Facilities in China.

    Science.gov (United States)

    Wang, Jing; Wang, Junqiao; Cao, Yuling; Jia, Shoumei; Wu, Bei

    2016-08-01

    China's formal long-term care (LTC) system is in its developmental stage due to lack of standardized health assessments for resident admission, limited government funding, an acute shortage of qualified staff at all levels, and regional disparities in quality of care. Relocation to LTC facilities changes the lives of older adults because they have to leave behind their homes and previous social networks. The current study aimed to provide an in-depth exploration of 25 older adult residents' lives in four LTC facilities in China. A conventional content analysis approach was used to interpret participant interviews. Residents experienced losses and gains from residential life. Three themes emerged: (a) influences of cultural beliefs, (b) basic care needs fulfilled in LTC facilities, and (c) lack of quality care in LTC facilities. Findings show that residents' basic needs were met in Chinese LTC facilities, but there is room for improvement in delivering quality care. [Journal of Gerontological Nursing, 42(8), 34-43.].

  18. Quality along the continuum: a health facility assessment of intrapartum and postnatal care in Ghana.

    Directory of Open Access Journals (Sweden)

    Robin C Nesbitt

    Full Text Available To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate "effective coverage" of skilled attendance in Brong Ahafo, Ghana.We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC, emergency newborn care (EmNC and non-medical quality. Linking the health facility assessment to surveillance data we estimated "effective coverage" of skilled attendance as the proportion of births in facilities of high quality.Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as "low" or "substandard" for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was "low" or "substandard" in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in health facilities, only 18% were in facilities with "high" or "highest" quality in all dimensions.Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated "effective coverage" of skilled attendance at 18%, thus revealing a large "quality gap." Effective coverage could be a meaningful indicator of progress towards

  19. A multi-organisation aged care emergency service for acute care management of older residents in aged care facilities.

    Science.gov (United States)

    Conway, Jane; Dilworth, Sophie; Hullick, Carolyn; Hewitt, Jacqueline; Turner, Catherine; Higgins, Isabel

    2015-11-01

    This case study describes a multi-organisation aged care emergency (ACE) service. The service was designed to enable point-of-care assessment and management for older people in residential aged care facilities (RACFs). Design of the ACE service involved consultation and engagement of multiple key stakeholders. The ACE service was implemented in a large geographical region of a single Medicare Local (ML) in New South Wales, Australia. The service was developed over several phases. A case control pilot evaluation of one emergency department (ED) and four RACFs revealed a 16% reduction in presentations to the ED as well as reductions in admission to the hospital following ED presentation. Following initial pilot work, the ACE service transitioned across another five EDs and 85 RACFs in the local health district. The service has now been implemented in a further 10 sites (six metropolitan and four rural EDs) across New South Wales. Ongoing evaluation of the implementation continues to show positive outcomes. The ACE service offers a model shown to reduce ED presentations and admissions from RACFs, and provide quality care with a focus on the needs of the older person. PMID:25981903

  20. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2012-02-03

    PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

  1. A rapid assessment of the availability and use of obstetric care in Nigerian healthcare facilities.

    Directory of Open Access Journals (Sweden)

    Daniel O Erim

    Full Text Available BACKGROUND: As part of efforts to reduce maternal deaths in Nigeria, pregnant women are being encouraged to give birth in healthcare facilities. However, little is known about whether or not available healthcare facilities can cope with an increasing demand for obstetric care. We thus carried out this survey as a rapid and tactical assessment of facility quality. We visited 121 healthcare facilities, and used the opportunity to interview over 700 women seeking care at these facilities. FINDINGS: Most of the primary healthcare facilities we visited were unable to provide all basic Emergency Obstetric Care (bEmOC services. In general, they lack clinical staff needed to dispense maternal and neonatal care services, ambulances and uninterrupted electricity supply whenever there were obstetric emergencies. Secondary healthcare facilities fared better, but, like their primary counterparts, lack neonatal care infrastructure. Among patients, most lived within 30 minutes of the visited facilities and still reported some difficulty getting there. Of those who had had two or more childbirths, the conditional probability of a delivery occurring in a healthcare facility was 0.91 if the previous delivery occurred in a healthcare facility, and 0.24 if it occurred at home. The crude risk of an adverse neonatal outcome did not significantly vary by delivery site or birth attendant, and the occurrence of such an outcome during an in-facility delivery may influence the mother to have her next delivery outside. Such an outcome during a home delivery may not prompt a subsequent in-facility delivery. CONCLUSIONS: In conclusion, reducing maternal deaths in Nigeria will require attention to both increasing the number of facilities with high-quality EmOC capability and also assuring Nigerian women have access to these facilities regardless of where they live.

  2. Does depression screening have an effect on the diagnosis and treatment of mood disorders in general medical settings?: an instrumental variable analysis of the national ambulatory medical care survey.

    Science.gov (United States)

    Mojtabai, Ramin

    2011-08-01

    This study examined the association of depression screening with the diagnoses of mood disorders and prescription of antidepressants in 73,712 visits to nonpsychiatrist physician offices drawn from the 2005-2007 U.S. National Ambulatory Medical Care Survey. Physicians used depression screening selectively for patients whom they perceived as more likely to have a mood disorder. In bivariate probit analyses with instrumental variables, depression screening did not increase the prevalence of either mood disorder diagnoses or prescription of antidepressants. However, screening was associated with lower rates of antidepressants prescription without a diagnosis of a mood disorder. In visits in which antidepressants were prescribed, 47.4% of the screened visits compared with 16.3% of nonscreened visits had a mood disorder diagnosis. As currently practiced in medical settings, depression screening may help improve targeting and appropriate use of antidepressant medications. Wider use of depression screening may help curb the growing trend of off-label antidepressant prescriptions. PMID:21454246

  3. Organizational factors influencing health information technology adoption in long-term-care facilities.

    Science.gov (United States)

    Wang, Tiankai; Wang, Yangmei; Moczygemba, Jackie

    2014-01-01

    Long-term care (LTC) is an important sector of the health care industry. However, the adoption of health information technology (HIT) systems in LTC facilities lags behind that in other sectors of health care. Previous literature has focused on the financial and technical barriers. This study examined the organizational factors associated with HIT adoption in LTC facilities. A survey of 500 LTC facilities in Texas enabled researchers to compile HIT indexes for further statistical analyses. A general linear model was used to study the associations between the clinical/administrative HIT indexes and organizational factors. The empirical outcomes show that the size of an LTC facility has a significant association with HIT adoption. Rural LTC facilities, especially freestanding ones, adopt less HIT than their urban counterparts, whereas freestanding LTC facilities have the lowest HIT adoption overall. There is not enough evidence to support ownership status as a significant factor in HIT adoption. Some implications are proposed, but further research is necessary.

  4. Prevention by Design: Construction and Renovation of Health Care Facilities for Patient Safety and Infection Prevention.

    Science.gov (United States)

    Olmsted, Russell N

    2016-09-01

    The built environment supports the safe care of patients in health care facilities. Infection preventionists and health care epidemiologists have expertise in prevention and control of health care-associated infections (HAIs) and assist with designing and constructing facilities to prevent HAIs. However, design elements are often missing from initial concepts. In addition, there is a large body of evidence that implicates construction and renovation as being associated with clusters of HAIs, many of which are life threatening for select patient populations. This article summarizes known risks and prevention strategies within a framework for patient safety. PMID:27515144

  5. 24 Hours chronomics of ambulatory blood pressure and its relation with circadian rhythm of 6-sulfatoxy melatonin in night shift health care workers

    Directory of Open Access Journals (Sweden)

    B. Anjum

    2015-08-01

    Results: Ambulatory BP and HR were recorded at every 30 min intervals in day time and each hour in night time synchronically with circadian pattern of 6 sulfatoxy melatonin during shift duties. Highly Significant difference was found in double amplitude (2DA of blood pressure between night and day shift (p<0.001. In night shift, hyperbaric index (HBI of mean systolic blood pressure was found to be increased at 00-03 am (midnight while during day shift, peak was found at 06-09 am. Peak melatonin was to be found in early morning as compared to mid night in both the shift. Conclusions: The present study concluded that the desynchronization was appeared during night shift and entrainment of circadian rhythm in the day shift. [Int J Res Med Sci 2015; 3(8.000: 1922-1931

  6. Comprehensive ambulatory medicine training for categorical internal medicine residents.

    Science.gov (United States)

    Bharel, Monica; Jain, Sharad; Hollander, Harry

    2003-04-01

    It is challenging to create an educational and satisfying experience in the outpatient setting. We developed a 3-year ambulatory curriculum that addresses the special needs of our categorical medicine residents with distinct learning objectives for each year of training and clinical experiences and didactic sessions to meet these goals. All PGY1 residents spend 1 month on a general medicine ambulatory care rotation. PGY2 residents spend 3 months on an ambulatory block focusing on 8 core medicine subspecialties. Third-year residents spend 2 months on an advanced ambulatory rotation. The curriculum was started in July 2000 and has been highly regarded by the house staff, with statistically significant improvements in the PGY2 and PGY3 evaluation scores. By enhancing outpatient clinical teaching and didactics with an emphasis on the specific needs of our residents, we have been able to reframe the thinking and attitudes of a group of inpatient-oriented residents. PMID:12709096

  7. Coverage and quality of antenatal care provided at primary health care facilities in the 'Punjab' province of 'Pakistan'.

    Directory of Open Access Journals (Sweden)

    Muhammad Ashraf Majrooh

    Full Text Available BACKGROUND: Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In 'Pakistan' antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to 'Divisions' and 'Districts'. By population 'Punjab' is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in 'Punjab' province of 'Pakistan'. METHODS: Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers. RESULTS: The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage. CONCLUSION: The coverage and quality of the antenatal care services in 'Punjab' are extremely compromised. Only half of the expected pregnancies are enrolled and

  8. Cochlear implant in an ambulatory surgery center.

    Science.gov (United States)

    Joseph, Aimee M; Lassen, L Frederick

    2013-02-01

    Presbycusis, or sensorineural hearing loss in the elderly population, affects approximately 40% to 50% of people over the age of 75. A variety of devices are available to those with hearing loss. Cochlear implants, for example, are especially useful for those with severe-to-profound hearing loss. The population is aging, so the demand for cochlear implantation in ambulatory surgery centers will likely increase. Ambulatory surgery centers (ASC) can provide a more convenient and less expensive location for cochlear implant surgery than hospital-based operating facilities. Patient selection using standard ASC criteria, coupled with an understanding of the unique surgical and anesthetic needs of cochlear implant patients, are key to bringing this once exotic inpatient procedure into the ASC.

  9. 38 CFR 17.63 - Approval of community residential care facilities.

    Science.gov (United States)

    2010-07-01

    ... extended care facilities have one), hot and cold water, electricity, plumbing, sewage, cooking, laundry... approved by the Director of the Federal Register, in accordance with 5 U.S.C. 552(a) and 1 CFR part 51... furniture and furnishings. (f) Nutrition. The facility must: (1) Provide a safe and sanitary food...

  10. 75 FR 37463 - Dispensing of Controlled Substances to Residents at Long Term Care Facilities

    Science.gov (United States)

    2010-06-29

    ... practitioners, pharmacists, LTCFs, nurses, residents and family of residents in long term care facilities, State... professional staff (physicians, nurses, etc.) and facilities to provide a proper standard of hospital service... legitimate medical purpose by DEA-registered practitioners acting in the usual course of their...

  11. Examining the role of information exchange in residential aged care work practices-a survey of residential aged care facilities

    OpenAIRE

    Gaskin Sarah; Georgiou Andrew; Barton Donna; Westbrook Johanna

    2012-01-01

    Abstract Background The provision of residential aged care is underpinned by information, and is reliant upon systems that adequately capture and effectively utilise and communicate this information. The aim of this study was to explicate and quantify the volume and method by which information is collected, exchanged within facilities and with external providers, and retrieved from facility information systems and hospitals. Methods A survey of staff (n = 119), including managers, health info...

  12. Investigating Preterm Care at the Facility Level: Stakeholder Qualitative Study in Central and Southern Malawi.

    Science.gov (United States)

    Gondwe, Austrida; Munthali, Alister; Ashorn, Per; Ashorn, Ulla

    2016-07-01

    Objectives Malawi is estimated to have one of the highest preterm birth rates in the world. However, care of preterm infants at facility level in Malawi has not been explored. We aimed to explore the views of health stakeholders about the care of preterm infants in health facilities and the existence of any policy protocol documents guiding the delivery of care to these infants. Methods We conducted 16 in-depth interviews with health stakeholders (11 service providers and 5 policy makers) using an interview guide and asked for any existing policy protocol documents guiding care for preterm infants in the health facilities in Malawi. The collected documents were reviewed and all the interviews were digitally recorded, transcribed and translated. All data were analysed using content analysis approach. Results We identified four policy protocol documents and out of these, one had detailed information explaining the care of preterm infants. Policy makers reported that policy protocol documents to guide care for preterm infants were available in the health facilities but majority (63.6 %) of the service providers lacked knowledge about the existence of these documents. Health stakeholders reported several challenges in caring for preterm infants including lack of trained staff in preterm infant care, antibiotics, space, supervision and poor referral system. Conclusions Our study highlights that improving health care service provider knowledge of preterm infant care is an integral part in preterm child birth. Our findings suggests that policy makers and health decision makers should retain those trained in preterm new born care in the health facility's preterm unit.

  13. Investigating Preterm Care at the Facility Level: Stakeholder Qualitative Study in Central and Southern Malawi.

    Science.gov (United States)

    Gondwe, Austrida; Munthali, Alister; Ashorn, Per; Ashorn, Ulla

    2016-07-01

    Objectives Malawi is estimated to have one of the highest preterm birth rates in the world. However, care of preterm infants at facility level in Malawi has not been explored. We aimed to explore the views of health stakeholders about the care of preterm infants in health facilities and the existence of any policy protocol documents guiding the delivery of care to these infants. Methods We conducted 16 in-depth interviews with health stakeholders (11 service providers and 5 policy makers) using an interview guide and asked for any existing policy protocol documents guiding care for preterm infants in the health facilities in Malawi. The collected documents were reviewed and all the interviews were digitally recorded, transcribed and translated. All data were analysed using content analysis approach. Results We identified four policy protocol documents and out of these, one had detailed information explaining the care of preterm infants. Policy makers reported that policy protocol documents to guide care for preterm infants were available in the health facilities but majority (63.6 %) of the service providers lacked knowledge about the existence of these documents. Health stakeholders reported several challenges in caring for preterm infants including lack of trained staff in preterm infant care, antibiotics, space, supervision and poor referral system. Conclusions Our study highlights that improving health care service provider knowledge of preterm infant care is an integral part in preterm child birth. Our findings suggests that policy makers and health decision makers should retain those trained in preterm new born care in the health facility's preterm unit. PMID:26976282

  14. Educational Needs of Health Care Providers Working in Long-Term Care Facilities with Regard to Pain Management

    Directory of Open Access Journals (Sweden)

    Yannick Tousignant-Laflamme

    2012-01-01

    Full Text Available BACKGROUND: The prevalence of chronic pain ranges from 40% to 80% in long-term care facilities (LTCF, with the highest proportion being found among older adults and residents with dementia. Unfortunately, pain in older adults is underdiagnosed, undertreated, inadequately treated or not treated at all. A solution to this problem would be to provide effective and innovative interdisciplinary continuing education to health care providers (HCPs.

  15. Report a Complaint (about a Health Care Organization)

    Science.gov (United States)

    ... Accreditation Accreditation Ambulatory Health Care Behavioral Health Care Critical Access Hospitals Home Care (+ Pharmacy) Hospital Laboratory Nursing Care Center International Accreditation Accreditation Top Spots What ...

  16. The Perceived Needs and Availability of Eye Care Services for Older Adults in Long-term Care Facilities

    Science.gov (United States)

    Kergoat, Hélène; Boisjoly, Hélène; Freeman, Ellen E.; Monette, Johanne; Roy, Sylvie; Kergoat, Marie-Jeanne

    2014-01-01

    Background The objective was to evaluate the eye care services offered to older residents living in long-term care facilities (LTCFs). Methods A questionnaire targeting residents aged ≥65 years was sent to all LTCFs in Quebec. Questions related to the institution’s characteristics, demographic data related to residents, oculovisual health of residents and barriers to eye care, eye care services offered within and outside the institution, and degree of satisfaction regarding the eye care services offered to residents. Results 196/428 (45.8%) LTCFs completed the questionnaire. Participating LTCFs had an average of 97.0 ± 5.1 residents with a mean age of 82.8 ± 3.0 yrs and 69% women. Eye care services were mostly offered outside the institution, on a “per request” basis. The main barriers to eye care were the perception that residents could not cooperate and the lack of eye care professionals. Most LTCFs were satisfied with the eye care services offered to residents. Conclusions The fact that the LTCFs were satisfied with the eye care services offered to their residents, although it was neither provided on a regular basis nor to all residents, suggests that eye care professionals should take a proactive educational role for improving services to older institutionalized adults. PMID:25232370

  17. Unaccompanied minors in the Netherlands and the care facility in which they flourish best

    NARCIS (Netherlands)

    Kalverboer, Margrite; Zijlstra, Angenietha; van Os, Carla; Zevulun, Daniëlle; ten Brummelaar, Mijntje; Beltman, Daan

    2016-01-01

    Abstract This study compares the views of unaccompanied minors living in four different types of care facilities in the Netherlands: namely in foster care, small living units, children's living groups and campuses on their wellbeing, living circumstances and place in Dutch society. Interviews with 1

  18. Residents Living in Residential Care Facilities: United States, 2010

    Science.gov (United States)

    ... population with a high burden of functional and cognitive impairment. Residential care is an important component of ... RCF and the month and year of the interview. Medicaid beneficiary : A resident who, during the 30 ...

  19. Supply-side barriers to maternity-care in India: a facility-based analysis.

    Directory of Open Access Journals (Sweden)

    Santosh Kumar

    Full Text Available BACKGROUND: Health facilities in many low- and middle-income countries face several types of barriers in delivering quality health services. Availability of resources at the facility may significantly affect the volume and quality of services provided. This study investigates the effect of supply-side determinants of maternity-care provision in India. METHODS: Health facility data from the District-Level Household Survey collected in 2007-2008 were analyzed to explore the effects of supply-side factors on the volume of delivery care provided at Indian health facilities. A negative binomial regression model was applied to the data due to the count and over-dispersion property of the outcome variable (number of deliveries performed at the facility. RESULTS: Availability of a labor room (Incidence Rate Ratio [IRR]: 1.81; 95% Confidence Interval [CI]: 1.68-1.95 and facility opening hours (IRR: 1.43; CI: 1.35-1.51 were the most significant predictors of the volume of delivery care at the health facilities. Medical and paramedical staff were found to be positively associated with institutional deliveries. The volume of deliveries was also higher if adequate beds, essential obstetric drugs, medical equipment, electricity, and communication infrastructures were available at the facility. Findings were robust to the inclusion of facility's catchment area population and district-level education, health insurance coverage, religion, wealth, and fertility. Separate analyses were performed for facilities with and without a labor room and results were qualitatively similar across these two types of facilities. CONCLUSIONS: Our study highlights the importance of supply-side barriers to maternity-care India. To meet Millennium Development Goals 4 and 5, policymakers should make additional investments in improving the availability of medical drugs and equipment at primary health centers (PHCs in India.

  20. Enfermagem em cirurgia ambulatorial de um hospital escola: clientela, procedimentos e necessidades biológicas e psicossociais Enfermería en cirugía ambulatoria en hospital escuela: clientela, procedimientos y necesidades biológicas y psicosociales Nursing care in ambulatory surgery at a teaching hospital: patients, procedures and biological and psychosocial needs

    Directory of Open Access Journals (Sweden)

    Tatiane Vegette Pinto

    2005-04-01

    local con o sin sedación. Como necesidades biológicas fueron identificadas: alteraciones en la tensión arterial, alteraciones electrocardiográficas, uso de medicamentos y alergias a los mismos, ayuno prolongado, náusea, vómito y dolor; como necesidades psicosociales: preocupación, miedo, ansiedad, incomodo por la espera para realizarse el procedimiento y dudas o desconocimiento respecto a los cuidados perioperatorios.This descriptive study aimed to characterize the profile of 167 subjects who were treated at the Ambulatory Surgical Center of a University Hospital in São Paulo State and procedures realized at the Ambulatory Surgical Center, as well as to identify the biological and psychosocial needs of these patients. Data were obtained through a semistructured interview and patients' files and were subject to descriptive analysis. The group was characterized by an equal number of individuals from both genders; average age was 51 years and socioeconomic levels were poor. The most common surgical and anesthetic procedures were ophthalmologic procedures and use of local anesthesia with or without sedation. The biological needs were: altered arterial pressure, electrocardiographic alterations, use of medication, allergy to medication, prolonged fasting, nausea, vomits and pain. The psychosocial needs were: worry, fear, anxiety, discomfort caused by waiting for the realization of procedures and doubts or lack of information concerning perioperative care.

  1. 78 FR 56711 - Health Insurance Exchanges; Application by the Accreditation Association for Ambulatory Health...

    Science.gov (United States)

    2013-09-13

    ... accreditation program to conduct surveys for ambulatory surgery centers that wish to participate in the Medicare... HUMAN SERVICES Centers for Medicare & Medicaid Services Health Insurance Exchanges; Application by the Accreditation Association for Ambulatory Health Care To Be a Recognized Accrediting Entity for the...

  2. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Shah U

    2015-04-01

    Full Text Available Ushma Shah, David T Wong, Jean Wong Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada Abstract: Most surgeries in North America are performed on an ambulatory basis, reducing health care costs and increasing patient comfort. Patient satisfaction is an important outcome indicator of the quality of health care services incorporated by the American Society of Anesthesiologists (ASA. Patient satisfaction is a complex concept that is influenced by multiple factors. A patient's viewpoint and knowledge plays an influential role in patient satisfaction with ambulatory surgery. Medical optimization and psychological preparation of the patient plays a pivotal role in the success of ambulatory surgery. Postoperative pain, nausea, and vomiting are the most important symptoms for the patient and can be addressed by multimodal drug regimens. Shared decision making, patient–provider relationship, communication, and continuity of care form the main pillars of patient satisfaction. Various psychometrically developed instruments are available to measure patient satisfaction, such as the Iowa Satisfaction with Anesthesia Scale and Evaluation du Vecu de I'Anesthesie Generale, but none have been developed specifically for ambulatory surgery. The ASA has made recommendations for data collection for patient satisfaction surveys and emphasized the importance of reporting the data to the Anesthesia Quality Institute. Future research is warranted to develop a validated tool to measure patient satisfaction in ambulatory surgery. Keywords: patient, satisfaction, anesthesia, outcomes, questionnaire, perspectives

  3. A New Long-Term Care Facilities Model in Nova Scotia, Canada: Protocol for a Mixed Methods Study of Care by Design

    OpenAIRE

    Marshall, Emily Gard; Boudreau, Michelle Anne; Jensen, Jan L; Edgecombe, Nancy; Clarke, Barry; Burge, Frederick; Archibald, Greg; Taylor, Anthony; Andrew, Melissa K.

    2013-01-01

    Background Prior to the implementation of a new model of care in long-term care facilities in the Capital District Health Authority, Halifax, Nova Scotia, residents entering long-term care were responsible for finding their own family physician. As a result, care was provided by many family physicians responsible for a few residents leading to care coordination and continuity challenges. In 2009, Capital District Health Authority (CDHA) implemented a new model of long-term care called “Care b...

  4. Effects of person-centered care on residents and staff in aged-care facilities: a systematic review

    Directory of Open Access Journals (Sweden)

    Brownie S

    2013-01-01

    Full Text Available Sonya Brownie, Susan NancarrowSchool of Health and Human Sciences, Southern Cross University, Lismore, NSW, AustraliaBackground: Several residential aged-care facilities have replaced the institutional model of care to one that accepts person-centered care as the guiding standard of practice. This culture change is impacting the provision of aged-care services around the world. This systematic review evaluates the evidence for an impact of person-centered interventions on aged-care residents and nursing staff.Methods: We searched Medline, Cinahl, Academic Search Premier, Scopus, Proquest, and Expanded Academic ASAP databases for studies published between January 1995 and October 2012, using subject headings and free-text search terms (in UK and US English spelling including person-centered care, patient-centered care, resident-oriented care, Eden Alternative, Green House model, Wellspring model, long-term care, and nursing homes.Results: The search identified 323 potentially relevant articles. Once duplicates were removed, 146 were screened for inclusion in this review; 21 were assessed for methodological quality, resulting in nine articles (seven studies that met our inclusion criteria. There was only one randomized, controlled trial. The majority of studies were quasi-experimental pre-post test designs, with a control group (n = 4. The studies in this review incorporated a range of different outcome measures (ie, dependent variables to evaluate the impact of person-centered interventions on aged-care residents and staff. One person-centered intervention, ie, the Eden Alternative, was associated with significant improvements in residents' levels of boredom and helplessness. In contrast, facility-specific person-centered interventions were found to impact nurses' sense of job satisfaction and their capacity to meet the individual needs of residents in a positive way. Two studies found that person-centered care was actually associated with an

  5. Priority Setting and Influential Factors on Acceptance of Pharmaceutical Recommendations in Collaborative Medication Reviews in an Ambulatory Care Setting – Analysis of a Cluster Randomized Controlled Trial (WestGem-Study)

    Science.gov (United States)

    Rose, Olaf; Mennemann, Hugo; John, Carina; Lautenschläger, Marcus; Mertens-Keller, Damaris; Richling, Katharina; Waltering, Isabel; Hamacher, Stefanie; Felsch, Moritz; Herich, Lena; Czarnecki, Kathrin; Schaffert, Corinna; Jaehde, Ulrich; Köberlein-Neu, Juliane

    2016-01-01

    Background Medication reviews are recognized services to increase quality of therapy and reduce medication risks. The selection of eligible patients with potential to receive a major benefit is based on assumptions rather than on factual data. Acceptance of interprofessional collaboration is crucial to increase the quality of medication therapy. Objective The research question was to identify and prioritize eligible patients for a medication review and to provide evidence-based criteria for patient selection. Acceptance of the prescribing general practitioner to implement pharmaceutical recommendations was measured and factors influencing physicians’ acceptance were explored to obtain an impression on the extent of collaboration in medication review in an ambulatory care setting. Methods Based on data of a cluster-randomized controlled study (WestGem-study), the correlation between patient parameters and the individual performance in a medication review was calculated in a multiple logistic regression model. Physician’s acceptance of the suggested intervention was assessed using feedback forms. Influential factors were analyzed. Results The number of drugs in use (p = 0.001), discrepancies between prescribed and used medicines (p = 0.014), the baseline Medication Appropriateness Index score (p0.05) and a low kidney function (p>0.05) do not predetermine the outcome. Longitudinal patient care with repeated reviews showed higher interprofessional acceptance and superior patient benefit. A total of 54.9% of the recommendations in a medication review on drug therapy were accepted for implementation. Conclusions The number of drugs in use and medication reconciliation could be a first rational step in patient selection for a medication review. Most elderly, multimorbid patients with polymedication experience a similar chance of receiving a benefit from a medication review. Longitudinal patient care should be preferred over confined medication reviews. The acceptance

  6. The Impact of Maternal Health Literacy on Structures, Interpersonal Processes and Outcomes of Ambulatory Care for Low-Income Latino Children

    OpenAIRE

    Fry-Bowers, Eileen Katherine

    2012-01-01

    Objective: Child health outcomes depend on a parent's ability to read, communicate, analyze, and use health information to participate in their child's care. Low maternal health literacy (HL) may disrupt access to pediatric health care, impede informed parent decision-making, and exacerbate pediatric health disparities. This dissertation explores relationships between maternal (HL), maternal self-efficacy (SE) in communication, interpersonal interactions with health care providers (HCPs), a...

  7. Appointment standardization evaluation in a primary care facility.

    Science.gov (United States)

    Huang, Yu-Li

    2016-07-11

    Purpose - The purpose of this paper is to evaluate the performance on standardizing appointment slot length in a primary care clinic to understand the impact of providers' preferences and practice differences. Design/methodology/approach - The treatment time data were collected for each provider. There were six patient types: emergency/urgent care (ER/UC), follow-up patient (FU), new patient, office visit (OV), physical exam, and well-child care. Simulation model was developed to capture patient flow and measure patient wait time, provider idle time, cost, overtime, finish time, and the number of patients scheduled. Four scheduling scenarios were compared: scheduled all patients at 20 minutes; scheduled ER/UC, FU, OV at 20 minutes and others at 40 minutes; scheduled patient types on individual provider preference; and scheduled patient types on combined provider preference. Findings - Standardized scheduling among providers increase cost by 57 per cent, patient wait time by 83 per cent, provider idle time by five minutes per patient, overtime by 22 minutes, finish time by 30 minutes, and decrease patient access to care by approximately 11 per cent. An individualized scheduling approach could save as much as 14 per cent on cost and schedule 1.5 more patients. The combined preference method could save about 8 per cent while the number of patients scheduled remained the same. Research limitations/implications - The challenge is to actually disseminate the findings to medical providers and adjust scheduling systems accordingly. Originality/value - This paper concluded standardization of providers' clinic preference and practice negatively impact clinic service quality and access to care. PMID:27298064

  8. The evolution of ambulatory ECG monitoring.

    Science.gov (United States)

    Kennedy, Harold L

    2013-01-01

    Ambulatory Holter electrocardiographic (ECG) monitoring has undergone continuous technological evolution since its invention and development in the 1950s era. With commercial introduction in 1963, there has been an evolution of Holter recorders from 1 channel to 12 channel recorders with increasingly smaller storage media, and there has evolved Holter analysis systems employing increasingly technologically advanced electronics providing a myriad of data displays. This evolution of smaller physical instruments with increasing technological capacity has characterized the development of electronics over the past 50 years. Currently the technology has been focused upon the conventional continuous 24 to 48 hour ambulatory ECG examination, and conventional extended ambulatory monitoring strategies for infrequent to rare arrhythmic events. However, the emergence of the Internet, Wi-Fi, cellular networks, and broad-band transmission has positioned these modalities at the doorway of the digital world. This has led to an adoption of more cost-effective strategies to these conventional methods of performing the examination. As a result, the emergence of the mobile smartphone coupled with this digital capacity is leading to the recent development of Holter smartphone applications. The potential of point-of-care applications utilizing the Holter smartphone and a vast array of new non-invasive sensors is evident in the not too distant future. The Holter smartphone is anticipated to contribute significantly in the future to the field of global health.

  9. Older Residents' Perspectives of Long-Term Care Facilities in China.

    Science.gov (United States)

    Wang, Jing; Wang, Junqiao; Cao, Yuling; Jia, Shoumei; Wu, Bei

    2016-08-01

    China's formal long-term care (LTC) system is in its developmental stage due to lack of standardized health assessments for resident admission, limited government funding, an acute shortage of qualified staff at all levels, and regional disparities in quality of care. Relocation to LTC facilities changes the lives of older adults because they have to leave behind their homes and previous social networks. The current study aimed to provide an in-depth exploration of 25 older adult residents' lives in four LTC facilities in China. A conventional content analysis approach was used to interpret participant interviews. Residents experienced losses and gains from residential life. Three themes emerged: (a) influences of cultural beliefs, (b) basic care needs fulfilled in LTC facilities, and (c) lack of quality care in LTC facilities. Findings show that residents' basic needs were met in Chinese LTC facilities, but there is room for improvement in delivering quality care. [Journal of Gerontological Nursing, 42(8), 34-43.]. PMID:27319405

  10. Advances in the use of intravenous techniques in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Eng MR

    2015-07-01

    Full Text Available Matthew R Eng,1 Paul F White1,2 1Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 2White Mountain Institute, The Sea Ranch, CA, USA Summary statement: Advances in the use of intravenous techniques in ambulatory anesthesia has become important for the anesthesiologist as the key perioperative physician in outpatient surgery. Key techniques and choices of anesthetics are important in accomplishing fast track goals of ambulatory surgery. Purpose of review: The anesthesiologist in the outpatient environment must focus on improving perioperative efficiency and reducing recovery times while accounting for patients' well-being and safety. This review article focuses on recent intravenous anesthetic techniques to accomplish these goals. Recent findings: This review is an overview of techniques in intravenous anesthesia for ambulatory anesthesia. Intravenous techniques may be tailored to accomplish outpatient surgery goals for the type of surgical procedure and individual patient needs. Careful anesthetic planning and the application of the plans are critical to an anesthesiologist's success with fast-track ambulatory surgery. Conclusion: Careful planning and application of intravenous techniques are critical to an anesthesiologist's success with fast-track ambulatory surgery. Keywords: intravenous anesthesia, outpatient anesthesia, fast-track surgery

  11. Can the US minimum data set be used for predicting admissions to acute care facilities?

    Science.gov (United States)

    Abbott, P A; Quirolgico, S; Candidate, D; Manchand, R; Canfield, K; Adya, M

    1998-01-01

    This paper is intended to give an overview of Knowledge Discovery in Large Datasets (KDD) and data mining applications in healthcare particularly as related to the Minimum Data Set, a resident assessment tool which is used in US long-term care facilities. The US Health Care Finance Administration, which mandates the use of this tool, has accumulated massive warehouses of MDS data. The pressure in healthcare to increase efficiency and effectiveness while improving patient outcomes requires that we find new ways to harness these vast resources. The intent of this preliminary study design paper is to discuss the development of an approach which utilizes the MDS, in conjunction with KDD and classification algorithms, in an attempt to predict admission from a long-term care facility to an acute care facility. The use of acute care services by long term care residents is a negative outcome, potentially avoidable, and expensive. The value of the MDS warehouse can be realized by the use of the stored data in ways that can improve patient outcomes and avoid the use of expensive acute care services. This study, when completed, will test whether the MDS warehouse can be used to describe patient outcomes and possibly be of predictive value. PMID:10384674

  12. Operationalising emergency care delivery in sub-Saharan Africa: consensus-based recommendations for healthcare facilities.

    Science.gov (United States)

    Calvello, Emilie J B; Tenner, Andrea G; Broccoli, Morgan C; Skog, Alexander P; Muck, Andrew E; Tupesis, Janis P; Brysiewicz, Petra; Teklu, Sisay; Wallis, Lee; Reynolds, Teri

    2016-08-01

    A major barrier to successful integration of acute care into health systems is the lack of consensus on the essential components of emergency care within resource-limited environments. The 2013 African Federation of Emergency Medicine Consensus Conference was convened to address the growing need for practical solutions to further implementation of emergency care in sub-Saharan Africa. Over 40 participants from 15 countries participated in the working group that focused on emergency care delivery at health facilities. Using the well-established approach developed in the WHO's Monitoring Emergency Obstetric Care, the workgroup identified the essential services delivered-signal functions-associated with each emergency care sentinel condition. Levels of emergency care were assigned based on the expected capacity of the facility to perform signal functions, and the necessary human, equipment and infrastructure resources identified. These consensus-based recommendations provide the foundation for objective facility capacity assessment in developing emergency health systems that can bolster strategic planning as well as facilitate monitoring and evaluation of service delivery. PMID:26202673

  13. Financial Pressures Prompt Teaching Hospitals to Cut Costs, Raising Fears about Medical Education and Patient Care.

    Science.gov (United States)

    Grassmuck, Karen

    1991-01-01

    Financial pressures are forcing the closure of some teaching hospitals and retrenchment using such strategies as development of ambulatory care and satellite facilities, merging with or acquiring other hospitals, and shortening patient hospital stays. A table lists revenues and profit margins for the 20 largest university-owned teaching hospitals.…

  14. [How can the patient's home be changed into a work place for the nurse? Interaction theoretical note on the role of the professional nurse in ambulatory care].

    Science.gov (United States)

    Wiese, M

    1995-09-01

    In home-care-situations nurses are confronted with the special problem of changing the house of the patients into a nurse's place of work and to play at this "stage" the role of professional nurses. The role-theory of Goffman is the background to outline some structural barriers for the performance of this role. In such and other care-giving-situations the nurse must be able to keep a necessary amount of role-distance, to regain professional autonomy.

  15. DuPont/HFM Forum on carpet in health care facilities. Roundtable discussion.

    Science.gov (United States)

    Murph, J; Hemmes, M; Blyth, P L; Plappert, K K; Noell, E; VanStavern, V; Cama, R; Lynn, V; Pollitt, B S; Rainey, P M

    1993-11-01

    DuPont and Health Facilities Management magazine invited 20 national experts to Dalton, GA--the carpet-manufacturing capital of the world--on May 13 to take part in DuPont's first-ever Forum on Carpet in Health Care Facilities. During the two-hour roundtable discussion, moderated by DuPont's C. Jack Murph and HFM's Michael Hemmes, end-users, interior designers and mill representatives talked about the aesthetic, economic and performance aspects of using carpet in health care settings. Here's an edited version of what they said. PMID:10183973

  16. DuPont/HFM forum on carpet in health care facilities.

    Science.gov (United States)

    1994-02-01

    DuPont and Health Facilities Management magazine invited 20 national experts to Dalton, GA--the carpet-manufacturing capital of the world--last year to take part in Dupont's first-ever Forum on Carpet in Health Care Facilities. During the two-hour roundtable discussion, moderated by DuPont's C. Jack Murph and HFM's Michael Hemmes, ender-users, interior designers and carpet mill representatives talked about the aesthetic, economic and performance aspects of using carpet in health care settings. Here's an edited version of what they said. PMID:10131499

  17. DuPont/HFM Forum on carpet in health care facilities. Third in a series.

    Science.gov (United States)

    1994-01-01

    DuPont and Health Facilities Management magazine invited 20 national experts to Dalton, GA--the carpet-manufacturing capital of the world--last year to take part in DuPont's first-ever Forum on Carpet in Health Care Facilities. During the two-hour roundtable discussion, moderated by DuPont's C. Jack Murph and HFM's Michael Hemmes, end-users, interior designers and carpet mill representative talked about the aesthetic, economic and performance aspects of using carpet in health care settings. Here's an edited version of what they said. PMID:10184014

  18. Prevalence of Respiratory Protective Devices in U.S. Health Care Facilities

    Science.gov (United States)

    Wizner, Kerri; Stradtman, Lindsay; Novak, Debra; Shaffer, Ronald

    2016-01-01

    An online questionnaire was developed to explore respiratory protective device (RPD) prevalence in U.S. health care facilities. The survey was distributed to professional nursing society members in 2014 and again in 2015 receiving 322 and 232 participant responses, respectively. The purpose of this study was to explore if the emergency preparedness climate associated with Ebola virus disease changed the landscape of RPD use and awareness. Comparing response percentages from the two sampling time frames using bivariate analysis, no significant changes were found in types of RPDs used in health care settings. N95 filtering facepiece respirators continue to be the most prevalent RPD used in health care facilities, but powered air-purifying respirators are also popular, with regional use highest in the West and Midwest. Understanding RPD use prevalence could ensure that health care workers receive appropriate device trainings as well as improve supply matching for emergency RPD stockpiling. PMID:27462029

  19. Adherence to hand hygiene in an Italian long-term care facility.

    Science.gov (United States)

    Pan, Angelo; Domenighini, Francesca; Signorini, Liana; Assini, Renata; Catenazzi, Patrizia; Lorenzotti, Silvia; Patroni, Andrea; Carosi, Giampiero; Guerrini, Gianbattista

    2008-09-01

    In an Italian long-term-care facility (LTCF), we observed a 17.5% adherence to hand hygiene (HH), as well as 47.5% rate of glove use. Performing a procedure at high risk for cross-transmission of germs was the factor most strongly associated with noncompliance (odds ratio = 13.3; 95% confidence interval = 6.2 to 28.8; P < .0001). No significant differences in compliance related to health care worker category were found. Adherence to HH in the LTCF was similar to that found in a rehabilitation medicine unit of an acute care hospital (15.8%) but significantly lower than that reported in an infectious disease unit (53.7%; P < .0001). Our findings indicate that compliance with HH is a similar problem in LTCFs as in acute care facilities. PMID:18786454

  20. Prevalence of Respiratory Protective Devices in U.S. Health Care Facilities: Implications for Emergency Preparedness.

    Science.gov (United States)

    Wizner, Kerri; Stradtman, Lindsay; Novak, Debra; Shaffer, Ronald

    2016-08-01

    An online questionnaire was developed to explore respiratory protective device (RPD) prevalence in U.S. health care facilities. The survey was distributed to professional nursing society members in 2014 and again in 2015 receiving 322 and 232 participant responses, respectively. The purpose of this study was to explore if the emergency preparedness climate associated with Ebola virus disease changed the landscape of RPD use and awareness. Comparing response percentages from the two sampling time frames using bivariate analysis, no significant changes were found in types of RPDs used in health care settings. N95 filtering facepiece respirators continue to be the most prevalent RPD used in health care facilities, but powered air-purifying respirators are also popular, with regional use highest in the West and Midwest. Understanding RPD use prevalence could ensure that health care workers receive appropriate device trainings as well as improve supply matching for emergency RPD stockpiling. PMID:27462029

  1. Organizational factors influencing health information technology adoption in long-term-care facilities.

    Science.gov (United States)

    Wang, Tiankai; Wang, Yangmei; Moczygemba, Jackie

    2014-01-01

    Long-term care (LTC) is an important sector of the health care industry. However, the adoption of health information technology (HIT) systems in LTC facilities lags behind that in other sectors of health care. Previous literature has focused on the financial and technical barriers. This study examined the organizational factors associated with HIT adoption in LTC facilities. A survey of 500 LTC facilities in Texas enabled researchers to compile HIT indexes for further statistical analyses. A general linear model was used to study the associations between the clinical/administrative HIT indexes and organizational factors. The empirical outcomes show that the size of an LTC facility has a significant association with HIT adoption. Rural LTC facilities, especially freestanding ones, adopt less HIT than their urban counterparts, whereas freestanding LTC facilities have the lowest HIT adoption overall. There is not enough evidence to support ownership status as a significant factor in HIT adoption. Some implications are proposed, but further research is necessary. PMID:24463588

  2. Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

    Directory of Open Access Journals (Sweden)

    Magnavita Nicola

    2012-05-01

    Full Text Available Abstract Background Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention. Methods All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form for reporting violent incidents, the DCS (demand/control/support model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health. Results One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress. Conclusion Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.

  3. Abuse of power against clients by professional staff in care facilities.

    OpenAIRE

    KUPSOVÁ, Jitka

    2010-01-01

    The objective of my dissertation work titled ``Abuse of power against clients by professional staff in care facilities{\\crqq} is to establish whether the ethical codes are observed in the social and health care institutions providing accommodation services to their clients. Another objective of the work is to find out whether the employers running these institutions take adequate measures to prevent the burnt-out syndrome in their employees. The theoretical part of the work deals with the phi...

  4. Social networks of nursing staff and organizational performance. A study in long-term care facilities

    OpenAIRE

    Beek, A.P.A. van

    2013-01-01

    Over the years, there has been increasing attention for the role of social networks in explaining performance differences between organizations. Yet, research on social networks within healthcare organizations in general and long-term care facilities specifically has been rare, despite growing interest in explanations for differences in performance. In this thesis, we study informal social networks of nursing staff and organizational performance in different care settings for residents with d...

  5. Prevalence of oral pain and barriers to use of emergency oral care facilities among adult Tanzanians

    Directory of Open Access Journals (Sweden)

    Kahabuka Febronia

    2008-09-01

    Full Text Available Abstract Background Oral pain has been the major cause of the attendances in the dental clinics in Tanzania. Some patients postpone seeing the dentist for as long as two to five days. This study determines the prevalence of oral pain and barriers to use of emergency oral care in Tanzania. Methods Questionnaire data were collected from 1,759 adult respondents aged 18 years and above. The study area covered six urban and eight rural study clusters, which had been selected using the WHO Pathfinder methodology. Chi-square tests and logistic regression analyses were performed to identify associations. Results Forty two percent of the respondents had utilized the oral health care facilities sometimes in their lifetime. About 59% of the respondents revealed that they had suffered from oral pain and/or discomfort within the twelve months that preceded the study, but only 26.5% of these had sought treatment from oral health care facilities. The reasons for not seeking emergency care were: lack of money to pay for treatment (27.9%; self medication (17.6%; respondents thinking that pain would disappear with time (15.7%; and lack of money to pay for transport to the dental clinic (15.0%. Older adults were more likely to report that they had experienced oral pain during the last 12 months than the younger adults (OR = 1.57, CI 1.07–1.57, P dental clinics far from home (OR = 5.31, CI = 2.09–13.54, P and being treated by traditional healer (OR = 5.31, CI = 2.25–12.49, P as reasons for not seeking emergency care from the oral health care facilities than their counterparts from urban areas. Conclusion Oral pain and discomfort were prevalent among adult Tanzanians. Only a quarter of those who experienced oral pain or discomfort sought emergency oral care from oral health care facilities. Self medication was used as an alternative to using oral care facilities mainly by rural residents. Establishing oral care facilities in rural areas is recommended.

  6. Awareness of the Food and Drug Administration's Bad Ad Program and Education Regarding Pharmaceutical Advertising: A National Survey of Prescribers in Ambulatory Care Settings.

    Science.gov (United States)

    O'Donoghue, Amie C; Boudewyns, Vanessa; Aikin, Kathryn J; Geisen, Emily; Betts, Kevin R; Southwell, Brian G

    2015-01-01

    The U.S. Food and Drug Administration's Bad Ad program educates health care professionals about false or misleading advertising and marketing and provides a pathway to report suspect materials. To assess familiarity with this program and the extent of training about pharmaceutical marketing, a sample of 2,008 health care professionals, weighted to be nationally representative, responded to an online survey. Approximately equal numbers of primary care physicians, specialists, physician assistants, and nurse practitioners answered questions concerning Bad Ad program awareness and its usefulness, as well as their likelihood of reporting false or misleading advertising, confidence in identifying such advertising, and training about pharmaceutical marketing. Results showed that fewer than a quarter reported any awareness of the Bad Ad program. Nonetheless, a substantial percentage (43%) thought it seemed useful and 50% reported being at least somewhat likely to report false or misleading advertising in the future. Nurse practitioners and physician assistants expressed more openness to the program and reported receiving more training about pharmaceutical marketing. Bad Ad program awareness is low, but opportunity exists to solicit assistance from health care professionals and to help health care professionals recognize false and misleading advertising. Nurse practitioners and physician assistants are perhaps the most likely contributors to the program. PMID:26176326

  7. Ambulatory anaesthesia and cognitive dysfunction

    DEFF Research Database (Denmark)

    Rasmussen, Lars S; Steinmetz, Jacob

    2015-01-01

    anaesthesia in the outpatient setting. Cognitive complications such as delirium and postoperative cognitive dysfunction are less frequent in ambulatory surgery than with hospitalization. SUMMARY: The elderly are especially susceptible to adverse effects of the hospital environment such as immobilisation...

  8. Provider practice models in ambulatory oncology practice: analysis of productivity, revenue, and provider and patient satisfaction.

    Science.gov (United States)

    Buswell, Lori A; Ponte, Patricia Reid; Shulman, Lawrence N

    2009-07-01

    Physicians, nurse practitioners, and physician assistants often work in teams to deliver cancer care in ambulatory oncology practices. This is likely to become more prevalent as the demand for oncology services rises, and the number of providers increases only slightly.

  9. Epidemiological investigation of a norovirus GII.4 Sydney outbreak in a China elder care facility.

    Science.gov (United States)

    Zheng, Qing-ming; Zeng, Hua-tang; Dai, Chuan-wen; Zhang, Shun-xiang; Zhang, Zhen; Mei, Shu-jiang; He, Ya-qing; Ma, Han-wu

    2015-01-01

    An outbreak of norovirus GII.4/Sydney_2012 affected a China elder care facility in December 2012. A total of 39 elderly people and staff met the outbreak case definition. The attack rates in the elderly and the staff were 15.9% (31/195) and 23.2% (19/82), respectively, including 13 asymptomatic cases in the staff. The result of gene sequencing revealed that the outbreak was caused by norovirus GII.4 Sydney. The mode of transmission of this outbreak was proven to be person-to-person. The first case (a self-cared elder) was affected outside the elder care facility and was not isolated after returning. Norovirus was transmitted via close contact among the self-cared elderly. Then, through service-related close contact, the attendants promoted the cross-transmission between the self-cared elderly and the nursed elderly. The virus was also spread among the staff via daily contact. In the elder care facility, the asymptomatic cases in the attendants played an important role in the transmission of norovirus, which deserves high attention.

  10. Surgical Site Infections Following Pediatric Ambulatory Surgery: An Epidemiologic Analysis.

    Science.gov (United States)

    Rinke, Michael L; Jan, Dominique; Nassim, Janelle; Choi, Jaeun; Choi, Steven J

    2016-08-01

    OBJECTIVE To identify surgical site infection (SSI) rates following pediatric ambulatory surgery, SSI outcomes and risk factors, and sensitivity and specificity of SSI administrative billing codes. DESIGN Retrospective chart review of pediatric ambulatory surgeries with International Classification of Disease, Ninth Revision (ICD-9) codes for SSI, and a systematic random sampling of 5% of surgeries without SSI ICD-9 codes, all adjudicated for SSI on the basis of an ambulatory-adapted National Healthcare Safety Network definition. SETTING Urban pediatric tertiary care center April 1, 2009-March 31, 2014. METHODS SSI rates and sensitivity and specificity of ICD-9 codes were estimated using sampling design, and risk factors were analyzed in case-rest of cohort, and case-control, designs. RESULTS In 15,448 pediatric ambulatory surgeries, 34 patients had ICD-9 codes for SSI and 25 met the adapted National Healthcare Safety Network criteria. One additional SSI was identified with systematic random sampling. The SSI rate following pediatric ambulatory surgery was 2.9 per 1,000 surgeries (95% CI, 1.2-6.9). Otolaryngology surgeries demonstrated significantly lower SSI rates compared with endocrine (P=.001), integumentary (P=.001), male genital (Psurgeries. Almost half of patients with an SSI were admitted, 88% received antibiotics, and 15% returned to the operating room. No risk factors were associated with SSI. The sensitivity of ICD-9 codes for SSI following ambulatory surgery was 55.31% (95% CI, 12.69%-91.33%) and specificity was 99.94% (99.89%-99.97%). CONCLUSIONS SSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children. Infect Control Hosp Epidemiol 2016;37:931-938.

  11. Surgical Site Infections Following Pediatric Ambulatory Surgery: An Epidemiologic Analysis.

    Science.gov (United States)

    Rinke, Michael L; Jan, Dominique; Nassim, Janelle; Choi, Jaeun; Choi, Steven J

    2016-08-01

    OBJECTIVE To identify surgical site infection (SSI) rates following pediatric ambulatory surgery, SSI outcomes and risk factors, and sensitivity and specificity of SSI administrative billing codes. DESIGN Retrospective chart review of pediatric ambulatory surgeries with International Classification of Disease, Ninth Revision (ICD-9) codes for SSI, and a systematic random sampling of 5% of surgeries without SSI ICD-9 codes, all adjudicated for SSI on the basis of an ambulatory-adapted National Healthcare Safety Network definition. SETTING Urban pediatric tertiary care center April 1, 2009-March 31, 2014. METHODS SSI rates and sensitivity and specificity of ICD-9 codes were estimated using sampling design, and risk factors were analyzed in case-rest of cohort, and case-control, designs. RESULTS In 15,448 pediatric ambulatory surgeries, 34 patients had ICD-9 codes for SSI and 25 met the adapted National Healthcare Safety Network criteria. One additional SSI was identified with systematic random sampling. The SSI rate following pediatric ambulatory surgery was 2.9 per 1,000 surgeries (95% CI, 1.2-6.9). Otolaryngology surgeries demonstrated significantly lower SSI rates compared with endocrine (P=.001), integumentary (P=.001), male genital (PSSI were admitted, 88% received antibiotics, and 15% returned to the operating room. No risk factors were associated with SSI. The sensitivity of ICD-9 codes for SSI following ambulatory surgery was 55.31% (95% CI, 12.69%-91.33%) and specificity was 99.94% (99.89%-99.97%). CONCLUSIONS SSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children. Infect Control Hosp Epidemiol 2016;37:931-938. PMID:27121727

  12. Unit managers' role in improving nursing teamwork in a mental health care facility / Mariska Elizabeth Oosthuizen–Van Tonder

    OpenAIRE

    Oosthuizen–Van Tonder, Mariska Elizabeth

    2014-01-01

    The nursing team in a mental health care facility is a known dynamic at every hospital, rehabilitation centre and out-patient unit which enables these units to be functional. Currently nursing teams function in a challenged environment in mental health care facilities. The National Department of Health in South Africa states that one of the priority areas in the core standards of health care is to improve values and attitudes of health care professionals. One of the ways to accomplish this is...

  13. Acupuncture in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Norheim AJ

    2015-09-01

    Full Text Available Arne Johan Norheim,1 Ingrid Liodden,1 Terje Alræk1,2 1National Research Center in Complementary and Alternative Medicine (NAFKAM, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø – The Arctic University of Norway, Tromsø, 2The Norwegian School of Health Sciences, Institute of Acupuncture, Kristiania University College, Oslo, NorwayBackground: Post-anesthetic morbidities remain challenging in our daily practice of anesthesia. Meta-analyses and reviews of acupuncture and related techniques for postoperative nausea and vomiting (POVN and postoperative vomiting (POV show promising results while many clinicians remain skeptical of the value of acupuncture. Given the interest in finding safe non-pharmacological approaches toward postoperative care, this body of knowledge needs to be considered. This review critically appraises and summarizes the research on acupuncture and acupressure in ambulatory anesthesia during the last 15 years.Methods: Articles were identified through searches of Medline, PubMed, and Embase using the search terms “acupuncture” or “acupuncture therapy” in combination with “ambulatory anesthesia” or “ambulatory surgery” or “day surgery” or “postoperative”. A corresponding search was done using “acupressure” and “wristbands”. The searches generated a total of 104, 118, and 122 references, respectively.Results: Sixteen studies were included; eight studies reported on acupuncture and eight on acupressure. Nine studies found acupuncture or acupressure effective on primary endpoints including postoperative nausea and vomiting, postoperative pain, sore throat, and emergence agitation. Four studies found acupuncture had a similar effect to antiemetic medication.Conclusion: Overall, the studies were of fairly good quality. A large proportion of the reviewed papers highlights an effect of acupuncture or acupressure on postoperative morbidities in an ambulatory setting

  14. Systematic care for caregivers of people with dementia in the ambulatory mental health service: designing a multicentre, cluster, randomized, controlled trial.

    NARCIS (Netherlands)

    Spijker, A.; Verhey, F.; Graff, M.J.L.; Grol, R.P.T.M.; Adang, E.M.M.; Wollersheim, H.C.H.; Vernooy-Dassen, M.J.F.J.

    2009-01-01

    BACKGROUND: Care for people with dementia and their informal caregivers is a challenging aim in healthcare. There is an urgent need for cost-effective support programs that prevent informal caregivers of people with dementia from becoming overburdened, which might result in a delay or decrease of pa

  15. Patient satisfaction and acceptability: a journey through an ambulatory gynaecology clinic in the West of Ireland

    LENUS (Irish Health Repository)

    Uzochukwu, I

    2016-06-01

    Ambulatory Gynaecology allows a “see-and-treat” approach to managing gynaecological conditions, providing a more streamlined, integrated care pathway than the traditional gynaecology clinic and inpatient care model. This study was designed to assess patient satisfaction and acceptability of Ambulatory Gynaecology services in Mayo University Hospital, Castlebar, Ireland. It also provided for feedback from patients as to how the service might be improved. \\r\

  16. Delivery of surgical care in a district general hospital without high dependency unit facilities

    OpenAIRE

    Coggins, R

    2000-01-01

    BACKGROUND—Many hospitals lack the facilities for high dependency care, and patients requiring this level of care are nursed on the surgical ward. The aim of this study was to assess the extent of this problem in a district general hospital, looking at the impact of providing high dependency unit (HDU) care at ward level.
METHODS—A 28 bed surgical ward was studied for 39 consecutive days. Patients were assessed as being either appropriately placed (routine) or inappropriately placed (HDU). Nu...

  17. Cuidando de idosos com Demência: um estudo a partir da prática ambulatorial de enfermagem Cuidando de ancianos con Demencia: pratica de enfermería en el ambulatorio Caring the elderly with Dementia: a study of the ambulatorial nursing practice

    Directory of Open Access Journals (Sweden)

    Rosimeire Ferreira Santana

    2005-02-01

    characteristics of sixteen elderly and their caregivers in attendence at the neurogeriatrical ambulatory of Rio de Janeiro during 2004; to identify nursing and care diagnosis used by caregivers, through EDG, MEEM, AIVDs and AVDs applied in nursing assessments. The quantitative descriptive method was employed, as a study of each case, obtaining the results: in the client- Disorientation, aggressiveness, skin drought, urinary incontinence, disturbance in the family relationship; In the caregivers- inefficient caregiver/ elderly communication, physical fatigue, lack of knowledge about care; accomplished types of care - feeding, medication and hygiene. In conclusion, educational nursing actions are necessary to improve the care quality to the elderly and their family.

  18. Challenges in Evaluating and Standardizing Medical Devices in Health Care Facilities

    OpenAIRE

    Ventola, C. Lee

    2008-01-01

    Advances in medical technologies have led to improved diagnoses and treatments, but medical devices do not always undergo the rigorous review process that is applied to drugs. To control costs, some health care facilities are becoming more selective in how they evaluate new devices.

  19. Insomnia, Sleepiness, and Depression in Adolescents Living in Residential Care Facilities

    Science.gov (United States)

    Moreau, Vincent; Belanger, Lynda; Begin, Gilles; Morin, Charles M.

    2009-01-01

    The main objective of this study was to document sleep patterns and disturbances reported by youths temporarily living in residential care facilities. A secondary objective was to examine the relationships between sleep disturbances and mood and daytime sleepiness. A self-reported questionnaire on sleep patterns and habits assessing duration,…

  20. Social networks of nursing staff and organizational performance. A study in long-term care facilities

    NARCIS (Netherlands)

    Beek, A.P.A van

    2013-01-01

    Over the years, there has been increasing attention for the role of social networks in explaining performance differences between organizations. Yet, research on social networks within healthcare organizations in general and long-term care facilities specifically has been rare, despite growing inter

  1. [3D printing in health care facilities: What legislation in France?].

    Science.gov (United States)

    Montmartin, M; Meyer, C; Euvrard, E; Pazart, L; Weber, E; Benassarou, M

    2015-11-01

    Health care facilities more and more use 3D printing, including making their own medical devices (MDs). However, production and marketing of MDs are regulated. The goal of our work was to clarify what is the current French regulation that should be applied concerning the production of custom-made MDs produced by 3D printing in a health care facility. MDs consist of all devices used for diagnosis, prevention, or treatment of diseases in patients. Prototypes and anatomic models are not considered as MDs and no specific laws apply to them. Cutting guides, splints, osteosynthesis plates or prosthesis are MDs. In order to become a MD manufacturer in France, a health care facility has to follow the requirements of the 93/42/CEE directive. In addition, custom-made 3D-printed MDs must follow the annex VIII of the directive. This needs the writing of a declaration of conformity and the respect of the essential requirements (proving that a MD is secure and conform to what is expected), the procedure has to be qualified, a risk analysis and a control of the biocompatibility of the material have to be fulfilled. The documents proving that these rules have been respected have to be available. Becoming a regulatory manufacturer of MD in France is possible for a health care facility but the specifications have to be respected.

  2. Ambulatory laparoscopic cholecystectomy: Is it safe and cost effective?

    Directory of Open Access Journals (Sweden)

    Ali Athar

    2009-01-01

    Full Text Available Background : Laparoscopic cholecystectomy (LC is the most commonly performed minimal invasive surgery. However, practice of its use as an ambulatory surgery in our hospital settings is uncommon. Objective : To evaluate safety and cost effectiveness of LC as an ambulatory day care surgery. Study Design : Quasiexperimental. Setting : Department of surgery, Aga Khan University Hospital, Karachi, Pakistan. Materials and Methods : Patients with uncomplicated symptomatic gallstones were selected for Ambulatory LC. They were admitted electively on the same day and operated on in the morning hours and discharged after a check by the surgeon 6-8 hrs later. Results : Of fifty (n = 50 patients selected for ambulatory LC, 92% were discharged successfully after 6-8 hrs observation. No significant perioperative complications were noted. Unplanned admission and readmission rate was 8 and 2%, respectively. Cost saving for the daycare surgery was Rs. 6,200, Rs. 13,300, and Rs.22,800 per patient as compared to in patient general, semiprivate, and private ward package, respectively. Conclusion : Practice ambulatory LC is safe and cost-effective in selected patients with uncomplicated symptomatic gallstones.

  3. Preoperative testing and risk assessment: perspectives on patient selection in ambulatory anesthetic procedures

    Directory of Open Access Journals (Sweden)

    Stierer TL

    2015-08-01

    Full Text Available Tracey L Stierer,1,2 Nancy A Collop3,41Department of Anesthesiology, 2Department of Critical Care Medicine, Otolaryngology Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, USA; 3Department of Medicine, 4Department of Neurology, Emory University, Emory Sleep Center, Wesley Woods Center, Atlanta, GA, USAAbstract: With recent advances in surgical and anesthetic technique, there has been a growing emphasis on the delivery of care to patients undergoing ambulatory procedures of increasing complexity. Appropriate patient selection and meticulous preparation are vital to the provision of a safe, quality perioperative experience. It is not unusual for patients with complex medical histories and substantial systemic disease to be scheduled for discharge on the same day as their surgical procedure. The trend to “push the envelope” by triaging progressively sicker patients to ambulatory surgical facilities has resulted in a number of challenges for the anesthesia provider who will assume their care. It is well known that certain patient diseases are associated with increased perioperative risk. It is therefore important to define clinical factors that warrant more extensive testing of the patient and medical conditions that present a prohibitive risk for an adverse outcome. The preoperative assessment is an opportunity for the anesthesia provider to determine the status and stability of the patient’s health, provide preoperative education and instructions, and offer support and reassurance to the patient and the patient’s family members. Communication between the surgeon/proceduralist and the anesthesia provider is critical in achieving optimal outcome. A multifaceted approach is required when considering whether a specific patient will be best served having their procedure on an outpatient basis. Not only should the patient's comorbidities be stable and optimized, but details regarding the planned procedure and the resources available

  4. The use and effectiveness of electronic clinical decision support tools in the ambulatory/primary care setting: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Cathy Bryan

    2008-07-01

    Conclusion Although there is validation that CDSS has the potential to produce statistically significant improvement in outcomes, there is much variability among the types and methods of CDSS implementation and resulting effectiveness. As CDSS will likely continue to be at the forefront of the march toward effective standards-based care, more work needs to be done to determine effective implementation strategies for the use of CDSS across multiple settings and patient populations.

  5. Preparedness of elderly long-term care facilities in HSE East for influenza outbreaks.

    LENUS (Irish Health Repository)

    O'Connor, L

    2015-01-01

    Abstract We assessed preparedness of HSE East elderly long-term care facilities for an influenza outbreak, and identified Public Health Department support needs. We surveyed 166 facilities based on the HSE checklist document for influenza outbreaks, with 58% response rate. Client flu vaccination rates were > 75%; leading barriers were client anxiety and consent issues. Target flu vaccine uptake of 40% in staff occurred in 43% of facilities and was associated with staff vaccine administration by afacility-attached GP (p = 0.035), having a facility outbreak plan (p = 0.013) and being anon-HSE run facility (p = 0.013). Leading barriers were staff personal anxiety (94%) and lack of awareness of the protective effect on clients (21%). Eighty-nine percent found Public Health helpful, and requested further educational support and advocacy. Staff vaccine uptake focus, organisational leadership, optimal vaccine provision models, outbreak plans and Public Health support are central to the influenza campaign in elderly long-term care facilities.

  6. Ambulatory surgery for the patient with breast cancer: current perspectives

    OpenAIRE

    Tan, Ern Yu; Pek, Chong Han; Tey,Boon Lim, John

    2016-01-01

    Chong Han Pek,1 John Tey,2 Ern Yu Tan1 1Department of General Surgery, 2Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore Abstract: Ambulatory breast cancer surgery is well accepted and is the standard of care at many tertiary centers. Rather than being hospitalized after surgery, patients are discharged on the day of surgery or within 23 hours. Such early discharge does not adversely affect patient outcomes and has the added benefit...

  7. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    OpenAIRE

    Wong, Jean; Shah, Ushma; Wong, David

    2015-01-01

    Ushma Shah, David T Wong, Jean Wong Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada Abstract: Most surgeries in North America are performed on an ambulatory basis, reducing health care costs and increasing patient comfort. Patient satisfaction is an important outcome indicator of the quality of health care services incorporated by the American Society of Anesthesiologists (ASA). Patient satisfaction is a complex concep...

  8. Urgent Care Facilities, Licensed Healthcare Facilities, Published in 2007, 1:24000 (1in=2000ft) scale, State of California - Office of the State Chief Information Officer.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Urgent Care Facilities dataset, published at 1:24000 (1in=2000ft) scale, was produced all or in part from Published Reports/Deeds information as of 2007. It is...

  9. Examining the role of information exchange in residential aged care work practices-a survey of residential aged care facilities

    Directory of Open Access Journals (Sweden)

    Gaskin Sarah

    2012-08-01

    Full Text Available Abstract Background The provision of residential aged care is underpinned by information, and is reliant upon systems that adequately capture and effectively utilise and communicate this information. The aim of this study was to explicate and quantify the volume and method by which information is collected, exchanged within facilities and with external providers, and retrieved from facility information systems and hospitals. Methods A survey of staff (n = 119, including managers, health informatics officers (HIOs, quality improvement staff, registered nurses (RNs, enrolled nurses (ENs/endorsed enrolled nurses (EENs and assistants in nursing (AINs was carried out in four residential aged care facilities in New South Wales and Victoria, Australia. Sites varied in size and displayed a range of information technology (IT capabilities. The survey investigated how and by whom information is collected, retrieved and exchanged, and the frequency and amount of time devoted to these tasks. Descriptive analysis was performed using SPSS, and open responses to questions were coded into key themes. Results Staff completed a median of six forms each, taking a median of 30 min per shift. 68.8% of staff reported transferring information from paper to a computer system, which took a median of 30 min per shift. Handover and face-to-face communication was the most frequently used form of information exchange within facilities. There was a large amount of faxing and telephone communication between facility staff and General Practitioners and community pharmacists, with staff reporting sending a median of 2 faxes to pharmacy and 1.5 faxes to General Practitioners, and initiating 2 telephone calls to pharmacies and 1.5 calls to General Practitioners per shift. Only 38.5% of respondents reported that they always had information available at the point-of-care and only 35.4% of respondents reported that they always had access to hospital stay information of residents

  10. The use of touch to enhance nursing care of older person in long-term mental health care facilities.

    Science.gov (United States)

    Gleeson, M; Timmins, F

    2004-10-01

    The self-care deficits experienced by older clients in long-term mental health settings, because of cognitive impairment, are likely to impact upon the clients' higher-order needs. The practice of nursing the elderly involves a lot of personal contact, during the delivery of fundamental physical care. While physiological and safety needs are crucial to clients in long-term settings, higher-order needs need also to be addressed. From the clients' perspective nurse's use of touch provides comfort, warmth and security, although there is a dearth of empirical evidence of these benefits. This paper explores the nurse's use of touch, the impact of touch and the experiences of touch on the older person in long-term settings. Because of the dearth of research in the use of touch with elderly clients in long-term care mental health facilities, a review of the literature was performed on the topic. This revealed that touch by nurses is frequently associated with routine tasks within nursing, and is less likely to be a caring touch intervention. Recommendations include further research on the topic and caution with widespread adoption of caring touch as an intervention. PMID:15450020

  11. A comparative cost analysis of polytrauma and neurosurgery Intensive Care Units at an apex trauma care facility in India

    Science.gov (United States)

    Kumar, Parmeshwar; Jithesh, V.; Gupta, Shakti Kumar

    2016-01-01

    Context: Although Intensive Care Units (ICUs) only account for 10% of the hospital beds, they consume nearly 22% of the hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. Aim: The aim of this study was to evaluate and compare the cost of intensive care delivery between multispecialty and neurosurgery ICUs at an apex trauma care facility in India. Materials and Methods: The study was conducted in a polytrauma and neurosurgery ICU at a 203-bedded Level IV trauma care facility in New Delhi, India, from May 1, 2012 to June 30, 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in the study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical Analysis: Statistical analysis was performed by Fisher's two tailed t-test. Results: Total cost/bed/day for the multispecialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU, it was Rs. 14,306.7/-, workforce constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Conclusions: Quantification of expenditure in running an ICU in a trauma center would assist health-care decision makers in better allocation of resources. Although multispecialty ICUs are more cost-effective, other factors will also play a role in defining the kind of ICU that needs to be designed.

  12. Energy management in long-term care facilities: a hot or cold issue?

    Science.gov (United States)

    Smith, H L; Discenza, R

    1981-01-01

    Conservation of energy resources through total energy management programs is receiving considerable attention in the health services sector. Although the total energy management concept has been favorably implemented in hospitals, the record is not entirely clear for other health care institutions. Thirty-one Arizona and 37 Minnesota long-term care facilities were surveyed to examine the attitudes, knowledge and practice of energy management in the nursing home context. Specific questions were directed toward average monthly energy costs, energy consumption, energy conservation methods implemented, energy conservation methods planned for future implementation, and administrator attitudes on the energy management problem. The results of this study indicate that energy is not perceived to be a major problem in long-term care facilities. Administrators generally lack basic knowledge about energy consumption and energy-related characteristics of their facilities. Few long-range plans and programs have been established to address energy problems. These results suggest the need for new energy policies in the health care system, particularly for institutions other than hospitals. PMID:10253193

  13. Preparedness of health care professionals in preventing maternal mortality at a public health facility in Ghana: a qualitative study

    OpenAIRE

    Amu, Hubert; Nyarko, Samuel H.

    2016-01-01

    Background Preparedness of health care professionals for emergency situations is quite indispensable in quality health care; yet, information barely exists on the preparedness of health care professionals for emergency cases in health facilities in Ghana. This study sought to assess the preparedness of health professionals in preventing maternal mortality cases at a public health facility in Ghana. Methods This is a qualitative study that used purposive and convenient sampling techniques to r...

  14. Why Give Birth in Health Facility? Users' and Providers' Accounts of Poor Quality of Birth Care in Tanzania.

    OpenAIRE

    2013-01-01

    Background In Tanzania, half of all pregnant women access a health facility for delivery. The proportion receiving skilled care at birth is even lower. In order to reduce maternal mortality and morbidity, the government has set out to increase health facility deliveries by skilled care. The aim of this study was to describe the weaknesses in the provision of acceptable and adequate quality care through the accounts of women who have suffered obstetric fistula, nurse-midwives at both BEmOC and...

  15. Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda

    Directory of Open Access Journals (Sweden)

    Gertrude Namazzi

    2015-03-01

    Full Text Available Background: In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities. Objective: This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. Design: This health system strengthening study, part of the Uganda Newborn Study (UNEST, aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening. Results: Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with

  16. Elder mistreatment in U.S. residential care facilities: the scope of the problem.

    Science.gov (United States)

    Phillips, Linda R; Guo, Guifang; Kim, Haesook

    2013-01-01

    Many in the United States believe elder mistreatment in long-term care is serious and widespread, but until recently few studies focused on the problem. This study was designed to describe the scope of mistreatment in assisted living facilities (ALFs) in Arizona during a 3-year period. Findings showed that receiving citations for elder mistreatment was relatively rare. However, analysis of narrative reports from only 7% of facilities showed 598 allegations of mistreatment in complaint investigations, of which 372 (62.2%) were substantiated and given citations for something other than mistreatment. Results show that elder mistreatment in ALFs is seriously underidentified, even by state inspectors.

  17. Long-term care and hospital collaboration. To survive in a reformed healthcare system, long-term care facilities can initiate hospital-based SNFs.

    Science.gov (United States)

    Hume, S K

    1993-06-01

    Establishing relationships with hospitals may be critical for long-term care facilities facing financial pressures and uncertain futures. One option is to initiate collaborative efforts to develop hospital-based skilled nursing facilities (SNFs). Hospitals, under pressure to move patients to less intensive settings and to diversify, are naturally drawn to long-term care as a related business where they can make limited personnel and financial commitments and extend their continuum of care. Before approaching hospitals to initiate collaborative efforts, long-term care providers should understand how they think and what their strengths and weaknesses are. Long-term and acute care providers have many options for collaboration, including management contracts and joint ventures. In a traditional management contract, the long-term care provider furnishes the administrator and a few key staff in exchange for direct reimbursement for those staff plus a management fee. Another option is for the long-term care facility to provide all the staff for a fee or percentage of revenue. Joint venture options are to form a subsidiary corporation to renovate a floor of the hospital or to have the hospital buy a large percentage of the long-term care facility and share the profits. All these options have potential pitfalls, including differing financial expectations and the threat of unionization at the SNF. Nevertheless, for long-term care facilities struggling under reimbursement cutbacks and other pressures, the benefits may outweigh the risks.

  18. Biomedical Wireless Ambulatory Crew Monitor

    Science.gov (United States)

    Chmiel, Alan; Humphreys, Brad

    2009-01-01

    A compact, ambulatory biometric data acquisition system has been developed for space and commercial terrestrial use. BioWATCH (Bio medical Wireless and Ambulatory Telemetry for Crew Health) acquires signals from biomedical sensors using acquisition modules attached to a common data and power bus. Several slots allow the user to configure the unit by inserting sensor-specific modules. The data are then sent real-time from the unit over any commercially implemented wireless network including 802.11b/g, WCDMA, 3G. This system has a distributed computing hierarchy and has a common data controller on each sensor module. This allows for the modularity of the device along with the tailored ability to control the cards using a relatively small master processor. The distributed nature of this system affords the modularity, size, and power consumption that betters the current state of the art in medical ambulatory data acquisition. A new company was created to market this technology.

  19. Cost Effectiveness of Facility-Based Care, Home-Based Care and Mobile Clinics for Provision of Antiretroviral Therapy in Uganda

    OpenAIRE

    Babigumira, Joseph B; Sethi, Ajay K.; Smyth, Kathleen A.; Singer, Mendel E.

    2009-01-01

    Background: Stakeholders in HIV/AIDS care currently use different programmes for provision of antiretroviral therapy (ART) in Uganda. It is not known which of these represents the best value for money. Objective: To compare the cost effectiveness of home-based care (HBC), facility-based care (FBC) and mobile clinic care (MCC) for provision of ART in Uganda. Methods: Incremental cost-effectiveness analysis was performed using decision and Markov modeling of adult AIDS patients in WHO Clinical ...

  20. Diagnosis and treatment of headache in the ambulatory care setting: a review of classic presentations and new considerations in diagnosis and management.

    Science.gov (United States)

    Hale, Natalie; Paauw, Douglas S

    2014-05-01

    Headaches represent the most common constellation of neurologic disorders and are a very common cause of morbidity, lost work time, and decreased quality of life among sufferers. In this article, the diagnostic features, workup, and treatment of common, nuanced, and difficult-to-diagnose headache conditions were addressed. The future will hold a number of changes, with respect to both the diagnosis and treatment of headache disorders. As the aging population continues to grow, primary care providers will need to become increasingly familiar with differentiating between benign primary and more serious secondary headache disorders and will need to be able to treat the headache disorders unique to the elderly. With respect to therapeutic options, the future for treatment of the various headache disorders is promising. With the rise in popularity of complementary medical practices, there is likely to be more research on the roles of acupuncture, herbal and alternative remedies, massage therapy, and mind-body techniques. Further, new research is suggesting that neurostimulation may be useful in certain chronic, intractable headache conditions. Finally, the pathophysiology of headache disorders is still poorly understood and there is great hope that better understanding of the underlying mechanics of headache might contribute to improved treatment modalities and better quality of life for patients. PMID:24758958

  1. Quality of care and its determinants in longer term mental health facilities across Europe; a cross-sectional analysis

    NARCIS (Netherlands)

    Killaspy, Helen; Cardoso, Graca; White, Sarah; Wright, Christine; Caldas de Almeida, Jose Miguel; Turton, Penny; Taylor, Tatiana L.; Schuetzwohl, Matthias; Schuster, Mirjam; Cervilla, Jorge A.; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Adamowski, Tomasz; Ploumpidis, Dimitris; Gonidakis, Fragiskos; King, Michael

    2016-01-01

    Background: The Quality Indicator for Rehabilitative Care (QuIRC) is an international, standardised quality tool for the evaluation of mental health facilities that provide longer term care. Completed by the service manager, it comprises 145 items that assess seven domains of care: living environmen

  2. Prevalence of type 2 diabetes mellitus in elderly in a primary care facility: An ideal facility

    Directory of Open Access Journals (Sweden)

    Archana Jain

    2013-01-01

    Full Text Available In 2011 census, 5.3% of the Indian population was > 65 years of age. This number has steadily grown over past few years and is steeply growing. Healthcare burden of elderly diabetics is immense and proper diagnosis and treatment alone can prevent further complications. According to the most recent surveillance data in U.S., the prevalence of diabetes among U.S. adults aged ≥65 years varies from 22 to 33%, depending on the diagnostic criteria used. In CSIR-NEERI, India, we have healthcare system wherein a fixed and limited number of patients are treated for their lifetime by qualified practitioners with negligible financial burden of the treatment costs. The patients have regular monthly follow up and hence we diagnose Diabetes and evaluate the control and diagnose micro vascular and macro vascular complications in all patients. We did retrospective analysis of all elderly patients following up in NEERI Hospital to find the exact prevalence of T2DM in elderly. It was observed that from total 585 elderly people, 178 had T2DM (30.42%- Prevalence.The sex ratio of Diabetic males to females was almost equal (1:0.97.Obesity was present in 114 people (64%.High prevalence of hypertension was found in Diabetic elderly population (80%. Comparing our prevalence rates with few other studies, it was found that our prevalence rates are quite high. The contributing factors may be urban living, with high prevalence of central obesity and Asian ethnicity, over and above, data of all patients undergoing treatment is available. We treated all diabetics with persistent values of Systolic BP > 130 mm of Hg and Diastolic values of BP > 80mm of Hg as Hypertensives, in order to achieve reduction in cardiovascular mortality and morbidity. This paper is for awareness of disease burden, in real primary care setup. It is not cross-sectional study but study with 100% inclusion of beneficiaries′. This is real world urban diabetes prevalence, also associated hypertension

  3. Horizontal equity and efficiency at primary health care facilities in rural Afghanistan: a seemingly unrelated regression approach.

    Science.gov (United States)

    Johns, Benjamin; Steinhardt, Laura; Walker, Damian G; Peters, David H; Bishai, David

    2013-07-01

    Producing services efficiently and equitably are important goals for health systems. Many countries pursue horizontal equity - providing people with the same illnesses equal access to health services - by locating facilities in remote areas. Staff are often paid incentives to work at such facilities. However, there is little evidence on how many fewer people are treated at remote facilities than facilities in more densely settled areas. This research explores if there is an association between the efficiency of health centers in Afghanistan and the remoteness of their location. Survey teams collected data on facility level inputs and outputs at a stratified random sample of 579 health centers in 2005. Quality of care was measured by observing staff interact with patients and determining if staff completed a set of normative patient care tasks. We used seemingly unrelated regression to determine if facilities in remote areas have fewer outpatient visits than other rural facilities. In this analysis, one equation compares the number of outpatient visits to facility inputs, while another compares quality of care to determinants of quality. The results indicate remote facilities have about 13% fewer outpatient visits than non-remote facilities, holding inputs constant. Our analysis suggests that facilities in remote areas are realizing horizontal equity since their clients are receiving comparable quality of care to those at non-remote facilities. However, we find the average labor cost for a visit at a remote facility is $1.44, but only $0.97 at other rural facilities, indicating that a visit in a remote facility would have to be 'worth' 1.49 times a visit at a rural facility for there to be no equity - efficiency trade-off. In determining where to build or staff health centers, this loss of efficiency may be offset by progress toward a social policy objective of providing services to disadvantaged rural populations. PMID:23726212

  4. A comparative study of ADL at home and at care facilities : differences between system of elderly daycare administration

    OpenAIRE

    Mitsumura, Mika; Someya, Fujiko

    2011-01-01

    [Purpose] In elderly daycare facilities, services are provided according to independence support, which is the basic philosophy of Long-Term Care Insurance, to maintain and improve the user s activities of daily living (ADL). However, the efforts aimed at independence support and methods of service vary from facility to facility. In this study, we examined the relationship between the administrations system of the facilities and the user s independence of ADL, comparing two typ...

  5. Using the balanced scorecard to align strategy and performance in long-term care.

    Science.gov (United States)

    Macdonald, M

    1998-01-01

    The Sisters of Charity of Ottawa Health Service (SCOHS) is a Canadian health care corporation that has adapted Kaplan and Norton's balanced scorecard to enhance strategic management and measurement in a multisite health care facility comprising long term care, continuing complex care, rehabilitative services, palliative care and ambulatory care. This article discusses how the SCOHS has incorporated the following principles into the balanced scorecard: demonstration of cause and effect; inclusion of outcomes and performance drivers; linkage to fiscal and utilization indicators; and integration of the mission and values of the organization. Examples of corporate level outcomes and performance measures are provided in the form of lead and lag indicators. PMID:10187659

  6. A CROSS SECTIONAL STUDY ON CHOICE OF HEALTH CARE FACILITY IN RURAL AREAS OF KRISHNA DISTRICT

    Directory of Open Access Journals (Sweden)

    Madhavi

    2014-03-01

    Full Text Available BACKGROUND: Government is trying to deliver health services to as many numbers of people as possible. The extent to which these health services are utilized by the public is to be estimated. OBJECTIVES: 1. to study the extent of utilization of health services in rural areas of Krishna district. 2. To study the factors influencing the utilization of health services in Krishna district. SAMPLE SIZE: 600, calculated by the formula, 4pq/ L.2 STUDY DESIGN: Cross sectional, descriptive. METHODOLOGY: thirty rural clusters are randomly selected and 20 adults from each cluster are interviewed. STATISTICAL ANALYSIS: percentages. RESULTS: 1. Utilization of services from private health care facility is more. 2. People are utilizing services from private health care facility due to belief in doctor.

  7. Indicadores da qualidade dos registros e da assistência ambulatorial em Maringá, (estado do Paraná, Brasil, 1991: um exercício de avaliação Indicators of quality for medical records and ambulatory care in Maringá (state of Paraná, Brazil, 1991: an exercise in evaluation

    Directory of Open Access Journals (Sweden)

    Maria José Scochi

    1994-09-01

    Full Text Available Buscou-se indicadores de qualidade da assistência passíveis de análise a partir de registros rotineiros na rede ambulatorial de serviços de saúde da Secretaria Municipal de Saúde de Maringá, Paraná (Brasil. Foram avaliados os atendimentos realizados em três Núcleos Integrados de Saúde (NIS com o objetivo de verificar se o que foi registrado permite a formulação de indicadores de qualidade. Pesquisou-se todos os prontuários dos 7.813 pacientes atendidos durante o mês de outubro de 1991. Foram formulados indicadores de qualidade de registro, procedência da clientela, demanda, cobertura e resolutividade por unidade de saúde. Em 49,7% dos prontuários, as hipóteses diagnósticas (HD estavam ausentes e em 14,8% haviam HD ilegíveis; 78% dos atendimentos foram destinados a moradores que residiam na área de abrangência das unidades; a cobertura de gestantes foi baixa 37%; 70% das crianças menores de um ano da comunidade foram atendidas no mês, e as pessoas atendidas tiveram em média três consultas médicas no ano precedente, 4,3% dos prontuários dos usuários atendidos apresentava registro de encaminhamentos para outros serviços. Os prontuários nestes três núcleos funcionam precariamente como fonte de informação, tanto para uso interno como para avaliação. Apesar destas insuficiências foi possível extrair alguns indicadores de qualidade, sendo necessário, melhoras significativas na qualidade do preenchimento, para sustentar avaliações mais aprofundadas.This study sought to establish health-care quality indicators based on data from routine clinical records produced by the Municipal Health Department in Maringá, Paraná State. Records for 7813 patients seen in the month of October 1991 at three Integrated Health Centers (IHC were assessed to determine whether the recorded information allowed for the formulation of quality indicators. Indicators of data quality, demand, coverage, resolubility, and geographic

  8. Diabetes management in Australian rural aged care facilities: A cross-sectional audit

    Directory of Open Access Journals (Sweden)

    Hanan Khalil

    2012-11-01

    Full Text Available AbstractBackground There is gap in the literature regarding the current practice of diabetes management of the elderly in Australia and its compliance with available Australian diabetes practice guidelines. Aims The aims of this study were to describe the pharmacological management of elderly residents with diabetes living in aged care facilities and to identify areas for improvement in the current management as recommended by the current diabetes management guidelines in Australia. Method Residents with diabetes from three rural aged care facilities were identified by nursing staff. A cross-sectional medical record audit was carried out to obtain data of residents diagnosed with diabetes. Thirty-four medical records were audited from three aged care facilities. Data including demographics, medical histories and medications were collected and analysed Results This study had two key findings; Firstly, it showed that about a third of residents with type 2 diabetes are managed with diet only. Secondly, of the residents who are managed with medications, less than half of those audited (41% were managed according to the current diabetes guidelines in terms of pharmacological treatment which included anti- hypertensive, lipid lowering and anti- platelet therapies. Of those patients with a history of CVD, all were receiving an antihypertensive medication, 71% were not managed for their lipids and 20% were not on any prophylactic anti-platelet therapy. Conclusion Management of patients with diabetes living in rural aged care facilities is inconsistent with the current management guidelines. Educational interventions targeting health professionals and patients might be beneficial to increase compliance with the current diabetes guidelines.

  9. How gender is born in a diagnostic child-care facility

    OpenAIRE

    Jana Benešová

    2014-01-01

    The article is a summary of the main findings concerning (re)construction of the gender identities of children placed in a contemporary diagnostic child-care facility in the Czech Republic. The research setting has the fictitious name DDÚ Archa. The author of the arcticle is summarizing the interim results from her Ph.D. dissertation project. The goal is to catch processes which have been neglected so far by the Czech professional community, and which may become potential disciplinary tools i...

  10. Long-term care facilities for the elderly: from legislation to needs

    OpenAIRE

    Ezequiel Vitório Lini; Marilene Rodrigues Portella; Marlene Doring; Maria Izabel Penha de Oliveira Santos

    2016-01-01

    Objective: to analyze existing federal legislation on public policies that deal with the elderly’s rights, with emphasis on the assistance provided in long-term care facilities for the elderly and the practical impact of these laws. Methods: this is a documentary analysis of descriptive character. Results: one identified, among nineteen laws, decrees and ordinances in the last 25 years, significant developments aimed at the elderly’s welfare, as well as structural proposals and the supervisio...

  11. Geographic accessibility around health care facilities for elderly residents in Hong Kong: a microscale walkability assessment

    OpenAIRE

    LOO, Becky P.Y.; Winnie Wing Yee Lam

    2012-01-01

    An ageing population poses various challenges to a society. Improvements in the medical system and the transportation network are both needed to maintain and to improve the quality of life of the elderly population. In this study we first analyze the travel patterns of elderly residents to health care facilities (HCFs) in Hong Kong. Then, we focus on elderly residents walking to and from major transit stops and on a major HCF for elderly residents as a case study. In particular, a microscale ...

  12. Patients' priorities for ambulant hospital care centres: a survey and discrete choice experiment among elderly and chronically ill patients of a Dutch hospital.

    NARCIS (Netherlands)

    Albada, A.; Triemstra, M.

    2009-01-01

    Objective: This study established patients' preferences regarding the facilities in an adjacent centre for ambulatory hospital care. It also identified determinants of patients' choice to visit this centre instead of the regional hospital. Methods: A questionnaire survey among 1477 elderly and chron

  13. Challenges Associated With Managing Suicide Risk in Long-Term Care Facilities

    Science.gov (United States)

    O'Riley, Alisa; Nadorff, Michael R.; Conwell, Yeates; Edelstein, Barry

    2016-01-01

    Little information about suicidal ideation and behavior in long-term care (LTC) facilities is available. Nonetheless, the implementation of the Minimum Data Set 3.0 requires that LTC facilities screen their residents for suicide risk and have protocols in place to effectively manage residents’ responses. In this article, the authors briefly discuss the risk factors of suicide in the elderly and the problems that suicidal ideation and behavior pose in the LTC environment. The authors explain issues that arise when trying to manage suicide risk in the elderly LTC population with general, traditional approaches. These inherent issues make it difficult to develop an effective protocol for managing suicide risk in LTC facilities, leading the authors to propose their own framework for assessing and managing suicide risk in the LTC setting.

  14. EURO-CARES: European Roadmap for a Sample Return Curation Facility and Planetary Protection Implications.

    Science.gov (United States)

    Brucato, John Robert

    2016-07-01

    A mature European planetary exploration program and evolving sample return mission plans gathers the interest of a wider scientific community. The interest is generated from studying extraterrestrial samples in the laborato-ry providing new opportunities to address fundamental issues on the origin and evolution of the Solar System, on the primordial cosmochemistry, and on the nature of the building blocks of terrestrial planets and on the origin of life. Major space agencies are currently planning for missions that will collect samples from a variety of Solar Sys-tem environments, from primitive (carbonaceous) small bodies, from the Moon, Mars and its moons and, final-ly, from icy moons of the outer planets. A dedicated sample return curation facility is seen as an essential re-quirement for the receiving, assessment, characterization and secure preservation of the collected extraterrestrial samples and potentially their safe distribution to the scientific community. EURO-CARES is a European Commission study funded under the Horizon-2020 program. The strategic objec-tive of EURO-CARES is to create a roadmap for the implementation of a European Extraterrestrial Sample Cu-ration Facility. The facility has to provide safe storage and handling of extraterrestrial samples and has to enable the preliminary characterization in order to achieve the required effectiveness and collaborative outcomes for the whole international scientific community. For example, samples returned from Mars could pose a threat on the Earth's biosphere if any living extraterrestrial organism are present in the samples. Thus planetary protection is an essential aspect of all Mars sample return missions that will affect the retrival and transport from the point of return, sample handling, infrastructure methodology and management of a future curation facility. Analysis of the state of the art of Planetary Protection technology shows there are considerable possibilities to define and develop

  15. Drug usage review sample studies in long-term care facilities.

    Science.gov (United States)

    Stewart, J E; Kabat, H F; Wertheimer, A I

    1976-02-01

    The usage of 10 drugs in five long-term care facilities was reviewed to evaluate the effectiveness of a five-step systematic method of drug usage review. Medical care evaluation sample studies are required under the Medicare and Medicaid programs, and drug usage review sample studies may satisfy this requirement. The five-step method involved selection of the health problem to be studied; development of criteria of care; measurement of specific performance data and comparison with the criteria; establishment of the audit committee evaluation process; and design and implementation of educational activities. In each facility, data were collected on abstract sheets designed to indicate when a patient's drug usage did not conform to criteria established by a committee of health professionals. Incidents of nonconformance were then examined. The largest number of exceptions to the criteria related to monitoring the effectiveness of drug therapy. Data by drug revealed higher nonconformance rates for digoxin, hydrochlorothiazide, methyldopa and thioridazine. A small number of exceptions was found in drug administration, indicating that the patients were receiving medications as ordered and that few errors were made in transcribing. This systematic approach to identifying drug usage patterns can be used by pharmacists to coordinate sample studies and to fulfill their consultant role in long-term facilities required by federal regulations. PMID:816197

  16. Interprofessional education in aged-care facilities: Tensions and opportunities among undergraduate health student cohorts.

    Science.gov (United States)

    Annear, Michael; Walker, Kim; Lucas, Peter; Lo, Amanda; Robinson, Andrew

    2016-09-01

    This article examines the reflective discourses of medical, nursing, and paramedic students participating in interprofessional education (IPE) activities in the context of aged-care clinical placements. The intent of the research is to explore how students engage with their interprofessional colleagues in an IPE assessment and care planning activity and elucidate how students configure their role as learners within the context of a non-traditional aged-care training environment. Research participants included cohorts of volunteer medical (n = 61), nursing (n = 46), and paramedic (n = 20) students who were on clinical placements at two large teaching aged-care facilities in Tasmania, Australia, over a period of 18 months. A total of 39 facilitated focus group discussions were undertaken with cohorts of undergraduate student volunteers from three health professions between February 2013 and October 2014. Thematic analysis of focus group transcripts was assisted by NVIVO software and verified through secondary coding and member checking procedures. With an acceptable level of agreement across two independent coders, four themes were identified from student focus group transcripts that described the IPE relations and perceptions of the aged-care environment. Emergent themes included reinforcement of professional hierarchies, IPE in aged care perceived as mundane and extraneous, opportunities for reciprocal teaching and learning, and understanding interprofessional roles. While not all students can be engaged with IPE activities in aged care, our evidence suggests that within 1 week of clinical placements there is a possibility to develop reciprocal professional relations, affirm a positive identity within a collaborative healthcare team, and support the health of vulnerable older adults with complex care needs. These important clinical learnings support aged-care-based IPE as a potentially powerful context for undergraduate learning in the 21st Century.

  17. An analysis of risk factors and adverse events in ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Kent C

    2014-06-01

    Full Text Available Christopher Kent, Julia Metzner, Laurent BollagDepartment of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USAAbstract: Care for patients undergoing ambulatory procedures is a broad and expanding area of anesthetic and surgical practice. There were over 35 million ambulatory surgical procedures performed in the US in 2006. Ambulatory procedures are diverse in both type and setting, as they span the range from biopsies performed under local anesthesia to intra-abdominal laparoscopic procedures, and are performed in offices, freestanding ambulatory surgery centers, and ambulatory units of hospitals. The information on adverse events from these varied settings comes largely from retrospective reviews of sources, such as quality-assurance databases and closed malpractice claims. Very few if any ambulatory procedures are emergent, and in comparison to the inpatient population, ambulatory surgical patients are generally healthier. They are still however subject to most of the same types of adverse events as patients undergoing inpatient surgery, albeit at a lower frequency. The only adverse events that could be considered to be unique to ambulatory surgery are those that arise out of the circumstance of discharging a postoperative patient to an environment lacking skilled nursing care. There is limited information on these types of discharge-related adverse events, but the data that are available are reviewed in an attempt to assist the practitioner in patient selection and discharge decision making. Among ambulatory surgical patients, particularly those undergoing screening or cosmetic procedures, expectations from all parties involved are high, and a definition of adverse events can be expanded to include any occurrence that interrupts the rapid throughput of patients or interferes with early discharge and optimal patient satisfaction. This review covers all types of adverse events, but focuses on the more

  18. Management of comorbidities in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Dabu-Bondoc S

    2015-06-01

    Full Text Available Susan Dabu-Bondoc, Kirk Shelley Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, USAAbstract: Advances in medical science now allow people with significant medical issues to live at home. As the outpatient population ages and surgical techniques advance, the ambulatory anesthesiologist has to be prepared to handle these “walking wounded”. The days of restricting ambulatory surgery procedures to American Society of Anesthesiologists class 1 and 2 patients are rapidly fading into the past. To remain competitive and economically viable, the modern ambulatory surgery center needs to expand its practice to include patients with medical comorbidities. In an environment where production and economic pressures exist, maintaining safety and good outcomes in high-risk patients for ambulatory surgery can be arduous. Adding to the complexity of this challenge is the rapid evolution of the therapeutic approaches to a variety of medical issues. For example, there has been a significant increase in the number and types of insulin a diabetic patient might be prescribed in recent years. In the case of the patient with coronary artery disease, the variety of both drug and nondrug eluding stents or new antithrombotic agents has also increased the complexity of perioperative management. Complex patients need careful, timely, and team-based preoperative evaluation by an anesthesia provider who is knowledgeable of outpatient care. Optimizing comorbidities preoperatively is a crucial initial step in minimizing risk. This paper will examine a number of common medical issues and explore their impact on managing outpatient surgical procedures.Keywords: ambulatory surgery, medical comorbidities, diabetes, coronary artery disease, respiratory disease, obesity

  19. Health system support and health system strengthening: two key facilitators to the implementation of ambulatory tuberculosis treatment in Uzbekistan.

    Science.gov (United States)

    Kohler, Stefan; Asadov, Damin Abdurakhimovich; Bründer, Andreas; Healy, Sean; Khamraev, Atadjan Karimovich; Sergeeva, Natalia; Tinnemann, Peter

    2015-12-01

    Uzbekistan inherited a hospital-based health system from the Soviet Union. We explore the health system-related challenges faced during the scale-up of ambulatory (outpatient) treatment for drug-susceptible and drug-resistant tuberculosis (TB) in Karakalpakstan in Uzbekistan. Semi-structured interviews were conducted with key informants of the TB services, the ministries of health and finance, and their TB control partners. Structural challenges and resource needs were both discussed as obstacles to the expansion of ambulatory TB treatment. Respondents stated need for revising the financing mechanisms of the TB services to incentivize referral to ambulatory TB treatment. An increased workload and need for transportation in ambulatory TB care were also pointed out by respondents, given the quickly rising outpatient numbers but per capita financing of outpatient care. Policy makers showed strong interest in good practice examples for financing ambulatory-based management of TB in comparable contexts and in guidance for revising the financing of the TB services in a way that strengthens ambulatory TB treatment. To facilitate changing the model of care, TB control strategies emphasizing ambulatory care in hospital-oriented health systems should anticipate health system support and strengthening needs, and provide a plan of action to resolve both. Addressing both types of needs may require not only involving TB control and health financing actors, but also increasing knowledge about viable and tested financing mechanisms that incentivize the adoption of new models of care for TB. PMID:27406392

  20. The Influence of Organizational Systems on Information Exchange in Long-Term Care Facilities: An Institutional Ethnography.

    Science.gov (United States)

    Caspar, Sienna; Ratner, Pamela A; Phinney, Alison; MacKinnon, Karen

    2016-06-01

    Person-centered care is heavily dependent on effective information exchange among health care team members. We explored the organizational systems that influence resident care attendants' (RCAs) access to care information in long-term care (LTC) settings. We conducted an institutional ethnography in three LTC facilities. Investigative methods included naturalistic observations, in-depth interviews, and textual analysis. Practical access to texts containing individualized care-related information (e.g., care plans) was dependent on job classification. Regulated health care professionals accessed these texts daily. RCAs lacked practical access to these texts and primarily received and shared information orally. Microsystems of care, based on information exchange formats, emerged. Organizational systems mandated written exchange of information and did not formally support an oral exchange. Thus, oral information exchanges were largely dependent on the quality of workplace relationships. Formal systems are needed to support structured oral information exchange within and between the microsystems of care found in LTC. PMID:26758177

  1. Urgent Care Facilities, DPH, Published in 2007, 1:24000 (1in=2000ft) scale, Massachusetts Emergency Managment Agency.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Urgent Care Facilities dataset, published at 1:24000 (1in=2000ft) scale, was produced all or in part from Orthoimagery information as of 2007. It is described...

  2. Three Genome Sequences of Legionella pneumophila subsp. pascullei Associated with Colonization of a Health Care Facility.

    Science.gov (United States)

    Kozak-Muiznieks, Natalia A; Morrison, Shatavia S; Sammons, Scott; Rowe, Lori A; Sheth, Mili; Frace, Michael; Lucas, Claressa E; Loparev, Vladimir N; Raphael, Brian H; Winchell, Jonas M

    2016-01-01

    Here, we report the complete genome sequences of three Legionella pneumophila subsp. pascullei strains (including both serogroup 1 and 5 strains) that were found in the same health care facility in 1982 and 2012. PMID:27151801

  3. Improving kidney care for residents in nursing facilities: a national model.

    Science.gov (United States)

    Neumann, Mark E

    2016-02-01

    The RRC Staff Assisted Home Hemodialysis Program started in September 2013 with the target of improving care for the frail elderly residents in skilled facilities by offering hemodialysis in their home setting. Residents all receive short time, frequent dialysis. The residents no longer need to be transported to a local dialysis center three times per week in all types of weather and subject to long waits by the transport company. In addition, Medicare/Medicaid save significant dollars on transportation expenses. Residents needing rehabilitation services can receive their therapy while their dialysis schedule is adjusted around the resident's therapy. Residents no longer miss meals and medications or family visits. Collaboration between RRC and the skilled facility is patient centric whereby the care of each patient is consistent and individualized. The most meaningful measure of the success of this program is the residents themselves. They have self-reported how much better they feel with more energy. The residents can increase their socialization activities within the skilled facility. The dietitians report that the residents are eating better because there are fewer restrictions on foods and fluids. PMID:26983182

  4. Carbapenem-Resistant Enterobacteriaceae Transmission in Health Care Facilities - Wisconsin, February-May 2015.

    Science.gov (United States)

    Elbadawi, Lina I; Borlaug, Gwen; Gundlach, Kristin M; Monson, Timothy; Warshauer, David; Walters, Maroya S; Kallen, Alexander; Gulvik, Christopher A; Davis, Jeffrey P

    2016-01-01

    Carbapenem-resistant Enterobacteriaceae (CRE) are multidrug-resistant gram-negative bacilli that can cause infections associated with high case fatality rates, and are emerging as epidemiologically important health care-associated pathogens in the United States (1). Prevention of CRE transmission in health care settings is dependent on recognition of cases, isolation of colonized and infected patients, effective use of infection control measures, and the correct use of antibiotics. The use of molecular technologies, including polymerase chain reaction (PCR) testing, pulsed-field gel electrophoresis (PFGE), and whole genome sequencing (WGS), can lead to detection of transmission events and interruption of transmission. In Wisconsin, acute care and critical access hospitals report laboratory-identified CRE to the Wisconsin Division of Public Health (WDPH), and clinical laboratories submit CRE isolates to the Wisconsin State Laboratory of Hygiene (WSLH) for molecular testing. During February-May 2015, a total of 49 CRE isolates from 46 patients were submitted to WSLH. On June 8, WSLH informed WDPH of five carbapenemase-producing CRE isolates with closely related PFGE patterns identified among four inpatients at two hospitals in southeastern Wisconsin. An investigation revealed a high degree of genetic relatedness among the patients' isolates, but did not identify the mechanism of transmission between the two facilities. No breaches in recommended practices were identified; after reviewing respiratory care procedures, no further cases were identified. Routine hospital- and laboratory-based surveillance can detect and prevent health care transmission of CRE. PMID:27584864

  5. Respecting your rights : a guide to the rights of people living in British Columbia long term care facilities

    OpenAIRE

    Spencer, Charmaine; Beck, Mary

    2003-01-01

    This booklet answers common questions about living in care facilities (including intermediate-, multi-level-, private-, and extended care facilities).Table of Contents: Introduction. 1. Your Right to Be Treated with Dignity and Respect: Your right to be treated as an adult; Your right to be treated with respect; Your right to be treated as a person capable of making your own decisions. 2. Your Right to Personal Choices: Your right to personal lifestyle choices; Your right to choices about you...

  6. Social and cultural dimensions of hygiene in Cambodian health care facilities

    Directory of Open Access Journals (Sweden)

    Faurand-Tournaire Anne-Laure

    2011-02-01

    Full Text Available Abstract Background The frequency of bloodborne pathogen healthcare-associated infections is thought to be high in developing Southeast Asian Countries. The underlying social-cultural logics contributing to the risks of transmission are rarely studied. This report provides some insights on the social and cultural factors that shape hygiene practices in Cambodian health care settings. Methods We conducted qualitative surveys in various public and private health facilities in Phnom Penh, the capital city and in provinces. We observed and interviewed 319 participants, health care workers and patients, regarding hygiene practices and social relationships amongst the health care staff and with patients. We also examined the local perceptions of hygiene, their impact on the relationships between the health care staff and patients, and perceptions of transmission risks. Data collection stem from face to face semi-structured and open-ended interviews and focus group discussions with various health care staffs (i.e. cleaners, nurses, midwives and medical doctors and with patients who attended the study health facilities. Results Overall responses and observations indicated that hygiene practices were burdened by the lack of adequate materials and equipements. In addition, many other factors were identified to influence and distort hygiene practices which include (1 informal and formal social rapports in hospitals, (2 major infection control roles played by the cleaners in absence of professional acknowledgment. Moreover, hygiene practices are commonly seen as an unessential matter to be devoted to low-ranking staff. Conclusion Our anthropological findings illustrate the importance of comprehensive understanding of hygiene practices; they need to be considered when designing interventions to improve infection control practices in a Cambodian medical setting.

  7. Impact of resistance training on sarcopenia in nursing care facilities: A pilot study.

    Science.gov (United States)

    Hassan, Bothaina H; Hewitt, Jennifer; Keogh, Justin W L; Bermeo, Sandra; Duque, Gustavo; Henwood, Tim R

    2016-01-01

    The impact of progressive resistance training on sarcopenia among very old institutionalized adults was investigated. Residents of Nursing Care Facilities were included in a controlled trial of twice weekly resistance and balance exercise program for six months (Age: 85.9 ± 7.5 years, Time in care: 707.1 ± 707.5 days, N = 21 per group). Sarcopenia was measured based on the European Working Group on Sarcopenia in Older People criteria. Of the recruited 42 participants, 35.7% had sarcopenia at baseline, with prevalence increasing in the control group post-intervention (42.9%-52.4%). Following training, the exercise group experienced a significant increase in grip strength when compared to controls (p = .02), and a within-group decrease in body mass index and increase in grip strength (p ≤ .007). Resistance and balance exercise has positive benefits for older adults residing in a nursing care facilities which may transfer to reduce disability and sarcopenia transition, but more work is needed to ensure improved program uptake among residents. PMID:26694694

  8. Relationship between professional antenatal care and facility delivery: an assessment of Colombia.

    Science.gov (United States)

    Trujillo, Juan C; Carrillo, Bladimir; Iglesias, Wilman J

    2014-07-01

    The determinants of maternal and child health have been the recurrent topics of study in developing countries. Using the Demographic and Health Survey (2010) of Colombia, this study aimed to identify the determinants for professional antenatal care and institutional delivery, taking into account the interdependence of these two decisions, which we consider using a bivariate probit model. This study found that when certain factors affecting both the decision to seek prenatal care and giving birth in a hospital are neglected, the results of the estimates are inefficient. Estimates show that the effects of education, parity, regional location and economic status on institutional delivery tend to be underestimated in a univariate probit model. The results indicate that economic status, level of education, parity and medical-insurance affiliation influenced the joint likelihood of accessing professional antenatal care and delivering in a health facility. An important finding is that mothers with a higher level of education are 9 percentage points more likely to access these two health services compared with mothers who are illiterate. Another observed finding is the regional disparities. The evidence indicates that mothers in the Pacific Region, the poorest region of Colombia, are 6 percentage points less likely to access such services. Thus, the results indicate that the Colombian health policy should emphasize increasing the level of schooling of mothers and establish health facilities in the poorest regions of the country to ensure that women in need are provided with social health insurance. PMID:23735737

  9. Characteristics of ambulatory anticoagulant adverse drug events: a descriptive study

    Directory of Open Access Journals (Sweden)

    Eckstrand Julie

    2010-02-01

    Full Text Available Abstract Background Despite the high frequency with which adverse drug events (ADEs occur in outpatient settings, detailed information regarding these events remains limited. Anticoagulant drugs are associated with increased safety concerns and are commonly involved in outpatient ADEs. We therefore sought to evaluate ambulatory anticoagulation ADEs and the patient population in which they occurred within the Duke University Health System (Durham, NC, USA. Methods A retrospective chart review of ambulatory warfarin-related ADEs was conducted. An automated trigger surveillance system identified eligible events in ambulatory patients admitted with an International Normalized Ratio (INR >3 and administration of vitamin K. Event and patient characteristics were evaluated, and quality/process improvement strategies for ambulatory anticoagulation management are described. Results A total of 169 events in 167 patients were identified from December 1, 2006-June 30, 2008 and included in the study. A median supratherapeutic INR of 6.1 was noted, and roughly half of all events (52.1% were associated with a bleed. Nearly 74% of events resulted in a need for fresh frozen plasma; 64.8% of bleeds were classified as major. A total of 59.2% of events were at least partially responsible for hospital admission. Median patient age was 68 y (range 36-95 y with 24.9% initiating therapy within 3 months prior to the event. Of events with a prior documented patient visit (n = 157, 73.2% were seen at a Duke clinic or hospital within the previous month. Almost 80% of these patients had anticoagulation therapy addressed, but only 60.0% had a follow-up plan documented in the electronic note. Conclusions Ambulatory warfarin-related ADEs have significant patient and healthcare utilization consequences in the form of bleeding events and associated hospital admissions. Recommendations for improvement in anticoagulation management include use of information technology to assist

  10. How gender is born in a diagnostic child-care facility

    Directory of Open Access Journals (Sweden)

    Jana Benešová

    2014-11-01

    Full Text Available The article is a summary of the main findings concerning (reconstruction of the gender identities of children placed in a contemporary diagnostic child-care facility in the Czech Republic. The research setting has the fictitious name DDÚ Archa. The author of the arcticle is summarizing the interim results from her Ph.D. dissertation project. The goal is to catch processes which have been neglected so far by the Czech professional community, and which may become potential disciplinary tools in the hands of professionals in a wide range of helping professions, including social and special pedagogy.

  11. Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

    DEFF Research Database (Denmark)

    Niwata, Satoko; Yamada, Yukari; Ikegami, Naoki

    2006-01-01

    conducted a retrospective cross-sectional study in 17 Japanese long-term care (LTC) facilities by collecting data from the comprehensive MDS assessment forms for 1669 patients aged 65 years and over who were assessed between January and July of 2002. Potentially inappropriate medications were identified...... dependent on the disease or condition was found in patients with chronic constipation. Multiple logistic regression analysis revealed psychotropic drug use (OR = 1.511), medication cost of per day (OR = 1.173), number of medications (OR = 1.140), and age (OR = 0.981) as factors related to inappropriate...

  12. Fluoroquinolone-resistant Escherichia coli Carriage in Long-Term Care Facility

    OpenAIRE

    Maslow, Joel N.; Lee, Betsy; Lautenbach, Ebbing

    2005-01-01

    We conducted a cross-sectional study to determine the prevalence of, and risk factors for, colonization with fluoroquinolone (FQ)-resistant Escherichia coli in residents in a long-term care facility. FQ-resistant E. coli were identified from rectal swabs for 25 (51%) of 49 participants at study entry. On multivariable analyses, prior FQ use was the only independent risk factor for FQ-resistant E. coli carriage and was consistent for FQ exposures in the previous 3, 6, 9, or 12 months. Pulsed-f...

  13. Replacing Ambulatory Surgical Follow-Up Visits With Mobile App Home Monitoring: Modeling Cost-Effective Scenarios

    OpenAIRE

    Armstrong, Kathleen A; Semple, John L; Coyte, Peter C.

    2014-01-01

    Background Women’s College Hospital (WCH) offers specialized surgical procedures, including ambulatory breast reconstruction in post-mastectomy breast cancer patients. Most patients receiving ambulatory surgery have low rates of postoperative events necessitating clinic visits. Increasingly, mobile monitoring and follow-up care is used to overcome the distance patients must travel to receive specialized care at a reduced cost to society. WCH has completed a feasibility study using a mobile ap...

  14. Guidance on The Use of Antiviral Drugs for Influenza in Acute Care Facilities in Canada, 2014-2015

    OpenAIRE

    H Grant Stiver; Evans, Gerald A; Fred Y Aoki; Allen, Upton D.; Michel Laverdière

    2015-01-01

    This article represents the second update to the AMMI Canada Guidelines document on the use of antiviral drugs for influenza. The article aims to inform health care professionals of the increased risk for influenza in long-term care facilities due to a documented mismatch between the components chosen for this season’s vaccine and currently circulating influenza strains. Adjusted recommendations for the use of antiviral drugs for influenza in the acute care setting for this season are provide...

  15. Regulatory review of closure, post-closure and perpetual care funds at the energy solutions, LLC mixed waste facility

    International Nuclear Information System (INIS)

    EnergySolutions, LLC operates its Mixed Waste Facility at Clive, Utah under the provisions of its State-issued Part B Permit. The facility accepts waste that contains both hazardous and radioactive contaminants. Utah is an EPA Agreement State and therefore the Utah Division of Solid and Hazardous Waste (DSHW) is authorized to regulate the hazardous waste operations at the facility. The radioactive portion of the waste is regulated by the Utah Division of Radiation Control. 40 CFR 264.142 outlines the facility requirements for Closure Costs. The owner or operator must have a detailed written estimate of the cost of closing the facility in accordance with the rules. For many years the State of Utah had relied on the facility's estimate of closure costs as the amount that needed to be funded. This amount is reviewed annually and adjusted for inflation and for changes at the facility. In 2004 the agency and the facility requested bids from independent contractors to provide their estimate for closure costs. Three engineering firms bid on the project. The facility funded the project and both the agency and the facility chose one of the firms to provide an independent estimate. The engineering firms met with both parties and toured the facility. They were also provided with the current closure cost line items. Each firm provided an estimated cost for closure of the facility at the point in the facility's active life that would make the closure most expensive. Included with the direct costs were indirect line items such as overhead, profit, mobilization, hazardous working conditions and regulatory oversight. The agency and the facility reviewed the independent estimates and negotiated a final Closure and Post-Closure Cost Estimate for the Mixed Waste Facility. There are several mechanisms allowed under the rules to fund the Closure and Post- Closure Care Funds. EnergySolutions has chosen to fund their costs through the use of an insurance policy. Changing mechanisms from

  16. Towards ambulatory mental stress measurement from physiological parameters

    NARCIS (Netherlands)

    Wijsman, Jacqueline; Vullers, Ruud; Polito, Salvatore; Agell, Carlos; Penders, Julien; Hermens, Hermie

    2013-01-01

    Ambulatory mental stress monitoring requires longterm physiological measurements. This paper presents a data collection protocol for ambulatory recording of physiological parameters for stress measurement purposes. We present a wearable sensor system for ambulatory recording of ECG, EMG, respiration

  17. Learning from other countries: an on-call facility for health care policy.

    Science.gov (United States)

    Nolte, Ellen; Ettelt, Stefanie; Thomson, Sarah; Mays, Nicholas

    2008-04-01

    Recognizing that robust information on health systems in other countries can provide valuable lessons for the English National Health Service, the Department of Health commissioned an academic team to provide an 'On-call Facility for International Healthcare Comparisons' in 2005. This paper describes the work of this novel approach to informing policy and reviews the experience of the first two years. It illustrates the well-documented challenges of comparative analysis of health systems. One important issue is understanding the health system context so as to interpret phenomena and draw appropriate policy conclusions. Other challenges include the potential tension between academic interest and rigour, and the need for timely analysis to inform the Department of Health's rapidly changing policy agenda. The diversity and nature of topics covered, as well as the rapid turn-around time have meant that the Facility has had to balance rigour and timeliness carefully to ensure the value and relevance of reports. A strong research base linked with an international network of country experts promotes the provision of high quality analyses at relatively low costs. However, such an arrangement can only be sustained if it provides scope for additional primary research. A formal evaluation of the influence on health care policy-making in England is not yet available. Such knowledge will be of crucial importance for the development of similar resources elsewhere. PMID:18416931

  18. 预警干预护理在预防脑卒中卧床患者褥疮发病中的应用%Warning intervention in the prevention of stroke care in ambulatory patients bedsore incidence Application

    Institute of Scientific and Technical Information of China (English)

    白洁琼

    2013-01-01

    目的:对脑卒中卧床患者实施预警干预护理,探讨和分析其预防患者发生褥疮的效果。方法:对我院此次收治的100例脑卒中卧床患者,根据Braden评分法来对患者发生褥疮的危险度进行预测。同时按照分值来进行分组,分为试验组和对照组,各为50例。对照组:对患者采用传统型的分级护理;试验组:对患者采用预警干预护理。结果:试验组:发生褥疮的患者为2例,占4.0%;其中I期1例,II期1例。对照组:发生褥疮的患者为7例,占14.0%;其中I期5例, II期2例。试验组患者发生褥疮的几率明显低于对照组,差异显著,具有统计学意义(P<0.05)。结论:在临床上,对脑卒中卧床患者采用Braden评分法进行预警干预护理,降低患者发生褥疮的几率,促进患者的康复,提高患者的生活质量。%Objective:Implementation of stroke warning intervention nursing bedridden patients to explore and analyze their preventive effect in patients with bedsores. Method:The admit ed in our hospital 100 cases of stroke bedridden patients, according to Braden score for patients to predict the risk of bedsores. Grouped according to both scores were divided into experimental and control groups, each of 50 cases. Control group: patients using traditional type of grading nursing; experimental group: nursing interventions for patients with early warning. Results:The experimental group:patients with pressure ulcers occur in 2 cases, accounting for 4.0%;including one case of stage I, II stage 1 case. Control group:patients with bedsores 7 cases, accounting for 14.0%;including five cases of stage I, II Phase 2 cases. Experimental group were significantly lower than the probability of occurrence of bedsores control group, the difference was significant, with statistical significance (P<0.05). Conclusions: In clinical practice, ambulatory patients with stroke using the Braden score early warning

  19. Health Facilities

    Science.gov (United States)

    Health facilities are places that provide health care. They include hospitals, clinics, outpatient care centers, and specialized care centers, such as birthing centers and psychiatric care centers. When you ...

  20. Optimizing pain care delivery in outpatient facilities: experience in NCI, Cairo, Egypt.

    Science.gov (United States)

    Hameed, Khaled Abdel

    2011-04-01

    satisfaction. In addition, monitoring the improvement of such plans is an integral part of the quality process. Importantly, the facility provides comprehensive care with professionals available 24 hours/7 days. On-call teams assigned to manage pain and other treatment modalities comprises of staff supervised by the primary cancer clinicians; this arrangement facilitates reaching this goal. This study will illustrate our experience through 25 years, trying to provide the highest care of patients with cancer pain on an outpatient basis. PMID:21448029

  1. Optimizing pain care delivery in outpatient facilities: experience in NCI, Cairo, Egypt.

    Science.gov (United States)

    Hameed, Khaled Abdel

    2011-04-01

    satisfaction. In addition, monitoring the improvement of such plans is an integral part of the quality process. Importantly, the facility provides comprehensive care with professionals available 24 hours/7 days. On-call teams assigned to manage pain and other treatment modalities comprises of staff supervised by the primary cancer clinicians; this arrangement facilitates reaching this goal. This study will illustrate our experience through 25 years, trying to provide the highest care of patients with cancer pain on an outpatient basis.

  2. When doctors come to prison – a pilot project for better HIV care in correctional facilities

    Directory of Open Access Journals (Sweden)

    I Vaz Pinto

    2012-11-01

    Full Text Available Recent rearrangements in national policies regarding follow-up of HIV-infected inmates have determined that hospitals closest to the prison facility be responsible for their care. Our HIV Unit and the two prison facilities in the area have established a clinical protocol whereby a clinical team goes to the prisons for blood collecting and visits instead of having the inmates transported to the hospital. The purpose of the protocol, from a clinical point of view, was to: (i promote adherence to blood tests and clinical visits; (ii promote adherence to antiretroviral (ARV therapy; (iii facilitate ARV administration by promoting once-daily-dosing. This retrospective review looks back at the first year of protocol implementation between the HIV Unit of HPP Cascais Hospital and the prisons of Tires and Linhó. The purpose of this study is to characterize the demographics of our inmate population; assess the number of inmates on ARV and describe the regimens as PI- or NNRTI-based and as once- or twice-daily dosed; evaluate ARV efficacy by HIV viral load undetectability; and assess opportunity for ARV switch from twice- to once-daily dosing. From April 2011 until June 2012 a total of 53 inmates were included in this protocol. The majority of patients were female (55% as one of the prisons is mainly for female inmates. The median age is 36 years (from 23–59. The average time of follow-up was 11 months (15 months maximum. From the total of 53 patients under study, 40 are currently under care, the other 13 having been released or transferred to other prison facilities. The majority of these patients are on ARV therapy (83%. By the end of follow-up time 88% of patients were on a once-daily dosed regimen; these are PI-based in 69% and NNRTI-based in 31%. At their last evaluation, 32/33 patients on therapy had undetectable HIV viremia (97%. As a conclusion, we assess that this protocol implementation has benefitted all parts: patients assure regular

  3. Evaluation of a hybrid paper-electronic medication management system at a residential aged care facility.

    Science.gov (United States)

    Elliott, Rohan A; Lee, Cik Yin; Hussainy, Safeera Y

    2016-06-01

    Objectives The aims of the study were to investigate discrepancies between general practitioners' paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper-electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5-12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18min to 98h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper-electronic medication management systems, in which prescribers' orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care

  4. Prevalência de dislipidemias na demanda laboratorial de três diferentes prestadores de assistência Prevalence of dyslipidemias in adult ambulatory laboratory tests from different health care providers

    Directory of Open Access Journals (Sweden)

    Ines Lessa

    1998-05-01

    Full Text Available OBJETIVO: Detectar diferenças nas prevalências das dislipidemias em adultos da demanda laboratorial de três diferentes prestadores de assistência médica, em Salvador, 1995. MÉTODOS: Estudo seccional, clínico epidemiológico, baseado em resultados das dosagens de lípides séricos de uma amostra probabilística de 25% dos 104 laboratórios que usavam o mesmo método de dosagem e o mesmo padrão para controle de qualidade. O critério de dislipidemia foi o do II Consenso Brasileiro de Dislipidemias para adultos. Os resultados foram agrupados conforme procedência: Sistema Único de Saúde (SUS, convênios (C e seguros privados + particulares (SP. Análise: prevalência com intervalos de confiança (IC a 95%, e teste do chi². RESULTADOS: Dos 5.464 adultos com menção da procedência, 14,8% foram do SUS, 31,6% dos C e 53,6% dos S+P. As mais elevadas prevalências de hipercolesterolemia - 28,0% (IC 24,0; 32,0 e de LDL-c elevado - 30,4% (IC 27,6; 33,2 foram detectadas no grupo C. No grupo S+P concentraram-se as maiores prevalências de HDL-c anormal - 12,3% (IC 10,0; 13,8 e hipertrigliceridemia - 17,8% (IC 16,3; 19,3. Quase todas as diferenças entre as prevalências foram estatisticamente significantes, favoráveis às taxas mais baixas do SUS. CONCLUSÃO: O melhor perfil lipídico do grupo SUS sugere diferenças sociais nas prevalências das dislipidemias. Para os três prestadores de assistência, a prevalência do HDL-c OBJECTIVE: To detect differences in the prevalence of dyslipidemia in adult ambulatory laboratory tests from three different health care providers, in Salvador-Brazil, 1995. METHODS: The study was carried out using a probabilistic sample of 24 out of 104 laboratories (@25% which performed the same enzymatic method for lipid tests with the same quality control. Laboratory tests results were separated into three groups, according to health care provider: Sistema Único de Saúde (SUS, governamental, Health Maintenance

  5. Avaliação da qualidade de atendimento ambulatorial em pediatria em um hospital universitário Quality-of-care assessment in a university hospital pediatric clinic

    Directory of Open Access Journals (Sweden)

    Selma Cristina Franco

    1998-01-01

    Full Text Available Estudou-se o ambulatório de Pediatria do Hospital das Clínicas da Unicamp, um serviço didático-assistencial que, inserido no Sistema Único de Saúde, presta assistência secundária e terciária para crianças de 0 a 18 anos. Foram aplicados 221 questionários entre clientes do ambulatório geral de pediatria e de uma de suas especialidades, permitindo comparar diversos indicadores de qualidade da assistência médica prestada. Evidenciou-se um bom nível de conhecimento dos responsáveis pelos usuários sobre seus problemas de saúde. Encontrou-se alto grau de satisfação dos mesmos, embora houvesse baixíssima vinculação entre médico e paciente. Com relação ao atendimento, 43,4% relataram problemas, mas apenas 17,6% propuseram sugestões para melhorá-lo. O tempo de espera nas consultas foi bastante longo. A clientela da especialidade se diferenciou da do ambulatório geral com relação a diversos indicadores.This study focuses on the Pediatric Clinic of the UNICAMP University Hospital, teaching and care facility belonging to the Brazilian National Health System, providing secondary and tertiary health care for children aged 0 to 18 years. A total of 221 questionnaires were applied with users of the general pediatric out-patient services and one of the specialties, allowing for comparison of various medical care indicators. Users were found to be quite knowledgeable about their health conditions and satisfied with the care received, despite a weak link in the physician-patient relationship. 43.4% reported problems related to the services, while only 17.6% made suggestions to improve them. Waiting time was found to be quite long. Users of specialized services differed from general care patients with regard to several indicators.

  6. Surgical Site Infection Surveillance Following Ambulatory Surgery

    OpenAIRE

    Rhee, Chanu; Huang, Susan S.; Berríos-Torres, Sandra I.; Kaganov, Rebecca; Bruce, Christina; Lankiewicz, Julie; Platt, Richard; Yokoe, Deborah S.

    2015-01-01

    We assessed 4045 ambulatory surgery patients for surgical site infection (SSI) using claims-based triggers for medical chart review. Of 98 patients flagged by codes suggestive of SSI, 35 had confirmed SSIs. SSI rates ranged from 0 to 3.2% for common procedures. Claims may be useful for SSI surveillance following ambulatory surgery.

  7. The care of Filipino juvenile offenders in residential facilities evaluated using the risk-need-responsivity model.

    Science.gov (United States)

    Spruit, Anouk; Wissink, Inge B; Stams, Geert Jan J M

    2016-01-01

    According to the risk-need-responsivity model of offender, assessment and rehabilitation treatment should target specific factors that are related to re-offending. This study evaluates the residential care of Filipino juvenile offenders using the risk-need-responsivity model. Risk analyses and criminogenic needs assessments (parenting style, aggression, relationships with peers, empathy, and moral reasoning) have been conducted using data of 55 juvenile offenders in four residential facilities. The psychological care has been assessed using a checklist. Statistical analyses showed that juvenile offenders had a high risk of re-offending, high aggression, difficulties in making pro-social friends, and a delayed socio-moral development. The psychological programs in the residential facilities were evaluated to be poor. The availability of the psychological care in the facilities fitted poorly with the characteristics of the juvenile offenders and did not comply with the risk-need-responsivity model. Implications for research and practice are discussed. PMID:27137741

  8. Using geographical information systems for defining the accessibility to health care facilities in Jeddah City, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Abdulkader A. Murad

    2014-12-01

    Full Text Available Spatial data play an important role in the planning of health care facilities and their allocation. Today, geographical information systems (GIS provide useful techniques for capturing, maintaining and analysing health care spatial data; indeed health geoinformatics is an emerging discipline that uses innovative geospatial technology to investigate health issues. The purpose of this paper is to define how GIS can be used for assessing the level of accessibility to health care. The paper identifies the advantages of using GIS in health care planning and covers GIS-based international accessibility with a focus on GIS applications for health care facilities in Jeddah city, Saudi Arabia. A geodatabase that includes location of health services, road networks, health care demand and population districts was created using ArcGIS software. The geodatabase produced is based on collected data and covers issues, such as defining the spatial distribution of health care facilities, evaluating health demand types and modelling health service areas based on analysis of driving-time and straight-line distances.

  9. Using geographical information systems for defining the accessibility to health care facilities in Jeddah City, Saudi Arabia.

    Science.gov (United States)

    Murad, Abdulkader A

    2014-01-01

    Spatial data play an important role in the planning of health care facilities and their allocation. Today, geographical information systems (GIS) provide useful techniques for capturing, maintaining and analysing health care spatial data; indeed health geoinformatics is an emerging discipline that uses innovative geospatial technology to investigate health issues. The purpose of this paper is to define how GIS can be used for assessing the level of accessibility to health care. The paper identifies the advantages of using GIS in health care planning and covers GIS-based international accessibility with a focus on GIS applications for health care facilities in Jeddah city, Saudi Arabia. A geodatabase that includes location of health services, road networks, health care demand and population districts was created using ArcGIS software. The geodatabase produced is based on collected data and covers issues, such as defining the spatial distribution of health care facilities, evaluating health demand types and modelling health service areas based on analysis of driving-time and straight-line distances. PMID:25599637

  10. CARE-JRA2* Activities on Photo-Injectors and CLIC Test Facility (CTF3)

    CERN Document Server

    Rinolfi, Louis

    2005-01-01

    In the frame of the CARE project, there is a Joint Research Activity (JRA2) called PHIN (PHoto-INjectors). The main objective of this JRA is to perform Research and Development on charge-production by interaction of a laser pulse with material within RF fields and improve or extend existing infrastructures. Another activity of PHIN is the coordination of the activities of various Institutes concerning photo-injectors. A brief review of the work of the eight European laboratories involved in PHIN is presented. One of these R&D topics is the construction of a photo-injector for the CLIC Test Facility (CTF3). In this context the status of CTF3 and its main goals - the demonstration of the feasibility of the key issues of the CLIC two-beam acceleration scheme - is also presented.

  11. Well-being, the Decision making process in residential care facilities and accommodation in Denmark

    DEFF Research Database (Denmark)

    Knudstrup, Mary-Ann; Harder, Henrik

    -based knowledge is needed: There is a need for research-based knowledge manuals among the actors involved in the planning and project design process which describe systematically the importance of working with the different aspects on well-being in residential care facilities and accommodation in Denmark. 2. More......This paper discusses the results from one of the sub-research projects, called “The Decision making process – Process, Architecture, Well-being” a project within the main project “Well-being and Housing” and is based on a case study which consist of four cases, realized and planned projects...... time should be devoted to discuss the aspects connected to well-being During the planning and project design process more time should be given to more qualified discussions about what Well-being means to the residents and the employees and these discussions should be embedded in the decision making...

  12. Examining physicians’ preparedness for tobacco cessation services in India: Findings from primary care public health facilities in two Indian states

    Directory of Open Access Journals (Sweden)

    Rajmohan Panda

    2013-03-01

    Full Text Available BackgroundA total of 275 million tobacco users live throughout India and are in need of tobacco cessation services. However, the preparation of physicians to deliver this service at primary care health facilities remains unknown.AimsThe study aimed to examine the primary care physicians’ preparedness to deliver tobacco cessation services in two Indian states.MethodResearchers surveyed physicians working in primary care public health facilities, primarily in rural areas using a semistructured interview schedule. Physicians’ preparedness was defined in the study as those possessing knowledge of tobacco cessation methods and exhibiting a positive attitude towards the benefits of tobacco cessation counselling as well as being willing to be part of tobacco prevention or cessation program.ResultsOverall only 17% of physicians demonstrated adequate preparation to provide tobacco cessation services at primary care health facilities in both the States. The findings revealed minimal tobacco cessation training during formal medical education (21.3% and on-the-job training (18.9%. Factors, like sex and age of service provider, type of health facility, location of health facility and number of patients attended by the service provider, failed to show significance during bivariate and regression analysis. Preparedness was significantly predicted by state health system.ConclusionThe study highlights a lack of preparedness of primary care physicians to deliver tobacco cessation services. Both the curriculum in medical school and on-the-job training require an addition of a learning component on tobacco cessation. The addition of this component will enable existing primary care facilities to deliver tobacco cessation services.

  13. Underreporting of influenza outbreaks in aged care facilities in South Western Sydney, Australia, 2014

    Directory of Open Access Journals (Sweden)

    Leng Boonwaat

    2016-03-01

    Full Text Available In 2014, influenza activity was high in New South Wales (NSW, Australia, and 21 443 people were hospitalized with a diagnosis of influenza-associated pneumonia. This translates to a rate of 252.4 cases per 100 000 population. More than 18 000 cases of laboratory-confirmed influenza were reported in NSW. The majority were influenza A, dominated by A/H3N2 subtype. There were also 111 influenza outbreaks in aged care facilities (ACFs reported in NSW in 2014, the highest number on record. Elderly residents in ACFs experience high rates of morbidity and mortality during influenza outbreaks. They are at increased risk of developing complications due to underlying diseases. These residents also have an increased risk of infection because of the institutional environment they share with many other residents and staff. Furthermore, impaired oral intake, limited dexterity and altered consciousness may limit treatment options when they are infected. The Australian Government’s Department of Health and Ageing (DHA has issued specific guidelines for prevention and control of influenza outbreaks in residential care facilities. While ACFs have primary responsibility for managing outbreaks, Public Health Units (PHUs are required to promote ACF compliance with these guidelines and facilitate delivery and administration of antivirals. However, effective influenza prophylaxis and other timely interventions can only occur if PHUs are notified in a timely manner. DHA guidelines indicate influenza outbreaks in ACFs are to be reported to PHUs. However, under NSW public health legislation, reporting of outbreaks in ACFs is not mandatory. In this report we investigated whether there were outbreaks that were not reported to the South Western Sydney Local Health Districts PHU during the 2014 influenza season.

  14. Minorities, men, and unmarried amyotrophic lateral sclerosis patients are more likely to die in an acute care facility.

    Science.gov (United States)

    Goutman, Stephen A; Nowacek, Dustin G; Burke, James F; Kerber, Kevin A; Skolarus, Lesli E; Callaghan, Brian C

    2014-09-01

    Studies suggest that dying at home is a more favorable experience. This study investigated where amyotrophic lateral sclerosis (ALS) patients die and the patient demographics associated with dying in an acute care facility or nursing home compared to home or hospice. Centers for Disease Control and Prevention Multiple Cause Mortality Files from 2005 to 2010 were used to identify ALS patients and to classify place of death. Multinomial logistic regression was used to determine the association between patient demographics and place of death. Between 2005 and 2010, 40,911 patients died of ALS in the United States. Place of death was as follows: home or hospice facility 20,231 (50%), acute care facility (25%), and nursing home (20%). African Americans (adjusted multinomial odds ratio (aMOR) 2.56, CI 2.32-2.83), Hispanics (aMOR 1.44, CI 1.30-1.62), and Asians (aMOR 1.87, CI 1.57-2.22) were more likely to die in an acute care facility, whereas females (aMOR 0.76, CI 0.72-0.80) and married individuals were less likely. Hispanics (aMOR 0.68, CI 0.58-0.79) and married individuals were less likely to die in a nursing home. In conclusion, minorities, men, and unmarried individuals are more likely to die in an acute care facility. Further studies are needed to better understand place of death preferences.

  15. The state of emergency obstetric care services in Nairobi informal settlements and environs: Results from a maternity health facility survey

    Directory of Open Access Journals (Sweden)

    Saliku Teresa

    2009-03-01

    Full Text Available Abstract Background Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1 delay in making the decision to seek care; 2 delay in reaching an appropriate obstetric facility; and 3 delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies. Methods We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system. Results Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden

  16. AgedCare+GP: description and evaluation of an in-house model of general practice in a residential aged-care facility.

    Science.gov (United States)

    Pain, Tilley; Stainkey, Lesley; Chapman, Sue

    2014-01-01

    This paper describes a medical model to provide in-house GP services to residents of aged-care facilities. Access to GP services for aged-care residents is decreasing, partially due to the changing demographic of the Australian GP workforce. The model we have developed is an in-house GP (AgedCare+GP) trialled in a publicly funded residential aged-care facility (RACF). The service model was based on the GP cooperative used in our after-hours general practice (AfterHours+GP). Briefly, the service model involves rostering a core group of GPs to provide weekly sessional clinics at the RACF. Financial contributions from appropriate Medicare Benefits Schedule (MBS) items for aged-care planning (including chronic conditions) provided adequate funds to operate the clinic for RACF residents. Evaluation of the service model used the number of resident transfers to the local emergency department as the primary outcome measure. There were 37 transfers of residents in the 3 months before the commencement of the AgedCare+GP and 11 transfers over a 3-month period at the end of the first year of operation; a reduction of almost 70%. This project demonstrates that AgedCare+GP is a successful model for GP service provision to RACF residents, and it also reduces the number of emergency department transfers. PMID:24134857

  17. Hepatitis B outbreak associated with a home health care agency serving multiple assisted living facilities in Texas, 2008-2010.

    Science.gov (United States)

    Zheteyeva, Yenlik A; Tosh, Pritish; Patel, Priti R; Martinez, Diana; Kilborn, Cindy; Awosika-Olumo, Debo; Khuwaja, Salma; Ibrahim, Syed; Ryder, Anthony; Tohme, Rania A; Khudyakov, Yury; Thai, Hong; Drobeniuc, Jan; Heseltine, Gary; Guh, Alice Y

    2014-01-01

    We investigated a multifacility outbreak of acute hepatitis B virus infection involving 21 residents across 10 assisted living facilities in Texas during the period January 2008 through July 2010. Epidemiologic and laboratory data suggested that these infections belonged to a single outbreak. The only common exposure was receipt of assisted monitoring of blood glucose from the same home health care agency. Improved infection control oversight and training of assisted living facility and home health care agency personnel providing assisted monitoring of blood glucose is needed. PMID:24176604

  18. DuPont/HFM Forum on Carpet in Health Care Facilities. Second in a series. Roundtable discussion.

    Science.gov (United States)

    1993-12-01

    DuPont and Health Facilities Management magazine invited 20 national expert to Dalton, GA--the carpet-manufacturing capital of the world--on May 13 to take part in DuPont's first-ever Forum on Carpet in Health Care Facilities. During the two-hour roundtable discussion, moderated by DuPont's Jack Murph and HFM's Michael Hemmes, end-users, interior designers and carpet mill representatives talked about the aesthetic, economic and performance aspects of using carpet in health care settings. Here's an edited version of what they said. PMID:10183994

  19. Old-age Care Modes and Facility Planning Based on the Concept of “Continuum of Care”

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    Through the comparative analysis on the theories and practical experience of the development of old-age care (OAC) in both China and other countries,and based on the interview and questionnaire survey in Zhejiang Province and Hangzhou City,this paper proposes the research and analysis framework for the old-age service system,i.e.,"OAC mode-OAC service system-OAC facility system." The paper argues that,oriented by OAC mode of "taking community-and home-based care as the main body and institution-based care as supplement," China should build an OAC facility system and planning thoughts that take "continuum of care" as concept and long-term care system as core.Taking Zhejiang Province and Hangzhou City as examples,the paper conducts the optimization research on current OAC facilities planning in terms of hierarchical system,scale,and differentiation,so as to formulate more systematic and operable planning standards for OAC facilities.

  20. Is higher volume of post-acute care patients associated with a lower rehospitalization rate in skilled nursing facilities?

    OpenAIRE

    Li, Yue; Cai, Xueya; Yin, Jun; Glance, Laurent G; Mukamel, Dana B

    2011-01-01

    This study determined whether higher patient volume of skilled nursing facility (SNF) care was associated with a lower hospital transfer rate. Using the nursing home Minimum Data Set and the On-line Survey, Certification, and Reporting file, we assembled a national cohort of Medicare SNF post-acute care admissions between January and September of 2008. Multivariable analyses based on Cox proportional hazards models found that patients admitted to high-volume SNFs (annual number of admissions ...

  1. The lived experiences of resilience in Iranian adolescents living in residential care facilities: A hermeneutic phenomenological study

    OpenAIRE

    Nourian, Manijeh; Shahbolaghi, Farahnaz Mohammadi; Tabrizi, Kian Nourozi; Rassouli, Maryam; Biglarrian, Akbar

    2016-01-01

    Background: Resilience is one of the main factors affecting human health, and perceiving its meaning for high-risk adolescents is of particular importance in initiating preventive measures and providing resilience care.Objectives: This qualitative study was conducted to explain the meaning of resilience in the lived experiences of Iranian adolescents living in governmental residential care facilities.Materials and methods: This study was conducted using the hermeneutic phenomenological method...

  2. Insights into the impact and use of research results in a residential long-term care facility: a case study

    OpenAIRE

    Cranley Lisa A; Birdsell Judy M; Norton Peter G; Morgan Debra G; Estabrooks Carole A

    2012-01-01

    Abstract Background Engaging end-users of research in the process of disseminating findings may increase the relevance of findings and their impact for users. We report findings from a case study that explored how involvement with the Translating Research in Elder Care (TREC) study influenced management and staff at one of 36 TREC facilities. We conducted the study at ‘Restwood’ (pseudonym) nursing home because the Director of Care engaged actively in the study and TREC data showed that this ...

  3. Helping small babies survive: an evaluation of facility-based Kangaroo Mother Care implementation progress in Uganda

    OpenAIRE

    Aliganyira, Patrick; Kerber, Kate; Davy, Karen; Gamache, Nathalie; Sengendo, Namaala Hanifah; Bergh, Anne-Marie

    2014-01-01

    Introduction Prematurity is the leading cause of newborn death in Uganda, accounting for 38% of the nation's 39,000 annual newborn deaths. Kangaroo mother care is a high-impact; cost-effective intervention that has been prioritized in policy in Uganda but implementation has been limited. Methods A standardised, cross-sectional, mixed-method evaluation design was used, employing semi-structured key-informant interviews and observations in 11 health care facilities implementing kangaroo mother ...

  4. Pathways to psychiatric care for children and adolescents at a tertiary facility in northern Nigeria

    Directory of Open Access Journals (Sweden)

    Jibril O. Abdulmalik

    2012-03-01

    Full Text Available There is limited availability of mental health services in Nigeria, and indeed most of Africa. Available services are also often under-utilized because of widespread ignorance and supernatural beliefs about the etiology of mental illnesses. The consequence, therefore, is a long and tedious pathway to care for the mentally ill, especially children and adolescents. This was a study of all new patients, aged 18 years and below, presenting over a 6 month period in 2009 (January – June at the outpatient clinic of a tertiary psychiatric facility in northern Nigeria. A socio-demographic questionnaire was utilized, along with a record of the clinician’s assessment of diagnosis for 242 patients. Subjects who had been withdrawn from school, or any previously engaged-in activity for longer than 4 weeks on account of the illness, were recorded as having disability from the illness. The children were aged 1-18 years (mean=12.3; SD=5.2 with males accounting for 51.7% (125 while 14.5% of the females (n=117 were married. Two thirds (64.5% of the patients had been ill for longer than 6 months prior to presentation. One hundred and forty four subjects (59.5% had received no care at all, while 36.4% had received treatment from traditional/religious healers prior to presentation. The most disabling conditions were ADHD (80%, mental retardation (77.8%, epilepsy (64.1% and psychotic disorders (50%. There is urgent need for extending mental health services into the community in order to improve access to care and increase awareness about effective and affordable treatments.

  5. Medication incident reporting in residential aged care facilities: Limitations and risks to residents’ safety

    Directory of Open Access Journals (Sweden)

    Tariq Amina

    2012-11-01

    Full Text Available Abstract Background Medication incident reporting (MIR is a key safety critical care process in residential aged care facilities (RACFs. Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a design MIR artefacts that facilitate identification of the root causes of medication incidents, b integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.

  6. Use of job aids to improve facility-based postnatal counseling and care in rural Benin.

    Science.gov (United States)

    Jennings, L; Yebadokpo, A; Affo, J; Agbogbe, M

    2015-03-01

    This study examined the effect of a job aids-focused intervention on quality of facility-based postnatal counseling, and whether increased communication improved in-hospital newborn care and maternal knowledge of home practices and danger signs requiring urgent care. Ensuring mothers and newborns receive essential postnatal services, including health counseling, is integral to their survival. Yet, quality of clinic-based postnatal services is often low, and evidence on effective improvement strategies is scarce. Using a pre-post randomized design, data were drawn from direct observations and interviews with 411 mother-newborn pairs. Multi-level regression models with difference-in-differences analyses estimated the intervention's relative effect, adjusting for changes in the comparison arm. The mean percent of recommended messages provided to recently-delivered women significantly improved in the intervention arm as compared to the control (difference-in-differences [∆i - ∆c] +30.9, 95 % confidence interval (CI) 19.3, 42.5), and the proportion of newborns thermally protected within the first hour (∆i - ∆c +33.7, 95 % CI 19.0, 48.4) and delayed for bathing (∆i - ∆c +23.9, 95 % CI 9.4, 38.4) significantly increased. No significant changes were observed in early breastfeeding (∆i - ∆c +6.8, 95 % CI -2.8, 16.4) which was nearly universal. Omitting traditional umbilical cord substances rose slightly, but was insignificant (∆i - ∆c +8.5, 95 % CI -2.8, 19.9). The proportion of mothers with correct knowledge of maternal (∆i - ∆c +27.8, 95 % CI 11.0, 44.6) and newborn (∆i - ∆c +40.3, 95 % CI 22.2, 58.4) danger signs grew substantially, as did awareness of several home-care practices (∆i - ∆c +26.0, 95 % CI 7.7, 44.3). Counseling job aids can improve the quality of postnatal services. However, achieving reduction goals in maternal and neonatal mortality will likely require more comprehensive approaches to link enhanced facility services with

  7. The impact of facility relocation on patients' perceptions of ward atmosphere and quality of received forensic psychiatric care.

    Science.gov (United States)

    Alexiou, Eirini; Degl' Innocenti, Alessio; Kullgren, Anette; Wijk, Helle

    2016-08-01

    In recent years, large groups of forensic psychiatric patients have been relocated into new medium- and maximum-security forensic psychiatric facilities in Sweden, where a psychosocial care approach is embedded. From this perspective and on the assumption that physical structures affect the therapeutic environment, a prospective longitudinal study was designed to investigate the impact of the facility relocation of three forensic psychiatric hospitals on patients' perceptions of ward atmosphere and quality of received forensic psychiatric care. Participants were patients over 18 years of age sentenced to compulsory forensic psychiatric treatment. Data were obtained by validated questionnaires. Overall, 58 patients (78%) answered the questionnaires at baseline with a total of 25 patients (34%) completing follow-up 1 at six months and 11 patients (15%) completing follow-up 2, one year after relocation. Approximately two-thirds of the participants at all time-points were men and their age range varied from 18 to 69. The results of this study showed that poor physical environment features can have a severe impact on care quality and can reduce the possibilities for person-centered care. Furthermore, the study provides evidence that the patients' perceptions of person-centered care in forensic psychiatric clinics are highly susceptible to factors in the physical and psychosocial environment. Future work will explore the staff's perception of ward atmosphere and the possibilities to adapt a person-centered approach in forensic psychiatric care after facility relocation. PMID:27213839

  8. The impact of facility relocation on patients' perceptions of ward atmosphere and quality of received forensic psychiatric care.

    Science.gov (United States)

    Alexiou, Eirini; Degl' Innocenti, Alessio; Kullgren, Anette; Wijk, Helle

    2016-08-01

    In recent years, large groups of forensic psychiatric patients have been relocated into new medium- and maximum-security forensic psychiatric facilities in Sweden, where a psychosocial care approach is embedded. From this perspective and on the assumption that physical structures affect the therapeutic environment, a prospective longitudinal study was designed to investigate the impact of the facility relocation of three forensic psychiatric hospitals on patients' perceptions of ward atmosphere and quality of received forensic psychiatric care. Participants were patients over 18 years of age sentenced to compulsory forensic psychiatric treatment. Data were obtained by validated questionnaires. Overall, 58 patients (78%) answered the questionnaires at baseline with a total of 25 patients (34%) completing follow-up 1 at six months and 11 patients (15%) completing follow-up 2, one year after relocation. Approximately two-thirds of the participants at all time-points were men and their age range varied from 18 to 69. The results of this study showed that poor physical environment features can have a severe impact on care quality and can reduce the possibilities for person-centered care. Furthermore, the study provides evidence that the patients' perceptions of person-centered care in forensic psychiatric clinics are highly susceptible to factors in the physical and psychosocial environment. Future work will explore the staff's perception of ward atmosphere and the possibilities to adapt a person-centered approach in forensic psychiatric care after facility relocation.

  9. International accreditation of ambulatory surgical centers and medical tourism.

    Science.gov (United States)

    McGuire, Michael F

    2013-07-01

    The two forces that have driven the increase in accreditation of outpatient ambulatory surgery centers (ASC's) in the United States are reimbursement of facility fees by Medicare and commercial insurance companies, which requires either accreditation, Medicare certification, or state licensure, and state laws which mandate one of these three options. Accreditation of ASC's internationally has been driven by national requirements and by the competitive forces of "medical tourism." The three American accrediting organizations have all developed international programs to meet this increasing demand outside of the United States. PMID:23830758

  10. An Enhanced Variable Two-Step Floating Catchment Area Method for Measuring Spatial Accessibility to Residential Care Facilities in Nanjing

    Directory of Open Access Journals (Sweden)

    Jianhua Ni

    2015-11-01

    Full Text Available Civil administration departments require reliable measures of accessibility so that residential care facility shortage areas can be accurately identified. Building on previous research, this paper proposes an enhanced variable two-step floating catchment area (EV2SFCA method that determines facility catchment sizes by dynamically summing the population around the facility until the facility-to-population ratio (FPR is less than the FPR threshold (FPRT. To minimize the errors from the supply and demand catchments being mismatched, this paper proposes that the facility and population catchment areas must both contain the other location in calculating accessibility. A case study evaluating spatial accessibility to residential care facilities in Nanjing demonstrates that the proposed method is effective in accurately determining catchment sizes and identifying details in the variation of spatial accessibility. The proposed method can be easily applied to assess other public healthcare facilities, and can provide guidance to government departments on issues of spatial planning and identification of shortage and excess areas.

  11. Certificate-of-Need regulation in outpatient surgery and specialty care: implications for plastic surgeons.

    Science.gov (United States)

    Pacella, Salvatore J; Comstock, Matthew; Kuzon, William M

    2005-09-15

    For plastic surgeons, independent development of outpatient surgical centers and specialty facilities is becoming increasingly common. These facilities serve as important avenues not only for increasing access and efficiency but in maintaining a sustainable, competitive specialty advantage. Certificate of Need regulation represents a major hurdle to plastic surgeons who attempt to create autonomy in this fashion. At the state level, Certificate of Need programs were initially established in an effort to reduce health care costs by preventing unnecessary capital outlays for facility expansion (i.e., managing supply of health care resources) in addition to assisting with patient safety and access to care. The purpose of this study was to examine the effect of Certificate of Need regulations on health care costs, patient safety, and access to care and to discuss specific implications of these regulations for plastic surgeons. Within Certificate of Need states, these regulations have done little, if anything, to control health care costs or affect patient safety. Presently, Certificate of Need effects coupled with recent provisions in the Medicare Modernization Act banning development of specialty hospitals may restrict patient access to ambulatory surgical and specialty care. For the plastic surgeon, these effects not only act as an economic barrier to entry but can threaten the efficiencies gained from providing surgical care in an ambulatory setting. An appreciation of these effects is critical to maintaining specialty autonomy and access to fiscal policy. PMID:16163102

  12. Certificate-of-Need regulation in outpatient surgery and specialty care: implications for plastic surgeons.

    Science.gov (United States)

    Pacella, Salvatore J; Comstock, Matthew; Kuzon, William M

    2005-09-15

    For plastic surgeons, independent development of outpatient surgical centers and specialty facilities is becoming increasingly common. These facilities serve as important avenues not only for increasing access and efficiency but in maintaining a sustainable, competitive specialty advantage. Certificate of Need regulation represents a major hurdle to plastic surgeons who attempt to create autonomy in this fashion. At the state level, Certificate of Need programs were initially established in an effort to reduce health care costs by preventing unnecessary capital outlays for facility expansion (i.e., managing supply of health care resources) in addition to assisting with patient safety and access to care. The purpose of this study was to examine the effect of Certificate of Need regulations on health care costs, patient safety, and access to care and to discuss specific implications of these regulations for plastic surgeons. Within Certificate of Need states, these regulations have done little, if anything, to control health care costs or affect patient safety. Presently, Certificate of Need effects coupled with recent provisions in the Medicare Modernization Act banning development of specialty hospitals may restrict patient access to ambulatory surgical and specialty care. For the plastic surgeon, these effects not only act as an economic barrier to entry but can threaten the efficiencies gained from providing surgical care in an ambulatory setting. An appreciation of these effects is critical to maintaining specialty autonomy and access to fiscal policy.

  13. Evaluation of the Color Me Healthy Program in Influencing Nutrition and Physical Activity in Mississippi Preschool Child Care Facilities

    Science.gov (United States)

    Huye, Holly F.; Bankston, Sarah; Speed, Donna; Molaison, Elaine F.

    2014-01-01

    Purpose/Objectives: The purpose of this research was to determine the level of implementation and perceived value in creating knowledge and behavior change from the Color Me Healthy (CMH) training program in child care centers, family day carehomes, or Head Start facilities throughout Mississippi. Methods: A two-phase survey was used to initially…

  14. Epidemiology of Gram Negative Antimicrobial Resistance in a Multi-State Network of Long Term Care Facilities

    Science.gov (United States)

    Lautenbach, Ebbing; Marsicano, Roseann; Tolomeo, Pam; Heard, Michael; Serrano, Steve; Stieritz, Donald D.

    2009-01-01

    We identified 1,805 gram-negative organisms in urine cultures from residents of 63 long-term care facilities (LTCFs) over 10 months. Fluoroquinolone resistance was 51% among E. coli, while 26% and 6% of Klebsiella were resistant to ceftazidime and imipenem, respectively. Resistance varied significantly by type of LTCF, LTCF size, and geographic region. PMID:19566445

  15. Bacteremia in a Long-Term -Care Facility: a Five-Year Prospective Study of 163 Consecutive Episodes

    NARCIS (Netherlands)

    R.R. Muder; C. Brennen; M.M. Wagener (Marilyn); A.M. Geotz

    1992-01-01

    textabstractThe clinical features, microbiological characteristics, and outcomes of 163 episodes of bacteremia occurring at a long-term-care facility were evaluated. The rate of nosocomial bacteremia increased from 0.20 to 0.36 cases/1,000 patient-days from 1985 to 1989; there was a parallel increas

  16. A Videotape-Based Training Method for Improving the Detection of Depression in Residents of Long-Term Care Facilities

    Science.gov (United States)

    Wood, Stacey; Cummings, Jeffrey L.; Schnelle, Betha; Stephens, Mary

    2002-01-01

    Purpose: This article reviews the effectiveness of a new training program for improving nursing staffs' detection of depression within long-term care facilities. The course was designed to increase recognition of the Minimal Data Set (MDS) Mood Trigger items, to be brief, and to rely on images rather than didactics. Design and Methods: This study…

  17. Laboratory-confirmed influenza B infection in immunized long-term care facility residents receiving oseltamivir prophylaxis in Ontario.

    Science.gov (United States)

    Winter, Anne-Luise; Peci, Adriana; Eshaghi, Alireza; Baird, Michelle; Memari, Nader; Kristjanson, Erik; Balogun, Elizabeth; Higgins, Rachel R; Li, Aimin; Farrell, David J; Gubbay, Jonathan B

    2013-11-01

    We report on an influenza B outbreak in an Ontario long-term care facility in which 2 immunized residents receiving oseltamivir prophylaxis for at least 5 days developed laboratory-confirmed influenza B infection. All isolates were tested for the most common oseltamivir resistance, and none of them had resistance identified. PMID:24113612

  18. Risk factors for fecal colonization with multiple distinct strains of Escherichia coli among long-term care facility residents.

    Science.gov (United States)

    Lautenbach, Ebbing; Tolomeo, Pam; Black, Nicole; Maslow, Joel N

    2009-05-01

    Of 49 long-term care facility residents, 21 (43%) were colonized with 2 or more distinct strains of Escherichia coli. There were no significant risk factors for colonization with multiple strains of E. coli. These results suggest that future efforts to efficiently identify the diversity of colonizing strains will be challenging. PMID:19292660

  19. Risk Factors for Fecal Colonization with Multiple Distinct Strains of Escherichia coli Among Long-Term Care Facility Residents

    OpenAIRE

    Lautenbach, Ebbing; Tolomeo, Pam; Black, Nicole; Maslow, Joel N.

    2009-01-01

    Of 49 long-term care facility residents, 21 (43%) were colonized with two or more distinct strains of Escherichia coli. There were no significant risk factors for colonization with multiple strains of E. coli. These results suggest future efforts to efficiently identify diversity of colonizing strains will be challenging.

  20. The environmental design of residential care facilities: A sense of home through the eyes of nursing home residents.

    NARCIS (Netherlands)

    van Dijck-Heinen, C.J.M.L.; Wouters, E.J.M.; Janssen, B.M.; van Hoof, J.

    2014-01-01

    C.J.M.L. van Dijck-Heinen, E.J.M. Wouters, B.M. Janssen, J. van Hoof (2014) The environmental design of residential care facilities: A sense of home through the eyes of nursing home residents. International Journal for Innovative Research in Science & Technology 1(4): 57-69

  1. Predictors of Poor Pregnancy Outcomes Among Antenatal Care Attendees in Primary Health Care Facilities in Cross River State, Nigeria: A Multilevel Model.

    Science.gov (United States)

    Ameh, Soter; Adeleye, Omokhoa A; Kabiru, Caroline W; Agan, Thomas; Duke, Roseline; Mkpanam, Nkese; Nwoha, Doris

    2016-08-01

    Objectives Pregnancy carries a high risk for millions of women and varies by urban-rural location in Nigeria, a country with the second highest maternal deaths in the world. Addressing multilevel predictors of poor pregnancy outcomes among antenatal care (ANC) attendees in primary health care (PHC) facilities could reduce the high maternal mortality rate in Nigeria. This study utilised the "Risk Approach" strategy to (1) compare the risks of poor pregnancy outcomes among ANC attendees by urban-rural location; and (2) determine predictors of poor pregnancy outcomes among ANC attendees in urban-rural PHC facilities in Cross River State, Nigeria. Methods A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15-49 years recruited through multistage sampling. Data on risk factors of poor pregnancy outcomes were collected using interviewer-administered questionnaires and clinic records. Respondents were categorised into low, medium or high risk of poor pregnancy outcomes, based on their overall risk scores. Predictors of poor pregnancy outcomes were determined by multilevel ordinal logistic regression. Results A greater proportion of the women in the rural areas were below the middle socio-economic quintile (75 vs. 4 %, p education (12 vs. 2 %, p outcomes than those in the rural facilities (64 vs. 50 %, p = 0.034). Pregnant women in the urban areas had decreased odds of being at high risk of poor pregnancy outcomes versus the combined medium and low risks compared with those in the rural areas (OR 0.55, 95 % CI 0.09-0.65). Conclusions for Practice Pregnant women attending antenatal care in rural PHC facilities are more at risk of poor pregnancy outcomes than those receiving care in the urban facilities. Health programmes that promote safe pregnancy should target pregnant women in rural settings. PMID:27004795

  2. Hazardous medical waste generation rates of different categories of health-care facilities

    International Nuclear Information System (INIS)

    Highlights: ► We calculated hazardous medical waste generation rates (HMWGR) from 132 hospitals. ► Based on a 22-month study period, HMWGR were highly skewed to the right. ► The HMWGR varied from 0.00124 to 0.718 kg bed−1 d−1. ► A positive correlation existed between the HMWGR and the number of hospital beds. ► We used non-parametric statistics to compare rates among hospital categories. - Abstract: Goal of this work was to calculate the hazardous medical waste unit generation rates (HMWUGR), in kg bed−1 d−1, using data from 132 health-care facilities in Greece. The calculations were based on the weights of the hazardous medical wastes that were regularly transferred to the sole medical waste incinerator in Athens over a 22-month period during years 2009 and 2010. The 132 health-care facilities were grouped into public and private ones, and, also, into seven sub-categories, namely: birth, cancer treatment, general, military, pediatric, psychiatric and university hospitals. Results showed that there is a large variability in the HMWUGR, even among hospitals of the same category. Average total HMWUGR varied from 0.012 kg bed−1 d−1, for the public psychiatric hospitals, to up to 0.72 kg bed−1 d−1, for the public university hospitals. Within the private hospitals, average HMWUGR ranged from 0.0012 kg bed−1 d−1, for the psychiatric clinics, to up to 0.49 kg bed−1 d−1, for the birth clinics. Based on non-parametric statistics, HMWUGR were statistically similar for the birth and general hospitals, in both the public and private sector. The private birth and general hospitals generated statistically more wastes compared to the corresponding public hospitals. The infectious/toxic and toxic medical wastes appear to be 10% and 50% of the total hazardous medical wastes generated by the public cancer treatment and university hospitals, respectively.

  3. [Pandemic influenza: impact on health care facilities in Lazio, Italy, and the role of hospitals in pandemic management].

    Science.gov (United States)

    Fusco, Franceso Maria; Pittalis, Silvia; Puro, Vincenzo; Lauria, Francesco Nicola; Ippolito, Giuseppe

    2007-09-01

    Highly Pathogenic Avian Influenza Virus H5N1 has so far caused more than 250 human cases. This virus is not transmitted efficaciously from person to person, but the capacity of human-to-human transmission could be acquired in the future. Consequently, the epidemiological and virological evolution of H5N1 is strictly monitored, insofar as the virus is a potential agent of an influenza pandemic. During such a pandemic, health care facilities would have to cope with many cases of severe respiratory illnesses, often requiring intensive care and mechanical pulmonary ventilation. In this article, the impact of the pandemic on health care facilities in Lazio, Italy, is evaluated using a statistical model, Flu-Surge. Moreover, some aspects of hospital preparedness for a pandemic, in particular in emergency departments, are discussed. PMID:17940401

  4. 75 FR 14606 - Medicare Program; Request for Nominations to the Advisory Panel on Ambulatory Payment...

    Science.gov (United States)

    2010-03-26

    ...; Center for Medicare Management, Hospital & Ambulatory Policy Group, Division of Outpatient Care; 7500... components of the Medicare hospital Outpatient Prospective Payment System (OPPS). The Charter requires that... consist of a chair and up to 15 members who are full- time employees of hospitals, hospital systems,...

  5. Treatment goals for ambulatory blood pressure and plasma lipids after stroke are often not reached

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Kofoed, Klaus

    2013-01-01

    In Danish health care, secondary prevention after stroke is currently handled mainly by general practitioners using office blood pressure (OBP) assessment of hypertension. The aim of this study was to compare the OBP approach to 24-hour assessment by ambulatory blood pressure (ABP) monitoring....... Furthermore, we aimed to record the degree of adherence to recommended therapy goals for blood pressure and plasma lipids....

  6. Treatment goals for ambulatory blood pressure and plasma lipids after stroke are often not reached

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Kofoed, Klaus

    2013-01-01

    In Danish health care, secondary prevention after stroke is currently handled mainly by general practitioners using office blood pressure (OBP) assessment of hypertension. The aim of this study was to compare the OBP approach to 24-hour assessment by ambulatory blood pressure (ABP) monitoring. Fu....... Furthermore, we aimed to record the degree of adherence to recommended therapy goals for blood pressure and plasma lipids....

  7. Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities

    Directory of Open Access Journals (Sweden)

    Scherer Samuel

    2009-08-01

    Full Text Available Abstract Background Residential care is important for older adults, particularly for those with advanced dementia and their families. Education interventions that achieve sustainable improvement in the care of older adults are critical to quality care. There are few systematic data available regarding the educational needs of Residential Care Facility (RCF staff and General Practitioners (GPs relating to dementia, or the sustainability of educational interventions. We sought to determine participation in dementia education, perceived levels of current knowledge regarding dementia, perceived unmet educational needs, current barriers, facilitators and preferences for dementia education. Methods A mixed methods study design was utilised. A survey was distributed to a convenience sample of general practitioners, and staff in 223 consecutive residential care facilities in Perth, Western Australia. Responses were received from 102 RCF staff working in 10 facilities (out of 33 facilities who agreed to distribute the survey and 202 GPs (19% of metropolitan GPs. Quantitative survey data were summarised descriptively and chi squared statistics were used to analyse the distribution of categorical variables. Qualitative data were collected from general practitioners, staff in residential care facilities and family carers of people with dementia utilizing individual interviews, surveys and focus groups. Qualitative data were analysed thematically. Results Among RCF staff and GPs attending RCF, participation in dementia education was high, and knowledge levels generally perceived as good. The individual experiences and needs of people with dementia and their families were emphasised. Participants identified the need for a person centred philosophy to underpin educational interventions. Limited time was a frequently mentioned barrier, especially in relation to attending dementia care education. Perceived educational needs relating to behaviours of concern

  8. Reduction of femoral fractures in long-term care facilities: the Bavarian fracture prevention study.

    Directory of Open Access Journals (Sweden)

    Clemens Becker

    Full Text Available BACKGROUND: Hip fractures are a major public health burden. In industrialized countries about 20% of all femoral fractures occur in care dependent persons living in nursing care and assisted living facilities. Preventive strategies for these groups are needed as the access to medical services differs from independent home dwelling older persons at risk of osteoporotic fractures. It was the objective of the study to evaluate the effect of a fall and fracture prevention program on the incidence of femoral fracture in nursing homes in Bavaria, Germany. METHODS: In a translational intervention study a fall prevention program was introduced in 256 nursing homes with 13,653 residents. The control group consisted of 893 nursing homes with 31,668 residents. The intervention consisted of staff education on fall and fracture prevention strategies, progressive strength and balance training, and on institutional advice on environmental adaptations. Incident femoral fractures served as outcome measure. RESULTS: In the years before the intervention risk of a femoral fracture did not differ between the intervention group (IG and control group (CG. During the one-year intervention period femoral fracture rates were 33.6 (IG and 41.0/1000 person years (CG, respectively. The adjusted relative risk of a femoral fracture was 0.82 (95% CI 0.72-0.93 in residents exposed to the fall and fracture prevention program compared to residents from CG. CONCLUSIONS: The state-wide dissemination of a multi-factorial fall and fracture prevention program was able to reduce femoral fractures in residents of nursing homes.

  9. Evaluation of Antidiabetic Prescriptions from Medical Reimbursement Applications at Banaras Hindu University Health Care Facility

    Directory of Open Access Journals (Sweden)

    Dev Priya

    2015-10-01

    Full Text Available Background: Diabetes is on rapid increase in third world countries undergoing rapid transition in terms of development particularly in India, which is often being referred as Diabetic capital. It is a disease more prevalent at latter part of life of human beings when finances dwindle and social care gets neglected. The medication continues till the whole life on a regular basis. In present study, the objective has been to provide pharmacoeconomic medication to the diabetic pensioners in the backdrop as mentioned in above background.Methods: The data was collected at the medical reimbursement section of pensioners of the University. The data was examined to answer issues of therapeutic decisions in the light of the pharmacoeconomic considerations. In this paper essentially data on choice of prescriptions with the angle of pharmacoeconomic prudence were included. The dichotomy of specialist versus non specialist prescribers at the tertiary center (i.e. medical college hospital was compared. Effort was made to define merit of the prescription based on comprehensive considerations of patient profile, disease profile and therapeutic choice.Results: Total 72 prescriptions were analyzed for the study in which 475 drugs were prescribed to the patients.  Total antidiabetic drugs prescribed to the patients were 169. Out of 72 cases 39 were males and 33 were females with mean age 66.04 ± 5.80 (Mean ± SEM. The average number of drugs per prescription was 6.59 which was very high as per guidelines. Most commonly prescribed antidiabetic drug was Metformin (63.89% followed by Glimepiride (31.95%.Conclusion: This study reflects that there is need to make available the standard therapeutic optionat University Health Care Facility based upon pharmacoeconomic considerations.

  10. A systematic method of accountability. Sound policies allow facilities to account for the level of charity care they provide.

    Science.gov (United States)

    Schmitz, H H; Weiss, S J; Melichar, C

    1992-11-01

    Charity care policies can help hospitals accurately determine, define, and account for the level of charity care they provide. This information will help hospitals budget appropriately and measure trends that will ultimately affect the organization's viability. State governments, the federal government, and the Internal Revenue Service are more closely scrutinizing not-for-profit hospitals' tax-exempt status. As a result, the American Institute of Certified Public Accountants (AICPA) has revised its requirement to report on charity care. To meet the AICPA's requirement, healthcare providers must develop their own definition of charity and determine criteria for providing care free or at a reduced rate. Setting policies to support the organization's definition of charity is necessary for the development of internal systems that promote the early identification of individuals seeking healthcare who will be unable to pay for services. Several policy implications may result from the facility's charity care determination process. For example, patients exhibiting extreme hardship might still be eligible to receive charity care even though their income and assets exceed the hospital's income guidelines. An organization planning to develop a charity care policy must first thoroughly assess its current charity care practices and cost accounting capabilities. Obtaining input from all the departments involved in the development of the charity care policy is necessary to make the transition as smooth as possible. PMID:10122079

  11. Evidence from facility level inputs to improve quality of care for maternal and newborn health: interventions and findings.

    Science.gov (United States)

    Das, Jai K; Kumar, Rohail; Salam, Rehana A; Lassi, Zohra S; Bhutta, Zulfiqar A

    2014-09-01

    Most of the maternal and newborn deaths occur at birth or within 24 hours of birth. Therefore, essential lifesaving interventions need to be delivered at basic or comprehensive emergency obstetric care facilities. Facilities provide complex interventions including advice on referrals, post discharge care, long-term management of chronic conditions along with staff training, managerial and administrative support to other facilities. This paper reviews the effectiveness of facility level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined facility level interventions and included 32 systematic reviews. Findings suggest that additional social support during pregnancy and labour significantly decreased the risk of antenatal hospital admission, intrapartum analgesia, dissatisfaction, labour duration, cesarean delivery and instrumental vaginal birth. However, it did not have any impact on pregnancy outcomes. Continued midwifery care from early pregnancy to postpartum period was associated with reduced medical procedures during labour and shorter length of stay. Facility based stress training and management interventions to maintain well performing and motivated workforce, significantly reduced job stress and improved job satisfaction while the interventions tailored to address identified barriers to change improved the desired practice. We found limited and inconclusive evidence for the impacts of physical environment, exit interviews and organizational culture modifications. At the facility level, specialized midwifery teams and social support during pregnancy and labour have demonstrated conclusive benefits in improving maternal newborn health outcomes. However, the generalizability of these findings is limited to high income countries. Future programs in resource limited settings should utilize these findings to implement relevant interventions tailored to their needs

  12. Brucellosis is not a major cause of febrile illness in patients at public health care facilities in Binh Thuan Province, Vietnam

    NARCIS (Netherlands)

    T.T.T. Nga; P.J. de Vries; T.H. Abdoel; H.L. Smits

    2006-01-01

    Objective: To determine the presence of brucellosis among patients with acute febrile illness at health care facilities in Binh Thuan province, Vietnam. Method: A retrospective seroepidemiological study on serum samples collected at 13 not adjacent health care facilities using the Rose Bengal test a

  13. Setting up of ambulatory hysteroscopy service.

    Science.gov (United States)

    Kolhe, Shilpa

    2015-10-01

    There is an obvious trend towards developing ambulatory procedures in gynaecology with ambulatory hysteroscopy as its mainstay. In the recent years, the fast pace of modern technological advances in gynaecologic endoscopy, and particularly in the field of hysteroscopy, have been both thrilling and spectacular. Despite this, the uptake of operative hysteroscopy in ambulatory settings has been relatively slow. There is some apprehension amongst gynaecologists to embark on therapeutic outpatient hysteroscopy, and an organisational change is required to alter the mindset. Although there are best practice guidelines for outpatient hysteroscopy, there are unresolved issues around adequate training and accreditation of future hysteroscopists. Virtual-reality simulation training for operative hysteroscopy has shown promising preliminary results, and it is being aggressively evaluated and validated. This review article is an attempt to provide a useful practical guide to all those who wish to implement ambulatory hysteroscopy services in their outpatient departments. PMID:25979350

  14. 452 Asthma Control and Quality of Care of Adult Asthma Patients in Primary Health Care Facilities in Saint-Petersburg, Russia

    OpenAIRE

    Emelyanov, Alexander; Tsukanova, Inessa; Fedoseev, Gleb; Sergeeva, Galina; Lisitsyna, Natalia; Bakanina, Lubov; Nikitina, Ekaterina

    2012-01-01

    Background This study was performed to assess the control asthma and quality of care of asthmatic patient in primary health care facilities in Saint-Petersburg, the second largest city in Russia. Methods We conducted telephone interviews with 205 asthma outpatients (aged 24 to 90 years). Asthma control was assessed by using the Asthma Control Test (ACT). Results During the past 12 month spirometry were performed in 26.8%. Only 2% of outpatients were consulted by allergist and 26.8% - by respi...

  15. Assessment of HIV Knowledge in Correctional Facility Health Care Workers: A Pilot Study of an Educational Intervention.

    Science.gov (United States)

    Hoang, Holly L; Khan, Muhammad Naeem; Berger, Sara; Moreau, Danusia; Nickel, Pamela; Woods, Dan; Jaipaul, Joy; Pyne, Diane; Moreland, Barbara; Singh, Ameeta; Ahmed, Rabia

    2016-07-01

    HIV rates are disproportionately higher in the incarcerated compared to the general population. Unfortunately, HIV sero-positive inmates report perceived discrimination and missed antiretroviral doses. Correctional facility nursing competency in HIV management may mitigate these concerns. Using validated knowledge instruments, the authors measured baseline HIV knowledge in correctional facility nurses from 3 correctional facilities in Alberta, Canada, and quantified changes after a targeted educational workshop. Basic HIV knowledge increased significantly, whereas perceived need for further HIV education significantly decreased postintervention. This study demonstrates that correctional facility nurses may not receive ideal HIV education during employment and that targeted HIV workshops can significantly increase knowledge and confidence when caring for affected individuals. PMID:26316522

  16. Searching for more comprehensive health care records: development, application and assessment of a new tool to register outpatient consultations Buscando um registro mais integral do cuidado à saúde: desenvolvimento, aplicação e avaliação de um novo instrumento de registro da consulta ambulatorial

    Directory of Open Access Journals (Sweden)

    Fabiana Braunstein Bassan

    2010-11-01

    Full Text Available

    The medical record is important for health care since it allows, through the analysis of data collected in several contacts between patients and health units, to appreciate and understand the disease and health care processes. This comprehension will be the more complete, the more the medical record accounts for the patient’s way of living, health-disease processes, investigations and therapeutic procedures, clinical evolution and possible difficulties to follow medical advice – that is, the way health care was/is delivered by different professionals in several sectors. In this sense, the service – and its record as well – must focus on the individual, the person as a whole, living and becoming ill, and not only on his diseases and morbidities. Based on this premise, this study aimed to develop, apply and assess a new tool for outpatient records at the Integral Ambulatory Care (AMI at Pedro Ernesto University.

    O prontuário médico constitui-se em um importante elemento no cuidado à saúde, na medida em que possibilita, por meio do levantamento das informações registradas nos diversos contatos dos indivíduos com as unidades de saúde, uma apreciação e compreensão de seu processo de adoecimento e de cuidado. Tal compreensão será tão mais completa quanto melhor o prontuário tiver registrado os elementos referentes ao seu modo de viver, ao seu processo de saúde-adoecimento, às investigações e condutas terapêuticas tomadas, à evolução clínica, bem como às eventuais dificuldades no atendimento, às orientações recebidas, o modo, enfim, como o cuidado foi ou está sendo prestado pelos diferentes profissionais responsáveis nos diversos setores de uma dada instituição. Para tal, o atendimento . e também o seu registro . deve ter como foco o indivíduo, a pessoa na sua totalidade do viver e adoecer, e não apenas as suas doenças ou o evoluir de suas morbidades. Tendo por foco o eixo acima, o objetivo deste

  17. The Association between Malnutrition and Pressure Ulcers in Elderly in Long-Term Care Facility

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    Lenche Neloska

    2016-08-01

    Full Text Available BACKGROUND: Malnutrition is common in elderly and is a risk factor for pressure ulcers. AIM: The aim of the present study was to determine the prevalence of malnutrition in geriatric and palliative patients hospitalised in long-term care facility, and to examine the influence of nutritional status on the prevalence of pressure ulcers (PU. MATERIAL AND METHODS: Descriptive, observational and cross-sectional study including 2099 patients admitted to the Hospital during a 24 month period (January 2013 to December 2014. We recorded: demographic data, body mass index (BMI, Braden score, laboratory parameters of interest (albumin, total protein, RBC count, haemoglobin and iron levels and presence or absence of malnutrition and pressure ulcers. RESULTS: The pressure ulcer prevalence was 12.9% (256 out of 2099. Based on the BMI classification, 61.7% of patients had a good nutritional status, 27.4% were undernourished, and 2.1% were considered malnourished. Nutritional status was statistically significantly different between patients with and without PU (p < 0.0001. This study also showed that hypoproteinemia, hypoalbuminemia, low RBC was positively associated with PU prevalence. CONCLUSION: The results highlight the impact of nutritional status on the prevalence of pressure ulcers in hospitalised geriatric and palliative population. It is of paramount importance to correctly evaluate the presence of malnutrition in patients at risk of pressure ulcers.

  18. Influence of a non-hospital medical care facility on antimicrobial resistance in wastewater.

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    Mathias Bäumlisberger

    Full Text Available The global widespread use of antimicrobials and accompanying increase in resistant bacterial strains is of major public health concern. Wastewater systems and wastewater treatment plants are considered a niche for antibiotic resistance genes (ARGs, with diverse microbial communities facilitating ARG transfer via mobile genetic element (MGE. In contrast to hospital sewage, wastewater from other health care facilities is still poorly investigated. At the instance of a nursing home located in south-west Germany, in the present study, shotgun metagenomics was used to investigate the impact on wastewater of samples collected up- and down-stream in different seasons. Microbial composition, ARGs and MGEs were analyzed using different annotation approaches with various databases, including Antibiotic Resistance Ontologies (ARO, integrons and plasmids. Our analysis identified seasonal differences in microbial communities and abundance of ARG and MGE between samples from different seasons. However, no obvious differences were detected between up- and downstream samples. The results suggest that, in contrast to hospitals, sewage from the nursing home does not have a major impact on ARG or MGE in wastewater, presumably due to much less intense antimicrobial usage. Possible limitations of metagenomic studies using high-throughput sequencing for detection of genes that seemingly confer antibiotic resistance are discussed.

  19. Prevalence of toenail onychomycosis among diabetics at a primary care facility in Malaysia.

    Science.gov (United States)

    Leelavathi, M; Azimah, M N; Kharuddin, N F; Tzar, M N

    2013-05-01

    Onychomycosis increases the risk of developing secondary bacterial infection and cellulitis if left untreated. The aim of this study was to determine the prevalence of onychomycosis among diabetics and its associated factors. A cross sectional study using universal sampling of all type 1 and 2 diabetic patients attending a primary care facility of the Universiti Kebangsaan Malaysia (UKM) from January to March 2011 was conducted. Samples were taken from clinically abnormal nails and from the first right toenail in the absence of nail abnormalities and cultured for fungal elements. A total of 151 diabetics participated in the study. The mean patient age was 60.7 +/- 9.1 years. A total of 123 nail samples (81.5%) were culture positive for fungal elements. A positive correlation was found between onychomycosis and increasing age (p = 0.011) and clinically abnormal nails (p < 0.05). There were no significant correlations with gender, ethnic group, duration of diabetes, types of diabetes or glycemic control. The prevalence of onychomycosis among diabetics in our study was high.

  20. Epidemiology and resistance patterns in urinary pathogens from long-term care facilities and GP populations.

    LENUS (Irish Health Repository)

    Brabazon, E D

    2012-06-01

    Urinary tract infections (UTIs) are a major source of antimicrobial prescribing in the clinical setting and a potential reservoir for the emergence of resistant organisms. Although studies have been published on resistance rates for urinary pathogens from both hospital and general practitioner (GP) settings, there is little information from Long-Term Care Facilities (LTCFs) in Ireland. This study aimed to document the epidemiology and resistance rates in urinary isolates, in the LTCF and GP setting, from samples submitted to a typical microbiology laboratory. In 2010, there were 963 urinary isolates from LTCFs and 1,169 urinary isolates from GPs, identified from patients 65 years and over, with cytology suggestive of infection. E. coil was the most common causative organism identified. There were significantly higher levels of resistance to ampicillin, co-amoxiclav, ciprofloxacin, nitrofurantoin, trimethoprim, and piperacillin\\/tazobactam in the LTCF population compared to the GP population (e.g. for E. coli, 86%-v-69%; 30%-v- 21%; 58%-v-26%, 10%-v-3%, 68%-v-48%, 10%-v- 4% respectively). Isolates with resistance mechanisms to beta-lactams, were identified in both populations. Results presented in this paper demonstrate significant differences between resistance rates in LTCF and GP populations which suggest that there are implications for empiric antimicrobial prescribing for UTIs in the LTCF setting.

  1. The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi.

    Science.gov (United States)

    Manthalu, Gerald; Yi, Deokhee; Farrar, Shelley; Nkhoma, Dominic

    2016-11-01

    The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P services, however, other determinants may be more important.

  2. Health providers' perception of quality of care for neonates in health facilities in a municipality in Southern Ghana.

    Science.gov (United States)

    Elikplim Pomevor, Kokui; Adomah-Afari, Augustine

    2016-10-10

    Purpose The purpose of this paper is to assess available human resources for neonatal care and their skills, in order to explore health providers' perceptions of quality of neonatal care in health facilities in Ghana. Design/methodology/approach Data were gathered using qualitative interviews with health providers working in the maternity and paediatric wards and midwives; direct observation; and documentary review at a regional hospital, a municipal hospital and four health centres in a municipality in a region in Southern Ghana. Data were analysed using thematic framework through the process of coding in six phases to create and establish meaningful patterns. Findings The study revealed that health providers were concerned about the number of staff available, their competence and also equipment available for them to work more efficiently. Some essential equipment for neonatal care was either not available or was non-functional where it was available, while aseptic procedures were not adhered to. Moreover, personal protective equipment such as facemask, caps, aprons were not used except in the labour wards where staff had to change their footwear before entering. Research limitations/implications Limited number of health providers and facilities used, lack of exploration of parents of neonates' perspective of quality of neonatal care in this study and other settings, including the teaching hospitals. The authors did not examine issues related to the ineffective use of IV cannulation for neonates by nurses as well as referral of neonates. Additionally, the authors did not explore the perspectives of management of the municipal and regional health directorates or policy makers of the Ministry of Health and Ghana Health Service regarding the shortage of staff, inadequate provision of medical equipment and infrastructure. Practical implications This paper suggests the need for policy makers to redirect their attention to the issues that would improve the quality of

  3. Health providers' perception of quality of care for neonates in health facilities in a municipality in Southern Ghana.

    Science.gov (United States)

    Elikplim Pomevor, Kokui; Adomah-Afari, Augustine

    2016-10-10

    Purpose The purpose of this paper is to assess available human resources for neonatal care and their skills, in order to explore health providers' perceptions of quality of neonatal care in health facilities in Ghana. Design/methodology/approach Data were gathered using qualitative interviews with health providers working in the maternity and paediatric wards and midwives; direct observation; and documentary review at a regional hospital, a municipal hospital and four health centres in a municipality in a region in Southern Ghana. Data were analysed using thematic framework through the process of coding in six phases to create and establish meaningful patterns. Findings The study revealed that health providers were concerned about the number of staff available, their competence and also equipment available for them to work more efficiently. Some essential equipment for neonatal care was either not available or was non-functional where it was available, while aseptic procedures were not adhered to. Moreover, personal protective equipment such as facemask, caps, aprons were not used except in the labour wards where staff had to change their footwear before entering. Research limitations/implications Limited number of health providers and facilities used, lack of exploration of parents of neonates' perspective of quality of neonatal care in this study and other settings, including the teaching hospitals. The authors did not examine issues related to the ineffective use of IV cannulation for neonates by nurses as well as referral of neonates. Additionally, the authors did not explore the perspectives of management of the municipal and regional health directorates or policy makers of the Ministry of Health and Ghana Health Service regarding the shortage of staff, inadequate provision of medical equipment and infrastructure. Practical implications This paper suggests the need for policy makers to redirect their attention to the issues that would improve the quality of

  4. Ambulatory oral surgery: 1-year experience with 11 680 patients from Zagreb district, Croatia

    Science.gov (United States)

    Jokić, Dražen; Macan, Darko; Perić, Berislav; Tadić, Marinka; Biočić, Josip; Đanić, Petar; Brajdić, Davor

    2013-01-01

    Aim To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia. Methods Sociodemographic and clinical data on 11 680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess the frequency of diagnoses and differences in sex and age. Results The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (P apicoectomies were performed among female patients (P < 0.001). A greater prevalence of periodontal disease was found in patients residing in Zagreb than in patients residing in rural areas. Conclusion The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients’ awareness of the importance of oral health. PMID:23444246

  5. Association of antenatal care with facility delivery and perinatal survival – a population-based study in Bangladesh

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    Pervin Jesmin

    2012-10-01

    Full Text Available Abstract Background Antenatal Care (ANC during pregnancy can play an important role in the uptake of evidence-based services vital to the health of women and their infants. Studies report positive effects of ANC on use of facility-based delivery and perinatal mortality. However, most existing studies are limited to cross-sectional surveys with long recall periods, and generally do not include population-based samples. Methods This study was conducted within the Health and Demographic Surveillance System (HDSS of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b in Matlab, Bangladesh. The HDSS area is divided into an icddr,b service area (SA where women and children receive care from icddr,b health facilities, and a government SA where people receive care from government facilities. In 2007, a new Maternal, Neonatal, and Child Health (MNCH program was initiated in the icddr,b SA that strengthened the ongoing maternal and child health services including ANC. We estimated the association of ANC with facility delivery and perinatal mortality using prospectively collected data from 2005 to 2009. Using a before-after study design, we also determined the role of ANC services on reduction of perinatal mortality between the periods before (2005 – 2006 and after (2008–2009 implementation of the MNCH program. Results Antenatal care visits were associated with increased facility-based delivery in the icddr,b and government SAs. In the icddr,b SA, the adjusted odds of perinatal mortality was about 2-times higher (odds ratio (OR 1.91; 95% confidence intervals (CI: 1.50, 2.42 among women who received ≤1 ANC compared to women who received ≥3 ANC visits. No such association was observed in the government SA. Controlling for ANC visits substantially reduced the observed effect of the intervention on perinatal mortality (OR 0.64; 95% CI: 0.52, 0.78 to non-significance (OR 0.81; 95% CI: 0.65, 1.01, when comparing cohorts before

  6. The effect of exercise intervention on frail elderly in need of care: half-day program in a senior day-care service facility specializing in functional training.

    Science.gov (United States)

    Sakamoto, Ryota; Miura, Yasushi

    2016-07-01

    [Purpose] This study investigated the long-term effect of a half-day exercise intervention program on health-related quality of life, life function, and physical function in frail elderly in need of care. The program was conducted at a senior day-care facility specializing in functional training. [Subjects and Methods] Subjects included 41 elderly in need of care who had visited the service facility for at least 1 year. Physical function and life function were evaluated at baseline, 6 months, and 12 months. Quality of life was evaluated with the Short Form-36 at baseline and 12 months. [Results] Improvements in balance, walking speed and endurance, complex performance abilities, self-efficacy during the activities, and the level and sphere of activity were observed at 6 months and maintained up to 12 months. Moreover, improvements in agility, activities of daily living, life function, and quality of life were also observed at 12 months. Improvements in muscle strength, walking ability, self-efficacy over an action, and activities of daily living were related to the improvement in quality of life. [Conclusion] The use of individualized exercise programs developed by physiotherapists led to improvements in activities of daily living and quality of life among elderly in need of care. PMID:27512243

  7. Approaches towards a regional, shared electronic patient record for health care facilities of different health care organizations--IT-strategy and first results.

    Science.gov (United States)

    Schabetsberger, Thomas; Gross, Erich; Haux, Reinhold; Lechleitner, Georg; Pellizzari, Thomas; Schindelwig, Klaus; Stark, Christian; Vogl, Raimund; Wilhelmy, Immanuel

    2004-01-01

    Today, information processing in healthcare facilities is usually primarily directed towards the information needs of the respective institution. This stands in apparent contradiction to the fact that patients may not be solely treated in one general practice or hospital. More information processing towards patient-centered, shared care would better support high quality as well as efficient health care. We developed a stepwise approach transforming trans-institutional information system architectures (TISAs) from an inefficient state caused by redundancy and media cracks towards a state which better supports patient centered, shared care. In a total of three steps we want to establish electronic communication between existing information systems of different healthcare facilities for transmission of discharge summaries and diagnostic results. In further stages we plan to expand this communication solution to a regional comprehensive and consistent electronic patient record for multiple hospitals and general practices in Tyrol, Austria. In addition, two related approaches towards supporting shared care have been compared with our approach. The aim of this paper is to report on our approach and first experiences.

  8. Perceived quality of care for common childhood illnesses: facility versus community based providers in Uganda.

    Directory of Open Access Journals (Sweden)

    Agnes Nanyonjo

    Full Text Available OBJECTIVE: To compare caretakers' perceived quality of care (PQC for under-fives treated for malaria, pneumonia and diarrhoea by community health workers (CHWs and primary health facility workers (PHFWs. METHODS: Caretaker rated PQC for children aged (2-59 months treated by either CHWs or PHFWs for a bought of malaria, pneumonia or diarrhoea was cross-sectionally compared in quality domains of accessibility, continuity, comprehensiveness, integration, clinical interaction, interpersonal treatment and trust. Child samples were randomly drawn from CHW (419 and clinic (399 records from eight Midwestern Uganda districts. An overall PQC score was predicted through factor analysis. PQC scores were compared for CHWs and PHFWs using Wilcoxon rank-sum test. Multinomial logistic regression models were used to specify the association between categorized PQC and service providers for each quality domain. Finally, overall PQC was dichotomized into "high" and "low" based on median score and relative risks (RR for PQC-service provider association were modeled in a "modified" Poisson regression model. RESULTS: Mean (SD overall PQC was significantly higher for CHWs 0.58 (0 .66 compared to PHFWs -0.58 (0.94, p<0.0001. In "modified" Poisson regression, the proportion of caretakers reporting high PQC was higher for CHWS compared to PHFWs, RR=3.1, 95%CI(2.5-3.8. In multinomial models PQC was significantly higher for CHWs compared to PHFWs in all domains except for continuity. CONCLUSION: PQC was significantly higher for CHWs compared to PHFWs in this resource constrained setting. CHWs should be tapped human resources for universal health coverage while scaling up basic child intervention as PQC might improve intervention utilization.

  9. [原著]Elder Abuse and Staff Awareness in Long-term Care Insurance Facilities in Okinawa

    OpenAIRE

    Kuniyoshi, Midori; Maeshiro, Chikako; Koja, Yasuko; Yokota, Takao; Departments of Coommunity Health Nursingschool of Health Sciences, Faculty of Medicine, University of the Ryukyus; Adult and Gerontotgical Nursing and Coommunity Health Nursingschool of Health Sciences, Faculty of Medicine, University of the Ryukyus

    2007-01-01

    Staff awareness of abusive actions to the elderly in long-term care insurance facilities was surveyed. A total of 702 responses (response rate, 65.6%) were obtained and then divided into abuse-experienced (n=432) and non-experienced group (n=270). Twentyseven abusive actions categorized by the Study Group for Treating the Elderly were evaluated by staff. Results were as follows:1) Men were more likely to commit abuse than women(p

  10. Exploring malaria case mangement of underfive children at households and public primary health care facilities in Kibaha district, Tanzania

    OpenAIRE

    Nsimba, Stephen ED

    2003-01-01

    Background: Chloroquine (CQ) was the first line drug for treating malaria in Tanzania until 2001 when it was replaced with sulfadoxine/pyrimethamine (SP). The first four studies (I -IV) were conducted before the policy change, and the last one (V) after. Aim: To explore different aspects of malaria case management of underfives in households and at primary health care facilities in the Kibaha district. Materials and methods: Four cross-sectional studies (I, II, IV & V) we...

  11. Use of Articaine in loco-regional anesthesia for day care surgical procedures

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2012-01-01

    Full Text Available The popularity of day case surgical procedures has increased immensely over the last few years. Though various techniques are available for carrying out day-case anesthesia, preference for a technique depends upon the type of procedure, patient profile, associated co-morbidities, available infrastructure and back-up facilities, monitoring devices and comfort of the attending anesthesiologist with the technique. Day-case spinal anesthesia for ambulatory surgery has gained a wider acceptance and numerous drugs are available for use in loco-regional anesthesia. Articaine is one such amide local anesthetic drug which is increasingly being used in day care surgeries. Properties of articaine such as faster onset, shorter elimination time and rapid recovery from sensory and motor blockade make it a very useful agent in local and regional anesthesia for day care surgical procedures. This article aims to review these properties of articaine so as to evaluate how useful articaine can be for ambulatory surgical procedures.

  12. Measuring patient satisfaction: A case study to improve quality of care at public health facilities

    Directory of Open Access Journals (Sweden)

    Sodani Prahlad

    2010-01-01

    Full Text Available Objective: The main objective of the study is to measure the satisfaction of OPD (Outpatient Department patients in public health facilities of Madhya Pradesh in India. Materials and Methods: Data were collected from OPD patients through pre-structured questionnaires at public health facilities in the sampled eight districts of Madhya Pradesh. The data were analyzed using SPSS. Settings: Outpatient Departments of district hospital, civil hospital, community health centre, and primary health centre of the eight selected districts of Madhya Pradesh. Results: A total of 561 OPD patients were included in the study to know their perceptions towards the public health facilities, choosing health facility, registration process, basic amenities, perception towards doctors and other staff, perception towards pharmacy and dressing room services. It was found that most of the respondents were youth and having low level of education. The major reason of choosing the public health facility was inexpensiveness, infrastructure, and proximity of health facility. Measuring patient satisfaction were more satisfied with the basic amenities at higher health facilities compared to lower level facilities. It was also observed that the patients were more satisfied with the behavior of doctors and staff at lower health facilities compared to higher level facilities.

  13. Prevalence of physical and verbal aggressive behaviours and associated factors among older adults in long-term care facilities

    Directory of Open Access Journals (Sweden)

    Desrosiers Johanne

    2005-11-01

    Full Text Available Abstract Background Verbal and physical aggressive behaviours are among the most disturbing and distressing behaviours displayed by older patients in long-term care facilities. Aggressive behaviour (AB is often the reason for using physical or chemical restraints with nursing home residents and is a major concern for caregivers. AB is associated with increased health care costs due to staff turnover and absenteeism. Methods The goals of this secondary analysis of a cross-sectional study are to determine the prevalence of verbal and physical aggressive behaviours and to identify associated factors among older adults in long-term care facilities in the Quebec City area (n = 2 332. Results The same percentage of older adults displayed physical aggressive behaviour (21.2% or verbal aggressive behaviour (21.5%, whereas 11.2% displayed both types of aggressive behaviour. Factors associated with aggressive behaviour (both verbal and physical were male gender, neuroleptic drug use, mild and severe cognitive impairment, insomnia, psychological distress, and physical restraints. Factors associated with physical aggressive behaviour were older age, male gender, neuroleptic drug use, mild or severe cognitive impairment, insomnia and psychological distress. Finally, factors associated with verbal aggressive behaviour were benzodiazepine and neuroleptic drug use, functional dependency, mild or severe cognitive impairment and insomnia. Conclusion Cognitive impairment severity is the most significant predisposing factor for aggressive behaviour among older adults in long-term care facilities in the Quebec City area. Physical and chemical restraints were also significantly associated with AB. Based on these results, we suggest that caregivers should provide care to older adults with AB using approaches such as the progressively lowered stress threshold model and reactance theory which stress the importance of paying attention to the severity of cognitive

  14. [Approach to the patient in the ambulatory surgery unit].

    Science.gov (United States)

    Cordero-Ponce, Montserrat; Romero-Sánchez, Isabel María; López-Barea, José; Martínez-Ramos, Pablo

    2008-01-01

    Ambulatory surgery aims to improve the quality of care, provide services in an environment closer to users' normal surroundings, reduce the risk of nosocomial infection and release hospital beds for other uses demanded by the population, thus reducing health costs. Nursing activity in these units should aim to restore health and aid the rapid recovery of patients in their homes. To achieve this, an effective health education program is required. Such programs should be simple and, at the same time, cover the care that these patients will require during the recovery period at home. The unit covers patients in the Virgen de Rocío University Hospital, The Fleming Peripheral Center for Specialties and the Virgen de los Reyes Peripheral Center for Specialties in Seville, Spain and the the specialties included are plastic surgery, otorhinolaryngology, orthopedic surgery, urology, and general surgery. The duration of the education program will be at most 14-17 h.

  15. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-11-01

    Full Text Available Daniela Ghisi, Stefano Bonarelli Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy Abstract: Spinal anesthesia is a reliable and safe technique for procedures of the lower extremities. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The current availability of short-acting local anesthetics has renewed interest for this technique also in the context of short- and ultra-short procedures. Chloroprocaine (CP is an amino-ester local anesthetic with a very short half-life. It was introduced and has been successfully used for spinal anesthesia since 1952. Sodium bisulfite was then added as a preservative after 1956. The drug was then abandoned in the 1980s for several reports of neurological deficits in patients receiving accidentally high doses of intrathecal CP during epidural labor analgesia. Animal studies have proven the safety of the preservative-free formulation, which has been extensively evaluated in volunteer studies as well as in clinical practice with a favorable profile in terms of both safety and efficacy. In comparison with bupivacaine, 2-chloroprocaine (2-CP showed faster offset times to end of anesthesia, unassisted ambulation, and discharge from hospital. These findings suggests that 2-CP may be a suitable alternative to low doses of long-acting local anesthetics in ambulatory surgery. Its safety profile also suggests that 2-CP could be a valid substitute for intrathecal short- and intermediate-acting local anesthetics, such as lidocaine and mepivacaine – often causes of transient neurological symptoms. In this context, literature suggests a dose ranging between 30 and 60 mg of 2-CP for procedures lasting 60 minutes or less, while 10 mg is considered the no-effect dose. The present review describes recent evidence about 2-CP as an anesthetic agent for

  16. HCUP State Ambulatory Surgery Databases (SASD) - Restricted Access Files

    Data.gov (United States)

    U.S. Department of Health & Human Services — The State Ambulatory Surgery Databases (SASD) contain the universe of hospital-based ambulatory surgery encounters in participating States. Some States include...

  17. A proposed emergency management program for acute care facilities in response to a highly virulent infectious disease.

    Science.gov (United States)

    Petinaux, Bruno; Ferguson, Brandy; Walker, Milena; Lee, Yeo-Jin; Little, Gary; Parenti, David; Simon, Gary

    2016-01-01

    To address the organizational complexities associated with a highly virulent infectious disease (HVID) hazard, such as Ebola Virus Disease (EVD), an acute care facility should institute an emergency management program rooted in the fundamentals of mitigation, preparedness, response, and recovery. This program must address all known facets of the care of a patient with HVID, from unannounced arrival to discharge. The implementation of such a program not only serves to mitigate the risks from an unrecognized exposure but also serves to prepare the organization and its staff to provide for a safe response, and ensure a full recovery. Much of this program is based on education, training, and infection control measures along with resourcing for appropriate personal protective equipment which is instrumental in ensuring an organized and safe response of the acute care facility in the service to the community. This emergency management program approach can serve as a model in the care of not only current HVIDs such as EVD but also future presentations in our healthcare setting. PMID:26963227

  18. Client views, perception and satisfaction with immunisation services at Primary Health Care Facilities in Calabar, South-South Nigeria

    Institute of Scientific and Technical Information of China (English)

    Udonwa NE; Gyuse AN; Etokidem AJ; Ogaji DST

    2010-01-01

    Objective:To determine the degree of client satisfaction with immunisation services at Primary Health facilities in Calabar, Cross River State, Nigeria.Method: A semi-structured questionnaire was administered on 402 caregivers who were selected using systematic random sampling from four primary health centres. The four centres were randomly selected from the 19 health centres using the table of random numbers. Data obtained were analysed using Epi-Info software version 2002.Results: The majority of clients were dissatisfied with most aspects of care given at the Health Care Centres including long waiting time, accessibility of immunisation services, poor respect for clients' rights, especially to their dignity, health information and counseling on their medical needs.Conclusions:The study concludes that client satisfaction with immunization service in Calabar was low due to poor attitude of health care providers, long waiting time and lack of respect for clients' rights.

  19. Orientation of Medical Residents to the Psychosocial Aspects of Primary Care: Influence of Training Program.

    Science.gov (United States)

    Eisenthal, Sherman; And Others

    1994-01-01

    A survey of 63 general medical residents found most accepted the psychosocial role of the primary care physician, found it most appropriate in ambulatory care settings, felt ambivalent about their ability to perform it, and assigned it secondary priority in patient care. More attention by training programs to ambulatory care and psychosocial…

  20. Depressive morbidity among elderly individuals who are hospitalized, reside at long-term care facilities, and are under outpatient care in Brazil: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Luís Fernando S. Castro-de-Araújo

    2013-06-01

    Full Text Available Objectives: i To investigate studies published between 1991 and 2010 on the prevalence of depressive morbidity (major depressive disorder [MDD], dysthymia and clinically significant depressive symptoms [CSDS] among elderly Brazilians assisted at healthcare facilities; ii to establish the prevalence of depression and identify its related factors; and iii to conduct a meta-analysis to assess the prevalence of depressive syndrome among elderly individuals assisted or hospitalized at healthcare facilities. Methods: Studies were selected from articles dated between January 1991 and June 2010 and extracted from the MEDLINE, LILACS, and SciELO databases. Results: The final analysis consisted of 15 studies, distributed as follows: i four sampled hospitalized patients, totaling 299 individuals, and found a prevalence of CSDS varying between 20 and 56%; ii four sampled outpatients, totaling 1,454 individuals; the prevalence of CSDS varied between 11 and 65%, and the prevalence of MDD varied between 23 and 42%; and iii seven sampled elderly individuals residing in long-term care facilities (LTCF, totaling 839 individuals, and the prevalence of CSDS varied between 11 and 65%. Conclusion: The present review indicated a higher prevalence of both MDD and CSDS among elderly Brazilians assisted at healthcare facilities.

  1. The accuracy of clinical malaria case reporting at primary health care facilities in Honiara, Solomon Islands

    Directory of Open Access Journals (Sweden)

    Kunimitsu Ayano

    2009-04-01

    Full Text Available Abstract Background The accuracy of malaria case reporting is challenging due to restricted human and material resources in many countries. The reporting often depends on the clinical diagnosis because of the scarcity of microscopic examinations. Particularly, clinical malaria case reporting by primary health care facilities (local clinics, which constitutes the baseline data of surveillance, has never previously been sufficiently evaluated. In order to improve the malaria reporting system to the level required to eventually eliminate this disease, this study estimates the gaps between the records of clinics and government statistics regarding the incidence of clinical malaria, and then also examines some factors that might explain the data discrepancy, including such variables as clinic staffing and record keeping. Methods All medical records for outpatients in 2007, handwritten by nurses, were collected from local clinics in Honiara, the capital of the Solomon Islands. The all-monthly clinical malaria cases were then recalculated. The corresponding monthly data in official statistics were provided by the government. Next, in order to estimate any data discrepancy, the ratio of the cases recorded at clinics to the cases reported to the government was determined on the monthly basis. Finally, the associations between the monthly discrepancy and other variables were evaluated by a multiple regression analysis. Results The mean data discrepancy between the records of clinics and government statistics was 21.2% (n = 96. Significant associations were observed between the discrepancy and the average number of patients (coefficient: 0.05, 95%CI: 0.31, 0.07, illegible handwriting (coefficient: 0.09, 95%CI: 0.04, 0.15, the use of tally sheets (coefficient:-0.38, 95%CI: -0.54, -0.22, and the clinic level (coefficient:-0.48, 95%CI:-0.89,-0.06. Conclusion The findings of this study demonstrate the huge data discrepancy between the records of clinics and

  2. The accuracy of clinical malaria case reporting at primary health care facilities in Honiara, Solomon Islands

    Science.gov (United States)

    Kunimitsu, Ayano

    2009-01-01

    Background The accuracy of malaria case reporting is challenging due to restricted human and material resources in many countries. The reporting often depends on the clinical diagnosis because of the scarcity of microscopic examinations. Particularly, clinical malaria case reporting by primary health care facilities (local clinics), which constitutes the baseline data of surveillance, has never previously been sufficiently evaluated. In order to improve the malaria reporting system to the level required to eventually eliminate this disease, this study estimates the gaps between the records of clinics and government statistics regarding the incidence of clinical malaria, and then also examines some factors that might explain the data discrepancy, including such variables as clinic staffing and record keeping. Methods All medical records for outpatients in 2007, handwritten by nurses, were collected from local clinics in Honiara, the capital of the Solomon Islands. The all-monthly clinical malaria cases were then recalculated. The corresponding monthly data in official statistics were provided by the government. Next, in order to estimate any data discrepancy, the ratio of the cases recorded at clinics to the cases reported to the government was determined on the monthly basis. Finally, the associations between the monthly discrepancy and other variables were evaluated by a multiple regression analysis. Results The mean data discrepancy between the records of clinics and government statistics was 21.2% (n = 96). Significant associations were observed between the discrepancy and the average number of patients (coefficient: 0.05, 95%CI: 0.31, 0.07), illegible handwriting (coefficient: 0.09, 95%CI: 0.04, 0.15), the use of tally sheets (coefficient:-0.38, 95%CI: -0.54, -0.22), and the clinic level (coefficient:-0.48, 95%CI:-0.89,-0.06). Conclusion The findings of this study demonstrate the huge data discrepancy between the records of clinics and government statistics in

  3. Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.

    Science.gov (United States)

    Munshi, Medha N; Florez, Hermes; Huang, Elbert S; Kalyani, Rita R; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S; Taveira, Tracey H; Haas, Linda B

    2016-02-01

    Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life.

  4. Evaluating the Effectiveness of Three Utah Wastewater Treatment Facilities in Removing Pharmaceuticals and Personal Care Products

    OpenAIRE

    Roth, Oksana

    2012-01-01

    The occurrence of Pharmaceuticals and Personal Care Products (PPCPs) in surface waters has become a growing concern within the last decade although the first mention of human PPCPs in the environment goes back to late 1970s. Pharmaceuticals include prescription drugs, over-the-counter medications, and veterinary drugs. Personal care products include products such as lotions, fragrances, and soaps. In addition to traditional personal care products, the term PPCPs has been adopted to represent ...

  5. Positive and negative emotional responses to workrelated trauma of intensive care nurses in private health care facilities

    OpenAIRE

    Lizelle Van der Vyver; Diane Elkonin

    2011-01-01

    Intensive care nursing is a stressful occupation and nurses are continually subjected to both primary and secondary trauma. Responses may be positive in the form of compassion satisfaction, or negative in the form of compassion fatigue. However, nurses tend to deny the negative impact of secondary trauma which leads to the silencing response and subsequent burnout. This article explores and describes the presence of these emotions and the relationships between them. A quantitative approach wi...

  6. Risk Factors for the Development of Gastrointestinal Colonization With Fluoroquinolone-Resistant Escherichia coli in Residents of Long-Term Care Facilities

    OpenAIRE

    Han, Jennifer H.; Maslow, Joel; Han, Xiaoyan; Xie, Sharon X; Tolomeo, Pam; Santana, Evelyn; Carson, Lesley; Lautenbach, Ebbing

    2013-01-01

    Background. The objective of this study was to assess risk factors for the development of fluoroquinolone (FQ)–resistant Escherichia coli gastrointestinal tract colonization in long-term care facility (LTCF) residents.

  7. Nursing staff's actions during older residents’ transition into long-term care facility in a nursing home in rural Norway

    Directory of Open Access Journals (Sweden)

    Marianne Eika

    2014-10-01

    Full Text Available Working in long-term care units poses particular staff challenges as these facilities are expected to provide services for seriously ill residents and give help in a homelike atmosphere. Licensed and unlicensed personnel work together in these surroundings, and their contributions may ease or inhibit a smooth transition for recently admitted residents. The aim of the study was to describe and explore different nursing staff's actions during the initial transition period for older people into a long-term care facility. Participant observation periods were undertaken following staff during 10 new residents’ admissions and their first week in the facility. In addition 16 interviews of different staff categories and reading of written documents were carried out. The findings show great variations of the staff's actions during the older residents’ initial transition period. Characteristics of their actions were (1 in the preparation period: “actions of sharing, sorting out, and ignoring information”; (2 on admission day: “actions of involvement and ignorance”; and (3 in the initial period: “targeted and random actions,” “actions influenced by embedded knowledge,” and “actions influenced by local transparency.”

  8. Exploring the Demands on Nurses Working in Health Care Facilities During a Large-Scale Natural Disaster

    Directory of Open Access Journals (Sweden)

    Gillian C. Scrymgeour

    2016-06-01

    Full Text Available Nurses are pivotal to an effective societal response to a range of critical events, including disasters. This presents nurses with many significant and complex challenges that require them to function effectively under highly challenging and stressful circumstances and often for prolonged periods of time. The exponential growth in the number of disasters means that knowledge of disaster preparedness and how this knowledge can be implemented to facilitate the development of resilient and adaptive nurses and health care organizations represents an important adjunct to nurse education, policy development, and research considerations. Although this topic has and continues to attract attention in the literature, a lack of systematic understanding of the contingencies makes it difficult to clearly differentiate what is known and what gaps remain in this literature. Providing a sound footing for future research can be facilitated by first systematically reviewing the relevant literature. Focused themes were identified and analyzed using an ecological and interactive systems framework. Ten of the 12 retained studies included evacuation, revealing that evacuation is more likely to occur in an aged care facility than a hospital. The unpredictability of an event also highlighted organizational, functional, and competency issues in regard to the complexity of decision making and overall preparedness. The integrative review also identified that the unique roles, competencies, and demands on nurses working in hospitals and residential health care facilities during a natural disaster appear invisible within the highly visible event.

  9. Healthcare-associated infections and antimicrobial use in long-term care facilities: the Irish experience with the HALT surveys.

    Science.gov (United States)

    Burns, K; Roche, F; Donlon, S

    2015-04-01

    In the context of an ageing European population, point prevalence surveys (PPS) of healthcare-associated infection and antimicrobial use in long-term care facilities (HALT) in Europe were commissioned by the European Centre for Disease Prevention and Control. Sixty-nine Irish long-term care facilities (LTCFs) took part in the first survey in 2010. A series of interventions to raise the profile of infection prevention and control and antimicrobial stewardship in Irish LTCFs followed. HALT was repeated in Ireland in 2011, with 108 participating LTCFs, and again in 2013 as part of the second European HALT survey, with 190 participating LTCFs. The latest Irish HALT report incorporates data from the three PPSs to date, and discusses the findings and the national implementation priorities recommended by the Irish multi-disciplinary steering group. Ireland contributed ∼10% of the total resident population in both of the European HALT PPSs. This, and the growing number of participating LTCFs, shows that healthcare professionals in Irish LTCFs are committed to improving the quality and safety of resident care.

  10. Measuring Patient Satisfaction: A Case Study to Improve Quality of Care at Public Health Facilities

    OpenAIRE

    Sodani Prahlad; Kumar Rajeev; Srivastava Jayati; Sharma Laxman

    2010-01-01

    Objective: The main objective of the study is to measure the satisfaction of OPD (Outpatient Department) patients in public health facilities of Madhya Pradesh in India. Materials and Methods: Data were collected from OPD patients through pre-structured questionnaires at public health facilities in the sampled eight districts of Madhya Pradesh. The data were analyzed using SPSS. Settings: Outpatient Departments of district hospital, civil hospital, community health centre, and primary ...

  11. Predictors of antibiotic prescription in respiratory tract infections by ambulatory care practitioners Predictores de la prescripción de antibióticos en infecciones del tracto respiratorio por médicos de atención ambulatoria

    Directory of Open Access Journals (Sweden)

    Mireya Aznar

    2005-12-01

    Full Text Available The use of antibiotics in viral respiratory infections (common cold, acute rhinosinusitis and acute bronchitis promotes the emergence and spread of resistant bacteria. Studies have found that antibiotics are prescribed for 50-70% of respiratory tract infections, despite the fact that most of them have a viral etiology. The objective of the study was to determine predictors of antibiotic use in acute respiratory infections. It was conducted as a cross-sectional study on physicians' practices for antibiotic use. The subjects were internists and otolaryngologists of adult patients in an ambulatory setting in Buenos Aires. The instrument was a questionnaire with 20 clinical vignettes that included relevant variables for making decisions regarding antibiotic use in acute respiratory infections. The vignettes were constructed with a fractional factorial design with nine clinical variables. The absolute and relative weight of each clinical variable that predicted antibiotic use were calculated for each individual practitioner using multiple linear regression. The predictors with the greatest absolute weight in the decision to prescribe antibiotics were nasal discharge and cough (24% and 21% of total weight. The correlation between predictors and individual physician answers was high (r² = 0.73. The mean probability and the rate of antibiotic prescription were both about 50%. Predictors of antibiotic use for acute respiratory infections among ambulatory physicians in this sample differ from internationally accepted guidelines. The likelihood of prescribing antibiotics for these illnesses is high. Wider implementation of management guidelines for acute respiratory infections could improve cost effective antibiotic use and decrease the development of antibiotic resistance.El uso excesivo de antibióticos promueve la aparición y diseminación de bacterias resistentes. Se ha encontrado una tasa de prescripción de antibióticos en infecciones

  12. Ambulatory Measurement of Ground Reaction Forces

    NARCIS (Netherlands)

    Veltink, Peter H.; Liedtke, Christian; Droog, Ed

    2004-01-01

    The measurement of ground reaction forces is important in the biomechanical analysis of gait and other motor activities. It is the purpose of this study to show the feasibility of ambulatory measurement of ground reaction forces using two six degrees of freedom sensors mounted under the shoe. One se

  13. The Effect of Mobile App Home Monitoring on Number of In-Person Visits Following Ambulatory Surgery: Protocol for a Randomized Controlled Trial

    OpenAIRE

    Armstrong, Kathleen A; Coyte, Peter C.; Bhatia, R Sacha; Semple, John L

    2015-01-01

    Background Women’s College Hospital, Toronto, Canada, offers specialized ambulatory surgical procedures. Patients often travel great distances to undergo surgery. Most patients receiving ambulatory surgery have a low rate of postoperative events necessitating clinic visits. However, regular follow-up is still considered important in the early postoperative phase. Increasingly, telemedicine is used to overcome the distance patients must travel to receive specialized care. Telemedicine data sug...

  14. Vaccination coverage of health care personnel working in health care facilities in France: results of a national survey, 2009.

    Science.gov (United States)

    Guthmann, Jean-Paul; Fonteneau, Laure; Ciotti, Céline; Bouvet, Elisabeth; Pellissier, Gérard; Lévy-Bruhl, Daniel; Abiteboul, Dominique

    2012-06-29

    We conducted a national cross-sectional survey to investigate vaccination coverage (VC) in health care personnel (HCP) working in clinics and hospitals in France. We used a two-stage stratified random sampling design to select 1127 persons from 35 health care settings. Data were collected by face-to-face interviews and completed using information gathered from the occupational health doctor. A total of 183 physicians, 110 nurses, 58 nurse-assistants and 101 midwives were included. VC for compulsory vaccinations was 91.7% for hepatitis B, 95.5% for the booster dose of diphtheria-tetanus-polio (DTP), 94.9% for BCG. For non-compulsory vaccinations, coverage was 11.4% for the 10 year booster of the DTP pertussis containing vaccine, 49.7% for at least one dose of measles, 29.9% for varicella and 25.6% for influenza. Hepatitis B VC did not differ neither between HCP working in surgery and HCP in other sectors, nor in surgeons and anaesthesiologists compared to physicians working in medicine. Young HCP were better vaccinated for pertussis and measles (pvaccinated for influenza and pertussis (pcompulsory vaccinations, whereas VC for non-compulsory vaccinations is very insufficient. The vaccination policy regarding these latter vaccinations should be reinforced in France.

  15. Positive and negative emotional responses to workrelated trauma of intensive care nurses in private health care facilities

    Directory of Open Access Journals (Sweden)

    Lizelle Van der Vyver

    2011-02-01

    Full Text Available Intensive care nursing is a stressful occupation and nurses are continually subjected to both primary and secondary trauma. Responses may be positive in the form of compassion satisfaction, or negative in the form of compassion fatigue. However, nurses tend to deny the negative impact of secondary trauma which leads to the silencing response and subsequent burnout. This article explores and describes the presence of these emotions and the relationships between them. A quantitative approach with a non-probability sampling method was used. The sample consisted of 30 registered nurses working in private health care intensive care units in East London, Eastern Cape. Data were gathered via the Professional Quality of Life Scale: Compassion Satisfaction and Fatigue Subscales – Revision IV (ProQOL – R-IV and the Silencing Response Scale and were analysed according to descriptive statistics and correlation coefficients. Findings suggest a high risk for compassion fatigue, a moderate risk for burnout and the silencing response and moderate potential for compassion satisfaction. A marked negative relationship was found between compassion satisfaction and burnout and a substantial positive relationship between compassion fatigue and burnout, as well as compassion fatigue and the silencing response.

    Opsomming

    Intensiewesorgverpleging is ‘n stresvolle beroep en verpleegsters word gedurig aan beide primêre en sekondêre trauma blootgestel. Reaksie hierop kan óf positief wees, in die vorm van empatie-tevredenheid, óf negatief, in die vorm van empatie-uitputting. Verpleegsters is egter geneig om die negatiewe impak van sekondêre trauma te ontken,wat gevolglik tot stilswye en uitbranding kan lei. Hierdie artikel ondersoek en beskryf die teenwoordigheid en verwantskap tussen hierdie emosies. ‘n Kwantitatiewe benadering met ‘n nie-waarskynlikheidsteekproefmetode is gebruik. Die steekproef het bestaan uit 30 geregistreerde

  16. Predicting recovery at home after Ambulatory Surgery

    Directory of Open Access Journals (Sweden)

    Ayala Guillermo

    2011-10-01

    Full Text Available Abstract The correct implementation of Ambulatory Surgery must be accompanied by an accurate monitoring of the patient post-discharge state. We fit different statistical models to predict the first hours postoperative status of a discharged patient. We will also be able to predict, for any discharged patient, the probability of needing a closer follow-up, or of having a normal progress at home. Background The status of a discharged patient is predicted during the first 48 hours after discharge by using variables routinely used in Ambulatory Surgery. The models fitted will provide the physician with an insight into the post-discharge progress. These models will provide valuable information to assist in educating the patient and their carers about what to expect after discharge as well as to improve their overall level of satisfaction. Methods A total of 922 patients from the Ambulatory Surgery Unit of the Dr. Peset University Hospital (Valencia, Spain were selected for this study. Their post-discharge status was evaluated through a phone questionnaire. We pretend to predict four variables which were self-reported via phone interviews with the discharged patient: sleep, pain, oral tolerance of fluid/food and bleeding status. A fifth variable called phone score will be built as the sum of these four ordinal variables. The number of phone interviews varies between patients, depending on the evolution. The proportional odds model was used. The predictors were age, sex, ASA status, surgical time, discharge time, type of anaesthesia, surgical specialty and ambulatory surgical incapacity (ASI. This last variable reflects, before the operation, the state of incapacity and severity of symptoms in the discharged patient. Results Age, ambulatory surgical incapacity and the surgical specialty are significant to explain the level of pain at the first call. For the first two phone calls, ambulatory surgical incapacity is significant as a predictor for all

  17. Falls related to accidental deactivation of deep brain stimulators in patients with Parkinson's disease living in long term care facilities.

    Science.gov (United States)

    Tousi, Babak; Wilson, Kathy

    2013-01-01

    This case series highlights three patients with Parkinson's disease residing at nursing home facilities whose deep brain stimulators were accidentally deactivated for varying lengths of time, which was associated with an increase in falls. In all three cases, neither the patients nor the caregivers were aware of the random deactivations/reactivations. We propose a specific care plan for these patients that includes further education of caregivers regarding deep brain stimulators and regular checks of the review device, especially when there is concern about a patient's mobility or balance that is out of character.

  18. FACTORS INFLUENCING THE CHOICE OF HEALTH CARE PROVIDING FACILITY AMONG WORKERS IN A LOCAL GOVERNMENT SECRETARIAT IN SOUTH WESTERN NIGERIA

    OpenAIRE

    Uchendu, O. C.; Ilesanmi, O. S,; Olumide, A.E.

    2013-01-01

    Background: There is increasing interest in the choice of health care providing facility in Nigeria. Objectives: This study aimed to assess the factors influencing choice and satisfaction with health service providers among local government staff. Methods: A cross sectional survey of all 312 workers in a Local Government Secretariat in South West Nigeria was done. Chi Square and logistic regression analysis was done. Results: The mean age was 38.6 ± 7.5 years, 55% were females and 71.7% had t...

  19. Influenza immunization coverage of residents and employees of long-term care facilities in New York State, 2000-2010.

    Science.gov (United States)

    Person, Cara J; Nadeau, Jessica A; Schaffzin, Joshua K; Pollock, Lynn; Wallace, Barbara J; McNutt, Louise Ann; Blog, Debra

    2013-08-01

    We describe influenza immunization coverage trends from the New York State (NYS) Department of Health long-term care facility (LTCF) reports. Overall median immunization coverage levels for NYS LTCF residents and employees were 84.0% (range: 81.6%-86.0%) and 37.7% (range: 32.7%-50.0%), respectively. LTCF resident immunization coverage levels in NYS have neared the Healthy People 2020 target of 90% but have not achieved high LTCF employee coverage, suggesting a need for more regulatory interventions.

  20. Assisted Living Facilities, ElderCareFacilities-Elder care facilities in the State of Utah, Published in 2005, 1:24000 (1in=2000ft) scale, State of Utah Automated Geographic Reference Center.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Assisted Living Facilities dataset, published at 1:24000 (1in=2000ft) scale, was produced all or in part from Other information as of 2005. It is described as...

  1. Is higher volume of postacute care patients associated with a lower rehospitalization rate in skilled nursing facilities?

    Science.gov (United States)

    Li, Yue; Cai, Xueya; Yin, Jun; Glance, Laurent G; Mukamel, Dana B

    2012-02-01

    This study determined whether higher patient volume of skilled nursing facility (SNF) care was associated with a lower hospital transfer rate. Using the nursing home Minimum Data Set and the Online Survey, Certification, and Reporting file, we assembled a national cohort of Medicare SNF postacute care admissions between January and September of 2008. Multivariable analyses based on Cox proportional hazards models found that patients admitted to high-volume SNFs (annual number of admissions in the top tertile group) showed an approximately 15% reduced risk for 30-day rehospitalization and an approximately 25% reduced risk for 90-day rehospitalization, compared with patients admitted to low-volume SNFs (annual number of admissions in the bottom tertile group, or practice makes perfect" effect, a "selective referral" effect, or both. PMID:21810798

  2. Quality of Longer Term Mental Health Facilities in Europe : Validation of the Quality Indicator for Rehabilitative Care against Service Users' Views

    NARCIS (Netherlands)

    Killaspy, Helen; White, Sarah; Wright, Christine; Taylor, Tatiana L.; Turton, Penny; Kallert, Thomas; Schuster, Mirjam; Cervilla, Jorge A.; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitris; Gonidakis, Fragiskos; Caldas-de-Almeida, Jose Miguel; Cardoso, Graca; King, Michael

    2012-01-01

    Background: The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise wit

  3. Brote por Pseudomonas aeruginosa, en el área de atención ambulatoria de heridas quirúrgicas, en pacientes posmastectomizadas Outbreak of postmastectomy wound infections caused by Pseudomonas aeruginosa in an ambulatory surgical care setting

    Directory of Open Access Journals (Sweden)

    Diana Vilar-Compte

    2003-10-01

    by a ciprofloxacin and gentamycin-resistant P. aeruginosa. The causative Pseudomonas was isolated from a nurse's nostrils and non-sterile gauzes left by her on the Mayo table at the Breast Tumor ambulatory clinic. None of the closed packages was positive to Pseudomonas. On April 14, 2000, the nurse was transferred to another ward and strict infection control practices were established. After this date, 4 additional cases were diagnosed. Radiation therapy was the only risk factor for infection (Or=5.1, 95% cI 1.1-28.4. CONCLUSIONS: This outbreak was probably caused by a common source initially, and later disseminated by cross-infection among patients. The poor compliance with infection control practices during wound cleaning and drainage led to implementing a series of specific preventive interventions.

  4. CARE. A model for radiation exposure calculations based on measured emission rates from nuclear facilities

    International Nuclear Information System (INIS)

    The programme CARE (calculation of the annual radiation exposure) calculates the annual environmental exposure of complex nuclear installations. In the diffusion calculation of pollutants, the real weather conditions of the year concerned are taken into account on an hourly basis together with the associated release rates measured for the various nuclides of individual emitters. According to their location in the plant, the contributions of the time-integrated pollutant concentrations of the individual emitters are superimposed at predefinable receiving points in the vicinity or on the boundary of an installation (plant fencing). In the conception of models for calculating the resultant 50-year dose commitments care was taken to ensure that the programme CARE is capable of treating both individual emissions limited in time and quasi-continuous emissions. The programme CARE can therefore be used also for a subsequent calculation of radiation exposure in the event of accidents. (orig.)

  5. Brief Bedside Refresher Training to Practice Cardiopulmonary Resuscitation Skills in the Ambulatory Surgery Center Setting.

    Science.gov (United States)

    Kemery, Stephanie; Kelly, Kelley; Wilson, Connie; Wheeler, Corrine A

    2015-08-01

    Cardiac arrest can occur in any health care setting at any time, requiring nursing staff to be prepared to quickly and adequately perform basic cardiopulmonary resuscitation (CPR). Currently, the American Heart Association certifies health care providers in Basic Life Support (BLS) for a 2-year period, but evidence indicates that psychomotor skills decline well before the end of the certification time frame. Nurses in the ambulatory surgery setting expressed concern regarding their ability to implement CPR successfully, given the infrequent occurrence of cardiac and respiratory arrests. Using a study by Niles et al. as a model, the authors piloted the implementation of brief CPR refresher training at the bedside of an ambulatory surgery center to assess and increase nurse confidence in BLS skills. PMID:26247660

  6. Pharmacist-documented interventions during the dispensing process in a primary health care facility in Qatar

    OpenAIRE

    Kheir, Nadir

    2009-01-01

    Richard Hooper1, Abdullah Adam2, Nadir Kheir31Medical Services Department, 2Pharmacy Department, Medical Services, Qatar Petroleum, Doha, Qatar; 3Qatar University, College of Pharmacy, Doha, QatarObjectives: To characterize prescribing error interventions documented by pharmacists in four pharmacies in a primary health care service in Qatar.Methods: The study was conducted in a primary health care service in the State of Qatar in the period from January to March 2008. Pharmacists in four clin...

  7. Characterization of infectious aerosols in health care facilities: an aid to effective engineering controls and preventive strategies.

    Science.gov (United States)

    Cole, E C; Cook, C E

    1998-08-01

    Assessment of strategies for engineering controls for the prevention of airborne infectious disease transmission to patients and to health care and related workers requires consideration of the factors relevant to aerosol characterization. These factors include aerosol generation, particle size and concentrations, organism viability, infectivity and virulence, airflow and climate, and environmental sampling and analysis. The major focus on attention to engineering controls comes from recent increases in tuberculosis, particularly the multidrug-resistant varieties in the general hospital population, the severely immunocompromised, and those in at-risk and confined environments such as prisons, long-term care facilities, and shelters for the homeless. Many workers are in close contact with persons who have active, undiagnosed, or insufficiently treated tuberculosis. Additionally, patients and health care workers may be exposed to a variety of pathogenic human viruses, opportunistic fungi, and bacteria. This report therefore focuses on the nature of infectious aerosol transmission in an attempt to determine which factors can be systematically addressed to result in proven, applied engineering approaches to the control of infectious aerosols in hospital and health care facility environments. The infectious aerosols of consideration are those that are generated as particles of respirable size by both human and environmental sources and that have the capability of remaining viable and airborne for extended periods in the indoor environment. This definition precludes skin and mucous membrane exposures occurring from splashes (rather than true aerosols) of blood or body fluids containing infectious disease agents. There are no epidemiologic or laboratory studies documenting the transmission of bloodborne virus by way of aerosols. PMID:9721404

  8. Mobility of Vulnerable Elders (MOVE: study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities

    Directory of Open Access Journals (Sweden)

    Slaughter Susan E

    2011-12-01

    Full Text Available Abstract Background Almost 90% of residents living in long-term care facilities have limited mobility which is associated with a loss of ability in activities of daily living, falls, increased risk of serious medical problems such as pressure ulcers, incontinence and a significant decline in health-related quality of life. For health workers caring for residents it may also increase the risk of injury. The effectiveness of rehabilitation to facilitate mobility has been studied with dedicated research assistants or extensively trained staff caregivers; however, few investigators have examined the effectiveness of techniques to encourage mobility by usual caregivers in long-term care facilities. Methods/Design This longitudinal, quasi-experimental study is designed to demonstrate the effect of the sit-to-stand activity carried out by residents in the context of daily care with health care aides. In three intervention facilities health care aides will prompt residents to repeat the sit-to-stand action on two separate occasions during each day and each evening shift as part of daily care routines. In three control facilities residents will receive usual care. Intervention and control facilities are matched on the ownership model (public, private for-profit, voluntary not-for-profit and facility size. The dose of the mobility intervention is assessed through the use of daily documentation flowsheets in the health record. Resident outcome measures include: 1 the 30-second sit-to-stand test; 2 the Functional Independence Measure; 3 the Health Utilities Index Mark 2 and 3; and, 4 the Quality of Life - Alzheimer's Disease. Discussion There are several compelling reasons for this study: the widespread prevalence of limited mobility in this population; the rapid decline in mobility after admission to a long-term care facility; the importance of mobility to quality of life; the increased time (and therefore cost required to care for residents with limited

  9. Local Anesthesia Combined With Sedation Compared With General Anesthesia for Ambulatory Operative Hysteroscopy

    DEFF Research Database (Denmark)

    Brix, Lone Dragnes; Thillemann, Theis Muncholm; Nikolajsen, Lone

    2016-01-01

    anesthesia combined with sedation (group LA + S; n = 76) or general anesthesia (group GA; n = 77). Primary outcome was the worst pain intensity score in the postanesthesia care unit (PACU) rated by the patients on a numerical rating scale. FINDING: Data from 144 patients were available for analysis (LA + S...... was shorter (P anesthesia with sedation can be recommended as a first choice anesthetic technique for operative ambulatory hysteroscopy....

  10. Levels and variations in the quality of facility-based antenatal care in Kenya: evidence from the 2010 service provision assessment.

    Science.gov (United States)

    Lee, Elizabeth; Madhavan, Supriya; Bauhoff, Sebastian

    2016-07-01

    Quality of care is emerging as an important concern for low- and middle-income countries working to expand and improve coverage. However, there is limited systematic, large-scale empirical guidance to inform policy design. Our study operationalized indicators for six dimensions of quality of care that are captured in currently available, standardized Service Provision Assessments. We implemented these measures to assess the levels and heterogeneity of antenatal care in Kenya. Using our indicator mix, we find that performance is low overall and that there is substantial variation across provinces, management authority and facility type. Overall, facilities performed highest in the dimensions of efficiency and acceptability/patient-centeredness, and lowest on effectiveness and accessibility. Public facilities generally performed worse or similarly to private or faith-based facilities. We illustrate how these data and methods can provide readily-available, low-cost decision support for policy. PMID:26879091

  11. Medicare beneficiaries more likely to receive appropriate ambulatory services in HMOs than in traditional medicare.

    Science.gov (United States)

    Ayanian, John Z; Landon, Bruce E; Zaslavsky, Alan M; Saunders, Robert C; Pawlson, L Gregory; Newhouse, Joseph P

    2013-07-01

    With quality-of-care bonus payments now available for Medicare Advantage health maintenance organizations (HMOs) and for accountable care organizations in traditional Medicare, the need to understand the relative quality of care delivered to Medicare enrollees has increased. We compared the quality of ambulatory care from 2003 through 2009 between beneficiaries enrolled in Medicare Advantage HMOs and those enrolled in traditional Medicare, and we assessed how the performance of various types of Medicare HMOs differed from that of traditional Medicare for these same measures. We found that beneficiaries in Medicare HMOs were consistently more likely than those in traditional Medicare to receive appropriate breast cancer screening, diabetes care, and cholesterol testing for cardiovascular disease. We also found that Medicare HMO physicians were rated less favorably by their patients than were physicians in traditional Medicare in 2003; however, by 2009 the opposite was true. Not-for-profit, larger, and older Medicare HMOs performed consistently more favorably on clinical measures and ratings of care than for-profit, smaller, and newer HMOs. Our results suggest that the positive effects of more-integrated delivery systems on the quality of ambulatory care in Medicare HMOs may outweigh the potential incentives to restrict care under capitated payments.

  12. 78 FR 38594 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

    Science.gov (United States)

    2013-06-27

    ... receive services under the Medicare hospice benefit. Medicare does not have a separate payment rate for... and board charges. If, however, a patient receiving Medicare hospice benefits in an LTC facility is... aide services that are paid for under the hospice benefit. (OIG, Medicare Hospices that Focus...

  13. Consumer Satisfaction in Long-Term Care: State Initiatives in Nursing Homes and Assisted Living Facilities

    Science.gov (United States)

    Lowe, Timothy J.; Lucas, Judith A.; Castle, Nicholas G.; Robinson, Joanne P.; Crystal, Stephen

    2003-01-01

    Purpose: We report the results of a survey of state initiatives that measure resident satisfaction in nursing homes and assisted living facilities, and we describe several model programs for legislators and public administrators contemplating the initiation of their own state programs. Design and Methods: Data on state initiatives and programs…

  14. A Preceptorship Model for Nurses in Rural Health Care Facilities. Rural Education Research Series No. 2.

    Science.gov (United States)

    Pottinger, M. Enid

    This report describes a preceptorship model that provides student nurses with clinical practice in rural health facilities. The development and implementation of a preceptorship model reflects a partnership between nursing education and nursing service--between the urban nursing school and the rural hospital. A five-stage preceptorship model is…

  15. A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana

    DEFF Research Database (Denmark)

    Ahiabu, Mary-Anne; Tersbøl, Britt Pinkowski; Biritwum, Richard;

    2016-01-01

    Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis...

  16. Opinions on building design for old-aged caring facility%关于养老设施建筑设计的几点看法

    Institute of Scientific and Technical Information of China (English)

    董越秀

    2016-01-01

    根据养老设施的建筑设计理念,介绍了养老设施的建筑内容,从整体规划、居住单元、绿色设计等方面,阐述了养老设施建筑设计的要点,使养老建筑的设计实现全面化、通达化、庭院化、舒适化。%According to building design concept of old-age caring facility,the paper introduces the old-age caring facility building contents. Start-ing from aspects of integral planning,housing unit and green design,it describes the building design points of old-age caring facility,so as to make old-age caring building design comprehensive,smooth,comfortable and garden-like yards.

  17. Type of soap and the incidence of skin tears among residents of a long-term care facility.

    Science.gov (United States)

    Mason, S R

    1997-09-01

    Skin tears are common among residents of long-term care facilities. This study evaluated the effectiveness of emollient antibacterial soap compared to non-emollient antibacterial soap in improving skin quality and reducing skin tears among residents of a long-term care facility. Skin tears were monitored over 4 months: non-emollient soap in the first and third months, and emollient soap in the second and fourth months were used. Rate of skin tears per resident per month were calculated. Incident reports were monitored the first month to establish skin tear rates using non-emollient soap. Skin tears decreased with the use of emollient soap (37% and 33% decrease in months two and four, respectively) and increased with the reintroduction of non-emollient soap (43% increase in month three). Overall incidence of skin tears with the use of emollient soap was 34.8 percent lower than that of the non-emollient soap. Analysis of variance did not show statistical significance [F(1,84) = 3.108, p = .0821], but clinical significance was demonstrated by the reduced number of skin tears with the use of emollient soap. While the etiology of skin tears seems to be a problem of aging, the decrease in skin tears in this study supports the continued use of emollient soap.

  18. Ambulatory Healthcare Utilization in the United States: A System Dynamics Approach

    Science.gov (United States)

    Diaz, Rafael; Behr, Joshua G.; Tulpule, Mandar

    2011-01-01

    Ambulatory health care needs within the United States are served by a wide range of hospitals, clinics, and private practices. The Emergency Department (ED) functions as an important point of supply for ambulatory healthcare services. Growth in our aging populations as well as changes stemming from broader healthcare reform are expected to continue trend in congestion and increasing demand for ED services. While congestion is, in part, a manifestation of unmatched demand, the state of the alignment between the demand for, and supply of, emergency department services affects quality of care and profitability. The central focus of this research is to provide an explanation of the salient factors at play within the dynamic demand-supply tensions within which ambulatory care is provided within an Emergency Department. A System Dynamics (SO) simulation model is used to capture the complexities among the intricate balance and conditional effects at play within the demand-supply emergency department environment. Conceptual clarification of the forces driving the elements within the system , quantifying these elements, and empirically capturing the interaction among these elements provides actionable knowledge for operational and strategic decision-making.

  19. Linking household and facility data for better coverage measures in reproductive, maternal, newborn, and child health care: systematic review

    Science.gov (United States)

    Do, Mai; Micah, Angela; Brondi, Luciana; Campbell, Harry; Marchant, Tanya; Eisele, Thomas; Munos, Melinda

    2016-01-01

    Background Currently many measures of intervention coverage obtained from household surveys do not measure actual health intervention/service delivery, resulting in a need for linking reports of care–seeking with assessments of the service environment in order to improve measurements. This systematic review aims to identify evidence of different methods used to link household surveys and service provision assessments, with a focus on reproductive, maternal, newborn and child health care, in low– and middle–income countries. Methods Using pre–defined search terms, articles published in peer–reviewed journals and the grey literature after 1990 were identified, their reference lists scanned and linking methods synthesized. Findings A total of 59 articles and conference presentations were carefully reviewed and categorized into two groups based on the linking method used: 1) indirect/ecological linking that included studies in which health care–seeking behavior was linked to all or the nearest facilities or providers of certain types within a geographical area, and 2) direct linking/exact matching where individuals were linked with the exact provider or facility where they sought care. The former approach was employed in 51 of 59 included studies, and was particularly common among studies that were based on independent sources of household and facility data that were nationally representative. Only eight of the 59 reviewed studies employed direct linking methods, which were typically done at the sub–national level (eg, district level) and often in rural areas, where the number of providers was more limited compared to urban areas. Conclusions Different linking methods have been reported in the literature, each category has its own set of advantages and limitations, in terms of both methodology and practicality for scale–up. Future studies that link household and provider/facility data should also take into account factors such as sources of data, the

  20. Identifying characteristics associated with performing recommended practices in maternal and newborn care among health facilities in Rwanda: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Sipsma Heather L

    2012-07-01

    Full Text Available Abstract Background Although rates of maternal and neonatal mortality have decreased in many countries over the last two decades, they remain unacceptably high, particularly in sub-Saharan Africa. Nevertheless, we know little about the quality of facility-based maternal and newborn care in low-income countries and little about the association between quality of care and health worker training, supervision, and incentives in these settings. We therefore sought to examine the quality of facility-based maternal and newborn health care by describing the implementation of recommended practices for maternal and newborn care among health care facilities. We also aimed to determine whether increased training, supervision, and incentives for health workers were associated with implementing these recommended practices. We chose to study these aims in the Republic of Rwanda, where rates of maternal and newborn mortality are high and where substantial attention is currently focused on strengthening health workforce capacity and quality. Methods We used data from the 2007 Rwanda Service Provision Assessment. Using observations from 455 facilities and interviews from 1357 providers, we generated descriptive statistics to describe the use of recommended practices and frequencies of provider training, supervision, and incentives in the areas of antenatal, delivery, and newborn care. We then constructed multivariable regression models to examine the associations between using recommended practices and health provider training, supervision, and incentives. Results Use of recommended practices varied widely, and very few facilities performed all recommended practices. Furthermore, in most areas of care, less than 25% of providers reported having had any pre-service or in-service training in the last 3 years. Contrary to our hypotheses, we found no evidence that training, supervision, or incentives were consistently associated with using recommended practices

  1. Preliminary Report of a Pilot Tele-Health Palliative Care and Bioethics Program for Residents in Skilled Nursing Facilities

    Directory of Open Access Journals (Sweden)

    Sean O’Mahony

    2009-12-01

    Full Text Available Currently about 25% of Americans die in nursing homes, many with poorly controlled pain and other symptoms, with minimal provisions for psychosocial support. New models are necessary to lessen structural and process barriers to give effective end-of-life care in nursing homes. Objectives: 1 To extend hospital-based Bioethics Consultation Services (BCS and Palliative Care Services (PCS at Montefiore Medical Center (MMC in the Bronx to two local Skilled Nursing Facilities (SNFs, Morningside House Aging in America (MSH using direct face-to-face consultations and Beth Abraham Health Systems (BAHS via video consultations (VC; 2 Achieve improvements in quality of life and comfort for elderly residents and their families; 2a Improve the level of practice and increase staff satisfaction with palliative care content-related knowledge and bioethical analysis. Methods: We report preliminary findings of this two group quasi experimental project with results of pre- and post- tests rating content-related knowledge in aspects of end-of-life care for staff. Select pre-test and post-test questions were given to physicians and other staff, but were re-configured for, registered and licensed practice nurses, social workers, and certified nursing assistants from the End-of-Life Physician Education Resource Center (EPERC. Patient, family, and staff ratings of the quality of palliative care were measured with a Palliative Outcomes Scale (POS one week prior to and post consultation. Results: 72 staff attended in-services; 53 completed pre-tests and 49 post-tests. Overall knowledge scores increased for 9 of the 16 items that were analyzed. There were improvements in knowledge scores in 12 of 16 items tested for staff content related knowledge which were statistically significant in regard to management of cancer pain from 63.8% to 81.5% (p = 0.03 and a trend to significance for assessment and management of delirium from 31.6% to 61.9% (p = 0.073. Seventy five POS

  2. Standards and general criteria for the planning and certification of need of megavoltage radiation oncology units in health care facilities

    International Nuclear Information System (INIS)

    Minimum standards and guidelines to be applied by State agencies and New Jersey health systems agencies in the examination of certificate-of-need applications and in the development of planning activities for radiation oncology units in health care facilities are presented. Radiation oncology is a medical discipline devoted to education and research in the use of ionizing radiation for the treatment of neoplastic disease. The proper application of radiation can be directed at either curative or palliative intent. It is an important and effective technique for the management of cancer. Radiotherapy equipment in clinical use is divided into four main categories: superficial, orthovoltage, megavoltage, and treatment planning facilities. Particular attention is given to megavoltage equipment which emits or generates rays over 1,000 kilovolts. These high energy rays effect better penetration of human tissue and are skin-sparing in nature, thus allowing for better tumor-to- skin dose ratios. The regionalization of megavoltage therapy services is discussed. Data on hospital megavoltage facilities in New Jersey for 1974, 1975, and 1976 are provided. The standards and guidelines pertain to utilization, personnel, and general criteria. A form for use by megavoltage radiation therapy units is appended

  3. A Practice Improvement Education Program Using a Mentored Approach to Improve Nursing Facility Depression Care-Preliminary Data.

    Science.gov (United States)

    Chodosh, Joshua; Price, Rachel M; Cadogan, Mary P; Damron-Rodriguez, JoAnn; Osterweil, Dan; Czerwinski, Alfredo; Tan, Zaldy S; Merkin, Sharon S; Gans, Daphna; Frank, Janet C

    2015-11-01

    Depression is common in nursing facility residents. Depression data obtained using the Minimum Data Set (MDS) 3.0 offer opportunities for improving diagnostic accuracy and care quality. How best to integrate MDS 3.0 and other data into quality improvement (QI) activity is untested. The objective was to increase nursing home (NH) capability in using QI processes and to improve depression assessment and management through focused mentorship and team building. This was a 6-month intervention with five components: facilitated collection of MDS 3.0 nine-item Patient Health Questionnaire (PHQ-9) and medication data for diagnostic interpretation; education and modeling on QI approaches, team building, and nonpharmacological depression care; mentored team meetings; educational webinars; and technical assistance. PHQ-9 and medication data were collected at baseline and 6 and 9 months. Progress was measured using team participation measures, attitude and care process self-appraisal, mentor assessments, and resident depression outcomes. Five NHs established interprofessional teams that included nursing (44.1%), social work (20.6%), physicians (8.8%), and other disciplines (26.5%). Members participated in 61% of eight offered educational meetings (three onsite mentored team meetings and five webinars). Competency self-ratings improved on four depression care measures (P = .05 to change while medication use declined, from 37.2% of residents at baseline to 31.0% at 9 months (P < .001). This structured mentoring program improved care processes, achieved medication reductions, and was well received. Application to other NH-prevalent syndromes is possible. PMID:26503548

  4. Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh

    Directory of Open Access Journals (Sweden)

    Sarika Chaturvedi

    2015-07-01

    Full Text Available Background: Access to facility delivery in India has significantly increased with the Janani Suraksha Yojana (JSY cash transfer programme to promote facility births. However, a decline in maternal mortality has only followed secular trends as seen from the beginning of the decade well before the programme began. We, therefore, examined the quality of intrapartum care provided in facilities under the JSY programme to study whether it ensures skilled attendance at birth. Design: 1 Non-participant observations (n=18 of intrapartum care during vaginal deliveries at a representative sample of 11 facilities in Madhya Pradesh to document what happens during intrapartum care. 2 Interviews (n=10 with providers to explore reasons for this care. Thematic framework analysis was used. Results: Three themes emerged from the data: 1 delivery environment is chaotic: delivery rooms were not conducive to safe, women-friendly care provision, and coordination between providers was poor. 2 Staff do not provide skilled care routinely: this emerged from observations that monitoring was limited to assessment of cervical dilatation, lack of readiness to provide key elements of care, and the execution of harmful/unnecessary practices coupled with poor techniques. 3 Dominant staff, passive recipients: staff sometimes threatened, abused, or ignored women during delivery; women were passive and accepted dominance and disrespect. Attendants served as ‘go-betweens’ patients and providers. The interviews with providers revealed their awareness of the compromised quality of care, but they were constrained by structural problems. Positive practices were also observed, including companionship during childbirth and women mobilising in the early stages of labour. Conclusions: Our observational study did not suggest an adequate level of skilled birth attendance (SBA. The findings reveal insufficiencies in the health system and organisational structures to provide an

  5. The lived experiences of resilience in Iranian adolescents living in residential care facilities: A hermeneutic phenomenological study

    Directory of Open Access Journals (Sweden)

    Manijeh Nourian

    2016-03-01

    Full Text Available Background: Resilience is one of the main factors affecting human health, and perceiving its meaning for high-risk adolescents is of particular importance in initiating preventive measures and providing resilience care. Objectives: This qualitative study was conducted to explain the meaning of resilience in the lived experiences of Iranian adolescents living in governmental residential care facilities. Materials and methods: This study was conducted using the hermeneutic phenomenological method. Semi-structured interviews were conducted with eight adolescents aged 13–17 living in governmental residential care facilities of Tehran province affiliated to the Welfare Organization of Iran who articulated their experiences of resilience. Sampling lasted from May 2014 to July 2015 and continued until new themes were no longer emerging. The researchers analyzed the verbatim transcripts using Van Manen's six-step method of phenomenology. Results: The themes obtained in this study included “going through life's hardships,” “aspiring for achievement,” “self-protection,” “self-reliance,” and “spirituality.” Conclusion: Our study indicates that the meaning of resilience coexists with self-reliance in adolescents’ lived experiences. Adolescents look forward to a better future. They always trust God in the face of difficulties and experience resilience by keeping themselves physically and mentally away from difficulties. Adverse and bitter experiences of the past positively affected their positive view on life and its difficulties and also their resilience. The five themes that emerged from the findings describe the results in detail. The findings of this study enable nurses, health administrators, and healthcare providers working with adolescents to help this vulnerable group cope better with their stressful life conditions and improve their health through increasing their capacity for resilience.

  6. Rural-Urban Differences in End-of-Life Nursing Home Care: Facility and Environmental Factors

    Science.gov (United States)

    Temkin-Greener, Helena; Zheng, Nan Tracy; Mukamel, Dana B.

    2012-01-01

    Purpose of the study: This study examines urban-rural differences in end-of-life (EOL) quality of care provided to nursing home (NH) residents. Data and Methods: We constructed 3 risk-adjusted EOL quality measures (QMs) for long-term decedent residents: in-hospital death, hospice referral before death, and presence of severe pain. We used…

  7. Menu Planning, Food Consumption, and Sanitation Practices in Day Care Facilities.

    Science.gov (United States)

    Kuratko, Connye N.; Martin, Ruth E.; Lan, William Y.; Chappell, James A.; Ahmad, Mahassen

    2000-01-01

    In 102 day care centers, data were collected on nutritional content of menus, compliance with guidelines, children's food consumption, and safety/sanitation. Although menus exceeded recommended daily allowances, quantities of food were below recommendations. No menu components were consumed by more than 65% of children. Sanitation problems were…

  8. Assessing post-abortion care in health facilities in Afghanistan : a cross-sectional study

    NARCIS (Netherlands)

    Ansari, Nasratullah; Zainullah, Partamin; Kim, Young Mi; Tappis, Hannah; Kols, Adrienne; Currie, Sheena; Haver, Jaime; van Roosmalen, Jos; Broerse, Jacqueline E. W.; Stekelenburg, Jelle

    2015-01-01

    Background: Complications of abortion are one of the leading causes of maternal mortality worldwide, along with hemorrhage, sepsis, and hypertensive diseases of pregnancy. In Afghanistan little data exist on the capacity of the health system to provide post-abortion care (PAC). This paper presents f

  9. Pharmacist-documented interventions during the dispensing process in a primary health care facility in Qatar

    Directory of Open Access Journals (Sweden)

    Richard Hooper

    2009-11-01

    Full Text Available Richard Hooper1, Abdullah Adam2, Nadir Kheir31Medical Services Department, 2Pharmacy Department, Medical Services, Qatar Petroleum, Doha, Qatar; 3Qatar University, College of Pharmacy, Doha, QatarObjectives: To characterize prescribing error interventions documented by pharmacists in four pharmacies in a primary health care service in Qatar.Methods: The study was conducted in a primary health care service in the State of Qatar in the period from January to March 2008. Pharmacists in four clinics within the service used online, integrated health care software to document all clinical interventions made. Documented information included: patient’s age and gender, drug therapy details, the intervention’s details, its category, and its outcome. Interventions were categorized according to the Pharmaceutical Care Network Europe Classification of drug-related problems (DRP.Results: The number of patients who had their prescriptions intercepted were 589 (0.71% of the total 82,800 prescriptions received. The intercepted prescriptions generated 890 DRP-related interventions (an average of 1.9% DRPs identified across the four clinics. Fifty-four percent of all interventions were classified as drug choice problems, and 42% had safety problems (dose too high, potential significant interaction. The prescriber accepted the intervention in 53% of all interventions, and the treatment was changed accordingly. Interventions as a result of transcription errors, legality and formulary issues were eliminated from this study through the use of computerized physician order entry (CPOE.Conclusions: Documenting and analyzing interventions should be a routine activity in pharmacy practice setting in primary health care services. Educational outreach visits and other strategies can improve prescribing practices and enhance patient safety.Keywords: pharmacists, interventions, prescribing errors

  10. Advances in ambulatory monitoring: regulatory considerations.

    Science.gov (United States)

    Buckles, David; Aguel, Felipe; Brockman, Randall; Cheng, James; Demian, Cindy; Ho, Charles; Jensen, Donald; Mallis, Elias

    2004-01-01

    Conventional ambulatory electrocardiogram (ECG) (Holter) monitoring involves 2 or 3 surface leads recorded with electrode positions and signal characteristics that are different from diagnostic quality 12-lead ECGs due to the limitations imposed by technology on the ambulatory recorders. The rapid pace of technological development for medical devices, particularly electrocardiography, has now enabled the recording of diagnostic quality 12-lead ECG waveforms for extended time periods. This capability allows Holter recording to become another source for diagnostic 12-lead ECG records on a par with other modalities such as resting ECG and exercise stress testing. Additionally, other diagnostic techniques such as S-T segment analysis and Q-T interval analysis that rely on diagnostic quality waveforms can now be applied. All of these enhancements to the traditional Holter modality have altered the regulatory perspective of these devices, since the enhancements may represent a new intended use for the device. PMID:15534803

  11. Advances in ambulatory monitoring: regulatory considerations.

    Science.gov (United States)

    Buckles, David; Aguel, Felipe; Brockman, Randall; Cheng, James; Demian, Cindy; Ho, Charles; Jensen, Donald; Mallis, Elias

    2004-01-01

    Conventional ambulatory electrocardiogram (ECG) (Holter) monitoring involves 2 or 3 surface leads recorded with electrode positions and signal characteristics that are different from diagnostic quality 12-lead ECGs due to the limitations imposed by technology on the ambulatory recorders. The rapid pace of technological development for medical devices, particularly electrocardiography, has now enabled the recording of diagnostic quality 12-lead ECG waveforms for extended time periods. This capability allows Holter recording to become another source for diagnostic 12-lead ECG records on a par with other modalities such as resting ECG and exercise stress testing. Additionally, other diagnostic techniques such as S-T segment analysis and Q-T interval analysis that rely on diagnostic quality waveforms can now be applied. All of these enhancements to the traditional Holter modality have altered the regulatory perspective of these devices, since the enhancements may represent a new intended use for the device.

  12. Behavioral and clinical characteristics of people receiving medical care for HIV infection in an outpatient facility in Sicily, Italy

    Directory of Open Access Journals (Sweden)

    Di Carlo P

    2016-05-01

    Full Text Available Paola Di Carlo,1 Giuliana Guadagnino,1 Palmira Immordino,1 Giovanni Mazzola,2 Pietro Colletti,2 Ilenia Alongi,1 Lucia Adamoli,1 Francesco Vitale,1 Alessandra Casuccio1 1Department of Sciences for Health Promotion and Mother-Child Care “G D’Alessandro”, University of Palermo, 2Department of Medicinal Clinics and Emerging Diseases, “Paolo Giaccone” Polyclinic University Hospital, Palermo, Italy Aim: The authors examined a cohort of HIV-positive outpatients at the AIDS Center of Palermo University in Italy in order to identify factors related to the frequency of their visits to the outpatient facility for health care services.Methods: Two hundred and twenty-four HIV-infected subjects were enrolled in the study. Demographic and HIV disease characteristics were recorded and assessed with the number of days accessed to our outpatients unit in univariate and multivariate analyses. The potential relationship with immunological status was also analyzed stratifying the patients into groups according to their CD4+ T-cell counts (≥500 vs <500/mm3, and ≥200 vs <200/mm3.Results: Both univariate and multivariate analyses showed that duration of antiretroviral therapy <5 years and hypertension were significantly associated with a CD4+ T-cell count of <500/mm3, whereas geographic origin (Africa was associated with a CD4+ T-cell count of <200/mm3. Mean number of days the patients sought access to day-care services for laboratory tests was negatively associated with CD4+ T-cell count.Conclusion: Patients with low CD4+ T-cell counts showed higher use of health care services, demonstrating how early HIV diagnosis can help to reduce health care costs. The CD4+ T-cell cut-off of 200 cells emphasizes the importance of identifying and managing HIV infection among hard-to-reach groups like vulnerable migrants. In our sample, the illegal status of immigrants does not influence the management of their HIV/AIDS condition, but the lack of European health card

  13. Avaliação da estrutura organizacional da assistência ambulatorial em HIV/Aids no Brasil Evaluation of the organizational structure of HIV/AIDS outpatient care in Brazil

    Directory of Open Access Journals (Sweden)

    Regina Melchior

    2006-02-01

    Full Text Available OBJETIVO: No contexto de acesso universal à terapia antiretroviral, os resultados do Programa de Aids dependem da qualidade do cuidado prestado. O objetivo do estudo foi avaliar a qualidade do cuidado dos serviços ambulatoriais que assistem pacientes de Aids. MÉTODOS: Estudo realizado em sete Estados brasileiros, em 2001 e 2002. Foi avaliada a qualidade do atendimento a pacientes com Aids quanto à disponibilidade de recursos e a organização do trabalho de assistência. Um questionário com 112 questões estruturadas abordando esses aspectos, foi enviado a 336 serviços. RESULTADOS: A taxa de resposta foi de 95,8% (322. Os indicadores de disponibilidade de recursos mostram uma adequação maior do que os indicadores de organização do trabalho. Não faltam antiretrovirais em 95,5% dos serviços, os exames de CD4 e Carga Viral estão disponíveis em quantidade adequada em 59 e 41% dos serviços, respectivamente. Em 90,4% dos serviços há pelo menos um profissional não médico (psicólogo, enfermeiro ou assistente social. Quanto à organização, 80% não agendavam consulta médica com hora marcada; 40,4% agendavam mais que 10 consultas médicas por período; 17% não possuíam gerentes exclusivos na assistência e 68,6% não realizavam reuniões sistemáticas de trabalho com a equipe. CONCLUSÕES: Os resultados apontam que além de garantir a distribuição mais homogênea de recursos, o programa precisa investir no treinamento e disseminação do manejo do cuidado, conforme evidenciado nos resultados da organização de trabalho.OBJECTIVE: In the context of universal access to antiretroviral treatment, the results of the Brazilian AIDS Program will depend on the quality of the care provided. The aim of the present study was to evaluate the healthcare provided by outpatient services for the treatment of AIDS patients. METHODS: The present study was carried out in seven Brazilian States between 2001 and 2002. We evaluated the quality of

  14. Role of Human Health Care Providers and Medical Treatment Facilities in Military Working Dog Care and Accessibility Difficulties with Military Working Dog Blood Products.

    Science.gov (United States)

    Giles Iii, James T

    2016-01-01

    The use of military working dogs (MWDs) in support of military operations has increased dramatically over recent years, as they have proven to be our most reliable deterrent to improvised explosive devices. Healthcare delivery for MWDs in combat presents unique challenges and requires extensive collaboration between veterinarians and human health care providers (HCPs). A successful example is the incorporation of MWD emergency care for nonveterinary HCPs into the Joint Trauma System Clinical Practice Guidelines, which has proven to be a helpful product. Additional challenges that need further solutions include MWDs as patients in human medical treatment facilities (MTFs) and the procurement of appropriate canine blood components in an operational environment. It is often necessary for MWDs to be treated as patients in human MTFs, however, there is no Department of Defense guidance to support this activity. Access to MWD blood products is limited to collection of fresh whole blood in the operational setting. Similar to humans, specific blood component therapy, such as fresh frozen plasma, is often indicated for sick or injured MWDs. Currently there is no formal system in place to deliver any blood products for MWDs or to facilitate collection in theater.

  15. Technological resources and personnel costs required to implement an automated alert system for ambulatory physicians when patients are discharged from hospitals to home

    Directory of Open Access Journals (Sweden)

    Terry S Field

    2013-03-01

    Full Text Available Background With the adoption of electronic medical records by medical group practices, there are opportunities to improve the quality of care for patients discharged from hospitals. However, there is little guidance for medical groups outside integrated hospital systems to automate the flow of patient information during transitions in care.Objective To describe the technological resources, expertise and time needed to develop an automated system providing information to ambulatory physicians when their patients are discharged from hospitals to home.Development Within a medical group practice, we developed an automated alert system that provides notification of discharges, reminders of the need for follow-up visits, drugs added during inpatient stays, and recommendations for laboratory monitoring of high-risk drugs. We tracked components of the information system required and the time spent by team members. We used USA national averages of hourly wages to estimate personnel costs.Application Critical components of the information system are notifications of hospital discharges through an admission, discharge and transfer registration (ADT interface, linkage to the group’s scheduling system, access to information on pharmacy dispensing and lab tests, and an interface engine. Total personnel cost was $76,314. Nearly half (47% was for 614 hours by physicians who developed content, provided overall project management, and reviewed alerts to ensure that only ‘actionable’ alerts would be sent.Conclusion Implementing a system to provide information about hospital discharges requires strong internal informatics expertise, cooperation between facilities and ambulatory providers, development of electronic linkages, and extensive commitment of physician time.

  16. Two Case Studies Using Mock-Ups for Planning Adult and Neonatal Intensive Care Facilities

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    Sue Hignett

    2010-01-01

    Full Text Available This paper describes two case studies using a 5-step protocol to determine functional space requirements for cardiac and neonatal intensive care clinical activities. Functional space experiments were conducted to determine the spatial requirements (defined as the minimumsized rectangle to encompass the Link Analysis. The data were collected with multi-directional filming and analysed frame-by-frame to plot the movements between the nurses and other components in the space. The average clinical functional space for the adult critical care unit was 22.83m2 (excluding family and hygiene space and in-room storage. The average functional clinical space for neonatal intensive care unit was 13.5m2 (excluding circulation and storage. The use of the 5-step protocol is reviewed, with limitations in case study 1 addressed in case study 2. The findings from both case studies have been incorporated into government guidance and achieved knowledge transfer by being implemented in building design.

  17. The need for language and cultural awareness in clinical and public health care facilities

    Directory of Open Access Journals (Sweden)

    Stăncuţa Ramona Dima-Laza

    2013-01-01

    Full Text Available In this study the author focuses on the cultural and linguistic barriers encountered by both physicians and patients in the medical process. In order to properly diagnose and treat multi-ethnic individuals, doctors must either have a powerful cross-cultural experience and certain linguistic skills, or benefit from the services provided by trained medical interpreters or by state-of-the-art-technologies that are meant to facilitate intercultural communication. The paper also underlines the dangers of using ad-hoc interpreters, who might put at risk the lives of many people as well as the carriers of health care practitioners.

  18. An Assessment of the Electric Power Quality and Electrical Installation Impacts on Medical Electrical Equipment Operations at Health Care Facilities

    Directory of Open Access Journals (Sweden)

    Mário C.G. Ramos

    2009-01-01

    Full Text Available Problem statement: Medical electrical equipments at health care facilities presented malfunction and wrong medical information due to poor electric power quality and to inadequate electrical Installations. Some equipment such as X-ray, computerized axial tomography and magnetic resonance imaging are considered as polluting ones due to their high amount of harmonics and voltage transients produced on the electrical power supply when in operation, while other equipments, connected to the same power supply, are considered sensitive or victim ones, presenting failure or producing wrong. Approach: The effects on some sensitive medical electrical equipment were verified in a controlled environment at energy quality technological center of the technical school of the University of Sao Paulo. A heart monitor, pulmonary ventilator and pulse oxymeter equipment types were submitted to a controlled voltage supply with high harmonic content and voltage sags. The test methodology used simulated conditions based on Brazilian NBR standards, ANSI/IEEE Std. 519, IEC 60601 and IEC 61000-4-11 standards. Results: The results of the polluting equipment current consumption measurements as well as the three sensitive equipments tested were presented and discussed. The pulmonary ventilator presented problems that range from stoppage to expiratory valve blockage and alarm system failures. The pulse oxymeter presented display malfunctions and it was extremely sensitive to voltage sags. The heart monitor maintained steady operation in all test cases. Conclusion/Recommendations: In spite of several existing recommendations and standards for testing medical electrical equipments, there is a lack of standard related to test cases considering the effects of high harmonic and voltage sags. The quality of electrical installation in health care facilities needs to be improved to reduce risks to the patients and to provide better health treatment.

  19. Volume of Cataract Surgery and Surgeon Gender: The Florida Ambulatory Surgery Center Experience 2005 Through 2012.

    Science.gov (United States)

    French, Dustin D; Margo, Curtis E; Campbell, Robert R; Greenberg, Paul B

    2016-01-01

    Cataract is the most common surgically reversible cause of vision loss and the most common major surgical procedure performed in the United States. To understand how gender composition might affect differences in health services, we examined the surgeon gender-specific rates of routine cataract surgery performed in ambulatory surgical centers in Florida. Routine cataract surgeries were identified through the Florida Agency for Health Care Administration (AHCA) ambulatory surgery center dataset. The background of individual surgeons was determined by linking license numbers in the dataset to physician profiles publicly available from AHCA. From 2005 through 2012, women ophthalmologists in Florida performed roughly half the annual rate of cataract surgery as their male counterparts. This difference is not explained by greater time in clinical practice for men. Further investigation into the causes of this gender-volume disparity is warranted to determine what roles choice and barriers may play.

  20. Nutritional and functional status indicators in residents of a long-term care facility.

    Science.gov (United States)

    Grieger, Jessica A; Nowson, Caryl A; Ackland, Leigh M

    2009-01-01

    In a cross-sectional study, we determined whether results from the Mini Nutritional Assessment (MNA), Geriatric Depression Scale (GDS), and Katz Activities of Daily Living (ADL), were associated with nutritional status and mobility in long-term care residents. One hundred and fifteen study participants (mean [SD] age: 80.2 [10.6]) provided informed consent. Fifty eight percent (n = 66) responded to all three questionnaires: 12 were assessed as malnourished (MNA or = 6). Higher levels of depression were associated with lower serum zinc (n = 71, r = -.356, p = .001) and associated with a slower Timed Up and Go test (TUG, n = 38, r = .301, p = .030). MNA was also associated with serum zinc (n = 44, r = .307, P = .021). Non responders to questionnaires (n = 36) had a lower BMI (mean difference: -2.5 +/- 1.0 kg/m(2), p = .013) and serum 25(OH)D (-8.7 +/- 3.8 nmol/l, p = .023) vs. responders. The GDS, in addition to the MNA, is useful in identifying poor nutritional status in residential care. Intervention programs that target depression and poor nutritional status could potentially improve overall quality of life, but it is not clear if depression is leading to poor nutritional status or if poor nutrition is leading to depression. PMID:19234994

  1. Health facility environment as humanization strategy care in the pediatric unit: systematic review

    Directory of Open Access Journals (Sweden)

    Juliane Portella Ribeiro

    2014-06-01

    Full Text Available Objective: To identify and analyze the production of knowledge about the strategies that health care institutions have implemented to humanize care of hospitalized children. Method: This is a systematic review conducted in the Virtual Health Library - Nursing and SciELO, using the seven steps proposed by the Cochrane Handbook. Results: 15 studies were selected, and strategies that involved relationship exchanges were used between the health professional, the hospitalized child and their families, which may be mediated by leisure activities, music and by reading fairy tales. We also include the use of the architecture itself as a way of providing welfare to the child and his/her family, as well as facilitating the development of the work process of health professionals. Conclusion: Investments in research and publications about the topic are necessary, so that, the National Humanization Policy does not disappear and that the identified strategies in this study do not configure as isolated and disjointed actions of health policy.

  2. A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana

    DEFF Research Database (Denmark)

    Ahiabu, Mary-Anne; Tersbøl, Britt Pinkowski; Biritwum, Richard;

    2016-01-01

    with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance Scheme, as the main purchaser of health services in Ghana, offers an opportunity that should be exploited to introduce policies in support......Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality...... Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis...

  3. Pattern of skin diseases in patients visiting a tertiary care health facility at hyderabad, pakistan

    International Nuclear Information System (INIS)

    Background: The morbidity associated with skin diseases makes them an important public health problem. Very scanty literature is found on the problem which is either disease-based, community based or a specified population group-based. objective of this study was to assess the pattern of skin diseases in patients and to determine their relation with demographic characteristics. Methods: This descriptive study was conducted at dermatology out-patient department of liaquat university hospital, jamshoro, pakistan for the period from 10th january to 10th february 2008. Four hundred and eleven patients were enrolled during the study period. The study population comprised of newly diagnosed cases as well as relapsing cases presenting at the facility. The criterion for registering the patients was clinical diagnosis although few cases were supported by investigations, too. The data was collected through a pre-designed questionnaire and analysed through spss-12. Result: Skin problems are fairly common among children and women. in children of less than 10 years age, 82.5% visiting the facility suffer from infectious skin diseases. among the infectious diseases, scabies is highly prevalent disease (45.5%). the majority of the patients belong to rural or slum areas (77.2%), low socio-economic strata (68.9%), and living in overcrowded families (82%). a strong association between skin infections and water inadequacy (p=0.016) was found, and scabies shows a strong statistical association with overcrowding (p=0.025). Conclusion: The skin diseases involve every age strata of our population but it is fairly common in younger age group, women, and people who do not practice hygiene. Out-reach services for the rural and slum communities and health education will give good results on prevention of skin diseases. (author)

  4. Poor knowledge – predictor of nonadherence to universal precautions for blood borne pathogens at first level care facilities in Pakistan

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    Chandir Subhash

    2007-07-01

    Full Text Available Abstract Background We conducted an assessment of knowledge about blood borne pathogens (BBP and use of universal precautions at first level care facilities (FLCF in two districts of Pakistan. Methods We conducted a cross-sectional survey and selected three different types of FLCFs ; public, general practitioners and unqualified practitioners through stratified random sampling technique. At each facility, we interviewed a prescriber, a dispenser, and a housekeeper for knowledge of BBPs transmission and preventive practices, risk perception, and use of universal precautions. We performed multiple linear regression to assess the effect of knowledge score (11 items on the practice of universal precautions score (4 items- use of gloves, gown, needle recapping, and HBV vaccination. Results We interviewed 239 subjects. Most of the participants 128 (53% were recruited from general practitioners clinics and 166 (69.5% of them were dispensers. Mean (SD knowledge score was 3.8 (2.3 with median of 4. MBBS prescribers had the highest knowledge score while the housekeepers had the lowest. Mean universal precautions use score was 2.7 ± 2.1. Knowledge about mode of transmission and the work experience alone, significantly predicted universal precaution use in multiple linear regression model (adR2 = 0.093. Conclusion Knowledge about mode of transmission of blood borne pathogens is very low. Use of universal precautions can improve with increase in knowledge.

  5. A Novel Hierarchical Model to Locate Health Care Facilities with Fuzzy Demand Solved by Harmony Search Algorithm

    Directory of Open Access Journals (Sweden)

    Mehdi Alinaghian

    2014-08-01

    Full Text Available In the field of health losses resulting from failure to establish the facilities in a suitable location and the required number, beyond the cost and quality of service will result in an increase in mortality and the spread of diseases. So the facility location models have special importance in this area. In this paper, a successively inclusive hierarchical model for location of health centers in term of the transfer of patients from a lower level to a higher level of health centers has been developed. Since determination the exact number of demand for health care in the future is difficult and in order to make the model close to the real conditions of demand uncertainty, a fuzzy programming model based on credibility theory is considered. To evaluate the proposed model, several numerical examples are solved in small size. In order to solve large scale problems, a meta-heuristic algorithm based on harmony search algorithm was developed in conjunction with the GAMS software which indicants the performance of the proposed algorithm.

  6. Inducing Herd Immunity against Seasonal Influenza in Long-Term Care Facilities through Employee Vaccination Coverage: A Transmission Dynamics Model

    Directory of Open Access Journals (Sweden)

    Aaron M. Wendelboe

    2015-01-01

    Full Text Available Introduction. Vaccinating healthcare workers (HCWs in long-term care facilities (LTCFs may effectively induce herd immunity and protect residents against influenza-related morbidity and mortality. We used influenza surveillance data from all LTCFs in New Mexico to validate a transmission dynamics model developed to investigate herd immunity induction. Material and Methods. We adjusted a previously published transmission dynamics model and used surveillance data from an active system among 76 LTCFs in New Mexico during 2006-2007 for model validation. We used a deterministic compartmental model with a stochastic component for transmission between residents and HCWs in each facility in order to simulate the random variation expected in such populations. Results. When outbreaks were defined as a dichotomous variable, our model predicted that herd immunity could be induced. When defined as an attack rate, the model demonstrated a curvilinear trend, but insufficiently strong to induce herd immunity. The model was sensitive to changes in the contact parameter β but was robust to changes in the visitor contact probability. Conclusions. These results further elucidate previous studies’ findings that herd immunity may not be induced by vaccinating HCWs in LTCFs; however, increased influenza vaccination coverage among HCWs reduces the probability of influenza infection among residents.

  7. Quality of longer term mental health facilities in Europe: validation of the quality indicator for rehabilitative care against service users' views.

    Directory of Open Access Journals (Sweden)

    Helen Killaspy

    Full Text Available BACKGROUND: The Quality Indicator for Rehabilitative Care (QuIRC is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care. METHOD: At least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit's therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables. RESULTS: 1750/2495 (70% users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users' autonomy and experiences of care. Associations between QuIRC ratings and service users' ratings of their quality of life and the unit's therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning. A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy. CONCLUSIONS: Ratings of the quality of longer term mental health facilities made by service managers were positively associated with service users' autonomy and experiences of care

  8. Development and Validation of an Index to Measure the Quality of Facility-Based Labor and Delivery Care Processes in Sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Vandana Tripathi

    Full Text Available High quality care is crucial in ensuring that women and newborns receive interventions that may prevent and treat birth-related complications. As facility deliveries increase in developing countries, there are concerns about service quality. Observation is the gold standard for clinical quality assessment, but existing observation-based measures of obstetric quality of care are lengthy and difficult to administer. There is a lack of consensus on quality indicators for routine intrapartum and immediate postpartum care, including essential newborn care. This study identified key dimensions of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC in facility deliveries and developed a quality assessment measure representing these dimensions.Global maternal and neonatal care experts identified key dimensions of QoPIIPC through a modified Delphi process. Experts also rated indicators of these dimensions from a comprehensive delivery observation checklist used in quality surveys in sub-Saharan African countries. Potential QoPIIPC indices were developed from combinations of highly-rated indicators. Face, content, and criterion validation of these indices was conducted using data from observations of 1,145 deliveries in Kenya, Madagascar, and Tanzania (including Zanzibar. A best-performing index was selected, composed of 20 indicators of intrapartum/immediate postpartum care, including essential newborn care. This index represented most dimensions of QoPIIPC and effectively discriminated between poorly and well-performed deliveries.As facility deliveries increase and the global community pays greater attention to the role of care quality in achieving further maternal and newborn mortality reduction, the QoPIIPC index may be a valuable measure. This index complements and addresses gaps in currently used quality assessment tools. Further evaluation of index usability and reliability is needed. The availability of a streamlined

  9. Which health care facilities do adult malawian antiretroviral therapy patients utilize during intercurrent illness? a cross sectional study

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    Masangalawe Caroline

    2011-12-01

    Full Text Available Abstract Background Antiretroviral therapy (ART clinic populations have expanded enormously in the successful Malawi ART scale-up programme. Overcrowding, long waiting times and living far away from the clinic may affect the extent to which patients use their ART clinic for intercurrent illnesses. Methods We interviewed patients of a large urban ART clinic in Blantyre, Malawi, during routine visits about the choice of health care facility during recent illness episodes. Results Out of 346 enrolled adults, mean age 39.8 (range 18-70 years, 54.3% female, 202 (58% reported one or more illness in the past 6 months, during which 85 (42.1%; 95%-confidence interval: 36.9-47.3% did not utilize their own clinic. Long distance to the clinic was the main subjective reason, while low education attainment, rural residence, perceived mild illness and dissatisfaction with the ART service were associated with not using their own clinic in multivariate analyses. Of all participants, 83.6% were satisfied with the service provided; only 6.1% were aware of the full service package of the ART clinic. Conclusions ART patients often seek health care outside their own clinic, which may have detrimental effects, and has consequences for ART counseling content and reporting of ART information in health passports.

  10. Behavioral and clinical characteristics of people receiving medical care for HIV infection in an outpatient facility in Sicily, Italy

    Science.gov (United States)

    Di Carlo, Paola; Guadagnino, Giuliana; Immordino, Palmira; Mazzola, Giovanni; Colletti, Pietro; Alongi, Ilenia; Adamoli, Lucia; Vitale, Francesco; Casuccio, Alessandra

    2016-01-01

    Aim The authors examined a cohort of HIV-positive outpatients at the AIDS Center of Palermo University in Italy in order to identify factors related to the frequency of their visits to the outpatient facility for health care services. Methods Two hundred and twenty-four HIV-infected subjects were enrolled in the study. Demographic and HIV disease characteristics were recorded and assessed with the number of days accessed to our outpatients unit in univariate and multivariate analyses. The potential relationship with immunological status was also analyzed stratifying the patients into groups according to their CD4+ T-cell counts (≥500 vs illegal status of immigrants does not influence the management of their HIV/AIDS condition, but the lack of European health card that documents the current antiretroviral status, could interfere with the efforts to eradicate AIDS. A better understanding of the major determinants of HIV treatment costs has led to appropriate large-scale actions, which in turn has increased resources and expanded intervention programs. Further guidance should be offered to hard-to-reach groups in order to improve early AIDS diagnosis, and procedures for identifying and managing these vulnerable subjects should be made available to care commissioners and service providers. PMID:27307712

  11. Resilience and Its Contributing Factors in Adolescents in Long-Term Residential Care Facilities Affiliated to Tehran Welfare Organization

    Science.gov (United States)

    Nourian, Manijeh; Mohammadi Shahboulaghi, Farahnaz; Nourozi Tabrizi, Kian; Rassouli, Maryam; Biglarrian, Akbar

    2016-01-01

    ABSTRACT Background: Resilience is a quality that affects an individual’s ability to cope with tension. The present study was conducted to determine resilience and its contributing factors in high-risk adolescents living in residential care facilities affiliated to Tehran Welfare Organization in order to help develop effective preventive measures for them. Methods: The present descriptive study was conducted on 223 adolescents living in 15 different governmental residential care centers in 2014. Participants were selected through convenience sampling. The data required were collected via the Wagnild and Young Resilience Scale with content validity (S-CVI=0.92) and a reliability of α=0.77 and r=0.83 (Padolescents’ mean score of resilience was 84.41±11.01. The level of resilience was moderate in 46.2% of the participants and was significantly higher in the female than in the male adolescents (P=0.006); moreover, the score obtained was lower in primary school children as compared to middle school and high school students (Padolescents, particularly the male. It is important to provide a basis to prevent adolescents’ academic failure and place a stronger value on education than the past. PMID:27713901

  12. Guidance for Practitioners on the Use of Antiviral Drugs to Control Influenza Outbreaks in Long-Term Care Facilities in Canada, 2014-2015 Season

    OpenAIRE

    Fred Y Aoki; Allen, Upton D.; H Grant Stiver; Michel Laverdière; Danuta Skowronski; Evans, Gerald A

    2015-01-01

    The AMMI Canada Guidelines document ‘The use of antiviral drugs for influenza: A foundation document for practitioners’, published in the Autumn 2013 issue of the Journal, outlines the recommendations for the use of antiviral drugs to treat influenza. This article, which represents the first of two updates to these guidelines published in the current issue of the Journal, aims to inform health care professionals of the increased risk for influenza in long-term care facilities due to a documen...

  13. A designated centre for people with disabilities operated by Redwood Extended Care Facility Ltd, Cavan

    LENUS (Irish Health Repository)

    Coyne, Imelda

    2013-01-01

    Children\\'s rights to have their views heard in matters that affect their lives are now well established since the publication of the UN Convention treaty (1989). Children with cancer generally prefer to be involved in decision-making and consider it important that they have the opportunity to take part in decision-making concerning their health care, even in end-of-life decisions. There is considerable support for involving children in healthcare decision-making at a level commensurate with their experience, age and abilities. Thus healthcare professionals and parents need to know how they should involve children in decision-making and what interventions are most effective in promoting shared decision-making (SDM) for children with cancer.

  14. Health care restructuring and family physician care for those who died of cancer

    Directory of Open Access Journals (Sweden)

    Johnston Grace

    2005-01-01

    Full Text Available Abstract Background During the 1990s, health care restructuring in Nova Scotia resulted in downsized hospitals, reduced inpatient length of stay, capped physician incomes and restricted practice locations. Concurrently, the provincial homecare program was redeveloped and out-of-hospital cancer deaths increased from 20% (1992 to 30% (1998. These factors all pointed to a transfer of end-of-life inpatient hospital care to more community-based care. The purpose of this study was to describe the trends in the provision of Family Physician (FP visits to advanced cancer patients in Nova Scotia (NS during the years of health care restructuring. Methods Design Secondary multivariate analysis of linked population-based datafiles including the Queen Elizabeth II Health Sciences Centre Oncology Patient Information System (NS Cancer Registry, Vital Statistics, the NS Hospital Admissions/Separations file and the Medical Services Insurance Physician Services database. Setting Nova Scotia, an eastern Canadian province (population: 950,000. Subjects: All patients who died of lung, colorectal, breast or prostate cancer between April 1992 and March 1998 (N = 7,212. Outcome Measures Inpatient and ambulatory FP visits, ambulatory visits by location (office, home, long-term care facility, emergency department, time of day (regular hours, after hours, total length of inpatient hospital stay and number of hospital admissions during the last six months of life. Results In total, 139,641 visits were provided by family physicians: 15% of visits in the office, 10% in the home, 5% in the emergency department (ED, 5% in a long-term-care centre and 64% to hospital inpatients. There was no change in the rate of FP visits received for office, home and long-term care despite the fact that there were 13% fewer hospital admissions, and length of hospital stay declined by 21%. Age-sex adjusted estimates using negative binomial regression indicate a decline in hospital inpatient FP

  15. Hysterectomy at a Canadian tertiary care facility: results of a one year retrospective review

    Directory of Open Access Journals (Sweden)

    Gorwill R Hugh

    2004-11-01

    Full Text Available Abstract Background The purpose of this study was to investigate the indications for and approach to hysterectomy at Kingston General Hospital (KGH, a teaching hospital affiliated with Queen's University at Kingston, Ontario. In particular, in light of current literature and government standards suggesting the superiority of vaginal versus abdominal approaches and a high number of concurrent oophorectomies, the aim was to examine the circumstances in which concurrent oophorectomies were performed and to compare abdominal and vaginal hysterectomy outcomes. Methods A retrospective chart audit of 372 consecutive hysterectomies performed in 2001 was completed. Data regarding patient characteristics, process of care and outcomes were collected. Data were analyzed using descriptive statistics, t-tests and linear and logistic regression. Results Average age was 48.5 years, mean body mass index (BMI was 28.6, the mean length of stay (LOS was 5.2 days using an abdominal approach and 3.0 days using a vaginal approach without laparoscopy. 14% of hysterectomies were performed vaginally, 5.9% were laparoscopically assisted vaginal hysterectomies and the rest were abdominal hysterectomies. The most common indication was dysfunctional or abnormal uterine bleeding (37%. The average age of those that had an oophorectomy (removal of both ovaries was 50.8 years versus 44.3 years for those that did not (p Conclusions A significant reduction in LOS was found using the vaginal approach. Both the patient and the health care system may benefit from the tendency towards an increased use of vaginal hysterectomies. The audit process demonstrated the usefulness of an on-going review mechanism to examine trends associated with common surgical procedures.

  16. Conceptual and methodological aspects in the study of hospitalizations for ambulatory care sensitive conditions Aspectos conceituais e metodológicos no estudo das hospitalizações por condições sensíveis à atenção primária

    Directory of Open Access Journals (Sweden)

    Fúlvio Borges Nedel

    2011-01-01

    Full Text Available Hospitalization rates for Ambulatory Care Sensitive Conditions have been used to assess effectiveness of the first level of health care. From a critical analysis of related concepts, we discuss principles for selecting a list of codes and, taking the example of the Brazilian Family Health Program, propose a methodological pathway for identifying variables in order to inform statistical models of analysis. We argue that for the indicator to be comparable between regions, disease codes should be selected based on sensitivity and specificity principles, not on observed disease frequency. Rates of hospitalization will be determined, at a distal level, by the socio-economic environment and their effect on the social and demographic structure. Timely and effective care depends on the organization of health services, their availability and access barriers, which depend on the ways health and related technology are conceptualised and on their adherence to the biomedical model or to the Primary Health Care (PHC principles; performance indicators of the health system will be the proximal determinants. This indicator is potentially useful for primary care evaluation. The historical reconstruction of PHC improves the analysis of the indicator variability.As taxas de hospitalização por condições sensíveis à atenção primária são um indicador da efetividade do primeiro nível de atenção à saúde. Partindo de breve revisão crítica, este artigo discute princípios para a seleção de códigos de internação por essas causas e, com o exemplo do Programa Saúde da Família, propõe um modelo teórico para a seleção de variáveis para análise estatística. A comparabilidade inter-regional do indicador depende da seleção de códigos de doenças baseada em princípios de sensibilidade e especificidade, não na frequência da doença. As taxas de hospitalização serão distalmente determinadas pela situação socioeconômica e seu efeito sobre a

  17. Crushing oral solid drugs: Assessment of nursing practices in health-care facilities in Auvergne, France.

    Science.gov (United States)

    Clauson, Hélène; Rull, Françoise; Thibault, Magali; Ordekyan, Audrey; Tavernier, Jérôme

    2016-08-01

    Iatrogenic harm from crushing oral drugs, a common but hazardous practice, can be largely avoided by following recommendations for good practice. The aims of this study were to evaluate the frequency of tablet crushing and opening capsules in hospitals and to compare the nursing practices with national recommendations. From 46 health facilities in Auvergne, 1110 nurses answered an anonymous self-completed questionnaire between September and November 2014 regarding general medication issues, prescription, preparation and administration of crushed medications. Crushing tablets or opening capsules was reported as a daily practice for 28% (increasing to 67% in geriatric units). While most best practice recommendations were followed by most nurses, scope for improvement remained: pharmacists were rarely contacted, rationales for change of medication formulation were seldom recorded in patients' files and medications were often crushed and administered together, risking drug interactions. Study data were used to inform recommendations for practice improvement. As findings bear similarities to those from other countries, this may be a widespread issue and study recommendations may be widely relevant. Practice will be reviewed again once practice improvement has been completed. PMID:27287304

  18. An Ambulatory Program for Surgical Residents and Medical Students.

    Science.gov (United States)

    Levy, Margaret

    1988-01-01

    A pilot program based in a freestanding ambulatory surgery center at the Chicago Medical School Department of Surgery is described, its curriculum outlined, and the daily activities of the residents and medical students are detailed. A brief history of ambulatory surgery is given. (Author/MLW)

  19. Challenges for dialysis facility medical directors and impact on patient care.

    Science.gov (United States)

    Kossmann, Robert J

    2013-10-01

    My service within the RPA began with my need to be a part of the solution, to help navigate the direction of inevitable change, and to ensure we do not lose focus of our ultimate goal as nephrologists-the provision of excellent kidney care. I would encourage all of you to participate in this process as well. It is essential that we maintain our independence, ethics and principals, and excellence in our roles and responsibilities as nephrologists and dialysis unit medical directors, especially in challenging times such as these. Engaging with the RPA in advocating redress of the ESRD PPS proposed 9.4% cut and support for maintaining our critical role as independent dialysis unit medical directors is one way we can make a difference. Become involved in the process. Communicate your concerns to legislators and policy makers. Only with the support of our community and a firm commitment to our goals can we effect change and ensure nephrology patients continue to be well served in the years to come. PMID:24279209

  20. The influence of social environment on the smoking status of women employed in health care facilities

    Directory of Open Access Journals (Sweden)

    Dragana Nikšić

    2013-04-01

    Full Text Available Introduction: Bosnia and Herzegovina has a high prevalence of smoking among women, especially among health care professionals. The goal of this study is to investigate the influence of the social environment of women employed in health institutions in relation to the cigarettes smoking habits.Methods: The study included 477 women employed in hospitals, outpatient and public health institutions in Sarajevo Canton Bosnia and Herzegovina. We used a modifi ed questionnaire assessing smoking habits of medical staff in European hospitalsResults: The results showed that 50% of women are smokers, with the highest incidence among nurses (58.1% and administrative staff (55.6%. The social environment is characterized by a high incidence of colleagues (60.1% and friends who are smokers (54.0% at the workplace and in the family (p<0.005. One third of women (27.8%, mainly non-smokers, states that the work environment supports employees smoking (p=0.003.Conclusion: Workplace and social environment support smoking as an acceptable cultural habit and is contributing to increasing rates of smoking among women.

  1. How to change organisational culture: Action research in a South African public sector primary care facility

    Science.gov (United States)

    De Sa, Angela; Christodoulou, Maria

    2016-01-01

    Background Organisational culture is a key factor in both patient and staff experience of the healthcare services. Patient satisfaction, staff engagement and performance are related to this experience. The department of health in the Western Cape espouses a values-based culture characterised by caring, competence, accountability, integrity, responsiveness and respect. However, transformation of the existing culture is required to achieve this vision. Aim To explore how to transform the organisational culture in line with the desired values. Setting Retreat Community Health Centre, Cape Town, South Africa. Methods Participatory action research with the leadership engaged with action and reflection over a period of 18 months. Change in the organisational culture was measured at baseline and after 18 months by means of a cultural values assessment (CVA) survey. The three key leaders at the health centre also completed a 360-degree leadership values assessment (LVA) and had 6 months of coaching. Results Cultural entropy was reduced from 33 to 13% indicating significant transformation of organisational culture. The key driver of this transformation was change in the leadership style and functioning. Retreat health centre shifted from a culture that emphasised hierarchy, authority, command and control to one that established a greater sense of cohesion, shared vision, open communication, appreciation, respect, fairness and accountability. Conclusion Transformation of organisational culture was possible through a participatory process that focused on the leadership style, communication and building relationships by means of CVA and feedback, 360-degree LVA, feedback and coaching and action learning in a co-operative inquiry group. PMID:27608671

  2. How to change organisational culture: Action research in a South African public sector primary care facility

    Directory of Open Access Journals (Sweden)

    Robert Mash

    2016-03-01

    Full Text Available Background: Organisational culture is a key factor in both patient and staff experience of the healthcare services. Patient satisfaction, staff engagement and performance are related to this experience. The department of health in the Western Cape espouses a values-based culture characterised by caring, competence, accountability, integrity, responsiveness and respect. However, transformation of the existing culture is required to achieve this vision. Aim: To explore how to transform the organisational culture in line with the desired values. Setting: Retreat Community Health Centre, Cape Town, South Africa. Methods: Participatory action research with the leadership engaged with action and reflection over a period of 18 months. Change in the organisational culture was measured at baseline and after 18 months by means of a cultural values assessment (CVA survey. The three key leaders at the health centre also completed a 360-degree leadership values assessment (LVA and had 6 months of coaching. Results: Cultural entropy was reduced from 33 to 13% indicating significant transformation of organisational culture. The key driver of this transformation was change in the leadership style and functioning. Retreat health centre shifted from a culture that emphasised hierarchy, authority, command and control to one that established a greater sense of cohesion, shared vision, open communication, appreciation, respect, fairness and accountability. Conclusion: Transformation of organisational culture was possible through a participatory process that focused on the leadership style, communication and building relationships by means of CVA and feedback, 360-degree LVA, feedback and coaching and action learning in a co-operative inquiry group.

  3. Nutritional assessment of residents in long-term care facilities (LTCFS): recommendations of the task force on nutrition and ageing of the IAGG Europe region and the IANA

    NARCIS (Netherlands)

    Salva, A.; Coll-Planas, L.; Bruce, S.; Groot, de C.P.G.M.; Andrieu, S.; Abellan, G.; Vellas, B.

    2009-01-01

    Unintentional weight loss and Undernutrition are major problems among older people living in Long-Term Care Facilities (LTCF). Undernutrition manifests in LTCF particularly as weight loss and low Body Mass Index (BMI) and is associated with increased morbidity and mortality as well as with functiona

  4. The development of the Quality Indicator for Rehabilitative Care (QuIRC) : a measure of best practice for facilities for people with longer term mental health problems

    NARCIS (Netherlands)

    Killaspy, Helen; White, Sarah; Wright, Christine; Taylor, Tatiana L.; Turton, Penny; Schuetzwohl, Matthias; Schuster, Mirjam; Cervilla, Jorge A.; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Adamowski, Tomasz; Ploumpidis, Dimitri; Gonidakis, Fragiskos; Caldas-de-Almeida, Jose; Cardoso, Graca; King, Michael B.

    2011-01-01

    Background: Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at

  5. Colonization with extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species in long-term care facility residents.

    Science.gov (United States)

    Lautenbach, Ebbing; Han, Jennifer; Santana, Evelyn; Tolomeo, Pam; Bilker, Warren B; Maslow, Joel

    2012-03-01

    We describe the prevalence of and risk factors for colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-EB) in the long-term care facility (LTCF) setting. Colonization prevalence differed significantly across the 3 LTCFs evaluated in the study, with recent use of levofloxacin and fecal incontinence demonstrating borderline significant associations with ESBL-EB colonization. PMID:22314070

  6. Colonization with Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella Species in Long-Term Care Facility Residents

    OpenAIRE

    Lautenbach, Ebbing; Han, Jennifer; Santana, Evelyn; Tolomeo, Pam; Bilker, Warren B.; Maslow, Joel

    2012-01-01

    We describe the prevalence of and risk factors for colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-EB) in the long-term care facility (LTCF) setting. Colonization prevalence differed significantly across the 3 LTCFs evaluated in the study, with recent use of levofloxacin and fecal incontinence demonstrating borderline significant associations with ESBL-EB colonization.

  7. Managing hypertension with ambulatory blood pressure monitoring.

    Science.gov (United States)

    White, William B; Gulati, Vinay

    2015-02-01

    There has been a dramatic shift in the manner in which blood pressure (BP) is measured to provide far more comprehensive clinical information than that provided by a single set of office BP readings. Extensive clinical and epidemiological research shows an important role of ambulatory BP monitoring (ABPM) in the management of hypertensive patients. A 24-h BP profile helps to determine the absence of nocturnal dipping status and evaluate BP control in patients on antihypertensive therapy. The ability to detect white-coat or masked hypertension is enhanced by ambulatory BP monitoring. In 2001, the Center for Medicare and Medicaid Services approved ABPM for reimbursement for the identification of patients with white-coat hypertension. In 2011, the National Institute for Health and Clinical Excellence (NICE) in the UK published guidelines that recommended the routine use of ABPM in all patients suspected of having hypertension. The European Society of Hypertension (ESH) 2013 guidelines also support greater use of ABPM in clinical practice. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to its cost, the complexity of data evaluation, as well as patient inconvenience. In this review, we evaluate the clinical importance of ABPM, highlighting its role in the current management of hypertension.

  8. The impact of social networks on knowledge transfer in long-term care facilities: Protocol for a study

    Directory of Open Access Journals (Sweden)

    Valente Thomas W

    2010-06-01

    Full Text Available Abstract Background Social networks are theorized as significant influences in the innovation adoption and behavior change processes. Our understanding of how social networks operate within healthcare settings is limited. As a result, our ability to design optimal interventions that employ social networks as a method of fostering planned behavior change is also limited. Through this proposed project, we expect to contribute new knowledge about factors influencing uptake of knowledge translation interventions. Objectives Our specific aims include: To collect social network data among staff in two long-term care (LTC facilities; to characterize social networks in these units; and to describe how social networks influence uptake and use of feedback reports. Methods and design In this prospective study, we will collect data on social networks in nursing units in two LTC facilities, and use social network analysis techniques to characterize and describe the networks. These data will be combined with data from a funded project to explore the impact of social networks on uptake and use of feedback reports. In this parent study, feedback reports using standardized resident assessment data are distributed on a monthly basis. Surveys are administered to assess report uptake. In the proposed project, we will collect data on social networks, analyzing the data using graphical and quantitative techniques. We will combine the social network data with survey data to assess the influence of social networks on uptake of feedback reports. Discussion This study will contribute to understanding mechanisms for knowledge sharing among staff on units to permit more efficient and effective intervention design. A growing number of studies in the social network literature suggest that social networks can be studied not only as influences on knowledge translation, but also as possible mechanisms for fostering knowledge translation. This study will contribute to building

  9. Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the global network's EmONC trial

    Directory of Open Access Journals (Sweden)

    Liechty Edward A

    2010-12-01

    Full Text Available Abstract Background Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes. Methods/Design We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis and 28-day neonatal mortality. Discussion In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant

  10. Prevalence and impact of Clostridium difficile infection in elderly residents of long-term care facilities, 2011: A nationwide study.

    Science.gov (United States)

    Ziakas, Panayiotis D; Joyce, Nina; Zacharioudakis, Ioannis M; Zervou, Fainareti N; Besdine, Richard W; Mor, Vincent; Mylonakis, Eleftherios

    2016-08-01

    The elderly population is particularly vulnerable to Clostridium difficile infection (CDI), but the epidemiology of CDI in long-term care facilities (LTCFs) is unknown.We performed a retrospective cohort study and used US 2011 LTCF resident data from the Minimum Data Set 3.0 linked to Medicare claims. We extracted CDI cases based on International Classification of Diseases-9 coding, and compared residents with the diagnosis of CDI to those who did not have a CDI diagnosis during their LTCF stay. We estimated CDI prevalence rates and calculated 3-month mortality rates.The study population consisted of 2,190,613 admissions (median age 82 years; interquartile range 76-88; female to male ratio 2:1; >80% whites), 45,500 of whom had a CDI diagnosis. The nationwide CDI prevalence rate was 1.85 per 100 LTCF admissions (95% confidence interval [CI] 1.83-1.87). The CDI rate was lower in the South (1.54%; 95% CI 1.51-1.57) and higher in the Northeast (2.29%; 95% CI 2.25-2.33). Older age, white race, presence of a feeding tube, unhealed pressure ulcers, end-stage renal disease, cirrhosis, bowel incontinence, prior tracheostomy, chemotherapy, and chronic obstructive pulmonary disease were independently related to "high risk" for CDI. Residents with a CDI diagnosis were more likely to be admitted to an acute care hospital (40% vs 31%, P < 0.001) and less likely to be discharged to the community (46% vs 54%, P < 0.001) than those not reported with CDI during stay. Importantly, CDI was associated with higher mortality (24.7% vs 18.1%, P = 0.001).CDI is common among the elderly residents of LTCFs and is associated with significant increase in 3-month mortality. The prevalence is higher in the Northeast and risk stratification can be used in CDI prevention policies. PMID:27495022

  11. Effect of Talbinah food consumption on depressive symptoms among elderly individuals in long term care facilities, randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Badrasawi MM

    2013-03-01

    Full Text Available Manal M Badrasawi, Suzana Shahar, Zahara Abd Manaf, Hasnah HaronDietetics program, School of Health Care Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaAbstract: Talbinah is a barley syrup cooked with milk and sweetened by honey. In his famous Hadith on Talbinah, the Prophet Mohammad (SAW recommended it when sad events happen for its effect on soothing hearts and relieving sadness. This 3-week crossover designed, randomized clinical trial was conducted to determine the effect of Talbinah on mood and depression among institutionalized elderly people in Seremban. A sample of 30 depressed elderly subjects (21 men and 9 women was selected from the long term care facility. Three different interview-based validated scales (Geriatric Depression Scale, Depression Anxiety Stress Scales, and Profile of Mood States were used to determine mood, depression, stress, and anxiety at week 0, 3, 4, and 7. The nutritional value of Talbinah was examined using proximate food analysis, minerals content analysis, and differential amino acid analysis. The results indicated that Talbinah is a high carbohydrate food (86.4% and has a high tryptophan: branch chain amino acids ratio (1:2. A Wilcoxon nonparametric test showed that there was a statistically significant decrease on depression, stress, and mood disturbances scores among the intervention group (P < 0.05 for all parameters. In conclusion, Talbinah has the potential to reduce depression and enhance mood among the subjects. Ingestion of functional foods such as Talbinah may provide a mental health benefit to elderly people.Keywords: Talbinah, food and depression, cross over study, elderly

  12. [Factors influencing continuation of home life after returning home from geriatric intermediate care facilities in a metropolitan suburb].

    Science.gov (United States)

    Miyata, K

    2000-11-01

    A follow-up study was conducted to elucidate the factors influencing continuation of home life after returning home from geriatric intermediate care facilities (GICFs). The subjects were 237 elderly persons (56 men, 181 women, average age of 84 years) who were admitted to three GICFs located in the suburbs of Osaka, and their family caregivers. A follow-up study was performed from 1997 to 1998. Seventy percent of the elderly were bedridden persons with grade B or C of activities of daily living (ADL) according to the criteria of disabled elderly of the Japanese government. Dementia was observed in 82.3% of them. Family caregivers were sons (30.7%), daughters (27.4%), daughters-in-law (27.8%) and spouses (9.7%). The percentage of families spending all day long with the elderly person was 57.5%. Although the rate of having their own detached house was high, that of a private room for the elderly individuals was only about 60%. Most of the families cared for the elderly before admission to the GICFs. The families desired them to stay in the GICFs for as long as possible. Therefore, the families did not want to take the elderly into their home after discharge and only 45% of the families desired home care after the discharge. Concerning the flow of the 237 elderly subjects, the rate of admission from hospitals was high (60.8%), and that of discharge to hospitals was also high (44.3%). The place of residence at the end of follow-up was the GICF (35.4%), the elderly subject's home (19.0%), and hospital (16.0%). Of the 96 elderly who had returned home from GICFs, 40.6% were re-admitted to GICFs. According to multiple logistic analysis, the factors related to continuation of home life were "the elderly with family caregivers who can always supervise him/her", and "the elderly without problem behavior". From the results obtained, it is important that in order for disabled elderly individuals to continue their home life, the GICFs must be the function as the center of a

  13. Insights into the impact and use of research results in a residential long-term care facility: a case study

    Directory of Open Access Journals (Sweden)

    Cranley Lisa A

    2012-09-01

    Full Text Available Abstract Background Engaging end-users of research in the process of disseminating findings may increase the relevance of findings and their impact for users. We report findings from a case study that explored how involvement with the Translating Research in Elder Care (TREC study influenced management and staff at one of 36 TREC facilities. We conducted the study at ‘Restwood’ (pseudonym nursing home because the Director of Care engaged actively in the study and TREC data showed that this site differed on some areas from other nursing homes in the province. The aims of the case study were two-fold: to gain a better understanding of how frontline staff engage with the research process, and to gain a better understanding of how to share more detailed research results with management. Methods We developed an Expanded Feedback Report for use during this study. In it, we presented survey results that compared Restwood to the best performing site on all variables and participating sites in the province. Data were collected regarding the Expanded Feedback Report through interviews with management. Data from staff were collected through interviews and observation. We used content analysis to derive themes to describe key aspects related to the study aims. Results We observed the importance of understanding organizational routines and the impact of key events in the facility’s environment. We gleaned additional information that validated findings from prior feedback mechanisms within TREC. Another predominant theme was the sense that the opportunity to engage in a research process was reaffirming for staff (particularly healthcare aides—what they did and said mattered, and TREC provided a means of having one’s voice heard. We gained valuable insight from the Director of Care about how to structure and format more detailed findings to assist with interpretation and use of results. Conclusions Four themes emerged regarding staff engagement with

  14. Layout Improvement Study to Reduce Staff Walking Distance in a Large Health Care Facility: How to Not Walk an Extra 4740 Miles.

    Science.gov (United States)

    Ley-Chavez, Adriana; Hmar-Lagroun, Tatiana; Douglas-Ntagha, Pamela; Cumbo, Charlotte L

    2016-01-01

    Inefficient facility layouts have been found to be a challenge in health care, with excessive walking adding to the demands of staff and creating delays, which can impact the quality of care. Minimizing unnecessary transportation during care delivery improves efficiency, reduces delays, and frees up resources for use on value-added activities. This article presents a methodology and application of facility design to improve responsiveness and efficiency at a large hospital. The approach described provides the opportunity to improve existing layouts in facilities in which the floor plan is already defined, but there is some flexibility to relocate key areas. The existing physical constraints and work flows are studied and taken into consideration, and the volume of traffic flow throughout the facility guides the decision of where to relocate areas for maximum efficiency. Details on the steps followed and general recommendations to perform the necessary process and data analyses are provided. We achieved a 34.8% reduction in distance walked (4740 miles saved per year) and a 30% reduction in floors traveled in elevators (344 931 floors, which translate to 842 hours spent using elevators) by relocating 4 areas in which frequently used resources are housed.

  15. Computer database of ambulatory EEG signals.

    Science.gov (United States)

    Jayakar, P B; Brusse, E; Patrick, J P; Shwedyk, E; Seshia, S S

    1987-01-01

    The paper describes an ambulatory EEG database. The database contains segments of AEEGs done on 45 subjects. Each epoch (1/8th second or more) of AEEG data has been annotated into 1 of 40 classes. The classes represent background activity, paroxysmal patterns and artifacts. The majority of classes have over 200 discrete epochs. The structure is flexible enough to allow additional epochs to be readily added. The database is stored on transportable media such as digital magnetic tape or hard disk and is thus available to other researchers in the field. The database can be used to design, evaluate and compare EEG signal processing algorithms and pattern recognition systems. It can also serve as an educational medium in EEG laboratories.

  16. Ambulatory ST segment monitoring after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1994-01-01

    The prevalence of transient myocardial ischaemia after myocardial infarction seems to be lower than in other subgroups with coronary artery disease. In postinfarction patients, however, a greater proportion of ischaemic episodes are silent. At present there is substantial evidence that transient...... ischaemia provides prognostic information in different subsets of patients with previous myocardial infarction, but there is considerable disagreement about how this is expressed in terms of cardiac events. Small patient numbers, patient selection, and different timing of ambulatory monitoring are proposed...... be that it can be performed early after infarction at the time of maximum risk. Secondly, it can be performed in most patients after infarction, including those recognised as being at high risk who are unable to perform an exercise stress test....

  17. Use of RDTs to improve malaria diagnosis and fever case management at primary health care facilities in Uganda

    Directory of Open Access Journals (Sweden)

    Nabakooza Jane

    2010-07-01

    Full Text Available Abstract Background Early and accurate diagnosis of malaria followed by prompt treatment reduces the risk of severe disease in malaria endemic regions. Presumptive treatment of malaria is widely practised where microscopy or rapid diagnostic tests (RDTs are not readily available. With the introduction of artemisinin-based combination therapy (ACT for treatment of malaria in many low-resource settings, there is need to target treatment to patients with parasitologically confirmed malaria in order to improve quality of care, reduce over consumption of anti-malarials, reduce drug pressure and in turn delay development and spread of drug resistance. This study evaluated the effect of malaria RDTs on health workers' anti-malarial drug (AMD prescriptions among outpatients at low level health care facilities (LLHCF within different malaria epidemiological settings in Uganda. Methods All health workers (HWs in 21 selected intervention (where RDTs were deployed LLHF were invited for training on the use RDTs. All HWs were trained to use RDTs for parasitological diagnosis of all suspected malaria cases irrespective of age. Five LLHCFs with clinical diagnosis (CD only were included for comparison. Subsequently AMD prescriptions were compared using both a 'pre - post' and 'intervention - control' analysis designs. In-depth interviews of the HWs were conducted to explore any factors that influence AMD prescription practices. Results A total of 166,131 out-patient attendances (OPD were evaluated at 21 intervention LLHCFs. Overall use of RDTs resulted in a 38% point reduction in AMD prescriptions. There was a two-fold reduction (RR 0.62, 95% CI 0.55-0.70 in AMD prescription with the greatest reduction in the hypo-endemic setting (RR 0.46 95% CI 0.51-0.53 but no significant change in the urban setting (RR1.01, p-value = 0.820. Over 90% of all eligible OPD patients were offered a test. An average of 30% (range 25%-35% of the RDT-negative fever patients received

  18. Prevalence and impact of Clostridium difficile infection in elderly residents of long-term care facilities, 2011

    Science.gov (United States)

    Ziakas, Panayiotis D.; Joyce, Nina; Zacharioudakis, Ioannis M.; Zervou, Fainareti N.; Besdine, Richard W.; Mor, Vincent; Mylonakis, Eleftherios

    2016-01-01

    Abstract The elderly population is particularly vulnerable to Clostridium difficile infection (CDI), but the epidemiology of CDI in long-term care facilities (LTCFs) is unknown. We performed a retrospective cohort study and used US 2011 LTCF resident data from the Minimum Data Set 3.0 linked to Medicare claims. We extracted CDI cases based on International Classification of Diseases-9 coding, and compared residents with the diagnosis of CDI to those who did not have a CDI diagnosis during their LTCF stay. We estimated CDI prevalence rates and calculated 3-month mortality rates. The study population consisted of 2,190,613 admissions (median age 82 years; interquartile range 76–88; female to male ratio 2:1; >80% whites), 45,500 of whom had a CDI diagnosis. The nationwide CDI prevalence rate was 1.85 per 100 LTCF admissions (95% confidence interval [CI] 1.83–1.87). The CDI rate was lower in the South (1.54%; 95% CI 1.51–1.57) and higher in the Northeast (2.29%; 95% CI 2.25–2.33). Older age, white race, presence of a feeding tube, unhealed pressure ulcers, end-stage renal disease, cirrhosis, bowel incontinence, prior tracheostomy, chemotherapy, and chronic obstructive pulmonary disease were independently related to “high risk” for CDI. Residents with a CDI diagnosis were more likely to be admitted to an acute care hospital (40% vs 31%, P < 0.001) and less likely to be discharged to the community (46% vs 54%, P < 0.001) than those not reported with CDI during stay. Importantly, CDI was associated with higher mortality (24.7% vs 18.1%, P = 0.001). CDI is common among the elderly residents of LTCFs and is associated with significant increase in 3-month mortality. The prevalence is higher in the Northeast and risk stratification can be used in CDI prevention policies. PMID:27495022

  19. Ambulatory Pessary Trial Unmasks Occult Stress Urinary Incontinence

    Directory of Open Access Journals (Sweden)

    Bilal Chughtai

    2012-01-01

    Conclusion. An ambulatory pessary trial is an effective, easy, and inexpensive method to approximate anatomic results achieved by surgery under real-life conditions. In our series, 20% of patients with occult SUI were identified by pessary trial alone.

  20. First operation of the medical research facility at the NSLS for coronary angiography

    International Nuclear Information System (INIS)

    The Synchrotron Medical Research Facility (SMERF) at the National Synchrotron Light Source has been completed and is operational for human coronary angiography experiments. The imaging system and hardware have been brought to SMERF from the Stanford Synchrotron Radiation Laboratory where prior studies were carried out. SMERF consists of a suite of rooms at the end of the high field superconducting wiggler X17 beamline and is classified as an Ambulatory health Care Facility. Since October of 1990 the coronary arteries of five patients have been imaged. Continuously improving image quality has shown that a large part of both the right coronary artery and the left anterior descending coronary artery can be imaged following a venous injection of contrast agent. 16 refs., 4 figs

  1. First operation of the medical research facility at the NSLS for coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Thomlinson, W.; Gmuer, N.; Chapman, D.; Garrett, R.; Lazarz, N.; Moulin, H. (Brookhaven National Lab., Upton, NY (United States)); Thompson, A.C. (Lawrence Berkeley Lab., CA (United States)); Zeman, H.D. (Dept. of Biomedical Engineering, University of Tennessee, Memphis, Tennessee, 38163 (US)); Brown, G.S. (Stanford Univ., CA (United States). Stanford Synchrotron Radiation Lab.); Morrison, J.; Reiser, P

    1991-01-01

    The Synchrotron Medical Research Facility (SMERF) at the National Synchrotron Light Source has been completed and is operational for human coronary angiography experiments. The imaging system and hardware have been brought to SMERF from the Stanford Synchrotron Radiation Laboratory where prior studies were carried out. SMERF consists of a suite of rooms at the end of the high field superconducting wiggler X17 beamline and is classified as an Ambulatory health Care Facility. Since October of 1990 the coronary arteries of five patients have been imaged. Continuously improving image quality has shown that a large part of both the right coronary artery and the left anterior descending coronary artery can be imaged following a venous injection of contrast agent. 16 refs., 4 figs.

  2. Computerized adaptive testing--ready for ambulatory monitoring?

    DEFF Research Database (Denmark)

    Rose, Matthias; Bjørner, Jakob; Fischer, Felix;

    2012-01-01

    Computerized adaptive tests (CATs) have abundant theoretical advantages over established static instruments, which could improve ambulatory monitoring of patient-reported outcomes (PROs). However, an empirical demonstration of their practical benefits is warranted.......Computerized adaptive tests (CATs) have abundant theoretical advantages over established static instruments, which could improve ambulatory monitoring of patient-reported outcomes (PROs). However, an empirical demonstration of their practical benefits is warranted....

  3. Pros and cons of the ambulatory surgery center joint venture.

    Science.gov (United States)

    Giannini, Deborah

    2008-01-01

    If a physician group has determined that it has a realistic patient base to establish an ambulatory surgery center, it may be beneficial to consider a partner to share the costs and risks of this new joint venture. Joint ventures can be a benefit or liability in the establishment of an ambulatory surgery center. This article discusses the advantages and disadvantages of a hospital physician-group joint venture. PMID:18061764

  4. Comparing Ambulatory Preceptors’ and Students’ Perceptions of Educational Planning

    OpenAIRE

    Qualters, Donna M.; Regan, Mary Beth; O’Brien, Mary Callery; Stone, Sarah L

    1999-01-01

    To compare ambulatory preceptors’ and students’ perceptions of the use of educational planning (setting goals, assessing needs, formulating objectives, choosing methods, and providing feedback and evaluation) in the office setting, we mailed a survey, which was returned by 127 longitudinal ambulatory preceptors and 168 first-year and second-year medical students. Faculty perceptions did not match student perceptions of what occurred in the longitudinal preceptor program teaching sessions in e...

  5. Pros and cons of the ambulatory surgery center joint venture.

    Science.gov (United States)

    Giannini, Deborah

    2008-01-01

    If a physician group has determined that it has a realistic patient base to establish an ambulatory surgery center, it may be beneficial to consider a partner to share the costs and risks of this new joint venture. Joint ventures can be a benefit or liability in the establishment of an ambulatory surgery center. This article discusses the advantages and disadvantages of a hospital physician-group joint venture.

  6. General practitioner's reported use of clinical guidelines for hypertension and ambulatory blood pressure.

    LENUS (Irish Health Repository)

    Flynn, E

    2012-03-01

    ABPM is an invaluable clinical tool, as it has been shown to improve blood pressure control in primary care. Many clinical guidelines for hypertension advocate ambulatory blood pressure monitoring. This study aims to quantify the use of clinical guidelines for hypertension and to explore the role of ABPM in Primary Care. A questionnaire survey was sent to GPs working in the West of Ireland. 88% (n=139) of GPs use clinical guidelines that recommend the use of ABPM. 82% (n=130) of GPs find use of clinic blood pressure monitoring insufficient for the diagnosis and monitoring of hypertension. Despite good access to ABPM, GPs report lack of remuneration, 72% (n=116), cost 68% (n=108), and lack of time, 51% (n=83) as the main limiting factors to use of ABPM. GPs recognise the clinical value of ABPM, but this study identifies definite barriers to the use of ABPM in Primary Care.

  7. Molecular characterization and drug resistance of Escherichia coli strains isolated from urine from long-term care facility residents in Cracow, Poland

    OpenAIRE

    Pobiega, Monika; Wojkowska-Mach, Jadwiga; Chmielarczyk, Agnieszka; Romaniszyn, Dorota; Adamski, Paweł; Heczko, Piort B.; Gryglewska, Barbara; Grodzicki, Tomasz

    2013-01-01

    Background The aim of this study was to assess the prevalence of multidrug-resistant Escherichia coli and extended-spectrum β-lactamases (ESBL) pathogens isolated from asymptomatic bacteriuria and urinary tract infections (UTIs), and the relationship between the phylogeny, antimicrobial resistance, and virulence among isolates in residents of 3 long-term care facilities (LTCF) in Krakow, Poland. Material/Methods This was point prevalence study and prospective infection control in a group of 2...

  8. Telemedicine-supported transition of stable coronary artery disease patients from tertiary to primary health care facilities: protocol for a randomized non-inferiority trial

    OpenAIRE

    Batista, Joanna d’Arc Lyra; Furtado, Mariana Vargas; Katz, Natan; Agostinho, Milena Rodrigues; Neto, Brasil Silva; Harzheim, Erno; Polanczyk, Carisi Anne

    2016-01-01

    Background Many Brazilian patients with complex diseases who are treated in tertiary referral clinics have been stable for long periods. The main needs of these patients involve monitoring of risk factors and review of drug prescriptions, which could be satisfactorily done in primary care facilities. The goal of this protocol is to evaluate the safety and effectiveness of telemedicine services to support the transition of patients with stable chronic coronary artery disease from the tertiary ...

  9. Programme level implementation of malaria rapid diagnostic tests (RDTs) use: outcomes and cost of training health workers at lower level health care facilities in Uganda

    OpenAIRE

    Kyabayinze Daniel J; Asiimwe Caroline; Nakanjako Damalie; Nabakooza Jane; Bajabaite Moses; Strachan Clare; Tibenderana James K; Van Geetruyden Jean

    2012-01-01

    Abstract Background The training of health workers in the use of malaria rapid diagnostic tests (RDTs) is an important component of a wider strategy to improve parasite-based malaria diagnosis at lower level health care facilities (LLHFs) where microscopy is not readily available for all patients with suspected malaria. This study describes the process and cost of training to attain competence of lower level health workers to perform malaria RDTs in a public health system setting in eastern U...

  10. Maternal Mortality and Distance to Facility-based Obstetric Care in Rural Southern Tanzania: A Secondary Analysis of Cross-sectional Census Data in 226 000 Households.

    OpenAIRE

    Dr. Claudia Hanson, PhD; Jonathan Cox, PhD; Godfrey Mbaruku, PhD; Fatuma Manzi, PhD; Sabine Gabrysch, PhD; Prof. David Schellenberg, PhD; Prof. Marcel Tanner, PhD; Prof. Carine Ronsmans, DrPH; Prof. Joanna Schellenberg, PhD

    2015-01-01

    Background: Access to skilled obstetric delivery and emergency care is deemed crucial for reducing maternal mortality. We assessed pregnancy-related mortality by distance to health facilities and by cause of death in a disadvantaged rural area of southern Tanzania. Methods: We did a secondary analysis of cross-sectional georeferenced census data collected from June to October, 2007, in five rural districts of southern Tanzania. Heads of georeferenced households were asked about household d...

  11. Older adults' pain communication during ambulatory medical visits: an exploration of communication accommodation theory.

    Science.gov (United States)

    Hehl, Jennifer; McDonald, Deborah Dillon

    2014-06-01

    The purpose of this descriptive secondary analysis was to explore the use of Communication Accommodation Theory as a framework to examine pain communication strategies used by older adults and their primary care practitioners during medical ambulatory care visits. Ambulatory medical visits for 22 older adults with moderate or greater osteoarthritis pain were audiotaped, transcribed verbatim, and coded by two independent raters for six a priori communication strategies derived from the attuning strategies of Communication Accommodation Theory: (1) patient selecting the pain topic; (2) patient taking a turn; (3) patient maintaining focus on the pain topic; (4) practitioner using an open-ended question without social desirability to start the pain discussion; (5) practitioner encouraging the patient to take a turn by asking open-ended questions; and (6) practitioner interruptions. The majority of practitioners did not start the pain discussion with an open-ended question, but did not interrupt the older adults as they discussed their pain. Five (22.7%) of the older adults did not discuss their osteoarthritis pain during the ambulatory medical visit. The majority of patients took their turn during the pain discussion, but did not maintain focus while describing important osteoarthritis pain information to their practitioner. Practitioners might assist older adults to communicate more information about their pain by initiating the pain discussion with an open-ended pain question. Older adults might provide more pain information to their practitioner by staying on the pain topic until they have completed all of the pain information they wish to discuss with the practitioner.

  12. Older adults' pain communication during ambulatory medical visits: an exploration of communication accommodation theory.

    Science.gov (United States)

    Hehl, Jennifer; McDonald, Deborah Dillon

    2014-06-01

    The purpose of this descriptive secondary analysis was to explore the use of Communication Accommodation Theory as a framework to examine pain communication strategies used by older adults and their primary care practitioners during medical ambulatory care visits. Ambulatory medical visits for 22 older adults with moderate or greater osteoarthritis pain were audiotaped, transcribed verbatim, and coded by two independent raters for six a priori communication strategies derived from the attuning strategies of Communication Accommodation Theory: (1) patient selecting the pain topic; (2) patient taking a turn; (3) patient maintaining focus on the pain topic; (4) practitioner using an open-ended question without social desirability to start the pain discussion; (5) practitioner encouraging the patient to take a turn by asking open-ended questions; and (6) practitioner interruptions. The majority of practitioners did not start the pain discussion with an open-ended question, but did not interrupt the older adults as they discussed their pain. Five (22.7%) of the older adults did not discuss their osteoarthritis pain during the ambulatory medical visit. The majority of patients took their turn during the pain discussion, but did not maintain focus while describing important osteoarthritis pain information to their practitioner. Practitioners might assist older adults to communicate more information about their pain by initiating the pain discussion with an open-ended pain question. Older adults might provide more pain information to their practitioner by staying on the pain topic until they have completed all of the pain information they wish to discuss with the practitioner. PMID:24882026

  13. Does procedure profitability impact whether an outpatient surgery is performed at an ambulatory surgery center or hospital?

    Science.gov (United States)

    Plotzke, Michael Robert; Courtemanche, Charles

    2011-07-01

    Ambulatory surgery centers (ASCs) are small (typically physician owned) healthcare facilities that specialize in performing outpatient surgeries and therefore compete against hospitals for patients. Physicians who own ASCs could treat their most profitable patients at their ASCs and less profitable patients at hospitals. This paper asks if the profitability of an outpatient surgery impacts where a physician performs the surgery. Using a sample of Medicare patients from the National Survey of Ambulatory Surgery, we find that higher profit surgeries do have a higher probability of being performed at an ASC compared to a hospital. After controlling for surgery type, a 10% increase in a surgery's profitability is associated with a 1.2 to 1.4 percentage point increase in the probability the surgery is performed at an ASC.

  14. Contributing influences of work environment on sleep quantity and quality of nursing assistants in long-term care facilities: A cross-sectional study.

    Science.gov (United States)

    Zhang, Yuan; Punnett, Laura; McEnany, Geoffry Phillips; Gore, Rebecca

    2016-01-01

    The effect of shift work on nurses' sleep is well-studied, but there are other challenging aspects of health care work that might also affect the sleep of direct caregivers. This study examined the influence of the long-term care work environment on sleep quantity and quality of nursing assistants. A cross-sectional survey collected data from 650 nursing assistants in 15 long-term care facilities; 46% reported short sleep duration and 23% reported poor sleep quality. A simple additive index of the number of beneficial work features (up to 7) was constructed for analysis with Poisson regression. With each unit increase of beneficial work features, nursing assistants were 7% less likely to report short sleep duration and 17% less likely to report poor sleep quality. These results suggest that effective workplace interventions should address a variety of work stressors, not only work schedule arrangements, in order to improve nursing assistants' sleep health.

  15. American Society of Regional Anesthesia and Pain Medicine 2010 Gaston Labat Lecture: Perineural catheter analgesia as a routine method after ambulatory surgery--effective but unrealistic.

    Science.gov (United States)

    Rawal, Narinder

    2012-01-01

    Adequate postoperative analgesia is a prerequisite for successful ambulatory surgery and remains a challenge. The problem of pain at home may be increasing because previously inpatient surgical procedures are becoming ambulatory and it is expected that the number and complexity of ambulatory surgical procedures will continue to increase. In 1998, we described the use of surgical-site and perineural catheter techniques that allowed patients to self-administer local anesthetics through disposable, elastomeric pumps for pain management at home. In recent years, availability of improved elastometric and other lightweight pump devices, the general trend of avoiding strong opioids and the preference for non-opioid analgesic techniques has led to increasing use of this technique after a variety of ambulatory surgical procedures. The two most common techniques are perineural and wound catheter infusions (WCI). Current evidence suggests that both are effective, although comparative studies are lacking. Perineural techniques are highly effective but are technically challenging and require labor-intensive and expensive home care that can be provided only in specialized centers. Disappointing past experience with implementation of perineural catheter techniques in inpatients suggests that it is unrealistic to expect their routine use in most ambulatory centers. Surgical-site catheter technique is a simpler, safer, and less expensive alternative and therefore more likely to gain widespread use. Only controlled comparisons can show whether the current belief about the superiority of ambulatory perineural techniques over WCI is justified. Such studies should address technical failures, side effects, home care of the medically unsupervised or undersupervised patient, and cost-effectiveness to demonstrate which of the 2 techniques is most appropriate for a particular procedure. PMID:22157738

  16. Teamwork in obstetric critical care

    OpenAIRE

    Guise, Jeanne-Marie; Segel, Sally

    2008-01-01

    Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well t...

  17. The efficacy of ginger added to ondansetron for preventing postoperative nausea and vomiting in ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Pragnadyuti Mandal

    2014-01-01

    Full Text Available Background: Post-operative nausea and vomiting (PONV frequently hampers implementation of ambulatory surgery in spite of so many costly antiemetic drugs and regimens. Objective: The study was carried out to compare the efficacy of ginger (Zingiber officinale added to Ondansetron in preventing PONV after ambulatory surgery. Materials and Methods: It was a prospective, double blinded, and randomized controlled study. From March 2008 to July 2010, 100 adult patients of either sex, aged 20-45, of ASA physical status I and II, scheduled for day care surgery, were randomly allocated into Group A[(n = 50 receiving (IV Ondansetron (4 mg and two capsules of placebo] and Group B[(n = 50 receiving IV Ondansetron (4 mg and two capsules of ginger] simultaneously one hour prior to induction of general anaesthesia (GA in a double-blind manner. One ginger capsule contains 0.5 gm of ginger powder. Episodes of PONV were noted at 0.5h, 1h, 2h, 4h, 6h, 12h and 18h post- operatively. Statistical Analysis and Results: Statistically significant difference between groups A and B (P < 0.05, was found showing that ginger ondansetron combination was superior to plain Ondansetron as antiemetic regimen for both regarding frequency and severity. Conclusion: Prophylactic administration of ginger and ondansetron significantly reduced the incidence of postoperative nausea and vomiting compared to ondansetron alone in patients undergoing day care surgery under general anaesthesia.

  18. The efficacy of ginger added to ondansetron for preventing postoperative nausea and vomiting in ambulatory surgery

    Science.gov (United States)

    Mandal, Pragnadyuti; Das, Anjan; Majumdar, Saikat; Bhattacharyya, Tapas; Mitra, Tapobrata; Kundu, Ratul

    2014-01-01

    Background: Post-operative nausea and vomiting (PONV) frequently hampers implementation of ambulatory surgery in spite of so many costly antiemetic drugs and regimens. Objective: The study was carried out to compare the efficacy of ginger (Zingiber officinale) added to Ondansetron in preventing PONV after ambulatory surgery. Materials and Methods: It was a prospective, double blinded, and randomized controlled study. From March 2008 to July 2010, 100 adult patients of either sex, aged 20-45, of ASA physical status I and II, scheduled for day care surgery, were randomly allocated into Group A[(n = 50) receiving (IV) Ondansetron (4 mg) and two capsules of placebo] and Group B[(n = 50) receiving IV Ondansetron (4 mg) and two capsules of ginger] simultaneously one hour prior to induction of general anaesthesia (GA) in a double-blind manner. One ginger capsule contains 0.5 gm of ginger powder. Episodes of PONV were noted at 0.5h, 1h, 2h, 4h, 6h, 12h and 18h post- operatively. Statistical Analysis and Results: Statistically significant difference between groups A and B (P < 0.05), was found showing that ginger ondansetron combination was superior to plain Ondansetron as antiemetic regimen for both regarding frequency and severity. Conclusion: Prophylactic administration of ginger and ondansetron significantly reduced the incidence of postoperative nausea and vomiting compared to ondansetron alone in patients undergoing day care surgery under general anaesthesia. PMID:24497743

  19. Facilitating Ambulatory Electronic Health Record System Implementation: Evidence from a Qualitative Study

    Directory of Open Access Journals (Sweden)

    Ann Scheck McAlearney

    2013-01-01

    Full Text Available Background. Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR systems, but little information is available documenting how organizations have successfully implemented these systems. Objective. To characterize elements of successful electronic health record (EHR system implementation and to synthesize the key informants' perspectives about successful implementation practices. Methods. Key informant interviews and focus groups were conducted with a purposive sample of individuals from US healthcare organizations identified for their success with ambulatory EHR implementation. Rigorous qualitative data analyses used both deductive and inductive methods. Results. Participants identified personal and system-related barriers, at both the individual and organization levels, including poor computer skills, productivity losses, resistance to change, and EHR system failure. Implementation success was reportedly facilitated by careful planning and consistent communication throughout distinct stages of the implementation process. A significant element of successful implementation was an emphasis on optimization, both during “go-live” and, subsequently, when users had more experience with the system. Conclusion. Successful EHR implementation requires both detailed planning and clear mechanisms to deal with unforeseen or unintended consequences. Focusing on user buy-in early and including plans for optimization can facilitate greater success.

  20. Peritonitis during continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Rubin, J; Rogers, W A; Taylor, H M; Everett, E D; Prowant, B F; Fruto, L V; Nolph, K D

    1980-01-01

    We initiated a therapeutic program of continuous ambulatory peritoneal dialysis for patients with chronic renal failure. Our program resulted in many episodes of peritonitis arising from contamination due to the technical aspects of the procedure. Microbiologic evaluation showed that 73% of 97 episodes were culture positive, with gram-positive organisms causing most of the cases, especially early in dialysis. Gram-negative rods tended to occur later. Gram stains of dialysate effluent resulted in a disappointingly low yield of only 9% positivity. Cell counts were a dependable indicator of the presence of peritoneal inflammation and also of therapeutic success. Most patients responded well to intraperitoneal cephalothin, 125 mg/L for 10 to 14 d. The occurrence of peritonitis resulted in 0.93 years of hospitalization during the total of 15.45 patient-years on dialysis, which essentially negated the financial advantages of this method of treatment of chronic renal failure. For this to be a successful mode of therapy, advances in the prevention of peritonitis must be made. PMID:6985785