Sample records for ambulatory care sensitive

  1. [Hospitalisations for ambulatory care sensitive conditions in Germany

    NARCIS (Netherlands)

    Freund, T.; Heller, G.; Szecsenyi, J.


    BACKGROUND: On the basis of the assumption that a significant proportion of hospitalisations for so-called ambulatory care sensitive conditions (ACSCs) are potentially avoidable by ambulatory care measures, hospitalisation rates for ACSCs are used internationally as population based indicators for a

  2. Hospitalizations for ambulatory care-sensitive conditions, Minas Gerais, Southeastern Brazil, 2000 and 2010

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    Rita Maria Rodrigues-Bastos


    Full Text Available OBJECTIVE To analyze hospitalization rates and the proportion of deaths due to ambulatory care-sensitive hospitalizations and to characterize them according to coverage by the Family Health Strategy, a primary health care guidance program. METHODS An ecological study comprising 853 municipalities in the state of Minas Gerais, under the purview of 28 regional health care units, was conducted. We used data from the Hospital Information System of the Brazilian Unified Health System. Ambulatory care-sensitive hospitalizations in 2000 and 2010 were compared. Population data were obtained from the demographic censuses. RESULTS The number of ambulatory care-sensitive hospitalizations declined from 20.75/1,000 inhabitants [standard deviation (SD = 10.42 in 2000 to 14.92/thousand inhabitants (SD = 10.04 in 2010 Heart failure was the most frequent cause in both years. Hospitalizations rates for hypertension, asthma, and diabetes mellitus, decreased, whereas those for angina pectoris, prenatal and birth disorders, kidney and urinary tract infections, and other acute infections increased. Hospitalization durations and the proportion of deaths due to ambulatory care-sensitive hospitalizations increased significantly. CONCLUSIONS Mean hospitalization rates for sensitive conditions were significantly lower in 2010 than in 2000, but no correlation was found with regard to the expansion of the population coverage of the Family Health Strategy. Hospitalization rates and proportion of deaths were different between the various health care regions in the years evaluated, indicating a need to prioritize the primary health care with high efficiency and quality.

  3. Hospital admissions due to ambulatory care sensitive conditions among children by age group and health region

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    Kelly Holanda Prezotto


    Full Text Available OBJECTIVE to describe hospital admissions for ambulatory care sensitive conditions in children under five years of age in the State of Paraná, Brazil by condition type, age group and health region. METHOD a temporal ecological study was conducted using data from the Unified Health System Hospital Information System for the period 2000 to 2011. Conditions were grouped in accordance with the list of ambulatory care sensitive conditions in Brazil. RESULTS there was an increase in the rate of admissions for ambulatory care sensitive conditions in all age groups in 50% of the health regions, with a marked increase in children under the age of one. Pneumonia, gastroenteritis and asthma were the main causes of admissions. There was an increase in the proportion of overall admissions accounted for by pneumonia and gastroenteritis. CONCLUSION the increase in admissions reveals the need for actions to improve access to primary healthcare and provide effective treatment of the main ambulatory care sensitive conditions in order to prevent hospital admissions among children.

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

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    Tania Cristina Morais Santa Barbara Rehem


    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.


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    Maria Aparecida Araújo Figueiredo


    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.

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

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    Aldo Rosano


    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

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

    DEFF Research Database (Denmark)

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


    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...

  8. Hospitalization for ambulatory care sensitive conditions at health insurance organization hospitals in Alexandria, Egypt. (United States)

    Mosallam, Rasha A; Guirguis, Wafaa W; Hassan, Mona Ha


    This study aimed at estimating the percentage of hospital discharges and days of care accounted for by Ambulatory Care Sensitive Conditions (ACSCs) at Health Insurance Organization (HIO) hospitals in Alexandria, calculating hospitalization rates for ACSCs among HIO population and identifying determinants of hospitalization for those conditions. A sample of 8300 medical records of patients discharged from three hospitals affiliated to HIO at Alexandria was reviewed. The rate of monthly discharges for ACSCs was estimated on the basis of counting number of combined ACSCs detected in the three hospitals and the hospitals' average monthly discharges. ACSCs accounted for about one-fifth of hospitalizations and days of care at HIO hospitals (21.8% and 20.8%, respectively). Annual hospitalization rates for ACSCs were 152.5 per 10,000 insured population. The highest rates were attributed to cellulitis/abscess (47.3 per 10,000 population), followed by diabetes complications and asthma (42.8 and 20.8 per 10,00 population). Logistic regression indicated that age, number of previous admissions, and admission department are significant predictors for hospitalization for an ACSC.

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

    LENUS (Irish Health Repository)

    Sheridan, A


    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.

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

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    Künzi Beat


    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

  11. National Hospital Ambulatory Medical Care Survey (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...

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

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    Renata Laszlo Torres


    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.

  13. Communication in acute ambulatory care. (United States)

    Dean, Marleah; Oetzel, John; Sklar, David P


    Effective communication has been linked to better health outcomes, higher patient satisfaction, and treatment adherence. Communication in ambulatory care contexts is even more crucial, as providers typically do not know patients' medical histories or have established relationships, conversations are time constrained, interruptions are frequent, and the seriousness of patients' medical conditions may create additional tension during interactions. Yet, health communication often unduly emphasizes information exchange-the transmission and receipt of messages leading to a mutual understanding of a patient's condition, needs, and treatments. This approach does not take into account the importance of rapport building and contextual issues, and may ultimately limit the amount of information exchanged.The authors share the perspective of communication scientists to enrich the current approach to medical communication in ambulatory health care contexts, broadening the under standing of medical communication beyond information exchange to a more holistic, multilayered viewpoint, which includes rapport and contextual issues. The authors propose a socio-ecological model for understanding communication in acute ambulatory care. This model recognizes the relationship of individuals to their environment and emphasizes the importance of individual and contextual factors that influence patient-provider interactions. Its key elements include message exchange and individual, organizational, societal, and cultural factors. Using this model, and following the authors' recommendations, providers and medical educators can treat communication as a holistic process shaped by multiple layers. This is a step toward being able to negotiate conflicting demands, resolve tensions, and create encounters that lead to positive health outcomes.

  14. National Ambulatory Medical Care Survey (NAMCS) (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 of...

  15. Planning an ambulatory care joint venture. (United States)

    Harpster, L M


    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.

  16. Ambulatory Care Skills: Do Residents Feel Prepared?

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    Denise Bonds


    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.

  17. Ambulatory Assessment of Depression in Primary Care (United States)


    Statement The auth~r hereby certifies that the use of any copyrighted material in the thesis manuscript entitled: "AMBULATORY ASSESSMENT OF DEPRESSION IN...Department Medical and Clinical Psychology Uniformed Services University of the Health Sciences 11 iii Abstract Depression is common among individuals in...primary care. Despite the prevalence of depression in primary care, patients are usually not adequately treated for depression . Often the treatment

  18. Redesigning ambulatory care business processes supporting clinical care delivery. (United States)

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


    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.

  19. Evaluation of a Professional Practice Model in the Ambulatory Care Setting (United States)


    patient satisfaction , nurse -sensitive indicators of quality care as measured by...Project Number: N10-C04 Aim one Evaluate levels of nursing and patient satisfaction in ambulatory care clinics following implementation of a...Clarke, S.P., Sloane, D., Lake, E.T., Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing

  20. Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses. (United States)

    Rapin, Joachim; D'Amour, Danielle; Dubois, Carl-Ardy


    The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2013). We conducted a scoping review in three databases (CINAHL, MEDLINE, and EMBASE) and the bibliographies of selected articles. From a total of 116 articles, we selected 22. The results of our study not only enable that framework to be extended to ambulatory nursing care but also enhance it with the addition of five new indicators. Our work offers nurses and managers in ambulatory nursing units indicators potentially sensitive to nursing that can be used to evaluate performance. For researchers, it presents the current state of knowledge on this construct and a framework with theoretical foundations for future research in ambulatory settings. This work opens an unexplored field for further research.

  1. Equine wellness care in ambulatory practice. (United States)

    Sandoval, Claudia; True, Claudia


    Clients want dependable veterinary care and to understand how the services will benefit and meet their horse’s needs. Wellness visits provide ambulatory practitioners with great opportunities to strengthen the doctor-client-patient bond; effective communication with clients during wellness visits, where new literature or facts can be presented, can offer opportunities for demonstrating the value of having the veterinarian maintain a primary role in disease control. The criteria for selecting vaccines, interpreting FECs, and diagnosing dental pathology require the continued need for veterinary involvement. When providing wellness services, veterinarians should discuss those services, the reasons for them, as well as the possibility of adverse reactions. In so doing, the veterinarian is able to clearly distinguish himself or herself from a technician who is merely giving a "shot." Although some of these services can be performed by clients and lay professionals, the knowledge and training that veterinarians bring to these tasks add benefits to the horse beyond the services provided. For example, by targeting treatment and conveying the goals and limitations of FECs and deworming to clients, the speed at which anthelmintic resistance occurs will be diminished, and veterinarians will regain control over equine parasite management. Additional client education, such as demonstrating dental pathology to clients and how veterinary treatment benefits their horse, will not only improve the health of the horse further but also solidify the veterinarian’s role in preventative medicine. While all components of a wellness program were not detailed here, services such as nutritional consultation, blood work, and lameness evaluation should be offered based on the practice’s equine population. With the increasing population of geriatric horses, dentistry, nutrition, blood work, and lameness should be assessed annually or biannually. Each practice has its own set of criteria

  2. The ten successful elements of an ambulatory care center. (United States)

    Watkins, G


    Experts in healthcare predict that in the future, over 80% of all care will be provided either in the home or ambulatory care centers. How radiology facilities position themselves for this shifting market is critical to their long-term success, even though it appears there are endless opportunities for providing care in this atmosphere. The ten most critical elements that healthcare providers must address to ensure their preparedness are discussed. Location is critical, particularly since patients no longer want to travel to regional medical centers. The most aggressive providers are building local care centers to serve specific populations. Ambulatory care centers should project a high tech, high touch atmosphere. Patient comfort and the appeal of the overall environment must be considered. Centers need to focus on their customers' needs in multiple areas of care. A quick and easy registration process, providing dressing gowns in patient areas, clear billing functions--these are all important areas that centers should develop. Physicians practicing in the ambulatory care center are key to its overall success and can set the tone for all staff members. Staff members must be friendly and professional in their work with patients. The hours offered by the center must meet the needs of its client base, perhaps by offering evening and weekend appointments. Keeping appointments on schedule is critical if a center wants satisfied customers. It's important to identify the target before developing your marketing plan. Where do your referrals come from? Look to such sources as referring physicians, managed care plans and patients themselves. Careful billing is critical for survival in the ambulatory care world. Costs are important and systems that can track cost per exam are useful. Know your bottom line. Service remains the central focus of all successful ambulatory care center functions.

  3. A vision for ambulatory care in the 21st century. (United States)

    Zuckerman, A M


    The 1990's have been a remarkable decade for ambulatory care providers. Ambulatory care services have flourished in an era of rapidly increasing demands and seemingly limitless potential. Will the first decade of the next millennium continue this trend or is something new on the horizon? Ambulatory care's future prospects need to be evaluated within the context of the overall health care delivery environment of the future. At this time, three alternative "futures" seem plausible for the next decade. Managed care dominates. This scenario appears most likely at present with managed care poised to make significant inroads into Medicaid and Medicare populations. National health insurance is instituted. Some believe that this is a logical reaction to the excesses of the current competitive marketplace and is possible following the presidential election of 2004. Slow evolution of current system. This scenario may be viewed as the status quo alternative and is likely in the absence of a crisis or a better, generally agreed upon way in which to improve health care delivery.

  4. Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement. (United States)

    Montano, Maria F; Mehdi, Harshal; Nash, David B


    The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting.

  5. Quality assurance in the ambulatory care setting. (United States)

    Tyler, R D


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

  6. Cognitive assessment on elderly people under ambulatory care

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    Bruna Zortea


    Full Text Available Objective: to evaluate the cognitive state of elderly people under ambulatory care and investigating the connection between such cognitive state and sociodemographic variables, health conditions, number of and adhesion to medicine. Methods: transversal, exploratory, and descriptive study, with a quantitative approach, realized with 107 elderly people under ambulatory care in a university hospital in southern Brazil, in november, 2013. The following variables were used: gender, age, civil status, income, schooling, occupation, preexisting noncommunicable diseases, number and type of prescribed medications, adhesion, mini-mental state examination score, and cognitive status. Data was analyzed through inferential and descriptive statistics. Results: the prevalence of cognitive deficit was of 42.1% and had a statistically significant connection to schooling, income, civil status, hypertension, and cardiopathy. Conclusion: nurses can intervene to avoid the increase of cognitive deficit through an assessment of the elderly person, directed to facilitative strategies to soften this deficit.

  7. A Atenção Primária à Saúde no sul de Santa Catarina: uma análise das internações por condições sensíveis à atenção ambulatorial, no período de 1999 a 2004 Primary Health Care in the south of Santa Catarina: analysis of admissions for ambulatory care-sensitive conditions, in the 1999-2004 period

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    Evelyn Elias


    ção adequada a sua magnitude foi muito menor. As taxas de internação por Acidente Vascular Cerebral foram crescentes em município com atenção adequada, com tênue queda linear para a população atendida de forma não adequada. Em relação às internações por Infarto Agudo do Miocárdio, tanto nos municípios com atenção adequada quanto naqueles com atenção não adequada, as taxas apresentaram tendência ao aumento, com tendência um pouco menor nos municípios com PSF adequado. CONCLUSÃO: É possível perceber algumas mudanças positivas na evolução de algumas taxas de internações por condições sensíveis à atenção ambulatorial, que podem estar associadas a maior cobertura e a melhor atenção recebida pelo PSF.INTRODUCTION: The reorientation of the health care model in Brazil is based on a strategy to structure a primary care network to cover the health needs of the population through access to family health teams. The impact of primary care on the health of the population can be assessed by tracking hospital admissions due to conditions sensitive to ambulatory care, an initiative that has been developed in recent years in several countries and also in Brazil OBJECTIVE: To analyze hospital admission trends for some conditions sensitive to ambulatory care in the Association of Cities of the South End of Santa Catarina - AMESC, associating it to the quality of care offered by the Family Health Program-PSF METHOD: An exploratory research with characteristics of an ecological study that qualified the primary care offered, based on a questionnaire directed to PSF professionals and information collected through national data information, defining two population groups: one assisted by services with a basic standard and another one assisted by services below this standard. Hospital admissions for some selected causes of these two populations were compared in the 1999-2004 period, analyzing their trend and statistical association. RESULTS: The statistical

  8. Ambulatory Melanoma Care Patterns in the United States

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    Andrew L. Ji


    Full Text Available Objective. To examine trends in melanoma visits in the ambulatory care setting. Methods. Data from the National Ambulatory Medical Care Survey (NAMCS from 1979 to 2010 were used to analyze melanoma visit characteristics including number of visits, age and gender of patients, and physician specialty. These data were compared to US Census population estimates during the same time period. Results. The overall rate of melanoma visits increased ( at an apparently higher rate than the increase in population over this time. The age of patients with melanoma visits increased at approximately double the rate (0.47 year per interval year, of the population increase in age (0.23 year per interval year. There was a nonsignificant decline in the proportion of female patients seen over the study interval. Lastly, ambulatory care has shifted towards dermatologists and other specialties managing melanoma patients and away from family/internal medicine physicians and general/plastic surgeons. Conclusions. The number and age of melanoma visits has increased over time with respect to the overall population, mirroring the increase in melanoma incidence over the past three decades. These trends highlight the need for further studies regarding melanoma management efficiency.

  9. Ambulatory Medical Care Utilization Estimates for 2007 (United States)

    ... Jennifer H. Madans, Ph.D., Associate Director for Science Division of Health Care Statistics Jane E. Sisk, Ph.D., Director Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... no 26. Hyattsville, MD: National Center for Health Statistics. 2010. 4. ... [computer software]. Research Triangle Park, NC: Research Triangle Institute. ...

  10. Regional variations in ambulatory care and incidence of cardiovascular events (United States)

    Tu, Jack V.; Chu, Anna; Maclagan, Laura; Austin, Peter C.; Johnston, Sharon; Ko, Dennis T.; Cheung, Ingrid; Atzema, Clare L.; Booth, Gillian L.; Bhatia, R. Sacha; Lee, Douglas S.; Jackevicius, Cynthia A.; Kapral, Moira K.; Tu, Karen; Wijeysundera, Harindra C.; Alter, David A.; Udell, Jacob A.; Manuel, Douglas G.; Mondal, Prosanta; Hogg, William


    BACKGROUND: Variations in the prevalence of traditional cardiac risk factors only partially account for geographic variations in the incidence of cardiovascular disease. We examined the extent to which preventive ambulatory health care services contribute to geographic variations in cardiovascular event rates. METHODS: We conducted a cohort study involving 5.5 million patients aged 40 to 79 years in Ontario, Canada, with no hospital stays for cardiovascular disease as of January 2008, through linkage of multiple population-based health databases. The primary outcome was the occurrence of a major cardiovascular event (myocardial infarction, stroke or cardiovascular-related death) over the following 5 years. We compared patient demographics, cardiac risk factors and ambulatory health care services across the province’s 14 health service regions, known as Local Health Integration Networks (LHINs), and evaluated the contribution of these variables to regional variations in cardiovascular event rates. RESULTS: Cardiovascular event rates across LHINs varied from 3.2 to 5.7 events per 1000 person-years. Compared with residents of high-rate LHINs, those of low-rate health regions received physician services more often (e.g., 4.2 v. 3.5 mean annual family physician visits, p value for LHIN-level trend = 0.01) and were screened for risk factors more often. Low-rate LHINs were also more likely to achieve treatment targets for hypercholes-terolemia (51.8% v. 49.6% of patients, p = 0.03) and controlled hypertension (67.4% v. 53.3%, p = 0.04). Differences in patient and health system factors accounted for 74.5% of the variation in events between LHINs, of which 15.5% was attributable to health system factors alone. INTERPRETATION: Preventive ambulatory health care services were provided more frequently in health regions with lower cardiovascular event rates. Health system interventions to improve equitable access to preventive care might improve cardiovascular outcomes. PMID

  11. Translating caring theory across the continuum from inpatient to ambulatory care. (United States)

    Tonges, Mary; McCann, Meghan; Strickler, Jeff


    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.

  12. A 2-wk reduction of ambulatory activity attenuates peripheral insulin sensitivity

    DEFF Research Database (Denmark)

    Krogh-Madsen, Rikke; Thyfault, John P; Broholm, Christa;


    US adults take between approximately 2,000 and approximately 12,000 steps per day, a wide range of ambulatory activity that at the low range could increase risk for developing chronic metabolic diseases. Dramatic reductions in physical activity induce insulin resistance; however, it is uncertain...... possible biological cause for the public health problem of Type 2 diabetes has been identified. Reduced ambulatory activity for 2 wk in healthy, nonexercising young men significantly reduced peripheral insulin sensitivity, cardiovascular fitness, and lean leg mass....... if and how low ambulatory activity would influence peripheral insulin sensitivity. We aimed to explore if healthy, nonexercising subjects who went from a normal to a low level of ambulatory activity for 2 wk would display metabolic alterations including reduced peripheral insulin sensitivity. To do this, ten...

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

    Directory of Open Access Journals (Sweden)

    Yvonne Ying Ru Ng


    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.

  14. Active ambulatory care management supported by short message services and mobile phone technology in patients with arterial hypertension. (United States)

    Kiselev, Anton R; Gridnev, Vladimir I; Shvartz, Vladimir A; Posnenkova, Olga M; Dovgalevsky, Pavel Ya


    The use of short message services and mobile phone technology for ambulatory care management is the most accessible and most inexpensive way to transition from traditional ambulatory care management to active ambulatory care management in patients with arterial hypertension (AH). The aim of this study was to compare the clinical efficacy of active ambulatory care management supported by short message services and mobile phone technology with traditional ambulatory care management in AH patients. The study included 97 hypertensive patients under active ambulatory care management and 102 patients under traditional ambulatory care management. Blood pressure levels, body mass, and smoking history of patients were analyzed in the study. The duration of study was 1 year. In the active ambulatory care management group, 36% of patients were withdrawn from the study within a year. At the end of the year, 77% of patients from the active care management group had achieved the goal blood pressure level. That was more than 5 times higher than that in the traditional ambulatory care management group (P mobile phone improves the quality of ambulatory care of hypertensive patients.

  15. Ibuprofen timing for hand surgery in ambulatory care (United States)

    Giuliani, Enrico; Bianchi, Anna; Marcuzzi, Augusto; Landi, Antonio; Barbieri, Alberto


    OBJECTIVE: To evaluate the effect of pre-operative administration of ibuprofen on post-operative pain control vs. early post-operative administration for hand surgery procedures performed under local anaesthesia in ambulatory care. METHODS: Candidates to trigger finger release by De Quervain tenosynovitis and carpal tunnel operation under local anesthesia were enrolled in the study. Group A received 400 mg ibuprofen before the operation and placebo after the procedure; group B received placebo before the operation and ibuprofen 400 mg at the end of the procedure; both groups received ibuprofen 400 mg every 6h thereafter. Visual analogue scale (VAS) was measured at fixed times before and every 6h after surgery, for a total follow-up of 18h. RESULTS: Groups were similar according to age, gender and type of surgery. Median VAS values did not produce any statistical significance, while there was a statistically significant difference on pre-operative and early post-operative VAS values between groups (A -8.53 mm vs. B 3.36 mm, p=0.0085). CONCLUSION: Average pain levels were well controlled by local anesthesia and post-operative ibuprofen analgesia. Pre-operative ibuprofen administration can contribute to improve early pain management. Level of Evidence II, Therapeutic Studies. PMID:26327799

  16. [Present and future ambulatory nursing care in Switzerland: what general practitioners should know]. (United States)

    Weber-Yaskevich, Olga; Reber, Alexandra; Gillabert, Cédric


    In response to the ambulatorization of medical care, the panel of ambulatory nursing medical care is operating important changes. Since 2011, "acute and transitional medical care" is being prescribed by hospital practitioners, implying a new definition of the nurse's profession. The consequence is more complex and more autonomous nursing care: an academic formation has been created for nurses (bachelor and master) and their assistants (healthcare and community assistants). The futur will probably be made of ambulatory case management by nurses (advanced nurse practictioner). General practictioners will not only collaborate with the nurses but also assign them with tasks handled until then by themselves, prescribing, among other things, domiciliary "long-term" medical care.

  17. Commentary on the required skills for ambulatory cardiac care in the young: is training necessary? (United States)

    Boris, Jeffrey R


    Extensive supplemental training exists for many subspecialty disciplines within fellowship training for paediatric cardiology in the United States of America. These disciplines, or domains, such as echocardiography, cardiac intensive care, interventional cardiology, and electrophysiology, allow for initial exposure and training during the basic 3 years of fellowship, plus mandate a 4th year of advanced training; however, ambulatory cardiology has no in-depth or additional training beyond the basic clinical exposure during fellowship training. Ambulatory cardiology is not included in the recommended scheduling of the various domains of cardiology training. This document reviews the reasons to consider augmenting the depth and breadth of training in ambulatory paediatric cardiology.

  18. Diagnosing malignant melanoma in ambulatory care: a systematic review of clinical prediction rules (United States)

    Harrington, Emma; Clyne, Barbara; Wesseling, Nieneke; Sandhu, Harkiran; Armstrong, Laura; Bennett, Holly; Fahey, Tom


    Objectives Malignant melanoma has high morbidity and mortality rates. Early diagnosis improves prognosis. Clinical prediction rules (CPRs) can be used to stratify patients with symptoms of suspected malignant melanoma to improve early diagnosis. We conducted a systematic review of CPRs for melanoma diagnosis in ambulatory care. Design Systematic review. Data sources A comprehensive search of PubMed, EMBASE, PROSPERO, CINAHL, the Cochrane Library and SCOPUS was conducted in May 2015, using combinations of keywords and medical subject headings (MeSH) terms. Study selection and data extraction Studies deriving and validating, validating or assessing the impact of a CPR for predicting melanoma diagnosis in ambulatory care were included. Data extraction and methodological quality assessment were guided by the CHARMS checklist. Results From 16 334 studies reviewed, 51 were included, validating the performance of 24 unique CPRs. Three impact analysis studies were identified. Five studies were set in primary care. The most commonly evaluated CPRs were the ABCD, more than one or uneven distribution of Colour, or a large (greater than 6 mm) Diameter (ABCD) dermoscopy rule (at a cut-point of >4.75; 8 studies; pooled sensitivity 0.85, 95% CI 0.73 to 0.93, specificity 0.72, 95% CI 0.65 to 0.78) and the 7-point dermoscopy checklist (at a cut-point of ≥1 recommending ruling in melanoma; 11 studies; pooled sensitivity 0.77, 95% CI 0.61 to 0.88, specificity 0.80, 95% CI 0.59 to 0.92). The methodological quality of studies varied. Conclusions At their recommended cut-points, the ABCD dermoscopy rule is more useful for ruling out melanoma than the 7-point dermoscopy checklist. A focus on impact analysis will help translate melanoma risk prediction rules into useful tools for clinical practice. PMID:28264830

  19. Exploring the link between ambulatory care and avoidable hospitalizations at the Veteran Health Administration. (United States)

    Pracht, Etienne E; Bass, Elizabeth


    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.

  20. A two-week reduction of ambulatory activity attenuates peripheral insulin sensitivity

    DEFF Research Database (Denmark)

    Krogh-Madsen, Rikke; Thyfault, John P; Broholm, Christa


    possible biological cause for the public health problem of type 2 diabetes has been identified. Reduced ambulatory activity for two weeks in healthy, non-exercising young men significantly reduced peripheral insulin sensitivity, cardiovascular fitness, and lean leg mass. Key words: Inactivity, Insulin...... activity would influence peripheral insulin sensitivity. We aimed to explore if healthy, non-exercising subjects who went from a normal to a low level of ambulatory activity for two weeks would display metabolic alterations including reduced peripheral insulin sensitivity. -To do this, ten healthy young...... after step reduction, with a post hoc analysis revealing the most pronounced effect after 4 h of insulin infusion. In addition, the two-week period induced a 7% decline in VO2max (ml/min; cardiovascular fitness). Lean mass of legs, but not arms and truck, decreased concurrently. Taken together, one...

  1. Process visibility analysis in ambulatory care: a simulation study with RFID data. (United States)

    Lin, Yi-Chin; Padman, Rema


    Healthcare is primarily delivered in the ambulatory care setting worldwide. The high variability in service delivery encountered in this environment negatively impacts process efficiency and patient satisfaction. In this study, we analyze care delivery process in ambulatory care using time and location stamped data collected via Radio Frequency Identification (RFID)-enabled badges worn by patients, clinicians, and staff as they complete each clinic visit. With the objective of improving process visibility and minimizing patient waiting time, we examine this data to delineate the major components of waiting time and use simulation modeling to evaluate the impact of possible interventions. Results indicate that as a prevalent strategy, different appointment scheduling rules can only reduce patient waiting time in the waiting room. Surprisingly, waiting time in the exam room is unchanged, requiring new approaches to improve care coordination that address this delay. The results also highlight the value of RFID technology and the challenges in deploying them to improve service delivery.

  2. Predictive value of ambulatory blood pressure shortly after withdrawal of antihypertensive drugs in primary care patients

    NARCIS (Netherlands)

    Beltman, FW; Heesen, WF; Smit, AJ; May, JF; deGraeff, PA; Havinga, TK; Schuurman, FH; vanderVeur, E; Lie, KI; MeyboomdeJong, B


    Objective-To determine whether ambulatory blood pressure eight weeks after withdrawal of antihypertensive medication is a more sensitive measure than seated blood pressure to predict blood pressure in the long term. Design-Patients with previously untreated diastolic hypertension were treated with a

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

    DEFF Research Database (Denmark)

    von Plessen, Christian; Aslaksen, Aslak


    PROBLEM: Most patients with advanced lung cancer currently receive much of their health care, including chemotherapy, as outpatients. Patients have to deal with the complex and time consuming logistics of ambulatory cancer care. At the same time, members of staff often waste considerable time......; satisfaction among patients. STRATEGIES FOR CHANGE: Rescheduled patients' appointments, automated retrieval of blood test results, systematic reporting in patients' files, design of an information leaflet, and refurnishing of the waiting area at the clinic. EFFECTS OF CHANGE: Interventions resulted...

  4. Ambulatory Care Visits to Pediatricians in Taiwan: A Nationwide Analysis

    Directory of Open Access Journals (Sweden)

    Ling-Yu Yang


    Full Text Available Pediatricians play a key role in the healthy development of children. Nevertheless, the practice patterns of pediatricians have seldom been investigated. The current study analyzed the nationwide profiles of ambulatory visits to pediatricians in Taiwan, using the National Health Insurance Research Database. From a dataset that was randomly sampled one out of every 500 records among a total of 309,880,000 visits in 2012 in the country, 9.8% (n = 60,717 of the visits were found paid to pediatricians. Children and adolescents accounted for only 69.3% of the visits to pediatricians. Male pediatricians provided 80.5% of the services and the main workforces were those aged 40–49 years. The most frequent diagnoses were respiratory tract diseases (64.7% and anti-histamine agents were prescribed in 48.8% of the visits to pediatricians. Our detailed results could contribute to evidence-based discussions on health policymaking.

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

    Directory of Open Access Journals (Sweden)

    Sen S


    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.

  6. Outcomes assessment of a pharmacist-directed seamless care program in an ambulatory oncology clinic. (United States)

    Edwards, Scott J; Abbott, Rick; Edwards, Jonathan; LeBlanc, Michael; Dranitsaris, George; Donnan, Jennifer; Laing, Kara; Whelan, Maria A; MacKinnon, Neil J


    The primary goal of seamless care is improved patient outcomes and improved standards of care for patients with cancer. The pharmacy service of the Newfoundland Cancer Treatment and Research Foundation conducted a randomized control study that measured clinical and humanistic outcomes of a pharmacist-directed seamless care program in an ambulatory oncology clinic. This article focuses on the intervention group, particularly the identification of drug-related problems (DRPs) and utilization of health care services as well the satisfaction of 3 types of health professionals with the services provided by the pharmacist-directed seamless care program. Overall, the seamless care pharmacist (SCP) identified an average of 3.7 DRPs per intervention patient; the most common DRP reported was a patient not receiving or taking a drug therapy for which there is an indication. The SCP identified more DRPs in patients receiving adjuvant treatment compared to those receiving palliative treatment. On average, family physicians, oncology nurses, and hospital pharmacists were satisfied with the SCP intervention indicating that they agreed the information collected and distributed by the SCP was useful to them. Pharmacist-directed seamless care services in an ambulatory oncology clinic have a significant impact on clinical outcomes and processes of patient care. The presence of a SCP can help identify and resolve DRPs experienced by patients in an outpatient oncology clinic, ensuring that patients are receiving the highest standard of care.

  7. Marketing ambulatory care to women: a segmentation approach. (United States)

    Harrell, G D; Fors, M F


    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.

  8. The predictive value of selected job rewards on occupational therapists' job satisfaction in ambulatory care settings. (United States)

    Painter, J; Akroyd, D; Wilson, S; Figuers, C


    Using a perceived reward model of overall job satisfaction, this study utilized a correlational research design with multiple regression analysis to determine the predictive power of extrinsic rewards and intrinsic rewards, collectively and individually, as determinants of overall job satisfaction among registered occupational therapists (OTR) working full-time in ambulatory care settings. The intrinsic rewards (task involvement and task autonomy), collectively and individually, were perceived to be significant overall job satisfaction determinants. General working conditions was the only significant extrinsic reward. Given the demand for OTRs in ambulatory care settings, a better understanding of factors that influence overall job satisfaction among OTRs could prove beneficial in developing appropriate recruitment and retention job design strategies.

  9. Manager's leadership is the main skill for ambulatory health care plan success. (United States)

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


    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.

  10. Strengthening the Effectiveness of State-Level Community Health Worker Initiatives Through Ambulatory Care Partnerships (United States)

    Allen, Caitlin; Nell Brownstein, J.; Jayapaul-Philip, Bina; Matos, Sergio; Mirambeau, Alberta


    The transformation of the US health care system and the recognition of the effectiveness of community health workers (CHWs) have accelerated national, state, and local efforts to engage CHWs in the support of vulnerable populations. Much can be learned about how to successfully integrate CHWs into health care teams, how to maximize their impact on chronic disease self-management, and how to strengthen their role as emissaries between clinical services and community resources; we share examples of effective strategies. Ambulatory care staff members are key partners in statewide initiatives to build and sustain the CHW workforce and reduce health disparities. PMID:26049655

  11. Experts Foresee a Major Shift From Inpatient to Ambulatory Care


    Beans, Bruce E.


    An American Society of Health-System Pharmacists Research and Education Foundation report predicts trends in health care delivery and financing, drug development and therapeutics, pharmaceutical marketplace, pharmacy workforce, and more.

  12. [Management and organization of ambulatory medical care in a district]. (United States)

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


    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.

  13. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings. (United States)

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


    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.

  14. Prescribing quality indicators of type 2 diabetes mellitus ambulatory care

    NARCIS (Netherlands)

    Martirosyan, L.; Braspenning, J.; Denig, P.; de Grauw, W. J. C.; Bouma, M.; Storms, F.; Haaijer-Ruskamp, F. M.


    Background: Existing performance indicators for assessing quality of care in type 2 diabetes mellitus (T2DM) focus mostly on registration of measurements and clinical outcomes, and not on quality of prescribing. Objective: To develop a set of valid prescribing quality indicators (PQI) for internal u

  15. Evaluation of The Products of Ambulatory Care and Products of Ambulatory Surgery Classification System For the Military Health Care System. (United States)


    98.97 IV Problem 13 24 Diagnostic Investigation with 21 .27 99.24 Nuclear or Computerized Axial Tomgrpy Imaging 14 2 Annual Well Care Examination, Child...720 7209 Spondylitis , Inflammatory, Unspec 72101 7210 Spondylosis, Cervical W/O Myelopathy 72131 7213 Spondylosis, Lumbosacral 7219 72190 Spondylosis

  16. [The social hygienic assessment of significance of diseases under organization of ambulatory polyclinic care]. (United States)

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


    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.

  17. Daily Energy Expenditure and Its Relation to Health Care Costs in Patients Undergoing Ambulatory Electrocardiographic Monitoring. (United States)

    George, Jason; Abdulla, Rami Khoury; Yeow, Raymond; Aggarwal, Anshul; Boura, Judith; Wegner, James; Franklin, Barry A


    Our increasingly sedentary lifestyle is associated with a heightened risk of obesity, diabetes, heart disease, and cardiovascular mortality. Using the recently developed heart rate index formula in 843 patients (mean ± SD age 62.3 ± 15.7 years) who underwent 24-hour ambulatory electrocardiographic (ECG) monitoring, we estimated average and peak daily energy expenditure, expressed as metabolic equivalents (METs), and related these data to subsequent hospital encounters and health care costs. In this cohort, estimated daily average and peak METs were 1.7 ± 0.7 and 5.5 ± 2.1, respectively. Patients who achieved daily bouts of peak energy expenditure ≥5 METs had fewer hospital encounters (p = 0.006) and median health care costs that were nearly 50% lower (p health care costs depending on whether they achieved monitoring (p = 0.005). Interestingly, patients who achieved ≥5 METs had lower and no significant difference in their health care costs, regardless of their body mass index (p = 0.46). Patients with previous percutaneous coronary intervention who achieved ≥5 METs had lower health care costs (p = 0.044) and fewer hospital encounters (p = 0.004) than those who achieved monitoring may provide useful information regarding health care utilization in patients with and without previous percutaneous coronary intervention, irrespective of body habitus. Our findings are the first to link lower intensities of peak daily energy expenditure, estimated from ambulatory ECG monitoring, with increased health care utilization.

  18. Identifying consumer segments in health services markets: an application of conjoint and cluster analyses to the ambulatory care pharmacy market. (United States)

    Carrol, N V; Gagon, J P


    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.

  19. 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


    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

  20. Impaired baroreflex sensitivity and the risks of new-onset ambulatory hypertension, in an elderly population-based study

    NARCIS (Netherlands)

    Dauphinot, Virginie; Kossovsky, Michel P.; Gueyffier, Francois; Pichot, Vincent; Gosse, Philippe; Roche, Frederic; Barthelemy, Jean-Claude


    / Background: Impairment of the autonomic nervous system activity may be involved in the development of hypertension. Yet the prognostic values of heart rate variability and baroreflex sensitivity in the risk of new-onset ambulatory hypertension have not been investigated. We sought to assess the re

  1. Marketing strategy adjustments in the ambulatory care center industry: implications for community pharmacy. (United States)

    Phillips, J H


    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.

  2. 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


    .4%; range 22.2-69.8%). Failure to prescribe prophylaxis to patients taking nonsteroidal antiinflammatory drugs or antiplatelet drugs frequently caused gastrointestinal toxicity, whereas lack of monitoring of diuretic, hypoglycemic, and anticoagulant use caused over- or under-diuresis, hyper- or hypoglycemia......-months. Cardiovascular drugs, analgesics, and hypoglycemic agents together accounted for 86.5% of pADEs, and 77.2% of pADEs resulted in symptoms of the central nervous system, electrolyte/renal system, and gastrointestinal tract. Medication errors resulting in pADEs occurred in the prescribing and monitoring stages......, and bleeding. CONCLUSIONS: ADEs in ambulatory care are common, with many being preventable and many resulting in hospitalization. Quality improvement programs should target errors in prescribing and monitoring, especially for patients using cardiovascular, analgesic, and hypoglycemic agents....


    Directory of Open Access Journals (Sweden)

    Javier Cruz Rodríguez


    Full Text Available Currently, there are constraints on coordination between the primary and secondary levels of care, and we lack a regulatory document for surgical activity in major ambulatory and short-stay surgery, which affects the quality of this modality of care. Such reasons led to the design of the “Organization and Procedures Guide for Performing Major Ambulatory and Short-stay Surgery in Coordination with the Primary Health Care Team". The guide was assessed by 90 experts with experience in the primary and secondary levels of care, who endorsed the quality and relevance of the proposal. It contains recommendations to help primary and secondary care professionals involved in surgical care to select the most appropriate approach to conditions treated by means of ambulatory or short-stay surgery. The recommendations are based on the latest available scientific evidence supporting the use of ambulatory surgery, short-stay surgery and home hospitalization.

  4. National Ambulatory Medical Care Survey: tobacco intervention practices in outpatient clinics. (United States)

    Payne, Thomas J; Chen, Chieh-I; Baker, Christine L; Shah, Sonali N; Pashos, Chris L; Boulanger, Luke


    Tobacco use remains the leading cause of preventable death. The outpatient medical clinic represents an important venue for delivering evidence-based interventions to large numbers of tobacco users. Extensive evidence supports the effectiveness of brief interventions. In a retrospective database analysis of 11,827 adult patients captured in the 2005 National Ambulatory Medical Care Survey (of which 2,420 were tobacco users), we examined the degree to which a variety of patient demographic, clinical and physician-related variables predict the delivery of tobacco counseling during a routine outpatient visit in primary care settings. In 2005, 21.7% of identified tobacco users received a tobacco intervention during their visit. The probability of receiving an intervention differed by gender, geographic region and source of payment. Individuals presenting with tobacco-related health conditions were more likely to receive an intervention. Most physicians classified as specialists were less likely to intervene. The provision of tobacco intervention services appears to be increasing at a modest rate, but remains well below desirable levels. It is a priority that brief interventions be routinely implemented to reduce the societal burden of tobacco use.

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

    Directory of Open Access Journals (Sweden)

    Quan Sherman


    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 (ID: NCT00252395

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

    Carel, R S


    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 patient perceptions and outcomes related to anticoagulation point-of-care testing in ambulatory care clinics

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    Fermo JD


    Full Text Available Until recently, Prothrombin Time/International Normalized Ratio (PT/INR measurements have typically been used to monitor patients on warfarin through institutional laboratories via venous puncture. The Point-of-Care Testing (POCT device has revolutionized the patient care process by allowing for laboratory testing outside of the central laboratory. Objective: To analyze humanistic and clinical outcomes in patients currently treated with warfarin and monitored through a pharmacist-managed anticoagulation clinic using point-of-care testing (POCT device versus venipuncture within ambulatory care clinics at our institution. Methods: All patients currently treated with warfarin therapy who were managed by clinical pharmacists for anticoagulation monitoring at the Medical University of South Carolina (MUSC Family Medicine Center and University Diagnostic Center, were enrolled. Patients were asked to complete a satisfaction survey regarding their anticoagulation monitoring. In addition, data related to emergency department (ED visits, hospitalizations and percent of time in the INR therapeutic range for 6 months pre- and post-implementation of POCT device was collected. This information was obtained through an electronic patient information database, Oacis. Results: A total of 145 patients were included in the data collection from the two clinics. The majority (41% of these patients were taking warfarin for atrial fibrillation. Satisfaction surveys were completed by 86 (59 % of patients. The surveys revealed that POCT device was preferred over venipuncture in 95% of patients. Reasons for the preference included more face-to-face interaction, less wait time, less pain, less blood needed, and quicker results. Of the 145 patients who were included in the objective data analysis, no significant differences were found in the number of hospitalizations, ED visits, or percent of time in the INR therapeutic range pre- and post- implementation of POCT device

  8. Potential collaboration with the private sector for the provision of ambulatory care in the Mekong region, Vietnam (United States)

    Duc, Ha Anh; Sabin, Lora L.; Cuong, Le Quang; Thien, Duong Duc; Feeley, Rich


    Background Over the past two decades, health insurance in Vietnam has expanded nationwide. Concurrently, Vietnam's private health sector has developed rapidly and become an increasingly integral part of the health system. To date, however, little is understood regarding the potential for expanding public-private partnerships to improve health care access and outcomes in Vietnam. Objective To explore possibilities for public-private collaboration in the provision of ambulatory care at the primary level in the Mekong region, Vietnam. Design We employed a mixed methods research approach. Qualitative methods included focus group discussions with health officials and in-depth interviews with managers of private health facilities. Quantitative methods encompassed facility assessments, and exit surveys of clients at the same private facilities. Results Discussions with health officials indicated generally favorable attitudes towards partnerships with private providers. Concerns were also voiced, regarding the over- and irrational use of antibiotics, and in terms of limited capacity for regulation, monitoring, and quality assurance. Private facility managers expressed a willingness to collaborate in the provision of ambulatory care, and private providers facilites were relatively well staffed and equipped. The client surveys indicated that 80% of clients first sought treatment at a private facility, even though most lived closer to a public provider. This choice was motivated mainly by perceptions of quality of care. Clients who reported seeking care at both a public and private facility were more satisfied with the latter. Conclusions Public-private collaboration in the provision of ambulatory care at the primary level in Vietnam has substantial potential for improving access to quality services. We recommend that such collaboration be explored by Vietnamese policy-makers. If implemented, we strongly urge attention to effectively managing such partnerships, establishing a

  9. Potential collaboration with the private sector for the provision of ambulatory care in the Mekong region, Vietnam

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    Ha Anh Duc


    Full Text Available Background: Over the past two decades, health insurance in Vietnam has expanded nationwide. Concurrently, Vietnam's private health sector has developed rapidly and become an increasingly integral part of the health system. To date, however, little is understood regarding the potential for expanding public-private partnerships to improve health care access and outcomes in Vietnam. Objective: To explore possibilities for public-private collaboration in the provision of ambulatory care at the primary level in the Mekong region, Vietnam. Design: We employed a mixed methods research approach. Qualitative methods included focus group discussions with health officials and in-depth interviews with managers of private health facilities. Quantitative methods encompassed facility assessments, and exit surveys of clients at the same private facilities. Results: Discussions with health officials indicated generally favorable attitudes towards partnerships with private providers. Concerns were also voiced, regarding the over- and irrational use of antibiotics, and in terms of limited capacity for regulation, monitoring, and quality assurance. Private facility managers expressed a willingness to collaborate in the provision of ambulatory care, and private providers facilites were relatively well staffed and equipped. The client surveys indicated that 80% of clients first sought treatment at a private facility, even though most lived closer to a public provider. This choice was motivated mainly by perceptions of quality of care. Clients who reported seeking care at both a public and private facility were more satisfied with the latter. Conclusions: Public-private collaboration in the provision of ambulatory care at the primary level in Vietnam has substantial potential for improving access to quality services. We recommend that such collaboration be explored by Vietnamese policy-makers. If implemented, we strongly urge attention to effectively managing such

  10. Finding falls in ambulatory care clinical documents using statistical text mining (United States)

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


    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

  11. Charging for Ambulatory Care in Military Health Care Facilities: An Evaluation and Analysis (United States)


    health care facilities, with resulting income used to subsidize CHAMPUS. This proposal, calling for $5.00 per visit as submitted by Senator Daniel...Analysis of Current Methods and Their Development," Inquiry, 16, Fall 1979, 230-246. 32 Jack Hadley, John Holahan , and William Scanlon, "Can Fee-for...other) were combined into a single category called "commercial insurance". An additional category, "Do Not Know", was added to reflect those

  12. Ambulatory Surgical Measures - National (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...

  13. Ambulatory Surgical Measures - Facility (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...

  14. Programa Saúde da Família e condições sensíveis à atenção primária, Bagé (RS Programa Salud de la Familia y condiciones sensibles a la atención primaria, Sur de Brasil Family Health Program and ambulatory care-sensitive conditions in Southern Brazil

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    Fúlvio Borges Nedel


    familia, ser usuaria del Programa Salud de la Familia, consulta médica en la emergencia en el mes anterior a la investigación y hospital de internación; b hombres: rango de edad, haber sufrido otra internación en el año anterior a la entrevista y el hospital de internación. CONCLUSIONES: Las condiciones sensibles a la atención primaria permiten identificar grupos carentes de atención a la salud adecuada. A pesar de que el estudio no permita hacer inferencias sobre el riesgo de internación, los análisis por sexo y modelo de atención sugieren que el programa Salud de la Familia es más equitativo que la atención básica tradicional.OBJECTIVE: Ambulatory care-sensitive conditions (ACSC are health problems managed by actions at the first level of care. The need for hospitalization by these causes is avoidable through an effective and proper primary health care. The objective of the study was to estimate ACSC among patients hospitalized by the Sistema Único de Saúde (Brazilian Health System. METHODS: Hospital-based cross-sectional study involving 1,200 inhabitants of Bagé (Southern Brazil who were inpatients between September/2006 and January/2007. The patients answered a questionnaire applied by interviewers and were classified according to the model of attention utilized prior to hospitalization. ACSC were defined in a workshop promoted by the Ministry of Health. The variables analyzed included demographic and socioeconomic characteristics, health and health services utilized. Multivariate analysis was conducted by the Poisson model, according to a hierarchical conceptual framework, stratified by sex and model of care. RESULTS: ACSC accounted for 42.6% of the hospitalizations. The probability that the main diagnosis for hospitalization is considered an ACSC is greater among women, children under five years of age, individuals with less then five years of schooling, hospitalization in the year prior to the interview, emergency room consultation, and being an

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

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    Fernando Nobre


    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.

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

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    Ann M. Fugit, Pharm.D., BCPS


    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.

  17. Redução das internações por condições sensíveis à atenção primária no Brasil entre 1998-2009 Reducción de las internaciones por condiciones susceptibles a atención primaria en Brasil entre 1998-2009 Reduction of ambulatory care sensitive conditions in Brazil between 1998 and 2009

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    Antonio Fernando Boing


    temporales con datos secundarios relacionados con las Internaciones Hospitalarias por condiciones susceptibles a atención primaria en el Sistema Único de Salud de Brasil. Los datos fueron obtenidos del Sistema de Informaciones Hospitalarias. Las tasas de internaciones por 10.000 habitantes fueron estandarizadas por grupo etario y sexo, considerando la población brasileña masculina recensada en 2000 como patrón. El análisis de tendencia de la serie histórica fue realizado por regresión linear generalizado por el método de Prais-Winsten. RESULTADOS: Hubo reducción en el promedio anual de internaciones por condiciones susceptibles a atención primaria de 3,7% entre hombres (IC95% -2,3;-5,1 y mujeres (IC95% -2,5;-5,6 entre 1998 y 2009. La tendencia varió en cada unidad federativa, sin embargo, en ninguna hubo aumento de las internaciones. En el sexo masculino y femenino las mayores reducciones fueron observadas en las internaciones por úlceras gastrointestinales (-11,7% al año y -12,1%, respectivamente, condiciones evitables (-8,8% y -8,9% y enfermedades de las vías aéreas inferiores (-8,0% y -8,1%. Angina (hombres, infección en el riñón y tracto urinario (hombres y mujeres y condiciones relacionados al prenatal y parto (mujeres presentaron aumento en las internaciones. Los tres grupos de enfermedades que más ocasionaron internaciones fueron gastroenteritis infecciosas y complicaciones, internaciones por insuficiencia cardíaca y asma. CONCLUSIONES: Hubo reducción sustancial en las internaciones por condiciones susceptibles a atención primaria en Brasil entre 1998 y 2009, sin embargo, algunas enfermedades presentaron estabilidad o aumento, exigiendo atención del sector salud.OBJECTIVE: To describe the trends in hospitalizations for ambulatory care sensitive conditions between 1998 and 2009 in Brazil. METHODS: The ecological time series study used secondary data on hospitalizations for ACSC in the Sistema Único de Saúde (SUS, National Unified Health System

  18. The Association Between Internet Use and Ambulatory Care-Seeking Behaviors in Taiwan: A Cross-Sectional Study (United States)

    Chen, Tsung-Fu; Liang, Jyh-Chong; Lin, Tzu-Bin; Tsai, Chin-Chung


    Background Compared with the traditional ways of gaining health-related information from newspapers, magazines, radio, and television, the Internet is inexpensive, accessible, and conveys diverse opinions. Several studies on how increasing Internet use affected outpatient clinic visits were inconclusive. Objective The objective of this study was to examine the role of Internet use on ambulatory care-seeking behaviors as indicated by the number of outpatient clinic visits after adjusting for confounding variables. Methods We conducted this study using a sample randomly selected from the general population in Taiwan. To handle the missing data, we built a multivariate logistic regression model for propensity score matching using age and sex as the independent variables. The questionnaires with no missing data were then included in a multivariate linear regression model for examining the association between Internet use and outpatient clinic visits. Results We included a sample of 293 participants who answered the questionnaire with no missing data in the multivariate linear regression model. We found that Internet use was significantly associated with more outpatient clinic visits (P=.04). The participants with chronic diseases tended to make more outpatient clinic visits (P<.01). Conclusions The inconsistent quality of health-related information obtained from the Internet may be associated with patients’ increasing need for interpreting and discussing the information with health care professionals, thus resulting in an increasing number of outpatient clinic visits. In addition, the media literacy of Web-based health-related information seekers may also affect their ambulatory care-seeking behaviors, such as outpatient clinic visits. PMID:27927606

  19. Non-EEG based ambulatory seizure detection designed for home use : What is available and how will it influence epilepsy care?

    NARCIS (Netherlands)

    van Andel, Judith; Thijs, Roland D.; de Weerd, Al; Arends, Johan; Leijten, Frans


    OBJECTIVE: This study aimed to (1) evaluate available systems and algorithms for ambulatory automatic seizure detection and (2) discuss benefits and disadvantages of seizure detection in epilepsy care. METHODS: PubMed and EMBASE were searched up to November 2014, using variations and synonyms of sea

  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

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    Mansfield Richard J


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

  1. Factors associated with health information exchange system usage in a safety-net ambulatory care clinic setting. (United States)

    Vest, Joshua R; Gamm, Larry D; Ohsfeldt, Robert L; Zhao, Hongwei; Jasperson, 'Jon Sean


    The Meaningful Use criteria promises to make health information exchange (HIE) much more widespread. However, the usage of the information systems made available by existing HIE efforts tends to be very low. This study sought to examine the factors associated with usage of an operational HIE system during ambulatory care visits to safety-net clinics. Overall the HIE system was accessed for 21% of encounters. However, system access took on two distinct forms. In general, usage was more likely for patients with recent emergency department visits and chronic conditions. This study indicates the organizational commitment to engage in HIE does not necessarily mean that the information systems will be always used. In addition, system usage will take on various forms for different reasons. These results reveal considerations for the development, operation and evaluation of HIE efforts.

  2. Hotel-based ambulatory care for complex cancer patients: a review of the University College London Hospital experience. (United States)

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


    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.

  3. Designing robots for care: care centered value-sensitive design. (United States)

    van Wynsberghe, Aimee


    The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship--what I refer to as care robots--require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What's more, given the stage of their development and lack of standards provided by the International Organization for Standardization to guide their development, ethics ought to be included into the design process of such robots. The manner in which this may be accomplished, as presented here, uses the blueprint of the Value-sensitive design approach as a means for creating a framework tailored to care contexts. Using care values as the foundational values to be integrated into a technology and using the elements in care, from the care ethics perspective, as the normative criteria, the resulting approach may be referred to as care centered value-sensitive design. The framework proposed here allows for the ethical evaluation of care robots both retrospectively and prospectively. By evaluating care robots in this way, we may ultimately ask what kind of care we, as a society, want to provide in the future.

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

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    Parvizi MM


    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

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

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    Claybon Louis


    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

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

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


    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

  7. Quality of care in sickle cell disease: Cross-sectional study and development of a measure for adults reporting on ambulatory and emergency department care. (United States)

    Evensen, Christian T; Treadwell, Marsha J; Keller, San; Levine, Roger; Hassell, Kathryn L; Werner, Ellen M; Smith, Wally R


    Documented deficiencies in adult sickle cell disease (SCD) care include poor access to knowledgeable providers and inadequate treatment in emergency departments (EDs).The aim of this study was to create patient-reported outcome measures of the quality of ambulatory and ED care for adults with SCD.We developed and pilot tested SCD quality of care questions consistent with Consumer Assessments of Healthcare Providers and Systems surveys. We applied psychometric methods to develop scores and evaluate reliability and validity.The participants of this study were adults with SCD (n = 556)-63% aged 18 to 34 years; 64% female; 64% SCD-SS-at 7 US sites.The measure used was Adult Sickle Cell Quality of Life Measurement information system Quality of Care survey.Most participants (90%) reported at least 1 severe pain episode (pain intensity 7.8 ± 2.3, 0-10 scale) in the past year. Most (81%) chose to manage pain at home rather than the ED, citing negative ED experiences (83%). Using factor analysis, we identified Access, Provider Interaction, and ED Care composites with reliable scores (Cronbach α 0.70-0.83) and construct validity (r = 0.32-0.83 correlations with global care ratings). Compared to general adult Consumer Assessments of Healthcare Providers and Systems scores, adults with SCD had worse care, adjusted for age, education, and general health.Results were consistent with other research reflecting deficiencies in ED care for adults with SCD. The Adult Sickle Cell Quality of Life Measurement Quality of Care measure is a useful self-report measure for documenting and tracking disparities in quality of SCD care.

  8. Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency's ambulatory care unit through simulation. (United States)

    Santibáñez, Pablo; Chow, Vincent S; French, John; Puterman, Martin L; Tyldesley, Scott


    We consider an ambulatory care unit (ACU) in a large cancer centre, where operational and resource utilization challenges led to overcrowding, excessive delays, and concerns regarding safety of critical patient care duties. We use simulation to analyze the simultaneous impact of operations, scheduling, and resource allocation on patient wait time, clinic overtime, and resource utilization. The impact of these factors has been studied before, but usually in isolation. Further, our model considers multiple clinics operating concurrently, and includes the extra burden of training residents and medical students during patient consults. Through scenario analyses we found that the best outcomes were obtained when not one but multiple changes were implemented simultaneously. We developed configurations that achieve a reduction of up to 70% in patient wait times and 25% in physical space requirements, with the same appointment volume. The key findings of the study are the importance of on time clinic start, the need for improved patient scheduling; and the potential improvements from allocating examination rooms flexibly and dynamically among individual clinics within each of the oncology programs. These findings are currently being evaluated for implementation by senior management.

  9. 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


    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.

  10. 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


    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

  11. Development and Evaluation of CAHPS® Questions to Assess the Impact of Health Information Technology on Patient Experiences with Ambulatory Care (United States)

    McInnes, D. Keith; Brown, Julie A.; Hays, Ron D.; Gallagher, Patricia; Ralston, James D.; Hugh, Mildred; Kanter, Michael; Serrato, Carl A.; Cosenza, Carol; Halamka, John; Ding, Lin; Cleary, Paul D.


    Background Little is known about whether health information technology (HIT) affects patient experiences with health care. Objective To develop HIT questions that assess patients care experiences not evaluated by existing ambulatory CAHPS measures. Research Design We reviewed published articles and conducted focus groups and cognitive testing to develop survey questions. We collected data, using mail and the internet, from patients of 69 physicians receiving care at an academic medical center and two regional integrated delivery systems in late 2009 and 2010. We evaluated questions and scales about HIT using factor analysis, item-scale correlations, and reliability (internal consistency and physician-level) estimates. Results We found support for three HIT composites: doctor use of computer (2 items), e-mail (2 items), and helpfulness of provider’s website (4 items). Corrected item-scale correlations were 0.37 for the two doctor use of computer items and 0.71 for the two e-mail items, and ranged from 0.50 to 0.60 for the provider’s website items. Cronbach’s alpha was high for e-mail (0.83) and provider’s website (0.75), but only 0.54 for doctor use of computer. As few as 50 responses per physician would yield reliability of 0.70 for e-mail and provider’s website. Two HIT composites, doctor use of computer (p<0.001) and provider’s website (p=0.02), were independent predictors of overall ratings of doctors. Conclusions New CAHPS HIT items were identified that measure aspects of patient experiences not assessed by the CAHPS C&G 1.0 survey. PMID:23064271

  12. Surgical Site Infections Following Pediatric Ambulatory Surgery: An Epidemiologic Analysis. (United States)

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


    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.

  13. Designing Robots for Care: Care Centered Value-Sensitive Design



    The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vulnerable and sensitive time in their lives. The ethical evaluation of care robots requires insight into the values at stake in the healthcare tradition. What’s more, given the stage of their develo...

  14. Impact of Safety-Related Regulatory Action on Drug Use in Ambulatory Care in the Netherlands

    NARCIS (Netherlands)

    Piening, S.; Reber, K. C.; Wieringa, J. E.; Straus, S. M. J. M.; de Graeff, P. A.; Haaijer-Ruskamp, F. M.; Mol, P. G. M.


    The effect of Direct Healthcare Professional Communications (DHPCs) informing health-care providers of serious drug safety issues has been questioned. The aim of this study was to evaluate the impact of DHPCs on drug use. Nationwide dispensing data for the period 2000-2008 for new users of 46 drugs

  15. A Break-Even Analysis of Optimum Faculty Assignment for Ambulatory Primary Care Training. (United States)

    Xakellis, George C.; And Others


    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…

  16. 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. (United States)

    Bilcke, Joke; Coenen, Samuel; Beutels, Philippe


    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.

  17. Sensitive hospitalizations to primary care and care in the health care network

    Directory of Open Access Journals (Sweden)

    Pollyanna Kássia de Oliveira Borges


    Full Text Available Objective: to check the profile of sensitive causes hospitalizations for primary care. Methods: this is an ecological, epidemiological study. Data was collected in the Hospital Information System at the Department of Health System Information, grouped according to the admissions list for Sensitive to Primary Causes of Health System. Results: there were 227,014 hospitalizations, 25.8% of them were sensitive to Primary care. The illnesses which caused sensitive admissions were pneumonia (n=19,832; 33.7%, heart failure (n=6,688, 11.3%, and gastroenteritis (n=6,287, 10.7%. Conclusion: sensitive hospitalizations for primary care have decreasing historical trend in the study area. Primary care services, with guidelines and principles, well conducted could minimize the risk of exacerbation of chronic conditions and also endorse lower rates of infection transmitted diseases.

  18. Society for Ambulatory Anesthesia (United States)

    ... We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, encourages research ... 6620 | E-mail: Copyright | 2016 Society for Ambulatory Anesthesia Home | Search | Terms | Privacy Policy | ...

  19. Brand name and generic proton pump inhibitor prescriptions in the United States: insights from the national ambulatory medical care survey (2006-2010). (United States)

    Gawron, Andrew J; Feinglass, Joseph; Pandolfino, John E; Tan, Bruce K; Bove, Michiel J; Shintani-Smith, Stephanie


    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 HMO visits

  20. "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

  1. PS1-10: How Can the Same Practice Be Classified as Having 2 and 900 MDs? NAMCS Data Collection in a Changing Ambulatory Care Environment (United States)

    Halley, Meghan; Gillespie, Katherine; Rendle, Katharine; Luft, Harold


    Background/Aims Since 1973, the National Ambulatory Medical Care Survey (NAMCS), administered by the National Center for Health Statistics (NCHS) has been widely used in studies of ambulatory care. With the growth in large multispecialty practices – including many members of the HMORN – there is a need to understand how NAMCS data are collected and whether current processes yield accurate and reliable data. NAMCS collects data from physicians about their practices and abstracts a sample of patient visit records. This study reports on the physician component. Methods In collaboration with NCHS, nine physicians were randomly sampled from a multispecialty clinic using standard NAMCS recruitment procedures; eight physicians were eligible and agreed to participate. Using their standard protocols, three Field Representatives (FRs) conducted NAMCS physician interviews while a trained ethnographer (MH, KR) observed and audio-recorded each interview. Transcripts and field notes were analyzed using a grounded theory approach to identify key themes. Results Data have been collected and analyzed. They are currently undergoing standard confidentiality review by NCHS. However, this process has been delayed due to the government shutdown. We fully anticipate that results will be released in time for presentation at the HMORN conference. Conclusions Though we are precluded from disseminating results at this time, we will provide a full report of our results in our HMORN conference presentation.

  2. Optimizing anesthesia techniques in the ambulatory setting

    NARCIS (Netherlands)

    E. Galvin


    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

  3. Depression and risk of hospitalisations and rehospitalisations for ambulatory care-sensitive conditions in Denmark

    DEFF Research Database (Denmark)

    Davydow, Dimitry S; Fenger-Grøn, Morten; Ribe, Anette Riisgaard;


    , at risikoen for indlæggelse var 2,35 gange højere hos danskere med depression. Forskerne har set på de såkaldte preventable hospitalizations – altså indlæggelser, som måske kunne være undgået, hvis forebyggelse og behandling havde fungeret optimalt, herunder at patienten havde fulgt lægens anvisninger......Dette studie viser, at danskere med depression oftere end andre bliver hospitalsindlagt for kroniske sygdomme, som måske godt kunne være behandlet i det nære sundhedsvæsen uden indlæggelse. Den samme gruppe har også en højere risiko for at blive genindlagt inden for 30 dage. Resultaterne viser...

  4. The Effect of Mobile App Follow-up Care on the Number of In-person Visits Following Ambulatory Surgery: A Randomized Control Trial. (United States)

    Armstrong, Kathleen; Coyte, Peter; Semple, John


    Women's College Hospital (WCH) in Toronto offers specialized ambulatory surgical procedures. A feasibility study using a mobile appliciation (app) to supplement in-person follow-up care after surgery suggests that the mobile app adequately detects postoperative complications, eliminates the need for in-person follow-up care and is cost-effective. This is concordant with other postoperative telemedicine studies. The purpose of this study is to determine if we can avert in-person follow-up care through the use of mobile app compared to conventional, in-person follow-up care in the first month following surgery amongst breast reconstruction patients at WCH. This will be a pragmatic, single-centre, open, controlled, 2-arm parallel-group superiority randomized trial. Mobile app follow-up care is a novel approach to managing patients postoperatively with the potential to avert in-person follow-up and generate cost-savings for the healthcare system and patient.

  5. Culturally Sensitive Health Care and Counseling Psychology: An Overview (United States)

    Herman, Keith C.; Tucker, Carolyn M.; Ferdinand, Lisa A.; Mirsu-Paun, Anca; Hasan, Nadia T.; Beato, Cristina


    This article introduces the Major Contribution, which focuses on counseling psychologists' roles in addressing health disparities through culturally sensitive health care research and interventions. First, the authors provide a rationale for conducting research focused on culturally sensitive health care and then offer definitions of…

  6. [A guide to good practice for information security in the handling of personal health data by health personnel in ambulatory care facilities]. (United States)

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


    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.

  7. 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


    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.

  8. Ambulatory spine surgery: a survey study. (United States)

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


    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.

  9. Designing Robots for Care: Care Centered Value-Sensitive Design

    NARCIS (Netherlands)

    Wynsberghe, van A.


    The prospective robots in healthcare intended to be included within the conclave of the nurse-patient relationship—what I refer to as care robots—require rigorous ethical reflection to ensure their design and introduction do not impede the promotion of values and the dignity of patients at such a vu

  10. Screening for High Blood Pressure in Adults During Ambulatory Nonprimary Care Visits: Opportunities to Improve Hypertension Recognition. (United States)

    Handler, Joel; Mohan, Yasmina; Kanter, Michael H; Reynolds, Kristi; Li, Xia; Nguyen, Miki; Young, Deborah R; Koebnick, Corinna


    Visits with nonprimary care providers such as optometrists may be missed opportunities for the detection of high blood pressure (BP). For this study, normotensive adults with at least 12 months of health plan membership on January 1, 2009 (n=1,075,522) were followed-up for high BP through March 14, 2011. Of 111,996 patients with a BP measurement ≥140/90 mm Hg, 82.7% were measured during primary care visits and 17.3% during nonprimary care visits. Individuals with a BP ≥140/90 mm Hg measured during nonprimary care visits were older and more likely to be male and non-Hispanic white. The proportion of patients with follow-up and false-positives were comparable between primary and nonprimary care. The main nonprimary care specialty to identify a first BP ≥140/90 mm Hg was ophthalmology/optometry with 24.5% of all patients. Results suggest that expanding screening for hypertension to nonprimary care settings may improve the detection of hypertension.

  11. National observatory on the therapeutic management in ambulatory care patients aged 65 and over, with type 2 diabetes, chronic pain or atrial fibrillation. (United States)

    Becquemont, Laurent; Benattar-Zibi, Linda; Bertin, Philippe; Berrut, Gilles; Corruble, Emmanuelle; Danchin, Nicolas; Delespierre, Tiba; Derumeaux, Geneviève; Falissard, Bruno; Forette, Francoise; Hanon, Olivier; Pasquier, Florence; Pinget, Michel; Ourabah, Rissane; Piedvache, Céline


    The primary objective of the S.AGES cohort is to describe the real-life therapeutic care of elderly patients. Patients and methods. This is a prospective observational cohort study of 3 700 non-institutionalized patients over the age of 65 years with either type 2 diabetes mellitus (T2DM), chronic pain or atrial fibrillation (AF) recruited by French general practitioners (GPs). Follow-up is planned for 3 years. Baseline characteristics. In the chronic pain sub-cohort, 33% of patients are treated with only grade 1 analgesics, 29% with grade 2 analgesics and 3% with grade 3 analgesics, and 22% have no pain treatment. In the T2DM sub-cohort, 61% of patients have well-controlled diabetes (Hb1c<7%) and 18% are treated with insulin. In the AF sub-cohort, 65% of patients have a CHADS2 score greater than 2, 77% are treated with oral anticoagulants, 17% with platelet inhibitors, 40% with antiarrhythmic drugs and 56% with rate slowing medications. Conclusion. The S.AGES cohort presents a unique opportunity to clarify the real-life therapeutic management of ambulatory elderly subjects and will help to identify the factors associated with the occurrence of major clinical events.

  12. Use of an electronic drug monitoring system for ambulatory patients with chronic disease: how does it impact on nurses' time spent documenting clinical care? (United States)

    Hordern, Antonia; Callen, Joanne; Gibson, Kathryn; Robertson, Louise; Li, Ling; Hains, Isla M; Westbrook, Johanna I


    Medication monitoring of ambulatory rheumatology patients on Disease Modifying Anti-Rheumatic Drugs (DMARDS) is time consuming and complex, with possibilities for error. Electronic systems have the potential to improve the process. The aim of this study was to evaluate the impact of an electronic Drug Monitoring System (eDMS) on the time nurses' spent on clinical documentation associated with monitoring. The study was conducted with all nurses (n=4) in the Rheumatology Department of a large metropolitan Australian teaching hospital. The eDMS was designed as a module of the Hospital Clinical Information System (HCIS) to assist clinicians in monitoring rheumatology patients on DMARDS. Timing data were collected using a modified time and motion work measurement technique using software on a handheld computer. Data included the time nurses spent on documentation regarding medication monitoring before and after the implementation of the eDMS. Results showed that following implementation of the eDMS nurses spent significantly less time documenting medication monitoring information (13.6% to 7.2%, PeDMS. Consequently, there was a significant decrease in the time nurses spent using the HCIS (13.01% to 2.8%, peDMS made the process of drug monitoring quicker and simpler for nurses and thus permitted them to increase their time spent in direct patient care.

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


    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.

  14. 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


    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

  15. Sensitizing Young English Language Learners Towards Environmental Care (United States)

    Castillo, Rigoberto; Rojas, María del Pilar


    This paper reports an action research study aimed at understanding how to sensitize young English language learners towards caring for the environment. The pedagogical intervention in a 5th grade class consisted in the use of creative writing strategies to express learners' ideas. Three stages were followed: "recognizing facts,"…

  16. Ongoing evaluation of ease-of-use and usefulness of wireless tablet computers within an ambulatory care unit. (United States)

    Murphy, Kevin C; Wong, Frances L; Martin, Lee Ann; Edmiston, Dave


    This ongoing research is to assess user acceptance of wireless convertible tablet portable computers in their support of patient care within the clinic environment and to determine their impact on workload reduction for the information staff. A previous publication described our initial experience with a limited wireless environment. There, we tested the premise that wireless convertible tablet computers were equivalent to desktop computers in their support of user tasks. Feedback from users demonstrated that convertible tablet computers were not able to replace desktop computers. Poor network access was a weakness as well as the "cognitive overhead" encountered due to technical problems. This paper describes our further experience with a centre-wide wireless implementation while using a new wireless device. The new tablets, which have some unique functions that existing desktop computers do not provide, have been well received by the clinicians.

  17. 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.

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

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    Adang Eddy


    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

  19. Ambulatory anesthesia: optimal perioperative management of the diabetic patient

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    Polderman JAW


    Full Text Available Jorinde AW Polderman, Robert van Wilpe, Jan H Eshuis, Benedikt Preckel, Jeroen Hermanides Department of Anaesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands Abstract: Given the growing number of patients with diabetes mellitus (DM and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients with DM requires a different approach than patients undergoing major surgery, as procedures are shorter and the stress response caused by surgery is minimal. However, DM is a risk factor for postoperative complications in ambulatory surgery, so should be managed carefully. Given the limited time ambulatory patients spend in the hospital, improvement in management has to be gained from the preanesthetic assessment. The purpose of this review is to summarize current literature regarding the anesthesiologic management of patients with DM in the ambulatory setting. We will discuss the risks of perioperative hyperglycemia together with the pre-, intra-, and postoperative considerations for these patients when encountered in an ambulatory setting. Furthermore, we provide recommendations for the optimal perioperative management of the diabetic patient undergoing ambulatory surgery. Keywords: diabetes mellitus, perioperative period, ambulatory surgery, insulin, complications, GLP-1 agonist, DPP-4 inhibitor

  20. 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


    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.

  1. Renal disease in pregnancy ambulatory issues. (United States)

    Phelan, Sharon T


    Acute and chronic renal disease will complicate prenatal care. Normal physiological changes during pregnancy make the urinary tract system more vulnerable to infectious complications or worsening of preexisting disease. Much of the focus of prenatal care includes screening for these concerns both at the onset of prenatal care and through the pregnancy and postpartum course. With careful and attentive care, the pregnancy outcome for women with significant renal disease has improved and the occurrence of renal injury or obstetric complications due to infectious insults has decreased. This manuscript reviews the current ambulatory prenatal care as it relates to the urinary tract in pregnancy.

  2. Blood cultures in ambulatory outpatients

    Directory of Open Access Journals (Sweden)

    Laupland Kevin B


    Full Text Available Abstract Background Blood cultures are a gold standard specific test for diagnosing many infections. However, the low yield may limit their usefulness, particularly in low-risk populations. This study was conducted to assess the utility of blood cultures drawn from ambulatory outpatients. Methods Blood cultures drawn at community-based collection sites in the Calgary Health Region (population 1 million in 2001 and 2002 were included in this study. These patients were analyzed by linkages to acute care health care databases for utilization of acute care facilities within 2 weeks of blood culture draw. Results 3102 sets of cultures were drawn from 1732 ambulatory outpatients (annual rate = 89.4 per 100,000 population. Significant isolates were identified from 73 (2.4% sets of cultures from 51 patients, including Escherichia coli in 18 (35% and seven (14% each of Staphylococcus aureus and Streptococcus pneumoniae. Compared to patients with negative cultures, those with positive cultures were older (mean 49.6 vs. 40.1 years, p Conclusion Blood cultures drawn in outpatient settings are uncommonly positive, but may define patients for increased intensity of therapy. Strategies to reduce utilization without excluding patients with positive cultures need to be developed for this patient population.

  3. 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

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    Vilas Boas, Laís Macêdo


    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

  4. Single incision laparoscopic primary and incisional ventral hernia repair as the standard of care in the ambulatory setting; Does less equal better outcomes; Case series and literature review

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    Ross O. Downes


    Conclusion: SILS prosthetic repair of primary and incisional ventral hernia is easily feasible. In our series, SILS ventral hernia repair appears to be safe and effective. It may decrease parietal trauma augmenting its use in the ambulatory setting. Technology will continue to improve the wide applicability of this technique. Larger randomized trial studies are required to determine the rates of port-site incisional hernia compared with multiport laparoscopy.

  5. Serious Mental Illness and Risk for Hospitalizations and Rehospitalizations for Ambulatory Care-sensitive Conditions in Denmark:

    DEFF Research Database (Denmark)

    Davydow, Dimitry; Ribe, Anette Riisgaard; Pedersen, Henrik Søndergaard;


    Antallet af akutte indlæggelser for kroniske sygdomme har i de senere år været stigende i den vestlige verden. De mange indlæggelser har medført øgede udgifter i sundhedsvæsenet, selvom nogle af disse indlæggelser potentielt kunne være undgået med forebyggelse og behandling i det nære sundhedsvæs...

  6. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D


    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.

  7. An implementation case study. Implementation of the Indian Health Service's Resource and Patient Management System Electronic Health Record in the ambulatory care setting at the Phoenix Indian Medical Center. (United States)

    Dunnigan, Anthony; John, Karen; Scott, Andrea; Von Bibra, Lynda; Walling, Jeffrey


    The Phoenix Indian Medical Center (PIMC) has successfully implemented the Resource and Patient Management System Electronic Health Record (RPMS-EHR) in its Ambulatory Care departments. One-hundred and twenty-six providers use the system for essentially all elements of documentation, ordering, and coding. Implementation of one function at a time, in one clinical area at a time, allowed for focused training and support. Strong departmental leadership and the development of 'super-users' were key elements. Detailed assessments of each clinic prior to implementation were vital, resulting in optimal workstation utilization and a greater understanding of each clinic's unique flow. Each phase saw an increasing reluctance to revert to old paper processes. The success of this implementation has placed pressure on the remainder of the hospital to implement the RPMS-EHR, and has given the informatics team an increased awareness of what resources are required to achieve this result.

  8. Effective analgesic modalities for ambulatory patients. (United States)

    Redmond, Martin; Florence, Barry; Glass, Peter S A


    The introduction of government-mandated standards for pain management has focused our attention on postoperative pain. With the recent JACHO standards' for ambulatory surgery, it is imperative that all health care workers who care for these patients are familiar with appropriate pain management. Developments in our understanding of the pathophysiology of acute pain have further enhanced our ability to improve pain management for postoperative ambulatory patients. This has led to the concept of preventive analgesia (inhibition of physiological and pathological secondary inflammatory pain). Extensive work has shown that this is best achieved using a multimodel approach usually consisting of an NSAID, opioid, and local anesthetic. NMDA antagonists (ketamine, dextromethorphan) and alpha-2 agnoists (clonodine) show potential supplements to further enhance pain management, especially if given preemptively. Nonpharmacological intervention such as cold therapy or acupuncture may also be considered. The armanentarium for effective pain management has improved substantially over the past few years. The challenge is for health care workers to implement these therapies to obtain optimum pain management in ambulatory surgical patients.

  9. 24 Hours chronomics of ambulatory blood pressure and its relation with circadian rhythm of 6-sulfatoxy melatonin in night shift health care workers

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    B. Anjum


    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

  10. 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


    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.

  11. Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators

    NARCIS (Netherlands)

    D. Stalpers (Dewi); R.A.M.M. Kieft (Renate A. M. M.); D. van der Linden (Dimitri); M.J. Kaljouw (Marian J.); M.J. Schuurmans (Marieke )


    textabstractBackground: Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-s

  12. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

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    Shah U


    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

  13. Culture and religion in nursing: providing culturally sensitive care. (United States)

    Mendes, Aysha

    Last month, Aysha Mendes discussed the impact on care of personal beliefs held by both nurses and patients. This month, she delves into the aspects of culture and religion, which form important pieces of this puzzle, as well as the importance of culturally appropriate care provision in nursing practice.

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


    Fry-Bowers, Eileen Katherine


    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...

  15. The evolution of ambulatory ECG monitoring. (United States)

    Kennedy, Harold L


    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.

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

    Directory of Open Access Journals (Sweden)

    Eng MR


    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

  17. Predictors of exercise participation in ambulatory and non-ambulatory older people with multiple sclerosis

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    Michelle Ploughman


    Full Text Available Background. Exercise at moderate intensity may confer neuroprotective benefits in multiple sclerosis (MS, however it has been reported that people with MS (PwMS exercise less than national guideline recommendations. We aimed to determine predictors of moderate to vigorous exercise among a sample of older Canadians with MS who were divided into ambulatory (less disabled and non-ambulatory (more disabled groups.Methods. We analysed data collected as part of a national survey of health, lifestyle and aging with MS. Participants (n = 743 were Canadians over 55 years of age with MS for 20 or more years. We identified ‘a priori’ variables (demographic, personal, socioeconomic, physical health, exercise history and health care support that may predict exercise at moderate to vigorous intensity (>6.75 metabolic equivalent hours/week. Predictive variables were entered into stepwise logistic regression until best fit was achieved.Results. There was no difference in explanatory models between ambulatory and non-ambulatory groups. The model predicting exercise included the ability to walk independently (OR 1.90, 95% CI [1.24–2.91]; low disability (OR 1.50, 95% CI [1.34–1.68] for each 10 point difference in Barthel Index score, perseverance (OR 1.17, 95% CI [1.08–1.26] for each additional point on the scale of 0–14, less fatigue (OR 2.01, 95% CI [1.32–3.07] for those in the lowest quartile, fewer years since MS diagnosis (OR 1.58, 95% CI [1.11–2.23] below the median of 23 years and fewer cardiovascular comorbidities (OR 1.55 95% CI [1.02–2.35] one or no comorbidities. It was also notable that the factors, age, gender, social support, health care support and financial status were not predictive of exercise.Conclusions. This is the first examination of exercise and exercise predictors among older, more disabled PwMS. Disability is a major predictor of exercise participation (at moderate to vigorous levels in both ambulatory and non-ambulatory

  18. Provider practice models in ambulatory oncology practice: analysis of productivity, revenue, and provider and patient satisfaction. (United States)

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


    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.

  19. The Immediate Impact of the 2009 USPSTF Screening Guideline Change on Physician Recommendation of a Screening Mammogram: Findings from a National Ambulatory and Medical Care Survey-Based Study. (United States)

    Rajan, Suja S; Suryavanshi, Manasi S; Karanth, Siddharth; Lairson, David R


    Regular screening is considered the most effective method to reduce the mortality and morbidity associated with breast cancer. Nevertheless, contradictory evidence about screening mammograms has led to periodic changes and considerable variations among different screening guidelines. This study is the first to examine the immediate impact of the 2009 US Preventive Services Task Force (USPSTF) guideline modification on physician recommendation of mammograms. The study included visits by women aged 40 years and older without prior breast cancer from the National Ambulatory and Medical Care Survey 2008-2010. Bivariate and multiple logistic regressions were used to determine the factors associated with mammography recommendation. Approximately 29,395 visits were included and mammography was recommended during 1350 visits; 50-64-year-old women had 72% higher odds, and 65-74-year-old women had twice the odds of getting a mammogram recommendation compared with 40-49-year-old women in 2009. However, there was no difference in recommendation by age groups in 2008 and 2010. Obstetricians and gynecologists did not modify their recommendation behavior in 2009, unlike all other specialists who reduced their recommendation for 40-49-year-old women in 2009. Other characteristics associated with mammogram recommendations were certain patient comorbidities, physician specialty and primary care physician status, health maintenance organization status of the clinic, and certain visit characteristics. This study demonstrated a temporary effect of the USPSTF screening guideline change on mammogram recommendation. However, in light of conflicting recommendations by different guidelines, the physicians erred toward the more rigorous guidelines and did not permanently reduce their mammogram recommendation for women aged 40-49 years.

  20. 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.


    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

  1. Acupuncture in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Norheim AJ


    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

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

    LENUS (Irish Health Repository)

    Uzochukwu, I


    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\

  3. 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


    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.

  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


    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. Nonmaternal Care's Association With Mother's Parenting Sensitivity: A Case of Self-Selection Bias? (United States)

    Nomaguchi, Kei M; Demaris, Alfred


    Although attachment theory posits that the use of nonmaternal care undermines quality of mothers' parenting, empirical evidence for this link is inconclusive. Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,233), the authors examined the associations between nonmaternal care characteristics and maternal sensitivity during the first 3 years of children's lives, with special attention to selection effects and moderation by resource levels. Findings from fixed-effects regression models suggested that, on average, there is little relationship between nonmaternal care characteristics and maternal sensitivity, once selection factors are held constant. Some evidence of moderation effects was found, however. Excellent-quality care is related to more sensitivity for mothers with lower family income. Poor-quality care is related to lower sensitivity for single mothers, but not partnered mothers. In sum, nonmaternal care characteristics do not seem to have as much influence on mothers' parenting as attachment theory claims.

  6. [Potential coverage and real coverage of ambulatory health care services in the state of Mexico. The case of 3 marginal communities in Atenco and Chalco]. (United States)

    Nájera-Aguilar, P; Infante-Castañeda, C


    Less than a third of the non-insured population studied through a sample in the State of Mexico was covered by the Institute of Health of the State of México. This low coverage was observed in spite the fact that health services were available within 2 kilometer radius. 33 per cent of the non-insured preferred to utilize other services within their own community, and 24 per cent of them traveled to bigger localities to receive care. These results suggest that to attain adequate coverage, utilization patterns should be investigated so that health services can meet the needs of the target population.

  7. Herniorrafia ambulatorial comparada à convencional Ambulatory versus conventional herniorraphy

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    Daniel Nunes e Silva


    Full Text Available OBJETIVO: O tratamento cirúrgico ambulatorial de hérnias inguinais é uma tendência em muitos serviços de saúde. No entanto, em nosso meio, tal procedimento ainda não perfaz uma rotina. Objetivamos analisar os benefícios e complicações da herniorrafia inguinal ambulatorial comparada à convencional. MÉTODO: Realizamos uma análise retrospectiva envolvendo, inicialmente, 105 pacientes submetidos a herniorrafia inguinal ambulatorial (HIA e internação convencional (IC de fevereiro a outubro de 2002 no Complexo Hospitalar Santa Casa de Porto Alegre (CHSCPA. Foram avaliados os benefícios e complicações no 15º, 90º e 180º dias de pós-operatório. Além disso, foi realizada avaliação dos custos hospitalares. Os métodos de análise incluíram o teste t de Fischer e X² . Foram considerados estatisticamente significativos resultados com pBACKGROUND: Ambulatory inguinal herniorraphy is performed worldwide. However, this procedure is not performed routinely in our reality. Our objetive is to analyze the benefits and complications of ambulatory inguinal herniorraphy in comparison to conventional intervention in our Service. METHODS: A retrospective analysis was performed with 105 patients who uwderwent ambulatorial or conventional inguinal herniorraphy between February and October of 2002. Variables, including costs, were analyzed at the 15th, 90th and 180th postoperative days. The Fischer's t test and chi-square test were used. Statistical significance was considered for a p value of p<0.05. RESULTS: From 105 patients, seven were excluded. The total rate complication was 36.08%. There was no significative statistical difference between groups at any time. The most common complication was local pain (24.7%. The costs decreased 20% when surgery was performed in an ambulatory basis as well as the waiting time which was also reduced. CONCLUSION: The ambulatory herniorraphy is a safe procedure, decreases hospital stay, costs and it has a

  8. Clinical exchange: one model to achieve culturally sensitive care. (United States)

    Scholes, J; Moore, D


    This paper reports on a clinical exchange programme that formed part of a pre-registration European nursing degree run by three collaborating institutions in England, Holland and Spain. The course included: common and shared learning including two summer schools; and the development of a second language before the students went on a three-month clinical placement in one of the other base institutions' clinical environments. The aim of the course was to enable students to become culturally sensitive carers. This was achieved by developing a programme based on transcultural nursing principles in theory and practice. Data were gathered by interview, focus groups, and questionnaires from 79 exchange students, fostering the strategies of illuminative evaluation. The paper examines: how the aims of the course were met; the factors that inhibited the attainment of certain goals; and how the acquisition of a second language influenced the students' learning about nursing. A model is presented to illustrate the process of transformative learning from the exchange experience.

  9. Diagnosis and treatment of headache in the ambulatory care setting: a review of classic presentations and new considerations in diagnosis and management. (United States)

    Hale, Natalie; Paauw, Douglas S


    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.

  10. Biomedical Wireless Ambulatory Crew Monitor (United States)

    Chmiel, Alan; Humphreys, Brad


    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.

  11. 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

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    Maria José Scochi


    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

  12. Marginal ambulatory teaching cost under varying levels of service utilization. (United States)

    Panton, D M; Mushlin, A I; Gavett, J W


    The ambulatory component of residency training jointly produces two products, namely, training and patient services. In costing educational programs of this type, two approaches are frequently taken. The first considers the total costs of the educational program, including training and patient services. These costs are usually constructed from historical accounting records. The second approach attempts to cost the joint products separately, based upon estimates of future changes in program costs, if the product in question is added to or removed from the program. The second approach relates to typical decisions facing the managers of medical centers and practices used for teaching purposes. This article reports such a study of costs in a primary-care residency training program in a hospital outpatient setting. The costs of the product, i.e., on-the-job training, are evaluated using a replacement-cost concept under different levels of patient services. The results show that the cost of the product, training, is small at full clinical utilization and is sensitive to changes in the volume of services provided.

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

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    Kent C


    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

  14. Management of comorbidities in ambulatory anesthesia: a review

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    Dabu-Bondoc S


    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

  15. Estado nutricional, clínico e padrão alimentar de pessoas vivendo com HIV/Aids em assistência ambulatorial no município de São Paulo Nutritional and clinical status, and dietary patterns of people living with HIV/AIDS in ambulatory care in Sao Paulo, Brazil

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    Erika Ferrari Rafael Silva


    Full Text Available INTRODUÇÃO: Atualmente, a abordagem nutricional desempenha papel essencial no tratamento de pessoas que vivem com HIV/aids, particularmente no caso de alterações metabólicas pelo uso da terapia antirretroviral (TARV que podem estar associadas ao maior risco de doenças cardiovasculares (DCV. OBJETIVO: Caracterizar o estado nutricional, clínico e a qualidade da dieta de pessoas que vivem com HIV/aids. METODOLOGIA: Trata-se de um estudo transversal envolvendo pessoas que vivem com HIV/aids em atendimento na rede de serviços especializados no município de São Paulo. Os usuários desta rede, em uso ou não de TARV, foram recrutados no período de dezembro de 2004 a maio de 2006, durante consultas de rotina. Foram coletados dados sociodemográficos, clínicos, bioquímicos, antropométricos e dietéticos. A qualidade da dieta foi avaliada segundo escores de padrão de consumo predominantemente "não protetor" e "protetor" para DCV. RESULTADOS: A amostra foi constituída por 238 pacientes em TARV e 76 sem TARV. A média dos níveis de colesterol total, triglicérides e glicemia foram maiores no grupo TARV (p INTRODUCTION: Nutrition currently plays a key role in the treatment of people living with HIV/AIDS (PLHA, especially in the case of metabolic alterations due to highly active antiretroviral therapy (HAART, which could be related to cardiovascular diseases (CD. OBJECTIVE: to describe the nutritional and clinical status, and the quality of diet of PLHA. METHODS: It is a cross-sectional study involving a network of ambulatory care facilities for PLHA in the city of São Paulo, Brazil. Patients, in use of HAART or not, were selected from December 2004 to may 2006, through routine clinic visits. We collected: socio-demographic, clinical, biochemical, anthropometric measures and dietary data. Diet quality was evaluated according to a "protecting" or "non-protecting" pattern of consumption scores for CD. RESULTS: The sample had 238 patients on

  16. Ambulatory Care Data Base. Part B. (United States)


    ARA ’-SE ASY I tb I$U, r -MtE IU f Sj 0, ൚ $II , 5 1 "’ l flit’ I z 1 t- _4 1I4 I4 III IIIIP Il , A I SiCA. II, lO~ IRY P US1LA! .I~l.NiOIINN,80...Dermatomycosis 110 25 112- Moniliasis, Excluding Urogenitis 26 1121 Moniliasis, Urogenital , Proven 112.1 27 1310 Trichomoniasis, Urogenital , Proven

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

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    Eckstrand Julie


    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

  18. Practical strategies for providing culturally sensitive, ethical care in developing nations. (United States)

    Crigger, Nancy J; Holcomb, Lygia


    Providing health care in developing nations results in cultural and ethical challenges for health care professionals. The authors' intent is to raise readers' awareness of how to maintain an ethical and culturally sensitive approach to practice in developing nations. Four practical approaches to ethical decision-making, developed from the literature and praxis, in conjunction with traditional moral theory and guidelines from professional and international organizations are discussed. Ethical multiculturalism, a view that combines universalism and multiculturalism undergirds culturally appropriate and ethically responsive decisions.

  19. Development of an Inventory for Health-Care Office Staff to Self-Assess Their Patient-Centered Cultural Sensitivity

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    Carolyn M. Tucker


    Full Text Available Background: Patient-centered culturally sensitive health care (PC-CSHC is a best practice approach for improving health-care delivery to culturally diverse populations and reducing health disparities. Despite patients’ report that cultural sensitivity by health-care office staff is an important aspect of PC-CSHC, the majority of available research on PC-CSHC focuses exclusively on health-care providers. This may be due in part to the paucity of instruments available to assess the cultural sensitivity of health-care office staff. The objective of the present study is to determine the psychometric properties of the Tucker-Culturally Sensitive Health Care Office Staff Inventory-Self-Assessment Form (T-CSHCOSI-SAF. This instrument is designed to enable health-care office staff to self-assess their level of agreement that they display behaviors and attitudes that culturally diverse patients have identified as office staff cultural sensitivity indicators. Methods: A sample of 510 health-care office staff were recruited at 67 health-care sites across the United States. These health-care office staff anonymously completed the T-CSHCOSI-SAF and a demographic data questionnaire. Results and Level of Evidence: Confirmatory factor analyses of the T-CSHCOSI-SAF revealed that this inventory has 2 factors with high internal consistency reliability (Cronbach’s αs= .916 and .912. Conclusion and Implications: The T-CSHCOSI-SAF is a useful inventory for health-care office staff to assess their own level of patient-centered cultural sensitivity. Such self-assessment data can be used in the development and implementation of trainings to promote patient-centered cultural sensitivity of health-care office staff and to help draw the attention of these staff to displaying patient-centered cultural sensitivity.


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    Full Text Available OBJECTIVES: To outline the spectrum of bacteria causing pneumonia and the pattern of antimicrobial sensitivity in outpatients with pneumonia in a tertiary care hospital in Himachal Pradesh. METHODS: Sputum of 108 immuno competent pneumonia patients attending outpatient departments of Medicine and Pulmonary medicine of Dr. R. P. Government Medical College , Kangra at Tanda was sent for Gram staining and culture and sensitivity testing. RESULTS: Commensals were detected in most of the cases (32 , 29.6% followed by Staphylococcus aureus in 17(15.7% and Streptococcus pneumoniae in 16(14.8%. This was followed by three Gram negative organisms namely E Coli (11 , 10.2% , Pseudomonas (10 , 9.2% and Klebsiella (8 , 7.2%. No growth was obtained in 7(6.5% and other organisms were isolated in 7(6.5% specimens. Staphylococcus aureus was sensitive to vancomycin , clindamycin , cefoxitin , azithromycin and cotrimoxazole. Streptococcus pneumoniae was found to be sensitive to vancomycin , clindamycin , gentamicin , azithromycin , penicillin , cotrimoxazole , amoxicillin +clavulanic acid. Klebsiella was found to be sensitive to imipenem , azithromycin , ciprofloxacin , gentamicin and amoxicillin +clavulanic acid. E coli was sensitive to imipenem , gentamicin and amoxicillin +clavulanic acid. Pseudomonas aeruginosa was found to be sensitive to gentamicin , cefta zidime , imipenem , ticarcillin and piperacillin. CONCLUSION: Staphylococcus aureus and Streptococcus pneumoniae are the commonest organism causing pneumonia. Streptococcus pneumoniae is resistant to many antibiotics. Azithromycin can be the first line therapy for pneumonia.

  1. Towards ambulatory mental stress measurement from physiological parameters

    NARCIS (Netherlands)

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


    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

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

    DEFF Research Database (Denmark)

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


    OBJECTIVE: Advance care planning (ACP) discussions are emphasized as a valuable way of improving communication about end-of-life care. Yet we have very little knowledge of what goes on during actual ACP discussions. The aim of our study was to explore how the sensitive topics of end-of-life......, and a physician, carried out in connection with a pilot study conducted in Denmark. RESULTS: Previous studies of directly observed patient-physician discussions about end-of-life care show largely ineffective communication, where end-of-life issues are toned down by healthcare professionals, who also tend...... choices. Patients actively explored different topics and asked questions about their current situation, but some also challenged the concept of ACP, especially the thought of being able to take control of end-of-life issues in advance. SIGNIFICANCE OF RESULTS: Our analysis indicates that during...

  3. 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)



    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

  4. [Home care in a culturally sensitive environment: perspectives of caregivers of Haitian elderly patients and relatives]. (United States)

    Ducharme, Francine; Paquet, Mario; Vissandjée, Bilkis; Carpentier, Normand; Lévesque, Louise; Trudeau, Denise


    In Canada, the care provided by families occurs in an increasingly multiethnic context. Against this backdrop, the present qualitative study aims to explore the needs/expectations and solutions not only of (female) natural caregivers of an elderly relative hailing from Haiti (presented in terms of tracking cases) but also of remunerated home care providers - all with a view to developing a culturally sensitive service offering. As such, this study works from a conceptual framework centring on the negotiation of a common area of agreement between the stakeholders involved (i.e., natural caregivers and home care providers). To this end, focus groups and individual interviews were conducted among 15 caregivers and 37 home care providers. The three recurrent themes emerging from the data analysis concern, in context, the needs/expectations and solutions surrounding the experience of service use, barriers to use, and the relationships between natural caregivers and home care providers. The statements of both groups evidenced a consistency of views and have thus provided a basis for developing some recommendations acceptable to all stakeholders from the perspective of making culturally-based adjustments to the service offering.

  5. 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

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    Ines Lessa


    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

  6. Pain Management in Ambulatory Surgery—A Review

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    Jan G. Jakobsson


    Full Text Available Day surgery, coming to and leaving the hospital on the same day as surgery as well as ambulatory surgery, leaving hospital within twenty-three hours is increasingly being adopted. There are several potential benefits associated with the avoidance of in-hospital care. Early discharge demands a rapid recovery and low incidence and intensity of surgery and anaesthesia related side-effects; such as pain, nausea and fatigue. Patients must be fit enough and symptom intensity so low that self-care is feasible in order to secure quality of care. Preventive multi-modal analgesia has become the gold standard. Administering paracetamol, NSIADs prior to start of surgery and decreasing the noxious influx by the use of local anaesthetics by peripheral block or infiltration in surgical field prior to incision and at wound closure in combination with intra-operative fast acting opioid analgesics, e.g., remifentanil, have become standard of care. Single preoperative 0.1 mg/kg dose dexamethasone has a combined action, anti-emetic and provides enhanced analgesia. Additional α-2-agonists and/or gabapentin or pregabalin may be used in addition to facilitate the pain management if patients are at risk for more pronounced pain. Paracetamol, NSAIDs and rescue oral opioid is the basic concept for self-care during the first 3–5 days after common day/ambulatory surgical procedures.

  7. Intercultural communication between patients and health care providers: an exploration of intercultural communication effectiveness, cultural sensitivity, stress, and anxiety. (United States)

    Ulrey, K L; Amason, P


    Cultural diversity is becoming increasingly more important in the workplace. This is particularly true in health care organizations facing demographic shifts in the patients served and their families. This study serves to aid the development of intercultural communication training programs for health care providers by examining how cultural sensitivity and effective intercultural communication, besides helping patients, personally benefit health care providers by reducing their stress. Effective intercultural communication and cultural sensitivity were found to be related. Health care providers' levels of intercultural anxiety also were found to correlate with effective intercultural communication.

  8. In vitro sensitivity of Acinetobacter baumannii and Pseudomonas aeruginosa to carbapenems among intensive care unit patients. (United States)

    Guzek, A; Korzeniewski, K; Nitsch-Osuch, Aneta; Rybicki, Z; Prokop, E


    Acinetobacter baumannii and Pseudomonas aeruginosa pathogens are the most common causes of fatal pneumonia among patients treated in Intensive Care Units (ICU). Carbapenems remain a group of antibiotics characterized by the highest effectiveness in treatment of heavy infections of the lower respiratory tract. This study compared in vitro sensitivity of A. baumannii and P. aeruginosa to three carbapenems: imipenem, meropenem and doripenem. The material was collected from 71 patients treated in the ICU from April 2009 to January 2010. Bronchial tree was the predominant source of samples. Fifty-four strains of A. baumannii and 17 strains of P. aeruginosa were analyzed. Sensitivity to carbapenems was interpreted in line with Clinical and Laboratory Standard Institute (CLSI) and European Committee for Antimicrobial Susceptibility Testing (EUCAST) criteria (imipenem and meropenem) or in compliance with the Food and Drug Administration (FDA) and CLSI guidelines (doripenem). We found that A. baumannii was significantly more often sensitive to imipenem than to doripenem and meropenem, but only according to the CLSI and FDA and not EUCAST criteria. The sensitivity of P. aeruginosa was higher to imipenem than to doripenem and meropenem, according to both CLSI and EUCAST criteria (64.7 %). We conclude that the EUCAST criteria demonstrate a higher rigor than those of CLSI and FDA in the determination of carbapenems sensitivity. Imipenem appears more effective than doripenem and meropenem in treatment of A. baumannii and P. aeruginosa infections.

  9. Educating Asthmatic Children in European Ambulatory Pediatrics: Facts and Insights. (United States)

    Robberecht, Marie Noëlle; Beghin, Laurent; Deschildre, Antoine; Hue, Valérie; Reali, Laura; Plevnik-Vodušek, Vesna; Moretto, Marilena; Agustsson, Sigurlaug; Tockert, Emile; Jäger-Roman, Elke; Deplanque, Dominique; Najaf-Zadeh, Abolfazl; Martinot, Alain


    The aim of this study was to assess the role of European ambulatory pediatricians in caring for asthmatic children, especially in terms of their therapeutic education. We developed a survey that was observational, declarative, retrospective and anonymous in nature. 436 ambulatory pediatricians in Belgium, France, Germany, Italy, Luxembourg and Slovenia were asked to participate in the survey providing information on three children over 6 years old suffering from persistent asthma, who had been followed for at least 6 months. We considered the pediatricians' profile, and their role in the therapeutic education of children. 277 pediatricians (64%) responded: 81% were primary care pediatricians; 46% participated in networks; 4% had specific training in Therapeutic Patient Education; 69% followed more than 5 asthmatic children per month, and over long periods (7 ± 4 years). The profiles of 684 children were assessed. Answers diverged concerning the provision of a Personalized Action Plan (60-88%), training the child to measure and interpret his Peak Expiratory Flow (31-99%), and the prescription of pulmonary function tests during the follow-up programme of consultations (62-97%). Answers converged on pediatricians' perception of their role in teaching children about their condition and its treatment (99%), about inhalation techniques (96%), and in improving the children's ability to take preventive measures when faced with risk situations (97%). This study highlights the role of European pediatricians in caring for asthmatic children, and their lack of training in Therapeutic Patient Education. Programmes and tools are required in order to train ambulatory pediatricians in Therapeutic Patient Education, and such resources should be integrated into primary health care, and harmonized at the European level.

  10. Sensitivity and specificity of point-of-care rapid combination syphilis-HIV-HCV tests.

    Directory of Open Access Journals (Sweden)

    Kristen L Hess

    Full Text Available New rapid point-of-care (POC tests are being developed that would offer the opportunity to increase screening and treatment of several infections, including syphilis. This study evaluated three of these new rapid POC tests at a site in Southern California.Participants were recruited from a testing center in Long Beach, California. A whole blood specimen was used to evaluate the performance of the Dual Path Platform (DPP Syphilis Screen & Confirm, DPP HIV-Syphilis, and DPP HIV-HCV-Syphilis rapid tests. The gold-standard comparisons were Treponema pallidum passive particle agglutination (TPPA, rapid plasma reagin (RPR, HCV enzyme immunoassay (EIA, and HIV-1/2 EIA.A total of 948 whole blood specimens were analyzed in this study. The sensitivity of the HIV tests ranged from 95.7-100% and the specificity was 99.7-100%. The sensitivity and specificity of the HCV test were 91.8% and 99.3%, respectively. The treponemal-test sensitivity when compared to TPPA ranged from 44.0-52.7% and specificity was 98.7-99.6%. The non-treponemal test sensitivity and specificity when compared to RPR was 47.8% and 98.9%, respectively. The sensitivity of the Screen & Confirm test improved to 90.0% when cases who were both treponemal and nontreponemal positive were compared to TPPA+/RPR ≥ 1 ∶ 8.The HIV and HCV on the multi-infection tests showed good performance, but the treponemal and nontreponemal tests had low sensitivity. These results could be due to a low prevalence of active syphilis in the sample population because the sensitivity improved when the gold standard was limited to those more likely to be active cases. Further evaluation of the new syphilis POC tests is required before implementation into testing programs.

  11. Assessing decision quality in patient-centred care requires a preference-sensitive measure

    DEFF Research Database (Denmark)

    Kaltoft, Mette Kjer; Cunich, Michelle; Salkeld, Glenn;


    A theory-based instrument for measuring the quality of decisions made using any form of decision technology, including both decision-aided and unaided clinical consultations is required to enable person- and patient-centred care and to respond positively to individual heterogeneity in the value...... aspects of decision making. Current instruments using the term 'decision quality' have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all...... conditions and decisions. MyDecisionQuality is grounded in prescriptive multi criteria decision analysis and employs a simple expected value algorithm to calculate a score for the quality of a decision that combines, in the clinical case, the patient's individual preferences for eight quality criteria...

  12. Primary Care Sensitive Hospitalization: users detect flaws on the access to services

    Directory of Open Access Journals (Sweden)

    Tania Cristina Morais Santa Barbara Rehem


    Full Text Available The aim of this study is to analyze and understand the reasons for the occurrence of sensitive hospitalizations in accordance with users. Qualitative study conducted with users who were admitted to Pedreira General Hospital, in São Paulo. The data was collected through semi structured interviews and thereafter, transcribed and processed in the electronic program Alceste. When analyzing the content, the access was seized fundamentally as an empirical category, bringing up problems that later deserved, from the Brazilian Ministry of Health, a specific Program to improve the quality and access to primary care. The hierarchical and pyramidal organization shape from the health system in the city of São Paulo can be one of the important aspects for the access matter and established as an important restricting factor in the primary care role in reducing or even preventing the occurrence of these hospitalizations.

  13. Premiums for Long-Term Care Insurance Packages: Sensitivity with Respect to Biometric Assumptions

    Directory of Open Access Journals (Sweden)

    Ermanno Pitacco


    Full Text Available Long-term care insurance (LTCI covers are rather recent products, in the framework of health insurance. It follows that specific biometric data are scanty; pricing and reserving problems then arise because of difficulties in the choice of appropriate technical bases. Different benefit structures imply different sensitivity degrees with respect to changes in biometric assumptions. Hence, an accurate sensitivity analysis can help in designing LTCI products and, in particular, in comparing stand-alone products to combined products, i.e., packages including LTCI benefits and other lifetime-related benefits. Numerical examples show, in particular, that the stand-alone cover is much riskier than all of the LTCI combined products that we have considered. As a consequence, the LTCI stand-alone cover is a highly “absorbing” product as regards capital requirements for solvency purposes.

  14. Institutional and familial cost of patients in continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Enrique Villarreal-Ríos


    Full Text Available Objective: to determine the cost of institutional and familial care for patients with chronic kidney disease replacement therapy with continuous ambulatory peritoneal dialysis. Methods: a study of the cost of care for patients with chronic kidney disease treated with continuous ambulatory peritoneal dialysis was undertaken. The sample size (151 was calculated with the formula of the averages for an infinite population. The institutional cost included the cost of outpatient consultation, emergencies, hospitalization, ambulance, pharmacy, medication, laboratory, x-rays and application of erythropoietin. The family cost included transportation cost for services, cost of food during care, as well as the cost of medication and treatment materials acquired by the family for home care. The analysis included averages, percentages and confidence intervals. Results: the average annual institutional cost is US$ 11,004.3. The average annual family cost is US$ 2,831.04. The average annual cost of patient care in continuous ambulatory peritoneal dialysis including institutional and family cost is US$ 13,835.35. Conclusion: the cost of chronic kidney disease requires a large amount of economic resources, and is becoming a serious problem for health services and families. It's also true that the form of patient management in continuous ambulatory peritoneal dialysis is the most efficient in the use of institutional resources and family.

  15. US National Practice Patterns in Ambulatory Operative Management of Lateral Epicondylitis. (United States)

    Buller, Leonard T; Best, Matthew J; Nigen, David; Ialenti, Marc; Baraga, Michael G


    Lateral epicondylitis is a common cause of elbow pain, frequently responsive to nonoperative management. There are multiple operative techniques for persistently symptomatic patients who have exhausted conservative therapies. Little is known regarding US national trends in operative management of lateral epicondylitis. We conducted a study to investigate changes in use of ambulatory procedures for lateral epicondylitis. Cases of lateral epicondylitis were identified using the National Survey of Ambulatory Surgery and were analyzed for trends in demographics and use of ambulatory surgery. Between 1994 and 2006, the population-adjusted rate of ambulatory surgical procedures increased from 7.29 to 10.44 per 100,000 capita. The sex-adjusted rate of surgery for lateral epicondylitis increased by 85% among females and decreased by 31% among males. Most patients were between ages 40 and 49 years, and the largest percentage increase in age-adjusted rates was found among patients older than 50 years (275%) between 1994 and 2006. Use of regional anesthesia increased from 17% in 1994 to 30% in 2006. Private insurance remained the most common payer. Awareness of the increasing use of ambulatory surgery for lateral epicondylitis may lead to changes in health care policies and positively affect patient care.

  16. Perspectives on ambulatory anesthesia: the patient’s point of view

    Directory of Open Access Journals (Sweden)

    Sehmbi H


    Full Text Available Herman Sehmbi, Jean Wong, David T WongDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, CanadaAbstract: Recent advances in anesthetic and surgical techniques have led to tremendous growth of ambulatory surgery. With patients with many co-morbid conditions undergoing complex procedures in an ambulatory setting, the challenges in providing ambulatory surgery and anesthesia are immense. In recent years, the paradigm has shifted from a health-care provider focus involving process compliance and clinical outcomes, to a patient-centered strategy that includes patients’ perspectives of desired outcomes. Improving preoperative patient education while reducing unnecessary testing, improving postoperative pain management, and reducing postoperative nausea and vomiting may help enhance patient satisfaction. The functional status of most patients is reduced postoperatively, and thus the pattern of recovery is an area of ongoing research. Standardized and validated psychometric questionnaires such as Quality of Recovery-40 and Postoperative Quality of Recovery Scale are potential tools to assess this. Patient satisfaction has been identified as an important outcome measure and dedicated tools to assess this in various clinical settings are needed. Identification of key aspects of ambulatory surgery deemed important from patients’ perspectives, and implementation of validated outcome questionnaires, are important in improving patient centered care and patient satisfaction.Keywords: ambulatory, patient, satisfaction, anesthesia, outcomes, questionnaire, perspectives

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

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Kofoed, Klaus


    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....

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

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Kofoed, Klaus


    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....

  19. 75 FR 14606 - Medicare Program; Request for Nominations to the Advisory Panel on Ambulatory Payment... (United States)


    ...; 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,...

  20. Is there a risk of sensitization and allergy to chlorhexidine in health care workers?

    DEFF Research Database (Denmark)

    Garvey, L H; Roed-Petersen, J; Husum, B


    BACKGROUND: In Denmark, chlorhexidine is the standard disinfectant in most hospitals and health care workers are repeatedly exposed to it. The aim of this study was to establish whether there is a risk of sensitization and allergy to chlorhexidine from this type of exposure. METHODS: Two hundred...... with chlorhexidine gluconate 1% and chlorhexidine acetate 1% were performed looking for type IV (delayed type) allergy. A prick test with chlorhexidine gluconate 0.5% and an intradermal test with chlorhexidine 0.0002% were performed looking for type I (immediate type) allergy. RESULTS: There were no positive tests...... in any of the 104 individuals tested (99% confidence interval 0-4.9%). There was a predominance of females in both groups and the overall median age was 42 years (28-63). No one in the group not tested reported to have a verified or suspected allergy to chlorhexidine. CONCLUSION: In this first study...

  1. Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of Fatmawati Hospital, Indonesia

    Institute of Scientific and Technical Information of China (English)

    Maksum Radji; Siti Fauziah; Nurgani Aribinuko


    Objective: To evaluate the sensitivity pattern of bacterial pathogens in the intensive care unit (ICU) of a tertiary care of Fatmawati Hospital Jakarta Indonesia. Methods: A cross sectional retrospective study of bacterial pathogen was carried out on a total of 722 patients that were admitted to the ICU of Fatmawati Hospital Jakarta Indonesia during January 2009 to March 2010. All bacteria were identified by standard microbiologic methods, and their antibiotic susceptibility testing was performed using disk diffusion method. Results: Specimens were collected from 385 patients who were given antimicrobial treatment, of which 249 (64.68%) were cultured positive and 136 (35.32%) were negative. The most predominant isolate was Pseudomonas aeruginosa (P. aeruginosa) (26.5%) followed by Klebsiella pneumoniae (K. pneumoniae) (15.3%) and Staphylococcus epidermidis (14.9%). P. aeruginosa isolates showed high rate of resistance to cephalexin (95.3%), cefotaxime (64.1%), and ceftriaxone (60.9%). Amikacin was the most effective (84.4%) antibiotic against P. aeruginosa followed by imipenem (81.2%), and meropenem (75.0%). K. pneumoniae showed resistance to cephalexin (86.5%), ceftriaxone (75.7%), ceftazidime (73.0%), cefpirome (73.0%) and cefotaxime (67.9%), respectively. Conclusions: Most bacteria isolated from ICU of Fatmawati Hospital Jakarta Indonesia were resistant to the third generation of cephalosporins, and quinolone antibiotics. Regular surveillance of antibiotic susceptibility patterns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients.

  2. Hospitalizações por condições sensíveis à atenção primária nos municípios em gestão plena do sistema no Estado do Rio Grande do Sul, Brasil Hospitalization for primary care sensitive conditions in municipalities with full local health management control in Rio Grande do Sul State, Brazil

    Directory of Open Access Journals (Sweden)

    Juvenal Soares Dias-da-Costa


    Full Text Available Avaliou-se a qualidade dos cuidados oferecidos nos municípios em gestão plena no Rio Grande do Sul, Brasil, por meio da taxa de internações hospitalares por condições sensíveis à atenção primária, no período de 1995 a 2005. Foram consideradas as internações hospitalares por: diabetes mellitus, insuficiência cardíaca, hipertensão arterial, doença pulmonar obstrutiva crônica e doenças imunopreveníveis em indivíduos na faixa etária de 20 a 59 anos. Verificou-se diminuição das taxas em quase todos os municípios do estado. A regressão de Poisson não mostrou tendências de diminuição das taxas após a adesão à gestão plena. Nos municípios menores, as taxas foram mais elevadas. As internações por condições sensíveis à atenção ambulatorial mostraram-se indicadores de fácil operação e de baixo custo que podem produzir conhecimentos sobre os sistemas de saúde, possibilitando a melhoria de sua qualidade.We assess the quality of care provided in the cities with full health system management, in the state of Rio Grande do Sul, Brazil, by means of the rate of hospitalizations for primary care sensitive conditions, between 1995 and 2005. The following were considered as hospitalizations for sensitive conditions: diabetes mellitus, heart failure, hypertension, chronic obstructive pulmonary disease and immunopreventive diseases in individuals aged between 20 and 59 years. Findings reveal that, beginning in 2001, there has been a reduction in rates in almost all cities. Through the Poisson regression we didn't observe a lower rates after the full health system management. Among cities with full health system management, rates of hospitalizations for ambulatory care sensitive conditions increased as the population size decreased. Hospitalizations for ambulatory care sensitive conditions were found to be low-cost, easily-operated indicators and can produce knowledge about health systems, enabling their quality

  3. Interactive effect of negative affectivity and anxiety sensitivity in terms of mental health among Latinos in primary care. (United States)

    Zvolensky, Michael J; Paulus, Daniel J; Bakhshaie, Jafar; Garza, Monica; Ochoa-Perez, Melissa; Medvedeva, Angela; Bogiaizian, Daniel; Robles, Zuzuky; Manning, Kara; Schmidt, Norman B


    From a public health perspective, primary care medical settings represent a strategic location to address mental health disapirty among Latinos. Yet, there is little empirical work that addresses affective vulnerability processes for mental health problems in such settings. To help address this gap in knowledge, the present investigation examined an interactive model of negative affectivity (tendency to experience negative mood states) and anxiety sensitivity (fear of the negative consequences of aversive sensations) among a Latino sample in primary care in terms of a relatively wide range of anxiety/depression indices. Participants included 390 Latino adults (Mage=38.7, SD=11.3; 86.9% female; 95.6% reported Spanish as first language) from a primary care health clinic. Primary dependent measures included depressive, suicidal, social anxiety, and anxious arousal symptoms, number of mood and anxiety disorders, and disability. Consistent with prediction, the interaction between negative affectivity and anxiety sensitivity was significantly related to suicidal, social anxiety, and anxious arousal symptoms, as well as number of mood/anxiety diagnoses and disability among the primary care Latino sample. The form of the interactions indicated a synergistic effect, such that the greatest levels of each outcome were found among those with high negative affectivity and high anxiety sensitivity. There was a trending interaction for depressive symptoms. Overall, these data provide novel empirical evidence suggesting that there is a clinically-relevant interplay between anxiety sensitivity and negative affectivity in regard to the expression of anxiety and depressive symptoms among a Latino primary care sample.

  4. Improving regional variation using quality of care measures

    Directory of Open Access Journals (Sweden)

    Scott A Berkowitz


    Full Text Available Scott A Berkowitz1, Gary Gerstenblith1, Robert Herbert2, Gerard Anderson1,21Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Center for Hospital Finance and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAAbstract: There is significant regional variability in the quality of care provided in the United States. This article compares regional performance for three measures that focus on transitions in care, and the care of patients with multiple conditions. Admissions for people with ambulatory care-sensitive conditions, hospital readmissions within 30 days of discharge, and compliance with practice guidelines for people with three chronic conditions (congestive heart failure, chronic obstructive pulmonary disease, and diabetes were analyzed using data drawn from the Centers for Medicare & Medicaid Services’ Standard Analytic Files for 5% of a 2004 national sample of Medicare beneficiaries which was divided by hospital referral regions and regional performance. There were significant regional differences in performance which we hypothesize could be improved through better care coordination and system management.Keywords: performance, quality, chronic condition, ambulatory care, sensitive conditions, readmissions

  5. [Approach to the patient in the ambulatory surgery unit]. (United States)

    Cordero-Ponce, Montserrat; Romero-Sánchez, Isabel María; López-Barea, José; Martínez-Ramos, Pablo


    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.

  6. Orientation of Medical Residents to the Psychosocial Aspects of Primary Care: Influence of Training Program. (United States)

    Eisenthal, Sherman; And Others


    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…

  7. Strategies to reduce medication errors in pediatric ambulatory settings

    Directory of Open Access Journals (Sweden)

    S Mehndiratta


    Full Text Available Worldwide, a large number of children are prescribed drugs on an outpatient basis. Medication errors are fairly common in these settings. Though this matter has been well recognized as a cause of concern, limited data is available from ambulatory settings. Medication errors can be defined as errors that may occur at any step, starting from ordering a medication, to dispensing, administration of the drug and the subsequent monitoring. The outcomes of such errors are variable and may range between those that are clinically insignificant to a life-threatening event. The reasons for these medication errors are multi-factorial. Children are unable to administer medications to themselves and also require a strict weight-based dosing regimen. The risk factors associated with medication errors include complex regimens with multiple medications. Overdosing and under-dosing (10-fold calculation errors, an increased or a decreased frequency of dosing or an inappropriate duration of administration of the medication, are frequently detected errors. The lack of availability of proper formulations adds to the confusion. The low level of literacy among the caregivers can aggravate this problem. There is a lack of proper reporting and monitoring mechanisms in most ambulatory settings, hence these errors remain unrecognized and often go unreported. This article summarizes the current available literature on medication errors in ambulatory settings and the possible strategies that can be adopted to reduce the burden of these errors in order to improve child care and patient safety. Voluntary, anonymous reporting can be introduced in the healthcare institutions to determine the incidence of these errors.

  8. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Ghisi D


    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

  9. Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of Fatmawati Hospital,Indonesia

    Institute of Scientific and Technical Information of China (English)

    Maksum; Radji; Siti; Fauziah; Nurgani; Aribinuko


    Objective:To evaluate the sensitivity pattern of bacterial pathogens in the intensive care unit(ICU) of a tertiary care of Falmawati Hospital Jakarta Indonesia.Methods:A cross sectional retrospective study of bacterial pathogen was carried out on a total of 722 patients that were admitted to the ICU of Fatmawati Hospital Jakarta Indonesia during January 2009 to March 2010. All bacteria were identified by standard microbiologic methods,and(heir antibiotic susceptibility testing was performed using disk diffusion method.Results:Specimens were collected from 385 patients who were given antimicrobial treatment,of which 249(64.68%) were cultured positive and 136(35.32%) were negative.The most predominant isolate was Pseudomonas aeruginosa(P.aeruginosa)(26.5%) followed by Klebsiella pneumoniae(K.pneumoniae)(15.3%) and Staphylococcus epidermidis(14.9%).P.aeruginosa isolates showed high rate of resistance to cephalexin(95.3%),cefotaxime(64.1%),and ceftriaxone(60.9%).Amikacin was the most effective(84.4%) antibiotic against P.aeruginosa followed by imipenem(81.2%),and meropenem(75.0%).K.pneumoniae showed resistance to cephalexin(86.5%),ceftriaxone(75.7%),ceftazidime(73.0%),cefpirome(73.0%) and cefotaxime(67.9%),respectively.Conclusions:Most bacteria isolated from ICU of Fatmawati Hospital Jakarta Indonesia were resistant to the third generation of cephalosporins,and quinolone antibiotics.Regular surveillance of antibiotic susceptibility pallerns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients.

  10. HCUP State Ambulatory Surgery Databases (SASD) - Restricted Access Files (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...

  11. Ambulatory ST segment monitoring after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H


    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...... as important reasons for the inconsistent findings. The precise role of ambulatory ST segment monitoring in clinical practice has yet to be established. Direct comparisons with exercise stress testing may not be appropriate for two reasons. Firstly, the main advantage of ambulatory monitoring may...... 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....

  12. The combination of health anxiety and somatic symptoms: Specificity to anxiety sensitivity cognitive concerns among patients in primary care. (United States)

    Fergus, Thomas A; Kelley, Lance P; Griggs, Jackson O


    Prior research has found that health anxiety is related to poor patient outcomes in primary care settings. Health anxiety is characterized by at least two presentations: with either severe or no/mild somatic symptoms. Preliminary data indicate that anxiety sensitivity may be important for understanding the presentation of health anxiety with severe somatic symptoms. We further examined whether the combination of health anxiety and somatic symptoms was related to anxiety sensitivity. Participants were adults presenting for treatment at a community health center (N=538). As predicted, the interactive effect between health anxiety and somatic symptoms was associated with anxiety sensitivity cognitive concerns. Health anxiety shared a stronger association with anxiety sensitivity cognitive concerns when coupled with severe, relative to mild, somatic symptoms. Contrary to predictions, the interactive effect was not associated with the other dimensions of anxiety sensitivity. We discuss the potential relevancy of anxiety sensitivity cognitive concerns to the combined presentation of health anxiety and severe somatic symptoms, as well as how this dimension of anxiety sensitivity could be treated in primary care settings.

  13. Self-Selected Walking Speed is Predictive of Daily Ambulatory Activity in Older Adults. (United States)

    Middleton, Addie; Fulk, George D; Beets, Michael W; Herter, Troy M; Fritz, Stacy L


    Daily ambulatory activity is associated with health and functional status in older adults; however, assessment requires multiple days of activity monitoring. The objective of this study was to determine the relative capabilities of self-selected walking speed (SSWS), maximal walking speed (MWS), and walking speed reserve (WSR) to provide insight into daily ambulatory activity (steps per day) in community-dwelling older adults. Sixty-seven older adults completed testing and activity monitoring (age 80.39 [6.73] years). SSWS (R2 = .51), MWS (R2 = .35), and WSR calculated as a ratio (R2 = .06) were significant predictors of daily ambulatory activity in unadjusted linear regression. Cutpoints for participants achieving < 8,000 steps/day were identified for SSWS (≤ 0.97 m/s, 44.2% sensitivity, 95.7% specificity, 10.28 +LR, 0.58 -LR) and MWS (≤ 1.39 m/s, 60.5% sensitivity, 78.3% specificity, 2.79 +LR, 0.50 -LR). SSWS may be a feasible proxy for assessing and monitoring daily ambulatory activity in older adults.

  14. 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


    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

  15. A highly sensitive and simply operated protease sensor toward point-of-care testing. (United States)

    Park, Seonhwa; Shin, Yu Mi; Seo, Jeongwook; Song, Ji-Joon; Yang, Haesik


    Protease sensors for point-of-care testing (POCT) require simple operation, a detection period of less than 20 minutes, and a detection limit of less than 1 ng mL(-1). However, it is difficult to meet these requirements with protease sensors that are based on proteolytic cleavage. This paper reports a highly reproducible protease sensor that allows the sensitive and simple electrochemical detection of the botulinum neurotoxin type E light chain (BoNT/E-LC), which is obtained using (i) low nonspecific adsorption, (ii) high signal-to-background ratio, and (iii) one-step solution treatment. The BoNT/E-LC detection is based on two-step proteolytic cleavage using BoNT/E-LC (endopeptidase) and l-leucine-aminopeptidase (LAP, exopeptidase). Indium-tin oxide (ITO) electrodes are modified partially with reduced graphene oxide (rGO) to increase their electrocatalytic activities. Avidin is then adsorbed on the electrodes to minimize the nonspecific adsorption of proteases. Low nonspecific adsorption allows a highly reproducible sensor response. Electrochemical-chemical (EC) redox cycling involving p-aminophenol (AP) and dithiothreitol (DTT) is performed to obtain a high signal-to-background ratio. After adding a C-terminally AP-labeled oligopeptide, DTT, and LAP simultaneously to a sample solution, no further treatment of the solution is necessary during detection. The detection limits of BoNT/E-LC in phosphate-buffered saline are 0.1 ng mL(-1) for an incubation period of 15 min and 5 fg mL(-1) for an incubation period of 4 h. The detection limit in commercial bottled water is 1 ng mL(-1) for an incubation period of 15 min. The developed sensor is selective to BoNT/E-LC among the four types of BoNTs tested. These results indicate that the protease sensor meets the requirements for POCT.

  16. Clinical Assessment Applications of Ambulatory Biosensors (United States)

    Haynes, Stephen N.; Yoshioka, Dawn T.


    Ambulatory biosensor assessment includes a diverse set of rapidly developing and increasingly technologically sophisticated strategies to acquire minimally disruptive measures of physiological and motor variables of persons in their natural environments. Numerous studies have measured cardiovascular variables, physical activity, and biochemicals…

  17. Predicting recovery at home after Ambulatory Surgery

    Directory of Open Access Journals (Sweden)

    Ayala Guillermo


    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

  18. 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


    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.

  19. Acceptance and side effects of ambulatory blood pressure monitoring: evaluation of a new technology. (United States)

    Beltman, F W; Heesen, W F; Smit, A J; May, J F; Lie, K I; Meyboom-de Jong, B


    Ambulatory blood pressure (BP) monitoring is probably becoming a clinically useful procedure for the evaluation of hypertensive patients. Previous reports have shown that the devices are safe and serious side effects are rare. Discomfort and inconveniences associated with its use are more frequent. In this study, patient acceptance of ambulatory blood pressure monitoring (ABPM) was compared with acceptance of other diagnostic procedures and their side effects were assessed. Patients were asked to fill in a form and 129 of 166 patients responded. The acceptance was measured with a visual analogue scale which ranged from 'very annoying' on the left to 'not annoying at all' on the right. All forms were collected anonymously. Mean distance (cm) of the visual likert scale was 8.6 to 9.4 for the diagnostic procedures frequently used in routine patient care. Ambulatory BP measurement (ABPM) scored 6.1 cm. Reported side effects (in 27% of patients) were: plan (9%), skin irritation (8%), noisy device (8%), inconvenience with work (3%), haematoma (2%) and other (4%). Reports from the patients on sleep quality were: 23% normal, 61% minor disturbance, 14% had sleep, and 2% did not sleep at all. It can be concluded that ambulatory BP monitoring was the diagnostic procedure with the lowest patient acceptance. Side effects of this new technology were reported by 27% of patients. However, risks are relatively minor. Sleep disturbances were very frequent and was a serious problem for 16% of patients.

  20. Ambulatory surgery center market share and rates of outpatient surgery in the elderly. (United States)

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


    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.

  1. Continuous ambulatory peritoneal dialysis: nurses' experiences of teaching patients. (United States)

    Shubayra, Amnah


    Nine nurses were interviewed to determine nurses' experiences of teaching patients to use continuous ambulatory peritoneal dialysis (CAPD). The material was analyzed using content analysis. Data were sorted into four themes and ten subthemes. The themes were presented as follows: Importance of language, individualized teaching, teaching needs and structure of care in teaching. The findings highlighted important insights into how nurses experience teaching patients to perform CAPD. The study revealed some barriers for the nurses during teaching. The major barrier was shortage of Arabic speaking nursing staff. Incidental findings involved two factors that played an important role in teaching, retraining and a special team to perform pre-assessments, including home visits. In conclusion, the findings of this study showed several factors that are considered as barriers for the nurses during teaching the CAPD patients and the need to improve the communication and teaching in the peritoneal dialysis units, including the importance of individualized teaching.

  2. Eliminating lateral violence in the ambulatory setting: one center's strategies. (United States)

    Dimarino, Tina J


    Lateral violence (eg, disruptive, disparaging, or uncivil behavior inflicted by one peer on another) creates an unpleasant work environment that can have harmful effects on individual nurses, team members, patients, and the bottom line of the health care organization. Educating nurses about the most common forms of lateral violence and strategies for handling inappropriate behavior can be the first step toward eliminating this behavior. Effective nursing leaders develop and maintain a "zero-tolerance" culture that includes clear and concise behavioral expectations and consequences for employees who exhibit unprofessional behavior. Use of a code of conduct, open communication, and quick resolution of issues that arise are strategies that one ambulatory surgery center has used to successfully combat lateral violence in the workplace.

  3. Modifications to the postanesthesia score for use in ambulatory surgery. (United States)

    Aldrete, J A


    The Aldrete Score has withstood the changes in anesthesia and surgical care that have developed in the past three decades. Nevertheless, it is imperative that (1) a modification is made to incorporate the most effective monitor of the respiratory and hemodynamic functions, e.g., pulse oximetry; and (2) the five indices previously used be expanded by incorporating five more indices including dressing, pain, ambulation, fasting/feeding, and urine output to evaluate patients undergoing ambulatory surgery and anesthesia. A patient's recovery from anesthesia and surgery, using 10 indices graded 0, 1, or 2, would provide criteria for street fitness and discharge to home when the patient reaches a postanesthesia recovery score of 18 or higher.

  4. 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


    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....

  5. Medication-related problem type and appearance rate in ambulatory hemodialysis patients


    Drayer Debra K; Manley Harold J; Muther Richard S


    Abstract Background Hemodialysis (HD) patients are at risk for medication-related problems (MRP). The MRP number, type, and appearance rate over time in ambulatory HD patients has not been investigated. Methods Randomly selected HD patients were enrolled to receive monthly pharmaceutical care visits. At each visit, MRP were identified through review of the patient chart, electronic medical record, patient interview, and communications with other healthcare disciplines. All MRP were categorize...

  6. Targeting Medicare consumers. Managed care providers can make inroads by understanding preference and cost-sensitivity issues. (United States)

    Stensrud, J; Sylvestre, E; Sivadas, E


    The authors' conjoint study provided valuable information on the preferences of the hugh Medicare-eligible and soon-to-be-eligible markets. Leading the list were hospitalization coverage, skilled nursing facilities, and out-of-area coverage. The task of defining choice sets was made easier and more meaningful by selecting the top six attributes for each respondent. Asking respondents to rank levels within each attribute and assessing the importance of the various levels provided a more robust estimate of consumer preferences. Using an innovative price-sensitivity method preserved the integrity of the data. The method minimized respondent fatigue and enabled the authors to gather price-sensitivity data from respondents who were not actually paying for their health services. Respondents preferred Supplemental F and Medicare products even though they placed more value on the qualities of alternative health care products. This suggests that managed care providers need to change consumer perceptions about their products.

  7. Antibiotic sensitivity of Enterobacteriaceae at a tertiary care center in India

    Directory of Open Access Journals (Sweden)

    Summaiya Mulla


    Full Text Available Aims and Objectives: It has been observed that various microorganisms are acquiring resistance to most of the available potent antibiotics; hence, there is a need for every hospital to follow the use of antibiotics according to antibiotic sensitivity pattern in that particular hospital or geographical area. It has been reported that Enterobacteriaceae group of microorganisms are increasingly acquiring resistance to many antibiotics and this resistance varies geographically. As there is a short of recent data with respect to Indian hospital, this particular study was designed with the aim of establishing sensitivity pattern of Enterobacteriaceae group of microorganisms to various antibiotics. Materials and Methods: Data of antibiotic sensitivity from December 2010 to April 2011 of different Enterobacteriaceae was taken from the Department of Microbiology, Govt. Medical College, Surat. Sensitivity of different Enterobacteriaceae was shown as using descriptive statistics. Results: E. coli (55.6% and Klebsiella (31.2% were the most frequent bacteria isolated. Enterobacteriaceae were very less sensitive to amoxicillin + clavulanic acid (13.7%, chloramphenicol (7.6%, cefoperazone (14.4%, cefixime (15.7%, and cefuroxime (17.6. Sensitivity to aztreonam was 32.7%. Sensitivity to carbapenem group of drugs included in this study, i.e., meropenem was 69.8%. Highest sensitivity was shown for ceftazidime (74.1%. E. coli is more sensitive to meropenem as compared with Klebsiella. Conclusion: Sensitivity of Enterobacteriaceae group of microorganisms to known antibiotics is decreasing. Decreased sensitivity to carbapenem group of antibiotics is a matter of concern.

  8. How Does Sensitivity Training of Health Care Workers Impact Patient Satisfaction? (United States)

    De Vinci, Katrina Marie


    Health care of the 21st century is undergoing major changes due to a myriad of social factors affecting every level of society. From financial desperation due to the high cost of health care to the increased awareness of a generation asking for better services, the importance of patient satisfaction is paramount. The Centers for Medicare and…

  9. Sensitivity of surveillance testing for multidrug-resistant Gram-negative bacteria in the intensive care unit. (United States)

    Ridgway, Jessica P; Peterson, Lance R; Thomson, Richard B; Miller, Becky A; Wright, Marc-Oliver; Schora, Donna M; Robicsek, Ari


    We tested intensive care unit patients for colonization with multidrug-resistant Gram-negative bacilli (MDR GNB) and compared the results with those of concurrent clinical cultures. The sensitivity of the surveillance test for detecting MDR GNB was 58.8% (95% confidence interval, 48.6 to 68.5%). Among 133 patients with positive surveillance tests, 61% had no prior clinical culture with MDR GNB.

  10. 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


    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.

  11. Advances in ambulatory monitoring: regulatory considerations. (United States)

    Buckles, David; Aguel, Felipe; Brockman, Randall; Cheng, James; Demian, Cindy; Ho, Charles; Jensen, Donald; Mallis, Elias


    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. Cochlear implant in an ambulatory surgery center. (United States)

    Joseph, Aimee M; Lassen, L Frederick


    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.

  13. Anticoagulation management in the ambulatory surgical setting. (United States)

    Eisenstein, Diana Hill


    Many people receiving maintenance anticoagulation therapy require surgery each year in ambulatory surgery centers. National safety organizations focus attention toward improving anticoagulation management, and the American College of Chest Physicians has established guidelines for appropriate anticoagulation management to balance the risk of thromboembolism when warfarin is discontinued with the risk of bleeding when anticoagulation therapy is maintained. The guidelines recommend that patients at high or moderate risk for thromboembolism should be bridged with subcutaneous low-molecular-weight heparin or IV unfractionated heparin with the interruption of warfarin, and low-risk patients may require subcutaneous low-molecular-weight heparin or no bridging with the interruption of warfarin. The guidelines recommend the continuation of warfarin for patients who are undergoing minor dermatologic or dental procedures or cataract removal. The literature reveals, however, that there is not adequate adherence to these recommendations and guidelines. Management of anticoagulation therapy by a nurse practitioner may improve compliance and safety in ambulatory surgery centers.

  14. 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


    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

  15. Ambulatory Blood Pressure Monitoring in the Elderly


    Juan Diego Mediavilla García; Fernando Jaén Águila; Celia Fernández Torres; Blas Gil Extremera; Juan Jiménez Alonso


    The incidence of hypertension is high in the elderly and is present in 2/3 of the patients older than 65 years. Prevalence can reach 90% in patients older than 80 years. The presence of isolated systolic hypertension (ISH) is characteristic of this population. However, the prevalence of hypertension by ambulatory blood pressure monitoring (ABPM) is not well known. In this study, we analyzed the special characteristics of hypertension in this population, giving special emphasis on ABPM readings.

  16. Ambulatory Blood Pressure Monitoring in Clinical Practice: A Review


    Turner, J. Rick; Viera, Anthony J.; Shimbo, Daichi


    Ambulatory blood pressure monitoring offers the ability to collect blood pressure readings several times an hour across a 24-hour period. Ambulatory blood pressure monitoring facilitates the identification of white-coat hypertension, the phenomenon whereby certain individuals who are not on antihypertensive medication show elevated blood pressure in a clinical setting but show non-elevated blood pressure averages when assessed by ambulatory blood pressure monitoring. Additionally, readings ca...

  17. Ambulatory anesthesia: optimal perioperative management of the diabetic patient


    Polderman JAW; van Wilpe R; Eshuis JH; Preckel B; Hermanides J


    Jorinde AW Polderman, Robert van Wilpe, Jan H Eshuis, Benedikt Preckel, Jeroen Hermanides Department of Anaesthesiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands Abstract: Given the growing number of patients with diabetes mellitus (DM) and the growing number of surgical procedures performed in an ambulatory setting, DM is one of the most encountered comorbidities in patients undergoing ambulatory surgery. Perioperative management of ambulatory patients wi...

  18. Making sense of high sensitivity troponin assays and their role in clinical care. (United States)

    Daniels, Lori B


    Cardiac troponin assays have an established and undisputed role in the diagnosis and risk stratification of patients with acute myocardial infarction. As troponin assays gets more sensitive and more precise, the number of potential uses has rapidly expanded, but the use of this test has also become more complicated and controversial. Highly sensitive troponin assays can now detect troponin levels in most individuals, but accurate interpretation of these levels requires a clear understanding of the assay in the context of the clinical scenario. This paper provides a practical and up-to-date overview of the uses of highly sensitive troponin assays for diagnosis, prognosis, and risk stratification in clinical practice.

  19. Determining resource intensity weights in ambulatory chemotherapy related to nursing workload. (United States)

    Green, Esther; Preyra, Colin; Stewart, Janice; McLennan, Cindy; Bland, Rosemary; Dus, Tamara; Langhorn, Marcia; Beattie, Kathy; Cheung, Annie; Hertz, Sherrie; Sechter, Haim; Burns, Judy; Angus, Helen; Sawka, Carol


    Ontario cancer programs aim to deliver high-quality nursing care and treatment that is safe for patients and staff. The reality of health care is that financial constraints, inherent in the delivery of care, require that funding mechanisms count not only the cost of drugs, but factors such as pharmacy and nursing human resource costs. While some organizations have developed patient classification systems to measure nursing intensity and workload, these systems apply primarily to inpatient populations, and are fraught with numerous challenges, such as the need for nurses to document to justify the workload required for care. The purpose of this paper is to outline the methodology and engagement of nurses to develop regimen-based resource intensity weights that can be applied to ambulatory chemotherapy suites. The methodology included determination of workload related to nursing time to prepare, teach, counsel and assess patients, as well as time to gather supplies, access lines, monitor, manage adverse reactions, manage symptoms and document care. Resource intensity weights provide better measures of the complexity of care required by cancer patients in ambulatory settings.

  20. Volume of Cataract Surgery and Surgeon Gender: The Florida Ambulatory Surgery Center Experience 2005 Through 2012. (United States)

    French, Dustin D; Margo, Curtis E; Campbell, Robert R; Greenberg, Paul B


    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.

  1. High sensitivity point-of-care device for direct virus diagnostics

    DEFF Research Database (Denmark)

    Kiilerich-Pedersen, Katrine; Dapra, Johannes; Cherré, Solène


    Influenza infections are associated with high morbidity and mortality, carry the risk of pandemics, and pose a considerable economic burden worldwide. To improve the management of the illness, it is essential with accurate and fast point-of-care diagnostic tools for use in the field or at the pat......Influenza infections are associated with high morbidity and mortality, carry the risk of pandemics, and pose a considerable economic burden worldwide. To improve the management of the illness, it is essential with accurate and fast point-of-care diagnostic tools for use in the field...... of its usability. An all polymer microfluidic system with a functionalized conductive polymer (PEDOT-OH:TsO) microelectrode array was developed and exploited for label free and real time electrochemical detection of intact influenza A virus (H1N1) particles. DNA aptamers with affinity for influenza...

  2. The Process of Interactional Sensitivity Coding in Health Care: Conceptually and Operationally Defining Patient-Centered Communication. (United States)

    Sabee, Christina M; Koenig, Christopher J; Wingard, Leah; Foster, Jamie; Chivers, Nick; Olsher, David; Vandergriff, Ilona


    This study aimed to develop a process for measuring sensitivity in provider-patient interactions to better understand patient-centered communication. The authors developed the Process of Interactional Sensitivity Coding in Healthcare (PISCH) by incorporating a multimethod investigation into conversations between physicians and their patients with type 2 diabetes. The PISCH was then applied and assessed for its reliability across the unitization of interactions, the activities that were reflected, and the characteristics of patient-centered interactional sensitivity that were observed within each unit. In most cases, the PISCH resulted in reliable analysis of the interactions, but a few key areas (shared decision making, enabling self-management, and responding to emotion) were not reliably assessed. Implications of the test of this coding scheme include the expansion of the theoretical notion of interactional sensitivity to the health care context, rigorous implementation of a multimethod measurement development that relied on qualitative and quantitative assessments, and important future questions about the role of communication concepts in future interpersonal research.

  3. Anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and disorders among Latinos in primary care. (United States)

    Zvolensky, Michael J; Bakhshaie, Jafar; Garza, Monica; Valdivieso, Jeanette; Ortiz, Mayra; Bogiaizian, Daniel; Robles, Zuzuky; Vujanovic, Anka


    The present investigation examined the interactive effects of anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and psychopathology among 143 Latinos (85.7% female; Mage=39.0, SD=10.9; 97.2% used Spanish as their first language) who attended a community-based primary healthcare clinic. Results indicated that the interaction between anxiety sensitivity and subjective social status was significantly associated with number of mood and anxiety disorders, panic, social anxiety, and depressive symptoms. The form of the significant interactions indicated that individuals reporting co-occurring higher levels of anxiety sensitivity and lower levels of subjective social status evidenced the greatest levels of psychopathology and panic, social anxiety, and depressive symptoms. The present findings suggest that there is merit in focusing further scientific attention on the interplay between anxiety sensitivity and subjective social status in regard to understanding, and thus, better intervening to reduce anxiety/depressive vulnerability among Latinos in primary care.

  4. Variation In Accountable Care Organization Spending And Sensitivity To Risk Adjustment: Implications For Benchmarking. (United States)

    Rose, Sherri; Zaslavsky, Alan M; McWilliams, J Michael


    Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients.

  5. Computer aided diagnosis for mental health care : On the clinical validation of sensitive machines

    NARCIS (Netherlands)

    Sluis, F. van der; Dijkstra, T.; Broek, E.L. van den


    This study explores the feasibility of sensitive machines; that is, machines with empathic abilities, at least to some extent. A signal processing and machine learning pipeline is presented that is used to analyze data from two studies in which 25 Post-Traumatic Stress Disorder (PTSD) patients parti

  6. Rapid, high sensitivity, point-of-care test for cardiac troponin based on optomagnetic biosensor

    NARCIS (Netherlands)

    Dittmer, W.U.; Evers, T.H.; Hardeman, W.M.; Huijnen-Keur, W.M.; Kamps, R.; De Kievit, P.; Neijzen, J.H.M.; Sijbers, M.J.J.; Nieuwenhuis, J.H.; Hefti, M.H.; Dekkers, D.; Martens, M.


    BACKGROUND: We present a handheld integrated device based on a novel magnetic-optical technology for the sensitive detection of cardiactroponin I, a biomarker for the positive diagnosis of myocardial infarct, in a finger-prick blood sample. The test can be performed with a turn-around time of 5 min

  7. Sensitive Periods of Emotion Regulation: Influences of Parental Care on Frontoamygdala Circuitry and Plasticity (United States)

    Gee, Dylan G.


    Early caregiving experiences play a central role in shaping emotional development, stress physiology, and refinement of limbic circuitry. Converging evidence across species delineates a sensitive period of heightened neuroplasticity when frontoamygdala circuitry is especially amenable to caregiver inputs early in life. During this period, parental…

  8. Utilization of lean management principles in the ambulatory clinic setting. (United States)

    Casey, Jessica T; Brinton, Thomas S; Gonzalez, Chris M


    The principles of 'lean management' have permeated many sectors of today's business world, secondary to the success of the Toyota Production System. This management method enables workers to eliminate mistakes, reduce delays, lower costs, and improve the overall quality of the product or service they deliver. These lean management principles can be applied to health care. Their implementation within the ambulatory care setting is predicated on the continuous identification and elimination of waste within the process. The key concepts of flow time, inventory and throughput are utilized to improve the flow of patients through the clinic, and to identify points that slow this process -- so-called bottlenecks. Nonessential activities are shifted away from bottlenecks (i.e. the physician), and extra work capacity is generated from existing resources, rather than being added. The additional work capacity facilitates a more efficient response to variability, which in turn results in cost savings, more time for the physician to interact with patients, and faster completion of patient visits. Finally, application of the lean management principle of 'just-in-time' management can eliminate excess clinic inventory, better synchronize office supply with patient demand, and reduce costs.

  9. Using the ecology model to describe the impact of asthma on patterns of health care

    Directory of Open Access Journals (Sweden)

    Yawn Barbara P


    Full Text Available Abstract Background Asthma changes both the volume and patterns of healthcare of affected people. Most studies of asthma health care utilization have been done in selected insured populations or in a single site such as the emergency department. Asthma is an ambulatory sensitive care condition making it important to understand the relationship between care in all sites across the health service spectrum. Asthma is also more common in people with fewer economic resources making it important to include people across all types of insurance and no insurance categories. The ecology of medical care model may provide a useful framework to describe the use of health services in people with asthma compared to those without asthma and identify subgroups with apparent gaps in care. Methods This is a case-control study using the 1999 U.S. Medical Expenditure Panel Survey. Cases are school-aged children (6 to 17 years and young adults (18 to 44 years with self-reported asthma. Controls are from the same age groups who have no self-reported asthma. Descriptive analyses and risk ratios are placed within the ecology of medical care model and used to describe and compare the healthcare contact of cases and controls across multiple settings. Results In 1999, the presence of asthma significantly increased the likelihood of an ambulatory care visit by 20 to 30% and more than doubled the likelihood of making one or more visits to the emergency department (ED. Yet, 18.8% of children and 14.5% of adults with asthma (over a million Americans had no ambulatory care visits for asthma. About one in 20 to 35 people with asthma (5.2% of children and 3.6% of adults were seen in the ED or hospital but had no prior or follow-up ambulatory care visits. These Americans were more likely to be uninsured, have no usual source of care and live in metropolitan areas. Conclusion The ecology model confirmed that having asthma changes the likelihood and pattern of care for Americans

  10. An Ambulatory Program for Surgical Residents and Medical Students. (United States)

    Levy, Margaret


    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)

  11. Using cadence to study free-living ambulatory behaviour. (United States)

    Tudor-Locke, Catrine; Rowe, David A


    The health benefits of a physically active lifestyle across a person's lifespan have been established. If there is any single physical activity behaviour that we should measure well and promote effectively, it is ambulatory activity and, more specifically, walking. Since public health physical activity guidelines include statements related to intensity of activity, it follows that we need to measure and promote free-living patterns of ambulatory activity that are congruent with this intent. The purpose of this review article is to present and summarize the potential for using cadence (steps/minute) to represent such behavioural patterns of ambulatory activity in free-living. Cadence is one of the spatio-temporal parameters of gait or walking speed. It is typically assessed using short-distance walks in clinical research and practice, but free-living cadence can be captured with a number of commercially available accelerometers that possess time-stamping technology. This presents a unique opportunity to use the same metric to communicate both ambulatory performance (assessed under testing conditions) and behaviour (assessed in the real world). Ranges for normal walking cadence assessed under laboratory conditions are 96-138 steps/minute for women and 81-135 steps/minute for men across their lifespan. The correlation between mean cadence and intensity (assessed with indirect calorimetry and expressed as metabolic equivalents [METs]) based on five treadmill/overground walking studies, is r = 0.93 and 100 steps/minute is considered to be a reasonable heuristic value indicative of walking at least at absolutely-defined moderate intensity (i.e. minimally, 3 METs) in adults. The weighted mean cadence derived from eight studies that have observed pedestrian cadence under natural conditions was 115.2 steps/minute, demonstrating that achieving 100 steps/minute is realistic in specific settings that occur in real life. However, accelerometer data collected in a large

  12. Evaluation of portable point-of-care CD4 counter with high sensitivity for detecting patients eligible for antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    Yukari C Manabe

    Full Text Available BACKGROUND: Accurate, inexpensive point-of-care CD4+ T cell testing technologies are needed that can deliver CD4+ T cell results at lower level health centers or community outreach voluntary counseling and testing. We sought to evaluate a point-of-care CD4+ T cell counter, the Pima CD4 Test System, a portable, battery-operated bench-top instrument that is designed to use finger stick blood samples suitable for field use in conjunction with rapid HIV testing. METHODS: Duplicate measurements were performed on both capillary and venous samples using Pima CD4 analyzers, compared to the BD FACSCalibur (reference method. The mean bias was estimated by paired Student's t-test. Bland Altman plots were used to assess agreement. RESULTS: 206 participants were enrolled with a median CD4 count of 396 (range; 18-1500. The finger stick PIMA had a mean bias of -66.3 cells/µL (95%CI -83.4-49.2, P500 cells/µL with a mean bias of -120.6 (95%CI -162.8, -78.4, P<0.001. The sensitivity (95%CI of the Pima CD4 analyzer was 96.3% (79.1-99.8% for a <250 cells/ul cut-off with a negative predictive value of 99.2% (95.1-99.9%. CONCLUSIONS: The Pima CD4 finger stick test is an easy-to-use, portable, relatively fast device to test CD4+ T cell counts in the field. Issues of negatively-biased CD4 cell counts especially at higher absolute numbers will limit its utility for longitudinal immunologic response to ART. The high sensitivity and negative predictive value of the test makes it an attractive option for field use to identify patients eligible for ART, thus potentially reducing delays in linkage to care and ART initiation.

  13. No systemic reactions to influenza vaccination in egg-sensitized tertiary-care pediatric patients

    Directory of Open Access Journals (Sweden)

    Upton Julia


    Full Text Available Abstract Background There are numerous, disparate guidelines for influenza vaccination in egg-allergic patients. We aimed to describe the outcome of selectively applied guidelines, based on risk-stratification, to our high risk, egg-allergic, tertiary-care pediatric population. Methods Egg allergy was confirmed with skin testing. The vaccine administered was an adjuvunated 2009 H1N1 influenza A vaccine with Results Ninety-nine patients were referred and 79 had positive egg testing. Asthma was present in 67% and 30% had prior anaphylaxis to egg. We vaccinated 77 of 79 patients: 71 without performing vaccine skin testing. Two refused vaccination. No patient had a systemic reaction or required treatment. Two patients experienced positive testing to the adjuvanated intradermal vaccine, but were negative without adjuvant. Conclusions Our results suggest that most egg-allergic tertiary care pediatric patients can be vaccinated with a low ovalbumin content influenza vaccine without prior vaccine testing. Vaccine skin testing, if used at all, can be reserved for special circumstances. The squalene adjuvant may cause an irritant reaction with intradermal testing.

  14. 76 FR 6572 - Non-Ambulatory Disabled Veal Calves and Other Non-Ambulatory Disabled Livestock at Slaughter... (United States)


    ... inspection regulations to prohibit the slaughter of non-ambulatory disabled pigs, sheep, goats, and other... the mother's colostrum, iron deficient diets, intensive confinement, and lack of activity, result in... to require that non- ambulatory disabled pigs, sheep, goats, and other amenable livestock species...

  15. Ambulatory blood pressure values in healthy children

    Directory of Open Access Journals (Sweden)

    Paripović Dušan


    Full Text Available Ambulatory blood pressure monitoring (ABPM is an important tool in the diagnosis and management of childhood hypertension. Normal ambulatory blood pressure (ABP values in children with body heights between 100 and 120 cm have not been reported. The aim of the study was to establish the normal range of values for ABPM in these children. 24-hour ABPM was performed in 40 normotensive (auscultatory casual blood pressure was obtained before ABPM subjects, aged from 4 to 6 years (26 males, 14 females with body heights between 95 and 125 cm. ABPM was carried out on non-dominant arm using the oscillometric device (SpaceLab 90207 with appropriate cuff size. The monitor was programmed to measure BP every 15 min. during the day (6 a.m. to 10 p.m. and every 30 min. during the night (10 p.m. to 6 a.m.. The mean daytime SBP/DBP in boys and girls was 108+/-6/67+/-5 and 105+/-5/66+/-1, respectively. The mean nighttime SBP/DBP in boys and girls was 98+/-6/56+/-5 and 97+/-7/56+/-4, respectively. There was a significant difference between day and night readings of SBP, DBP and heart rate (nocturnal fall was observed. The distribution of ABP noted in this study could serve as preliminary reference. A multicenter study should be performed to provide normal ranges of ABP.

  16. Point-Of-Care p24 Infant Testing for HIV May Increase Patient Identification despite Low Sensitivity (United States)

    Bollinger, Timothy; Mabunda, Nédio; Vubil, Adolfo; Tobaiwa, Ocean; Quevedo, Jorge I.; Loquiha, Osvaldo; Vojnov, Lara; Peter, Trevor F.; Jani, Ilesh V.


    The long delay in returning test results during early infant diagnosis of HIV (EID) often causes loss-to-follow-up prior to antiretroviral treatment (ART) initiation in resource-limited settings. A point-of-care (POC) test may help overcome these challenges. We evaluated the performance of the LYNX p24 Antigen POC test in Mozambique. 879 HIV-exposed infants under 18 months of age were enrolled consecutively at three primary healthcare clinics (PHC). Lancet heel-drawn blood was tested on-site by nurses using a prototype POC test for HIV Gag p24 antigen detection. Results of POC testing were compared to laboratory-based nucleic acid testing on dried blood spots. A comparison of the effect of sensitivity and timely test results return on successful diagnosis by POC and laboratory-based platforms was also calculated. The sensitivity and specificity of the LYNX p24 Ag test were 71.9%; (95% confidence interval [CI]: 58.5–83.0%) and 99.6% (95% CI: 98.9–99.9%), respectively. The predictive value of positive and negative tests were 93.2% (95% CI: 81.3–98.6%) and 97.9% (95% CI: 96.8–98.8%), respectively. Overall agreement was high (Cohen Kappa = 0.80; 95% CI: 0.71–0.89). Despite its lower sensitivity, the POC test had the potential to provide test results to up to 81% more patients compared to the laboratory-based test. This prototype POC p24 assay was feasible for use in PHCs but demonstrated low sensitivity for HIV detection. POC EID technologies that perform below standard recommendations may still be valuable diagnostic tools in settings with inefficient EID networks. PMID:28060886

  17. Ambulatory Patient Groups. An Evaluation for Military Health Care Use (United States)


    Cerebrovascular Events 737 Headache 738 Central Nervous System Diseases Except TIA, CVA, and Headache EYE DISEASES 751 Cataracts 752 Refraction Disorder 753...Child Neglect V6124 V6120 Suspected Child Abuse V6125 V6121 Confirmed Child Abuse V6126 V6121 Non- Accidental Trauma V6180 V618 Other Specified Family...Occlusion of Cerebral Arteries 435 4359 Transient Cerebral Ischemia 43591 4359 Trans lschemic Attck w/Neuro Def (Rine) 4361 436 Cerebrovascular Accident

  18. Air Force Aerospace Medicine Enterprise Ambulatory Medical Care Survey (United States)


    2 28.57 - - - - - - 1 100.00 Distortion Product Evoked Otoacoustic Emissions 1 7.14 - - 1 100.00... DME and supplies 400 7.68 34 7.67 57 13.73 62 14.76 41 10.41 28 8.83 27 10.00 27 7.12 22 4.26 48 7.66 54 3.79 Traction, splints, and other wound...5.66 52 7.41 59 6.99 153 5.49 DME and supplies 484 6.35 41 7.50 69 12.90 75 15.09 53 10.71 43 10.89 30 9.17 30 6.06 25 3.56 59 6.99 59 2.12

  19. Walsh-Hadamard Based 3D Steganography for Protecting Sensitive Information in Point-of-Care. (United States)

    Abuadbba, Alsharif; Khalil, Ibrahim


    Remote points-of-care has recently had a lot of attention for their advantages such as saving lives and cost reduction. The transmitted streams usually contain (1) normal biomedical signals (e.g. ECG) and (2) highly private information (e.g. patient identity). Despite the obvious advantages, the primary concerns are privacy and authenticity of the transferred data. Therefore, this paper introduces a novel steganographic mechanism that ensures (1) strong privacy preservation of private information by random concealing inside the transferred signals employing a key, and (2) evidence of originality for the biomedical signals. To maximize hiding, Fast Walsh-Hadamard Transform is utilized to transform the signals into a group of coefficients. To ensure the lowest distortion, only less-significant values of coefficients are employed. To strengthen security, the key is utilized in a 3-Dimensional random coefficients' reform to produce a 3D order employed in the concealing process. The resultant distortion has been thoroughly measured in all stages. After extensive experiments on three types of signals, it has been proven that the algorithm has little impact on the genuine signals (< 1 %). The security evaluation also confirms that unlawful retrieval of the hidden information within rational time is mightily improbable.

  20. Efficacy of the combined use of a facial cleanser and moisturizers for the care of mild acne patients with sensitive skin. (United States)

    Isoda, Kenichi; Seki, Tsuyoshi; Inoue, Yosuke; Umeda, Koji; Nishizaka, Takahiro; Tanabe, Hisateru; Takagi, Yutaka; Ishida, Koichi; Mizutani, Hitoshi


    Acne is a common skin disease that involves the seborrheic area of the face and results from the obstruction of hair follicles followed by inflammation. Careful face washing helps to improve and prevent acne; however, intensive washing has a risk of inducing skin barrier impairment and dry skin, especially in sensitive skin. We hypothesized that skin care combining mild skin cleansing and intensive moisturizing ("combination skin care") may be effective in the care of acne in subjects with dry skin and/or sensitive skin. We developed a combination skin care with a weakly acidic foaming facial skin cleanser based on a mild detergent, an aqueous lotion with eucalyptus extract and a moisturizing gel containing pseudo-ceramide and eucalyptus extract. To optimize an ideal facial skin care system for mild acne on sensitive skin, we performed a 4-week clinical trial with 29 post-adolescent Japanese women with mild acne with dry and sensitive skin. The acne significantly decreased after this trial accompanied by the improvement of dry skin, a significantly increased endogenous ceramide level in the stratum corneum and an elongated alkyl chain length of the non-hydroxy acyl sphingosine type ceramide. No adverse events due to the test samples were observed. Based on diagnosis by a dermatologist, 97% of the subjects found the combination skin care to be "useful" or "slightly useful". Based on these findings, the combined use of a facial skin cleanser and moisturizers is safe and effective for the care of acne in post-adolescent Japanese women with sensitive skin.

  1. [Molecular epidemiologic surveillance and antifungal agent sensitivity of Candida albicans isolated from anesthesia intensive care units]. (United States)

    Gülay, Zeynep; Ergon, Cem; Ozkütük, Aydan; Yücesoy, Mine; Biçmen, Meral


    Patients in intensive care units (ICU) are at risk of nosocomial infections. The incidence of nosocomial fungal infections has increased in parallel with the increase of nosocomial infections. Candida albicans is the most frequent pathogenic species among the fungi. The aim of this study was to make an epidemiological surveillance of C. albicans urine isolates which were isolated from patients who were hospitalized in ICU between June 2000 and October 2001 by antifungal susceptibility testing and Randomly Amplified Polymorphic DNA (RAPD) analysis. For this purpose, 38 C. albicans which were isolated from 29 patients were investigated for amphotericin B and fluconazole susceptibility with the microdilution method. The range of minimal inhibitory concentration (MIC) of amphotericin B was between 0.25-1 microgram/ml and MIC50 value was 0.5 microgram/ml and none of the isolates had high (MIC > 1 microgram/ml) MIC values. The MIC values for fluconazole varied between 0.25-16 micrograms/ml and MIC50 value was 1 microgram/ml. While none of the isolates was resistant to fluconazole, two isolates were detected as dose dependent susceptible. RAPD analysis was performed with two different primers in order to investigate clonal relationship, and 22 patterns were detected with one of the primers and 24 patterns were detected with the other. In conclusion, it is thought that the origin of the C. albicans urine isolates were mostly endogenous but exogenous spread might also be considered as isolates that were clonally related were isolated from different patients at the same time interval.

  2. Computer database of ambulatory EEG signals. (United States)

    Jayakar, P B; Brusse, E; Patrick, J P; Shwedyk, E; Seshia, S S


    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.

  3. A multiplexed microfluidic PCR assay for sensitive and specific point-of-care detection of Chlamydia trachomatis.

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    Deborah Dean

    Full Text Available BACKGROUND: Chlamydia trachomatis (Ct is the most common cause of bacterial sexually transmitted diseases (STD worldwide. While commercial nucleic acid amplification tests (NAAT are available for Ct, none are rapid or inexpensive enough to be used at the point-of-care (POC. Towards the first Ct POC NAAT, we developed a microfluidic assay that simultaneously interrogates nine Ct loci in 20 minutes. METHODOLOGY AND PRINCIPAL FINDINGS: Endocervical samples were selected from 263 women at high risk for Ct STDs (∼35% prevalence. A head-to-head comparison was performed with the Roche-Amplicor NAAT. 129 (49.0% and 88 (33.5% samples were positive by multiplex and Amplicor assays, respectively. Sequencing resolved 71 discrepant samples, confirming 53 of 53 positive multiplex samples and 12 of 18 positive Amplicor samples. The sensitivity and specificity were 91.5% and 100%, and 62.4% and 95.9%, respectively, for multiplex and Amplicor assays. Positive and negative predictive values were 100% and 91%, and 94.1% and 68.6%, respectively. CONCLUSIONS: This is the first rapid multiplex approach to Ct detection, and the assay was also found to be superior to a commercial NAAT. In effect, nine simultaneous reactions significantly increased sensitivity and specificity. Our assay can potentially increase Ct detection in globally diverse clinical settings at the POC.

  4. [Ambulatory ureteral lithotripsy with "Modulith SL-20"]. (United States)

    González Enguita, C; Calahorra Fernández, F J; García de la Peña, E; Rodríguez-Miñón Cifuentes, J L; Vela Navarrete, R


    Analysis of our experience in 'in situ' ambulatory shockwave extracorporeal lithofragmentation of ureteral stones in 104 patients seen in the Lithotrity Unit, Urology Service, Fundación "Jiménez Díaz". Using Modulith SL 20, a third generation lithotripter, 'in situ' disintegration was achieved in 82.69% of cases, 51.92% of which were fragmented in a single lithotrity session. As a first choice, no ureteral handling was used in any of the patients prior to lithotrity. In 9.62% of patients it was necessary to place a 'double J' by-pass catheter, due to the disease presenting with a septic picture. The patient's position was either dorsal or ventral decubitus depending on the lithiatic site, while location and focusing of the stones was done radiologically. All patients were treated ambulatory without hospitalization. Only 18% was given oral or i.v. anaesthesia. Fursemide 40 mg was administered to all patients shortly before starting the session. Each patient received an average of 3,200 shockwaves per session (14-18 Kv, average 16 Kv). Haematuria was the single and modest side effect that happened during the 24 hours following lithofragmentation in 30% of patients, while 20% reported slight discomfort at the time of eliminating the gritted stones. We conclude stating that 'in situ' shockwave extracorporeal lithotrity of ureteral stones with Modulith SL 20 allows for elective disintegration of ureteral stones in whatever location they are found, due to the patient's easy positioning. The simple location and focusing of ureteral stones has allowed us to treat and solve some cases of ureteral lithiasis at the precise moment of the nephritic colic painful emergency, thus speeding up and facilitating the resolution of the condition. Our results and our strategy imply a new change of direction in the management of these lithiasis, as opposed to the well established and historical doctrines in existence regarding stones with ureteral location.

  5. Sensitivity and specificity of a two-question screening tool for depression in a specialist palliative care unit.

    LENUS (Irish Health Repository)

    Payne, Ann


    OBJECTIVES: The primary objective in this study is to determine the sensitivity and specificity of a two-item screening interview for depression versus the formal psychiatric interview, in the setting of a specialist palliative in-patient unit so that we may identify those individuals suffering from depressive disorder and therefore optimise their management in this often-complex population. METHODS: A prospective sample of consecutive admissions (n = 167) consented to partake in the study, and the screening interview was asked separately to the formal psychiatric interview. RESULTS: The two-item questionnaire, achieved a sensitivity of 90.7% (95% CI 76.9-97.0) but a lower specificity of 67.7% (95% CI 58.7-75.7). The false positive rate was 32.3% (95% CI 24.3-41.3), but the false negative rate was found to be a low 9.3% (95% CI 3.0-23.1). A subgroup analysis of individuals with a past experience of depressive illness, (n = 95), revealed that a significant number screened positive for depression by the screening test, 55.2% (16\\/29) compared to those with no background history of depression, 33.3% (22\\/66) (P = 0.045). CONCLUSION: The high sensitivity and low false negative rate of the two-question screening tool will aid health professionals in identifying depression in the in-patient specialist palliative care unit. Individuals, who admit to a previous experience of depressive illness, are more likely to respond positively to the two-item questionnaire than those who report no prior history of depressive illness (P = 0.045).

  6. Validation of a provider self-report inventory for measuring patient-centered cultural sensitivity in health care using a sample of medical students. (United States)

    Mirsu-Paun, Anca; Tucker, Carolyn M; Herman, Keith C; Hernandez, Caridad A


    The paper describes the construction and initial evaluation of the new Tucker-Culturally Sensitive Health Care Inventory (T-CSHCI) Provider Form, which was developed to address the shortcomings of existing similar measures. Two hundred seventeen (217) 3rd and 4th year medical students completed the T-CSHCI-Provider Form. Factor analysis was used to identify non-overlapping items. The final solution produced five factors: patient-centeredness, interpersonal skills, disrespect/disempowerment, competence, and cultural knowledge/responsiveness. The five T-CSHCI-Provider Form factors/subscales proved to be reliable and were associated with related constructs as hypothesized. This study provides initial evidence that the T-CSHCI-Provider Form measures independent dimensions of patient-centered culturally sensitive health care as perceived by medical students. Recommendations for ways in which the T-CSHCI Provider Form can be used to guide culturally sensitive health care training are provided.

  7. Computerized adaptive testing--ready for ambulatory monitoring?

    DEFF Research Database (Denmark)

    Rose, Matthias; Bjørner, Jakob; Fischer, Felix


    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....

  8. Ambulatory Pessary Trial Unmasks Occult Stress Urinary Incontinence

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    Bilal Chughtai


    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.

  9. General practitioner's reported use of clinical guidelines for hypertension and ambulatory blood pressure.

    LENUS (Irish Health Repository)

    Flynn, E


    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.

  10. Pros and cons of the ambulatory surgery center joint venture. (United States)

    Giannini, Deborah


    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.

  11. Older adults' pain communication during ambulatory medical visits: an exploration of communication accommodation theory. (United States)

    Hehl, Jennifer; McDonald, Deborah Dillon


    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. Teamwork in obstetric critical care


    Guise, Jeanne-Marie; Segel, Sally


    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...

  13. Bacteriological profile and antibiotic sensitivity pattern of neonatal septicaemia in a rural tertiary care hospital in North India

    Directory of Open Access Journals (Sweden)

    S Thakur


    Full Text Available Background: There is not much published literature on neonatal septicemia available for the Sub-Himalayan region of North India. Hence, we undertook this study to find out the bacteriological profile and antibiotic sensitivity pattern of neonatal septicemia in the neonatal Intensive Care Unit. Material and Methods: Blood cultures were performed for all clinically suspected neonatal septicemia cases for 1-year. Identification of all pathogenic isolates was followed by antibiotic sensitivity testing. Results: We did blood cultures for 450 neonates and 42% were culture positive. Early onset sepsis were 92 (49% and 96 (51% were late onset sepsis. Gram-positive isolates were 60% and 40% were Gram-negative. Staphylococcus aureus (40%, coagulase negative Staphylococcus species (16%, non-fermenter group of organisms (NFGOs (15%, and Klebsiella pneumoniae (10% were the main isolates. Nasal cannula 101 (54%, birth asphyxia 91 (48%, and prematurity 73 (38% were the prominent risk factors associated with septicemia. Gram-positive organisms were highly resistant to penicillin (87% whereas Gram-negative isolates showed high resistance to third generation cephalosporins (53–89% and aminoglycosides (50–67%. The S. aureus isolates were methicillin-resistant in 41% whereas extended spectrum beta lactamase production was seen in 48% Gram-negative isolates.Conclusion: Our study highlights the recent emergence of Gram-positive organisms as predominant cause of neonatal septicemia in this part of Sub-Himalayan region, along with the review of literature which shows similar results from North India and rest of the world too. Though Gram-negative bacteria still remain the main cause of mortality in neonatal septicemia, we want to dispel the common notion among practitioners that they are the predominant isolates in neonatal septicemia.

  14. The efficacy of ginger added to ondansetron for preventing postoperative nausea and vomiting in ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Pragnadyuti Mandal


    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.

  15. Facilitating Ambulatory Electronic Health Record System Implementation: Evidence from a Qualitative Study

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    Ann Scheck McAlearney


    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.


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    Full Text Available Urinary tract infection (UTI includes a spectrum of Asymptomatic Bacteruria (ABU, Cystitis, Prostitis and Pyelonephritis. Except in ABU, UTI is represented by symptomatic disease that warrants antimicrobial therapy. 1 Many of the studies have shown increasing antibiotic resistance to these agents. This study consists of a retrospective observational study of culture and sensitivity of 150 urinary samples, collected from patients who presented with symptoms of UTI, in a tertiary care teaching hospital, Northern Kerala, irrespective of their age and sex for a period of six months from June 2015 to November 2015. These results are then analyzed to find common organisms causing UTI in different age groups in either sex and their respective antibiotic resistance are noted. Out of 150 urinary samples 69.34% were sterile, while 30.66% were culture positive. Among the culture positive patients sex distribution was almost equal, with a slight female predominance, having a contribution of 54.35% females and 45.65% males. The most common organism was found to be E.coli, which contributed more than 50 per cent of total culture positivity (54.35%. Others include Staphylococci, Klebsiella Pnuemoniae, Proteus species, Pseudomonas, Enterococci, Candida Albicans etc. Collateral damage is an ecological adverse effect that resist the use of a highly efficacious drug to be considered as first line agent. Our study shows that drugs causing minimal collateral damages like Nitrofurantoin and Fosfomycin can be used as first line agent for treatment of UTI.

  17. Spectrum of Microbial Flora in Diabetic Foot Ulcer and Its Antibiotic Sensitivity Pattern in Tertiary Care Hospital in Ahmedabad, Gujarat

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    Manisha Jain


    Full Text Available Introduction: A Prospective study “Spectrum of Microbial flora in diabetic foot ulcer and its antibiotic sensitivity pattern” was carried out in a tertiary care hospital, Ahmedabad on 125 patients in which 85 were male patients and 40 were female patients. Material and Methods: Swabs samples were collected from the edge and margins of ulcers and organism were identified by gram staining culture and biochemical reactions. Results: Out of 125 specimens 108 specimens showed growth of organisms. Total 157 aerobic organisms were isolated from culture positive specimens. It represents an average of 1.25 organisms per case. Among these organisms, 130 gram negative and 27 gram positive organisms were isolated. Pseudomonas aeruginosa (30.57% was predominant organism followed by Klebsiella spp. (22.29%. Staphylococcus aureus were 12.74% in which Methicillin resistant S. aureus (MRSA was 55%. Conclusion: incidence of growth was 86.4% in which Pseudomonas aeruginosa (30.57% is most common isolate. Organisms in mixed infections showed multidrug resistance as compared to single isolated strain. Diabetic foot infections are polymicrobial in nature. As the Wagner’s grade increased, the prevalence of isolates also increased. [National J of Med Res 2012; 2(3.000: 354-357

  18. A sensitivity analysis of the Children's Treatment Network trial: a randomized controlled trial of integrated services versus usual care for children with special health care needs

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    Ye C


    Full Text Available Chenglin Ye,1,2 Gina Browne,1,3 Joseph Beyene,1 Lehana Thabane1,2 1Department of Clinical Epidemiology and Biostatistics, McMaster University, 2Biostatistcs Unit, St Joseph's Healthcare Hamilton, 3School of Nursing, McMaster University, Hamilton, ON, Canada Background: The value of integrated care through comprehensive, coordinated, and family-centered services has been increasingly recognized for improving health outcomes of children with special health care needs (CSHCN. In a randomized controlled trial (RCT, the integrated care provided through the Children's Treatment Network (CTN was compared with usual care in improving the psychosocial health of target CSHCN. In this paper, we aimed to estimate the effect of CTN care by conducting multiple analyses to handle noncompliance in the trial. Methods: The trial recruited target children in Simcoe County and York Region, ON, Canada. Children were randomized to receive CTN or usual care and were followed for 2 years. The CTN group received integrated services through multiple providers to address their specific needs while the usual care group continued to receive care directed by their parents. The outcome was change in psychosocial quality of life at 2 years. We conducted intention-to-treat, as-treated, per-protocol, and instrumental variable analyses to analyze the outcome. Results: The trial randomized 445 children, with 229 in the intervention group and 216 in the control group. During follow-up, 52% of children in the intervention group did not receive complete CTN care for various reasons. At 2 years, we did not find a significant improvement in psychosocial quality of life among the children receiving CTN care compared with usual care (intention-to-treat mean difference 1.50, 95% confidence interval −1.49 to 4.50; P = 0.32. Other methods of analysis yielded similar results. Conclusion: Although the effect of CTN care was not significant, there was evidence showing benefits of integrated

  19. Continuous ambulatory peritoneal dialysis: Indian scenario. (United States)

    Abraham, Georgi; Mathew, Milli; Hinduja, Anish; Padma, G


    Chronic peritoneal dialysis (CPD) has been initiated as a treatment modality for chronic renal failure patients in the Indian subcontinent since 1990. Over a period of 9 years both continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD) have emerged as accepted forms of renal replacement therapy in our country. Although there were government restrictions on import of dialysis fluid until 1993, the availability of locally manufactured fluid in collapsible bags had facilitated the expansion of the programme to the far corners of the country and in neighbouring countries. Initially majority (78%) of the patients who were started on this programme were diabetics with other comorbid conditions who were drop-outs from haemodialysis and unfit for transplantation. Both CAPD and CCPD have been used for all age groups and for men and women. Majority of the patients do 3 x 2 l exchanges a day on CAPD; 8-10 l using a cycler at night those who are onCCPD. Peritonitis rate was 1 episode every 18 patient months. With the introduction of new connection and disposable sets the incidence of peritonitis is dropping down. The major cause of drop-out is cardiovascular death followed by peritonitis. Malnutrition is a major problem in both CAPD and haemodialysis patients. The programme has been expanded and there are over one thousand patients on this treatment in the country. The introduction of CPD had a major impact on the treatment of renal failure in India.

  20. Cuff inflation during ambulatory blood pressure monitoring and heart rate

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    Mia Skov-Madsen


    Full Text Available Mia Skov-Madsen, My Svensson, Jeppe Hagstrup ChristensenDepartment of Nephrology, Aarhus University Hospital, Aalborg, DenmarkIntroduction: Twenty four-hour ambulatory blood pressure monitoring is a clinically validated procedure in evaluation of blood pressure (BP. We hypothesised that the discomfort during cuff inflation would increase the heart rate (HR measured with 24-h ambulatory BP monitoring compared to a following HR measurement with a 24-h Holter monitor.Methods: The study population (n = 56 were recruited from the outpatient’s clinic at the Department of Nephrology, Aalborg Hospital, Aarhus University Hospital at Aalborg, Denmark. All the patients had chronic kidney disease (CKD. We compared HR measured with a 24-h Holter monitor with a following HR measured by a 24-h ambulatory BP monitoring.Results: We found a highly significant correlation between the HR measured with the Holter monitor and HR measured with 24-h ambulatory blood pressure monitoring (r = 0.77, p < 0.001. Using the Bland-Altman plot, the mean difference in HR was only 0.5 beat/min during 24 hours with acceptable limits of agreement for both high and low HR levels. Dividing the patients into groups according to betablocker treatment, body mass index, age, sex, angiotensin-converting enzyme inhibitor treatment, statins treatment, diuretic treatment, or calcium channel blocker treatment revealed similar results as described above.Conclusion: The results indicate that the discomfort induced by cuff inflation during 24-h ambulatory BP monitoring does not increase HR. Thus, 24-h ambulatory BP monitoring may be a reliable measurement of the BP among people with CKD.Keywords: ambulatory blood pressure monitoring, Holter monitoring, heart rate, chronic kidney disease, hypertension

  1. Pairing of Customer’ Satisfaction with Brand Consciousness and Price Sensitivity (A Feminine Study in Pakistan on Beauty Care Products’ selection, Use and Satisfaction

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    Saima Ulfat


    Full Text Available This research study targets the role of brand consciousness and price sensitivity in relation with satisfaction of females with their selected beauty care products. Data is collected from both working and non-working females via quota sampling primarily and convenience sampling as sub sampling. Responses of 108 females are collected via online Survey. In presented model, Satisfaction is appearing as dependent variable whereas Brand Consciousness and Price Sensitivity are appearing as independent variables. Gathered data is analyzed while using Correlation Coefficient and Multiple Linear Regression. Results indicate a strongest relation of brand consciousness and price sensitivity along with satisfaction and females association with their selected beauty care products. Significance of this research is that manufacturing companies can use its results in order to enhance their marketing related efforts regarding this category of their brands especially with the context of Pakistani females.

  2. The Paediatric Ambulatory Consulting Service (PACS) program: a role for family pediatricians in the hospital emergency rooms. (United States)

    Nigri, Luigi; Piazzolla, Ruggiero; Pettoello-Mantovani, Massimo; Giardino, Ida; Abbinante, Micaela; Gorgoni, Giovanni


    This paper describes the Paediatric Ambulatory Consulting Service (PACS) project, developed by ASL-BT (Azienda Sanitaria Locale, Barletta-Andria-Trani), an Italian regional Public Health Centers network, in response to the current global situation of economic distress.PACS consist in integrating existing public health care services that are independently provided by hospitals and the Primary Care Paediatrics network. It has been developed with the aim to establish innovative yet efficient managerial solutions able to rationalize the resources not weakening the quality of services provided to the population.

  3. An algorithm to detect low incidence arrhythmic events in electrocardiographic records from ambulatory patients. (United States)

    Hungenahally, S K; Willis, R J


    An algorithm was devised to detect low incidence arrhythmic events in electrocardiograms obtained during ambulatory monitoring. The algorithm incorporated baseline correction and R wave detection. The RR interval was used to identify tachycardia, bradycardia, and premature ventricular beats. Only a few beats before and after the arrhythmic event were stored. The software was evaluated on a prototype hardware system which consisted of an Intel 86/30 single board computer with a suitable analog pre-processor and an analog to digital converter. The algorithm was used to determine the incidence and type of arrhythmia in records from an ambulatory electrocardiogram (ECG) database and from a cardiac exercise laboratory. These results were compared to annotations on the records which were assumed to be correct. Standard criteria used previously to evaluate algorithms designed for arrhythmia detection were sensitivity, specificity, and diagnostic accuracy. Sensitivities ranging from 77 to 100%, specificities from 94 to 100%, and diagnostic accuracies from 92 to 100% were obtained on the different data sets. These results compare favourably with published results based on more elaborate algorithms. By circumventing the need to make a continuous record of the ECG, the algorithm could form the basis for a compact monitoring device for the detection of arrhythmic events which are so infrequent that standard 24-h Holter monitoring is insufficient.

  4. Ambulatory anesthesia in plastic surgery: opportunities and challenges

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    Facque AR


    Full Text Available Alexander R Facque, Peter J Taub Division of Plastic and Reconstructive Surgery, Department of Surgery, Mount Sinai Medical Center, New York, NY, USA Abstract: In 2013, there were 17 million procedures performed by plastic and reconstructive surgeons in the United States in the private office or ambulatory “surgicenter” setting, as well as additional operations performed in hospitals on an outpatient basis. As interest in performing increasingly complex surgical procedures on an outpatient basis continues to grow, the surgeon and anesthesiologist alike must be prepared to offer safe and reliable anesthesia and analgesia in the ambulatory setting. Surgeons must be aware of the possible techniques that will be employed in their surgeries in order to anticipate and prepare patients for possible postoperative side effects, and anesthesiologists must be prepared to offer such techniques in order to ensure a relatively rapid return to normal activity despite potentially having undergone major surgery. The following is a review of the specific considerations that should be given to ambulatory plastic surgery patients with comments on recent developments in the techniques used to safely administer agreeable and effective anesthesia. Keywords: ambulatory surgery, cosmetic anesthesia, outpatient, ambulatory anesthesia

  5. Análise situacional do atendimento ambulatorial prestado a recém-nascidos egressos das unidades de terapia intensiva neonatais no Estado do Rio de Janeiro Situational analysis of outpatient care for newborns discharged from neonatal intensive care units in the State of Rio de Janeiro

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    Maria Dalva Barbosa Baker Méio


    Full Text Available A diminuição da mortalidade neonatal contribui para o aumento de crianças que necessitam de maior atenção em relação a morbidades clínicas e à evolução do desenvolvimento neuropsicomotor. O objetivo deste estudo foi discutir a situação da assistência às crianças egressas das Unidades de Terapia Intensiva Neonatais (UTIN em cinco unidades em diferentes regiões do Estado do Rio de Janeiro; em nenhuma havia informações sobre o perfil dos egressos da UTIN. Evidenciou-se restrição ao acesso e baixa estruturação da rede em relação à assistência prestada a esses bebês. Não há uniformidade no atendimento prestado, e ambulatórios específicos para essa população concentram-se na cidade do Rio de Janeiro. Constatou-se deficiência de profissionais nas áreas de reabilitação - fisioterapia motora, terapia ocupacional, fonoaudiologia e psicologia -, e de especialistas para atendimento oftalmológico adequado e para a criança portadora de deficiência auditiva. Os autores discutem possíveis explicações para essa situação, propondo a organização de um sistema de atendimento em graus de complexidade para poder viabilizar o acesso das crianças de risco a um atendimento diferenciado, importante para detecção precoce de anormalidades do desenvolvimento.The decrease in neonatal mortality contributes for the increase of children needing more attention to clinical morbidities and to neuro-psycho-motor development outcome. The objective of this study was to discuss the situation of care of children discharged from the Neonatal Intensive Care Units (NICU in five units from differents regions of the state of Rio de Janeiro. In none of them were found informations regarding the description of those discharged from the NICU. This study revealed restricted access and scarcy organization of the health network for the care of these babies. The care provided is not uniform, with a concentration of specific outpatient clinics for

  6. Ambulatory laparoscopic cholecystectomy: A single center experience

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    Cagri Tiryaki


    Full Text Available Aim: To evaluate the demographic and clinical parameters affecting the outcomes of ambulatory laparoscopic cholecystectomy (ALC in terms of pain, nausea, anxiety level, and satisfaction of patients in a tertiary health center. Materials and Methods: ALC was offered to 60 patients who met the inclusion criteria. Follow-up (questioning for postoperative pain or discomfort, nausea or vomiting, overall satisfaction was done by telephone contact on the same day at 22:00 p.m. and the first day after surgery at 8: 00 a.m. and by clinical examination one week after operation. STAI I and II data were used for proceeding to the level of anxiety of patients before and/or after the operation. Results: Sixty consecutive patients, with a mean age of 40.6 ± 8.1 years underwent ALC. Fifty-five (92% patients could be sent to their homes on the same day but five patients could not be sent due to anxiety, pain, or social indications. Nausea was reported in four (6.7% cases and not associated with any demographic or clinical features of patients. On the other hand, pain has been reported in 28 (46.7% cases, and obesity and shorter duration of gallbladder disease were associated with the increased pain perception (P = 0.009 and 0.004, respectively. Preopereative anxiety level was significantly higher among patients who could not complete the ALC procedure (P = 0.018. Conclusion: Correct management of these possible adverse effects results in the increased satisfaction of patients and may encourage this more cost-effective and safe method of laparoscopic cholecystectomy.

  7. [Certification of an ambulatory gastroenterologic service fulfilling ISO Law 9001--criteria and national guidelines of the Gastroenterologic Association]. (United States)

    Birkner, B


    The objectives of certification and accreditation are the deployment and examination of quality improvement measures in health care services. The quality management system of the ISO 9001 is created to install measures and tools leading to assured and improved quality in health care. Only some experiences with certification fulfilling ISO 9001 criteria exist in the German health care system. Evidence-based clinical guidelines can serve as references for the development of standards in quality measurement. Only little data exists on the implementation strategy of guidelines and evaluation, respectively. A pilot quality management system in consistence with ISO 9001 criteria was developed for ambulatory, gastroenterological services. National guidelines of the German Society of Gastroenterology and Metabolism and the recommendations of the German Association of Physicians for quality assurance of gastrointestinal endoscopy were included in the documentation and internal auditing. This pilot quality management system is suitable for the first steps in the introduction of quality management in ambulatory health care. This system shows validity for accreditation and certification of gastrointestinal health care units as well.

  8. Pediatric ambulatory blood pressure monitoring: indications and interpretations. (United States)

    Flynn, Joseph T; Urbina, Elaine M


    The prevalence of hypertension in children and adolescents is increasing, especially in obese and ethnic children. The adverse long-term effects of hypertension beginning in youth are known; therefore, it is important to identify young patients who need intervention. Unfortunately, measuring blood pressure (BP) is difficult due to the variety of techniques available and innate biologic variation in BP levels. Ambulatory BP monitoring may overcome some of the challenges clinicians face when attempting to categorize a young patient's BP levels. In this article, the authors review the use of ambulatory BP monitoring in pediatrics, discuss interpretation of ambulatory BP monitoring, and discuss gaps in knowledge in usage of this technique in the management of pediatric hypertension.

  9. Abordagem ambulatorial do nutricionista em anemia hemolítica Nutritional ambulatory approach in hemolytic anemia

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    Maria Aparecida Vieira


    Full Text Available Descreve a atuação do nutricionista em ambulatório de Hematologia Pediátrica em um hospital escola e relata as condutas dietéticas necessárias na abordagem de crianças com anemia hemolítica com e sem sobrecarga de ferro, e também as atitudes mais freqüentes dos familiares em relação à alimentação desses pacientes.The Authors describe the performance of the Dietitian in a Pediatric Hematology Ambulatory. They emphasize the necessary dietetic procedures for adequate management of children with hemolytic anemia, with and without iron overload. Furthermore, they approach the family's attitude towards the patient's nutrition.

  10. How to successfully select and implement electronic health records (EHR in small ambulatory practice settings

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    Detmer Don E


    Full Text Available Abstract Background Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. Discussion The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff

  11. Curricula and Organization of Primary Care Residencies in Internal Medicine. (United States)

    Eisenberg, John M.


    The organization and curricula of internal medicine residencies programs that emphasize primary care are described and compared with traditional residencies in internal medicine. It is noted that primary care residents spend more time in ambulatory care and are allowed more electives in specialties outside of internal medicine. Out-of-hospital…

  12. The integration of public health in European primary care systems.

    NARCIS (Netherlands)

    Kringos, D.S.; Bolibar, Y.; Bourgueil, T.; Cartier, T.; Dedeum, T.; Hasvold, A.; Hutchinson, M.; Lember, M.; Oleszczyk, D.; Rotar Pavlick, I.; Svab, P.; Tedeschi, A.; Wilson, S.; Wilm, A.; Windak, A.; Boerma, W.


    Background: A strong primary care (PC) system provides accessible, comprehensive care in an ambulatory setting on a continuous basis and by coordinated care processes. These features give PC the opportunity to play a key role in providing public health (PH) services to their practice population. Th

  13. Accuracy of patient's turnover time prediction using RFID technology in an academic ambulatory surgery center. (United States)

    Marchand-Maillet, Florence; Debes, Claire; Garnier, Fanny; Dufeu, Nicolas; Sciard, Didier; Beaussier, Marc


    Patients flow in outpatient surgical unit is a major issue with regards to resource utilization, overall case load and patient satisfaction. An electronic Radio Frequency Identification Device (RFID) was used to document the overall time spent by the patients between their admission and discharge from the unit. The objective of this study was to evaluate how a RFID-based data collection system could provide an accurate prediction of the actual time for the patient to be discharged from the ambulatory surgical unit after surgery. This is an observational prospective evaluation carried out in an academic ambulatory surgery center (ASC). Data on length of stay at each step of the patient care, from admission to discharge, were recorded by a RFID device and analyzed according to the type of surgical procedure, the surgeon and the anesthetic technique. Based on these initial data (n = 1520), patients were scheduled in a sequential manner according to the expected duration of the previous case. The primary endpoint was the difference between actual and predicted time of discharge from the unit. A total of 414 consecutive patients were prospectively evaluated. One hundred seventy four patients (42%) were discharged at the predicted time ± 30 min. Only 24% were discharged behind predicted schedule. Using an automatic record of patient's length of stay would allow an accurate prediction of the discharge time according to the type of surgery, the surgeon and the anesthetic procedure.

  14. Determinants of Diabetes and Hypertension Control in Ambulatory Healthcare in Al Ain, United Arab Emirates

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    Latifa M. Baynouna


    Full Text Available bjectives: This study aims to study determinants for the control of diabetes and hypertension in Al Ain Ambulatory Healthcare patients. Method: This is a cross sectional observational study of patients attending ambulatory healthcare centers in Al Ain, United Arab Emirates in 2009. From a yearly audit evaluating the care of patients with diabetes and hypertension, the determinants for improved diabetes and hypertension outcomes were identified from a total of 512 patients and its association with glycemic and blood pressure control were studied. Results: From all variables studied, only the clinic where the patient was treated helped predict both improved blood sugar and blood pressure control. For patients with diabetes, poor control the year before (p<0.001, the number of chronic disease clinic visits (p=0.042 and triglyceride levels (p=0.007 predicted worse control of diabetes. A predictor of poor control of blood pressure (p<0.001 for patients with hypertension was poor control of blood pressure in the year before. Conclusion: In this population, the healthcare system and the team played major roles as determinants in the control of patient’s diabetes and blood pressure more than any of the other factors examined.

  15. Ambulatory monitoring in the diagnosis and management of obstructive sleep apnoea syndrome

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    Jaime Corral-Peñafiel


    Full Text Available Obstructive sleep apnoea (OSA is a highly prevalent disorder associated with complications such as arterial hypertension, cardiovascular diseases and traffic accidents. The resources allocated for OSA are insufficient and OSA is a significant public health problem. Portable recording devices have been developed for the detection of OSA syndrome and have proved capable of providing an equivalent diagnosis to in-laboratory polysomnography (PSG, at least in patients with a high pre-test probability of OSA syndrome. PSG becomes important in patients who have symptoms and certain comorbidities such as chronic obstructive pulmonary disease or stroke, as well as in patients with a clinical history suggesting a different sleep disorder. Continuous positive airway pressure is the most effective treatment in OSA. Ambulatory monitoring of the therapeutic modalities has been evaluated to enhance the care process and reduce costs compared to the conventional approach, without sacrificing efficiency. This review evaluates the role of portable monitoring devices in the diagnostic process of OSA and the search for alternative strategies based on ambulatory management protocols.

  16. Quality indicators and performance measures in diabetes care. (United States)

    Aron, David C


    The operations of any portion of the healthcare delivery system, eg, ambulatory care, the consultation and referral process, or hospital care, are critically dependent upon their control systems. The quality of health care produced by the system and its components is also subject to "control." One of the regulatory mechanisms involves performance measures. The development of good measures of quality is a complex and dynamic process. Within endocrinology, most measures have addressed diabetes care and most quality measurement in diabetes has focused on the ambulatory setting and mainly includes measures of process and intermediate outcomes. This review addresses quality and performance measures for diabetes, their development, characteristics, use, misuse, and future prospects.

  17. Parent perceptions of pediatric ambulatory surgery: using family feedback for program evaluation. (United States)

    Voepel-Lewis, T; Andrea, C M; Magee, S S


    Pediatric ambulatory surgery programs have grown tremendously during the past decade. However, limited nursing time places severe constraints on the care and education of surgical outpatients. Preoperative teaching, patient support, and postoperative instruction, previously conducted over days, is now completed in several hours. The ambulatory surgical program at Mott Children's Hospital was designed to provide thorough patient and family education, comprehensive patient care, and short-term follow-up. A formal evaluation of the program was conducted to ensure quality care for outpatients. This study evaluated preoperative and discharge preparation, postoperative problems and follow-up, preoperative waiting, stress, and privacy. The sample was composed of 332 families. Of the respondents, 289 (87%) felt very prepared overall for outpatient surgery; 33 families (10%) attended the preoperative tour, and felt significantly better prepared for surgery than families who did not attend; 322 families (97%) felt adequately prepared to very prepared for discharge; 245 families (76%) felt that the recovery time was just right; 40 parents (12%) felt that their children experienced more pain and 34 (10.4%) more nausea and vomiting than expected postoperatively; 54 families called a PACU nurse postoperatively with questions, and 92% rated the call as very helpful; 31 families called the surgical service with concerns, and 61% rated the surgeon as helpful; 83 families (25%) perceived the outpatient experience as being very stressful. Stress correlated significantly with preoperative preparation, preoperative wait, previous outpatient experience, and perceived postoperative pain. Privacy in the environment was rated as fair to poor by 192 families (59%).(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Unsupervised machine-learning method for improving the performance of ambulatory fall-detection systems

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    Yuwono Mitchell


    Full Text Available Abstract Background Falls can cause trauma, disability and death among older people. Ambulatory accelerometer devices are currently capable of detecting falls in a controlled environment. However, research suggests that most current approaches can tend to have insufficient sensitivity and specificity in non-laboratory environments, in part because impacts can be experienced as part of ordinary daily living activities. Method We used a waist-worn wireless tri-axial accelerometer combined with digital signal processing, clustering and neural network classifiers. The method includes the application of Discrete Wavelet Transform, Regrouping Particle Swarm Optimization, Gaussian Distribution of Clustered Knowledge and an ensemble of classifiers including a multilayer perceptron and Augmented Radial Basis Function (ARBF neural networks. Results Preliminary testing with 8 healthy individuals in a home environment yields 98.6% sensitivity to falls and 99.6% specificity for routine Activities of Daily Living (ADL data. Single ARB and MLP classifiers were compared with a combined classifier. The combined classifier offers the greatest sensitivity, with a slight reduction in specificity for routine ADL and an increased specificity for exercise activities. In preliminary tests, the approach achieves 100% sensitivity on in-group falls, 97.65% on out-group falls, 99.33% specificity on routine ADL, and 96.59% specificity on exercise ADL. Conclusion The pre-processing and feature-extraction steps appear to simplify the signal while successfully extracting the essential features that are required to characterize a fall. The results suggest this combination of classifiers can perform better than MLP alone. Preliminary testing suggests these methods may be useful for researchers who are attempting to improve the performance of ambulatory fall-detection systems.

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

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    Stierer TL


    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

  20. Atendimento ambulatorial individualizado versus programa de educação em grupo: qual oferece mais mudança de hábitos alimentares e de atividade física em crianças obesas? Individual outpatient care versus group education programs: which leads to greater change in dietary and physical activity habits for obese children?

    Directory of Open Access Journals (Sweden)

    Elza D. de Mello


    Full Text Available OBJETIVO: Comparar duas estratégias de manejo da obesidade infantil: atendimento ambulatorial (individual e programa de educação (em grupo. MÉTODO: Foram recrutados aleatoriamente crianças e adolescentes de 7 a 13 anos de idade, divididos em dois grupos: atendimento individual e atendimento em grupo. Foi criado um programa de educação em obesidade infantil, com encontros mensais que consistiam em aulas expositivas com a participação dos pais e trabalhos em grupos. Simultaneamente, o outro grupo era acompanhado individualmente em ambulatório. O acompanhamento ocorreu por 6 meses, sendo avaliados composição corporal, hábitos alimentares e atividade física, antes e depois das intervenções. RESULTADOS: A amostra foi constituída por 38 crianças e adolescentes com média de idade de 9,9 anos. O programa foi mais efetivo no aumento da atividade física (p = 0,003, especialmente caminhadas (p = 0,003, e na redução do colesterol total (p = 0,038. A redução do índice de massa corporal, do índice de obesidade e do consumo energético foi semelhante para os dois grupos. Quanto aos hábitos alimentares, o grupo acompanhado em ambulatório aumentou o consumo de frutas (p = 0,033 e hortaliças (p = 0,002 e reduziu o de salgadinho e batata frita (p = 0,041, enquanto o grupo que participou do programa reduziu o consumo de refrigerantes (p = 0,022, sanduíches, pizza e fast food (p = 0,006. CONCLUSÕES: Ambas as estratégias de manejo da obesidade infantil foram favoráveis a mudanças de hábitos alimentares e de atividade física. O atendimento em grupo, em um programa de educação em nutrição e saúde, foi tão ou mais efetivo que o atendimento individualizado em um ambulatório de referência, firmando-se como alternativa de tratamento à obesidade.OBJECTIVE: To compare two strategies for childhood obesity management: ambulatory assistance (individual and educational program (in group. METHOD: Children and adolescents from 7 to 13

  1. Accuracy of complete compression ultrasound in ruling out suspected deep venous thrombosis in the ambulatory setting. A prospective cohort study. (United States)

    Sevestre, Marie-Antoinette; Labarère, José; Casez, Pierre; Bressollette, Luc; Taiar, Mébarka; Pernod, Gilles; Quéré, Isabelle; Bosson, Jean-Luc


    Evidence on the safety of complete compression ultrasound for ruling out deep venous thrombosis (DVT) is derived from studies conducted in tertiary care centers, although most patients with suspected DVT are managed in the ambulatory office setting. It was the objective of this study to estimate the rate of venous thromboembolism when anticoagulant therapy is withheld from ambulatory patients with normal findings on a single complete compression ultrasound. As part of a prospective cohort study, 3,871 ambulatory patients with clinically suspected DVT were enrolled by 255 board-certified vascular medicine physicians practicing in private offices in France. Compression ultrasound of the entire lower extremities was performed using a standardised examination protocol. Anticoagulant therapy was withheld from patients with negative findings on compression ultrasound, and 1,254 of them were randomly selected for follow-up. The main outcome measure was the three-month incidence of symptomatic venous thromboembolic events confirmed by objective testing. DVT was detected in 1,023 patients (26.4%), including 454 (11.7%) and 569 (14.7%) cases of proximal and isolated distal DVT, respectively. Of the 1,254 patients with negative results sampled for follow-up, six received anticoagulant therapy during follow-up and five were lost to follow-up. Five of 1,243 patients (0.4%, 95% confidence interval [CI], 0.1-0.9) experienced non-fatal symptomatic venous thromboembolic events (pulmonary embolism in two patients and DVT in three patients) and eight of 1,254 patients (0.6%, 95% CI, 0.3-1.2) died during the three-month follow-up. In conclusion, anticoagulant therapy can be safely withheld after negative complete compression ultrasound without further testing in the ambulatory office setting.

  2. Reproducibility of the ambulatory arterial stiffness index in hypertensive patients

    DEFF Research Database (Denmark)

    Dechering, D.G.; Steen, M.S. van der; Adiyaman, A.;


    BACKGROUND: We studied the repeatability of the ambulatory arterial stiffness index (AASI), which can be computed from 24-h blood pressure (BP) recordings as unity minus the regression slope of diastolic on systolic BP. METHODS: One hundred and fifty-two hypertensive outpatients recruited...

  3. Ambulatory Estimation of Relative Foot Positions using Ultrasound

    NARCIS (Netherlands)

    Weenk, Dirk; Coelen, van der Michiel; Geessink, Arno A.G.; Hoek, van der Frank J.; Verstoep, Bart; Kortier, Henk G.; Meulen, van Fokke B.; Beijnum, van Bert-Jan F.; Veltink, Peter H.


    The recording of human movement is used for biomedical applications like physical therapy and sports training. Over the last few years inertial sensors have been proven to be a useful ambulatory alternative to traditional optical systems. An example of a successful application is the instrumented sh

  4. Ambulatory position and orientation tracking fusing magnetic and inertial sensing

    NARCIS (Netherlands)

    Roetenberg, Daniel; Slycke, Per J.; Veltink, Peter H.


    This paper presents the design and testing of a portable magnetic system combined with miniature inertial sensors for ambulatory 6 degrees of freedom ( DOF) human motion tracking. The magnetic system consists of three orthogonal coils, the source, fixed to the body and 3-D magnetic sensors, fixed to

  5. Screening for Pediatric Obstructive Sleep Apnea before Ambulatory Surgery (United States)

    Ishman, Stacey L.; Tawfik, Kareem O.; Smith, David F.; Cheung, Kristin; Pringle, Lauren M.; Stephen, Matthew J.; Everett, Tiffany L.; Stierer, Tracey L.


    Purpose: The American Society of Anesthesia practice guidelines recommend that pediatric and adult patients who undergo ambulatory surgery be screened for obstructive sleep apnea (OSA). With this in mind, our objective was to assess the frequency of screening by anesthesia providers for the signs and symptoms of OSA in children undergoing surgery in an ambulatory setting. Methods: Prospective single-blinded observational study of anesthesia providers' preoperative interview of caregivers of consecutive patients younger than age 18 who were scheduled for ambulatory surgery. Results: One hundred one children (30 females) were identified, with a mean age of 6.9 ± 5.0 years; 54 were classified as white, 33 as black, and 14 as other. Total OSA-18 scores ranged from 18 to 97, with a mean of 33.1 ± 14.8. The mean score for adenotonsillectomy patients was higher than that for children who underwent procedures other than adenotonsillectomy. Thirty-one percent of children were screened for OSA, and snoring was the most common symptom recorded (28%). Patients who were screened for OSA were more likely to have snoring (p Tawfik KO, Smith DF, Cheung K, Pringle LM, Stephen MJ, Everett TL, Stierer TL. Screening for pediatric obstructive sleep apnea before ambulatory surgery. J Clin Sleep Med 2015;11(7):751–755. PMID:25902820

  6. Antibiotic sensitivity profile of bacterial pathogens in postoperative wound infections at a tertiary care hospital in Gujarat, India

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    Nutanbala N Goswami


    Full Text Available Objective: To find out the most common bacterial pathogens responsible for post-operative wound infection and their antibiotic sensitivity profile. Materials and Methods: This prospective, observational study was carried out in patients of postoperative wound infection. Samples from wound discharge were collected using a sterile swab and studied for identification of isolates by Gram stains and culture growth followed by in vitro antibiotic susceptibility testing performed by disc diffusion method on Mueller Hinton agar. Results: Out of 183 organisms, 126 (68.85% isolated organisms were gram negative. Staphylococcus aureus, 48 (26.23%, was the predominant organism. S. aureus was sensitive to rifampicin (89.58%, levofloxacin (60.42%, and vancomycin (54.17%. Pseudomonas aeruginosa was sensitive to ciprofloxacin (83.78%, gatifloxacin (51.35%, and meropenem (51.35%. Escherichia coli was sensitive to levofloxacin (72.41% and ciprofloxacin (62.07%. Klebsiella pneumoniae was sensitive to ciprofloxacin (63.16%, levofloxacin (63.16%, gatifloxacin (63.16%, and linezolid (56.52%. Proteus mirabilis was sensitive to ciprofloxacin (75% and linezolid (62.50. Proteus vulgaris was sensitive to ampicillin+sulbactam (57.14% followed by levofloxacin (50%. Conclusions: There is an alarming increase of infections caused by antibiotic-resistant bacteria, particularly in the emergence of VRSA/VISA, meropenem, and third generation cephalosporin resistant Pseudomonas aeruginosa. Linezolid showing sensitivity against Gram negative bacteria.

  7. Pharmacological treatment of ambulatory schizophrenic patients in Belgium

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    Reginster J-Y


    Full Text Available Abstract Background the objective of this study was twofold: 1 Describe the use of antipsychotic treatments in ambulatory patients suffering from schizophrenia in Belgium. 2 Evaluate to which extend antipsychotic treatment prescribing patterns are in accordance with published treatment guidelines. Method A cross-sectional survey was carried out in 16 Belgian hospitals selected from a sample of 67 hospitals. The hospitals were equally distributed between the north and south part of the country and were representative of Belgian practice. During 2 months, participating psychiatrists were asked to record the medication use as well as demographic parameters of all consecutive ambulatory patients seen at their consultation or attending a day-hospital. Data concerning 1000 ambulatory patients with schizophrenia or schizoaffective disorder were collected. Results In Belgium, the use of atypical antipsychotics is frequent (69% in ambulatory patients with schizophrenia. In the overall sample, 73% receive only one antipsychotic drug. The majority of patients are treated with drugs of only one antipsychotic drug group, either first- typical (29.8% or second-generation, atypical antipsychotics (53.2%. 15.8% of patients combine different types of antipsychotics. Antipsychotic dosing is adequate for the majority of patients but about one fifth receives a higher than recommended dose as per package inserts. Polypharmacy remains within reasonable limits. The use of concomitant medication varies according the antipsychotic treatment: patients who take second-generation antipsychotics only, receive the least additional drugs. Conclusion Atypical antipsychotics appear to be the first line treatment for schizophrenic psychosis. Psychiatrists working with ambulatory patients are well aware of treatment guidelines and follow them quite adequately.

  8. Dental loss among ambulatory patients with diabetes

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    Kenneth E. Izuora


    Conclusions: Dental loss is common in patients with diabetes and is associated with older age, diabetic retinopathy and not flossing. In order to reduce dental loss among patients with diabetes, regular flossing should be emphasized as an important component of dental care.

  9. Patient satisfaction with ambulatory healthcare services: waiting time and filling time. (United States)

    Dansky, K H; Miles, J


    Customer satisfaction is an important measure of service quality in healthcare organizations. This study investigated the relationship between patient waiting and satisfaction with ambulatory healthcare services, with waiting times divided into segments of the patient-care episode. Two management techniques to alter perceptions of waiting were also examined. Regression models measuring the effect of waiting times on satisfaction found that the total time spent waiting for the clinician was the most significant predictor of patient satisfaction. Informing patients how long their wait would be and being occupied during the wait were also significant predictors of patient satisfaction. These results show that waiting times, even if they cannot be shortened, can be managed more effectively to improve patient satisfaction.

  10. The abolition of user charges and the demand for ambulatory visits: evidence from the Czech Republic. (United States)

    Votapkova, Jana; Zilova, Pavlina


    This paper estimates the effect of the abolition of user charges for children's outpatient care (30 CZK/1.2 EUR) in 2009 on the demand for ambulatory doctor visits in the Czech Republic. Because the reform applied only to children, we can employ the difference-in-differences approach, where children constitute a treatment group and adults serve as a control group. The dataset covers 1841 observations. Aside from the treatment effect, we control for a number of personal characteristics using micro-level data (European Union Statistics on Income and Living Conditions). Using the zero-inflated negative binomial model, we found no significant effect from the abolition of user charges on doctor visits, suggesting either that user charges are ineffective in the Czech environment or that their value was set too low. On the contrary, personal income, the number of household members and gender have a significant effect. A number of robustness checks using restricted samples confirm the results.

  11. SEMICONDUCTOR INTEGRATED CIRCUITS Design of an analog front-end for ambulatory biopotential measurement systems (United States)

    Jiazhen, Wang; Jun, Xu; Lirong, Zheng; Junyan, Ren


    A continuously tunable gain and bandwidth analog front-end for ambulatory biopotential measurement systems is presented. The front-end circuit is capable of amplifying and conditioning different biosignals. To optimize the power consumption and simplify the system architecture, the front-end only adopts two-stage amplifiers. In addition, careful design eliminates the need for chopping circuits. The input-referred noise of the system is only 1.19 μVrms (0.48-2000 Hz). The chip is fabricated via a SMIC 0.18 μm CMOS process. Although the power consumption is only 32.1 μW under a 3 V voltage supply, test results show that the chip can successfully extract biopotential signals.

  12. Medication-related problem type and appearance rate in ambulatory hemodialysis patients

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    Drayer Debra K


    Full Text Available Abstract Background Hemodialysis (HD patients are at risk for medication-related problems (MRP. The MRP number, type, and appearance rate over time in ambulatory HD patients has not been investigated. Methods Randomly selected HD patients were enrolled to receive monthly pharmaceutical care visits. At each visit, MRP were identified through review of the patient chart, electronic medical record, patient interview, and communications with other healthcare disciplines. All MRP were categorized by type and medication class. MRP appearance rate was determined as the number of MRP identified per month/number of months in study. The number of MRP per patient-drug exposures were determined using: {[(number of patients × (mean number of medications]/(number of months of study} /number of MRP identified. Results were expressed as mean ± standard deviation or percentages. Results Patients were 62.6 ± 15.9 years old, had 6.4 ± 2.0 comorbid conditions, were taking 12.5 ± 4.2 medications, and 15.7 ± 7.2 doses per day at baseline. Medication-dosing problems (33.5%, adverse drug reactions (20.7%, and an indication that was not currently being treated (13.5% were the most common MRP. 5,373 medication orders were reviewed and a MRP was identified every 15.2 medication exposures. Overall MRP appearance rate was 0.68 ± 0.46 per patient per month. Conclusion MRP continue to occur at a high rate in ambulatory HD patients. Healthcare providers taking care of HD patients should be aware of this problem and efforts to avoid or resolve MRP should be undertaken at all HD clinics.

  13. Medication-related problem type and appearance rate in ambulatory hemodialysis patients (United States)

    Manley, Harold J; Drayer, Debra K; Muther, Richard S


    Background Hemodialysis (HD) patients are at risk for medication-related problems (MRP). The MRP number, type, and appearance rate over time in ambulatory HD patients has not been investigated. Methods Randomly selected HD patients were enrolled to receive monthly pharmaceutical care visits. At each visit, MRP were identified through review of the patient chart, electronic medical record, patient interview, and communications with other healthcare disciplines. All MRP were categorized by type and medication class. MRP appearance rate was determined as the number of MRP identified per month/number of months in study. The number of MRP per patient-drug exposures were determined using: {[(number of patients) × (mean number of medications)]/(number of months of study)} /number of MRP identified. Results were expressed as mean ± standard deviation or percentages. Results Patients were 62.6 ± 15.9 years old, had 6.4 ± 2.0 comorbid conditions, were taking 12.5 ± 4.2 medications, and 15.7 ± 7.2 doses per day at baseline. Medication-dosing problems (33.5%), adverse drug reactions (20.7%), and an indication that was not currently being treated (13.5%) were the most common MRP. 5,373 medication orders were reviewed and a MRP was identified every 15.2 medication exposures. Overall MRP appearance rate was 0.68 ± 0.46 per patient per month. Conclusion MRP continue to occur at a high rate in ambulatory HD patients. Healthcare providers taking care of HD patients should be aware of this problem and efforts to avoid or resolve MRP should be undertaken at all HD clinics. PMID:14690549

  14. Diagnósticos de enfermagem em pacientes com o Vírus da Imunodeficiência Humana/ Síndrome da Imunodeficiência Adquirida em assistência ambulatorial Diagnósticos de enfermería en pacientes con el Virus de la Inmunodeficiencia Humana/Síndrome de la Inmunodeficiencia Adquirida en asistencia de ambulatorio Nursing diagnoses in patients with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in outpatient care

    Directory of Open Access Journals (Sweden)

    Gilmara Holanda da Cunha


    Full Text Available OBJETIVO: Identificar diagnósticos de enfermagem em portadores de Vírus da Imunodeficiência Humana/ Síndrome da Imunodeficiência Adquirida (HIV/AIDS em assistência ambulatorial. MÉTODOS: Estudo transversal e descritivo realizado por meio da aplicação de um questionário com referencial na Teoria do Autocuidado de Orem. A amostra foi de 51 pacientes atendidos no ambulatório de um hospital público na cidade de Fortaleza-CE. RESULTADOS: Foram identificados 17 diagnósticos de enfermagem, destacando-se risco de infecção, disfunção sexual, déficit no autocuidado para alimentação e controle ineficaz do regime terapêutico. CONCLUSÃO: Os diagnósticos de enfermagem obtidos identificaram os principais problemas apresentados pelos portadores de HIV/AIDS, verificando déficits no autocuidado e em educação em saúde. O estudo contribuiu para que as intervenções de enfermagem sejam adequadas e direcionadas às necessidades existentes.OBJETIVO: Identificar diagnósticos de enfermería en portadores del Virus de la Inmunodeficiencia Humana/Síndrome de la Inmunodeficiencia Adquirida (HIV/SIDA en asistencia de ambulatorio. MÉTODOS: Estudio transversal y descriptivo realizado por medio de la aplicación de un cuestionario basado en la Teoría del Auto-cuidado de Orem. La muestra fue de 51 pacientes atendidos en el ambulatorio de un hospital público en la ciudad de Fortaleza-CE. RESULTADOS: Fueron identificados 17 diagnósticos de enfermería, destacándose: riesgo de infección, disfunción sexual, déficit en el auto-cuidado para alimentación y control ineficaz del régimen terapéutico. CONCLUSIÓN: Los diagnósticos de enfermería obtenidos identificaron los principales problemas presentados por los portadores de HIV/SIDA, verificándose déficits en el auto-cuidado y en la educación en salud. El estudio contribuye para que las intervenciones de enfermería sean adecuadas y dirigidas a las necesidades existentes.OBJECTIVE: To

  15. Integration of an optical CMOS sensor with a microfluidic channel allows a sensitive readout for biological assays in point-of-care tests. (United States)

    Van Dorst, Bieke; Brivio, Monica; Van Der Sar, Elfried; Blom, Marko; Reuvekamp, Simon; Tanzi, Simone; Groenhuis, Roelf; Adojutelegan, Adewole; Lous, Erik-Jan; Frederix, Filip; Stuyver, Lieven J


    In this manuscript, a microfluidic detection module, which allows a sensitive readout of biological assays in point-of-care (POC) tests, is presented. The proposed detection module consists of a microfluidic flow cell with an integrated Complementary Metal-Oxide-Semiconductor (CMOS)-based single photon counting optical sensor. Due to the integrated sensor-based readout, the detection module could be implemented as the core technology in stand-alone POC tests, for use in mobile or rural settings. The performance of the detection module was demonstrated in three assays: a peptide, a protein and an antibody detection assay. The antibody detection assay with readout in the detection module proved to be 7-fold more sensitive that the traditional colorimetric plate-based ELISA. The protein and peptide assay showed a lower limit of detection (LLOD) of 200 fM and 460 fM respectively. Results demonstrate that the sensitivity of the immunoassays is comparable with lab-based immunoassays and at least equal or better than current mainstream POC devices. This sensitive readout holds the potential to develop POC tests, which are able to detect low concentrations of biomarkers. This will broaden the diagnostic capabilities at the clinician's office and at patient's home, where currently only the less sensitive lateral flow and dipstick POC tests are implemented.

  16. Marketing ambulatory services in the 1990s. (United States)

    Hicks, S


    The ability to predict, to adapt to change, and to develop strategic low cost marketing plans are the components essential to remaining financially solvent in today's health care environment. The marketing process is analogous to the nursing process and should support the institution's mission statement, philosophy, and goals. Managers who are able to empower their personnel to become the sales force and implement the marketing plan will be the survivors in the 1990s.

  17. Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the intensive care unit

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    Goel Nidhi


    Full Text Available Background: Lower respiratory tract infections (LRTIs are the most frequent infections among patients in Intensive care units (ICUs. Aims: To know the bacterial profile and determine the antibiotic susceptibility pattern of the lower respiratory tract isolates from patients admitted to the ICU. Settings and Design: Tertiary care hospital, retrospective study. Materials and Methods: Transtracheal or bronchial aspirates from 207 patients admitted to the ICU were cultured, identified, and antibiotic sensitivity was performed by standard methods. Statistical Analysis Used: SPSS software was used for calculation of % R of 95% confidence interval (CI. Results: Of 207 specimens, 144 (69.5% were culture positive and 63 (30.4% showed no growth. From 144 culture positives, 161 isolates were recovered, of which 154 (95.6% were Gram negative bacilli (GNB. In 17 (11.0% patients, two isolates per specimen were recovered. The most common GNB in order of frequency were Pseudomonas aeruginosa (35%, Acinetobacter baumannii (23.6%, and Klebsiella pneumoniae (13.6%. A very high rate of resistance (80-100% was observed among predominant GNB to ciprofloxacin, ceftazidime, co-trimoxazole, and amoxycillin/clavulanic acid combination. Least resistance was noted to meropenem and doxycycline. Conclusion: Nonfermenters are the most common etiological agents of LRTIs in ICU. There is an alarmingly high rate of resistance to cephalosporin and β-lactam-β-lactamase inhibitor group of drugs. Meropenem was found to be the most sensitive drug against all GNB. Acinetobacter and Klebsiella spp. showed good sensitivity to doxycycline.

  18. Life history trade-offs and behavioral sensitivity to testosterone: an experimental test when female aggression and maternal care co-occur.

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    Kimberly A Rosvall

    Full Text Available Research on male animals suggests that the hormone testosterone plays a central role in mediating the trade-off between mating effort and parental effort. However, the direct links between testosterone, intrasexual aggression and parental care are remarkably mixed across species. Previous attempts to reconcile these patterns suggest that selection favors behavioral insensitivity to testosterone when paternal care is essential to reproductive success and when breeding seasons are especially short. Females also secrete testosterone, though the degree to which similar testosterone-mediated trade-offs occur in females is much less clear. Here, I ask whether testosterone mediates trade-offs between aggression and incubation in females, and whether patterns of female sensitivity to testosterone relate to female life history, as is often the case in males. I experimentally elevated testosterone in free-living, incubating female tree swallows (Tachycineta bicolor, a songbird with a short breeding season during which female incubation and intrasexual aggression are both essential to female reproductive success. Testosterone-treated females showed significantly elevated aggression, reduced incubation temperatures, and reduced hatching success, relative to controls. Thus, prolonged testosterone elevation during incubation was detrimental to reproductive success, but females nonetheless showed behavioral sensitivity to testosterone. These findings suggest that the relative importance of both mating effort and parental effort may be central to understanding patterns of behavioral sensitivity in both sexes.

  19. Creating a roadmap for delivering gender-sensitive comprehensive care for women veterans: Results of a national expert panel

    NARCIS (Netherlands)

    Kleijn, M.J.J. de; Lagro-Janssen, A.L.M.; Canelo, I.; Yano, E.M.


    BACKGROUND: Women Veterans are a significant minority of users of the VA healthcare system, limiting provider and staff experience meeting their needs in environments historically designed for men. The VA is nonetheless committed to ensuring that women Veterans have access to comprehensive care in e

  20. Patients Suspected of Irritable Bowel Syndrome-Cross-Sectional Study Exploring the Sensitivity of Rome III Criteria in Primary Care

    DEFF Research Database (Denmark)

    Engsbro, Anne Line; Begtrup, Luise Mølenberg; Kjeldsen, Jens;


    The Rome III criteria for irritable bowel syndrome (IBS) are recommended by guidelines to help identify the syndrome. The majority of IBS patients are managed in primary care, where a pragmatic approach to diagnosis is usually adopted, using clinical judgment and knowledge about the patient. Many...

  1. Adesão de pacientes HIV positivos à dietoterapia ambulatorial Adherence of positive HIV patients to ambulatory diet therapy

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    Késia Diego Quintaes


    Full Text Available É conhecida a importância do estado nutricional para a evolução clínica de pacientes HIV positivos. Entretanto, é desconhecida a expectativa do paciente com relação à dietoterapia. Por um período de 30 semanas foram acompanhados 50,0% dos pacientes HIV positivo (grupos II e IV atendidos pelo ambulatório de Doenças Sexualmente Transmissíveis do Hospital e Maternidade Celso Pierro. Neste período foram realizadas duas entrevistas, sendo o intervalo entre elas de 10 semanas. Na primeira foram colhidos dados socioeconômicos, antropométricos, verificadas as modificações voluntárias feitas na alimentação e também a expectativa do paciente quanto a este tipo de tratamento. Na segunda foram colhidos indicadores diretos e indiretos de adesão ao tratamento. A adesão foi maior entre os pacientes do grupo IV (64,7% do que entre os do grupo II (35,3%. No entanto, 81,3% dos pacientes do grupo II, após tomarem conhecimento da sorologia positiva para HIV, modificaram voluntariamente sua alimentação, demostrando ser este um importante período para sensibilização do paciente para o tratamento.It's well known the importance of nutritional status to the clinical evolution of positive HIV patients. However, the patient expectation in relation to diet therapy is unknown. During 30 weeks, 50.0% of the patients HIV positive (groups II and IV attended by the ambulatory of Sexually Transmitted Diseases of Hospital and Maternity Celso Pierro, were interviewed. In this period two interviews with an interval of ten weeks were carried out. At the first one socioeconomic and anthropometric data were collected voluntary feeding modifications and also the patient expectation about such treatment were verified. At the second one, direct and indirect indicators of the adherence to treatment were colleded. The adherence was greater in pacients of group IV (64.7% than in group II (35.3%. However, 81.3% of the patients from group II, after being aware

  2. Ambulatory management of chronic hypertension in pregnancy. (United States)

    Ames, Mary; Rueda, Jose; Caughey, Aaron B


    Chronic hypertension in pregnancy is one of the most common medical diseases affecting pregnancy. It is associated with serious maternal and fetal complications, including superimposed pre-eclampsia, fetal growth restriction, premature delivery, placental abruption, and stillbirth. Baseline evaluation as early as possible is important to differentiate women with essential hypertension from those with severe hypertension, coexisting end-organ damage, and secondary causes of hypertension, as their risks of poor outcomes are increased. An optimal plan for maternal treatment and fetal surveillance can then be formulated. Coordination of care after delivery is important for long-term maternal health and future pregnancies.

  3. Microscopy, culture, and sensitive management of uncomplicated urinary tract infections in adults in the primary care setting. (United States)

    Sivathasan, Niroshan; Rakowski, Krzysztof R


    The high prevalence of urinary tract infections (UTIs) places a significant burden on healthcare systems. Clinicians may over-manage the issue, and there is great variability in practice, with economic- and resource- implications. Up to 40% of patients with a suspected UTI do not have an infection. Using PubMed (Medline) to shortlist relevant papers in English from the last 30 years, and further sub-selection to include only uncomplicated UTIs in adults in primary care, we reviewed the literature pertaining to uncomplicated UTIs, and how it should be managed efficiently in the primary care setting. In general practice, there is no advantage to routinely request microscopy and culture of urine samples in the presence of an appropriate history and urinalysis reagent-strip testing. If antibiotics are required, then a 3-day course shall suffice. Larger epidemiological studies focusing on more susceptible sub-populations may provide better guidance for discriminatory factors to produce an algorithm for treatment.

  4. Point-of-care test for detection of urogenital chlamydia in women shows low sensitivity. A performance evaluation study in two clinics in Suriname.

    Directory of Open Access Journals (Sweden)

    Jannie J van der Helm

    Full Text Available BACKGROUND: In general, point-of-care (POC tests for Chlamydia trachomatis (Ct show disappointing test performance, especially disappointing sensitivity results. However, one study sponsored by the manufacturer (Diagnostics for the Real World reported over 80% sensitivity with their Chlamydia Rapid Test (CRT. We evaluated the performance of this CRT in a non-manufacturer-sponsored trial. METHODS: Between July 2009 and February 2010, we included samples from 912 women in both high- and low-risk clinics for sexually transmitted infections (STIs in Paramaribo, Suriname. Sensitivity, specificity, positive- and negative predictive values (PPV and NPV for CRT compared to NAAT (Aptima, Gen-Probe were determined. Quantitative Ct load and human cell load were determined in all CRT and/or NAAT positive samples. RESULTS: CRT compared to NAAT showed a sensitivity and specificity of 41.2% (95% CI, 31.9%-50.9% and 96.4% (95% CI, 95.0%-97.5%, respectively. PPV and NPV were 59.2% (95% CI, 47.5%-70.1% and 92.9% (95% CI, 91.0%-94.5%, respectively. Quantitative Ct bacterial load was 73 times higher in NAAT-positive/CRT-positive samples compared to NAAT-positive/CRT-negative samples (p<0.001. Human cell load did not differ between true-positive and false-negative CRT results (p = 0.835. Sensitivity of CRT in samples with low Ct load was 12.5% (95% CI, 5.2%-24.2% and in samples with high Ct load 73.5% (95% CI, 59.9%-84.4%. CONCLUSIONS: The sensitivity of CRT for detecting urogenital Ct in this non-manufacturer-sponsored study did not meet the expectations as described previously. The CRT missed samples with a low Ct load. Improved POC are needed as meaningful diagnostic to reduce the disease burden of Ct.

  5. [The ambulatory polyclinic institutions in closed administrative territorial municipality]. (United States)

    Fomin, E P


    The article presents the results characterizing functioning of ambulatory polyclinic institutions included into medical sanitary unit of closed administrative territorial municipality of lesser towns. The study established the resource support of staff and full-time positions of physician and paramedical personnel, dynamics of indicators from 2005 to 2013, coverage of population of able-bodied age with preventive and target medical examinations for syphilis and tuberculosis. The progression of contingents under dispensary registration was determined.

  6. Biomechanical investigation of ambulatory training in patients with acetabular dysplasia. (United States)

    Kanai, Akira; Kiyama, Takahiro; Genda, Eiichi; Suzuki, Yasuo


    The purpose of this study was to investigate the effectiveness and safety of ambulatory training in patients with acetabular dysplasia. To achieve this, we studied the hip joint moment in subjects walking with laterally and horizontally elevated arms and changing speeds as a form of training to strengthen hip joint abductor muscles. We studied eight women with pre- or early stage hip disease (center-edge angle of Wieberg 18.5 degrees to -3.0 degrees ) and six healthy women. In exercise task 1 the subjects walked at a rate of 90 steps/min, with abduction of 90 degrees in the shoulder joint ipsilateral or contralateral to the affected hip joint, and either no load or a 1 kg weight in either hand. In exercise task 2, walking speed was changed in three stages from 60 steps/min (s-gait), 90 steps/min (n-gait), and 120 steps/min (f-gait), with both hands swinging freely. Using results from a three-dimensional motion analysis system, the hip joint moments were calculated. In both the healthy and the acetabular dysplasia groups, the abduction moment of the hip joint decreased significantly with ipsilateral elevation and increased significantly with contralateral elevation. There was no significant change in hip flexion moment in either group. The hip extension moment decreased significantly with contralateral elevation, but no significant changes were seen in ipsilateral elevation. In the walking rate variation, the extension hip moment in fast gait was higher than in slow gait. It was concluded that ambulatory training with contralateral horizontal arm elevation may be an effective way of increasing hip joint abductor muscle strength. Ipsilateral arm elevation decreases gluteus medius muscle tension and is an effective way of ambulatory training for people with compensated trendelenburg gait. Variable speed walking is an effective exercise method that can strengthen extensor muscles. Therefore, these ambulatory training methods are useful for acetabular dysplasia patients.


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    Full Text Available In view of the reported emergence of vancomycin resistance in MRSA from the state and the country as a whole we evaluated the pattern of culture and sensitivity on 160 samples from Orthopaedic Department over a period of one year between Nov 2014 and Nov 2015. These belonged to 111 males and 49 females with different aetiologies. Using standard protocols for the culture, 84 (52% samples grew no organisms while Staph aureus was grown in 43 samples (26.8% and gram negative organism in 28 and 5 samples grew mixed organism. Out of these 43 isolates of Staph aureus, MRSA was grown in 32 (74.4% and MSSA in 11 (25.6%. These belonged to 23 (71.8% males and 9 (28.1% females. Majority of MRSA were grown from the patients of acute osteomyelitis and operated fractures (63.3%. Linezolid showed highest sensitivity (100% followed by Vancomycin (96.8%, Clindamycin (37.5%, erythromycin (21%, Amikacin (21%, Levofloxacin (9.3%, cotrimoxazole (9.3% and ciprofloxacin (3.1%. By diffusion method 6 positive cultures depicted doubtful sensitivity pattern for vancomycin (18.75%. However, on further analysis using MIC only one isolate (3.3% showed intermediate resistance to vancomycin; 12 cultures (37.5% were sensitive to vancomycin and linezolid only. The presence of vancomycin resistance calls for a watchful approach towards these infections and an extensive study to better define the problem.

  8. Pathway to Best Practice in Spirometry in the Ambulatory Setting. (United States)

    Peracchio, Carol


    Spirometry performed in the ambulatory setting is an invaluable tool for diagnosis, monitoring, and evaluation of respiratory health in patients with chronic lung disease. If spirometry is not performed according to American Thoracic Society (ATS) guidelines, unnecessary repeated testing, increased expenditure of time and money, and increased patient and family anxiety may result. Two respiratory therapists at Mission Health System in Asheville, NC, identified an increase in patients arriving at the pulmonary function testing (PFT) laboratories with abnormal spirometry results obtained in the ambulatory setting. These abnormal results were due to incorrect testing procedure, not chronic lung disease. Three training methods were developed to increase knowledge of correct spirometry testing procedure in the ambulatory setting. The therapists also created a plan to educate offices that do not perform spirometry on the importance and availability of PFT services at our hospital for the population of patients with chronic lung disease. Notable improvements in posttraining test results were demonstrated. The education process was evaluated by a leading respiratory expert, with improvements suggested and implemented. Next steps are listed.

  9. Role of ambulatory blood pressure monitoring in resistant hypertension. (United States)

    Grassi, Guido; Bombelli, Michele; Seravalle, Gino; Brambilla, Gianmaria; Dell'oro, Raffaella; Mancia, Giuseppe


    Ambulatory blood pressure monitoring has gained growing popularity in the diagnosis and treatment of essential hypertension for several reasons, such as the lack of the so-called white-coat effect, the greater reproducibility as compared with clinic blood pressure, the ability to provide information on blood pressure phenomena of prognostic value and the closer relationship with the risk of cardiovascular morbidity and mortality. All the above-mentioned main features of ambulatory blood pressure monitoring are also true for resistant hypertension. In addition, however, in resistant hypertension, blood pressure monitoring allows one to precisely define the diagnosis of this clinical condition, by excluding the presence of white-coat hypertension, which is responsible for a consistent number of "false" resistant hypertensive cases. The approach also allows one to define the patterns of blood pressure variability in this clinical condition, as well as its relationships with target organ damage. Finally, it allows one to assess the effects of therapeutic interventions, such as renal nerves ablation, aimed at improving blood pressure control in this hypertensive state. The present paper will critically review the main features of ambulatory blood pressure monitoring in resistant hypertension, with particular emphasis on the diagnosis and treatment of this high-risk hypertensive state.

  10. Health problems presented in general practice by survivors before and after a fireworks disaster: associations with mental health care.

    NARCIS (Netherlands)

    Ouden, D.J. den; Dirkzwager, A.J.E.; IJzermans, C.J.


    Objective: To study the health problems presented to general practitioners by disaster survivors who received specialized ambulatory mental health care. Design: (Longitudinal) case-control study based on general practitioners' electronic medical records. Setting: General practice and a mental health

  11. Evaluation of Ambulatory Care Classification Systems for the Military Health Care System (United States)


    FOLLOW-UP EXAM FOLLOWING SURGERY BCAA FAMILY PLANNING V2509 CONTRACEPTIVE MANAGEMENT, OTHER BCBA GYNECOLOGY V670 FOLLOW-UP EXAM FOLLOWING SURGERY BCCA...Surgery BCAA Family Planning 906 Family Planning BCBA Gynecology 905 Gynecology BCCA Obstetrics 904 Obstetrics BDAA Pediatric 936 Pediatric General

  12. Community acquired pneumonia due to gram negative bacilli and its antibiotic sensitivity pattern in a tertiary care centre


    Ashish Jitendranath; Sudin Koshy


    Background: Gram negative bacteria along with Pseudomonas constitute a significant cause of morbidity and mortality due to pneumonia. As a result it is essential to have appropriate empirical antimicrobial treatment strategies based on the sensitivity pattern of a particular region. In cases with high likelihood of gram negative pneumonia it is essential to start appropriate empirical antibiotics as early as possible to reduce the morbidity and mortality. This study is done to know the antibi...

  13. Comparison of Clinic and Ambulatory Blood Pressure in Response to Antihypertensive Drugs in Chinese Patients

    Institute of Scientific and Technical Information of China (English)


    Objective To compare the difference between 24-h ambulatory blood pressure (ABP) and trough clinic blood pressure (CBP) after 8 weeks of therapy. Methods The study used meta-regression analysis to summarize three randomized,double-blind, active controlled trials in order to compare the difference between the magnitude of the reduction in 24-h average ABP and CBP Patients. Chinese patients with seated diastolic blood pressure (SDBP) 95-115 mmHg and ambulatory diastolic blood pressure (ADBP) ≥85 mmHg. Results The average age of 126 patients was 47.7±8.3 years, ranging from 25 to 67 (95 males and 31 females). All regimens reduced 24-h ABP and CBP after 8 weeks of treatment. In the 126 patients the baseline 24-h SBP and DBP values (142.7/94.4 mmHg) were markedly lower than those for clinic values (152.6/102.6 mmHg;P<0.0001). Similarly, the 24-h SBP and DBP values (132.7/87.7 mmHg) in week 8 were markedly lower than the clinic values (138.9/92.7 mmHg; P<0.0001). The differences between the treatment-induced reductions in 24-h ABP and CBP were statistically significant (the difference was 3.7/3.3 mmHg for SBP/DBP, P=0.0069/P<0.0001). Conclusion All regimens significantly reduced seated CBP and ABP. The effect of antihypertensive treatment was greater on CBP than that on ABP,suggesting that assessment on effectiveness of an antihypertensive treatment using CBP readings only has to be carefully interpreted, and a more systematic application of ABP monitoring should be adopted.

  14. Community acquired pneumonia due to gram negative bacilli and its antibiotic sensitivity pattern in a tertiary care centre

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    Ashish Jitendranath


    Results: During the study period in 120 cases of pneumonia, there was growth of pathogenic organism. Among the GNB isolated Klebsiella spp was the most common organism isolated at 33.9% followed by Pseudomonas aeruginosa and Escherichia coli at 22.1%. Out of the 53 gram negative samples isolated 4 (7% were Amp C positive, 10 (18.8% were ESBL positive and there was one single case of MBL. The antibiotic sensitivity showed that all the isolates were sensitive to colisitin (100%, while Klebsiella spp, Pseudomonas spp, and Escherichia coli were 100% sensitive to imipenem and meropenem. Resistance pattern of all the isolates showed that the isolates exhibited high resistance to amoxycillin-clavulunate, cefuroxime and cotrimoxazole. While resistance against ceftazidime and cefipime was >40%. On the other hand, isolates showed a low level of resistance against piperacillin tazobactam and cefoperazone-sulbactam. Extremely low level of resistance was observed against imipenem and meropenem, while colistin showed no resistance among the isolates obtained in this study. Conclusions: The study showed that gram-negative bacteria and P. aeruginosa form a relevant part of the microbial pattern of CAP in patients who require hospitalization, particularly those with severe CAP. Initiating antibiotics with gram negative coverage should be considered in this subgroup of patients since initiating the correct antibiotic plays a critical role in the outcome of pneumonia. [Int J Res Med Sci 2016; 4(8.000: 3121-3124

  15. Mapping out structural features in clinical care calling for ethical sensitivity: a theoretical approach to promote ethical competence in healthcare personnel and clinical ethical support services (CESS). (United States)

    Baerøe, Kristine; Norheim, Ole Frithjof


    Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the 'favourite' ethical issues of the day. In this paper we attempt to capture a comprehensive overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS.


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    Full Text Available BACKGROUND Genus Citrobacter is one of the aerobic Gram negative non-sporing bacilli, from the Enterobacteriaceae family. Citrobacter koseri and Citrobacter freundii are the commonest species implicated in infections. It is emerging as an important nosocomial pathogen. It is associated with high mortality and morbidity rate. They are often resistant to routinely used antibiotics. Emerging drug resistance is a therapeutic concern for clinicians worldwide, thus isolation and antibiotic sensitivity of Citrobacter is critically needed. OBJECTIVES Identification of Citrobacter species and antibiotic sensitivity pattern with AmpC and ESBL Detection. METHODS Prospective study was done from June 2014 to March 2015. The samples were collected from patients attending VIMS and RC. The samples were processed and identified by standard protocol. Citrobacter isolates were tested for antibiotic sensitivity by Kirby-Bauer disc diffusion method as per clinical and standard institute guidelines. Detection of AmpC by Cephamycin Hodge test using Cefoxitin 30 μg with ATCC strains of Escherichia coli 25922 was done. ESBL detection was done by Ceftazidime (30 μg and Ceftazidime/clavulanic acid (30 μg/10 μg and Cefotaxime (30 ug Cefotaxime/clavulanic acid (30 ug/10 ug. RESULTS Out of 5695 Gram negative isolates identified, 690 were Citrobacter isolates. Citrobacter koseri 398 (62.5% and Citrobacter freundii 292 (37.5% were the commonest species isolated. The antibiogram as per CLSI Guidelines showed resistance to Fluoroquinolones, Cephalosporins and beta lactamase inhibitors. Carbapenems were found to be sensitive. The resistance to beta lactamase inhibitors increased with the presence of AmpC beta lactamase (76% and ESBL (50%. CONCLUSION Citrobacter species are emerging as an important nosocomial pathogen. Citrobacter koseri and Citrobacter freundii were the commonest species isolated. Antibiogram showing an increase in resistance among the beta lactamase

  17. A population-based study of ambulatory and surgical services provided by orthopaedic surgeons for musculoskeletal conditions

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    Davis Aileen M


    Full Text Available Abstract Background The ongoing process of population aging is associated with an increase in prevalence of musculoskeletal conditions with a concomitant increase in the demand of orthopaedic services. Shortages of orthopaedic services have been documented in Canada and elsewhere. This population-based study describes the number of patients seen by orthopaedic surgeons in office and hospital settings to set the scene for the development of strategies that could maximize the availability of orthopaedic resources. Methods Administrative data from the Ontario Health Insurance Plan and Canadian Institute for Health Information hospital separation databases for the 2005/06 fiscal year were used to identify individuals accessing orthopaedic services in Ontario, Canada. The number of patients with encounters with orthopaedic surgeons, the number of encounters and the number of surgeries carried out by orthopaedic surgeons were estimated according to condition groups, service location, patient's age and sex. Results In 2005/06, over 520,000 Ontarians (41 per 1,000 population had over 1.3 million encounters with orthopaedic surgeons. Of those 86% were ambulatory encounters and 14% were in hospital encounters. The majority of ambulatory encounters were for an injury or related condition (44% followed by arthritis and related conditions (37%. Osteoarthritis accounted for 16% of all ambulatory encounters. Orthopaedic surgeons carried out over 140,000 surgeries in 2005/06: joint replacement accounted for 25% of all orthopaedic surgeries, whereas closed repair accounted for 16% and reductions accounted for 21%. Half of the orthopaedic surgeries were for arthritis and related conditions. Conclusion The large volume of ambulatory care points to the significant contribution of orthopaedic surgeons to the medical management of chronic musculoskeletal conditions including arthritis and injuries. The findings highlight that surgery is only one component of the work

  18. 连续非卧床腹膜透析患者的护理%Nursing of 16 patients wtih receiving contiuous ambulatory peritoneal dialysis

    Institute of Scientific and Technical Information of China (English)

    郭康萍; 王戬; 俞凯


    腹膜透析是延长终末期肾脏病患者生命的重要手段之一,连续非卧床腹膜透析便于患者在家操作,成为在院治疗的重要补充.加强连续非卧床腹透的护理,可以有效保障治疗过程的安全性和有效性.%Peritoneal dialysis is one important means to extend the life of end - stage renal disease , continuous ambulatory peritoneal dialysis patients at home is easy to operate, as an important supplement in the hospital for treatment. To enhance the care of continuous ambulatory peritoneal dialvsis can effectively protect the safety and efficacy of the treatment process.

  19. Casual and ambulatory blood pressure monitoring in children with renal scarring

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    Miloševski Gordana


    Full Text Available INTRODUCTION Renal scarring is the most common cause of arterial hypertension in children. High blood pressure (BP and microalbuminuria contribute to the progression of chronic renal disease. OBJECTIVE The aims of the study were: to assess BP in children with renal scarring by continuous ambulatory blood pressure measurement (ABPM in comparison to the casual method (CBP, and to determine the correlation between ambulatory blood pressure (ABP and/or casual blood pressure (CBP values and proteinuria in children with renal scarring. METHOD This forward-looking study comprised thirty-five children (26 girls and 9 boys, aged between 3-13 years, 10.4±3.9, X+SD. Blood pressure was measured using the casual method (CBP with a mercury manometer; BP was measured three times and the average was taken as a referent value. ABPM was performed using the oscillometric method with the Space Labs device, model 90207. RESULTS 45.71% of patients were classified as hypertensive by ABPM, while only 22.6% of CBP measurements were above the 95th percentile (p<0.01. "White coat hypertension" was present in 40% of the patients. Non-dipping BP alteration was detected in 37.14% of the patients. CONCLUSION Nocturnal systolic hypertension (systolic non-dipping alteration is very frequent in children with renal scarring. Nocturnal diastolic blood pressure, detectable only via ABPM, is positively correlated with proteinuria and may be an initial sign of the progression of renal scarring. ABPM is more sensitive than CBP in the evaluation of BP in children with renal scarring.

  20. Limits to ambulatory displacement of coconut mites in absence and presence of food-related cues. (United States)

    Melo, J W S; Lima, D B; Sabelis, M W; Pallini, A; Gondim, M G C


    Ambulatory movement of plant-feeding mites sets limits to the distances they can cover to reach a new food source. In absence of food-related cues these limits are determined by survival, walking activity, walking path tortuosity and walking speed, whereas in presence of food the limits are also determined by the ability to orient and direct the path towards the food source location. For eriophyoid mites such limits are even more severe because they are among the smallest mites on earth, because they have only two pairs of legs and because they are very sensitive to desiccation. In this article we test how coconut mites (Aceria guerreronis Keifer) are constrained in their effective displacement by their ability to survive in absence of food (meristematic tissue under the coconut perianth) and by their ability to walk and orient in absence or presence of food-related cues. We found that the mean survival time decreased with increasing temperature and decreasing humidity. Under climatic conditions representative for the Tropics (27 °C and 75 % relative humidity) coconut mites survived on average for 11 h and covered 0.4 m, representing the effective linear displacement away from the origin. Within a period of 5 h, coconut mites collected from old fruits outside the perianth moved further away from the origin than mites collected under the perianth of young fruits. However, in the presence of food-related cues coconut mites traveled over 30 % larger distances than in absence of these cues. These results show that ambulatory movement of eriophyoid mites may well bring them to other coconuts within the same bunch and perhaps also to other bunches on the same coconut palm, but it is unlikely to help them move from palm to palm, given that palms usually do not touch each other.

  1. Do we care about sustainability? An analysis of time sensitivity of social preferences under environmental time-persistent effects. (United States)

    Faccioli, Michela; Hanley, Nick; Torres, Cati; Font, Antoni Riera


    Environmental cost-benefit analysis has traditionally assumed that the value of benefits is sensitive to their timing and that outcomes are valued higher, the sooner in time they occur following implementation of a project or policy. Though, this assumption might have important implications especially for the social desirability of interventions aiming at counteracting time-persistent environmental problems, whose impacts occur in the long- and very long-term, respectively involving the present and future generations. This study analyzes the time sensitivity of social preferences for preservation policies of adaptation to climate change stresses. Results show that stated preferences are time insensitive, due to sustainability issues: individuals show insignificant differences in benefits they can experience within their own lifetimes compared to those which occur in the longer term, and which will instead be enjoyed by future generations. Whilst these results may be specific to the experimental design employed here, they do raise interesting questions regarding choices over time-persistent environmental problems, particularly in terms of the desirability of interventions which produce longer-term benefits.

  2. The Psychometric Properties of the Center for Epidemiologic Studies Depression Scale in Chinese Primary Care Patients: Factor Structure, Construct Validity, Reliability, Sensitivity and Responsiveness.

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    Weng Yee Chin

    Full Text Available The Center for Epidemiologic Studies Depression Scale (CES-D is a commonly used instrument to measure depressive symptomatology. Despite this, the evidence for its psychometric properties remains poorly established in Chinese populations. The aim of this study was to validate the use of the CES-D in Chinese primary care patients by examining factor structure, construct validity, reliability, sensitivity and responsiveness.The psychometric properties were assessed amongst a sample of 3686 Chinese adult primary care patients in Hong Kong. Three competing factor structure models were examined using confirmatory factor analysis. The original CES-D four-structure model had adequate fit, however the data was better fit into a bi-factor model. For the internal construct validity, corrected item-total correlations were 0.4 for most items. The convergent validity was assessed by examining the correlations between the CES-D, the Patient Health Questionnaire 9 (PHQ-9 and the Short Form-12 Health Survey (version 2 Mental Component Summary (SF-12 v2 MCS. The CES-D had a strong correlation with the PHQ-9 (coefficient: 0.78 and SF-12 v2 MCS (coefficient: -0.75. Internal consistency was assessed by McDonald's omega hierarchical (ωH. The ωH value for the general depression factor was 0.855. The ωH values for "somatic", "depressed affect", "positive affect" and "interpersonal problems" were 0.434, 0.038, 0.738 and 0.730, respectively. For the two-week test-retest reliability, the intraclass correlation coefficient was 0.91. The CES-D was sensitive in detecting differences between known groups, with the AUC >0.7. Internal responsiveness of the CES-D to detect positive and negative changes was satisfactory (with p value 0.2. The CES-D was externally responsive, with the AUC>0.7.The CES-D appears to be a valid, reliable, sensitive and responsive instrument for screening and monitoring depressive symptoms in adult Chinese primary care patients. In its original


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    Karin Mitie Kubo


    Full Text Available Este trabalho objetivou caracterizar o perfil do paciente ambulatorial com valvopatia aórtica, identificar o grau de conhecimento sobre sua doença, suas principais limitações no cotidiano e como ocorre o processo de enfrentamento nessa situação. Os dados obtidos através de entrevista semi-estruturada aplicada a 12 pacientes e analisados através de metodologia de análise quantitativa e qualitativa, permitiram identificar como estes sujeitos representam para si a doença e o tratamento, bem como suas implicações no cotidiano, ou seja, possibilitaram captar a realidade a partir da perspectiva do sujeito, um conhecimento imprescindível para a elaboração de uma proposta educacional.El objetivo del este trabajo, es caracterizar el perfil del paciente ambulatorio con valvulopatía aórtica, identificar su conocimiento sobre la enfermedad, las principales limitaciones en su cotidiano y como ocurre el proceso de enfrentamiento en ésta situación. Los datos obtenidos a través de entrevista semi-estructurada de 12 pacientes y analizados de acuerdo con la metodología de análisis cuantitativa y cualitativa, permitieron identificar como estos sujetos representan para si la enfermedad y su tratamiento, así como también sus implicaciones en el cotidiano, o sea, hicieron posible captar la realidad vista desde la perspectiva del sujeto, conocimiento imprescindible para la elaboración de una propuesta educativa.This study aimed at characterizing the profile of outpatients with aortic valve dysfunction, identifying their knowledge about the disease, their major limitations during everyday activities and their means of coping with their predicament. The data obtained by semi-structured interviews with 12 patients and analyzed by quantitative and qualitative methods enabled to identify how the patients perceive the illness and the treatment as well as the implications to their everyday activities, that is, they allowed to capture reality from the

  4. A randomized study of telephonic care support in populations at risk for musculoskeletal preference-sensitive surgeries

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    Veroff David R


    Full Text Available Abstract Background The rate of elective surgeries varies dramatically by geography in the United States. For many of these surgeries, there is not clear evidence of their relative merits over alternate treatment choices and there are significant tradeoffs in short- and long-term risks and benefits of selecting one treatment option over another. Conditions and symptoms for which there is this lack of a single clear evidence-based treatment choice present great opportunities for patient and provider collaboration on decision making; back pain and joint osteoarthritis are two such ailments. A number of decision aids are in active use to encourage this shared decision-making process. Decision aids have been assessed in formal studies that demonstrate increases in patient knowledge, increases in patient-provider engagement, and reduction in surgery rates. These studies have not widely demonstrated the added benefit of health coaching in support of shared decision making nor have they commonly provided strong evidence of cost reductions. In order to add to this evidence base, we undertook a comparative study testing the relative impact on health utilization and costs of active outreach through interactive voice response technology to encourage health coaching in support of shared decision making in comparison to mailed outreach or no outreach. This study focused on individuals with back pain or joint pain. Methods We conducted four waves of stratified randomized comparisons for individuals with risk for back, hip, or knee surgery who did not have claims-based evidence of one or more of five chronic conditions and were eligible for population care management services within three large regional health plans in the United States. An interactive voice response (IVR form of outreach that included the capability for individuals to directly connect with health coaches telephonically, known as AutoDialog®, was compared to a control (mailed outreach or

  5. The structure, organisation and perioperative management of ambulatory surgery and anaesthesia in France: Methodology of the SFAR-OPERA study. (United States)

    Albaladejo, Pierre; Aubrun, Frédéric; Samama, Charles-Marc; Jouffroy, Laurent; Beaussier, Marc; Benhamou, Dan; Romegoux, Pauline; Skaare, Kristina; Bosson, Jean-Luc; Ecoffey, Claude


    The organization of health care establishments and perioperative care are essential for ensuring the quality of care and safety of patients undergoing outpatient surgery. In order to correctly inventory these organizations and practices, in 2013-2014, the French society of anaesthesia and intensive care organized an extensive practical survey in French ambulatory surgery units entitled the "OPERA" study (Organisation periopératoire de l'anesthésie en chirurgie ambulatoire). From among all of the ambulatory surgery centres listed by the Agences régionales de santé (Regional health agencies, France), 206 public and private centres were randomly selected. A structural (typology, organization) survey and a medical-practice survey (focusing on the management of postoperative pain, nausea and vomiting as well as the prevention of venous thromboembolism) were collected and managed by a prospective audit of practices occurring on two randomly selected days. The latter was further accompanied by an additional audit specifically focussing on ten representative procedures: (1) stomatology surgery (third molar removal); (2) knee arthroscopy; (3) surgery of the abdominal wall (including inguinal hernia); (4) perianal surgery; (5) varicose vein surgery; (6) digestive laparoscopy-cholecystectomy; (7) breast surgery (tumourectomy); (8) uterine surgery; (9) hallux valgus and (10) hand surgery (excluding carpal tunnel). Over the 2 days of observation, 7382 patients were included comprising 2174 patients who underwent one of the procedures from the above list. The analysis of these data will provide an overview of the organization of health establishments, the modalities thus supported and compliance with standards.

  6. Induction of sexual arousal in women under conditions of institutional and ambulatory laboratory circumstances: a comparative study

    NARCIS (Netherlands)

    J. Bloemers; J. Gerritsen; R. Bults; H. Koppeschaar; W. Everaerd; B. Olivier; A. Tuiten


    Introduction. Measuring under naturally occurring circumstances increases ecological validity. We developed an ambulatory psychophysiological laboratory that allows experiments to be performed at home. Aims.  To compare institutional laboratory task measures with ambulatory laboratory task measures.

  7. Strategic response by providers to specialty hospitals, ambulatory surgery centers, and retail clinics. (United States)

    Burns, Lawton R; David, Guy; Helmchen, Lorens A


    Radical innovation and disruptive technologies are frequently heralded as a solution to delivering higher quality, lower cost health care. According to the literature on disruption, local hospitals and physicians (incumbent providers) may be unable to competitively respond to such "creative destruction" and alter their business models for a host of reasons, thus threatening their future survival. However, strategic management theory and research suggest that, under certain conditions, incumbent providers may be able to weather the discontinuities posed by the disrupters. This article analyzes 3 disruptive innovations in service delivery: single-specialty hospitals, ambulatory surgical centers, and retail clinics. We first discuss the features of these innovations to assess how disruptive they are. We then draw on the literature on strategic adaptation to suggest how incumbents develop competitive responses to these disruptive innovations that assure their continued survival. These arguments are then evaluated in a field study of several urban markets based on interviews with both incumbents and entrants. The interviews indicate that entrants have failed to disrupt incumbent providers primarily as a result of strategies pursued by the incumbents. The findings cast doubt on the prospects for these disruptive innovations to transform health care.

  8. A real life clinical practice of neurologists in the ambulatory setting in Thailand: a pragmatic study

    Directory of Open Access Journals (Sweden)

    Kannikar Kongbunkiat


    Full Text Available The burden of neurological disorders is high in developing countries. Real life data from neurologists as to how they practice in Thailand are limited in literature. Practices of neurologists in a university hospital clinical setting in Thailand were studied. A prospective study was performed at the ambulatory neurology clinic, Khon Kaen University Hospital, between 1 February and 31 October 2009. The following data were recorded: numbers of patients, characteristics of patients, consultation notes, and time spent for each patient. There were three neurologists, each of whom ran one afternoon clinic, once a week. There were 6137 visits during the 9 months, with an average of 681 visits per month. The total number of patients was 2834. The three most common diseases were cerebrovascular diseases (33%, epilepsy (16%, and movement disorders (non-Parkinson’s disease, 12%. Neurologists spent an average of 6.34 minutes per patient. In conclusion, neurologists in medical schools have limited time to take care of each patient. Several strategies are needed in medical education and neurology training to improve the quality of care.

  9. El papel de los profesionales en centros de atención en drogas en ambulatorios de la ciudad de Bogotá, Colombia Papéis de profissionais, em centros de atenção ambulatorial em drogas, na cidade de Bogotá, Colômbia Roles of professionals in drug outpatient care centers, in the city of Bogota, Colombia

    Directory of Open Access Journals (Sweden)

    Luz Patricia Díaz Heredia


    Full Text Available Se trata de un estudio descriptivo y trasversal, desarrollado con 93 profesionales, que tuvo por objetivo caracterizar el papel de los profesionales que se desempeñaban en los centros de atención en drogadicción en ambulatorios de la ciudad de Bogotá, Colombia. Los resultados mostraron que los profesionales que se encontraron con mayor frecuencia fueron los psicólogos (38% y los que desempeñaban actividades terapéuticas eran el 34%. Se evidencia que los enfermeros, que correspondieron al 8% del profesionales, enfatizaron su papel en el ámbito administrativo (43% y predominantemente en los aspectos de promoción del auto cuidado (100%, prevención (57% y muy poco en la rehabilitación y reinserción social (14%. Los papeles desempeñados por los profesionales coinciden con lo esperado a respecto de las actividades de las diferentes profesiones, con excepción de los terapeutas ocupacionales. Se considera que las enfermeras necesitan ganar más espacio dentro del equipo de atención a los usuarios de drogas.Estudo descritivo, transversal, desenvolvido com 93 profissionais. O objetivo foi caracterizar o papel e as atividades desempenhadas pelos profissionais atuantes nos centros de atenção ambulatorial a usuários de drogas, da cidade de Bogotá, Colômbia. Os resultados mostraram que os profissionais atuantes em maior número foram os psicólogos (38%, desempenhando atividades em comunidades terapêuticas (34%. Evidenciou-se que os enfermeiros, que correspondem a 8% dos profissionais, enfatizaram seu papel em atividades administrativas (43% e, predominantemente, nos aspectos de promoção do autocuidado (100%, prevenção (57% e pouco na reabilitação e reinserção social (14%. O papel desempenhado pelos profissionais coincide com o esperado em relação às condutas e atividades desempenhadas pelas diferentes profissões, com exceção dos terapeutas ocupacionais. Considera-se que os enfermeiros precisam conquistar maior espa

  10. Flexible Capacitive Electrodes for Minimizing Motion Artifacts in Ambulatory Electrocardiograms

    Directory of Open Access Journals (Sweden)

    Jeong Su Lee


    Full Text Available This study proposes the use of flexible capacitive electrodes for reducing motion artifacts in a wearable electrocardiogram (ECG device. The capacitive electrodes have conductive foam on their surface, a shield, an optimal input bias resistor, and guarding feedback. The electrodes are integrated in a chest belt, and the acquired signals are transmitted wirelessly for ambulatory heart rate monitoring. We experimentally validated the electrode performance with subjects standing and walking on a treadmill at speeds of up to 7 km/h. The results confirmed the highly accurate heart rate detection capacity of the developed system and its feasibility for daily-life ECG monitoring.

  11. Twenty-five years of ambulatory laparoscopic cholecystectomy. (United States)

    Bueno Lledó, José; Granero Castro, Pablo; Gomez I Gavara, Inmaculada; Ibañez Cirión, Jose L; López Andújar, Rafael; García Granero, Eduardo


    It is accepted by the surgical community that laparoscopic cholecystectomy (LC) is the technique of choice in the treatment of symptomatic cholelithiasis. However, more controversial is the standardization of system implementation in Ambulatory Surgery because of its different different connotations. This article aims to update the factors that influence the performance of LC in day surgery, analyzing the 25 years since its implementation, focusing on the quality and acceptance by the patient. Individualization is essential: patient selection criteria and the implementation by experienced teams in LC, are factors that ensure high guarantee of success.

  12. Scheduling of procedures and staff in an ambulatory surgery center. (United States)

    Pash, Joel; Kadry, Bassam; Bugrara, Suhabe; Macario, Alex


    For ambulatory surgical centers (ASC) to succeed financially, it is critical for ASC managers to schedule surgical procedures in a manner that optimizes operating room (OR) efficiency. OR efficiency is maximized by using historical data to accurately predict future OR workload, thereby enabling OR time to be properly allocated to surgeons. Other strategies to maintain a well-functioning ASC include recruiting and retaining the right staff and ensuring patients and surgeons are satisfied with their experience. This article reviews different types of procedure scheduling systems. Characteristics of well-functioning ASCs are also discussed.

  13. Assessment of access to primary health care among children and adolescents hospitalized due to avoidable conditions

    Directory of Open Access Journals (Sweden)

    Ana Paula Scoleze Ferrer

    Full Text Available Introduction: Hospitalizations for ambulatory care-sensitive conditions (HACSC are considered an indicator of the effectiveness of primary health care (PHC. High rates of HACSC represent problems in the access or the quality of health care. In Brazil, HACSC rates are high and there are few studies on the factors associated with it. Objective: To evaluate the access to PHC offered to children and adolescents hospitalized due to ACSC and analyze the conditioning factors. Method: Cross-sectional study with a quantitative and qualitative approach. Five hundred and one (501 users (guardians/caregivers and 42 professionals of PHC units were interviewed over one year. Quantitative data were obtained using Primary Care Assessment Tool validated in Brazil (PCATool-Brazil, while qualitative data were collected by semi-structured interview. The independent variables were: age, maternal education, family income, type of diagnosis, and model of care offered, and the dependent variables were access and its components (accessibility and use of services. Results: Sixty-five percent (65.2% of hospitalizations were ACSC. From the perspective of both users and professionals, access and its components presented low scores. Age, type of diagnosis, and model of care affected the results. Conclusion: The proportion of HACSC was high in this population. Access to services is inappropriate due to: barriers to access, appreciation of the emergency services, and attitude towards health needs. Professional attitudes and opinions reinforce inadequate ideas of users reflecting on the pattern of service use.

  14. 76 FR 65885 - Medicare Program; Changes to the Ambulatory Surgical Centers Patient Rights Conditions for Coverage (United States)


    ... 42 CFR Chapter IV Medicare and Medicaid Programs; Changes to the Ambulatory Surgical Centers Patient... Service 42 CFR Part 416 RlN 0938-AP93 Medicare Program; Changes to the Ambulatory Surgical Centers Patient..., or the patient's surrogate prior to the start of the surgical procedure. In addition, we made...

  15. Estimating qualitative parameters for assessment of body balance and arm function in a simulated ambulatory setting

    NARCIS (Netherlands)

    Meulen, van Fokke B.; Reenalda, Jasper; Veltink, Peter H.


    Continuous daily-life monitoring of balance control and arm function of stroke survivors in an ambulatory setting, is essential for optimal guidance of rehabilitation. In a simulated ambulatory setting, balance and arm function of seven stroke subjects is evaluated using on-body measurement systems

  16. 42 CFR 419.31 - Ambulatory payment classification (APC) system and payment weights. (United States)


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Ambulatory payment classification (APC) system and... Outpatient Services § 419.31 Ambulatory payment classification (APC) system and payment weights. (a) APC... the Federal Food, Drug and Cosmetic Act. (3) The payment rate determined for an APC group...

  17. Increased systolic ambulatory blood pressure and microalbuminuria in treated and non-treated hypertensive smokers

    DEFF Research Database (Denmark)

    Sørensen, Kaspar; Kristensen, Kjeld S; Bang, Lia E;


    The primary aim of the present study was to evaluate the impact of smoking status on both clinic and ambulatory blood pressure (BP) and heart rate (HR) by using 24-h ambulatory BP monitoring in treated and non-treated hypertensive smokers and non-smokers. A secondary aim was to evaluate the inter...... the interrelations between BP, smoking status and microalbuminuria....

  18. Determinants of the ambulatory arterial stiffness index in 7604 subjects from 6 populations

    DEFF Research Database (Denmark)

    Adiyaman, Ahmet; Dechering, Dirk G; Boggia, José


    The ambulatory arterial stiffness index (AASI) is derived from 24-hour ambulatory blood pressure recordings. We investigated whether the goodness-of-fit of the AASI regression line in individual subjects (r(2)) impacts on the association of AASI with established determinants of the relation between...

  19. Estimation of blood pressure variability from 24-hour ambulatory finger blood pressure

    NARCIS (Netherlands)

    Omboni, S.; Parati, G.; Castiglioni, P.; Rienzo, M. di; Imholz, B.P.M.; Langewouters, G.J.; Wesseling, K.H.; Mancia, G.


    Portapres is a noninvasive, beat-to-beat finger blood pressure (BP) monitor that has been shown to accurately estimate 24-hour intra-arterial BP at normal and high BPs. However, no information is available on the ability of this device to accurately track ambulatory BP variability. In 20 ambulatory

  20. 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. (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...

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

  2. Pathogenesis and early detection of inflammatory arthritis: the role of musculoskeletal symptoms, infections and arthritis-related comorbidities in primary care.

    NARCIS (Netherlands)

    Nielen, M.; Beers-Tas, M. van; Korevaar, J.; Schaardenburg, D. van


    Background & Aim: Rheumatoid arthritis is a chronic systemic autoimmune disease characterized by clinically apparent inflammatory arthritis (IA). A preclinical phase has been recognized in which symptoms arise and ambulatory care utilization increases. However, information on location and timing of

  3. Ambulatory oxygen: why do COPD patients not use their portable systems as prescribed? A qualitative study

    Directory of Open Access Journals (Sweden)

    Fenwick Angela


    Full Text Available Abstract Background Patients with COPD on long term oxygen therapy frequently do not adhere to their prescription, and they frequently do not use their ambulatory oxygen systems as intended. Reasons for this lack of adherence are not known. The aim of this study was to obtain in-depth information about perceptions and use of prescribed ambulatory oxygen systems from patients with COPD to inform ambulatory oxygen design, prescription and management. Methods A qualitative design was used, involving semi-structured face-to-face interviews informed by a grounded theory approach. Twenty-seven UK community-dwelling COPD patients using NHS prescribed ambulatory systems were recruited. Ambulatory oxygen systems comprised cylinders weighing 3.4 kg, a shoulder bag and nasal cannulae. Results Participants reported that they: received no instruction on how to use ambulatory oxygen; were uncertain of the benefits; were afraid the system would run out while they were using it (due to lack of confidence in the cylinder gauge; were embarrassed at being seen with the system in public; and were unable to carry the system because of the cylinder weight. The essential role of carers was also highlighted, as participants with no immediate carers did not use ambulatory oxygen outside the house. Conclusions These participants highlighted previously unreported problems that prevented them from using ambulatory oxygen as prescribed. Our novel findings point to: concerns with the lack of specific information provision; the perceived unreliability of the oxygen system; important carer issues surrounding managing and using ambulatory oxygen equipment. All of these issues, as well as previously reported problems with system weight and patient embarrassment, should be addressed to improve adherence to ambulatory oxygen prescription and enhance the physical and social benefits of maintaining mobility in this patient group. Increased user involvement in both system development

  4. High Sensitivity C-reactive Protein Levels in Acute Ischemic Stroke and Subtypes: A study from a Tertiary Care Center

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    Jaydip Ray Chaudhuri


    Full Text Available Background: Stroke is a heterogeneous disease with several risk factors. High sensitivity C-reactive protein (hsCRP is a marker for cardiovascular and cerebrovascular diseases. Recent studies have shown that high hsCRP level is a risk factor for ischemic stroke. The objective of our study was to investigate the association of high hsCRP(> 3 mg/L levels with ischemic stroke and its subtypes in Indian patients.Methods: We recruited 210 consecutive acute stroke patients and 150 age and sex matched controls. Stroke patients were admitted within 72 hours of onset, at Yashoda Hospital, Hyderabad, India. The study period was from January 2011 to December 2012. All patients underwent tests as per standard protocol for stroke workup. Serum hsCRP level was assessed in all stroke patients and controls on the day of admission.Results: The mean hsCRP was significantly higher in stroke patients (3.8 ± 2.5 than controls (1.8 ± 1.5 (P < 0.001. High hsCRP had higher frequency in stroke patients 130 (61.9% compared to controls 10 (6.6%, P < 0.001. High hsCRP level was more prevalent in the stroke subtypes of cardioembolic stroke (83.3% and large artery atherosclerosis (72%. High hsCRP level was significantly associated with hypercholesterolemia (P = 0.001, age(P = 0.01, and mortality (0.04. After adjustment of regression analysis it was observed that high level hsCRP is independently associated with acute ischemic stroke (Odds 4.5; 95% CI: 2.5-12.2; especially the stroke subtypes of cardioembolic stroke, (odds ratio 3.4, 95% CI: 1.9-10.5 and large artery atherosclerosis (odds ratio 2.1, 95% CI: 1.5-3.8.Conclusion: High hsCRP level is strongly associated with and an independent predictor of acute ischemic stroke. The association was found in all ischemic stroke subtypes.

  5. Ambulatory blood pressure status in children: comparing alternate limit sources. (United States)

    Bell, Cynthia S; Poffenbarger, Tim S; Samuels, Joshua A


    The American Heart Association has included alternate ambulatory blood pressure (ABP) limits for children published by Wühl in 2002. These updated limits employ the same pediatric cohort data as the previous ABP limits published by Soergel in 1997 but differ in analysis technique. The implications of changing ABP limit source on the diagnosis of hypertension has yet to be examined in a large pediatric cohort. We reviewed 741 ABP monitorings performed in children referred to our hypertension clinic between 1991-2007. Hypertension was defined as 24-h mean blood pressure ≥ 95 th percentile or 24-h blood pressure load ≥ 25%, by Soergel and Wühl limits separately. Six hundred seventy-three (91%) children were classified the same by both limit sources. Wühl limits were more likely than Soergel to classify a child as hypertensive (443 vs. 409, respectively). There was an increased classification of prehypertension and decreased white-coat hypertension by the Wühl method, whereas ambulatory and severe hypertension counts remained relatively the same by both limits sources. The use of either limit source will not significantly affect most clinical outcomes but should remain consistent over long-term research projects. Collection of new normative data from a larger, multiethnic population is needed for better measurement of ABP in children.

  6. Wearable and superhydrophobic hardware for ambulatory biopotential acquisition. (United States)

    Martinez-Tabares, F J; Delgado-Trejos, E; Castellanos-Dominguez, G


    Wearable monitoring devices are a promising trend for ambulatory and real time biosignal processing, because they improve access and coverage by means of comfortable sensors, with real-time communication via mobile networks. In this paper, we present a garment for ambulatory electrocardiogram monitoring, a smart t-shirt with a textile electrode that conducts electricity and has a coating designed to preserve the user's hygiene, allowing long-term mobile measurements. Silicon dioxide nanoparticles were applied on the surface of the textile electrodes to preserve conductivity and impart superhydrophobic properties. A model to explain these results is proposed. The best result of this study is obtained when the contact angles between the fluid and the fabric exceeded 150°, while the electrical resistivity remained below 5 Ω·cm, allowing an acquisition of high quality electrocardiograms in moving patients. Thus, this tool represents an interesting alternative for medium and long-term measurements, preserving the textile feeling of clothing and working under motion conditions.

  7. Can Quantitative Muscle Strength and Functional Motor Ability Differentiate the Influence of Age and Corticosteroids in Ambulatory Boys with Duchenne Muscular Dystrophy? (United States)

    Buckon, Cathleen; Sienko, Susan; Bagley, Anita; Sison-Williamson, Mitell; Fowler, Eileen; Staudt, Loretta; Heberer, Kent; McDonald, Craig M.; Sussman, Michael


    Background: In the absence of a curative treatment for Duchenne Muscular Dystrophy (DMD), corticosteroid therapy (prednisone, deflazacort) has been adopted as the standard of care, as it slows the progression of muscle weakness and enables longer retention of functional mobility. The ongoing development of novel pharmacological agents that target the genetic defect underlying DMD offer hope for a significant alteration in disease progression; however, substantiation of therapeutic efficacy has proved challenging. Identifying functional outcomes sensitive to the early, subtle changes in muscle function has confounded clinical trials. Additionally, the alterations in disease progression secondary to corticosteroid therapy are not well described making it difficult to ascertain the benefits of novel agents, often taken concurrently with corticosteroids. Objective: The purpose of this study was to examine outcome responsiveness to corticosteroid therapy and age at the onset of a natural history study of ambulatory boys with DMD. Methods: Eighty-five ambulatory boys with DMD (mean age 93 mo, range 49 to 180 mo) were recruited into this study. Fifty participants were on corticosteroid therapy, while 33 were corticosteroid naïve at the baseline assessment. Within each treatment group boys were divided in two age groups, 4 to 7 years and 8 and greater years of age. The Biodex System 3 Pro isokinetic dynamometer was used to assess muscle strength. Motor skills were assessed using the upper two dimensions (standing/walking, running & jumping) of the Gross Motor Function Measure (GMFM 88) and Timed Motor Tests (TMTs) (10-meter run, sit to stand, supine to stand, climb 4-stairs). Two way analysis of variance and Pearson correlations were used for analysis. Results: A main effect for age was seen in select lower extremity muscle groups (hip flexors, knee extensors and ankle dorsiflexors), standing dimension skills, and all TMTs with significantly greater weakness and loss of

  8. Self-care in heart failure patients


    Ana Paula da Conceição; Mariana Alvina dos Santos; Bernardo dos Santos; Diná de Almeida Lopes Monteiro da Cruz


    Abstract Objective: to describe self-care behavior and its associated factors in a sample of heart failure Brazilian patients. Method: descriptive cross-sectional study with non-probabilistic sample of 116 ambulatory patients undergoing heart failure treatment. Self-care was evaluated using the Self-Care of Heart Failure Index, (scores ≥70 points=appropriate self-care). Association tests were applied, considering a descriptive level of 0.05. Results: the mean age of participants was 57.7 (SD ...

  9. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting. (United States)

    Vadivelu, Nalini; Kai, Alice M; Kodumudi, Vijay; Berger, Jack M


    Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed.

  10. Multimorbidity, Mental Illness, and Quality of Care: Preventable Hospitalizations among Medicare Beneficiaries

    Directory of Open Access Journals (Sweden)

    Mayank Ajmera


    Full Text Available Background. Individuals with multimorbidity are vulnerable to poor quality of care due to issues related to care coordination. Ambulatory care sensitive hospitalizations (ACSHs are widely accepted quality indicators because they can be avoided by timely, appropriate, and high-quality outpatient care. Objective. To examine the association between multimorbidity, mental illness, and ACSH. Study Design. We used a longitudinal panel design with data from multiple years (2000–2005 of Medicare Current Beneficiary Survey. Individuals were categorized into three groups: (1 multimorbidity with mental illness (MM/MI; (2 MM/no MI; (3 no MM. Multivariable logistic regressions were used to analyze the association between multimorbidity and ACSH. Results. Any ACSH rates varied from 10.8% in MM/MI group to 8.8% in MM/No MI group. Likelihood of any ACSH was higher among beneficiaries with MM/MI (AOR = 1.62; 95% CI = 1.14, 2.30 and MM (AOR = 1.54; 95% CI = 1.12, 2.11 compared to beneficiaries without multimorbidity. There was no statistically significant difference in likelihood of ACSH between MM/MI and MM/No MI groups. Conclusion. Multimorbidity (with or without MI had an independent and significant association with any ACSH. However, presence of mental illness alone was not associated with poor quality of care as measured by ACSH.

  11. Developing a composite index of spatial accessibility across different health care sectors: A German example. (United States)

    Siegel, Martin; Koller, Daniela; Vogt, Verena; Sundmacher, Leonie


    The evolving lack of ambulatory care providers especially in rural areas increasingly challenges the strict separation between ambulatory and inpatient care in Germany. Some consider allowing hospitals to treat ambulatory patients to tackle potential shortages of ambulatory care in underserved areas. In this paper, we develop an integrated index of spatial accessibility covering multiple dimensions of health care. This index may contribute to the empirical evidence concerning potential risks and benefits of integrating the currently separated health care sectors. Accessibility is measured separately for each type of care based on official data at the district level. Applying an Improved Gravity Model allows us to factor in potential cross-border utilization. We combine the accessibilities for each type of care into a univariate index by adapting the concept of regional multiple deprivation measurement to allow for a limited substitutability between health care sectors. The results suggest that better health care accessibility in urban areas persists when taking a holistic view. We believe that this new index may provide an empirical basis for an inter-sectoral capacity planning.


    Directory of Open Access Journals (Sweden)

    J.S. Santos


    Full Text Available Introdução: As listas de espera para colecistectomia, associadas à elevada demanda dos leitos e salas cirúrgicas dos Hospitais Universitários, são incentivos para adoção de novos programas de assistência. Objetivo: Avaliar o processo de organização e os resultados clínicos dos Mutirões de Colecistectomia por Videolaparoscopia, em regime de Cirurgia Ambulatorial. Pacientes e Métodos: Dentre os 314 pacientes portadores de colelitíase sintomática que aguardavam cirurgia no HCFMRP-USP, 160 foram selecionados para tratamento em regime ambulatorial. Uma equipe multiprofissional, formada por cirurgiões, anestesistas, enfermeiros e assistentes sociais, programou 4 mutirões para serem realizados em fins de semana, em função da disponibilidade do bloco cirúrgico e da sala de recuperação pós-anestésica. Mediante avaliação retrospectiva, foram analisados 79 prontuários dos pacientes operados nos Mutirões I e II (Grupo A e 79 dos 80 operados nos Mutirões III e IV (Grupo B. Análise estatística: teste de Wilcoxon e exato de Fisher (pIntroduction: The growing list of patients awaiting cholecystectomy, together with the great demand for beds and operating rooms at University Hospitals have encouraged the adoption of different solutions. Objective: To evaluate the process of organization and the clinical results of intensive programs of cholecystectomy by videolaparoscopy on an ambulatory surgery basis. Methods: Among the 314 patients with symptomatic cholelithiasis who were waiting for surgery at HCFMRP-USP, 160 were selected for treatment on an ambulatory basis. A multiprofessional team consisting of surgeons, anesthesiologists, nurses and social workers scheduled 4 intensive programs to be performed on weekends according to the availability of the surgical block and of the post-anesthesia recovery room. In a retrospective evaluation, the authors analyzed 79 medical records of patients operated upon in the intensive programs I

  13. Implementation of an Anesthesia Information Management System in an Ambulatory Surgery Center. (United States)

    Mudumbai, Seshadri C


    Anesthesia information management systems (AIMS) are increasingly being implemented throughout the United States. However, little information exists on the implementation process for AIMS within ambulatory surgery centers (ASC). The objectives of this descriptive study are to document: 1) the phases of implementation of an AIMS at an ASC; and 2) lessons learnt from a socio-technical perspective. The ASC, within the Veterans Health Administration (VHA), has hosted an AIMS since 2008. As a quality improvement effort, we implemented a new version of the AIMS. This new version involved fundamental software changes to enhance clinical care such as real-time importing of laboratory data and total hardware exchange. The pre-implementation phase involved coordinated preparation over six months between multiple informatics teams along with local leadership. During this time, we conducted component, integration, and validation testing to ensure correct data flow from medical devices to AIMS and centralized databases. The implementation phase occurred in September 2014 over three days and was successful. Over the next several months, during post-implementation phase, we addressed residual items like latency of the application. Important lessons learnt from the implementation included the utility of partnering early with executive leadership; ensuring end user acceptance of new clinical workflow; continuous testing of data flow; use of a staged rollout; and providing additional personnel throughout implementation. Implementation of an AIMS at an ASC can utilize methods developed for large hospitals. However, issues unique to an ASC such as limited number of support personnel and distinctive workflows must be considered.

  14. Bidirectional peritoneal transport of albumin in continuous ambulatory peritoneal dialysis

    DEFF Research Database (Denmark)

    Joffe, P; Henriksen, Jens Henrik Sahl


    The present study was undertaken in order to assess bidirectional peritoneal kinetics of albumin after simultaneous i.v. and i.p. injection of radioiodinated albumin tracers (125I-RISA and 131I-RISA) in eight clinically stable uraemic patients undergoing continuous ambulatory peritoneal dialysis...... (CAPD). The plasma volume, intravascular albumin mass (IVM), and overall extravasation rate of albumin were not significantly different from that found in healthy controls. Albumin flux from the plasma into the peritoneal cavity was 3.71 +/- 0.82 (SD) mumol/h, which was only 3% of the overall...... extravasation rate (137 +/- 52 mumol/h). Albumin flux from the peritoneal cavity into the plasma was substantially lower (0.22 +/- 0.07 mumol/h, P peritoneal accumulation of the albumin from plasma over 4 h was 14 +/- 3.2 mumol, which was significantly lower than the intraperitoneal albumin...

  15. Is aerobic workload positively related to ambulatory blood pressure?

    DEFF Research Database (Denmark)

    Korshøj, Mette; Clays, Els; Lidegaard, Mark;


    PURPOSE: Cardiovascular disease is prevalent among workers with high levels of occupational physical activity. The increased risk may be due to a high relative aerobic workload, possibly leading to increased blood pressure. However, studies investigating the relation between relative aerobic...... workload and ambulatory blood pressure (ABP) are lacking. The aim was to explore the relationship between objectively measured relative aerobic workload and ABP. METHODS: A total of 116 cleaners aged 18-65 years were included after informed consent was obtained. A portable device (Spacelabs 90217......) was mounted for 24-h measurements of ABP, and an Actiheart was mounted for 24-h heart rate measurements to calculate relative aerobic workload as percentage of relative heart rate reserve. A repeated-measure multi-adjusted mixed model was applied for analysis. RESULTS: A fully adjusted mixed model...

  16. Ambulatory surgery center joint ventures involving tax-exempt entities. (United States)

    Becker, S; Pristave, R J; McConnell, W


    This article provides an overview of the tax-exempt related issues for ambulatory surgery center joint ventures involving tax-exempt entities. The article analyzes the key points of analysis of the guidance released by the IRS, in particular General Counsel Memorandum 39862, Revenue Ruling 98-15, and Redlands Surgical Services v. Commissioner of the Internal Revenue Service. These key points include whether the venture results in private inurement to insiders and whether the venture furthers the charitable purposes of the tax-exempt entity. The article also provides practical guidance to analyze the documents and structure of the joint venture to ensure compliance with the IRS guidance. These practical considerations include, among other things, whether the charitable purposes of the tax-exempt entity are clearly expressed in the documents and whether the tax-exempt entity has sufficient control over the joint venture to ensure the charitable purposes are being adhered to.

  17. Tuberculous peritonitis in a child undergoing continuous ambulatory peritoneal dialysis. (United States)

    Tsai, T C; Hsu, J C; Chou, L H; Lee, M L


    We present a 13-year-old girl with Arnold-Chiari syndrome and uremia secondary to neurogenic bladder. She had been treated with continuous ambulatory peritoneal dialysis (CAPD) for 13 months prior to the development of peritonitis. The patient demonstrated no improvement with a 3-day therapy of intraperitoneal vancomycin and netilmicin. Meanwhile, smear of centrifuged dialysate revealed acid fast bacilli on two occasions. We, then, started anti-TB therapy with oral isoniazid (INAH), rifampin and ethambutal. The symptoms subsided within three days. In the first week, the patient lost her peritoneal ultrafiltration and needed daytime automatic peritoneal dialysis. At the last follow-up examination, 12 months after treatment, she remained well on standard CAPD.

  18. Ambulatory Blood Pressure Monitoring – Clinical Practice Recommendations

    Directory of Open Access Journals (Sweden)

    Katalin Mako


    Full Text Available Ambulatory blood pressure monitoring (ABPM became a subject of considerable scientific interest. Due to the increasing use of the ABPM in everyday clinical practice it is important that all the users have a correct knowledge on the clinical indications, the methodology of using the device including some technical issues and the interpretation of results. In the last years several guidelines and position papers have been published with recommendations for the monitoring process, reference values, for clinical practice and research. This paper represents a summary of the most important aspects related to the use of ABPM in daily practice, being a synthesis of recommendations from the recent published guidelines and position papers. This reference article presents the practical and technical issues of ABPM, the use of this method in special situations, the clinical interpretation of measured values including the presentation of different ABPM patterns, derived parameters, the prognostic significance and the limitations of this method.

  19. Factors contributing to nonadherence to oral hypoglycemic medications among ambulatory type 2 diabetes patients in Southwestern Nigeria

    Directory of Open Access Journals (Sweden)

    Adisa R


    Full Text Available Objective: The overall goal of the study was to evaluate the probable reasons for patients’ nonadherence to prescribed oral hypoglycemic medications in an ambulatory care setting in Nigeria with a view to identifying points for necessary intervention to improve adherence and treatment outcomes. Also, the recommended non-drug management options for diabetes patients with emphasis on self monitoring of blood glucose were assessed.Methods: A cross-sectional study was conducted at a 200-bed secondary health care facility in Southwestern Nigeria between 2nd April and 31st May 2008. Copies of pre-tested questionnaire were administered directly to 121 ambulatory patients with type 2 diabetes at the study site. Information on socio-demographic characteristic, probable barriers that affect adherence to prescribed oral hypoglycemic medications, non-drug treatment options for diabetes, and patients’ self management efforts were obtained. Descriptive and chi-square statistics were used to evaluate the distribution of respondents’ opinion.Results: The response rate was almost 100%. The commonly cited intentional nonadherence practice included dose omission (70.2%. Almost 50% respondents were fed up with daily ingestion of drugs and 19.8% were inconvenienced with taking medications outside home and gave these as reasons for the dose omission. Forgetfulness (49.6% and high cost of medication (35.5% were mentioned as major non-intentional reasons for nonadherence. Aside oral medications, 82.6% and 95.0% of respondents respectively, reported moderate exercise and dietary restrictions as part of the prescribed treatment modalities. More than two third of respondents (81.8% had never monitored blood glucose by themselves. Significant association exist between sex, occupation and patients’ tendencies to forget doses of prescribed oral medications (p<0.05. Conclusion: Nonadherence behaviors among ambulatory patients with type 2 diabetes occur mostly, as

  20. Hepatic Dysfunction in Ambulatory Patients With Heart Failure (United States)

    Farr, Maryjane; Wu, Christina; Givens, Raymond C.; Collado, Ellias; Mancini, Donna M.; Schulze, P. Christian


    Objectives This study evaluated the Model for End-Stage Liver Disease (MELD) score and its modified versions, which are established measures of liver dysfunction, as a tool to assess heart transplantation (HTx) urgency in ambulatory patients with heart failure. Background Liver abnormalities have a prognostic impact on the outcome of patients with advanced heart failure. Methods We retrospectively evaluated 343 patients undergoing HTx evaluation between 2005 and 2009. The prognostic effectiveness of MELD and 2 modifications (MELDNa [includes serum sodium levels] and MELD-XI [does not include international normalized ratio]) for endpoint events, defined as death/HTx/ventricular assist device requirement, was evaluated in our cohort and in subgroups of patients on and off oral anticoagulation. Results The MELD and MELDNa scores were excellent predictors for 1-year endpoint events (areas under the curve: 0.71 and 0.73, respectively). High scores (>12) were strongly associated with poor survival at 1 year (MELD 69.3% vs. 90.4% [p < 0.0001]; MELDNa 70.4% vs. 96.9% [p < 0.0001]). Increased scores were associated with increased risk for HTx (hazard ratio: 1.10 [95% confidence interval: 1.06 to 1.14]; p < 0.0001 for both scores), which was independent of other known risk factors (MELD p = 0.0055; MELDNa p = 0.0083). Anticoagulant use was associated with poor survival at 1 year (73.7% vs. 86.4%; p = 0.0118), and the statistical significance of MELD/MELDNa was higher in patients not receiving oral anticoagulation therapy. MELD-XI was a fair but limited predictor of the endpoint events in patients receiving oral anticoagulation therapy. Conclusions Assessment of liver dysfunction according to the MELD scoring system provides additional risk information in ambulatory patients with heart failure. PMID:23563127

  1. Fatores associados ao abandono de acompanhamento ambulatorial em um serviço de assistência especializada em HIV/aids na cidade do Rio de Janeiro, RJ Factors associated with HIV/AIDS treatment dropouts in a special care unit in the City of Rio de Janeiro, RJ, Brazil

    Directory of Open Access Journals (Sweden)

    Louise Bastos Schilkowsky


    Full Text Available OBJETIVO: Este estudo visou a identificar fatores associados ao abandono do serviço de saúde por pacientes com HIV/aids. MÉTODOS: O estudo foi desenvolvido no Serviço de Assistência Especializada de um hospital universitário do Rio de Janeiro, considerando uma amostra estratificada de pacientes adultos, incluindo todos os casos de abandono (155 e 44,0% dos 790 casos em acompanhamento regular. Análises bivariadas visaram a identificar associações entre o abandono do serviço de saúde e variáveis demográficas, socioeconômicas e clínicas. Um modelo de regressão logística e um modelo de Cox foram utilizados para a identificação dos efeitos independentes das variáveis explicativas sobre o risco de abandono, no segundo caso incorporando a informação sobre a ocorrência do desfecho no decorrer do tempo. RESULTADOS: Os pacientes tinham em média 35 anos, sendo predominantemente do sexo masculino (66,4% e de nível socioeconômico baixo (45%. Em ambos os modelos, mostraram-se consistentemente associados ao risco de abandono estar desempregado ou possuir vínculo instável, usar drogas ilícitas e ter antecedentes psiquiátricos - associação positiva; e idade, ter o diagnóstico de aids e ter usado vários esquemas antirretrovirais - associação negativa. Na regressão logística, mostrou-se também positivamente associado à ocorrência de abandono o tempo entre o diagnóstico e a primeira consulta, enquanto no modelo Cox, o hazard de ocorrência de abandono mostrou-se positivamente associado a ser solteiro e negativamente associado a ter nível de escolaridade mais elevado. CONCLUSÕES: Os resultados deste trabalho permitem a identificação de pacientes com HIV/aids mais vulneráveis ao abandono do serviço de saúde.OBJECTIVE: This study aimed to identify factors associated with the health care of patients with HIV/AIDS who drop out. METHODS: The study was developed in a specialized health care unit of a University hospital in

  2. Isothermal strand displacement amplification (iSDA): a rapid and sensitive method of nucleic acid amplification for point-of-care diagnosis. (United States)

    Toley, Bhushan J; Covelli, Isabela; Belousov, Yevgeniy; Ramachandran, Sujatha; Kline, Enos; Scarr, Noah; Vermeulen, Nic; Mahoney, Walt; Lutz, Barry R; Yager, Paul


    We present a method of rapid isothermal amplification of DNA without initial heat denaturation of the template, and methods and probes for (a) real-time fluorescence detection and (b) lateral flow detection of amplicons. Isothermal strand displacement amplification (iSDA) can achieve >10(9)-fold amplification of the target sequence in isothermal DNA amplification methods. iSDA initiates at sites where DNA base pairs spontaneously open or transiently convert into Hoogsteen pairs, i.e. "breathe", and proceeds to exponential amplification by repeated nicking, extension, and displacement of single strands. We demonstrate successful iSDA amplification and lateral flow detection of 10 copies of a Staphylococcus aureus gene, NO.-inducible l-lactate dehydrogenase (ldh1) (Richardson, Libby, and Fang, Science, 2008, 319, 1672-1676), in a clean sample and 50 copies in the presence of high concentrations of genomic DNA and mucins in isothermal amplification reactions. Finally, we demonstrate the multiplexing capability of iSDA by the simultaneous amplification of the target gene and an engineered internal control sequence. The speed, sensitivity, and specificity of iSDA make it a powerful method for point-of-care molecular diagnosis.

  3. Modeling regional aerosol variability over California and its sensitivity to emissions and long-range transport during the 2010 CalNex and CARES campaigns

    Directory of Open Access Journals (Sweden)

    J. D. Fast


    Full Text Available The performance of the Weather Research and Forecasting regional model with chemistry (WRF-Chem in simulating the spatial and temporal variations in aerosol mass, composition, and size over California is quantified using measurements collected during the California Nexus of Air Quality and Climate Experiment (CalNex and the Carbonaceous Aerosol and Radiative Effects Study (CARES conducted during May and June of 2010. The extensive meteorological, trace gas, and aerosol measurements collected at surface sites and along aircraft and ship transects during CalNex and CARES were combined with operational monitoring network measurements to create a single dataset that was used to evaluate the one configuration of the model. Simulations were performed that examined the sensitivity of regional variations in aerosol concentrations to anthropogenic emissions and to long-range transport of aerosols into the domain obtained from a global model. The configuration of WRF-Chem used in this study is shown to reproduce the overall synoptic conditions, thermally-driven circulations, and boundary layer structure observed in region that controls the transport and mixing of trace gases and aerosols. However, sub-grid scale variability in the meteorology and emissions as well as uncertainties in the treatment of secondary organic aerosol chemistry likely contribute to errors at a primary surface sampling site located at the edge of the Los Angeles basin. Differences among the sensitivity simulations demonstrate that the aerosol layers over the central valley detected by lidar measurements likely resulted from lofting and recirculation of local anthropogenic emissions along the Sierra Nevada. Reducing the default emissions inventory by 50% led to an overall improvement in many simulated trace gases and black carbon aerosol at most sites and along most aircraft flight paths; however, simulated organic aerosol was closer to observed when there were no adjustments to the

  4. Efficiency evaluation for pooling resources in health care: An interpretation for managers

    NARCIS (Netherlands)

    Vanberkel, Peter T.; Boucherie, Richard J.; Hans, Erwin W.; Hurink, Johann L.; Litvak, Nelly


    Subject/Research problem Hospitals traditionally segregated resources into centralized functional departments such as diagnostic departments, ambulatory care centres, and nursing wards. In recent years this organizational model has been challenged by the idea that higher quality of care and efficie

  5. Care of the Patient with Renal Disease: Peritoneal Dialysis and Transplants, Nursing 321A. (United States)

    Hulburd, Kimberly

    A description is provided of a course, "Care of the Patient with Renal Disease," offered at the community college level to prepare licensed registered nurses to care for patients with renal disease, including instruction in performing the treatments of peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD). The first…

  6. Longitudinal ambulatory measurements of gait abnormality in dystrophin-deficient dogs

    Directory of Open Access Journals (Sweden)

    Voit Thomas


    Full Text Available Abstract Background This study aimed to measure the gait abnormalities in GRMD (Golden retriever muscular dystrophy dogs during growth and disease progression using an ambulatory gait analyzer (3D-accelerometers as a possible tool to assess the effects of a therapeutic intervention. Methods Six healthy and twelve GRMD dogs were evaluated twice monthly, from the age of two to nine months. The evolution of each gait variable previously shown to be modified in control and dystrophin-deficient adults was assessed using two-ways variance analysis (age, clinical status with repeated measurements. A principal component analysis (PCA was applied to perfect multivariate data interpretation. Results Speed, stride length, total power and force significantly already decreased (p Conclusion The gait variables measured by the accelerometers were sensitive to early detect and follow the gait disorders and mirrored the heterogeneity of clinical presentations, giving sense to monitor gait in GRMD dogs during progression of the disease and pre-clinical therapeutic trials.

  7. [Nursing care systematization for outpatient treatment care of patients with multiple sclerosis]. (United States)

    Corso, Nair Assunta Antônia; Gondim, Ana Paula Soares; Dalmeida, Patrícia Chagas Rocha; Albuquerque, Maria Girlene de Freitas


    An experience report of nurses in the implementation of care systematization in ambulatory care in an interdisciplinary care center for patients with multiple sclerosis of a public hospital in Fortaleza, Ceará, Brazil. This implementation is based on the NANDA International, Inc., Nursing Interventions Classification, and Nursing Outcomes Classifications. One of the results concerns systemized nursing care, which has enabled the identification and understanding of the responses of MS patients to potential and current health problems. Systematization entails expanding knowledge through a practice based on approach and encourage further research scientific evidence, in addition to promoting the role of the nurse in acomprehensive approachand encourage further research.

  8. Medical healthcare use in Parkinson's disease: survey in a cohort of ambulatory patients in Italy

    Directory of Open Access Journals (Sweden)

    Frigo Gianmario


    Full Text Available Abstract Background Parkinson's disease (PD is a chronic neurodegenerative disease which at present has no cure, and it usually results in severe disability. The burden of PD increases as the illness progresses, resulting in the extensive utilisation of both health and community services. Knowledge of healthcare use patterns and of their determinants may greatly contribute to improve patient care, however few studies have examined this issue in PD. The present study was devised to describe the type of and reasons for medical healthcare resource use in persons with PD attending a Centre for PD and Movement Disorders, and to examine drug prescriptions issued on such occasions. Methods The study was a retrospective, cross-sectional survey in a cohort of ambulatory patients with PD, conducted by means of standard interviews. Results In the year before the study, 92 (70.8% of 130 patients used medical healthcare resources: 1/5 of the patients was admitted to hospital, 1/5 to emergency room, 2/5 were visited by a non-neurology specialist, and 1/4 by the GP. Reasons were: nearly 20% programmed hospital admissions and visits, and more than 25% injuries and musculo-skeletal diseases. Other conditions typically occurring in PD (e.g. dementia, diabetes and cardio- and cerebro-vascular disease were less frequently involved. On such occasions, drugs for PD were occasionally changed, however drug prescriptions for other indications were issued to more than 66% of the patients. Conclusion Several physicians other than the neurologist may take care of PD patients on different occasions, thus emphasising the need for communication between the reference neurologist and other physicians who from time to time may visit the patient.

  9. European Society of Hypertension position paper on ambulatory blood pressure monitoring. (United States)

    O'Brien, Eoin; Parati, Gianfranco; Stergiou, George; Asmar, Roland; Beilin, Laurie; Bilo, Grzegorz; Clement, Denis; de la Sierra, Alejandro; de Leeuw, Peter; Dolan, Eamon; Fagard, Robert; Graves, John; Head, Geoffrey A; Imai, Yutaka; Kario, Kazuomi; Lurbe, Empar; Mallion, Jean-Michel; Mancia, Giuseppe; Mengden, Thomas; Myers, Martin; Ogedegbe, Gbenga; Ohkubo, Takayoshi; Omboni, Stefano; Palatini, Paolo; Redon, Josep; Ruilope, Luis M; Shennan, Andrew; Staessen, Jan A; vanMontfrans, Gert; Verdecchia, Paolo; Waeber, Bernard; Wang, Jiguang; Zanchetti, Alberto; Zhang, Yuqing


    Ambulatory blood pressure monitoring (ABPM) is being used increasingly in both clinical practice and hypertension research. Although there are many guidelines that emphasize the indications for ABPM, there is no comprehensive guideline dealing with all aspects of the technique. It was agreed at a consensus meeting on ABPM in Milan in 2011 that the 34 attendees should prepare a comprehensive position paper on the scientific evidence for ABPM.This position paper considers the historical background, the advantages and limitations of ABPM, the threshold levels for practice, and the cost-effectiveness of the technique. It examines the need for selecting an appropriate device, the accuracy of devices, the additional information and indices that ABPM devices may provide, and the software requirements.At a practical level, the paper details the requirements for using ABPM in clinical practice, editing considerations, the number of measurements required, and the circumstances, such as obesity and arrhythmias, when particular care needs to be taken when using ABPM.The clinical indications for ABPM, among which white-coat phenomena, masked hypertension, and nocturnal hypertension appear to be prominent, are outlined in detail along with special considerations that apply in certain clinical circumstances, such as childhood, the elderly and pregnancy, and in cardiovascular illness, examples being stroke and chronic renal disease, and the place of home measurement of blood pressure in relation to ABPM is appraised.The role of ABPM in research circumstances, such as pharmacological trials and in the prediction of outcome in epidemiological studies is examined and finally the implementation of ABPM in practice is considered in relation to the issue of reimbursement in different countries, the provision of the technique by primary care practices, hospital clinics and pharmacies, and the growing role of registries of ABPM in many countries.

  10. Features of ambulatory blood pressure in 540 patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)



    Objective To explore the features and influencing factors of ambulatory blood pressure in chronic kidney disease(CKD)patients.Methods A total of 540 CKD patients from May 2010 to May 2012 in our department

  11. Validating hyperbilirubinemia and gut mucosal atrophy with a novel ultramobile ambulatory total parenteral nutrition piglet model (United States)

    Total parenteral nutrition (TPN) provides all nutrition intravenously. Although TPN therapy has grown enormously, it causes significant complications, including gut and hepatic dysfunction. Current models use animal tethering which is unlike ambulatory human TPN delivery and is cost prohibitive. We ...

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

  13. Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations

    DEFF Research Database (Denmark)

    Fan, Hong-Qi; Li, Yan; Thijs, Lutgarde;


    We and other investigators previously reported that isolated nocturnal hypertension on ambulatory measurement (INH) clustered with cardiovascular risk factors and was associated with intermediate target organ damage. We investigated whether INH might also predict hard cardiovascular endpoints....

  14. Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting

    Directory of Open Access Journals (Sweden)

    Vadivelu N


    Full Text Available Nalini Vadivelu,1 Alice M Kai,2 Vijay Kodumudi,3 Jack M Berger4 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 2Stony Brook University School of Medicine, Stony Brook, NY, 3Department of Molecular and Cell Biology, College of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, 4Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with

  15. Vascular calcification is not associated with increased ambulatory central aortic systolic pressure in prevalent dialysis patients (United States)

    Freercks, Robert J; Swanepoel, Charles R; Turest-Swartz, Kristy L; Rayner, Brian L; Carrara, Henri RO; Moosa, Sulaiman EI; Lachman, Anthony S


    Summary Introduction Central aortic systolic pressure (CASP) strongly predicts cardiovascular outcomes. We undertook to measure ambulatory CASP in 74 prevalent dialysis patients using the BPro (HealthStats, Singapore) device. We also determined whether coronary or abdominal aortic calcification was associated with changes in CASP and whether interdialytic CASP predicted ambulatory measurement. Methods All patients underwent computed tomography for coronary calcium score, lateral abdominal radiography for aortic calcium score, echocardiography for left ventricular mass index and ambulatory blood pressure measurement using BPro calibrated to brachial blood pressure. HealthStats was able to convert standard BPro SOFT® data into ambulatory CASP. Results Ambulatory CASP was not different in those without and with coronary (137.6 vs 141.8 mmHg, respectively, p = 0.6) or aortic (136.6 vs 145.6 mmHg, respectively, p = 0.2) calcification. Furthermore, when expressed as a percentage of brachial systolic blood pressure to control for peripheral blood pressure, any difference in CASP was abolished: CASP: brachial systolic blood pressure ratio = 0.9 across all categories regardless of the presence of coronary or aortic calcification (p = 0.2 and 0.4, respectively). Supporting this finding, left ventricular mass index was also not different in those with or without vascular calcification (p = 0.7 and 0.8 for coronary and aortic calcification). Inter-dialytic office blood pressure and CASP correlated excellently with ambulatory measurements (r = 0.9 for both). Conclusion Vascular calcification was not associated with changes in ambulatory central aortic systolic pressure in this cohort of prevalent dialysis patients. Inter-dialytic blood pressure and CASP correlated very well with ambulatory measurement. PMID:24626513

  16. A critical insight into the development pipeline of microfluidic immunoassay devices for the sensitive quantitation of protein biomarkers at the point of care. (United States)

    Barbosa, Ana I; Reis, Nuno M


    The latest clinical procedures for the timely and cost-effective diagnosis of chronic and acute clinical conditions, such as cardiovascular diseases, cancer, chronic respiratory diseases, diabetes or sepsis (i.e. the biggest causes of death worldwide), involve the quantitation of specific protein biomarkers released into the blood stream or other physiological fluids (e.g. urine or saliva). The clinical thresholds are usually in the femtomolar to picolomar range, and consequently the measurement of these protein biomarkers heavily relies on highly sophisticated, bulky and automated equipment in centralised pathology laboratories. The first microfluidic devices capable of measuring protein biomarkers in miniaturised immunoassays were presented nearly two decades ago and promised to revolutionise point-of-care (POC) testing by offering unmatched sensitivity and automation in a compact POC format; however, the development and adoption of microfluidic protein biomarker tests has fallen behind expectations. This review presents a detailed critical overview into the pipeline of microfluidic devices developed in the period 2005-2016 capable of measuring protein biomarkers from the pM to fM range in formats compatible with POC testing, with a particular focus on the use of affordable microfluidic materials and compact low-cost signal interrogation. The integration of these two important features (essential unique selling points for the successful microfluidic diagnostic products) has been missed in previous review articles and explain the poor adoption of microfluidic technologies in this field. Most current miniaturised devices compromise either on the affordability, compactness and/or performance of the test, making current tests unsuitable for the POC measurement of protein biomarkers. Seven core technical areas, including (i) the selected strategy for antibody immobilisation, (ii) the surface area and surface-area-to-volume ratio, (iii) surface passivation, (iv) the

  17. Study of oral care on improving cough reflex sensitivity of recurrent pneumonia patients%口腔护理提高再发肺炎患者咳嗽反射敏感性的研究

    Institute of Scientific and Technical Information of China (English)

    韩则政; 刘慧; 方燕红; 程爱红; 赵欢欢; 余红梅; 吴长蓉


    Objective To explore the effects of oral care on improving cough reflex sensitivity and prolonging time span of recurrent pneumonia. Methods Oral care was conducted among 19 pateints with recurrent pneumonia. Using capsaicin-induced cough reflex method, cough reflex thresholds were measured in 19 patients with recurrent pneumonia before the study began, at the 20th day and the twelfth month after the study began. The recorrent time spans were recorded before and after the oral care at the same time. Results Cough reflex threshold was (1.54±0.06) mmol at the 20th day after the oral care began, which was significantly lower than (2.13±0.05) mmol before the the oral care began (P0.05). Pneumonia recurrent time span (210±54)days was significandy longer after performing the oral care than that (143±71)days of before performing the oral care (P0.05);口腔护理后肺炎再发间隔时间为(210±54)d,显著长于口腔护理前的(143±71)d(P<0.05).结论 口腔护理可以提高再发肺炎患者咳嗽反射的敏感性,延长肺炎再发的间隔时间.

  18. Wound care in horses. (United States)

    Caston, Stephanie S


    Care of equine wounds in the field can be a challenging endeavor. Many times, wound care is complicated by chronicity or by prior inappropriate care in addition to the great degree of tissue trauma that occurred when the horse was wounded. Recognizing involvement of synovial structures, loss of skin, and damage to bone are critical in the initial examination of wounds and will guide future care. Education of clients is also important in that preparing them for possible outcomes during healing may help improve compliance and proper treatment of wound. Owners and trainers often perform much of the daily care and monitoring of equine wounds and thus can greatly assist or impede the progress. Bandaging is important to management of equine wounds-especially on the limbs-and is sometimes overlooked because of its labor-intensive nature and the desire for a spray, ointment, or salve that will heal the wound. The practitioner that improves and utilizes his or her understanding of the wound-healing process in concert with his or her knowledge of local anatomy will be the one who is best equipped to care for wounds in ambulatory practice.

  19. Teamwork in obstetric critical care. (United States)

    Guise, Jeanne-Marie; Segel, Sally


    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 trained and competent medically, they have not traditionally been trained in how to work well as part of a team. Given the complexity and acuity of critical care medicine, which often relies on more than one medical team, teamwork skills are essential. This chapter discusses the history and importance of teamwork in high-reliability fields, reviews key concepts and skills in teamwork, and discusses approaches to training and working in teams.

  20. Emergence of infection control surveillance in alternative health care settings. (United States)

    Clark, Pamela


    During the past decade, health care delivery has undergone enormous changes. The nationwide growth in managed care organizations and the changing methods of provider reimbursement are restructuring the entire health care system. Diversification and integration strategies have blurred historical separations between the activities of hospitals, nursing homes, physicians, and other providers. Services are being offered in and shifting to less costly settings, such as ambulatory clinics, work sites, and homes. Many factors have contributed to the increasing trend of health care delivery outside hospitals. This presentation will provide insight to the management and surveillance of infection prevention in these health care settings.

  1. When direct health-care professional communications have an impact on inappropriate and unsafe use of medicines : A retrospective analysis of determinants of impact of safety warnings

    NARCIS (Netherlands)

    Reber, K.C.; Piening, S.; Wieringa, J.E.; Straus, S.M.J.M.; Raine, J.M.; de Graeff, Pauline; Haaijer-Ruskamp, F.M.; Mol, P.G.


    Serious safety issues relating to drugs are communicated to health-care professionals via Direct Health-Care Professional Communications (DHPCs). We explored which characteristics determined the impact of DHPCs issued in the Netherlands for ambulatory-care drugs (2001-2008). With multiple linear reg

  2. Ambulatory blood pressure monitoring for the early identification of hypertension in pregnancy. (United States)

    Ayala, Diana E; Hermida, Ramón C


    Gestational hypertension and preeclampsia are major contributors to perinatal morbidity and mortality. The diagnosis of gestational hypertension still relies on conventional clinic blood pressure (BP) measurements and thresholds of ≥140/90 mm Hg for systolic (SBP)/diastolic (DBP) BP. However, the correlation between BP level and target organ damage, cardiovascular disease risk, and long-term prognosis is greater for ambulatory BP monitoring (ABPM) than clinic BP measurement. Accordingly, ABPM has been suggested as the logical approach to overcoming the low sensitivity and specificity of clinic BP measurements in pregnancy. With the use of ABPM, differing predictable BP patterns throughout gestation have been identified for clinically healthy and hypertensive pregnant women. In normotensive pregnancies, BP steadily decreases up to the middle of gestation and then increases up to the day of delivery. In contrast, women who develop gestational hypertension or preeclampsia show stable BP during the first half of pregnancy and a continuous linear BP increase thereafter until delivery. Epidemiologic studies have also consistently reported sex differences in the 24-h patterns of ambulatory BP and heart rate. Typically, men exhibit a lower heart rate and higher BP than women, the differences being larger for SBP than DBP. Additionally, as early as in the first trimester of gestation, statistically significant increased 24-h SBP and DBP means characterize women complicated with gestational hypertension or preeclampsia compared with women with uncomplicated pregnancies. However, the normally lower BP in nongravid women as compared with men, additional decrease in BP during the second trimester of gestation in normotensive but not in hypertensive pregnant women, and significant differences in the 24-h BP pattern between healthy and complicated pregnancies at all gestational ages have not been taken into consideration when establishing reference BP thresholds for the

  3. CT features of peritonitis associated with continuous ambulatory peritoneal dialysis

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Ji Young; Byun, Jae Young; Lee, Sang Hoon; Kwon, Tae Ahn; Kim, Yeon Kil; Kim, Young Ok; Song, Kyung Sup [The Catholic Univ. of Korea College of Medicine, Seoul (Korea, Republic of)


    To evaluate the CT findings of peritonitis associated with continuous ambulatory peritoneal dialysis(CAPD). We retrospectively analyzed CT scans of 14 symptomatic patients with peritonitis after CAPD. Diffuse abdominal pain was present in 11, fever in two, and abdominal mass with vomiting in one. The mean duration of CAPD ranged from 10 months to 5 years(mean : 3.9 years). On abdominal CT, we evaluated the presence and location of ascites, bowel wall thickening, cocoon formation, the pattern of enhancement of peritoneal thickening, the presence of calcifications in the peritoneum, and mesenteric and omental change. On enhanced CT, multiloculated ascites was observed in all cases(n=14) ; it was located mainly in the pelvic cavity with small multi-loculated fluid collections in the peritoneal cavity(n=13), including the lesser sac(n=3). In one patient, ascites was located in the space between the greater omentum and anterior peritoneal surface. CT showed ileus in 12 cases, small bowel wall thickening in 11, and cocoon formation in five. Uneven but smooth thickening of the peritoneum, with contrast enhancement, was seen in eight cases, and in five of these, peritoneal thickening was more prominent in the anterior peritoneum. Other findings included reticular opacity in two cases, hematoma of the rectus muscle in one, and umbilical hernia in one. Multiloculated fluid collection, ileus, small bowel wall thickening, uneven but smooth peritoneal thickening, and cocoon formation appear to be CT features of CAPD peritonitis.

  4. Dynamics of ambulatory surgery centers and hospitals market entry. (United States)

    Housman, Michael; Al-Amin, Mona


    In this article, we investigate the diversity of healthcare delivery organizations by comparing the market determinants of hospitals entry rates with those of ambulatory surgery centers (ASCs). Unlike hospitals, ASCs is one of the growing populations of specialized healthcare delivery organizations. There are reasons to believe that firm entry patterns differ within growing organizational populations since these markets are characterized by different levels of organizational legitimacy, technological uncertainty, and information asymmetry. We compare the entry patterns of firms in a mature population of hospitals to those of firms within a growing population of ASCs. By using patient-level datasets from the state of Florida, we break down our explanatory variables by facility type (ASC vs. hospital) and utilize negative binomial regression models to evaluate the impact of niche density on ASC and hospital entry. Our results indicate that ASCs entry rates is higher in markets with overlapping ASCs while hospitals entry rates are less in markets with overlapping hospitals and ASCs. These results are consistent with the notion that firms in growing populations tend to seek out crowded markets as they compete to occupy the most desirable market segments while firms in mature populations such as general hospitals avoid direct competition.

  5. Mobile Personal Health System for Ambulatory Blood Pressure Monitoring

    Directory of Open Access Journals (Sweden)

    Luis J. Mena


    Full Text Available The ARVmobile v1.0 is a multiplatform mobile personal health monitor (PHM application for ambulatory blood pressure (ABP monitoring that has the potential to aid in the acquisition and analysis of detailed profile of ABP and heart rate (HR, improve the early detection and intervention of hypertension, and detect potential abnormal BP and HR levels for timely medical feedback. The PHM system consisted of ABP sensor to detect BP and HR signals and smartphone as receiver to collect the transmitted digital data and process them to provide immediate personalized information to the user. Android and Blackberry platforms were developed to detect and alert of potential abnormal values, offer friendly graphical user interface for elderly people, and provide feedback to professional healthcare providers via e-mail. ABP data were obtained from twenty-one healthy individuals (>51 years to test the utility of the PHM application. The ARVmobile v1.0 was able to reliably receive and process the ABP readings from the volunteers. The preliminary results demonstrate that the ARVmobile 1.0 application could be used to perform a detailed profile of ABP and HR in an ordinary daily life environment, bedsides of estimating potential diagnostic thresholds of abnormal BP variability measured as average real variability.

  6. Endoscope ambulatory nasal polipectomy. Introduction in Sancti Spiritus province.

    Directory of Open Access Journals (Sweden)

    Raquel M. García Alemán


    Full Text Available A longitudinal retrospective descriptive study carried out in the Otorrinolaringology Services of the “Camilo Cienfuegos” General Hospital in Sancti Spiritus from september 2007 to september 2009.The population comprised 130 patients diagnosed with Chronic rhinosinusitis and the sample included 48 who showed Bilateral Poliposis grade III-IV who fulfilled the inclusion criteria. The general objective was to determine the results of the endoscopic ambulatory nasal polipectomy; specific objective to evaluate the variables of age and gender clinical manifestations, endoscopic findings, complication histological findings and degree of satisfaction. The statistical analysis included the calculation of frequency stadigraphs expressed in numbers and percentages. Chronic rhinosinusitis which nasal polyposis was more frequent in white men over 40 years-old, the primary symptoms were nasal obstruction and anosmia. The post-surgical medical treatment was carried out depending on the histological study with a predominance of eosinophils. The endoscopy determined the degree of grade III; the classic bilateral anterior tamponing was remplaced by surgical neurolentins made in the room. No patient showed pain during the surgery act, they improved their life quality.

  7. Non Infectious Complications of Continuous Ambulatory Peritoneal Dialysis

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    K. Flayou


    Full Text Available Introduction: Continuous ambulatory peritoneal dialysis has proven to be as effective as hemodialysis. However, it is associated with several complications. The aim of this study is to evaluate the prevalence and outcome of complications in patients treated with peritoneal dialysis at our center. Material and methods: A retrospective study between January 2007 and February 2015 at the nephrology, dialysis and renal transplantation department of Ibn Sina university. Predisposing factors and long-term outcomes were analyzed. Results: Fifty two mechanical complications were noted among thirty eight patients between June 2007 and February 2015. Migration was the most common (23 cases followed by obstruction, hernia and dialysate leakes in respectively 9, 7 and 6 cases. We have also noted 2 cases of hemoperitoneum, 3 catheter perforation and 2 cases of externalization. Onset time of complications was 25,4 ± 12,7 months. Conclusion: this study proves the interest of the prevention of mechanical complications in peritoneal dialysis. This requires a periodic retraining of patients and caregivers.

  8. Kidney volume and ambulatory blood pressure in children. (United States)

    Gurusinghe, Shari; Palvanov, Arkadiy; Bittman, Mark E; Singer, Pamela; Frank, Rachel; Chorny, Nataliya; Infante, Lulette; Sethna, Christine B


    Low nephron number has been shown to be a risk factor for hypertension (HTN) in adulthood. Kidney volume may serve as a surrogate marker for nephron mass. The relationship between kidney volume and ambulatory blood pressure (BP) in the pediatric population is not known. A retrospective chart review of children younger than 21 years who were evaluated for HTN was performed. Twenty-four-hour BP and ultrasonography data were obtained. Multiple regression was used to examine associations between BP and kidney volume. Of 84 children (mean age 13.87 years, 72.6% males), 54 had HTN. Systolic BP index during the awake, sleep, and 24-hour periods (all P≤.05) was found to be positively correlated with total kidney volume. Greater total kidney volume was found to be a positive predictor of 24-hour and sleep systolic index (P≤.05). It failed to serve as a predictor of HTN, pre-HTN, or white-coat HTN. Contrary to expectation, total kidney volume was positively associated with systolic BP indices.

  9. The content of hope in ambulatory patients with colon cancer. (United States)

    Beckman, Emily S; Helft, Paul R; Torke, Alexia M


    Although hope is a pervasive concept in cancer treatment, we know little about how ambulatory patients with cancer define or experience hope. We explored hope through semistructured interviews with ten patients with advanced (some curable, some incurable) colon cancer at one Midwestern, university-based cancer center. We conducted a thematic analysis to identify key concepts related to patient perceptions of hope. Although we did ask specifically about hope, patients also often revealed their hopes in response to indirect questions or by telling stories about their cancer experience. We identified four major themes related to hope: 1) hope is essential, 2) a change in perspective, 3) the content of hope, and 4) communicating about hope. The third theme, the content of hope, included three subthemes: a) the desire for normalcy, b) future plans, and c) hope for a cure. We conclude that hope is an essential concept for patients undergoing treatment for cancer as it pertains to their psychological well-being and quality of life, and hope for a cure is not and should not be the only consideration. In a clinical context, the exploration of patients' hopes and aspirations in light of their cancer diagnosis is important because it provides a frame for understanding their goals for treatment. Exploration of the content of patients' hope can not only help to illuminate misunderstandings but also clarify how potential treatments may or may not contribute to achieving patients' goals.

  10. Trabalho em equipe e interdisciplinaridade: desafios para a efetivação da integralidade na assistência ambulatorial às pessoas vivendo com HIV/Aids em Pernambuco Team Work and Interdiciplinarity: Challenges facing the implementation of Comprehensive Outpatient Care for People with HIV/Aids in Pernambuco

    Directory of Open Access Journals (Sweden)

    Maria Jucineide Lopes Borges


    Full Text Available A complexidade da atenção à saúde das pessoas vivendo com HIV/Aids requer o investimento na integralidade das ações e do cuidado, lançando às equipes multiprofissionais o desafio da construção de uma prática interdisciplinar. Este estudo teve o objetivo de analisar a integralidade da atenção à saúde em Serviços de Assistência Especializada em HIV/Aids (SAE-HIV/Aids de Recife/Pernambuco, a partir do processo e organização do trabalho em equipe. Trata-se de um estudo de caso desenvolvido em três unidades de SAE-HIV/Aids, com base em abordagem qualitativa, por meio de diferentes técnicas de investigação. Os resultados apontam que os SAE atendem a grande parte das recomendações do Ministério da Saúde, sobre a infraestrutura básica, mas nenhum serviço apresentava a constituição da equipe mínima satisfatória. Há o reconhecimento da fragmentação do trabalho em equipe e da dificuldade de sistematizar uma prática interdisciplinar e intersetorial, sendo apontadas falhas para garantir o fluxo de referência e contrarreferência. Identificou-se pouca valorização do papel do gerente como articulador da equipe; a necessidade de perceber o usuário como um todo; e de a equipe trabalhar de forma articulada, buscando a prática comunicativa e as atividades relacionais.The complexity of providing healthcare to people with HIV/Aids requires investment in comprehensive action and care, constituting a challenge for the multidisciplinary work teams to build an interdisciplinary practice. This study sought to analyze comprehensive healthcare in the Specialized Assistance Services for HIV/Aids (SAE-HIV/Aids in Recife, in the State of Pernambuco, starting with the process and organization of team work. This is a case study developed in three SAE-HIV/Aids units, based on a qualitative approach using different research techniques. The results show that SAE-HIV/Aids have complied with most of the Brazilian Health Ministry

  11. Does a medical history of hypertension influence disclosing genetic testing results of the risk for salt-sensitive hypertension, in primary care?

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    Okayama M


    Full Text Available Masanobu Okayama,1,2 Taro Takeshima,2 Masanori Harada,3 Ryusuke Ae,4 Eiji Kajii2 1Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Hyogo, 2Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, 3Department of Support of Rural Medicine, Yamaguchi Grand Medical Center, Hofu, Yamaguchi, 4Division of Public Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan Objective: Disclosing genetic testing results may contribute to the prevention and management of many common diseases. However, whether the presence of a disease influences these effects is unclear. This study aimed to clarify the difference in the effects of disclosing genetic testing results of the risk for developing salt-sensitive hypertension on the behavioral modifications with respect to salt intake in hypertensive and nonhypertensive patients.Methods: A cross-sectional study using a self-administered questionnaire was conducted for outpatients aged >20 years (N=2,237 at six primary care clinics and hospitals in Japan. The main factors assessed were medical histories of hypertension, salt preferences, reduced salt intakes, and behavior modifications for reducing salt intake. Behavioral modifications of participants were assessed using their behavior stages before and after disclosure of the hypothetical genetic testing results. Results: Of the 2,237 participants, 1,644 (73.5% responded to the survey. Of these respondents, 558 (33.9% patients were hypertensive and 1,086 (66.1% were nonhypertensive. After being notified of the result “If with genetic risk”, the nonhypertensive participants were more likely to make positive behavioral modifications compared to the hypertensive patients among all participants and in those aged <65 years (adjusted relative ratio [ad-RR], 1.76; 95% confidence interval, 1.12−2.76 and ad-RR, 1

  12. A hospitalização por asma e a carência de acompanhamento ambulatorial Asthma-related hospitalizations and lack of outpatient follow-up treatment

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    Emanuel Sarinho


    Full Text Available OBJETIVO: Verificar se as crianças e os adolescentes internados por crise aguda de asma em duas unidades de saúde da cidade do Recife faziam acompanhamento ambulatorial preventivo para controle da asma. MÉTODOS: Estudo prospectivo de uma série de casos de pacientes internados por asma aos quais foi aplicado um questionário no momento da internação para verificar a freqüência de acompanhamento ambulatorial para tratamento profilático. Foi considerado asmático aquele paciente que apresentou duas ou mais crises de broncoespasmo com boa resposta aos broncodilatadores. RESULTADOS: Do total de 169 pacientes internados por asma, 67% (112/167 - dados referentes a 2 pacientes não foram fornecidos foram atendidos exclusivamente em serviços de urgência no período intercrise. Apesar de haver encaminhamento médico para atendimento ambulatorial em 53,3% (89/167 - dados referentes a 2 pacientes não foram fornecidos dos casos, apenas 16% (27/169 dos pacientes efetivamente freqüentavam um ambulatório específico de asma para tratamento preventivo e somente 13% (22/169 usavam medicação profilática. CONCLUSÃO: A maioria das crianças e dos adolescentes internados por asma não fazia acompanhamento ambulatorial preventivo. Uma série de problemas, tais como a não referência para acompanhamento ambulatorial após a alta hospitalar, a dificuldade de acesso ao ambulatório e a impossibilidade de se obter a medicação profilática gratuitamente, entre outros fatores relacionados ao sistema de saúde, podem ter contribuído para esta baixa taxa de procura por atendimento ambulatorial. Recomenda-se a implementação de uma política de saúde que possibilite o efetivo funcionamento do programa de controle da asma.OBJECTIVE: To determine whether the children and adolescents with acute asthma attacks admitted to two public hospitals in the city of Recife, Brazil underwent outpatient follow-up treatment for the prevention and control of asthma

  13. Determinants of heart failure self-care behaviour in community-based patients: a cross-sectional study

    NARCIS (Netherlands)

    Peters-Klimm, F.; Freund, T.; Kunz, C.; Laux, G.; Frankenstein, L.; Muller-Tasch, T.; Szecsenyi, J.


    Background: Self-care behaviour in patients with heart failure (HF) represents a series of specific actions that patients should take, as an important treatment component. Aims: The aim of this study was to identify potential determinants of HF self-care in ambulatory patients with stable systolic H

  14. Terceira etapa método Canguru: convergência de práticas investigativas e cuidado com famílias em atendimento ambulatorial Tercera etapa método Canguro: convergencia de prácticas de investigación y cuidado con familias en la atención ambulatoria Third stage of the Kangaroo method: converging investigative and care practices with families in outpatient care

    Directory of Open Access Journals (Sweden)

    Márcia Borck


    Full Text Available Trata-se de uma Pesquisa Convergente-Assistencial, de natureza qualitativa, que teve como objetivos investigar a experiência no processo de adaptação de famílias na terceira etapa do Método Canguru com recém-nascidos pré-termo e/ou de baixo peso e implementar a consulta de enfermagem dentro dos quatro modos adaptativos da Teoria de Roy. Desenvolvido no período de outubro de 2006 a fevereiro de 2007 em um Hospital Universitário. Os sujeitos foram seis mães, familiares e seus bebês. A coleta de dados foi realizada através do processo de cuidar do modelo adaptativo de Roy, utilizando as técnicas de observação e da entrevista semi-estruturada. O processo de análise ocorreu através da apreensão, síntese, teorização e transferência. Os resultados mostram a necessidade de fortalecer o papel da família na desospitalização, a comunicação entre a equipe interdisciplinar e rever critérios de alta da terceira etapa.Es una Investigación Convergente-Asistencial, cualitativo, sus objetivos fueron investigar la experiencia en el proceso de adaptación de familias en la tercera etapa del Método Canguro con recién nacidos pretérmino y/o de bajo peso, implementar la consulta de enfermería dientro de las cuatro modos adaptativos de la Teoría de Roy. Fue desarrollada en el período de octubre de 2006 a febrero de 2007 en un Hospital Universitario. Los sujetos fueron seis madres, los familiares y sus bebés. La recolección de los datos fue realizada a través del proceso de cuidar del modelo adaptativo de Roy, utilizando las técnicas de observación y la entrevista parcialmente estructurada. El proceso de análisis se hizo por medio de la aprehensión, síntesis, teorización y transferencia. Los resultados muestran la necesidad de fortalecer el papel de la familia en la deshospitalización, la comunicación entre el equipo disciplinario y rever criterios de alta de la tercera etapa.This study deals with qualitative, Convergent-Care

  15. Outpatient costing and classification: are we any closer toa national standard for ambulatory classification systems? (United States)

    Cleary, M I; Murray, J M; Michael, R; Piper, K


    The Outpatient Costing and Classification Study was commissioned by the Department of Health and Family Services to evaluate the suitability of the Developmental Ambulatory Classification System (DACS). Data on the full range of ambulatory services (outpatient clinics, emergency departments and allied health services) were collected prospectively from a stratified sample of 28 public hospitals. Patient encounters captured in the study represent 1% of the total ambulatory encounters in Australia in one year. Costing per encounter included time spent with the patient, cost of procedures, indirect costs (salaries and consumables), overhead costs and diagnostic costs. The most significant variable explaining cost variation was hospital type, followed by outpatient clinic type. Visit type and presence or absence of a procedure--major splits for the proposed DACS--did not produce splits that were consistent across all hospital strata. The study found that DACS is not an appropriate classification for hospital ambulatory services. A clinic-based structure for outpatients and allied health departments is recommended for classifying and funding ambulatory services in Australia.

  16. National Trends in Foot and Ankle Arthrodesis: 17-Year Analysis of the National Survey of Ambulatory Surgery and National Hospital Discharge Survey. (United States)

    Best, Matthew J; Buller, Leonard T; Miranda, Alejandro


    Foot and ankle arthrodesis reliably reduces pain and functional disability among patients with arthritis and deformity. Since its introduction in 1953, improvements in surgical technique have enhanced the outcomes and reduced complications. However, little is known regarding US national trends of foot and ankle arthrodesis. The present study sought to use the most recently available Centers for Disease Control and Prevention data to investigate changes in the usage of inpatient and ambulatory foot and ankle arthrodesis. Cases of foot and ankle arthrodesis were identified using the National Hospital Discharge Survey and National Survey of Ambulatory Surgery, and the data were analyzed for trends in demographics, treatment, and usage. From 1994 to 2006, the population-adjusted rates of foot and ankle arthrodeses increased by 146% (8.2/100,000 capita to 20.2/100,000 capita). The number of outpatient arthrodeses performed with arthroscopic assistance increased by 858%. The population-adjusted rate of outpatient and inpatient procedures increased by 415% and 17%, respectively. The gender-adjusted rates increased by 59% for males and 209% for females. The age-adjusted rates increased among patients >35 years old in both settings. The use of peripheral nerve blocks during ambulatory procedures increased from 3.3% to 10.1%. Private insurance was the largest compensator. In conclusion, the rate of foot and ankle arthrodesis increased dramatically from 1990 to 2007 using the most up-to-date publicly available data. Knowledge of these national practice patterns could aid policy-makers and surgeons in appropriately allocating healthcare resources to ensure quality patient care.

  17. Ambulatory assessed implicit affect is associated with salivary cortisol

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    Joram eMossink


    Full Text Available One of the presumed pathways linking negative emotions to adverse somatic health is an overactive HPA-axis, usually indicated by elevated cortisol levels. Traditionally, research has focused on consciously reported negative emotions. Yet, given that the majority of information processing occurs without conscious awareness, stress physiology might also be influenced by affective processes that people are not aware of. In a 24-hour ambulatory study we examined whether cortisol levels were associated with two implicit measures. Implicit affect was assessed using the Implicit Positive and Negative Affect Test, and implicit negative memory bias was assessed with the word fragment completion tasks. In 55 healthy participants, we measured subjective stress levels, worries, implicit and explicit affect each hour during waking hours. Also, saliva samples were collected at three fixed times during the day, as well as upon waking and 30 minutes thereafter (cortisol awakening response. Multilevel analyses of the daytime cortisol levels revealed that the presence of an implicit negative memory bias was associated with increased cortisol levels. Additionally, implicit PA and, unexpectedly, implicit NA were negatively associated with cortisol levels. Finally, participants demonstrating higher levels of implicit sadness during the first measurement day, had a stronger cortisol rise upon awakening at the next day. Contrary to previous research, no associations between explicit affect and cortisol were apparent. The current study was the first to examine the concurrent relation between implicit measures and stress physiology in daily life. The results suggest that the traditional focus on consciously reported feelings and emotions is limited, and that implicit measures can add to our understanding of how stress and emotions contribute to daily physiological activity and, in the long term, health problems.

  18. Use of antibiotics in upper respiratory infections on patients under 16 years old in private ambulatory medicine

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    Peláez-Ballestas Ingris


    Full Text Available OBJECTIVE: To assess antibiotic use for upper respiratory infections (URI treatment on patients under 16 years-old who are beneficiaries of a pre-paid health care scheme. MATERIAL AND METHODS: A database containing the record of all the medical prescriptions for URI treatment, from May 1997 to April 1998 was analyzed. Patients were under 16 years old and had been diagnosed with common colds, pharyngitis, bronchitis, sinusitis, otitis, and other unspecified upper respiratory tract infections. Three hundred and fifty-one physicians of seven different specialties who attended 25 300 beneficiaries wrote such prescriptions. RESULTS: A total of 30 889 assorted medications were prescribed to 5 533 patients with the above diagnoses. Antibiotics were prescribed for 77.5% of all diagnoses, ranging from 58% for pharyngitis to 91% for laryngitis. The most frequently used antibiotics were: penicillin, cephalosporins, and macrolides. CONCLUSIONS: This study presents the information of antibiotics prescription practices for URI in a pre-paid health plan in Mexico. These findings may be used to support specific campaigns for rational use of antibiotics among children attended at private ambulatory health care practices.

  19. A study on the bacteriological profile of urinary tract infection in adults and their antibiotic sensitivity pattern in a tertiary care hospital in central Kerala, India

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    Jubina Bency A. T.


    Conclusions: In this study, females were mostly affected and the most common organisms were E.Coli and Klebsiella. These organisms were most sensitive to Amikacin, Nitrofurantoin and resistant predominantly to Ampicillin. The sensitivity and resistance pattern of uropathogens to common antimicrobial agents must be taken into account when selecting treatment plans for UTI.

  20. Analysis and specification of an open platform for outpatient care in consideration of actual standard solutions

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    Rosales Saurer, Bruno


    Full Text Available The field of ambulatory nursing is rapidly growing due to rising health care costs and the demographic development. Today there are approximately 2 million persons in Germany who need outpatient care. Experts predict that there will be more than twice as much by 2050. Ambulatory care nurses must quickly and efficiently assess their patients’ condition and needs. Against this background, the VitaBIT project started in July 2007 with the objective of reorganizing ambulatory care in order to improve quality while at the same time increasing efficiency and saving costs. VitaBIT is promoted by the German federal ministry of economy and technology (BMWi. VitaBIT runs up to the end of 2009, partners of the project are CAS Software AG, PTV Planung Transport Verkehr AG, FZI Forschungszentrum Informatik, Sozial- und Diakoniestation Weinstadt e.V. und Wibu-Systems AG. VitaBIT aims to design an ICT platform for the safe application of mobile information services in ambulatory nursing. Communication and secure information exchange between all parties involved in the care process will also be guaranteed. The article explains the project’s current approach to develop a user-oriented solution by integrating already existing components and services.

  1. Age-specific differences between conventional and ambulatory daytime blood pressure values

    DEFF Research Database (Denmark)

    Conen, David; Aeschbacher, Stefanie; Thijs, Lutgarde;


    Mean daytime ambulatory blood pressure (BP) values are considered to be lower than conventional BP values, but data on this relation among younger individuals individuals not taking antihypertensive treatment from 13...... population-based cohorts. We compared individual differences between daytime ambulatory and conventional BP according to 10-year age categories. Age-specific prevalences of white coat and masked hypertension were calculated. Among individuals aged 18 to 30, 30 to 40, and 40 to 50 years, mean daytime BP...... was significantly higher than the corresponding conventional BP (6.0, 5.2, and 4.7 mm Hg for systolic; 2.5, 2.7, and 1.7 mm Hg for diastolic BP; all Pindividuals aged 60 to 70 and ≥70 years, conventional BP was significantly higher than daytime ambulatory BP (5.0 and 13.0 mm Hg for systolic; 2.0 and 4...

  2. Office, ambulatory and home blood pressure measurement in children and adolescents. (United States)

    Karpettas, Nikos; Kollias, Anastasios; Vazeou, Andriani; Stergiou, George S


    There is an increasing interest in pediatric hypertension, the prevalence of which is rising in parallel with the obesity epidemic. Traditionally the assessment of hypertension in children has relied on office blood pressure (BP) measurements by the physician. However, as in adults, office BP might be misleading in children mainly due to the white coat and masked hypertension phenomena. Thus, out-of-office BP assessment, using ambulatory or home monitoring, has gained ground for the accurate diagnosis of hypertension and decision-making. Ambulatory monitoring is regarded as indispensable for the evaluation of pediatric hypertension. Preliminary data support the usefulness of home monitoring, yet more evidence is needed. Office, ambulatory and home BP normalcy tables providing thresholds for diagnosis have been published and should be used for the assessment of elevated BP in children.

  3. Ambulatory electroencephalogram in children: A prospective clinical audit of 100 cases

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    Nahin Hussain


    Full Text Available Ambulatory electroencephalogram has been used for differentiating epileptic from nonepileptic events, recording seizure frequency and classification of seizure type. We studied 100 consecutive children prospectively aged 11 days to 16 years that were referred for an ambulatory electroencephalogram to a regional children′s hospital. Ambulatory electroencephalogram was clinically useful in contributing to a clinical diagnosis in 71% of children who were referred with a range of clinical questions. A diagnosis of epileptic disorder was confirmed by obtaining an ictal record in 26% and this included 11 children that had previously normal awake and or sleep electroencephalogram. We recommend making a telephone check of the current target event frequency and prioritising those with typical events on most days in order to improve the frequency of recording a typical attack.

  4. Blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome

    DEFF Research Database (Denmark)

    Stolarz-Skrzypek, Katarzyna; Thijs, Lutgarde; Richart, Tom


    Ambulatory blood pressure (BP) monitoring provides information not only on the BP level but also on the diurnal changes in BP. In the present review, we summarized the main findings of the International Database on Ambulatory BP in relation to Cardiovascular Outcome (IDACO) with regard to risk...

  5. Knee Muscle Strength at Varying Angular Velocities and Associations with Gross Motor Function in Ambulatory Children with Cerebral Palsy (United States)

    Hong, Wei-Hsien; Chen, Hseih-Ching; Shen, I-Hsuan; Chen, Chung-Yao; Chen, Chia-Ling; Chung, Chia-Ying


    The aim of this study was to evaluate the relationships of muscle strength at different angular velocities and gross motor functions in ambulatory children with cerebral palsy (CP). This study included 33 ambulatory children with spastic CP aged 6-15 years and 15 children with normal development. Children with CP were categorized into level I (n =…

  6. Early detection and treatment of myocardial ischaemia after operation using continual ambulatory arterial pressure monitoring and ECG ST segment analysis. (United States)

    Edwards, N D; Troy, G; Yeo, W; Jackson, P; Reilly, C S


    We report a case in which the use of continual ambulatory arterial pressure monitoring and ECG ST-segment analysis allowed early detection and treatment of myocardial ischaemia in the postoperative period. We believe that this case illustrates the potential value of ambulatory monitoring in the early postoperative period in high-risk patients.

  7. Effects of physician joint ventures on health care costs, access, and quality: exploring some issues. (United States)

    Ahern, M; Scott, E


    Increasingly, physicians are joint-venturing with health care businesses such as physical therapy centers, diagnostic imaging centers, ambulatory surgical centers, and other services. Simultaneously, outpatient costs have been rising. Theoretical and empirical evidence, including results of an exploratory survey of experts, indicate that these two events are linked. Specifically, joint ventures between referring physicians and health care businesses often appear to increase costs, increase utilization, reduce quality of care, and reduce access.

  8. Finding economies of scale and coordination of care along the continuum to achieve true system integration. (United States)

    Davies, Maura


    Is it time to reduce hospitals and replace them with digitally enabled distributed specialty service delivery channels that focus on ambulatory care, urgent care, and patient reactivation? Is delivery system integration immaterial if care is standardized and supported by integrated information systems? Maybe Lean methodology needs to be applied across the entire delivery systems, not just within its component functions and processes. Comments are offered on each of these perspectives.

  9. Strategies for classifying patients based on office, home, and ambulatory blood pressure measurement. (United States)

    Zhang, Lu; Li, Yan; Wei, Fang-Fei; Thijs, Lutgarde; Kang, Yuan-Yuan; Wang, Shuai; Xu, Ting-Yan; Wang, Ji-Guang; Staessen, Jan A


    Hypertension guidelines propose home or ambulatory blood pressure monitoring as indispensable after office measurement. However, whether preference should be given to home or ambulatory monitoring remains undetermined. In 831 untreated outpatients (mean age, 50.6 years; 49.8% women), we measured office (3 visits), home (7 days), and 24-h ambulatory blood pressures. We applied hypertension guidelines for cross-classification of patients into normotension or white-coat, masked, or sustained hypertension. Based on office and home blood pressures, the prevalence of white-coat, masked, and sustained hypertension was 61 (10.3%), 166 (20.0%), and 162 (19.5%), respectively. Using daytime (from 8 am to 6 pm) instead of home blood pressure confirmed the cross-classification in 575 patients (69.2%), downgraded risk from masked hypertension to normotension (n=24) or from sustained to white-coat hypertension (n=9) in 33 (4.0%), but upgraded risk from normotension to masked hypertension (n=179) or from white-coat to sustained hypertension (n=44) in 223 (26.8%). Analyses based on 24-h ambulatory blood pressure were confirmatory. In adjusted analyses, both the urinary albumin-to-creatinine ratio (+20.6%; confidence interval, 4.4-39.3) and aortic pulse wave velocity (+0.30 m/s; confidence interval, 0.09-0.51) were higher in patients who moved up to a higher risk category. Both indexes of target organ damage and central augmentation index were positively associated (P≤0.048) with the odds of being reclassified. In conclusion, for reliably diagnosing hypertension and starting treatment, office measurement should be followed by ambulatory blood pressure monitoring. Using home instead of ambulatory monitoring misses the high-risk diagnoses of masked or sustained hypertension in over 25% of patients.

  10. An Implantable MEMS Drug Delivery Device for Rapid Delivery in Ambulatory Emergency Care (United States)


    even engaged 2 telemetrically, as opposed to passive devices that depend on the degradation chemistry of the specific device materials in the...cardioverter-defibrillator," American Journal of Cardiology , vol. 85, pp. 981-985, 2000. A. C. R. Grayson, I. S. Choi, B. M. Tyler, P. P. Wang...cardioverter defibrillator patients," Journal of Interventional Cardiology , vol. 11, pp. 205-211, 1998. M. Staples, K. Daniel, M. J. Cima, and R

  11. An Analysis of Several Dimensions of Patient Safety in Ambulatory-Care Facilities (United States)


    similar vials on a medication cart . A syringe of regular insulin is drawn up and infused into a IV instead of the normal saline flush the nurse...Annals of Family Medicine 2004; (2)2: 125-129. 10. Gandhi , T, Sittig, D, Franklin, M, et al. Communication breakdown in the outpatient

  12. The Army Ambulatory Care Data Base (ACDB) Study: Implementation and Preliminary Data (United States)



  13. Ambulatory Care Data Base (ACDB) Data Dictionary Sequential Files of Phase 1 (United States)



  14. Ambulatory Care Data Base (ACDB) Data Dictionary Sequential Files of Phase 2. (United States)



  15. Effectiveness of interventions in reducing antibiotic use for upper respiratory infections in ambulatory care practices. (United States)

    Vinnard, Christopher; Linkin, Darren R; Localio, A Russell; Leonard, Charles E; Teal, Valerie L; Fishman, Neil O; Hennessy, Sean


    The objective was to evaluate the effect of separate interventions on antimicrobial prescribing for uncomplicated upper respiratory tract infections. The authors conducted a quasi-experimental pre-post study with concurrent control groups for each intervention. Academic detailing led to a significant reduction in unnecessary antibiotic prescribing. However, there was no significant change in antibiotic prescribing in response to educational mailings to providers or to provider involvement in patient mailings. Organizations that seek to reduce inappropriate use of antibiotics should use proven approaches, even when they are more expensive.

  16. Effectiveness of Interventions in Reducing Antibiotic Use for Upper Respiratory Infections in Ambulatory Care Practices


    Vinnard, Christopher; Linkin, Darren R.; Localio, A. Russell; Leonard, Charles E; Teal, Valerie L.; Fishman, Neil O.; Hennessy, Sean


    The objective was to evaluate the effect of separate interventions on antimicrobial prescribing for uncomplicated upper respiratory tract infections. The authors conducted a quasi-experimental pre-post study with concurrent control groups for each intervention. Academic detailing led to a significant reduction in unnecessary antibiotic prescribing. However, there was no significant change in antibiotic prescribing in response to educational mailings to providers or to provider involvement in ...

  17. [Detection of latent disorders of visual function during ambulatory care of children]. (United States)

    Puchkovskaia, N A; Serdiuchenko, V I; Seniakina, A S; Balezina, T V; Boĭchuk, I M


    For the purpose to select tests for diagnosis of latent disturbances of visual functions, dynamic observation was conducted over 88 healthy school children within 5 years (from the 3d to the 8th form). Once a year, the children underwent examination of visual acuity for far and near, the state of binocular vision on a synoptophore and a color test, the volume of relative and absolute accommodation, muscular balance of eyes for far and near, contrast sensibility, the time of perception of the negative successive contrast, refraction. For the period of 5 years, 7 children developed myopia of low degree, 32 showed transitory or lasting reduction of visual acuity due to spasm of accommodation. The authors believe that the most rapid and informative tests for diagnosis of latent disturbances in accommodation-convergence system are visual acuity for near, the volume of absolute accommodation, the threshold of remote vision, muscular balance of eyes for near. It is recommended to use these tests widely when conducting ophthalmologic thorough prophylactic examinations of children.

  18. Assigning Patients According to Curriculum: A Strategy for Improving Ambulatory Care Residency Training. (United States)

    Brush, Alan D.; Moore, Gordon T.


    The strategy used by one health maintenance organization (HMO) for balancing residents' training needs and patient health problems, often limited and routine in an HMO, is to allocate patients to residents by matching them with curriculum content. A process for handling patient resistance to such an arrangement was also instituted. (MSE)

  19. The Anxiolytic Effect of Aromatherapy on Patients Awaiting Ambulatory Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Cheng-Hua Ni


    Full Text Available The aim of this study was to determine if aromatherapy could reduce preoperative anxiety in ambulatory surgery patients. A total of 109 preoperative patients were randomly assigned to experimental (bergamot essential oil and control (water vapor conditions and their responses to the State Trait Anxiety Inventory and vital signs were monitored. Patients were stratified by previous surgical experience, but that did not influence the results. All those exposed to bergamot essential oil aromatherapy showed a greater reduction in preoperative anxiety than those in the control groups. Aromatherapy may be a useful part of a holistic approach to reducing preoperative anxiety before ambulatory surgery.

  20. Transient myocardial ischaemia during ambulatory monitoring out of hospital in patients with chronic stable angina pectoris

    DEFF Research Database (Denmark)

    Egstrup, K


    Transient myocardial ischaemia during daily life, detected by ambulatory electrocardiographic monitoring, was investigated in 42 patients with chronic stable angina and documented coronary artery disease. Ambulatory monitoring was initiated for 36 hours after all prophylactic antianginal medication...... had been withdrawn for 5 days. There were 196 episodes of ST-segment depression, 145 (74%) of which were not accompanied by angina. As well, a tendency to more prolonged and greater ST-segment change with symptomatic ischaemic episodes was noted. A diurnal variation in transient ischaemia both...


    Directory of Open Access Journals (Sweden)

    Maria Josefina da Silva


    Full Text Available The renal disease imposes to its porter a new conception due. Nowadays, modern techniques, makepossible more freedom to the client, being one of them, continuum Dialise peritoneal ambulatorial. Our objective isto study the election by the method and the feelings related to this chose by the client. We conclude that thermethod, despite its advantages, is not the first option yet, the patient, in some cases are not well trained withintercorrences, but most of them are satisfied with the chose. The nursing still participates just a bit of this processbut it has important role in the ambulatorial and domiciliar attendance of this client, needing more specificformation.

  2. Ambulatory hysteroscopy and its role in the management of abnormal uterine bleeding. (United States)

    Cooper, Natalie A M; Robinson, Lynne L L; Clark, T Justin


    Hysteroscopy is now an ambulatory procedure, having moved from a conventional day-case operating theatre environment to the outpatient clinic setting. Outpatient hysteroscopy can be used as a diagnostic test and as a therapeutic modality for women presenting with abnormal uterine bleeding. In many cases women can be diagnosed and treated efficiently during a single hospital appointment. This article reviews the development of ambulatory hysteroscopy and how it should optimally be performed and implemented. The contemporary role of this technology for investigating and treating women with abnormal uterine bleeding is then discussed.

  3. Bacteriemia por Chryseobacterium indologenes em diabético em hemodiálise ambulatorial Bacteremia by Chryseobacterium indologenes in a diabetic patient undergoing ambulatory hemodialysis

    Directory of Open Access Journals (Sweden)

    Marcus Machado Ramos Souza de Souza


    Full Text Available Chryseobacterium indologenes é uma bactéria de baixa virulência, encontrada no meio ambiente, raramente associada às infecções não hospitalares. A maioria das infecções causadas por ela associa-se ao uso de dispositivos invasivos durante a permanência em hospital. O presente relato trata de paciente renal crônico, diabético, apresentando episódios de bacteriemia durante sessões de hemodiálise ambulatorial por meio de cateter permcath.Chryseobacterium indologenes is a low-virulent bacterium found in the environment, which is rarely associated with non-nosocomial infections. Most infections caused by this pathogen are associated with the use of invasive devices in hospitalized patients. This study reports the case of a diabetic patient with chronic renal disease presenting episodes of bacteremia undergoing ambulatory hemodialysis with permcath catheter.

  4. Challenges for the German Health Care System. (United States)

    Dietrich, C F; Riemer-Hommel, P


    The German Health Care System (GHCS) faces many challenges among which an aging population and economic problems are just a few. The GHCS traditionally emphasised equity, universal coverage, ready access, free choice, high numbers of providers and technological equipment; however, real competition among health-care providers and insurance companies is lacking. Mainly in response to demographic changes and economic challenges, health-care reforms have focused on cost containment and to a lesser degree also quality issues. In contrast, generational accounting, priorisation and rationing issues have thus far been completely neglected. The paper discusses three important areas of health care in Germany, namely the funding process, hospital management and ambulatory care, with a focus on cost control mechanisms and quality improving measures as the variables of interest. Health Information Technology (HIT) has been identified as an important quality improvement tool. Health Indicators have been introduced as possible instruments for the priorisation debate.

  5. Financial Pressures Prompt Teaching Hospitals to Cut Costs, Raising Fears about Medical Education and Patient Care. (United States)

    Grassmuck, Karen


    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.…

  6. 42 CFR 433.56 - Classes of health care services and providers defined. (United States)


    ... organizations, preferred provider organizations); (9) Ambulatory surgical center services, as described for... defined. 433.56 Section 433.56 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF...) Nursing facility services (other than services of intermediate care facilities for the mentally...


    NARCIS (Netherlands)



    The feasibility of day treatment with community care for schizophrenic patients was tested by means of a longitudinal randomized experiment with 34 experimentals and 16 controls: 38 percent could be treated satisfactorily in a day program that included a very active ambulatory service. The new appro

  8. 77 FR 33133 - Patient Protection and Affordable Care Act; Data Collection To Support Standards Related to... (United States)


    ...; mental health and substance use disorder services, including behavioral health treatment; prescription...: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health... exercise the option to select a benchmark health plan, we intend to propose in future rulemaking that...

  9. Estimating qualitative parameters for assessment of body balance in a simulated ambulatory setting

    NARCIS (Netherlands)

    Meulen, van Fokke B.; Reenalda, Jasper; Veltink, Peter H.


    Continuous daily-life monitoring of balance control of stroke survivors in an ambulatory setting, is essential for optimal guidance of rehabilitation. The purpose of this study is to demonstrate the relation between qualitative parameters of body balance while measuring in stroke patients in a simul

  10. Effects of an isocaloric healthy Nordic diet on ambulatory blood pressure in metabolic syndrome

    DEFF Research Database (Denmark)

    Brader, L; Uusitupa, M; Dragsted, Lars Ove


    beneficial effects on ambulatory BP in subjects with metabolic syndrome (MetS).Subjects/methods:In total, 37 subjects were randomized to either a healthy Nordic diet or a control diet. A healthy Nordic diet embraced whole grains, rapeseed oil, berries, fruits, vegetables, fish, nuts and low-fat dairy...

  11. Temporal changes in clinic and ambulatory blood pressure during cyclic post-menopausal hormone replacement therapy

    DEFF Research Database (Denmark)

    Sørensen, M B; Rasmussen, Verner; Jensen, Gorm Boje


    cyclic norethisterone acetate (NETA) or placebo in two 12-week periods separated by a 3-month washout Clinic blood pressure was measured sitting by the same observer with a mercury manometer at four visits in each period. Twenty-four hour ambulatory blood pressure was measured at baseline...

  12. Association between endothelial dysfunction and arterial stiffness in continuous ambulatory peritoneal dialysis patients

    Institute of Scientific and Technical Information of China (English)



    Objective To investigate the association between endothelial dysfunction and arterial stiffness in continuous ambulatory peritoneal dialysis(CAPD)patients.Methods Ninety-four stable CAPD patients from a single center were enrolled in this cross-sectional study.Ultrasound evaluation was conducted on brachial artery to estimate endothelial-dependent

  13. The comparison of two analgesic regimes after ambulatory surgery: an observational study

    NARCIS (Netherlands)

    Worp, F. van der; Stapel, J.T.; Lako, S.J.; Hendriks, J.C.M.; Vissers, K.C.P.; Steegers, M.A.H.


    INTRODUCTION: Over the past 15 years, the number of ambulatory surgical procedures worldwide has increased continuously. Studies show that 30% to 40% of the patients experience moderate-to-severe pain in the first 48 hours. The objective of this observational study is to compare the percentage of mo

  14. Perceived Racism and Ambulatory Blood Pressure in African American College Students (United States)

    Hill, LaBarron K.; Kobayashi, Ihori; Hughes, Joel W.


    Experiences with racial discrimination may contribute to stress-induced blood pressure (BP) elevations among African Americans. It was reported that perceived racism was associated with ambulatory BP (ABP) during waking hours. This study examined perceived racism and ABP among 40 African American college students, who completed an ABP assessment…

  15. A 15-year longitudinal study on ambulatory blood pressure tracking from childhood to early adulthood

    NARCIS (Netherlands)

    Li, Zhibin; Snieder, Harold; Harshfield, Gregory A.; Treiber, Frank A.; Wang, Xiaoling


    This study evaluates the tracking stability of office blood pressure (BP), ambulatory BP (ABP), BP variability (BPV) and nocturnal BP drops (dipping) from childhood to early adulthood, and their dependence on ethnicity, gender and family history (FH) of essential hypertension (EH). Generalized estim


    NARCIS (Netherlands)



    Background. Ambulatory blood pressure measurements in haemodialysis patients are relevant in view of the high cardiovascular morbidity and mortality in chronic haemodialysis patients. Methods. Twelve normotensive patients were studied from the beginning of one dialysis until the end of the next (mea

  17. Staphylococcus Aureus Nasal Carriage and Infection in Patients on Continuous Ambulatory Peritoneal Dialysis

    NARCIS (Netherlands)

    M.A. Luzar; G.A. Coles; B. Faller; A. Slingeneyer; G. Dah Dah; C. Briat; C. Wone; Y. Knefati; M. Kessler; F. Peluso


    textabstractWe studied 140 consecutive patients beginning continuous ambulatory peritoneal dialysis (CAPD) at one of seven hospitals to assess the relation of the nasal carriage of Staphylococcus aureus to subsequent catheter-exit-site infection or peritonitis. Shortly before the implantation of the

  18. Raoultella planticola peritonitis in a patient on continuous ambulatory peritoneal dialysis. (United States)

    Kim, Sun Woo; Kim, Ji Eun; Hong, Yu Ah; Ko, Gang Jee; Pyo, Heui Jung; Kwon, Young Joo


    A 65-year-old man on continuous ambulatory peritoneal dialysis was admitted with peritonitis. Empirical antibiotic therapy was initiated, and Raoultella planticola was identified in the peritoneal fluid culture. We treated the patient with intraperitoneally administered ciprofloxacin and ceftazidime according to the antibiotic susceptibility. His condition improved, and he was well treated with a 2-week antibiotic course.

  19. Improving patient experience in a pediatric ambulatory clinic : a mixed method appraisal of service delivery

    NARCIS (Netherlands)

    Soeteman, Marijn; Peters, Vera; Busari, Jamiu O


    OBJECTIVE: In 2013, customer satisfaction surveys showed that patients were unhappy with the services provided at our ambulatory clinic. In response, we performed an appraisal of our services, which resulted in the development of a strategy to reduce waiting time and improve quality of service. Infr

  20. Peritonitis Due to Roseomonas fauriae in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis


    Bibashi, Evangelia; Sofianou, Danai; Kontopoulou, Konstantina; Mitsopoulos, Efstathios; Kokolina, Elisabeth


    Roseomonas is a newly described genus of pink-pigmented, nonfermentative, gram-negative bacteria that have been recognized as a cause of human infections. Roseomonas fauriae is a species rarely isolated from clinical specimens. We report the first known case of peritonitis caused by R. fauriae in a patient receiving continuous ambulatory peritoneal dialysis.

  1. Peritonitis due to Roseomonas fauriae in a patient undergoing continuous ambulatory peritoneal dialysis. (United States)

    Bibashi, E; Sofianou, D; Kontopoulou, K; Mitsopoulos, E; Kokolina, E


    Roseomonas is a newly described genus of pink-pigmented, nonfermentative, gram-negative bacteria that have been recognized as a cause of human infections. Roseomonas fauriae is a species rarely isolated from clinical specimens. We report the first known case of peritonitis caused by R. fauriae in a patient receiving continuous ambulatory peritoneal dialysis.

  2. Prognostic value of ambulatory heart rate revisited in 6928 subjects from 6 populations

    DEFF Research Database (Denmark)

    Hansen, Tine Willum; Thijs, Lutgarde; Staessen, Jan A.;


    The evidence relating mortality and morbidity to heart rate remains inconsistent. We performed 24-hour ambulatory blood pressure monitoring in 6928 subjects (not on beta-blockers; mean age: 56.2 years; 46.5% women) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uru...

  3. Ciprofloxacin treatment of bacterial peritonitis associated with chronic ambulatory peritoneal dialysis caused by Neisseria cinerea. (United States)

    Taegtmeyer, M; Saxena, R; Corkill, J E; Anijeet, H; Parry, C M


    Bacterial peritonitis is a well-recognized complication of chronic ambulatory peritoneal dialysis (CAPD) in patients with end-stage renal failure. We present a case of peritonitis due to an unusual pathogen, Neisseria cinerea, unresponsive to the standard intraperitoneal (i.p.) vancomycin and gentamicin, which responded rapidly to oral ciprofloxacin.

  4. Coping with a life event in bipolar disorder : ambulatory measurement, signalling and early treatment

    NARCIS (Netherlands)

    Knapen, Stefan E; Riemersma-van der Lek, Rixt F; Haarman, Bartholomeus C M; Schoevers, Robert A


    Disruption of the biological rhythm in patients with bipolar disorder is a known risk factor for a switch in mood. This case study describes how modern techniques using ambulatory assessment of sleep parameters can help in signalling a mood switch and start early treatment. We studied a 40-year-old

  5. Ambulatory human motion tracking by fusion of inertial and magnetic sensing with adaptive actuation

    NARCIS (Netherlands)

    Schepers, H. Martin; Roetenberg, Daniel; Veltink, Peter H.


    Over the last years, inertial sensing has proven to be a suitable ambulatory alternative to traditional human motion tracking based on optical position measurement systems, which are generally restricted to a laboratory environment. Besides many advantages, a major drawback is the inherent drift cau

  6. The Prognostic Value of Ambulatory Heart Rate Revisited in 6928 Subjects from 6 Populations

    DEFF Research Database (Denmark)

    Hansen, Tine Willum; Thijs, Lutgarde; Staessen, Jan A.;


    The evidence relating mortality and morbidity to heart rate remains inconsistent. We performed 24-hour ambulatory blood pressure monitoring in 6928 subjects (not on β-blockers; mean age: 56.2 years; 46.5% women) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uruguay...

  7. Ambulatory diffuse optical tomography and multimodality physiological monitoring system for muscle and exercise applications (United States)

    Hu, Gang; Zhang, Quan; Ivkovic, Vladimir; Strangman, Gary E.


    Ambulatory diffuse optical tomography (aDOT) is based on near-infrared spectroscopy (NIRS) and enables three-dimensional imaging of regional hemodynamics and oxygen consumption during a person's normal activities. Although NIRS has been previously used for muscle assessment, it has been notably limited in terms of the number of channels measured, the extent to which subjects can be ambulatory, and/or the ability to simultaneously acquire synchronized auxiliary data such as electromyography (EMG) or electrocardiography (ECG). We describe the development of a prototype aDOT system, called NINscan-M, capable of ambulatory tomographic imaging as well as simultaneous auxiliary multimodal physiological monitoring. Powered by four AA size batteries and weighing 577 g, the NINscan-M prototype can synchronously record 64-channel NIRS imaging data, eight channels of EMG, ECG, or other analog signals, plus force, acceleration, rotation, and temperature for 24+ h at up to 250 Hz. We describe the system's design, characterization, and performance characteristics. We also describe examples of isometric, cycle ergometer, and free-running ambulatory exercise to demonstrate tomographic imaging at 25 Hz. NINscan-M represents a multiuse tool for muscle physiology studies as well as clinical muscle assessment.

  8. Limits to Ambulatory Displacement of Coconut Mites in Absence and Presence of Food-Related Cues

    NARCIS (Netherlands)

    Melo, J.W.S.; Lima, D.B.; Sabelis, M.W.; Pallini, A.; Gondim Jr., M.G.C.


    Ambulatory movement of plant-feeding mites sets limits to the distances they can cover to reach a new food source. In absence of food-related cues these limits are determined by survival, walking activity, walking path tortuosity and walking speed, whereas in presence of food the limits are also det

  9. Impact of natalizumab on ambulatory improvement in secondary progressive and disabled relapsing-remitting multiple sclerosis.

    Directory of Open Access Journals (Sweden)

    Diego Cadavid

    Full Text Available BACKGROUND: There is an unmet need for disease-modifying therapies to improve ambulatory function in disabled subjects with multiple sclerosis. OBJECTIVES: Assess the effects of natalizumab on ambulatory function in disabled subjects with relapsing-remitting multiple sclerosis (RRMS or secondary progressive multiple sclerosis (SPMS. METHODS: We retrospectively reviewed ambulatory function as measured by timed 25-foot walk (T25FW in clinical trial subjects with an Expanded Disability Status Scale score ≥3.5, including RRMS subjects from the phase 3 AFFIRM and SENTINEL trials, relapsing SPMS subjects from the phase 2 MS231 study, and nonrelapsing SPMS subjects from the phase 1b DELIVER study. For comparison, SPMS subjects from the intramuscular interferon beta-1a (IM IFNβ-1a IMPACT study were also analyzed. Improvement in ambulation was measured using T25FW responder status; response was defined as faster walking times over shorter (6-9-month or longer (24-30-month treatment periods relative to subjects' best predose walking times. RESULTS: There were two to four times more T25FW responders among disabled MS subjects in the natalizumab arms than in the placebo or IM IFNβ-1a arms. Responders walked 25 feet an average of 24%-45% faster than nonresponders. CONCLUSION: Natalizumab improves ambulatory function in disabled RRMS subjects and may have efficacy in disabled SPMS subjects. Confirmation of the latter finding in a prospective SPMS study is warranted.

  10. Accelerometry: A Feasible Method to Quantify Physical Activity in Ambulatory and Nonambulatory Adolescents with Cerebral Palsy

    Directory of Open Access Journals (Sweden)

    Jan Willem Gorter


    Full Text Available Objective. To determine the feasibility of physical activity monitoring in adolescents with cerebral palsy (CP. Methods. A convenience sample of ambulatory and non-ambulatory adolescents (N=23; 17 males, 6 females; mean age 13.5 y, SD 2.6 y; Gross Motor Function Classification System (GMFCS distribution: n=9 Level I, n=5 Level II, n=5 Level III, n=4 Level IV was recruited. Physical activity (PA was objectively assessed using the ActiGraph GT1M activity monitor. Discomfort or adverse effects of wearing the accelerometers were recorded by participants. Levels of physical activity were determined as total PA, light PA (LPA, moderate PA (MPA, moderate-to-vigorous (MVPA, and vigorous PA (VPA using cut-points recently validated for CP. Results. Most participants showed little reluctance. Mean daily MVPA for all participants was 30.7 minutes (SD 30.3, which corresponded to 2.7 (SD 2.4 minutes of MVPA per hour or 4.5% (SD 3.9 of the total monitoring time. Total PA and MVPA were greatest in ambulatory youth (GMFCS levels I and II compared with youth who use a walking aid or wheelchair (GMFCS levels III and IV (P<0.05. Conclusion(s. The results support the use of the accelerometer as a feasible and useful measure of activity in ambulatory and nonambulatory adolescents with CP.

  11. Ambulatory Activity of Children with Cerebral Palsy: Which Characteristics Are Important? (United States)

    van Wely, Leontien; Becher, Jules G.; Balemans, Astrid C. J.; Dallmeijer, Annet J.


    Aim: To assess ambulatory activity of children with cerebral palsy (CP), aged 7 to 13 years, and identify associated characteristics. Method: Sixty-two children with spastic CP (39 males, 23 females; mean age 10y 1mo, SD 1y 8mo; age range 7-13y), classified as Gross Motor Function Classification System (GMFCS) levels I to III, participated.…

  12. 76 FR 74121 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical... (United States)


    .... Background b. Packaging Issues (1) CMS Presentation of Findings Regarding Expanded Packaging at the February... CONTACT: Marjorie Baldo, (410) 786-4617, Hospital outpatient prospective payment issues. Char Thompson, (410) 786-2300, Ambulatory surgical center issues. Michele Franklin, (410) 786-4533, and Jana...

  13. Blood pressure load does not add to ambulatory blood pressure level for cardiovascular risk stratification

    DEFF Research Database (Denmark)

    Li, Yan; Thijs, Lutgarde; Boggia, José


    Experts proposed blood pressure (BP) load derived from 24-hour ambulatory BP recordings as a more accurate predictor of outcome than level, in particular in normotensive people. We analyzed 8711 subjects (mean age, 54.8 years; 47.0% women) randomly recruited from 10 populations. We expressed BP...

  14. Survival in Mediterranean Ambulatory Patients With Chronic Heart Failure. A Population-based Study

    NARCIS (Netherlands)

    Frigola Capell, E.; Comin-Colet, J.; Davins-Miralles, J.; Gich-Saladich, I.J.; Wensing, M.; Verdu-Rotellar, J.M.


    INTRODUCTION AND OBJECTIVES: Scarce research has been performed in ambulatory patients with chronic heart failure in the Mediterranean area. Our aim was to describe survival trends in our target population and the impact of prognostic factors. METHODS: We carried out a population-based retrospective

  15. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring

    NARCIS (Netherlands)

    Parati, Gianfranco; Stergiou, George; O'Brien, Eoin; Asmar, Roland; Beilin, Lawrence; Bilo, Grzegorz; Clement, Denis; de la Sierra, Alejandro; de Leeuw, Peter; Dolan, Eamon; Fagard, Robert; Graves, John; Head, Geoffrey A; Imai, Yutaka; Kario, Kazuomi; Lurbe, Empar; Mallion, Jean-Michel; Mancia, Giuseppe; Mengden, Thomas; Myers, Martin; Ogedegbe, Gbenga; Ohkubo, Takayoshi; Omboni, Stefano; Palatini, Paolo; Redon, Josep; Ruilope, Luis M; Shennan, Andrew; Staessen, Jan A; vanMontfrans, Gert; Verdecchia, Paolo; Waeber, Bernard; Wang, Jiguang; Zanchetti, Alberto; Zhang, Yuqing


    Given the increasing use of ambulatory blood pressure monitoring (ABPM) in both clinical practice and hypertension research, a group of scientists, participating in the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability, in year 2013 published

  16. High Prevalence of Obesity in Ambulatory Children and Adolescents with Intellectual Disability (United States)

    Stewart, L.; Van de Ven, L.; Katsarou, V.; Rentziou, E.; Doran, M.; Jackson, P.; Reilly, J. J.; Wilson, D.


    Background: Obesity prevalence is unusually high among adults with intellectual disability (ID). There is limited and conflicting evidence on obesity prevalence among ambulatory children and adolescents with ID. The present study aimed to estimate obesity prevalence in this group and to compare with population prevalence. Methods: Survey of nine…

  17. How the Trivialization of the Demands of High-Tech Care in the Home is Turning Family Members Into Para-Medical Personnel (United States)

    Guberman, Nancy; Gagnon, Eric; Cote, Denyse; Gilbert, Claude; Thivierge, Nicole; Tremblay, Marielle


    This study analyzes the transfer of specialized professional activities from health care workers to patients and their family members in the context of the shift to ambulatory care for acute and chronic illnesses requiring hospitalization. Based on 119 semidirective interviews with patients released from hospital after early discharge and/or with…

  18. Spatial analysis of elderly access to primary care services

    Directory of Open Access Journals (Sweden)

    Lozano-Gracia Nancy


    Full Text Available Abstract Background Admissions for Ambulatory Care Sensitive Conditions (ACSCs are considered preventable admissions, because they are unlikely to occur when good preventive health care is received. Thus, high rates of admissions for ACSCs among the elderly (persons aged 65 or above who qualify for Medicare health insurance are signals of poor preventive care utilization. The relevant geographic market to use in studying these admission rates is the primary care physician market. Our conceptual model assumes that local market conditions serving as interventions along the pathways to preventive care services utilization can impact ACSC admission rates. Results We examine the relationships between market-level supply and demand factors on market-level rates of ACSC admissions among the elderly residing in the U.S. in the late 1990s. Using 6,475 natural markets in the mainland U.S. defined by The Health Resources and Services Administration's Primary Care Service Area Project, spatial regression is used to estimate the model, controlling for disease severity using detailed information from Medicare claims files. Our evidence suggests that elderly living in impoverished rural areas or in sprawling suburban places are about equally more likely to be admitted for ACSCs. Greater availability of physicians does not seem to matter, but greater prevalence of non-physician clinicians and international medical graduates, relative to U.S. medical graduates, does seem to reduce ACSC admissions, especially in poor rural areas. Conclusion The relative importance of non-physician clinicians and international medical graduates in providing primary care to the elderly in geographic areas of greatest need can inform the ongoing debate regarding whether there is an impending shortage of physicians in the United States. These findings support other authors who claim that the existing supply of physicians is perhaps adequate, however the distribution of them across

  19. Is There Any Infl uence of the Ambulatory Status of Children with Myelomeningocele on Their Clinical and Renal Outcomes?

    Directory of Open Access Journals (Sweden)

    Meryem BENZER


    Full Text Available OBJECTIVE: The aim of this study is to evaluate the infl uence of the ambulatory status of children with MMC on renal functions, clinical and radiological fi ndings. MATERIAL and METHODS: The records of 83 children with MMC between 2005-2010 were reviewed retrospectively. The ambulatory status of the patients was classifi ed as independent walkers (walks without assistive appliances, assisted walkers (requires walking aid, and non-ambulatory (wheelchair bound and the patient characteristics were evaluated according to the ambulatory status. RESULTS: The mean age was 7.1±0.61 years and median follow-up was 58 (32-97 months. Thirtyseven patients (44.6% had been operated in the fi rst three days of life. The patients with earlier initiation of follow-up earlier had less hydronephrosis and trabeculated bladder. Sixty-one children (73.5% were non-ambulatory, 14 (16.9% were assisted walkers and eight (9.6% were independent walkers. GFR was less than 80 ml/minute/1.73m² in six patients. There were no relation between ambulatory status and patients' renal functions, radiological and clinical fi ndings. CONCLUSION: Ambulatory status does not infl uence renal functions, clinical and radiological fi ndings of children with MMC. Beginning follow-up earlier may lead to fewer complications such as hydronephrosis and deformed and trabeculated bladder. Besides, patients operated in the fi rst three days of life were more compliant with regular follow-ups.

  20. [Prioritizing prescriptions in a ambulatory care setting: a tool to achieve appropriateness of care in public health management]. (United States)

    Semeraro, V; Zantedeschi, E; Pasquarella, A; Guerrera, C; Guasticchi, G


    Waiting lists are one of the main Public Health issues within developed countries. To promote appropriateness about General Practitioners' (GPs) prescriptions, during 2009 the project "Priority setting in outpatient prescriptions" in Latium Region has been approved. Regional referees, Latium Public Health Agency managers and advisors, managers and advisors of three Local Public Health Units (LPHUs) within the Latium region and some voluntarily recruited General Practitioners (each one with more than 800 patients enrolled) were included in a team work with the duty to develop the project. During two selected months of 2010, 46 GPs have forwarded overall 2.229 medical prescriptions. The six most numerous prescriptions were picked out and analyzed by the team work. 42% of these prescriptions were identified as belonging to category D of the priority level--"standard", while 42% and 41% of prescriptions bore the expressions of "control" and "diagnostic purpose" respectively. Among these ones, 75% were represented by bilateral mammography, prescribed to women aged between 50 and 69 years: but for those people bilateral mammography is already provided free of charge within the regional program of breast cancer screening, making the routine prescription by their physician a useless duplication, unacceptable in a healthcare system of good quality. Therefore at the conclusion of the project, the team work suggests proper standards be applied by healthcare professionals and GPs to achieve a significant objective: mammography appropriateness prescriptions.

  1. Synergistic effects of pain intensity and anxiety sensitivity in relation to anxiety and depressive symptoms and disorders among economically disadvantaged latinos in a community-based primary care setting. (United States)

    Velasco, Ricardo Valdés; Bakhshaie, Jafar; Walker, Rheeda L; Viana, Andres G; Garza, Monica; Ochoa-Perez, Melissa; Paulus, Daniel J; Robles, Zuzuky; Valdivieso, Jeanette; Zvolensky, Michael J


    The present investigation examined the interactive effects of anxiety sensitivity and pain intensity in relation to anxious arousal, social anxiety, and depressive symptoms and disorders among 203 Latino adults with an annual income of less than $30,000 (84.4% female; Mage=38.9, SD=11.3 and 98.6% used Spanish as their first language) who attended a community-based primary healthcare clinic. As expected, the interaction between anxiety sensitivity and pain intensity was significantly related to increased anxious arousal, social anxiety, and depressive symptoms as well as number of depressive/anxiety disorder diagnoses. The form of the significant interactions indicated that participants reporting co-occurring higher levels of anxiety sensitivity and pain intensity evinced the greatest levels of anxious arousal, social anxiety, and depressive symptoms as well as higher levels of depressive and anxiety disorders. These data provide novel empirical evidence suggesting that there is clinically-relevant interplay between anxiety sensitivity and pain intensity in regard to a relatively wide array of anxiety and depressive variables among Latinos in a primary care medical setting.

  2. Ambulatory blood pressure and echocardiographic left ventricular dimensions in elderly hypertensive subjects. (United States)

    Rizzo, V; Piccirillo, G; Cicconetti, P; Bianchi, A; Capponi, L; Salza, M C; Cacciafesta, M; Marigliano, V


    In a consecutive series of 62 hypertensive elderly subjects, the authors studied the relation of blood pressure circadian variations with echocardiographic parameters of left ventricular (LV) hypertrophy. All the subjects were submitted to an ambulatory blood pressure monitoring (ABPM) and to B- and M-mode echocardiography. In the elderly hypertensive group, LV mass index (LVMI) was more strongly related to twenty-four-hour, daytime and nighttime systolic ambulatory blood pressure (r = 0.52, r = 0.37, r = 0.51) than diastolic ambulatory blood pressures were (r = 0.32, r = 0.18, r = 0.33). Casual systolic and diastolic blood pressure (CBP) was found more weakly related to LVMI than ambulatory blood pressures were (r = 0.35, r = 0.26). Elderly hypertensive subjects were divided into two subgroups in relation to the presence (group 1) or absence (group 2) of blood pressure nocturnal decline. No differences were found between these two subgroups in regard to: casual blood pressure values, ambulatory blood pressures in the diurnal period, sex, body surface area, height, weight, and age. LVMIs were computed in all three groups and showed the following results: 89.32 +/- 19.76 in elderly normotensives, 91.21 +/- 31.32 in group 1, and 99.80 +/- 18.21 in group 2. Echocardiographic parameters of LV dimensions and LVMIs were different in group 1 and 2. An inverse correlation, statistically significant, was observed between LVMIs and the nocturnal blood pressure reduction (systolic: r = -0.36, P < 0.05; diastolic: r = -0.29, P < 0.05). These results suggest an association between a smaller LV mass and nocturnal blood pressure decline in elderly hypertensive patients.

  3. [Ambulatory blood pressure profiles of patients with permanent or occasional hypertension. Correlation with clinical data]. (United States)

    Herpin, D; Amiel, A; Boutaud, P; Ciber, M A; Demange, J


    Ambulatory blood pressure (BP) recording was performed in 57 untreated hypertensive patients by means of the "Spacelabs" non-invasive apparatus. Patients were divided into two groups according to BP measurements previously made during medical consultation. Group I comprised 25 "permanently hypertensive" patients (diastolic BP always above 95 mmHg) and group II, 32 "occasionally hypertensive" patients (diastolic BP sometimes normal, sometimes above 95 mmHg). The same circadian rhythm was observed in both groups. The mean ambulatory BP level was significantly higher (p less than 0.001) in group I patients than in group II patients, either over the whole of the 24-hour period (142.0/88.0 versus 122.7/75.3 mmHg), or in day time (149.0/92.5 versus 128.2/78.9 mmHg) or at night (128.0/80.1 versus 111.5/68.0 mmHg). In contrast, there did not seem to be any significant difference between the two groups in relative long-term variability of BP, expressed as the standard deviation/mean BP values ratio. Comparison with clinical data showed that BP values measured during consultation (160/103 mmHg in group I, 143/94 mmHg in group II) were higher than ambulatory values and, chiefly, that there was very poor correlation between the two measurement methods, precluding any extrapolation. Automatic ambulatory BP recording provides for more accurate evaluation of hypertensive patients, enabling emotional "artefacts" to be excluded and patients "reactivity" to their socio-professional environment to be assessed. However, in the absence of sufficient epidemiological data, doctors should not feel authorized to base their therapeutic decisions on the sole data supplied by ambulatory BP recordings.

  4. Diagnostic and prognostic value of a careful symptom evaluation and high sensitive troponin in patients with suspected stable angina pectoris without prior cardiovascular disease

    DEFF Research Database (Denmark)

    Madsen, Debbie M; Diederichsen, Axel C P; Hosbond, Susanne E


    BACKGROUND AND AIMS: Typical angina pectoris (AP) and high-sensitive troponin I (hs-TnI) are independently associated with coronary artery disease (CAD) and future cardiovascular events (CVE). This study aimed to assess the individual and combined diagnostic and prognostic impact of symptoms and hs...

  5. Cost estimation of hypertension management based on home blood pressure monitoring alone or combined office and ambulatory blood pressure measurements. (United States)

    Boubouchairopoulou, Nadia; Karpettas, Nikos; Athanasakis, Kostas; Kollias, Anastasios; Protogerou, Athanase D; Achimastos, Apostolos; Stergiou, George S


    This study aims at estimating the resources consumed and subsequent costs for hypertension management, using home blood pressure (BP) monitoring (HBPM) alone versus combined clinic measurements and ambulatory blood pressure monitoring (C/ABPM). One hundred sixteen untreated hypertensive subjects were randomized to use HBPM or C/ABPM for antihypertensive treatment initiation and titration. Health resources utilized within 12-months follow-up, their respective costs, and hypertension control were assessed. The total cost of the first year of hypertension management was lower in HBPM than C/ABPM arm (€1336.0 vs. €1473.5 per subject, respectively; P cost was identical in both arms. There was no difference in achieved BP control and drug expenditure (HBPM: €233.1 per subject; C/ABPM: €247.6 per subject; P = not significant), whereas the cost of BP measurements and/or visits was higher in C/ABPM arm (€393.9 vs. €516.9, per patient, respectively P cost for subsequent years (>1) was €348.9 and €440.2 per subject, respectively for HBPM and C/ABPM arm and €2731.4 versus €3234.3 per subject, respectively (P cost than C/ABPM, and the same trend is observed in 5-year projection. The results on the resources consumption can be used to make cost estimates for other health-care systems.

  6. Diagnostic thresholds for ambulatory blood pressure moving lower: a review based on a meta-analysis-clinical implications

    DEFF Research Database (Denmark)

    Hansen, T.W.; Kikuya, M.; Thijs, L.;


    Upper limits of normal ambulatory blood pressure (ABP) have been a matter of debate in recent years. Current diagnostic thresholds for ABP rely mainly on statistical parameters derived from reference populations. Recent findings from the International Database of Ambulatory Blood Pressure....../75 mm Hg, 130/85 mm Hg, and 110/70 mm Hg, respectively, and those for ambulatory hypertension were 130/80 mm Hg, 140/85 mm Hg, and 120/70 mm Hg. However, in clinical practice, any diagnostic threshold for blood pressure needs to be assessed in the context of the patient's overall risk profile. The IDACO...

  7. [Approaches potentiating cardioprotective effect of ambulatory physical training in patients with ischemic heart disease and multivessel coronary artery involvement after coronary stenting]. (United States)

    Liamina, N P; Kotel'nikova, E V; Biziaeva, E A; Karpova, É S


    Cardiorehabilitation of patients with multivessel coronary lesions is an obligatory component of ambulatory stage of care. With the aim of potentiating cardioprotective and antiischemic impact of rehabilitative preventive measures in 36 patients with ischemic heart disease (IHD) and multivessel coronary artery involvement who had undergone percutaneous coronary intervention we studied cardioprotective and antiischemic effect of long-term (24 weeks) administration of 70 mg/day trimetazidine in combination with moderate intensity physical training with the use of distance surveillance by a physician. The chosen therapeutic approach in patients with residual ischemia after incomplete anatomical revascularization provided early persistent formation of cardioprotective and antiischemic effect proven by increase of tolerance to physical exercise, improvement of diastolic function, and positive dynamics of both ECG parameters and biochemical markers of myocardial ischemia.

  8. Intervenção sobre tabagismo realizada por cardiologista em rotina ambulatorial Anti-smoking intervention performed by cardiologist during ambulatory care

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    Jaqueline Scholz Issa


    Full Text Available OBJETIVO: Avaliar a efetividade da intervenção sobre o tabagismo, realizada por médico cardiologista em rotina de ambulatório, utilizando a prescrição de adesivos de nicotina. MÉTODOS: Foram avaliados, consecutivamente, 100 pacientes (50 homens e 50 mulheres, incluindo consulta médica, aplicação de escore para definição do grau de dependência à nicotina, determinação da concentração de monóxido de carbono expirado e peso corpóreo. Os adesivos foram utilizados entre 8 e 12 semanas, com redução progressiva da concentração até a suspensão (concentrações de 21, 14 e 7mg RESULTADOS: A taxa de abstinência um ano após o início do tratamento foi de 41%, confirmada pela concentração do monóxido de carbono. CONCLUSÃO: A intervenção sobre o tabagismo pode ser realizada em rotina de atendimento cardiológico com resultados satisfatórios. Os adesivos de nicotina são seguros, bem tolerados, e devem ser utilizados, mais freqüentemente, no auxílio aos fumantes, para deixarem de fumar.PURPOSE: The aim of this study was to evaluate the effectiveness of nicotine patches as a strategy to help patients quit smoking in the cardiovascular clinic. METHODS: The population studied was composed of 100 patients (50 women and 50 men. The strategy included medical consultation, Fangerstron escore application and prescription of nicotine patches. Nicotine patches were continuously used for 8 to 12 weeks, with progressive concentration reduction releasing 21, 14, and 7mg/day. RESULTS: The abstinence rate one year later was 41% confirmed by carbon monoxide exhaled air concentration. CONCLUSION: Nicotine patches are safe, and well tolerated and, for these reasons, should be more frenquently prescribed by cardiologists to help patients quit smoking.

  9. Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City

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    Torres-Arreola Laura del Pilar


    Full Text Available Abstract Background In Mexico, inappropriate prescription of drugs with potential interactions causing serious risks to patient health has been little studied. Work in this area has focused mainly on hospitalized patients, with only specific drug combinations analyzed; moreover, the studies have not produced conclusive results. In the present study, we determined the frequency of potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age, who used Mexican Institute of Social Security (IMSS family medicine clinics. In addition, we aimed to identify the associated factors for these interactions. Methods We collected information on general patient characteristics, medical histories, and medication (complete data. The study included 624 ambulatory patients over 50 years of age, with non-malignant pain syndrome, who made ambulatory visits to two IMSS family medicine clinics in Mexico City. The patients received 7-day prescriptions for non-opioid analgesics. The potential interactions were identified by using the Thompson Micromedex program. Data were analyzed using descriptive, bivariate and multiple logistic regression analyses. Results The average number of prescribed drugs was 5.9 ± 2.5. About 80.0% of patients had prescriptions implying one or more potential drug-drug interactions and 3.8% of patients were prescribed drug combinations with interactions that should be avoided. Also, 64.0% of patients had prescriptions implying one or more potential drug disease interactions. The factors significantly associated with having one or more potential interactions included: taking 5 or more medicines (adjusted Odds Ratio (OR: 4.34, 95%CI: 2.76–6.83, patient age 60 years or older (adjusted OR: 1.66, 95% CI: 1.01–2.74 and suffering from cardiovascular diseases (adjusted OR: 7.26, 95% CI: 4.61–11.44. Conclusion The high frequency of prescription of drugs with potential drug interactions showed in

  10. Knowledge about diabetes mellitus of patients treated at interdisciplinary ambulatory program of a public university hospital Conhecimento sobre diabetes mellitus de pacientes atendidos em programa ambulatorial interdisciplinar de um hospital universitário público

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    Maria Helena D. Menezes Guariente


    Full Text Available As diabetes mellitus (DM is a disease that needs changes that last a life time, an educational action is necessary to instruct and make the diabetic aware of the importance of his/her knowledge about the disease as an integral part of the care. The purpose of this research is to evaluate the knowledge acquired by the diabetic treated at an interdisciplinary ambulatory about themes related to DM and compare these results with those obtained in a study with the same purpose carried out in 1995 when discouraging results were obtained, leading to a methodological alteration of the educational activity. This is a descriptive study in the qualitative approach carried out with patients treated at an interdisciplinary ambulatory of a public university hospital. The subjects that took part in this study were ten diabetic selected by asystematic sampling. Data were obtained by means of an audio-taped semi-structured interview. The interview questions consisted of themes concerning knowledge acquired about the DM, medication therapy, nutrition, self-monitoring, physical activity and body care. The interviewees showed good knowledge of diabetes mellitus, medication therapy, nutrition and the importance of physical activity. Self-monitoring was mentioned as necessary for the glycemic control and insulin scheme readjustment. Feet care was the most mentioned activity regarding body care. Knowledge about the questioned theme was greater than that of the study carried out previously. It was concluded that, after the educational activity alteration, patients became more aware about their disease, highlighting the importance of health education for the DM control. Como o diabetes mellitus (DM é uma doença que necessita de mudanças que duram para toda a vida, torna-se necessária uma ação educativa para instruir e conscientizar o diabético da importância do seu conhecimento sobre a doença como parte integral do cuidado. Tem-se como objetivo nesta pesquisa

  11. Technological resources and personnel costs required to implement an automated alert system for ambulatory physicians when patients are discharged from hospitals to home

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    Terry S Field


    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.

  12. Improving the Sensitivity and Functionality of Mobile Webcam-Based Fluorescence Detectors for Point-of-Care Diagnostics in Global Health

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    Reuven Rasooly


    Full Text Available Resource-poor countries and regions require effective, low-cost diagnostic devices for accurate identification and diagnosis of health conditions. Optical detection technologies used for many types of biological and clinical analysis can play a significant role in addressing this need, but must be sufficiently affordable and portable for use in global health settings. Most current clinical optical imaging technologies are accurate and sensitive, but also expensive and difficult to adapt for use in these settings. These challenges can be mitigated by taking advantage of affordable consumer electronics mobile devices such as webcams, mobile phones, charge-coupled device (CCD cameras, lasers, and LEDs. Low-cost, portable multi-wavelength fluorescence plate readers have been developed for many applications including detection of microbial toxins such as C. Botulinum A neurotoxin, Shiga toxin, and S. aureus enterotoxin B (SEB, and flow cytometry has been used to detect very low cell concentrations. However, the relatively low sensitivities of these devices limit their clinical utility. We have developed several approaches to improve their sensitivity presented here for webcam based fluorescence detectors, including (1 image stacking to improve signal-to-noise ratios; (2 lasers to enable fluorescence excitation for flow cytometry; and (3 streak imaging to capture the trajectory of a single cell, enabling imaging sensors with high noise levels to detect rare cell events. These approaches can also help to overcome some of the limitations of other low-cost optical detection technologies such as CCD or phone-based detectors (like high noise levels or low sensitivities, and provide for their use in low-cost medical diagnostics in resource-poor settings.

  13. [25 years of organized ambulatory heart sport in Luxembourg. The development of a sustained rehabilitation model]. (United States)

    Delagardelle, Charles; Feiereisen, Patrick


    After Second World War cardiovascular disease (CVD), especially coronary artery disease (CAD), turned out to be an epidemic in the western countries including the Grand-Duchy of Luxembourg, and accounted for nearly half of all deaths. A lot of strategies, among them treatment by physical activity, were developed to fight this challenge and, fortunately, a mortality regression of about 50 % could be achieved. Nowadays, eastern European countries and, more recently, China and India face an increasing CVD mortality. During the seventies ambulatory heart sport clubs, then labeled as, "coronary clubs" became very popular in Europe especially in West-Germany. Around 2000 there were more than 6000 heart sports groups in Germany. In 1984 a first group was founded in Luxembourg City (Centre) a, 1991 a second group started in Esch/Alzette (South) and in 2002 a third regional group in Ettelbruck (North) so that, by now, the 3 main public health districts of the Grand-Duchy of Luxembourg can offer regular ambulatory sports activities to almost all concerned cardiac patients in the country. The ambulatory heart sport groups of Luxembourg cooperate in a federated association allowing an integrated logistic organization. Since the beginning nineties cardiac rehabilitation became a field of interest to the university faculties and later of scientific societies, like the American Heart Association (AHA) and the European Society of Cardiology (ESC). New subgroups were founded and guidelines were published and renewed. The movement of ambulatory heart sport groups was more or less neglected in the prevention and rehabilitation activities of the scientific societies. Recently the ESC proposed a new definition of comprehensive CVD prevention and rehabilitation programmes as "coordinated, multifaceted interventions designed to optimize a cardiac patient's physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the

  14. Tratamento ambulatorial da endocardite bacteriana estreptocócica Tratamiento clínico de la endocarditis bacteriana estreptocócica Ambulatory treatment of streptococcal bacterial endocarditis

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    Sirio Hassem Sobrinho


    Full Text Available A endocardite bacteriana é uma grave doença infecciosa cujo tratamento é tradicionalmente feito com o paciente internado. recebendo medicação intravenosa. A possibilidade de tratamento domiciliar ou ambulatorial. em casos estritamente selecionados. é atraente tanto do ponto de vista social quanto do econômico. Apresentamos o relato de 6 pacientes com diagnóstico de endocardite bacteriana por Streptococcus. tratados parcial ou integralmente em regime ambulatorial. Todos evoluíram sem complicações e com resolução completa do quadro infeccioso.La endocarditis bacteriana es una severa enfermedad infecciosa cuyo tratamiento se hace tradicionalmente con el paciente internado, recibiendo medicación intravenosa. La posibilidad de tratamiento domiciliar o clínico, en casos estrictamente seleccionados, es atractivo desde el punto de vista social como del económico. Presentamos el caso clínico de 6 pacientes con diagnóstico de endocarditis bacteriana por streptococcus, tratados parcial o integralmente en régimen ambulatorio. Todos evolucionaron sin complicaciones y con resolución completa del cuadro infeccioso.Bacterial endocarditis is a severe infectious disease. of which treatment is traditionally carried out in hospitalized patients through intravenous medication. The possibility of at-home or ambulatory treatment. for stringently selected cases. is attractive from the social as well as from the economic point of view. We report 6 patients with a diagnosis of bacterial endocarditis caused by Streptococcus. treated partially or completely on an outpatient basis. All of them evolved without complications and presented complete resolution of the infection.

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

  16. Ambulatory teaching: Do approaches to learning predict the site and preceptor characteristics valued by clerks and residents in the ambulatory setting?

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    Kirby John R


    Full Text Available Abstract Background In a study to determine the site and preceptor characteristics most valued by clerks and residents in the ambulatory setting we wished to confirm whether these would support effective learning. The deep approach to learning is thought to be more effective for learning than surface approaches. In this study we determined how the approaches to learning of clerks and residents predicted the valued site and preceptor characteristics in the ambulatory setting. Methods Postal survey of all medical residents and clerks in training in Ontario determining the site and preceptor characteristics most valued in the ambulatory setting. Participants also completed the Workplace Learning questionnaire that includes 3 approaches to learning scales and 3 workplace climate scales. Multiple regression analysis was used to predict the preferred site and preceptor characteristics as the dependent variables by the average scores of the approaches to learning and perception of workplace climate scales as the independent variables. Results There were 1642 respondents, yielding a 47.3% response rate. Factor analysis revealed 7 preceptor characteristics and 6 site characteristics valued in the ambulatory setting. The Deep approach to learning scale predicted all of the learners' preferred preceptor characteristics (β = 0.076 to β = 0.234, p Direction was more strongly associated with the Surface Rational approach (β = .252, p Surface Disorganized approach to learning (β = .154, p Deep approach. The Deep approach to learning scale predicted valued site characteristics of Office Management, Patient Logistics, Objectives and Preceptor Interaction (p Surface Rational approach to learning predicted valuing Learning Resources and Clinic Set-up (β = .09, p = .001; β = .197, p Surface Disorganized approach to learning weakly negatively predicted Patient Logistics (β = -.082, p = .003 and positively the Learning Resources (β = .088, p = .003. Climate

  17. Online Health Information Impacts Patients’ Decisions to Seek Emergency Department Care


    Pourmand, Ali; Sikka, Neal


    Objective: To investigate the impact of online health information (OHI) and patients’ decisions to seek emergency department (ED) care. Methods: We conducted a survey of a convenience sample of 489 ambulatory patients at an academic ED between February and September 2006. The primary measure was the prevalence of Internet use, and the secondary outcome was the impact of OHI on patients’ decision to seek ED care. Results: The study group comprised 175 (38%) males. Mean age wa...

  18. Ear Acupuncture for Post-Operative Pain Associated with Ambulatory Arthroscopic Knee Surgery: A Randomized Controlled Trial (United States)


    E7(/(3+21(180%(5 ,QFOXGHDUHDFRGH 14 Jan 2014 Final Report Ear acupuncture for post-operative pain associated with ambulatory arthroscopic...DISTRIBUTION A. Approved for public release: distribution unlimited. The purpose of this study is to compare ear acupuncture plus standard therapy versus...3298 Ear Acupuncture for Post-operative Pa111 Assoc1ated With Ambulatory Arthroscopic Knee Surgery A Randomized Controlled Trial ’• V ’’ ’-’ I

  19. Are published characteristics of the ambulatory blood pressure generalizable to rural Chinese? The JingNing population study



    OBJECTIVE: We investigated the ambulatory blood pressure (BP) in rural Chinese and compared its characteristics with those reported in other population-based studies. METHODS: We enrolled inhabitants from six villages of the JingNing County, China. We recorded the ambulatory BP using 90207 SpaceLabs monitors. Trained physicians measured the conventional BP at the participants' homes. Hypertension was defined as a conventional BP of >/=140/>/=90 mmHg or a condition requiring the intake of anti...

  20. Urinary infection in patients of public health care of Campo Mourão-PR, Brazil: bacterial prevalence and sensitivity profile

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    Josiane dos Santos Bitencourt


    Full Text Available Introduction: Cases of bacterial resistance in urinary tract infections (UTIs have increased significantly, mainly due to indiscriminate use of antimicrobials. Objective: Objective: To evaluate the prevalence and antimicrobial susceptibility of microorganisms isolated in urine cultures of patients of Consórcio Intermunicipal de Saúde da Comunidade dos Municípios da Região de Campo Mourão (CISCOMCAM clinical laboratory. Method: We performed a retrospective study of data from urine culture and sensitivity done between January 2012 and December 2013. Results: The most prevalent bacteria were Escherichia coli; women were the most affected gender and people 16-45 years, the most affected age group. The sensitivity profile showed that the antimicrobial combination trimethoprim/ sulfamethoxazole was not associated with the highest rate of bacterial resistance (59.7% and the combination of amoxicillin/clavulanic acid showed the lowest resistance rate (15.3%. For most antimicrobials, including ciprofloxacin and norfloxacin, the rates of bacterial resistance have increased from 2012 to 2013 with statistical significance (p < 0.05 in some cases. Discussion: The prevalence of Gram-negative bacilli in urinary infections is due to the fact that intestinal flora is rich in enterobacteria, and women are most affected by anatomical factors. The development of bacterial resistance to antimicrobials probably arises from their indiscriminate use. Conclusion: The rate of microbial resistance has risen, showing the need for a more effective control of antimicrobial use.

  1. From Aldrete to PADSS: Reviewing discharge criteria after ambulatory surgery. (United States)

    Ead, Heather


    Nurses working in perianesthesia care areas use discharge scoring criteria to complete patient assessments and ensure patient readiness for discharge or transfer to the next phase of recovery. However, all discharge criteria have both advantages and disadvantages. Comparative studies on the reliability of the different discharge criteria in use are extremely limited. As the acuity of our aging population increases, as well as the number of annual surgeries performed on an outpatient basis, it is most timely to ensure that we are following evidence-based discharge criteria.

  2. [Relevant publications in ambulatory general internal medicine in 2007]. (United States)

    Amstutz, R; Humair, J P; Junod Perron, N; Malacarne, S; Nyffenegger, L; Rieder, J P; Steiner, A S; Motamed, S


    Screening procedures for genital Chlamydia infection, cancer risks linked to oral contraceptives, indications and efficacy of HPV vaccination, and diagnostic tools for celiac disease in adults; these are just a few of the general practice themes that were reviewed and analysed in 2007 by residents and chief residents at the Community medicine and primary care Service of the Geneva University Hospitals. These commented summaries, intended for all our colleagues, constitute Geneva's contribution to the literature data base initiated in 2005 by chief residents in Lausanne.

  3. The Effects of Ambulatory Accelerations on the Stability of a Magnetically Suspended Impeller for an Implantable Blood Pump. (United States)

    Paul, Gordon; Rezaienia, Mohammed Amin; Rahideh, Akbar; Munjiza, Ante; Korakianitis, Theodosios


    This article describes the effects of ambulatory accelerations on the stability of a magnetically suspended impeller for use in implantable blood pumps. A magnetic suspension system is developed to control the radial position of a magnetic impeller using coils in the pump casing. The magnitude and periodicity of ambulatory accelerations at the torso are measured. A test rig is then designed to apply appropriate accelerations to the suspension system. Accelerations from 0 to 1 g are applied to the suspended impeller with ambulatory periodicity while the radial position of the impeller and power consumption of the suspension system are monitored. The test is carried out with the impeller suspended in air, water, and a glycerol solution to simulate the viscosity of blood. A model is developed to investigate the effects of the radial magnetic suspension system and fluid damping during ambulatory accelerations. The suspension system reduces the average displacement of the impeller suspended in aqueous solutions within its casing to 100 µm with a power consumption of below 2 W during higher magnitude ambulatory accelerations (RMS magnitude 0.3 g). The damping effect of the fluid is also examined and it is shown that buoyancy, rather than drag, is the primary cause of the damping at the low displacement oscillations that occur during the application of ambulatory accelerations to such a suspension system.

  4. Cobalt sensitization and dermatitis

    DEFF Research Database (Denmark)

    Thyssen, Jacob P


    : This clinical review article presents clinical and scientific data on cobalt sensitization and dermatitis. It is concluded that cobalt despite being a strong sensitizer and a prevalent contact allergen to come up on patch testing should be regarded as a very complex metal to test with. Exposure...... data together with clinical data from metal workers heavily exposed to cobalt suggest that patch-test reactions are sometimes false positive and that patch testers should carefully evaluate their clinical relevance....

  5. Curvularia lunata, a rare fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD); a rare case report (United States)

    Subramanyam, Haritha; Elumalai, Ramprasad; Kindo, Anupma Jyoti; Periasamy, Soundararajan


    Peritonitis is an inflammation of the peritoneum that occurs in patients with end-stage renal disease (ESRD) treated by peritoneal dialysis. Fungal peritonitis is a dreaded complication of peritoneal dialysis. Curvularia lunata is known to cause extra renal disease like endocarditis, secondary allergic bronchopulmonary aspergillosis and endophthalmitis. This case report presents a case of continuous ambulatory peritoneal dialysis peritonitis with this disease and its management. This case is of a 45-year-old man, presented with ESRD, secondary to diabetic nephropathy. After 3 months of hemodialysis the patient was put on continuous ambulatory peritoneal dialysis (CAPD). Local Examination at catheter site showed skin excoriation and purulent discharge. Further peritoneal dialysis (PD) fluid analysis showed neutrophilic leukocytosis and diagnosis of Curvularia lunata PD peritonitis.

  6. Effects of Baroreflex Activation Therapy on Ambulatory Blood Pressure in Patients With Resistant Hypertension. (United States)

    Wallbach, Manuel; Lehnig, Luca-Yves; Schroer, Charlotte; Lüders, Stephan; Böhning, Enrico; Müller, Gerhard A; Wachter, Rolf; Koziolek, Michael J


    Baroreflex activation therapy (BAT) has been demonstrated to decrease office blood pressure (BP) in the randomized, double-blind Rheos trial. There are limited data on 24-hour BP changes measured by ambulatory BP measurements (ABPMs) using the first generation rheos BAT system suggesting a significant reduction but there are no information about the effect of the currently used, unilateral BAT neo device on ABPM. Patients treated with the BAT neo device for uncontrolled resistant hypertension were prospectively included into this study. ABPM was performed before BAT implantation and 6 months after initiation of BAT. A total of 51 patients were included into this study, 7 dropped out from analysis because of missing or insufficient follow-up. After 6 months, 24-hour ambulatory systolic (from 148 ± 17 mm Hg to 140 ± 23 mm Hg, Phypertension. Randomized controlled trials are needed to evaluate BAT effects on ABPM in patients with resistant hypertension accurately.

  7. Curvularia lunata, a rare fungal peritonitis in continuous ambulatory peritoneal dialysis (CAPD; a rare case report

    Directory of Open Access Journals (Sweden)

    Subramanyam Haritha


    Full Text Available Peritonitis is an inflammation of the peritoneum that occurs in patients with end-stage renal disease (ESRD treated by peritoneal dialysis. Fungal peritonitis is a dreaded complication of peritoneal dialysis. Curvularia lunata is known to cause extra renal disease like endocarditis, secondary allergic bronchopulmonary aspergillosis and endophthalmitis. This case report presents a case of continuous ambulatory peritoneal dialysis peritonitis with this disease and its management. This case is of a 45-year-old man, presented with ESRD, secondary to diabetic nephropathy. After 3 months of hemodialysis the patient was put on continuous ambulatory peritoneal dialysis (CAPD. Local Examination at catheter site showed skin excoriation and purulent discharge. Further peritoneal dialysis (PD fluid analysis showed neutrophilic leukocytosis and diagnosis of Curvularia lunata PD peritonitis.

  8. Treatable renal failure found in non-ambulatory Duchenne muscular dystrophy patients. (United States)

    Motoki, Takahiro; Shimizu-Motohashi, Yuko; Komaki, Hirofumi; Mori-Yoshimura, Madoka; Oya, Yasushi; Takeshita, Eri; Ishiyama, Akihiko; Saito, Takashi; Nakagawa, Eiji; Sugai, Kenji; Murata, Miho; Sasaki, Masayuki


    Duchenne muscular dystrophy (DMD) is a progressive muscular disorder in which respiratory and heart failures are the main causes of death. Intensive intervention in respiratory and cardiac function has dramatically improved the prognosis; however, dysfunction in other multiple organs may emerge in the later stages of the disease. We report the case of four non-ambulatory DMD patients who presented with renal failure. Common findings included decreased fluid intake, use of diuretics, and presence of chronic heart failure. The levels of serum cystatin C (CysC), a marker of kidney function unaffected by reduced muscle mass, were elevated in all four patients. In two patients, renal failure improved by increasing fluid intake, and discontinuing or reducing the dose of diuretics. The findings suggest that non-ambulatory DMD patients are at a risk of reduced kidney perfusion, which potentially leads to prerenal failure. Therefore, in DMD patients, dehydration signs and CysC levels should be monitored.

  9. Channel Selection and Feature Projection for Cognitive Load Estimation Using Ambulatory EEG

    Directory of Open Access Journals (Sweden)

    Tian Lan


    Full Text Available We present an ambulatory cognitive state classification system to assess the subject's mental load based on EEG measurements. The ambulatory cognitive state estimator is utilized in the context of a real-time augmented cognition (AugCog system that aims to enhance the cognitive performance of a human user through computer-mediated assistance based on assessments of cognitive states using physiological signals including, but not limited to, EEG. This paper focuses particularly on the offline channel selection and feature projection phases of the design and aims to present mutual-information-based techniques that use a simple sample estimator for this quantity. Analyses conducted on data collected from 3 subjects performing 2 tasks (n-back/Larson at 2 difficulty levels (low/high demonstrate that the proposed mutual-information-based dimensionality reduction scheme can achieve up to 94% cognitive load estimation accuracy.

  10. Exposure to Racial Discrimination and Ambulatory Blood Pressure in Women with Type 2 Diabetes. (United States)

    Wagner, Julie; Tennen, Howard; Finan, Patrick; Feinn, Richard; Burg, Matthew M; Seawell, Asani; White, William B


    Diabetes is the only disorder in which women's risk for heart disease exceeds men's. Elevated blood pressure (BP) increases cardiovascular risk in people with type 2 diabetes. Racial discrimination and neuroticism are both associated with BP levels but have not been examined in concert. This study investigated self-reported racial discrimination, neuroticism and ambulatory BP in women with type 2 diabetes. Thirty-nine Black and 38 White women completed a race-neutral version of the Schedule of Racist Events; BP was evaluated using ambulatory monitoring devices. Actigraphy and diaries were used to document times of sleep and wakefulness. Racial discrimination interacted with neuroticism to predict systolic and diastolic BP both while awake and during sleep, after adjustment for covariates. For each, the influence of racist events was stronger at lower levels of neuroticism. Racial discrimination is associated with higher levels of 24-h BP in diabetic women who are low in neuroticism. Copyright © 2015 John Wiley & Sons, Ltd.

  11. Mood-congruent memory in daily life: evidence from interactive ambulatory monitoring. (United States)

    Loeffler, Simone N; Myrtek, Michael; Peper, Martin


    Evidence from the psychological laboratory indicates that emotional states tend to facilitate the encoding and retrieval of stimuli of the same emotional valence. To explore mood-congruent memory and the role of arousal in daily life, we applied a new interactive ambulatory technique. Psychophysiological arousal as indexed by non-metabolic heart rate, self-reported emotions and situational information were assessed during 24-h recordings in 70 healthy participants. The emotional state was used to trigger word list presentations on a minicomputer. Our results show that psychophysiological arousal at the time of encoding enhanced the recall of negative words in negative emotional conditions, whereas low psychophysiological arousal facilitated recall of positive words. In positive contexts, mood congruency was more prominent when arousal was low. These results demonstrate how automated experimentation with an ambulatory technique may help to assess emotional memory in real-world contexts, thus providing new methods for diverse fields of application.

  12. Preoperative ambulatory inspiratory muscle training in patients undergoing esophagectomy. A pilot study. (United States)

    Agrelli, Taciana Freitas; de Carvalho Ramos, Marisa; Guglielminetti, Rachel; Silva, Alex Augusto; Crema, Eduardo


    A major decline in pulmonary function is observed on the first day after upper abdominal surgery. This decline can reduce vital and inspiratory capacity and can culminate in restrictive lung diseases that cause atelectasis, reduced diaphragm movement, and respiratory insufficiency. The objective of this study was to evaluate the efficacy of preoperative ambulatory respiratory muscle training in patients undergoing esophagectomy. The sample consisted of 20 adult patients (14 men [70%] and 6 women [30%]) with a diagnosis of advanced chagasic megaesophagus. A significant increase in maximum inspiratory pressure was observed after inspiratory muscle training when compared with baseline values (from -55.059 ± 18.359 to -76.286 ± 16.786). Preoperative ambulatory inspiratory muscle training was effective in increasing respiratory muscle strength in patients undergoing esophagectomy and contributed to the prevention of postoperative complications.

  13. Effects of dietary fish and weight reduction on ambulatory blood pressure in overweight hypertensives. (United States)

    Bao, D Q; Mori, T A; Burke, V; Puddey, I B; Beilin, L J


    Obesity is a major factor contributing to hypertension and increased risk of cardiovascular disease. Regular consumption of dietary fish and omega3 fatty acids of marine origin can lower blood pressure (BP) levels and reduce cardiovascular risk. This study examined the potential effects of combining dietary fish rich in omega3 fatty acids with a weight loss regimen in overweight hypertensive subjects, with ambulatory BP levels as the primary end point. Using a factorial design, 69 overweight medication-treated hypertensives were randomized to a daily fish meal (3.65 g omega3 fatty acids), weight reduction, the 2 regimens combined, or a control regimen for 16 weeks. Sixty-three subjects with a mean+/-SEM body mass index of 31.6+/-0.5 kg/m2 completed the study. Weight fell by 5.6+/-0.8 kg with energy restriction. Dietary fish and weight loss had significant independent and additive effects on 24-hour ambulatory BP. Effects were greatest on awake systolic and diastolic BP (Phour (-3.1+/-1.4 bpm, P=0.036) and awake (-4.2+/-1.6 bpm, P=0. 013) ambulatory heart rates. Weight reduction had a significant effect on sleeping heart rate only (-3.2+/-1.7 bpm, P=0.037). Combining a daily fish meal with a weight-reducing regimen led to additive effects on ambulatory BP and decreased heart rate. The effects were large, suggesting that cardiovascular risk and antihypertensive drug requirements are likely to be reduced substantially by combining dietary fish meals rich in omega3 fatty acids with weight-loss regimens in overweight medication-treated hypertensives. The reduction in heart rate seen with dietary fish suggests a cardiac/autonomic component, as well as vascular effects, of increased consumption of omega3 fatty acid from fish.

  14. Aspergillus niger peritonitis in a patient on continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Usha Kalawat


    Full Text Available Fungal peritonitis is an uncommon condition which is associated with high morbidity and mortality in patients on continuous ambulatory peritoneal dialysis (CAPD. It is associated with several complications and many of the patients who develop this condition are unable to resume CAPD treatment and have to shift to haemodialysis. Here we report the rare occurrence of fungal peritonitis due to Aspergillus niger in a patient on CAPD.

  15. Imaging features of encapsulating peritoneal sclerosis in continuous ambulatory peritoneal dialysis patients.

    LENUS (Irish Health Repository)

    Ti, Joanna P


    OBJECTIVE: The purpose of this article is to present the spectrum of radiologic findings of encapsulating peritoneal sclerosis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). CONCLUSION: Although a rare diagnosis, encapsulating peritoneal sclerosis in patients undergoing CAPD has a high morbidity and mortality. Diagnosis is often delayed because clinical features are insidious and nonspecific. Radiologic imaging may be helpful in the early diagnosis of encapsulating peritoneal sclerosis and in facilitating timely intervention for CAPD patients with encapsulating peritoneal sclerosis.

  16. 45. Ezetimibe and statins yields on silent holter ambulatory myocardial ischemia

    Directory of Open Access Journals (Sweden)

    W. Kadro


    Full Text Available Further cholestrol lowering may affect silent ischemia detected on holter monitoring. Cholesterol lowering is associated with a reduction in cardiovascular morbidity and mortality. Statins are the main drugs for cholesterol lowering. Ezetimibe when added to statins gives further reduction in cholesterol but its long-term effect on cardiovascular morbidity and mortality and ischemic events is not known. This study sought to determine whether further cholesterol lowering with ezitimibe will also results in a reduction of myocardial ischemia during daily life. We enrolled 50 patients with proven stable coronary artery disease (CAD and at least one episode of ST-segment depression on ambulatory ECG monitoring. All of them were receiving optimal therapy for CAD including statin therapy for cholesterol reduction. 25 patients were randomized to continue their statin therapy (Statin only group and 25 to recieve statin plus ezitimibe 10 mg/day (ezitimibe group. Serum cholesterol and LDL cholesterol levels and ambulatory monitoring were repeated after 4–6 months of therapy. The two groups were comparable with respect to baseline characteristics, number of episodes of ST-segment depression, and baseline serum cholesterol levels. The ezitimibe group had lower mean total and LDL cholesterol levels at study end and experienced a significant reduction in the number of episodes of ST-segment depression compared with the statin only group. ST-segment depression was completely resolved in 13 of 25 patients (52% in the ezitimibe group versus 3 of 25 (12% in the statin only group. The ezitimibe group exhibited a highly significant reduction in ambulatory ischemia (P < .001. By logistic regression, treatment with ezitimibe was an independent predictor of ischemia resolution. Further cholesterol lowering with ezitimibe can result in reduction or resolution of myocardial ischemia recorded as episodes of ST-segment depression in ambulatory monitoring of the ECG.

  17. Facial nerve palsy: incidence of different ethiologies in a tertiary ambulatory


    Atolini Junior, Nédio; Jorge Junior, José Jarjura; Gignon, Vinícius de Faria; Kitice, Adriano Tomio; Prado, Letícia Suriano de Almeida; Santos, Vânia Gracia Wolff


    Introduction: The ethiologic diferencial diagnostic for facial nerve paralisis is still a challenge and the literature has shown conflictive results concerning its epidemiology. Objective: To outline the incidence of the different ethiologies and the profile of peripheral facial nerve paralysis patients in the otolaryngology ambulatory of the Faculdade de Ciencias Medicas e Biologicas da PUC-SP - campus Sorocaba. Method: The records of 54 patients with facial nerve paralysis seen during the y...

  18. Severe “sweet” pleural effusion in a continuous ambulatory peritoneal dialysis patient



    Introduction: Hydrothorax is a rare complication of continuous ambulatory peritoneal dialysis (CAPD) which can progress quickly to cause acute respiratory distress. Case presentation: We present a 76 year-old female with a past medical history significant for end-stage renal disease (ESRD) on daily home peritoneal dialysis for 2 years presented to the hospital from home with shortness of breath at rest and cough for 2 days prior to admission. She developed severe respiratory distress and h...

  19. Controlled-Release Oxycodone Versus Naproxen at Home After Ambulatory Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Björn Stessel, MD


    Conclusions: Paracetamol/CR oxycodone and paracetamol/naproxen are equally effective in treatment of acute postoperative pain at home after ambulatory surgery with comparable patient satisfaction level. We suggest paracetamol/CR oxycodone to be a valuable alternative for the current paracetamol/naproxen gold standard, particularly in patients with a contraindication for nonsteroidal anti-inflammatory drugs. identifier: NCT02152592.

  20. Recurrent bacterial peritonitis caused by Neisseria cinerea in a chronic ambulatory peritoneal dialysis (CAPD) patient. (United States)

    George, M J; DeBin, J A; Preston, K E; Chiu, C; Haqqie, S S


    We present an unusual case of recurrent (chronic ambulatory peritoneal dialysis) CAPD-associated peritonitis caused by Neisseria cinerea. Using DNA restriction fragment length polymorphism (RFLP) analysis, we determined that the recurrent infection was caused by reinfection with a different N. cinerea strain rather than relapse with the index strain and that the probable origin of the reinfecting organism was the patient's upper respiratory tract.