WorldWideScience

Sample records for ambulatory healthcare centre

  1. Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for ambulatory surgical centers - Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of ambulatory surgical center ratings for the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey....

  2. Waste management in primary healthcare centres of Iran.

    Science.gov (United States)

    Mesdaghinia, Alireza; Naddafi, Kazem; Mahvi, Amir Hossein; Saeedi, Reza

    2009-06-01

    The waste management practices in primary healthcare centres of Iran were investigated in the present study. A total of 120 primary healthcare centres located across the country were selected using the cluster sampling method and the current situation of healthcare waste management was determined through field investigation. The quantities of solid waste and wastewater generation per outpatient were found to be 60 g outpatient(-1) day(-1) and 26 L outpatient(-1) day(-1), respectively. In all of the facilities, sharp objects were separated almost completely, but separation of other types of hazardous healthcare solid waste was only done in 25% of the centres. The separated hazardous solid waste materials were treated by incineration, temporary incineration and open burning methods in 32.5, 8.3 and 42.5% of the healthcare centres, respectively. In 16.7% of the centres the hazardous solid wastes were disposed of without any treatment. These results indicate that the management of waste materials in primary healthcare centres in Iran faced some problems. Staff training and awareness, separation of healthcare solid waste, establishment of the autoclave method for healthcare solid waste treatment and construction of septic tanks and disinfection units in the centres that were without access to a sewer system are the major measures that are suggested for improvement of the waste management practices.

  3. Ambulatory Healthcare Utilization in the United States: A System Dynamics Approach

    Science.gov (United States)

    Diaz, Rafael; Behr, Joshua G.; Tulpule, Mandar

    2011-01-01

    Ambulatory health care needs within the United States are served by a wide range of hospitals, clinics, and private practices. The Emergency Department (ED) functions as an important point of supply for ambulatory healthcare services. Growth in our aging populations as well as changes stemming from broader healthcare reform are expected to continue trend in congestion and increasing demand for ED services. While congestion is, in part, a manifestation of unmatched demand, the state of the alignment between the demand for, and supply of, emergency department services affects quality of care and profitability. The central focus of this research is to provide an explanation of the salient factors at play within the dynamic demand-supply tensions within which ambulatory care is provided within an Emergency Department. A System Dynamics (SO) simulation model is used to capture the complexities among the intricate balance and conditional effects at play within the demand-supply emergency department environment. Conceptual clarification of the forces driving the elements within the system , quantifying these elements, and empirically capturing the interaction among these elements provides actionable knowledge for operational and strategic decision-making.

  4. [Interdisciplinary healthcare centres--a way of organising healthcare in the future from a health insurer's perspective].

    Science.gov (United States)

    Hecke, Torsten L; Hoyer, Jens Martin

    2009-01-01

    The German healthcare system modernization act enables healthcare providers to fund interdisciplinary healthcare centres. The Techniker Krankenkasse (TK) is a statutory health sickness fund that has contracted with some of the interdisciplinary healthcare centres named ATRIO-MED to achieve high-quality medical care and healthcare management. A range of patient-centred services is described in the cooperation agreement; in addition to central medical patient records one of the core competencies includes integrated pathways for defined diagnosis. The concept of the interdisciplinary healthcare centre is highly accepted among patients. It will serve as a platform for future TK healthcare policies.

  5. Person-centred healthcare research: a personal influence

    Directory of Open Access Journals (Sweden)

    * Corresponding author: University of Windesheim, Zwolle, The Netherlands Email: am.vandenberg@windesheim.nl Submitted for publication: 3rd November 2017 Accepted for publication: 12th March 2018 Published: 16th May 2018 https://doi.org/10.19043/ipdj.81.011 Abstract Context: This critical reflection is about the positive effects for educational and research settings of participation in a two-day programme entitled ‘Using participatory action research and appreciative inquiry to research healthcare practice’. Aims: To reflect on the journey of positive developments in research and education that started with participation in this programme. Using Caring Conversations (Dewar, 2011 as a reflective framework of questions, this article discusses the journey in order to encourage others to consider the approach of appreciative inquiry to bring to life the concept of co-creation in research and education. Conclusions and implications for practice: Participation in this programme has led to the implementation of a variety of actions in educational and research settings. Central to all these actions is an appreciative approach to co-creation as a counterpart to today’s prevailing problem-based viewpoint. A possible factor behind these developments was the power of vulnerability experienced during the programme, a shared process of transformational learning. Implications for practice: This critical reflection: Provides an invitation to shift from a problem-based focus to a positive revolution Provides an appreciative reflective story about the power of vulnerability as an inspiration for others to move out of their comfort zone and seek to discover their own exceptionality Supports a shift from a facilitator-led to a co-creation approach in doing research and teaching with older adults Keywords: Emotional touchpoints, appreciative inquiry, Caring Conversations, practice development, co-creation, transformational learning theory   IDEAS AND INFLUENCES Person-centred healthcare research: a personal influence Hazel M. Chapman

    2018-05-01

    Full Text Available This commentary assesses the contribution made by the person-centred healthcare research of McCormack et al (2017 to research methodology and our ability to evaluate an organisation’s claims to be person-centred. It discusses the importance of person-centred ethical approaches within rigorous research methodologies.

  6. DGNB certified Healthcare Centres

    DEFF Research Database (Denmark)

    Brunsgaard, Camilla; Larsen, Tine Steen

    2015-01-01

    for sustainability and wants a certification. This research investigates the decision‐making and design process (DMaDP) behind four DGNB certified Healthcare Centres (HCC) in Northern Jutland in Denmark. In general, knowledge about the DMaDP is important. However it is important to know what part DGNB plays...... a dialog about DGNB and energy concept is important even before anyone start sketching. Experiences with the different approaches will be further outlined in the paper.Future research has the intention to collect further knowledge about DGNB and DMaDP in practise. This project was limited to Healthcare...

  7. [Analysis of several containment measures of pharmaceutical expenditure in an Ambulatory Surgery Centre].

    Science.gov (United States)

    Esteban, J L; León, A; Porras, I

    2013-11-01

    In the context of the current crisis, sustainability of National Health Service must be considered a priority issue. To compare several cost saving measures in drug expenditure due to outpatient drug treatment after surgery in an Ambulatory Surgical Centre. Pharmaco-economic analysis of cost minimization of ambulatory pharmaceutical services during the year 2011. A total of 3,346 patients were operated on and discharged on the same day, were included. Treatments were collected from the discharge report of each patient. We compared changes in real outpatient drug spending after separately applying each of the following measures: 1) increasing the co-payment; 2) improving the quality of prescribing; 3) dispensing by units of drugs through pharmacies, and 4) dispensing through the hospital pharmacy service. The real outpatient pharmaceutical expenditure was 29,454.21€. Increasing the co-payment mean a transfer of 2,091.82€ from the funding institutions to users. Improving the quality of prescriptions, dispensing through units of drugs in the pharmacy, and dispensing through the hospital pharmacy service led to a pharmaceutical expenditure of 24,215.14€, 21,766.24€ and 7,827.71€, respectively. Only considering co-payment to contain pharmaceutical expenditure arising from prescribing in an Ambulatory Surgical Centre is the least effective measure. The most effective measure, for this purpose, is the supply of drugs through the hospital pharmacy service. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  8. [Medical waste management in healthcare centres in the occupied Palestinian territory].

    Science.gov (United States)

    Al-Khatib, Issam A

    2007-01-01

    Medical waste management in primary and secondary healthcare centres in the occupied Palestinian territory was assessed. The overall monthly quantity of solid healthcare waste was estimated to be 512.6 tons. Only 10.8% of the centres completely segregated the different kinds of healthcare waste and only 15.7% treated their medical waste. In the centres that treated waste, open burning was the main method of treatment. The results indicate that Palestinians are exposed to health and environmental risks because of improper disposal of medical waste and steps are needed to improve the situation through the establishment and enforcement of laws, provision of the necessary infrastructure for proper waste management and training of healthcare workers and cleaners.

  9. Safety and cost benefit of an ambulatory program for patients with low-risk neutropenic fever at an Australian centre.

    Science.gov (United States)

    Teh, Benjamin W; Brown, Christine; Joyce, Trish; Worth, Leon J; Slavin, Monica A; Thursky, Karin A

    2018-03-01

    Neutropenic fever (NF) is a common complication of cancer chemotherapy. Patients at low risk of medical complications from NF can be identified using a validated risk assessment and managed in an outpatient setting. This is a new model of care for Australia. This study described the implementation of a sustainable ambulatory program for NF at a tertiary cancer centre over a 12-month period. Peter MacCallum Cancer Centre introduced an ambulatory care program in 2014, which identified low-risk NF patients, promoted early de-escalation to oral antibiotics, and early discharge to a nurse-led ambulatory program. Patients prospectively enrolled in the ambulatory program were compared with a historical-matched cohort of patients from 2011 for analysis. Patient demographics, clinical variables (cancer type, recent chemotherapy, treatment intent, site of presentation) and outcomes were collected and compared. Total cost of inpatient admissions was determined from diagnosis-related group (DRG) codes and applied to both the prospective and historical cohorts to allow comparisons. Twenty-five patients were managed in the first year of this program with a reduction in hospital median length of stay from 4.0 to 1.1 days and admission cost from Australian dollars ($AUD) 8580 to $AUD2360 compared to the historical cohort. Offsetting salary costs, the ambulatory program had a net cost benefit of $AUD 71895. Readmission for fever was infrequent (8.0%), and no deaths were reported. Of relevance to hospitals providing cancer care, feasibility, safety, and cost benefits of an ambulatory program for low-risk NF patients have been demonstrated.

  10. Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for hospital outpatient departments - Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of hospital outpatient department ratings for the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS)...

  11. Medical data transmission system for remote healthcare centres

    International Nuclear Information System (INIS)

    Gonzalez, E A; Cagnolo, F J; Olmos, C E; Centeno, C A; Riva, G G; Zerbini, C A

    2007-01-01

    The main motivation of this project is to improve the healthcare centres equipment and human resources efficiency, enabling those centres for transmission of parameters of medical interest. This system facilitates remote consultation, in particular between specialists and remote healthcare centres. Likewise it contributes to the qualification of professionals. The electrocardiographic (ECG) and electroencephalographic (EEG) signals are acquired, processed and then sent, fulfilling the effective norms, for application in the hospital network of Cordoba Province, which has nodes interconnected by phone line. As innovative aspects we emphasized the low cost of development and maintenance, great versatility and handling simplicity with a modular design for interconnection with diverse data transmission media (Wi-Fi, GPRS, etc.). Successfully experiences were obtained during the acquisition of the signals and transmissions on wired LAN networks. As improvements, we can mention: energy consumption optimization and mobile communication systems usage, in order to offer more autonomy

  12. Are healthcare professionals working in Australia's immigration detention centres condoning torture?

    Science.gov (United States)

    Isaacs, David

    2016-07-01

    Australian immigration detention centres are in secluded locations, some on offshore islands, and are subject to extreme secrecy, comparable with 'black sites' elsewhere. There are parallels between healthcare professionals working in immigration detention centres and healthcare professionals involved with or complicit in torture. In both cases, healthcare professionals are conflicted between a duty of care to improve the health of patients and the interests of the government. While this duality of interests has been recognised previously, the full implications for healthcare professionals working in immigration detention have not been addressed. The Australian Government maintains that immigration detention is needed for security checks, but the average duration of immigration detention has increased from 10 weeks to 14 months, and detainees are not informed of the progress of their application for refugee status. Long-term immigration detention causes major mental health problems, is illegal in international law and arguably fulfils the recognised definition of torture. It is generally accepted that healthcare professionals should not participate in or condone torture. Australian healthcare professionals thus face a major ethical dilemma: patients in immigration detention have pressing mental and physical health needs, but providing healthcare might support or represent complicity in a practice that is unethical. Individual healthcare professionals need to decide whether or not to work in immigration detention centres. If they do so, they need to decide for how long and to what extent restrictive contracts and gagging laws will constrain them from advocating for closing detention centres. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. Spirituality and healthcare: Towards holistic people-centred healthcare in South Africa

    Directory of Open Access Journals (Sweden)

    Andre de la Porte

    2016-07-01

    Full Text Available Healthcare in South Africa is in a crisis. Problems with infrastructure, management, human resources and the supply of essential medicines are at a critical level. This is compounded by a high burden of disease and disparity in levels of service delivery, particularly between public and private healthcare. The government has put ambitious plans in place, which are part of the National Development Plan to ward 2030. In the midst of this we find the individual person and their family and community staggering under the suffering caused by disease, poverty, crime and violence. There is a more than 70% chance that this person and their family and community are trying to make sense of this within a spiritual framework and that they belong to a faith-based community. This article explores the valuable contribution of spirituality, spiritual and pastoral work, the faith-based community (FBC and faith-based organisations (FBOs to holistic people-centred healthcare in South Africa. Keywords: Healthcare; Spirituality; Clinical Spiritual Counselling

  14. Providing value in ambulatory anesthesia.

    Science.gov (United States)

    Fosnot, Caroline D; Fleisher, Lee A; Keogh, John

    2015-12-01

    The purpose of this review is to discuss current practices and changes in the field of ambulatory anesthesia, in both hospital and ambulatory surgery center settings. New trends in ambulatory settings are discussed and a review of the most current and comprehensive guidelines for the care of ambulatory patients with comorbid conditions such as postoperative nausea and vomiting (PONV), obstructive sleep apnea and diabetes mellitus are reviewed. Future direction and challenges to the field are highlighted. Ambulatory anesthesia continues to be in high demand for many reasons; patients and surgeons want their surgical procedures to be swift, involve minimal postoperative pain, have a transient recovery time, and avoid an admission to the hospital. Factors that have made this possible for patients are improved surgical equipment, volatile anesthetic improvement, ultrasound-guided regional techniques, non-narcotic adjuncts for pain control, and the minimization of PONV. The decrease in time spent in a hospital also decreases the risk of wound infection, minimizes missed days from work, and is a socioeconomically favorable model, when possible. Recently proposed strategies which will allow surgeons and anesthesiologists to continue to meet the growing demand for a majority of surgical cases being same-day include pharmacotherapies with less undesirable side-effects, integration of ultrasound-guided regional techniques, and preoperative evaluations in appropriate candidates via a telephone call the night prior to surgery. Multidisciplinary communication amongst caregivers continues to make ambulatory settings efficient, safe, and socioeconomically favorable.It is also important to note the future impact that healthcare reform will have specifically on ambulatory anesthesia. The enactment of the Patient Protection and Affordable Care Act of 2010 will allow 32 million more people to gain access to preventive services that will require anesthesia such as screening

  15. Assessment of drug treatment quality in two Danish health-care centres

    DEFF Research Database (Denmark)

    Andersen, Stig Ejdrup; Edfors, Kajsa

    2011-01-01

    Bridging the primary and secondary sector, health-care centres aim to reduce morbidity and prevent further hospitalization in patients with chronic heart diseases. The aim of this study was to describe the quality of drug treatment in patients with chronic heart diseases in two Copenhagen health-care...

  16. Audit of antenatal services in primary healthcare centres in Jos ...

    African Journals Online (AJOL)

    Introduction: Maternal mortality remains a big challenge in developing countries including Nigeria where the figures are amongst the highest in the world. The Nigerian government's response in providing primary healthcare centres (PHCs) in all local government areas is commendable but access to quality antenatal care is ...

  17. Information security requirements in patient-centred healthcare support systems.

    Science.gov (United States)

    Alsalamah, Shada; Gray, W Alex; Hilton, Jeremy; Alsalamah, Hessah

    2013-01-01

    Enabling Patient-Centred (PC) care in modern healthcare requires the flow of medical information with the patient between different healthcare providers as they follow the patient's treatment plan. However, PC care threatens the stability of the balance of information security in the support systems since legacy systems fall short of attaining a security balance when sharing their information due to compromises made between its availability, integrity, and confidentiality. Results show that the main reason for this is that information security implementation in discrete legacy systems focused mainly on information confidentiality and integrity leaving availability a challenge in collaboration. Through an empirical study using domain analysis, observations, and interviews, this paper identifies a need for six information security requirements in legacy systems to cope with this situation in order to attain the security balance in systems supporting PC care implementation in modern healthcare.

  18. Effect of the delegation of GP-home visits on the development of the number of patients in an ambulatory healthcare centre in Germany

    Science.gov (United States)

    2012-01-01

    Background The AGnES-concept (AGnES: GP-supporting, community-based, e-health-assisted, systemic intervention) was developed to support general practitioners (GPs) in undersupplied regions. The project aims to delegate GP-home visits to qualified AGnES-practice assistants, to increase the number of patients for whom medical care can be provided. This paper focuses on the effect of delegating GP-home visits on the total number of patients treated. First, the theoretical number of additional patients treated by delegating home visits to AGnES-practice assistants was calculated. Second, actual changes in the number of patients in participating GP-practices were analyzed. Methods The calculation of the theoretical increase in the number of patients was based on project data, data which were provided by the Association of Statutory Health Insurance Physicians, or which came from the literature. Setting of the project was an ambulatory healthcare centre in the rural county Oberspreewald-Lausitz in the Federal State of Brandenburg, which employed six GPs, four of which participated in the AGnES project. The analysis of changes in the number of patients in the participating GP-practices was based on the practices’ reimbursement data. Results The calculated mean capacity of AGnES-practice assistants was 1376.5 home visits/year. GPs perform on average 1200 home visits/year. Since home visits with an urgent medical reason cannot be delegated, we included only half the capacity of the AGnES-practice assistants in the analysis (corresponding to a 20 hour-work week). Considering all parameters in the calculation model, 360.1 GP-working hours/year can be saved. These GP-hours could be used to treat 170 additional patients/quarter year. In the four participating GP-practices the number of patients increased on average by 133 patients/quarter year during the project period, which corresponds to 78% of the theoretically possible number of patients. Conclusions The empirical

  19. Effect of the delegation of GP-home visits on the development of the number of patients in an ambulatory healthcare centre in Germany

    Directory of Open Access Journals (Sweden)

    van den Berg Neeltje

    2012-10-01

    Full Text Available Abstract Background The AGnES-concept (AGnES: GP-supporting, community-based, e-health-assisted, systemic intervention was developed to support general practitioners (GPs in undersupplied regions. The project aims to delegate GP-home visits to qualified AGnES-practice assistants, to increase the number of patients for whom medical care can be provided. This paper focuses on the effect of delegating GP-home visits on the total number of patients treated. First, the theoretical number of additional patients treated by delegating home visits to AGnES-practice assistants was calculated. Second, actual changes in the number of patients in participating GP-practices were analyzed. Methods The calculation of the theoretical increase in the number of patients was based on project data, data which were provided by the Association of Statutory Health Insurance Physicians, or which came from the literature. Setting of the project was an ambulatory healthcare centre in the rural county Oberspreewald-Lausitz in the Federal State of Brandenburg, which employed six GPs, four of which participated in the AGnES project. The analysis of changes in the number of patients in the participating GP-practices was based on the practices’ reimbursement data. Results The calculated mean capacity of AGnES-practice assistants was 1376.5 home visits/year. GPs perform on average 1200 home visits/year. Since home visits with an urgent medical reason cannot be delegated, we included only half the capacity of the AGnES-practice assistants in the analysis (corresponding to a 20 hour-work week. Considering all parameters in the calculation model, 360.1 GP-working hours/year can be saved. These GP-hours could be used to treat 170 additional patients/quarter year. In the four participating GP-practices the number of patients increased on average by 133 patients/quarter year during the project period, which corresponds to 78% of the theoretically possible number of patients

  20. Ambulatory surgery and anaesthesia in HUKM, a teaching hospital in Malaysia: the first two years experience.

    Science.gov (United States)

    Norsidah, A M; Yahya, N; Adeeb, N; Lim, A L

    2001-03-01

    Ambulatory or day care surgery is still in its infancy in this part of the world. Our newly built university affiliated hospital started its Day Surgery Centre in February 1998. It is the first multidisciplinary ambulatory surgery centre in a teaching hospital in the country. It caters for Orthopaedic surgery, Urology, Plastic surgery, Otorhinolaryngology, General surgery, Paediatric surgery and Ophthalmology. We have done 2,604 cases and our unanticipated admission rate is less than 2%. There has been no major morbidity or mortality. The problems of setting up a multidisciplinary ambulatory centre in a teaching hospital are discussed.

  1. Assessment of a high-fidelity mobile simulator for intrauterine contraception training in ambulatory reproductive health centres

    Directory of Open Access Journals (Sweden)

    Laura E. Dodge

    2016-02-01

    Full Text Available Objectives. Little is known about the utility of simulation-based training in office gynaecology. The objective of this cross-sectional study was to evaluate the self-reported effectiveness and acceptability of the PelvicSim™ (VirtaMed, a high-fidelity mobile simulator, to train clinicians in intrauterine device (IUD insertion. Methods. Clinicians at ambulatory healthcare centres participated in a PelvicSim IUD training programme and completed a self-administered survey. The survey assessed prior experience with IUD insertion, pre- and post-training competency and comfort and opinions regarding the acceptability of the PelvicSim. Results. The 237 participants were primarily female (97.5% nurse practitioners (71.3%. Most had experience inserting the levonorgestrel LNG20 IUD and the copper T380A device, but only 4.1% had ever inserted the LNG14 IUD. For all three devices, participants felt more competent following training, with the most striking change reported for insertion of the LNG14 IUD. The majority of participants reported increased comfort with uterine sounding (57.7%, IUD insertion on a live patient (69.8%, and minimizing patient pain (72.8% following training. Of the respondents, 89.6% reported the PelvicSim IUD insertion activities as “valuable” or “very valuable.” All participants would recommend the PelvicSim for IUD training, and nearly all (97.2% reported that the PelvicSim was a better method to teach IUD insertion than the simple plastic models supplied by IUD manufacturers. Conclusions. These findings support the use of the PelvicSim for IUD training, though whether it is superior to traditional methods and improves patient outcomes requires evaluation.

  2. Assuring measurement quality in person-centred healthcare

    Science.gov (United States)

    Pendrill, L. R.

    2018-03-01

    Is it realistic to aspire to the same kind of quality-assurance of measurement in person-centred care, currently being implemented in healthcare globally, as is established in the physical sciences and engineering? Ensuring metrological comparability (‘traceability’) and reliably declaring measurement uncertainty when assessing patient ability or increased social capital are however challenging for subjective measurements often characterised by large dispersion. Drawing simple analogies between ‘instruments’ in the social sciences—questionnaires, ability tests, etc—and engineering instruments such as thermometers does not go far enough. A possible way forward, apparently equally applicable to both physical and social measurement, seems to be to model inferences in terms of performance metrics of a measurement system. Person-centred care needs person-centred measurement and a full picture of the measurement process when man acts as a measurement instrument is given in the present paper. This complements previous work by presenting the process, step by step, from the observed indication (e.g. probability of success, P success, of achieving a task), through restitution with Rasch measurement theory, to the measurand (e.g. task difficulty). Rasch invariant measure theory can yield quantities—‘latent’ (or ‘explanatory’) variables such as task challenge or person ability—with characteristics akin to those of physical quantities. Metrological references for comparability via traceability and reliable estimates of uncertainty and decision risks are then in reach even for perceptive measurements (and other qualitative properties). As a case study, the person-centred measurement of cognitive ability is examined, as part of the EU project EMPIR 15HLT04 NeuroMet, for Alzheimer’s, where better analysis of correlations with brain atrophy is enabled thanks to the Rasch metrological approach.

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

    Directory of Open Access Journals (Sweden)

    Polderman JAW

    2016-05-01

    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

  4. Is cost-effective healthcare compatible with publicly financed academic medical centres?

    Science.gov (United States)

    Chia, Whay Kuang; Toh, Han Chong

    2013-01-01

    Probably more than any country, Singapore has made significant investment into the biomedical enterprise as a proportion of its economy and size. This focus recently witnessed a shift towards a greater emphasis on translational and clinical development. Key to the realisation of this strategy will be Academic Medical Centres (AMCs), as a principal tool to developing and applying useful products for the market and further improving health outcomes. Here, we explore the principal value proposition of the AMC to Singapore society and its healthcare system. We question if the values inherent within academic medicine--that of inquiry, innovation, pedagogy and clinical exceptionalism--can be compatible with the seemingly paradoxical mandate of providing cost-effective or rationed healthcare.

  5. Exploring the business case for ambulatory electronic health record system adoption.

    Science.gov (United States)

    Song, Paula H; McAlearney, Ann Scheck; Robbins, Julie; McCullough, Jeffrey S

    2011-01-01

    Widespread implementation and use of electronic health record (EHR) systems has been recognized by healthcare leaders as a cornerstone strategy for systematically reducing medical errors and improving clinical quality. However, EHR adoption requires a significant capital investment for healthcare providers, and cost is often cited as a barrier. Despite the capital requirements, a true business case for EHR system adoption and implementation has not been made. This is of concern, as the lack of a business case can influence decision making about EHR investments. The purpose of this study was to examine the role of business case analysis in healthcare organizations' decisions to invest in ambulatory EHR systems, and to identify what factors organizations considered when justifying an ambulatory EHR. Using a qualitative case study approach, we explored how five organizations that are considered to have best practices in ambulatory EHR system implementation had evaluated the business case for EHR adoption. We found that although the rigor of formal business case analysis was highly variable, informants across these organizations consistently reported perceiving that a positive business case for EHR system adoption existed, especially when they considered both financial and non-financial benefits. While many consider EHR system adoption inevitable in healthcare, this viewpoint should not deter managers from conducting a business case analysis. Results of such an analysis can inform healthcare organizations' understanding about resource allocation needs, help clarify expectations about financial and clinical performance metrics to be monitored through EHR systems, and form the basis for ongoing organizational support to ensure successful system implementation.

  6. Patient-centred improvements in health-care built environments: perspectives and design indicators.

    Science.gov (United States)

    Douglas, Calbert H; Douglas, Mary R

    2005-09-01

    To explore patients' perceptions of health-care built environments, to assess how they perceived health-care built facilities and designs. To develop a set of patient-centred indicators by which to appraise future health-care designs. Qualitative and quantitative methodologies, including futures group conferencing, autophotographic study, novice-expert exchanges and a questionnaire survey of a representative sample of past patients. The research was carried out at Salford Royal Hospitals NHS Trust (SRHT), Greater Manchester, UK, selected for the study because of planned comprehensive redevelopment based on the new NHS vision for hospital care and service delivery for the 21st century. Participants included 35 patients who took part in an autophotographic study, eight focus groups engaged in futures conferencing, a sample of past inpatients from the previous 12 months that returned 785 completed postal questionnaires. The futures group provided suggestions for radical improvements which were categorized into transport issues; accessibility and mobility; ground and landscape designs; social and public spaces; homeliness and assurance; cultural diversity; safety and security; personal space and access to outside. Patients' autophotographic study centred on: the quality of the ward design, human interactions, the state and quality of personal space, and facilities for recreation and leisure. The novices' suggestions were organized into categories of elemental factors representing patient-friendly designs. Experts from the architectural and surveying professions and staff at SRHT in turn considered these categories and respective subsets of factors. They agreed with the novices in terms of the headings but differed in prioritizing the elemental factors. The questionnaire survey of past patients provided opinions about ward designs that varied according to where they stayed, single room, bay ward or long open ward. The main concerns were limitation of private space

  7. A qualitative study into the perceived barriers of accessing healthcare among a vulnerable population involved with a community centre in Romania.

    Science.gov (United States)

    George, Siân; Daniels, Katy; Fioratou, Evridiki

    2018-04-03

    Minority vulnerable communities, such as the European Roma, often face numerous barriers to accessing healthcare services, resulting in negative health outcomes. Both these barriers and outcomes have been reported extensively in the literature. However, reports on barriers faced by European non-Roma native communities are limited. The "Health Care Access Barriers" (HCAB) model identifies pertinent financial, structural and cognitive barriers that can be measured and potentially modified. The present study thus aims to explore the barriers to accessing healthcare for a vulnerable population of mixed ethnicity from a charity community centre in Romania, as perceived by the centre's family users and staff members, and assess whether these reflect the barriers identified from the HCAB model. Eleven community members whose children attend the centre and seven staff members working at the centre participated in face-to-face semi-structured interviews, exploring personal experiences and views on accessing healthcare. The interviews were transcribed and analysed using an initial deductive and secondary inductive approach to identify HCAB themes and other emerging themes and subthemes. Identified themes from both groups aligned with HCAB's themes of financial, structural and cognitive barriers and emergent subthemes important to the specific population were identified. Specifically, financial barriers related mostly to health insurance and bribery issues, structural barriers related mostly to service availability and accessibility, and cognitive barriers related mostly to healthcare professionals' attitudes and discrimination and the vulnerable population's lack of education and health literacy. A unique theme of psychological barriers emerged from both groups with associated subthemes of mistrust, hopelessness, fear and anxiety of this vulnerable population. The current study highlights healthcare access barriers to a vulnerable non-Roma native population involved with a

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

    Science.gov (United States)

    Pracht, Etienne E; Bass, Elizabeth

    2011-01-01

    This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable. © 2011 National Association for Healthcare Quality.

  9. Economic evaluation of centre haemodialysis and continuous ambulatory peritoneal dialysis in Ministry of Health hospitals, Malaysia.

    Science.gov (United States)

    Hooi, Lai Seong; Lim, Teck Onn; Goh, Adrian; Wong, Hin Seng; Tan, Chwee Choon; Ahmad, Ghazali; Morad, Zaki

    2005-02-01

    This is a multi-centre study to determine cost efficiency and cost effectiveness of the Ministry of Health centre haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) programme. Forty-four haemodialysis and 11 CAPD centres were enrolled in this study in 2001. Sixty patients, 30 from each modality, were evaluated. Micro-costing was used to determine costs. The number of haemodialyses conducted ranged from 402 to 23,000 procedures per year, while for CAPD, output ranged from 70 to 2300 patient months/year. Cost ranged from RM79.61 to RM475.79 per haemodialysis treatment, with a mean cost of RM169 per HD (USD 1 = RM 3.80). The cost of CAPD treatment ranged from RM1400 to RM3200 per patient month, with a mean of RM2186. Both modalities incurred similar outpatient costs. The cost of erythropoeitin per year is RM4500 and RM2500 for haemodialysis and CAPD, respectively. The number of life years saved is 10.96 years for haemodialysis and 5.21 years for CAPD. Cost per life year saved is RM33 642 for haemodialysis and RM31 635 for CAPD. The cost for land, building, equipment, overheads, and staff were higher for haemodialysis, while consumables and hospitalization cost more for CAPD. Sensitivity analysis was performed for two discount rates (3 and 5%), varying erythropoietin doses and maximum and minimum overheads. Relative cost effectiveness of haemodialysis and CAPD was unchanged in all sensitivity scenarios, except for overhead costs, which influenced the cost effectiveness of HD. It is economically viable to promote the use of both CAPD and haemodialysis because the cost effectiveness of both are nearly equal.

  10. The ten successful elements of an ambulatory care center.

    Science.gov (United States)

    Watkins, G

    1997-01-01

    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.

  11. Inventory Control System for a Healthcare Apparel Service Centre with Stockout Risk: A Case Analysis.

    Science.gov (United States)

    Pan, An; Hui, Chi-Leung

    2017-01-01

    Based on the real-world inventory control problem of a capacitated healthcare apparel service centre in Hong Kong which provides tailor-made apparel-making services for the elderly and disabled people, this paper studies a partial backordered continuous review inventory control problem in which the product demand follows a Poisson process with a constant lead time. The system is controlled by an ( Q , r ) inventory policy which incorporate the stockout risk, storage capacity, and partial backlog. The healthcare apparel service centre, under the capacity constraint, aims to minimize the inventory cost and achieving a low stockout risk. To address this challenge, an optimization problem is constructed. A real case-based data analysis is conducted, and the result shows that the expected total cost on an order cycle is reduced substantially at around 20% with our proposed optimal inventory control policy. An extensive sensitivity analysis is conducted to generate additional insights.

  12. Motivators and barriers to mammography screening uptake by female health-care workers in primary health-care centres: a cross-sectional study.

    Science.gov (United States)

    Nazzal, Zaher; Sholi, Hisham; Sholi, Suha B; Sholi, Mohammad B; Lahaseh, Rawya

    2018-02-21

    Mammography screening is an effective tool for early detection and management of breast cancer. Female health-care workers' awareness of breast cancer screening is important because their beliefs and behaviours could influence other women. The aim of this study was to assess mammography screening uptake by female health-care workers at primary health-care centres and to identify the primary motivators and barriers that affect uptake. This cross-sectional study included all governmental primary health-care centres in the West Bank. Governorates were grouped into three regions as follows: north West Bank (Nablus, Jenin, Tulkarm, Tubas, Qalqiliya, and Salfit), middle West Bank (Jerusalem, Jericho, and Ramallah), and south West Bank (Hebron, and Bethlehem). The study population included all female health-care workers older than 40 years. Those who performed mammography for a suspected mass or other breast abnormalities were excluded. A self-administered questionnaire was used to collect data on demographic characteristics, knowledge about mammography screening, the extent and regularity of mammography screening, and motivators and barriers influencing their mammography screening uptake. The rate of mammography screening uptake was calculated. χ 2 test and t tests were used to assess screening motivators and barriers. The study was approved by the Institutional Review Board of the An-Najah National University. Participation was voluntary, and written consent was obtained from each participant. 299 female health-care workers completed a self-administered questionnaire. The mean age of the participants was 46 years (SD 4·7). 284 (95%) women had adequate knowledge about breast cancer and mammography screening, and 149 (50%) women reported having had at least one mammogram. 62 (21%) women had had regular scheduled mammograms. The most frequent reported motivators were the perceived benefit that early detection of breast cancer is important for its management (269 [90

  13. Inventory Control System for a Healthcare Apparel Service Centre with Stockout Risk: A Case Analysis

    Directory of Open Access Journals (Sweden)

    An Pan

    2017-01-01

    Full Text Available Based on the real-world inventory control problem of a capacitated healthcare apparel service centre in Hong Kong which provides tailor-made apparel-making services for the elderly and disabled people, this paper studies a partial backordered continuous review inventory control problem in which the product demand follows a Poisson process with a constant lead time. The system is controlled by an (Q,r inventory policy which incorporate the stockout risk, storage capacity, and partial backlog. The healthcare apparel service centre, under the capacity constraint, aims to minimize the inventory cost and achieving a low stockout risk. To address this challenge, an optimization problem is constructed. A real case-based data analysis is conducted, and the result shows that the expected total cost on an order cycle is reduced substantially at around 20% with our proposed optimal inventory control policy. An extensive sensitivity analysis is conducted to generate additional insights.

  14. Ambulatory surgery centers best practices for the 90s.

    Science.gov (United States)

    Hoover, J A

    1994-05-01

    Outpatient surgery will be the driving force in the continued growth of ambulatory care in the 1990s. Providing efficient, high-quality ambulatory surgical services should therefore be a priority among healthcare providers. Arthur Andersen conducted a survey to discover best practices in ambulatory surgical service. General success characteristics of best performers were business-focused relationships with physicians, the use of clinical protocols, patient convenience, cost management, strong leadership, teamwork, streamlined processes and efficient design. Other important factors included scheduling to maximize OR room use; achieving surgical efficiencies through reduced case pack assembly errors and equipment availability; a focus on cost capture rather than charge capture; sound materiel management practices, such as standardization and vendor teaming; and the appropriate use of automated systems. It is important to evaluate whether the best practices are applicable to your environment and what specific changes to your current processes would be necessary to adopt them.

  15. centred healthcare in South Africa

    African Journals Online (AJOL)

    2016-07-15

    Puchalski) was one of the editors of the Oxford textbook on spirituality in ..... and in some cases provide up to 70% of all healthcare services. A hallmark of ..... including the business world, education, healthcare, the arts, ecology ...

  16. Doing more with Less : A client-centred approach to healthcare logistics in a nursing home setting

    NARCIS (Netherlands)

    Lineke Verkooijen; Dennis Moeke

    2013-01-01

    Dutch nursing homes are currently confronted with two seemingly incompatible goals: a more client-centred approach and the necessity to reduce costs at the same time. It is becoming increasingly apparent that healthcare logistics can contribute to providing high-quality care and support at a

  17. Wait watchers: the application of a waiting list active management program in ambulatory care.

    Science.gov (United States)

    de Belvis, Antonio Giulio; Marino, Marta; Avolio, Maria; Pelone, Ferruccio; Basso, Danila; Dei Tos, Gian Antonio; Cinquetti, Sandro; Ricciardi, Walter

    2013-04-01

    This study describes and evaluates the application of a waiting list management program in ambulatory care. Waiting list active management survey (telephone call and further contact); before and after controlled trial. Local Health Trust in Veneto Region (North-East of Italy) in 2008-09. Five hundred and one people on a 554 waiting list for C Class ambulatory care diagnostic and/or clinical investigations (electrocardiography plus cardiology ambulatory consultation, eye ambulatory consultation, carotid vessels Eco-color-Doppler, legs Eco-color-Doppler or colonoscopy, respectively). Active list management program consisting of a telephonic interview on 21 items to evaluate socioeconomic features, self-perceived health status, social support, referral physician, accessibility and patients' satisfaction. A controlled before-and-after study was performed to evaluate anonymously the overall impact on patients' self-perceived quality of care. The rate of patients with deteriorating healthcare conditions; rate of dropout; interviewed degree of satisfaction about the initiative; overall impact on citizens' perceived quality of care. 95.4% patients evaluated the initiative as useful. After the intervention, patients more likely to have been targeted with the program showed a statistically significant increase in self-reported quality of care. Positive impact of the program on some dimensions of ambulatory care quality (health status, satisfaction, willingness to remain in the queue), thus confirming the outstanding value of 'not to leave people alone' and 'not to leave them feeling themselves alone' in healthcare delivery.

  18. Challenges to Safe Injection Practices in Ambulatory Care.

    Science.gov (United States)

    Anderson, Laura; Weissburg, Benjamin; Rogers, Kelli; Musuuza, Jackson; Safdar, Nasia; Shirley, Daniel

    2017-05-01

    Most recent infection outbreaks caused by unsafe injection practices in the United States have occurred in ambulatory settings. We utilized direct observation and a survey to assess injection practices at 31 clinics. Improper vial use was observed at 13 clinics (41.9%). Pharmacy support and healthcare worker education may improve injection practices. Infect Control Hosp Epidemiol 2017;38:614-616.

  19. Torwards a more patient-centred healthcare system and effective services

    Directory of Open Access Journals (Sweden)

    Philip Michael Chircop

    2013-03-01

    Full Text Available The European Patients’ Forum is a non-governmental, non-profit organisation set up in 2003 and based in Brussels. EPF is an umbrella body with currently 54 members - who are national coalitions of patients’ organisations, and disease-specific patients’ organisations active at European level. EPF’s raison d’être is to contribute a strong and united patients’ voice into EU-level policies that have an impact on patients’ lives. EPF works with the EU institutions and agencies, as well as a range of other stakeholders, on a number of health-related policy areas and projects. EPF’s vision is: high-quality, patient-centred, and equitable healthcare for all patients across the EU.

  20. A PDA based Point of Care E-Health Solution for Ambulatory Care

    Directory of Open Access Journals (Sweden)

    Daniel Walsh

    2005-11-01

    Full Text Available The adoption of PDAs and mobile communication is expected to provide a solution to the use of computer technology by healthcare workers at the point-of-care. The Australian National Health Information Strategy, Health Online, is providing national leadership for approaches to address the quality and availability of information to assist in the planning and delivery of care. One area for potential growth is the availability and capture of information at the point of care by healthcare providers. A key factor in the lack of adoption of systems, is that traditionally health care information systems have been designed for desktop computing whereas many healthcare workers are highly mobile. This paper discusses phase one of a larger, four-phase project which aims to develop information access applications at point-of-care for Ambulatory Care Services. The initial phase of the research (phase one involves workflow analysis, requirements specification and the development and testing of a system prototype to assess the feasibility of achieving increased efficiencies in workflow at the Ambulatory Care Service.

  1. An Optimization of Inventory Demand Forecasting in University Healthcare Centre

    Science.gov (United States)

    Bon, A. T.; Ng, T. K.

    2017-01-01

    Healthcare industry becomes an important field for human beings nowadays as it concerns about one’s health. With that, forecasting demand for health services is an important step in managerial decision making for all healthcare organizations. Hence, a case study was conducted in University Health Centre to collect historical demand data of Panadol 650mg for 68 months from January 2009 until August 2014. The aim of the research is to optimize the overall inventory demand through forecasting techniques. Quantitative forecasting or time series forecasting model was used in the case study to forecast future data as a function of past data. Furthermore, the data pattern needs to be identified first before applying the forecasting techniques. Trend is the data pattern and then ten forecasting techniques are applied using Risk Simulator Software. Lastly, the best forecasting techniques will be find out with the least forecasting error. Among the ten forecasting techniques include single moving average, single exponential smoothing, double moving average, double exponential smoothing, regression, Holt-Winter’s additive, Seasonal additive, Holt-Winter’s multiplicative, seasonal multiplicative and Autoregressive Integrated Moving Average (ARIMA). According to the forecasting accuracy measurement, the best forecasting technique is regression analysis.

  2. Ambulatory Phlebectomy

    Science.gov (United States)

    ... for Every Season How to Choose the Best Skin Care Products In This Section Dermatologic Surgery What is dermatologic ... for Every Season How to Choose the Best Skin Care Products Ambulatory Phlebectomy What is ambulatory phlebectomy? Ambulatory phlebectomy ...

  3. [Day hospital in internal medicine: A chance for ambulatory care].

    Science.gov (United States)

    Grasland, A; Mortier, E

    2018-04-16

    Internal medicine is an in-hospital speciality. Along with its expertise in rare diseases, it shares with general medicine the global care of patients but its place in the ambulatory shift has yet to be defined. The objective of our work was to evaluate the benefits of an internal medicine day-hospital devoted to general medicine. Named "Centre Vi'TAL" to underline the link between the city and the hospital, this novel activity was implemented in order to respond quickly to general practitioners having difficulties to synthesize their complex patients or facing diagnostic or therapeutic problems. Using preferentially email for communication, the general practitioners can contact an internist who is committed to respond on the same day and take over the patient within 7 days if day-hospital is appropriate for his condition. The other patients are directed either to the emergency department, consultation or full hospitalization. In 14 months, the center has received 213 (144 women, 69 men) patients, mean age 53.6, addressed by 88 general practitioners for 282 day-hospital sessions. Requests included problem diagnoses (n=105), synthesis reviews for complex patients (n=65), and treatment (n=43). In the ambulatory shift advocated by the authorities, this experience shows that internal medicine should engage in the recognition of day-hospital as a place for diagnosis and synthesis reviews connected with the city while leaving the general practitioners coordinator of their patient care. This activity of synthesis in day-hospital is useful for the patients and efficient for our healthcare system. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Sehmbi H

    2014-12-01

    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

  5. Meta-synthesis on nurse practitioner autonomy and roles in ambulatory care.

    Science.gov (United States)

    Wang-Romjue, Pauline

    2018-04-01

    Many healthcare stakeholders view nurse practitioners (NPs) as an important workforce resource to help fill the anticipated shortage of 20,400 ambulatory care physicians that is expected by 2020. Multiple quantitative studies revealed the attributes of NPs' practice autonomy and roles. However, there is no qualitative meta-synthesis that describes the experiences of NPs' practice autonomy and roles. To describe and understand the experiences of NPs regarding their practice autonomy and roles in various ambulatory settings through the exploration of existing qualitative studies: meta-synthesis. A qualitative meta-synthesis was conducted to gain insight into ambulatory NPs' practice autonomy and roles through content analysis and reciprocal translation. Articles published between 2000 and 2017 were retrieved by searching 7 databases using the following key words: U.S. qualitative studies, advance practice nurses, NP role in ambulatory care, NP autonomy, and outpatient care. Autonomy, NPs' roles and responsibilities, practice relationships, and organizational work environment pressures are the four main themes that emerged from the content analysis of the nine selected qualitative studies. Within and between states, NPs' experiences with autonomy and NPs' roles are multifaceted depending on state regulations, practice relationships, and organizational work environments. © 2017 Wiley Periodicals, Inc.

  6. Sustainable business models: systematic approach toward successful ambulatory care pharmacy practice.

    Science.gov (United States)

    Sachdev, Gloria

    2014-08-15

    This article discusses considerations for making ambulatory care pharmacist services at least cost neutral and, ideally, generate a margin that allows for service expansion. The four pillars of business sustainability are leadership, staffing, information technology, and compensation. A key facet of leadership in ambulatory care pharmacy practice is creating and expressing a clear vision for pharmacists' services. Staffing considerations include establishing training needs, maximizing efficiencies, and minimizing costs. Information technology is essential for efficiency in patient care delivery and outcomes assessment. The three domains of compensation are cost savings, pay for performance, and revenue generation. The following eight steps for designing and implementing an ambulatory care pharmacist service are discussed: (1) prepare a needs assessment, (2) analyze existing strengths, weaknesses, opportunities, and threats, (3) analyze service gaps and feasibility, (4) consider financial opportunities, (5) consider stakeholders' interests, (6) develop a business plan, (7) implement the service, and (8) measure outcomes. Potential future changes in national healthcare policy (such as pharmacist provider status and expanded pay for performance) could enhance the opportunities for sustainable ambulatory care pharmacy practice. The key challenges facing ambulatory care pharmacists are developing sustainable business models, determining which services yield a positive return on investment, and demanding payment for value-added services. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  7. Patient care delivery and integration: stimulating advancement of ambulatory care pharmacy practice in an era of healthcare reform.

    Science.gov (United States)

    Epplen, Kelly T

    2014-08-15

    This article discusses how to plan and implement an ambulatory care pharmacist service, how to integrate a hospital- or health-system-based service with the mission and operations of the institution, and how to help the institution meet its challenges related to quality improvement, continuity of care, and financial sustainability. The steps in implementing an ambulatory care pharmacist service include (1) conducting a needs assessment, (2) aligning plans for the service with the mission and goals of the parent institution, (3) collaborating with patients and physicians, (4) standardizing the patient care process, (5) proposing the service, (6) attaining the necessary resources, (7) identifying stakeholders, (8) identifying applicable quality standards, (9) defining competency standards, (10) planning for service payment, and (11) monitoring outcomes. Ambulatory care pharmacists have current opportunities to become engaged with patient-centered medical homes, accountable care organizations, preventive and wellness programs, and continuity of care initiatives. Common barriers to the advancement of ambulatory care pharmacist services include lack of complete access to patient information, inadequate information technology, and lack of payment. Ambulatory care pharmacy practitioners must assertively promote appropriate medication use, provide patient-centered care, pursue integration with the patient care team, and seek appropriate recognition and compensation for the services they provide. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  8. Organisational innovation in health services: lessons from the NHS treatment centres

    National Research Council Canada - National Science Library

    Gabbay, J

    2011-01-01

    ... design and methods References Index 103 133 147 149 155 165 v List of abbreviationsOrganisational innovation in health services List of abbreviations A&E ACAD DH DTC GP G-Supp NHS NIHR PCT PFI SDO SHA TC accident and emergency (department) Ambulatory Care and Diagnostic Centre Department of Health ('the Department') diagnosis and treatment centr...

  9. Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence.

    Science.gov (United States)

    McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia; Rizer, Milisa; Huerta, Timothy R

    2014-07-01

    While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating

  10. Analysis of the economic impact of environmental biosafety works projects in healthcare centres in extremadura (spain)

    OpenAIRE

    García Sanz-Calcedo, Justo; Monzón-González, Pedro

    2014-01-01

    The aim of this paper is to analyze the results obtained in the methodological application of techniques aimed at the maintenance of environmental biosafety in works of reform and expansion of healthcare centres in Extremadura, Spain during 2004-2010, assessing the costs of its implementation and contrasting if the use of a BSA project in phase of works affects the probability of nosocomial infection and the conditions of health and safety. The average investment accounted for a cost of 5.5 €...

  11. The Healthcare Future for the iGeneration: Integrating the Patient and the Healthcare System

    OpenAIRE

    Cathy H. Ficzere, PharmD, BCPS; Traci M. Poole, PharmD, BCACP; Rachel B. Franks, PharmD, BCACP; Elisa M. Greene, PharmD, BCACP; Kristina D. Wood, PharmD, BCACP; Philip E. Johnston, PharmD

    2013-01-01

    Objective: To propose a vision to integrate patients, their health-related data, and their wellness plans into the healthcare system using smartphone and tablet computer technology. Setting: Ambulatory care and community practice Practice Innovation: Utilization of smartphone and tablet computer technology to assess health care conditions, educate and involve patients, and facilitate seamless communication between the patient, electronic health record, pharmacy system, third-party p...

  12. [Face-lift surgery in ambulatory].

    Science.gov (United States)

    Soulhiard, F

    2017-10-01

    The proposal is to demonstrate that facelift surgery is particularly suitable for the care in ambulatory. Between 2010 and 2016, 246 patients were operated for a facelift in ambulatory. No major complication arose in this series (241). Among the patients, 98% expressed their satisfaction and would accept again this intervention in ambulatory. The facelift can be realized in ambulatory with complete safety. The rate of satisfaction shows a very strong support of the patients for the ambulatory care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. A designated centre for people with disabilities operated by Nua Healthcare Services, Kildare

    LENUS (Irish Health Repository)

    Xiao, Liang

    2011-02-01

    Abstract Background In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. Methods A set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. Results The use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research. Conclusions The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Ireland.

  14. Producing the BEANs needed for person-centred healthcare decision making requires translating the wisdom of the clinical crowd

    DEFF Research Database (Denmark)

    Kaltoft, Mette Kjer; Eiring, Øystein; Nielsen, Jesper Bo

    Producing the BEANs needed for person-centred healthcare decision making requires translating the wisdom of the clinical crowd Mette Kjer Kaltoft, University of Southern Denmark Øystein Eiring, Norwegian Knowledge Centre for the Health Services Jesper Bo Nielsen, University of Southern Denmark...... requirement in relation to the BEANs only by assuming professionals are able to make up the shortfalls remaining after the peer-reviewed published products of scientific research have been fully exploited. Since the clinical judgement of individual professionals has never been subjected to scientific...... never get near to meeting the needs of practice. What is required is the translation of the wisdom of the clinical crowd through the processing of the beliefs of expert professionals into BEANs. The process must be appropriately analytically rigorous, but this should not be confounded with scientific...

  15. Examining chronic care patient preferences for involvement in health-care decision making: the case of Parkinson's disease patients in a patient-centred clinic.

    Science.gov (United States)

    Zizzo, Natalie; Bell, Emily; Lafontaine, Anne-Louise; Racine, Eric

    2017-08-01

    Patient-centred care is a recommended model of care for Parkinson's disease (PD). It aims to provide care that is respectful and responsive to patient preferences, values and perspectives. Provision of patient-centred care should entail considering how patients want to be involved in their care. To understand the participation preferences of patients with PD from a patient-centred care clinic in health-care decision-making processes. Mixed-methods study with early-stage Parkinson's disease patients from a patient-centred care clinic. Study involved a modified Autonomy Preference Index survey (N=65) and qualitative, semi-structured in-depth interviews, analysed using thematic qualitative content analysis (N=20, purposefully selected from survey participants). Interviews examined (i) the patient preferences for involvement in health-care decision making; (ii) patient perspectives on the patient-physician relationship; and (iii) patient preferences for communication of information relevant to decision making. Preferences for participation in decision making varied between individuals and also within individuals depending on decision type, relational and contextual factors. Patients had high preferences for communication of information, but with acknowledged limits. The importance of communication in the patient-physician relationship was emphasized. Patient preferences for involvement in decision making are dynamic and support shared decision making. Relational autonomy corresponds to how patients envision their participation in decision making. Clinicians may need to assess patient preferences on an on-going basis. Our results highlight the complexities of decision-making processes. Improved understanding of individual preferences could enhance respect for persons and make for patient-centred care that is truly respectful of individual patients' wants, needs and values. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

  16. A double-blind comparison of terazosin and tamsulosin on their differential effects on ambulatory blood pressure and nocturnal orthostatic stress testing

    NARCIS (Netherlands)

    de Mey, C.; Michel, M. C.; McEwen, J.; Moreland, T.

    1998-01-01

    OBJECTIVES: This single-centre, double-blind, randomized parallel-group study compared ambulatory blood pressure (AMBP) and heart rate (HR) profiles and responses to orthostatic testing (OT) for recommended regimens of tamsulosin (TAM, modified release formulation) and terazosin (TER), two

  17. Society for Ambulatory Anesthesia

    Science.gov (United States)

    ... SAMBA Link Digital Newsletter Educational Bibliography Research IARS/Anesthesia & Analgesia SCOR About SCOR Sponsor SAMBA Meetings Affinity Sponsor Program We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, ...

  18. Electronic health record "super-users" and "under-users" in ambulatory care practices.

    Science.gov (United States)

    Rumball-Smith, Juliet; Shekelle, Paul; Damberg, Cheryl L

    2018-01-01

    This study explored variation in the extent of use of electronic health record (EHR)-based health information technology (IT) functionalities across US ambulatory care practices. Use of health IT functionalities in ambulatory care is important for delivering high-quality care, including that provided in coordination with multiple practitioners. We used data from the 2014 Healthcare Information and Management Systems Society Analytics survey. The responses of 30,123 ambulatory practices with an operational EHR were analyzed to examine the extent of use of EHR-based health IT functionalities for each practice. We created a novel framework for classifying ambulatory care practices employing 7 domains of health IT functionality. Drawing from the survey responses, we created a composite "use" variable indicating the extent of health IT functionality use across these domains. "Super-user" practices were defined as having near-full employment of the 7 domains of health IT functionalities and "under-users" as those with minimal or no use of health IT functionalities. We used multivariable logistic regression to investigate how the odds of super-use and under-use varied by practice size, type, urban or rural location, and geographic region. Seventy-three percent of practices were not using EHR technologies to their full capability, and nearly 40% were classified as under-users. Under-user practices were more likely to be of smaller size, situated in the West, and located outside a metropolitan area. To achieve the broader benefits of the EHR and health IT, health systems and policy makers need to identify and address barriers to full use of health IT functionalities.

  19. The analysis of antibiotic consumption and bacterial resistance in tertiary Healthcare Centre Niš

    Directory of Open Access Journals (Sweden)

    Veličković-Radovanović Radmila M.

    2016-01-01

    Full Text Available Introduction: Antibiotics are the most frequently used drugs in hospitalized patients, but studies have shown that the prescribed antibiotics may be inappropriate and may contribute to bacterial resistance. The aim of this work is the evaluation of antibiotic consumption in Clinical Centre Nis, Serbia from 2011 to 2014, with the focus on the monitoring of the ceftriaxone (CTX and ciprofloxacin (CIP utilization. Secondly, we screened bacterial resistance towards monitored antibiotics used for intra-abdominal infection (IAI and urinary tract infection (UTI in tertiary healthcare institution. Methods: Antibiotics consumption and antimicrobial resistance were monitored in the tertiary care university hospital-Clinical Centre Nis from 2011 to 2014. Data on the use of antibiotics in inpatients were obtained and expressed as defined daily doses per 100 bed days (DBD. Bacterial resistances were given as percentages of resistant isolates. Results: During the investigation period the use of cephalosporins increased by 6.39 %, from 2011 to 2013, but in 2014 there was a reduction in its consumption by 16.46 %. Penicillins consumption had a decreasing trend, whereas quinolones consumption was variable during observation period. The resistance of K. pneumoniae to CTX and CIP for the isolates from IAI, and resistance of E. coli to analyze antibiotics for isolates from UTI showed increasing trend within observed period of time. Conclusions: Our findings shows that cephalosporins were the most frequently used antibiotics in Clinical Centre Nis, and they were followed by penicillins and quinolones. Additionally, K. pneumoniae resistance to CTX and CIP increased markedly in IAI, while E. coli resistance showed an increasing trend to CTX and CIP in UTI over the study period.

  20. Side effects after ambulatory lumbar iohexol myelography

    International Nuclear Information System (INIS)

    Sand, T.; Myhr, G.; Stovner, L.J.; Dale, L.G.; Tangerud, A.

    1989-01-01

    Side effect incidences after ambulatory (22G needle and two h bed rest) and after non-ambulatory (22 and 20G needles and 20 h bed rest) lumbar iohexol myelography have been estimated and compared. Headache incidence was significantly greater in ambulatory (50%, n=107) as compared to nonambulatory myelography (26%, n=58). Headaches in the ambulatory group tended to be of shorter duration and the difference between severe headaches in ambulatory and non-ambulatory groups was not significant. Serious adverse reactions did not occur and none of the ambulatory patients required readmission because of side effects. The headache was predominantly postural and occurred significantly earlier in the ambulatory group. Headache incidence was significantly greater after 20G needle myelography (44%, n=97) as compared to 22G needle iohexol myelography (26%, n=58). The results support the hypothesis that CSF leakage is a major cause of headache after lumbar iohexol myelography. (orig.)

  1. Anaesthesia for Ambulatory Paediatric Surgery: Common ...

    African Journals Online (AJOL)

    BACKGROUND: Ambulatory surgical care accounts for over 70% of elective procedures in Northern America. Ambulatory paediatric surgical practice is not widespread in Nigeria. This report examined clinical indicators for quality care in paediatric ambulatory surgery using common outcomes after day case procedures as ...

  2. The DIY Digital Medical Centre.

    Science.gov (United States)

    Timmis, James Kenneth; Timmis, Kenneth

    2017-09-01

    Healthcare systems worldwide are confronted with major economic, organizational and logistical challenges. Historic evolution of health care has led to significant healthcare sector fragmentation, resulting in systemic inefficiencies and suboptimal resource exploitation. To attain a sustainable healthcare model, fundamental, system-wide improvements that effectively network, and ensure fulfilment of potential synergies between sectors, and include and facilitate coherent strategic planning and organisation of healthcare infrastructure are needed. Critically, they must be specifically designed to sustainably achieve peak performance within the current policy environment for cost-control, and efficiency and quality improvement for service delivery. We propose creation of a new healthcare cluster, to be embedded in existing healthcare systems. It consists of (i) local 24/7 walk-in virtually autonomous do-it-yourself Digital Medical Centres performing routine diagnosis, monitoring, prevention, treatment and standardized documentation and health outcome assessment/reporting, which are online interfaced with (ii) regional 24/7 eClinician Centres providing on-demand clinical supervision/assistance to Digital Medical Centre patients. Both of these are, in turn, online interfaced with (iii) the National Clinical Informatics Centre, which houses the national patient data centre (cloud) and data analysis units that conduct patient- and population-level, personalized and predictive(-medicine) intervention optimization analyses. The National Clinical Informatics Centre also interfaces with biomedical research and prioritizes and accelerates the translation of new discoveries into clinical practice. The associated Health Policy Innovation and Evaluation Centre rapidly integrates new findings with health policy/regulatory discussions. This new cluster would synergistically link all health system components in a circular format, enable not only access by all arms of the health

  3. Ambulatory heart rate is underestimated when measured by an Ambulatory Blood Pressure device

    NARCIS (Netherlands)

    Vrijkotte, T.G.M.; de Geus, E.J.C.

    1999-01-01

    Objective: To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor. Design: Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous

  4. Ambulatory heart rate is underestimated when measured by an ambulatory blood pressure device

    NARCIS (Netherlands)

    Vrijkotte, T. G.; de Geus, E. J.

    2001-01-01

    To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor. Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous electrocardiogram (ECG) recordings

  5. Ambulatory heart rate is underestimated when measured by an ambulatory blood pressure device

    NARCIS (Netherlands)

    Vrijkotte, T.G.M.; de Geus, E.J.C.

    2001-01-01

    Objective: To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor. Design: Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous

  6. Patient- and family-centred care in the intensive care unit: a challenge in the daily practice of healthcare professionals.

    Science.gov (United States)

    van Mol, Margo Mc; Boeter, Trudi Gw; Verharen, Lisbeth; Kompanje, Erwin Jo; Bakker, Jan; Nijkamp, Marjan D

    2017-10-01

    To evaluate the impact of supportive interventions perceived by both the intensive care unit patients' relatives and the healthcare providers, such as deferred intake interviews for providing information and discussing the emotional impacts, encouragement to keep a diary, and the introduction of weekly psychosocial rounds, on the perceptions of relatives of patients in the intensive care unit. Patient- and family-centred care is gaining interest, with a shift from provider-centric norms to care arranged around patients' and relatives individual beliefs and needs. This is expected to have a positive influence on the quality of care. Communication is one of the most important factors impacting the perceived quality of care in the intensive care unit from the perspective of patients' relatives. New interventions have been introduced to help the patients' relatives to meet their communication needs. A time-trend quantitative design. Two convenience samples of relatives were included (in 2012 and 2013) in four different intensive care units from a large university medical centre in the Netherlands. Survey data from 211 relatives (75% net response rate in 2012) and 123 relatives (66% net response rate in 2013) were used for the analysis. The second measurement showed significant improvements regarding informational aspects of care, clarification of roles in participatory caretaking and shared decision-making. The results suggest that the additional support offered to patients' relatives increased perceived quality of care, particularly with respect to informational needs. However, patient- and family-centred care still requires a change in the mindset of healthcare professionals. This new point of view should overcome perceived barriers and foster a culture of partnership with patients' relatives in the intensive care unit. Training in providing psychosocial support for the needs of relatives leads to a stronger perception of patient-centredness. © 2016 John Wiley

  7. Healthcare Practitioners' Personal and Professional Values

    Science.gov (United States)

    Moyo, Mpatisi; Goodyear-Smith, Felicity A.; Weller, Jennifer; Robb, Gillian; Shulruf, Boaz

    2016-01-01

    Personal and professional values of healthcare practitioners influence their clinical decisions. Understanding these values for individuals and across healthcare professions can help improve patient-centred decision-making by individual practitioners and interprofessional teams, respectively. We aimed to identify these values and integrate them…

  8. Investigating the role of healthcare centre accessibility on the decision to attend for screening for gestational diabetes mellitus in Ireland [presentation

    LENUS (Irish Health Repository)

    Cullinan, John

    2011-01-01

    Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy and is associated with several serious maternal and neonatal complications and conditions. Screening practices for GDM vary within and across European countries, with some offering universal screening to all pregnant women and others only to selective high risk groups. In Ireland, no single policy with respect to GDM screening is implemented nationally and a debate exists as to what form such a policy should take. Within this context, the Atlantic Diabetes in Pregnancy (ATLANTIC DIP) network was established in 2005 to provide robust information on pregnancy outcomes for women with diabetes. The network includes five healthcare centres along the Atlantic seaboard and provides testing for all pregnant women at 24-28 weeks using a 75g Oral Glucose Tolerance Test. The centres are linked using a clinical information system which allows for data to be captured within a central database, containing a comprehensive range of data on screening uptake rates, maternal characteristics, outcomes for mothers and infants, healthcare resource usage over the course of pregnancy, as well as the postal address of each individual. At present it contains observations on 9,043 pregnant women offered the screening, 5,218 (58%) of whom participated in testing.\\r\

  9. Building National Infrastructures for Patient-Centred Digital Services

    DEFF Research Database (Denmark)

    Thorseng, Anne; Jensen, Tina Blegind

    2015-01-01

    Patient-centred digital services are increasingly gaining impact in the healthcare sector. The premise is that patients will be better equipped for taking care of their own health through instant access to relevant information and by enhanced electronic communication with healthcare providers. One...... infrastructure theory, we highlight the enabling and constraining dynamics when designing and building a national infrastructure for patient-centred digital services. Furthermore, we discuss how such infrastructures can accommodate further development of services. The findings show that the Danish national e...

  10. Does procedure profitability impact whether an outpatient surgery is performed at an ambulatory surgery center or hospital?

    Science.gov (United States)

    Plotzke, Michael Robert; Courtemanche, Charles

    2011-07-01

    Ambulatory surgery centers (ASCs) are small (typically physician owned) healthcare facilities that specialize in performing outpatient surgeries and therefore compete against hospitals for patients. Physicians who own ASCs could treat their most profitable patients at their ASCs and less profitable patients at hospitals. This paper asks if the profitability of an outpatient surgery impacts where a physician performs the surgery. Using a sample of Medicare patients from the National Survey of Ambulatory Surgery, we find that higher profit surgeries do have a higher probability of being performed at an ASC compared to a hospital. After controlling for surgery type, a 10% increase in a surgery's profitability is associated with a 1.2 to 1.4 percentage point increase in the probability the surgery is performed at an ASC. Copyright © 2010 John Wiley & Sons, Ltd.

  11. Specialist participation in healthcare delivery transformation: influence of patient self-referral.

    Science.gov (United States)

    Aliu, Oluseyi; Sun, Gordon; Burke, James; Chung, Kevin C; Davis, Matthew M

    2014-01-01

    Improving coordination of care and containing healthcare costs are prominent goals of healthcare reform. Specialist involvement in healthcare delivery transformation efforts like Accountable Care Organizations (ACOs) is necessary to achieve these goals. However, patients’ self-referrals to specialists may undermine care coordination and incur unnecessary costs if patients frequently receive care from specialists not engaged in such healthcare delivery transformation efforts. Additionally, frequent self-referrals may also diminish the incentive for specialist participation in reform endeavors like ACOs to get access to a referral base. To examine recent national trends in self-referred new visits to specialists. A descriptive cross-sectional study of new ambulatory visits to specialists from 2000 to 2009 using data from the National Ambulatory Medical Care Survey. We calculated nationally representative estimates of the proportion of new specialist visits through self-referrals among Medicare and private insurance beneficiaries. We also estimated the nationally representative absolute number of self-referred new specialist visits among both groups of beneficiaries. Among Medicare and private insurance beneficiaries, self-referred visits declined from 32.2% (95% confidence interval [CI], 24.0%-40.4%) to 19.6% (95% CI, 13.9%-23.3%) and from 32.4% (95% CI, 27.9%-36.8%) to 24.1% (95% CI,18.8%-29.4%), respectively. Hence, at least 1 in 5 and 1 in 4 new visits to specialists among Medicare and private insurance beneficiaries, respectively, are self-referred. The current considerable rate of self-referred new specialist visits among both Medicare and private insurance beneficiaries may have adverse implications for organizations attempting to transform healthcare delivery with improved care coordination.

  12. 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, Peter G. M.

    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

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

    Directory of Open Access Journals (Sweden)

    Drayer Debra K

    2003-12-01

    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.

  14. Ambulatory thyroidectomy: A multistate study of revisits and complications

    OpenAIRE

    Orosco, RK; Lin, HW; Bhattacharyya, N

    2015-01-01

    © 2015 American Academy of Otolaryngology - Head and Neck Surgery Foundation. Objective. Determine rates and reasons for revisits after ambulatory adult thyroidectomy. Study Design. Cross-sectional analysis of multistate ambulatory surgery and hospital databases. Setting. Ambulatory surgery data from the State Ambulatory Surgery Databases of California, Florida, Iowa, and New York for calendar years 2010 and 2011. Subjects and Methods. Ambulatory thyroidectomy cases were linked to state ambul...

  15. National Hospital Ambulatory Medical Care Survey

    Data.gov (United States)

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

  16. Software engineering principles applied to large healthcare information systems--a case report.

    Science.gov (United States)

    Nardon, Fabiane Bizinella; de A Moura, Lincoln

    2007-01-01

    São Paulo is the largest city in Brazil and one of the largest cities in the world. In 2004, São Paulo City Department of Health decided to implement a Healthcare Information System to support managing healthcare services and provide an ambulatory health record. The resulting information system is one of the largest public healthcare information systems ever built, with more than 2 million lines of code. Although statistics shows that most software projects fail, and the risks for the São Paulo initiative were enormous, the information system was completed on-time and on-budget. In this paper, we discuss the software engineering principles adopted that allowed to accomplish that project's goals, hoping that sharing the experience of this project will help other healthcare information systems initiatives to succeed.

  17. Knowledge and Attitude about Multidrug-Resistant Tuberculosis among Healthcare Workers in Public Health Centres

    Directory of Open Access Journals (Sweden)

    Bony Wiem Lestari

    2016-12-01

    Full Text Available Background: Multidrug-resistant Tuberculosis (MDR-TB is a significant public health problem and poses a threat to global tuberculosis (TB control. In 2015, at least 504 new MDR-TB cases were identified in Indonesia. Treating MDR-TB patients is very challenging. It may take more than two years for MDR-TB treatment. Therefore, it is crucial healthcare workers (HCWs are knowledgeable about MDR-TB. The aim of this study was to measure level of knowledge and attitude regarding MDR-TB among HCWs in public health centres. Methods: A cross-sectional study was conducted at 73 Public Health Centres in Bandung the capital of West Java Province from August until November 2015. The samples were 73 TB nurses and 32 laboratory staff. A self-administered questionnaire was given comprising 27 knowledge questions and 29 attitude questions. Correlation between knowledge and attitude scores was calculated by Pearson correlation test. Results: The majority of study participants were women (82.9%, married (92.4%, nursing staff (65.7% with history of TB training (98.1%. Most of the participants were 40-59 years old (69.5% with working experience in TB programme < 10 years (69.5%. Less than half (38.1% of study participants had good knowledge. In terms of attitude, more than half (53.3% of study participants had a positive attitude towards MDR-TB. Conclusions: The level of knowledge among HCWs about MDR-TB is still at an unacceptable level. Certain educational interventions aim to ensure prompt diagnosis, implement infection control and accurate treatment should be established among those HCWs.

  18. Perceived and normative needs, utilization of oral healthcare services, and barriers to utilization of dental care services at peripheral medical centre: Poonjeri, Mamallapuram, India

    Directory of Open Access Journals (Sweden)

    Prabhu Subramani

    2017-01-01

    Full Text Available Introduction: Dental care utilization is limited, and teeth are often left untreated or extracted in India. Several barriers exist for the utilization of dental services. The present study was undertaken to assess the oral healthcare needs, utilization pattern of oral healthcare services, and barriers to utilization of oral healthcare services among the outpatients of Peripheral Medical Centre, Poonjeri, Mamallapuram, India. Materials and Methods: Simple random sampling was conducted among outpatients and their attenders reporting to the health centre; demographic profile of the patients were recorded followed by interviewer-administered questionnaire for recording the self-perceived dental needs and barriers in utilizing dental care services followed by Type II clinical examination to assess normative dental treatment needs. Results: N =282 study participants participated in the present study; majority of the study participants were from upper lower class and lower middle class. Among the study subjects n = 124 (44% have not accessed any dentist, n = 112 (39.7% had visited dentist for toothache. Common reason cited as Self – perceived barriers for dental care are n = 184 (65.2% – 'Unaware of the dental problems' and n = 118 (41.8% 'Fear of dental treatment'. Logistic regression showed that significant difference was seen in gender, socioeconomic status, and barriers to dental care (P < 0.05 in influencing the utilization pattern of dental care. Conclusion: Perceived and normative dental needs were high among the study population due to problem-oriented care, and it is influenced by various barriers such as unawareness of dental problems, fear, cost, accessibility, and time.

  19. Investigating the job satisfaction of healthcare providers at primary healthcare centres in Lebanon: A national cross-sectional study.

    Science.gov (United States)

    Alameddine, Mohamad; Baroud, Maysa; Kharroubi, Samer; Hamadeh, Randa; Ammar, Walid; Shoaib, Hikma; Khodr, Hiba

    2017-11-01

    Low job satisfaction is linked to higher staff turnover and intensified shortages in healthcare providers (HCP). This study investigates the level of, and factors associated with, HCP job satisfaction in the national primary healthcare (PHC) network in Lebanon. The study adopts a cross-sectional design to survey HCP at 99 PHC centres distributed across the country between October 2013 and May 2014. The study questionnaire consisted of four sections: socio-demographics/professional background, employment characteristics, level of job satisfaction (Measure of Job Satisfaction scale) and level of professional burnout (Maslach Burnout Inventory-HSS scale). A total of 1,000 providers completed the questionnaire (75.8% response rate). Bivariate and multivariate regression analyses were used to identify factors significantly associated with job satisfaction. Findings of the study highlight an overall mean job satisfaction score of 3.59 (SD 0.54) indicating that HCP are partially satisfied. Upon further examination, HCP were least satisfied with pay, training and job prospects. Gender, age, career plans, salary, exposure to violence, and level of burnout were significantly associated with the overall level of job satisfaction which was also associated with increased likelihood to quit. Overall, the study highlights how compensation, development and protection of PHC HCP can influence their job satisfaction. Recommendations include the necessity of developing a nationally representative committee, led by the Ministry of Public Health, to examine the policies and remuneration scales within the PHC sector and suggest mechanisms to bridge the pay differential with other sectors. The effective engagement of key stakeholders with the development, organisation and evaluation of professional development programmes offered to HCP in the PHC sector remains crucial. Concerned stakeholders should assess and formulate initiatives and programmes that enrich the physical, psychological

  20. Understanding the healthcare experiences of teenaged cancer patients and survivors.

    Science.gov (United States)

    Farjou, G; Sinha, R; Dix, D; Shahbaz, A; Klaassen, R J; Klassen, A F

    2014-09-01

    Despite literature supporting a client and family-centred approach to healthcare delivery in paediatric facilities, there is little information about healthcare delivery from the perspective of teenagers in the oncology setting. The objective of this study is to describe the healthcare experiences of teenagers with cancer. As part of a larger study on teen-centred care delivery in paediatric oncology, a survey included several open-ended questions to learn about the following: (1) what teenagers liked about the cancer care they received; (2) what they disliked about the cancer care received; and (3) what they would include if they could design the perfect cancer centre for teenagers. The survey was completed by 200 teenagers (aged 12-20 years) from three paediatric hospitals in Canada. Answers to these questions were coded and developed into themes and subthemes using a thematic analysis approach. The number of patients providing answers was 89% for question 1, 63% for question 2 and 68.5% for question 3. Likes and dislikes were conceptualized in terms of four key themes as follows: (1) staff at the treatment centre; (2) the cancer care they received; (3) the treatment centre itself; and (4) social activities. The most common suggestions for the perfect cancer centre included having access to better entertainment, more social opportunities to interact with peers, and a more comfortable environment for themselves and their families. Understanding teenagers' experiences in the paediatric oncology setting provides information that could be used to shape the delivery of healthcare in a way that is tailored to their needs. Further research in this area is required in order to improve existing oncology care. © 2013 John Wiley & Sons Ltd.

  1. A designated centre for people with disabilities operated by Nua Healthcare Services, Laois

    LENUS (Irish Health Repository)

    Brabazon, E D

    2010-01-01

    The use of routinely available electronic sources of healthcare data on the spread of influenza has the potential to enhance current surveillance activities. This study aimed to develop a method for identifying influenza-related records from general practitioner(GP) out-of-hours (OOH) services in Ireland. Data from one such service were interrogated for keywords relating to influenza-like illness (ILI) and a proxy measure of influenza activity in the community setting was developed. Comparison of this syndromic surveillance measure with national data on ILI consultation rates demonstrated a statistically significant temporal correlation.In five out of six influenza seasons investigated,peaks in the GP OOH influenza-related calls appeared at least one week ahead of peaks in the national ILI consultation rates. The method described in this paper has been extended to nine OOH services in Ireland (covering 70% of the Irish population) to provide weekly figures on self-reported illness for influenza in the community and its data have been incorporated into the national weekly influenza reports produced by the Health Protection Surveillance Centre. These data should provide early warnings of both seasonal and pandemic influenza in Ireland.

  2. Anesthesia for ambulatory anorectal surgery.

    Science.gov (United States)

    Gudaityte, Jūrate; Marchertiene, Irena; Pavalkis, Dainius

    2004-01-01

    The prevalence of minor anorectal diseases is 4-5% of adult Western population. Operations are performed on ambulatory or 24-hour stay basis. Requirements for ambulatory anesthesia are: rapid onset and recovery, ability to provide quick adjustments during maintenance, lack of intraoperative and postoperative side effects, and cost-effectiveness. Anorectal surgery requires deep levels of anesthesia. The aim is achieved with 1) regional blocks alone or in combination with monitored anesthesia care or 2) deep general anesthesia, usually with muscle relaxants and tracheal intubation. Modern general anesthetics provide smooth, quickly adjustable anesthesia and are a good choice for ambulatory surgery. Popular regional methods are: spinal anesthesia, caudal blockade, posterior perineal blockade and local anesthesia. The trend in regional anesthesia is lowering the dose of local anesthetic, providing selective segmental block. Adjuvants potentiating analgesia are recommended. Postoperative period may be complicated by: 1) severe pain, 2) urinary retention due to common nerve supply, and 3) surgical bleeding. Complications may lead to hospital admission. In conclusion, novel general anesthetics are recommended for ambulatory anorectal surgery. Further studies to determine an optimal dose and method are needed in the group of regional anesthesia.

  3. Evaluation of percutaneous kidney biopsy complications in ambulatory patients- a two year review from a tertiary care centre

    International Nuclear Information System (INIS)

    Mansoor, K.; Azam, N.; Hashim, R.

    2016-01-01

    Objective: To evaluate the complications of percutaneous kidney biopsy in ambulatory patients in a tertiary care centre over a two year period. Study Design: Cross sectional, descriptive. Place and Duration of Study: The study was carried out at the Department of Nephrology Military Hospital, Rawalpindi from Jan 2008 to Jan 2010. Material and Methods: Patients referred to the Nephrology Department for kidney biopsy were considered for inclusion in the study provided they did not have any contraindications to the procedure and had a normotensive state with BP <130/90 mm Hg and a normal coagulation profile including partial thromboplastin time, prothrombin time, bleeding time and platelet count. Patients with an evidence of malignancy, congenital anomalies of kidneys on ultrasound examination or a skin disorder affecting the likely site of biopsy were excluded. Results: A total of 100 patients who merited standard indications for kidney biopsy were included in the study. Average age was 45.53 years (+1 SD = 10.96) with age range of 25 years to 75 years. There were 83 males (83 percent) and 17 females (17 percent) with male to female ratio of 4.9:1. Microscopic hematuria occurred in 82 (82 percent) patients. Gross hematuria occurred in 12 (12 percent) patients. Decrease in hemoglobin level by 1 g/dL or more occurred in 35 (35 percent). There was no episode of hypotension secondary to severe bleeding. No patient required transfusion. Surgery was not required in any patient for controlling bleeding. Death was not recorded among the reported complications. Conclusion: Percutaneous kidney biopsy can be safely conducted as an outpatient procedure with an observation time of 12 hours post-biopsy to watch for any complications. (author)

  4. Ambulatory percutaneous nephrolithotomy: initial series.

    Science.gov (United States)

    Shahrour, Walid; Andonian, Sero

    2010-12-01

    To assess the safety and feasibility of ambulatory percutaneous nephrolithotomy (PCNL). PCNL is the gold standard for the management of large renal stones. Although tubeless PCNL has been previously described, no case series have been published of ambulatory PCNL. The criteria for ambulatory PCNL were: single tract, stone-free status documented by flexible nephroscopy, adequate pain control, and satisfactory postoperative hematocrit level and chest radiographic findings. Patient information, including operating room and fluoroscopy times, stone size and Hounsfield units, and number of needle punctures, were collected prospectively. The time spent in the recovery room, in addition to the amount of narcotics used in the recovery room and at home, was documented. Of 10 patients, 8 had nephrostomy tracts established intraoperatively by the urologist and 2 had preoperative nephrostomy tubes placed. The median operating and fluoroscopy time was 83.5 and 4.45 minutes, respectively. The median stone diameter was 20 mm (800 Hounsfield units) in addition to a patient with a staghorn calculus. The patients spent a median of 240 minutes in the recovery room and had received a median of 19.25 mg of morphine equivalents. Only 3 patients (30%) used narcotics at home. No intraoperative complications occurred, and none of the patients required transfusions. Two postoperative complications developed: a deep vein thrombosis requiring outpatient anticoagulation and multiresistant Escherichia coli infection requiring intravenous antibiotics. In highly selected patients, ambulatory PCNL is safe and feasible. More patients are needed to verify the criteria for patients undergoing the ambulatory approach. Copyright © 2010 Elsevier Inc. All rights reserved.

  5. Tracking unnecessary negative urinalyses to reduce healthcare costs: a transversal study.

    Science.gov (United States)

    Malmartel, A; Dutron, M; Ghasarossian, C

    2017-09-01

    About 7 million urinalyses are reimbursed yearly by the French public healthcare system, but the results of most of these tests are normal. The aim of this study was to estimate the prevalence of negative urinalyses in ambulatory care, identify the associated factors and assess the relevance of prescriptions by general practitioners (GPs) according to French guidelines. A cross-sectional study was conducted in patients over 18 coming for urinalyses in two French ambulatory laboratories. Patients received a questionnaire on their symptoms, the reason for performing urinalysis and the use of urinary dipsticks. GP who prescribed urinalyses received a questionnaire assessing their practice. A total of 510 patients were included, and 71% of urinalyses were negative. Urinalyses were prescribed to 283 patients by GPs. Compared to those of specialists, GP prescriptions were associated with fewer negative urinalyses (59 vs 86%; p GPs, the reasons of prescription were as follows: suspected urinary tract infection (UTI) (42.7%), control of bacteriological cure after UTI (24%), fever or abdominal pain (13%) and routine test (7%). About 35% of urinalyses were not indicated according to guidelines. Only 12% of patients used dipsticks before performing urinalysis although 87% of GPs were favourable to their use if they were provided by healthcare services. The annual cost of non-indicated urinalyses is estimated at 13 million euro. A systematic use of dipsticks provided by healthcare services could help to reduce health costs and the unnecessary use of antibiotics.

  6. Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: prospective cohort study.

    Science.gov (United States)

    Head, Geoffrey A; Mihailidou, Anastasia S; Duggan, Karen A; Beilin, Lawrence J; Berry, Narelle; Brown, Mark A; Bune, Alex J; Cowley, Diane; Chalmers, John P; Howe, Peter R C; Hodgson, Jonathan; Ludbrook, John; Mangoni, Arduino A; McGrath, Barry P; Nelson, Mark R; Sharman, James E; Stowasser, Michael

    2010-04-14

    Twenty-four hour ambulatory blood pressure thresholds have been defined for the diagnosis of mild hypertension but not for its treatment or for other blood pressure thresholds used in the diagnosis of moderate to severe hypertension. We aimed to derive age and sex related ambulatory blood pressure equivalents to clinic blood pressure thresholds for diagnosis and treatment of hypertension. We collated 24 hour ambulatory blood pressure data, recorded with validated devices, from 11 centres across six Australian states (n=8575). We used least product regression to assess the relation between these measurements and clinic blood pressure measured by trained staff and in a smaller cohort by doctors (n=1693). Mean age of participants was 56 years (SD 15) with mean body mass index 28.9 (5.5) and mean clinic systolic/diastolic blood pressure 142/82 mm Hg (19/12); 4626 (54%) were women. Average clinic measurements by trained staff were 6/3 mm Hg higher than daytime ambulatory blood pressure and 10/5 mm Hg higher than 24 hour blood pressure, but 9/7 mm Hg lower than clinic values measured by doctors. Daytime ambulatory equivalents derived from trained staff clinic measurements were 4/3 mm Hg less than the 140/90 mm Hg clinic threshold (lower limit of grade 1 hypertension), 2/2 mm Hg less than the 130/80 mm Hg threshold (target upper limit for patients with associated conditions), and 1/1 mm Hg less than the 125/75 mm Hg threshold. Equivalents were 1/2 mm Hg lower for women and 3/1 mm Hg lower in older people compared with the combined group. Our study provides daytime ambulatory blood pressure thresholds that are slightly lower than equivalent clinic values. Clinic blood pressure measurements taken by doctors were considerably higher than those taken by trained staff and therefore gave inappropriate estimates of ambulatory thresholds. These results provide a framework for the diagnosis and management of hypertension using ambulatory blood pressure values.

  7. Patients' subjective concepts about primary healthcare utilisation: the study protocol of a quality comparative study between Norway and Germany

    OpenAIRE

    Herrmann, Wolfram; Haarmann, Alexander; Flick, Uwe; Bærheim, Anders; Lichte, Thomas; Herrmann, Markus

    2013-01-01

    Background In Germany, utilisation of ambulatory healthcare services is high compared with other countries: While a study based on the process data of German statutory health insurances showed an average of 17.1 physician-patient-contacts per year, the comparable figure for Norway is about five. The usual models of healthcare utilisation, such as Rosenstock's Health Belief Model and Andersen's Behavioural Model, cannot explain these differences adequately. Organisational factors of th...

  8. Improving visit cycle time using patient flow analysis in a high-volume inner-city hospital-based ambulatory clinic serving minority New Yorkers.

    Science.gov (United States)

    Dhar, Sanjay; Michel, Raquel; Kanna, Balavenkatesh

    2011-01-01

    Patient waiting time and waiting room congestion are quality indicators that are related to efficiency of ambulatory care systems and patient satisfaction. Our main purpose was to test a program to decrease patient visit cycle time, while maintaining high-quality healthcare in a high-volume inner-city hospital-based clinic in New York City. Use of patient flow analysis and the creation of patient care teams proved useful in identifying areas for improvement, target, and measure effectiveness of interventions. The end result is reduced visit cycle time, improved provider team performance, and sustained patient care outcomes. © 2010 National Association for Healthcare Quality.

  9. Ambulatory cleft lip surgery: A value analysis.

    Science.gov (United States)

    Arneja, Jugpal S; Mitton, Craig

    2013-01-01

    Socialized health systems face fiscal constraints due to a limited supply of resources and few reliable ways to control patient demand. Some form of prioritization must occur as to what services to offer and which programs to fund. A data-driven approach to decision making that incorporates outcomes, including safety and quality, in the setting of fiscal prudence is required. A value model championed by Michael Porter encompasses these parameters, in which value is defined as outcomes divided by cost. To assess ambulatory cleft lip surgery from a quality and safety perspective, and to assess the costs associated with ambulatory cleft lip surgery in North America. Conclusions will be drawn as to how the overall value of cleft lip surgery may be enhanced. A value analysis of published articles related to ambulatory cleft lip repair over the past 30 years was performed to determine what percentage of patients would be candidates for ambulatory cleft lip repair from a quality and safety perspective. An economic model was constructed based on costs associated with the inpatient stay related to cleft lip repair. On analysis of the published reports in the literature, a minority (28%) of patients are currently discharged in an ambulatory fashion following cleft lip repair. Further analysis suggests that 88.9% of patients would be safe candidates for same-day discharge. From an economic perspective, the mean cost per patient for the overnight admission component of ambulatory cleft surgery to the health care system in the United States was USD$2,390 and $1,800 in Canada. The present analysis reviewed germane publications over a 30-year period, ultimately suggesting that ambulatory cleft lip surgery results in preservation of quality and safety metrics for most patients. The financial model illustrates a potential cost saving through the adoption of such a practice change. For appropriately selected patients, ambulatory cleft surgery enhances overall health care value.

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

    Science.gov (United States)

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

    2011-04-01

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

  11. At the interface of community and healthcare systems: a longitudinal cohort study on evolving health and the impact of primary healthcare from the patient's perspectiv

    Directory of Open Access Journals (Sweden)

    Haggerty Jeannie

    2010-09-01

    Full Text Available Abstract Background Massive efforts in Canada have been made to renew primary healthcare. However, although early evaluations of initiatives and research on certain aspects of the reform are promising, none have examined the link between patient assessments of care and health outcomes or the impacts at a population level. The goal of this project is to examine the effect of patient-centred and effective primary healthcare on the evolution of chronic illness burden and health functioning in a population, and in particularly vulnerable groups: the multi-morbid and the poor. Methods/Design A randomly selected cohort of 2000 adults aged 25 to 75 years will be recruited within the geographic boundaries of four local healthcare networks in Quebec. At recruitment, cohort members will report on socio-demographic information, functional health and healthcare use. Two weeks, 12 months and 24 months after recruitment, cohort participants will complete a self-administered questionnaire on current health and health behaviours in order to evaluate primary healthcare received in the previous year. The dependent variables are calculated as change over time of functional health status, chronic illness burden, and health behaviours. Dimensions of patient-centred care and clinical processes are measured using sub-scales of validated instruments. We will use Poisson regression modelling to estimate the incidence rate of chronic illness burden scores and structural equation modelling to explore relationships between variables and to examine the impact of dimensions of patient-centred care and effective primary healthcare. Discussion Results will provide valuable information for primary healthcare clinicians on the course of chronic illness over time and the impact on health outcomes of accessible, patient-centred and effective care. A demonstration of impact will contribute to the promotion of continuous quality improvement activities at a clinical level. While

  12. From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care.

    Science.gov (United States)

    Wilf-Miron, R; Lewenhoff, I; Benyamini, Z; Aviram, A

    2003-02-01

    The development of a medical risk management programme based on the aviation safety approach and its implementation in a large ambulatory healthcare organisation is described. The following key safety principles were applied: (1). errors inevitably occur and usually derive from faulty system design, not from negligence; (2). accident prevention should be an ongoing process based on open and full reporting; (3). major accidents are only the "tip of the iceberg" of processes that indicate possibilities for organisational learning. Reporting physicians were granted immunity, which encouraged open reporting of errors. A telephone "hotline" served the medical staff for direct reporting and receipt of emotional support and medical guidance. Any adverse event which had learning potential was debriefed, while focusing on the human cause of error within a systemic context. Specific recommendations were formulated to rectify processes conducive to error when failures were identified. During the first 5 years of implementation, the aviation safety concept and tools were successfully adapted to ambulatory care, fostering a culture of greater concern for patient safety through risk management while providing support to the medical staff.

  13. Ambulatory phlebectomy at radiologic outpatient clinic

    International Nuclear Information System (INIS)

    Yoon, Chang Jin; Kang, Sung Gwon; Choi, Sang Il; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung

    2007-01-01

    To evaluate safety, efficacy, and patient's satisfaction of an ambulatory phlebectomy, performed at a radiology outpatient clinic. Between 2003 and 2006, an ambulatory phlebectomy was performed in 12 patients. Endovenous radiofrequency ablation was performed through a venotomy. The venotomy was ligated after RF ablation, and the ambulatory phlebectomy was performed. The patients visited the radiology outpatient clinic one day, one week, and 2 months after the procedure. The improvement in the clinical symptoms, cosmetic change in varicosity, and the procedure related complications were evaluated. The patient's satisfaction was evaluated using a 5-grade scale. RF ablation through a venotomy was performed successfully in all 12 patients. On average, 4.5 incisions were made, and 12.5 cm of varicosity had been removed. The mean procedure time was one hour and forty minutes. The complications of the ambulatory phlebectomy were bruising in one patient, and skin pigmentation in another. The complications associated with RF ablation were a hard palpable vein in 7 patients, numbness in 7 patients, and skin pigmentation along the vein in 2 patients. Follow-up duplex sonography was performed at 2 months after the procedure, showed complete occlusion in all 12 patients. The clinical symptoms had improved in 11 patients, and the varicosity disappeared cosmetically in 11 patients. An ambulatory phlebectomy, combined with RF ablation of the greater saphenous vein, can be performed safely and effectively at a radiology outpatient clinic

  14. Ambulatory phlebectomy at radiologic outpatient clinic

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Chang Jin; Kang, Sung Gwon; Choi, Sang Il [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Lee, Whal; Chung, Jin Wook; Park, Jae Hyung [Seoul National University, Medical College, Seoul (Korea, Republic of)

    2007-03-15

    To evaluate safety, efficacy, and patient's satisfaction of an ambulatory phlebectomy, performed at a radiology outpatient clinic. Between 2003 and 2006, an ambulatory phlebectomy was performed in 12 patients. Endovenous radiofrequency ablation was performed through a venotomy. The venotomy was ligated after RF ablation, and the ambulatory phlebectomy was performed. The patients visited the radiology outpatient clinic one day, one week, and 2 months after the procedure. The improvement in the clinical symptoms, cosmetic change in varicosity, and the procedure related complications were evaluated. The patient's satisfaction was evaluated using a 5-grade scale. RF ablation through a venotomy was performed successfully in all 12 patients. On average, 4.5 incisions were made, and 12.5 cm of varicosity had been removed. The mean procedure time was one hour and forty minutes. The complications of the ambulatory phlebectomy were bruising in one patient, and skin pigmentation in another. The complications associated with RF ablation were a hard palpable vein in 7 patients, numbness in 7 patients, and skin pigmentation along the vein in 2 patients. Follow-up duplex sonography was performed at 2 months after the procedure, showed complete occlusion in all 12 patients. The clinical symptoms had improved in 11 patients, and the varicosity disappeared cosmetically in 11 patients. An ambulatory phlebectomy, combined with RF ablation of the greater saphenous vein, can be performed safely and effectively at a radiology outpatient clinic.

  15. Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda

    Science.gov (United States)

    Lu, Chunling; Cook, Benjamin; Desmond, Chris

    2017-01-01

    Background Rural healthcare facilities in low-income countries play a major role in providing primary care to rural populations. We examined the link of foreign aid with government investments and medical service provision in rural health centres in Rwanda. Methods Using the District Health System Strengthening Tool, a web-based database built by the Ministry of Health in Rwanda, we constructed two composite indices representing provision of (1) child and maternal care and (2) HIV, tuberculosis (TB) and malaria services in 330 rural health centres between 2009 and 2011. Financing variables in a healthcare centre included received funds from various sources, including foreign donors and government. We used multilevel random-effects model in regression analyses and examined the robustness of results to a range of alternative specification, including scale of dependent variables, estimation methods and timing of aid effects. Findings Both government and foreign donors increased their direct investments in the 330 rural healthcare centres during the period. Foreign aid was positively associated with government investments (0.13, 95% CI 0.06 to 0.19) in rural health centres. Aid in the previous year was positively associated with service provision for child and maternal health (0.008, 95% CI 0.002 to 0.014) and service provision for HIV, TB and malaria (0.014, 95% CI 0.004 to 0.022) in the current year. The results are robust when using fixed-effects models. Conclusions These findings suggest that foreign aid did not crowd out government investments in the rural healthcare centres. Foreign aid programmes, conducted in addition to government investments, could benefit rural residents in low-income countries through increased service provision in rural healthcare facilities. PMID:29082015

  16. INCAS—Interactive Teleconsultation Network for Worldwide Healthcare Services

    Science.gov (United States)

    Castelli, A.; Colombo, C.; Garlaschelli, A.; Pepe, G.

    2001-01-01

    The INCAS Project arises from the needs of an Italian oil company in order to support the doctors responsible for the healthcare in remote drilling sites. The INCAS telemedicine1 system implements a prototype of teleconsultation medical service allowing for the interactive on-line connection with Italian healthcare reference centres in order to: • provide support to the expatriate doctor with the diagnoses and treatment of routine complaints; • contribute to the general improvement of healthcare in remote areas.

  17. Ambulatory anaesthesia and cognitive dysfunction

    DEFF Research Database (Denmark)

    Rasmussen, Lars S; Steinmetz, Jacob

    2015-01-01

    serious adverse outcomes, hence difficult to obtain sound scientific evidence for avoiding complications. RECENT FINDINGS: Few studies have assessed recovery of cognitive function after ambulatory surgery, but it seems that both propofol and modern volatile anaesthetics are rational choices for general...... anaesthesia in the outpatient setting. Cognitive complications such as delirium and postoperative cognitive dysfunction are less frequent in ambulatory surgery than with hospitalization. SUMMARY: The elderly are especially susceptible to adverse effects of the hospital environment such as immobilisation...

  18. Ambulatory ST segment monitoring after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1994-01-01

    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...

  19. Optimizing anesthesia techniques in the ambulatory setting

    NARCIS (Netherlands)

    E. Galvin (Eilish)

    2007-01-01

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

  20. Ambulatory activity classification with dendogram-based support vector machine: Application in lower-limb active exoskeleton.

    Science.gov (United States)

    Mazumder, Oishee; Kundu, Ananda Sankar; Lenka, Prasanna Kumar; Bhaumik, Subhasis

    2016-10-01

    Ambulatory activity classification is an active area of research for controlling and monitoring state initiation, termination, and transition in mobility assistive devices such as lower-limb exoskeletons. State transition of lower-limb exoskeletons reported thus far are achieved mostly through the use of manual switches or state machine-based logic. In this paper, we propose a postural activity classifier using a 'dendogram-based support vector machine' (DSVM) which can be used to control a lower-limb exoskeleton. A pressure sensor-based wearable insole and two six-axis inertial measurement units (IMU) have been used for recognising two static and seven dynamic postural activities: sit, stand, and sit-to-stand, stand-to-sit, level walk, fast walk, slope walk, stair ascent and stair descent. Most of the ambulatory activities are periodic in nature and have unique patterns of response. The proposed classification algorithm involves the recognition of activity patterns on the basis of the periodic shape of trajectories. Polynomial coefficients extracted from the hip angle trajectory and the centre-of-pressure (CoP) trajectory during an activity cycle are used as features to classify dynamic activities. The novelty of this paper lies in finding suitable instrumentation, developing post-processing techniques, and selecting shape-based features for ambulatory activity classification. The proposed activity classifier is used to identify the activity states of a lower-limb exoskeleton. The DSVM classifier algorithm achieved an overall classification accuracy of 95.2%. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. Biomedical Wireless Ambulatory Crew Monitor

    Science.gov (United States)

    Chmiel, Alan; Humphreys, Brad

    2009-01-01

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

  2. Falls and fear of falling predict future falls and related injuries in ambulatory individuals with spinal cord injury: a longitudinal observational study.

    Science.gov (United States)

    Jørgensen, Vivien; Butler Forslund, Emelie; Opheim, Arve; Franzén, Erika; Wahman, Kerstin; Hultling, Claes; Seiger, Åke; Ståhle, Agneta; Stanghelle, Johan K; Roaldsen, Kirsti S

    2017-04-01

    What is the 1-year incidence of falls and injurious falls in a representative cohort of community-dwelling ambulatory individuals with chronic spinal cord injury? What are the predictors of recurrent falls (more than two/year) and injurious falls in this population? One-year longitudinal observational multi-centre study. A representative sample of 68 (of 73 included) community-dwelling ambulatory individuals with traumatic SCI attending regular follow-up programs at rehabilitation centres. Primary outcome measures were incidence and predictors of recurrent falls (more than two/year) and injurious falls reported every 2 weeks for 1year. A total of 48% of participants reported recurrent falls. Of the 272 reported falls, 41% were injurious. Serious injuries were experienced by 4% of participants, all of whom were women. Multivariate logistic regression analysis showed that recurrent falls in the previous year (OR=111, 95% CI=8.6 to 1425), fear of falling (OR=6.1, 95% CI=1.43 to 26) and longer time taken to walk 10m (OR=1.3, 95% CI=1.0 to 1.7) were predictors of recurrent falls. Fear of falling (OR=4.3, 95% CI=1.3 to 14) and recurrent falls in the previous year (OR=4.2, 95% CI=1.2 to 14) were predictors of injurious falls. Ambulatory individuals have a high risk of falling and of fall-related injuries. Fall history, fear of falling and walking speed could predict recurrent falls and injurious falls. Further studies with larger samples are needed to validate these findings. [Jørgensen V, Butler Forslund E, Opheim A, Franzén E, Wahman K, Hultling C, Seiger Å, Ståhle A, Stanghelle JK, Roaldsen KS (2017) Falls and fear of falling predict future falls and related injuries in ambulatory individuals with spinal cord injury: a longitudinal observational study. Journal of Physiotherapy 63: 108-113]. Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

  3. Association between medication supplies and healthcare costs in older adults from an urban healthcare system.

    Science.gov (United States)

    Stroupe, K T; Murray, M D; Stump, T E; Callahan, C M

    2000-07-01

    The amount of medication dispensed to older adults for the treatment of chronic disease must be balanced carefully. Insufficient medication supplies lead to inadequate treatment of chronic disease, whereas excessive supplies represent wasted resources and the potential for toxicity. We used an electronic medical record system to determine the distribution of medications supplied to older urban adults and to examine the correlations of these distributions with healthcare costs and use. A cross-sectional study using data acquired over 3 years (1994-1996). A tax-supported urban public healthcare system consisting of a 300-bed hospital, an emergency department, and a network of community-based ambulatory care centers. Patients were >60 years of age and had at least one prescription refill and at least two ambulatory visits or one hospitalization during the 3-year period. Focusing on 12 major categories of drugs used to treat chronic diseases, we determined the amounts and direct costs of these medications dispensed to older adult patients. Amounts of medications that were needed by patients to medicate themselves adequately were compared with the medication supply actually dispensed considering all sources of care (primary, emergency, and inpatient). We calculated the excess drug costs attributable to oversupply of medication (>120% of the amount needed) and the drug cost reduction caused by undersupply of medication (120% of the supply needed. The total direct cost of targeted medications for 3 years was $1.96 million or, on average, $654,000 annually. During the 3-year period, patients receiving >120% of their needed medications had excess direct medication costs of $279,084 or $144 per patient, whereas patients receiving <80% of drugs needed had reduced medication costs of $423,438 or $634 per patient. Multivariable analyses revealed that both under- and over-supplies of medication were associated with a greater likelihood of emergency department visits and hospital

  4. Investigating composition and production rate of healthcare waste and associated management practices in Bandar Abbass, Iran.

    Science.gov (United States)

    Koolivand, Ali; Mahvi, Amir Hossein; Alipoor, Vali; Azizi, Kourosh; Binavapour, Mohammad

    2012-06-01

    The objective of this study was to identify the composition and production rate of healthcare waste and associated management practices in healthcare centres in Bandar Abbas, southern Iran. A total of 90 centres, including 30 physician offices, 30 dental offices and 30 clinics were selected in random way. Two samples in summer and two samples in winter were taken and weighed from each selected centre at the end of successive working day on Mondays and Tuesdays. Results showed that the mean of daily production rate for each clinic, dental and physician office were 2125.3, 498.3 and 374.9 g, respectively. Domestic-type and potentially infectious waste had the highest and chemical and pharmaceutical waste and sharps had the lowest percentages in all centres. Questionnaire results indicated that there were no effective activity for waste minimization, separation, reuse and recycling in healthcare centres and management of sharps, potentially infectious and other hazardous waste was poor.

  5. Uganda | IDRC - International Development Research Centre

    International Development Research Centre (IDRC) Digital Library (Canada)

    Our funding helped develop the Uganda Health Information Network, an electronic ... Hand-held computers, mobile caching services, and mobile telephones enable ... Now used in hundreds of health centres, the technology has enhanced healthcare ... promote land policies that are fair to women; stimulate high-quality, ...

  6. Ambulatory Feedback System

    Science.gov (United States)

    Finger, Herbert; Weeks, Bill

    1985-01-01

    This presentation discusses instrumentation that will be used for a specific event, which we hope will carry on to future events within the Space Shuttle program. The experiment is the Autogenic Feedback Training Experiment (AFTE) scheduled for Spacelab 3, currently scheduled to be launched in November, 1984. The objectives of the AFTE are to determine the effectiveness of autogenic feedback in preventing or reducing space adaptation syndrome (SAS), to monitor and record in-flight data from the crew, to determine if prediction criteria for SAS can be established, and, finally, to develop an ambulatory instrument package to mount the crew throughout the mission. The purpose of the Ambulatory Feedback System (AFS) is to record the responses of the subject during a provocative event in space and provide a real-time feedback display to reinforce the training.

  7. Developments in ambulatory surgery in orthopedics in France in 2016.

    Science.gov (United States)

    Hulet, C; Rochcongar, G; Court, C

    2017-02-01

    Under the new categorization introduced by the Health Authorities, ambulatory surgery (AS) in France now accounts for 50% of procedures, taking all surgical specialties together. The replacement of full hospital admission by AS is now well established and recognized. Health-care centers have learned, in coordination with the medico-surgical and paramedical teams, how to set up AS units and the corresponding clinical pathways. There is no single model handed down from above. The authorities have encouraged these developments, partly by regulations but also by means of financial incentives. Patient eligibility and psychosocial criteria are crucial determining factors for the success of the AS strategy. The surgeons involved are strongly committed. Feedback from many orthopedic subspecialties (shoulder, foot, knee, spine, hand, large joints, emergency and pediatric surgery) testify to the rise of AS, which now accounts for 41% of all orthopedic procedures. Questions remain, however, concerning the role of the GP in the continuity of care, the role of innovation and teaching, the creation of new jobs, and the attractiveness of AS for surgeons. More than ever, it is the patient who is "ambulatory", within an organized structure in which surgical technique and pain management are well controlled. Not all patients can be eligible, but the AS concept is becoming standard, and overnight stay will become a matter for medical and surgical prescription. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  8. The Healthcare Future for the iGeneration: Integrating the Patient and the Healthcare System

    Directory of Open Access Journals (Sweden)

    Kristina D. Wood

    2013-01-01

    Full Text Available Objective: To propose a vision to integrate patients, their health-related data, and their wellness plans into the healthcare system using smartphone and tablet computer technology. Setting: Ambulatory care and community practice Practice Innovation: Utilization of smartphone and tablet computer technology to assess health care conditions, educate and involve patients, and facilitate seamless communication between the patient, electronic health record, pharmacy system, third-party payers, point-of-care testing, and all health-care providers. Main Outcome Measures: By providing integrated and customized information at the point of use, medication adherence and access to care will be increased and patients will engage in healthy behaviors more often resulting in an improved level of care for patients. Results: In the future, the authors believe if the vision is achieved, the health care system and patients will see improved health outcomes and more efficient utilization of the healthcare system. Conclusions: Our proposed use of technology provides an opportunity to empower patients to positively improve their own health which could be a vital advancement in health care, especially in the areas of medication adherence, improving access to care, and health behavior support. As pharmacists, we may also embrace technology opportunities to expand our roles as health care professionals as we continue to partner with patients and the health care team to improve outcomes.   Type: Idea Paper

  9. The Healthcare Future for the iGeneration: Integrating the Patient and the Healthcare System

    Directory of Open Access Journals (Sweden)

    Cathy H. Ficzere, PharmD, BCPS

    2013-01-01

    Full Text Available Objective: To propose a vision to integrate patients, their health-related data, and their wellness plans into the healthcare system using smartphone and tablet computer technology.Setting: Ambulatory care and community practicePractice Innovation: Utilization of smartphone and tablet computer technology to assess health care conditions, educate and involve patients, and facilitate seamless communication between the patient, electronic health record, pharmacy system, third-party payers, point-of-care testing, and all health-care providers.Main Outcome Measures: By providing integrated and customized information at the point of use, medication adherence and access to care will be increased and patients will engage in healthy behaviors more often resulting in an improved level of care for patients.Results: In the future, the authors believe if the vision is achieved, the health care system and patients will see improved health outcomes and more efficient utilization of the healthcare system.Conclusions: Our proposed use of technology provides an opportunity to empower patients to positively improve their own health which could be a vital advancement in health care, especially in the areas of medication adherence, improving access to care, and health behavior support. As pharmacists, we may also embrace technology opportunities to expand our roles as health care professionals as we continue to partner with patients and the health care team to improve outcomes.

  10. Cost-effectiveness of ambulatory blood pressure monitoring in the management of hypertension.

    Science.gov (United States)

    Costa, Diogo; Peixoto Lima, Ricardo

    2017-02-01

    The prevalence of hypertension in Portugal is between 29.1% and 42.2%. International studies show that 13% of individuals have masked hypertension and 13% of diagnoses based on office blood pressure measurements are in fact white coat hypertension. More sensitive and specific blood pressure measuring methods could avoid costs associated with misdiagnosis. The aim of this study was to review the cost-effectiveness of ambulatory blood pressure monitoring (ABPM) compared to other methods in the management of hypertension. We performed a literature search in CMA Infobase, Guidelines Finder, National Guideline Clearinghouse, Bandolier, BMJ Clinical Evidence, the Cochrane Library, DARE, Medline, the Trip Database, SUMSearch and Índex das Revistas Médicas Portuguesas. We researched articles published between January 2005 and August 2015 in Portuguese, English and Spanish, using the MeSH terms "Hypertension", "Blood Pressure Monitoring, Ambulatory" and "Cost-Benefit Analysis" and the Portuguese search terms "Hipertensão", "Monitorização Ambulatorial da Pressão Arterial" and "Análise Custo-Benefício". Levels of evidence and grades of recommendation were attributed according to the Oxford Centre for Evidence-Based Medicine scale. Five hundred and twenty-five articles were identified. We included five original studies and one clinical practice guideline. All of them state that ABPM is the most cost-effective method. Two report better blood pressure control, and a Portuguese study revealed a saving of 23%. The evidence shows that ABPM is cost-effective, avoiding iatrogenic effects and reducing expenditure on treatment (grade of recommendation B). The included studies provide a solid basis, but further evidence of reproducibility is needed in research that is not based mainly on analytical models. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Patient-centred outcomes research: perspectives of patient stakeholders.

    Science.gov (United States)

    Chhatre, Sumedha; Gallo, Joseph J; Wittink, Marsha; Schwartz, J Sanford; Jayadevappa, Ravishankar

    2017-11-01

    To elicit patient stakeholders' experience and perspectives about patient-centred care. Qualitative. A large urban healthcare system. Four patient stakeholders who are prostate cancer survivors. Experience and perspectives of patient stakeholders regarding patient-centred care and treatment decisions. Our patient stakeholders represented a diverse socio-demographic group. The patient stakeholders identified engagement and dialogue with physicians as crucial elements of patient-centred care model. The degree of patient-centred care was observed to be dependent on the situations. High severity conditions warranted a higher level of patient involvement, compared to mild conditions. They agreed that patient-centred care should not mean that patients can demand inappropriate treatments. An important attribute of patient-centred outcomes research model is the involvement of stakeholders. However, we have limited knowledge about the experience of patient stakeholders in patient-centred outcomes research. Our study indicates that patient stakeholders offer a unique perspective as researchers and policy-makers aim to precisely define patient-centred research and care.

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

    Directory of Open Access Journals (Sweden)

    Messieha Z

    2015-01-01

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

  13. Ambulatory laparoscopic minor hepatic surgery: Retrospective observational study.

    Science.gov (United States)

    Gaillard, M; Tranchart, H; Lainas, P; Tzanis, D; Franco, D; Dagher, I

    2015-11-01

    Over the last decade, laparoscopic hepatic surgery (LHS) has been increasingly performed throughout the world. Meanwhile, ambulatory surgery has been developed and implemented with the aims of improving patient satisfaction and reducing health care costs. The objective of this study was to report our preliminary experience with ambulatory minimally invasive LHS. Between 1999 and 2014, 172 patients underwent LHS at our institution, including 151 liver resections and 21 fenestrations of hepatic cysts. The consecutive series of highly selected patients who underwent ambulatory LHS were included in this study. Twenty patients underwent ambulatory LHS. Indications were liver cysts in 10 cases, liver angioma in 3 cases, focal nodular hyperplasia in 3 cases, and colorectal hepatic metastasis in 4 cases. The median operative time was 92 minutes (range: 50-240 minutes). The median blood loss was 35 mL (range: 20-150 mL). There were no postoperative complications or re-hospitalizations. All patients were hospitalized after surgery in our ambulatory surgery unit, and were discharged 5-7 hours after surgery. The median postoperative pain score at the time of discharge was 3 (visual analogue scale: 0-10; range: 0-4). The median quality-of-life score at the first postoperative visit was 8 (range: 6-10) and the median cosmetic satisfaction score was 8 (range: 7-10). This series shows that, in selected patients, ambulatory LHS is feasible and safe for minor hepatic procedures. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Achieving the AAAs of Ambulatory Care: Aptitude, Appeal, and Appreciation

    Science.gov (United States)

    Rybolt, Ann H.; Staton, Lisa J.; Panda, Mukta; Jones, Roger C.

    2009-01-01

    Background In the current health care environment more patient care has moved from in-hospital care to the ambulatory primary care settings; however, fewer internal medicine residents are pursuing primary care careers. Barriers to residents developing a sense of competency and enjoyment in ambulatory medicine include the complexity of practice-based systems, patients with multiple chronic diseases, and the limited time that residents spend in the outpatient setting. Objective In an effort to accelerate residents' ambulatory care competence and enhance their satisfaction with ambulatory practice, we sought to change the learning environment. Interns were provided a series of intensive, focused, ambulatory training sessions prior to beginning their own continuity clinic sessions. The sessions were designed to enable them to work confidently and effectively in their continuity clinic from the beginning of the internship year, and it was hoped this would have a positive impact on their perception of the desirability of ambulatory practice. Methods Improvement needs assessment after a performance, so we developed a structured, competency-based, multidisciplinary curriculum for initiation into ambulatory practice. The curriculum focused on systems-based practice, patient safety, quality improvement, and collaborative work while emphasizing the importance of continuity of care and long-term doctor-patient relationships. Direct observation of patient encounters was done by an attending physician to evaluate communication and physical examination skills. Systems of care commonly used in the clinic were demonstrated. Resources for practice-based learning were used. Conclusion The immersion of interns in an intensive, hands-on experience using a structured ambulatory care orientation curriculum early in training may prepare the intern to be a successful provider and learner in the primary care ambulatory setting. PMID:21975724

  15. Allied Health Professional Support in Pediatric Inflammatory Bowel Disease: A Survey from the Canadian Children Inflammatory Bowel Disease Network—A Joint Partnership of CIHR and the CH.I.L.D. Foundation

    Directory of Open Access Journals (Sweden)

    Wael El-Matary

    2017-01-01

    Full Text Available Objectives. The current number of healthcare providers (HCP caring for children with inflammatory bowel disease (IBD across Canadian tertiary-care centres is underinvestigated. The aim of this survey was to assess the number of healthcare providers (HCP in ambulatory pediatric IBD care across Canadian tertiary-care centres. Methods. Using a self-administered questionnaire, we examined available resources in academic pediatric centres within the Canadian Children IBD Network. The survey evaluated the number of HCP providing ambulatory care for children with IBD. Results. All 12 tertiary pediatric gastroenterology centres participating in the network responded. Median full-time equivalent (FTE of allied health professionals providing IBD care at each site was 1.0 (interquartile range (IQR 0.6–1.0 nurse, 0.5 (IQR 0.2–0.8 dietitian, 0.3 (IQR 0.2–0.8 social worker, and 0.1 (IQR 0.02–0.3 clinical psychologists. The ratio of IBD patients to IBD physicians was 114 : 1 (range 31 : 1–537 : 1, patients to nurses/physician assistants 324 : 1 (range 150 : 1–900 : 1, dieticians 670 : 1 (range 250 : 1–4500 : 1, social workers 1558 : 1 (range 250 : 1–16000 : 1, and clinical psychologists 2910 : 1 (range 626 : 1–3200 : 1. Conclusions. There was a wide variation in HCP support among Canadian centres. Future work will examine variation in care including patients’ outcomes and satisfaction across Canadian centres.

  16. Primary care training and the evolving healthcare system.

    Science.gov (United States)

    Peccoralo, Lauren A; Callahan, Kathryn; Stark, Rachel; DeCherrie, Linda V

    2012-01-01

    With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians. © 2012 Mount Sinai School of Medicine.

  17. Predicting recovery at home after Ambulatory Surgery

    Directory of Open Access Journals (Sweden)

    Ayala Guillermo

    2011-10-01

    Full Text Available Abstract The correct implementation of Ambulatory Surgery must be accompanied by an accurate monitoring of the patient post-discharge state. We fit different statistical models to predict the first hours postoperative status of a discharged patient. We will also be able to predict, for any discharged patient, the probability of needing a closer follow-up, or of having a normal progress at home. Background The status of a discharged patient is predicted during the first 48 hours after discharge by using variables routinely used in Ambulatory Surgery. The models fitted will provide the physician with an insight into the post-discharge progress. These models will provide valuable information to assist in educating the patient and their carers about what to expect after discharge as well as to improve their overall level of satisfaction. Methods A total of 922 patients from the Ambulatory Surgery Unit of the Dr. Peset University Hospital (Valencia, Spain were selected for this study. Their post-discharge status was evaluated through a phone questionnaire. We pretend to predict four variables which were self-reported via phone interviews with the discharged patient: sleep, pain, oral tolerance of fluid/food and bleeding status. A fifth variable called phone score will be built as the sum of these four ordinal variables. The number of phone interviews varies between patients, depending on the evolution. The proportional odds model was used. The predictors were age, sex, ASA status, surgical time, discharge time, type of anaesthesia, surgical specialty and ambulatory surgical incapacity (ASI. This last variable reflects, before the operation, the state of incapacity and severity of symptoms in the discharged patient. Results Age, ambulatory surgical incapacity and the surgical specialty are significant to explain the level of pain at the first call. For the first two phone calls, ambulatory surgical incapacity is significant as a predictor for all

  18. From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care

    Science.gov (United States)

    Wilf-Miron, R; Lewenhoff, I; Benyamini, Z; Aviram, A

    2003-01-01

    

 The development of a medical risk management programme based on the aviation safety approach and its implementation in a large ambulatory healthcare organisation is described. The following key safety principles were applied: (1) errors inevitably occur and usually derive from faulty system design, not from negligence; (2) accident prevention should be an ongoing process based on open and full reporting; (3) major accidents are only the "tip of the iceberg" of processes that indicate possibilities for organisational learning. Reporting physicians were granted immunity, which encouraged open reporting of errors. A telephone "hotline" served the medical staff for direct reporting and receipt of emotional support and medical guidance. Any adverse event which had learning potential was debriefed, while focusing on the human cause of error within a systemic context. Specific recommendations were formulated to rectify processes conducive to error when failures were identified. During the first 5 years of implementation, the aviation safety concept and tools were successfully adapted to ambulatory care, fostering a culture of greater concern for patient safety through risk management while providing support to the medical staff. PMID:12571343

  19. Trust in the early chain of healthcare: lifeworld hermeneutics from the patient's perspective.

    Science.gov (United States)

    Norberg Boysen, Gabriella; Nyström, Maria; Christensson, Lennart; Herlitz, Johan; Wireklint Sundström, Birgitta

    2017-12-01

    Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for a non-urgent condition and been referred to the healthcare centre. A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patients participated: seven female and three male. The setting is the early chain of healthcare in south-western Sweden. The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient's lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the "voice of the lifeworld" enables the patient to feel trust. Trust in the early chain of healthcare entails caregivers' ability to pay attention to both medical and existential issues in compliance with the patient's information and questions. Thus, the patient must be invited to participate in assessments and decisions concerning his or her own healthcare, in a credible manner and using everyday language.

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

    Data.gov (United States)

    U.S. Department of Health & Human Services — The State Ambulatory Surgery Databases (SASD) contain the universe of hospital-based ambulatory surgery encounters in participating States. Some States include...

  1. Ambulatory Surgical Measures - Facility

    Data.gov (United States)

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

  2. Ambulatory care registered nurse performance measurement.

    Science.gov (United States)

    Swan, Beth Ann; Haas, Sheila A; Chow, Marilyn

    2010-01-01

    On March 1-2, 2010, a state-of-the-science invitational conference titled "Ambulatory Care Registered Nurse Performance Measurement" was held to focus on measuring quality at the RN provider level in ambulatory care. The conference was devoted to ambulatory care RN performance measurement and quality of health care. The specific emphasis was on formulating a research agenda and developing a strategy to study the testable components of the RN role related to care coordination and care transitions, improving patient outcomes, decreasing health care costs, and promoting sustainable system change. The objectives were achieved through presentations and discussion among expert inter-professional participants from nursing, public health, managed care, research, practice, and policy. Conference speakers identified priority areas for a unified practice, policy, and research agenda. Crucial elements of the strategic dialogue focused on issues and implications for nursing and inter-professional practice, quality, and pay-for-performance.

  3. Infusing an Inter-Professional and Inter-University Perspective into Healthcare Education

    Science.gov (United States)

    Goldberg, Lynette R.; Koontz, Jennifer Scott; Downs, David; Uhlig, Paul; Kumar, Neil G.; Shah, Sapna; Clark, Paige E.; Coiner, Christina; Crumrine, Daiquirie

    2010-01-01

    A national (USA) student-led, case-based CLinician/Administrator Relationship Improvement OrganizatioN (CLARION) competition focuses students in medical and related healthcare programs on the provision of healthcare that is safe, timely, equitable, patient-centred, effective and efficient. Students work in four-person, inter-professional teams to…

  4. Balancing Health Information Exchange and Privacy Governance from a Patient-Centred Connected Health and Telehealth Perspective.

    Science.gov (United States)

    Kuziemsky, Craig E; Gogia, Shashi B; Househ, Mowafa; Petersen, Carolyn; Basu, Arindam

    2018-04-22

     Connected healthcare is an essential part of patient-centred care delivery. Technology such as telehealth is a critical part of connected healthcare. However, exchanging health information brings the risk of privacy issues. To better manage privacy risks we first need to understand the different patterns of patient-centred care in order to tailor solutions to address privacy risks.  Drawing upon published literature, we develop a business model to enable patient-centred care via telehealth. The model identifies three patient-centred connected health patterns. We then use the patterns to analyse potential privacy risks and possible solutions from different types of telehealth delivery.  Connected healthcare raises the risk of unwarranted access to health data and related invasion of privacy. However, the risk and extent of privacy issues differ according to the pattern of patient-centred care delivery and the type of particular challenge as they enable the highest degree of connectivity and thus the greatest potential for privacy breaches.  Privacy issues are a major concern in telehealth systems and patients, providers, and administrators need to be aware of these privacy issues and have guidance on how to manage them. This paper integrates patient-centred connected health care, telehealth, and privacy risks to provide an understanding of how risks vary across different patterns of patient-centred connected health and different types of telehealth delivery. Georg Thieme Verlag KG Stuttgart.

  5. Health equity monitoring for healthcare quality assurance.

    Science.gov (United States)

    Cookson, R; Asaria, M; Ali, S; Shaw, R; Doran, T; Goldblatt, P

    2018-02-01

    Population-wide health equity monitoring remains isolated from mainstream healthcare quality assurance. As a result, healthcare organizations remain ill-informed about the health equity impacts of their decisions - despite becoming increasingly well-informed about quality of care for the average patient. We present a new and improved analytical approach to integrating health equity into mainstream healthcare quality assurance, illustrate how this approach has been applied in the English National Health Service, and discuss how it could be applied in other countries. We illustrate the approach using a key quality indicator that is widely used to assess how well healthcare is co-ordinated between primary, community and acute settings: emergency inpatient hospital admissions for ambulatory care sensitive chronic conditions ("potentially avoidable emergency admissions", for short). Whole-population data for 2015 on potentially avoidable emergency admissions in England were linked with neighborhood deprivation indices. Inequality within the populations served by 209 clinical commissioning groups (CCGs: care purchasing organizations with mean population 272,000) was compared against two benchmarks - national inequality and inequality within ten similar populations - using neighborhood-level models to simulate the gap in indirectly standardized admissions between most and least deprived neighborhoods. The modelled inequality gap for England was 927 potentially avoidable emergency admissions per 100,000 people, implying 263,894 excess hospitalizations associated with inequality. Against this national benchmark, 17% of CCGs had significantly worse-than-benchmark equity, and 23% significantly better. The corresponding figures were 11% and 12% respectively against the similar populations benchmark. Deprivation-related inequality in potentially avoidable emergency admissions varies substantially between English CCGs serving similar populations, beyond expected statistical

  6. Development of Quality Metrics in Ambulatory Pediatric Cardiology.

    Science.gov (United States)

    Chowdhury, Devyani; Gurvitz, Michelle; Marelli, Ariane; Anderson, Jeffrey; Baker-Smith, Carissa; Diab, Karim A; Edwards, Thomas C; Hougen, Tom; Jedeikin, Roy; Johnson, Jonathan N; Karpawich, Peter; Lai, Wyman; Lu, Jimmy C; Mitchell, Stephanie; Newburger, Jane W; Penny, Daniel J; Portman, Michael A; Satou, Gary; Teitel, David; Villafane, Juan; Williams, Roberta; Jenkins, Kathy

    2017-02-07

    The American College of Cardiology Adult Congenital and Pediatric Cardiology (ACPC) Section had attempted to create quality metrics (QM) for ambulatory pediatric practice, but limited evidence made the process difficult. The ACPC sought to develop QMs for ambulatory pediatric cardiology practice. Five areas of interest were identified, and QMs were developed in a 2-step review process. In the first step, an expert panel, using the modified RAND-UCLA methodology, rated each QM for feasibility and validity. The second step sought input from ACPC Section members; final approval was by a vote of the ACPC Council. Work groups proposed a total of 44 QMs. Thirty-one metrics passed the RAND process and, after the open comment period, the ACPC council approved 18 metrics. The project resulted in successful development of QMs in ambulatory pediatric cardiology for a range of ambulatory domains. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  7. Smoking prevalence, knowledge and attitudes among primary healthcare professionals: a study from Jordan.

    Science.gov (United States)

    Alkhatatbeh, M J; Alefan, Q; Alzghool, M

    2017-02-01

    This was a questionnaire-based cross-sectional study of 400 healthcare professionals recruited from primary healthcare centres in northern Jordan between April and October 2015. The questionnaire included questions about smoking behaviour, risks, opinions and providing anti-smoking counselling. More than 80% of participants reported that smoking-free policies were not enforced at primary healthcare centres. Compared to hospitals and the general population, smoking was less prevalent among primary healthcare professionals and more prevalent in men. More than 90% of participants believed that smoking was dangerous and associated with cardiovascular and respiratory diseases. Around 92% believed that they should set a good example to patients by not smoking and advise them about smoking cessation. Only 15.3% of participants felt well prepared when counselling patients about smoking and 92.8% believed that they needed training. This study suggests that primary healthcare professionals should act as anti-smoking role models after receiving professional training.

  8. Ambulatory Care Skills: Do Residents Feel Prepared?

    Directory of Open Access Journals (Sweden)

    Denise Bonds

    2002-10-01

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

  9. Personal information documents for people with dementia: Healthcare staff 's perceptions and experiences.

    Science.gov (United States)

    Baillie, Lesley; Thomas, Nicola

    2018-01-01

    Person-centred care is internationally recognised as best practice for the care of people with dementia. Personal information documents for people with dementia are proposed as a way to support person-centred care in healthcare settings. However, there is little research about how they are used in practice. The aim of this study was to analyse healthcare staff 's perceptions and experiences of using personal information documents, mainly Alzheimer's Society's 'This is me', for people with dementia in healthcare settings. The method comprised a secondary thematic analysis of data from a qualitative study, of how a dementia awareness initiative affected care for people with dementia in one healthcare organisation. The data were collected through 12 focus groups (n = 58 participants) and 1 individual interview, conducted with a range of healthcare staff, both clinical and non-clinical. There are four themes presented: understanding the rationale for personal information documents; completing personal information documents; location for personal information documents and transfer between settings; impact of personal information documents in practice. The findings illuminated how healthcare staff use personal information documents in practice in ways that support person-centred care. Practical issues about the use of personal information documents were revealed and these may affect the optimal use of the documents in practice. The study indicated the need to complete personal information documents at an early stage following diagnosis of dementia, and the importance of embedding their use across care settings, to support communication and integrated care.

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

    DEFF Research Database (Denmark)

    Rose, Matthias; Bjørner, Jakob; Fischer, Felix

    2012-01-01

    Computerized adaptive tests (CATs) have abundant theoretical advantages over established static instruments, which could improve ambulatory monitoring of patient-reported outcomes (PROs). However, an empirical demonstration of their practical benefits is warranted.......Computerized adaptive tests (CATs) have abundant theoretical advantages over established static instruments, which could improve ambulatory monitoring of patient-reported outcomes (PROs). However, an empirical demonstration of their practical benefits is warranted....

  11. [Rethinking the place of primary healthcare in France--role of general practice].

    Science.gov (United States)

    Gay, B

    2013-06-01

    Primary healthcare is poorly structured in France while it is well defined at the international level: it is the point of first medical contact of the population with the healthcare system. General practice is the clinical specialty oriented to primary healthcare. Data in the scientific literature highlight the need of refocusing the health system on primary care known to improve both morbi-mortality and care efficiency. In France, health authorities acknowledge general practitioners as playing a key role in the health care system: its time to move from intention to action. Structural changes are needed to achieve this reinforcement of primary healthcare: to re-orientate medical studies towards primary care; to develop research in primary care; to promote cooperation between care providers; to ease the daily workload of practitioners; to diversify methods of payment; to propose a guide for patient's use of primary care. The transformation of the healthcare system in France requires a real strategy of primary healthcare implementation. Regardless of financial constraints, it is possible to redistribute the resources towards ambulatory care. Strengthening the role of general practice and favoring its societal recognition will be the major stages of this change. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  12. Prevalence of needle stick injuries among healthcare workers

    African Journals Online (AJOL)

    Abe Olugbenga

    stick injury among healthcare workers at the Federal Medical Centre (FMC), Owerri. Materials and ... health workers when exposed to work .... factors and prevention of Health care workers at .... software called Statistical Package for Social.

  13. Improving client-centred care and services : the role of front/back-office configurations

    NARCIS (Netherlands)

    Broekhuis, Manda; de Blok, C.; Meijboom, B.

    Improving client-centred care and services: the role of front/back-officeconfigurations. This paper is a report of a study conducted to explore the application of designing front- and back-office work resulting in efficient client-centred care in healthcare organizations that supply home care,

  14. Reproducibility of blood pressure variation in older ambulatory and bedridden subjects.

    Science.gov (United States)

    Tsuchihashi, Takuya; Kawakami, Yasunobu; Imamura, Tsuyoshi; Abe, Isao

    2002-06-01

    We investigated the influence of ambulation on the reproducibility of circadian blood pressure variation in older nursing home residents. Ambulatory blood pressure monitoring was performed twice in 37 older nursing home residents. Nursing home in Japan. Subjects included 18 ambulatory nursing home residents who had no limitation on physical activity and 19 bedridden residents who did not participate in physical activity. Twenty-four-hour, daytime, and nighttime blood pressure levels and their variability. The 24-hour and daytime variability of systolic blood pressure (SBP) was significantly greater in ambulatory than in bedridden subjects, whereas nighttime variability was similar. Significant correlations in SBP averaged for the whole day, daytime, and nighttime were observed between the two examinations in ambulatory (r =.80-.83) and bedridden (r =.83-.91) subjects, but the variabilities of SBP for the whole day and during the daytime of the first measurement were correlated with those of the second measurement in bedridden (r =.67 and r =.47, respectively) but not in ambulatory (r =.39 and r =.28, respectively) subjects. Significant correlations were found between the nocturnal SBP changes at two occasions in both ambulatory (r =.50) and bedridden (r =.51) subjects, but the dipper versus nondipper profiles, defined as reduction in SBP of greater than 10% versus not, showed low reproducibility in ambulatory subjects; five ambulatory (28%) and one bedridden (5%) subjects showed divergent profiles between the two examinations. The reproducibility of blood pressure variation in nursing home residents is influenced by ambulation.

  15. Cervical cancer screening in women referred to healthcare centres in Tabriz, Iran.

    Science.gov (United States)

    Farshbaf-Khalili, Azizeh; Salehi-Pourmehr, Hanieh; Shahnazi, Mahnaz; Yaghoubi, Sina; Gahremani-Nasab, Parvaneh

    2015-01-01

    Cervical cancer is the second most common cancer among Iranian women and among the few cancers that could be easily diagnosed in the pre-malignant stage. We aimed to assess the status of cervical cancer screening in women referred to health care centres in Tabriz, northwest Iran. This descriptive-analytical study was done on 441 women referred to health care centres of Tabriz, northwest Iran. The centres were selected using the multi-stage cluster sampling method. The participants were selected from the active records of those centres. A questionnaire regarding the socio-demographic characteristics and cervical cancer screening and reasons for referring or not referring for screening was completed by the participants A P marriage or having sexual intercourse at a young age, history of obvious cervical infection, cautery, cryotherapy or repeated curettage), age and type of family planning] in screening was controlled. Suitable and continuous educational programmes especially for high risk women should be implemented through the health care services. Preparing educational brochures and pamphlets and providing adequate training on the necessity of early referral and marriage counseling could also be effective in improving woman's awareness and performance.

  16. Implementing standards for the interoperability among healthcare providers in the public regionalized Healthcare Information System of the Lombardy Region.

    Science.gov (United States)

    Barbarito, Fulvio; Pinciroli, Francesco; Mason, John; Marceglia, Sara; Mazzola, Luca; Bonacina, Stefano

    2012-08-01

    Information technologies (ITs) have now entered the everyday workflow in a variety of healthcare providers with a certain degree of independence. This independence may be the cause of difficulty in interoperability between information systems and it can be overcome through the implementation and adoption of standards. Here we present the case of the Lombardy Region, in Italy, that has been able, in the last 10 years, to set up the Regional Social and Healthcare Information System, connecting all the healthcare providers within the region, and providing full access to clinical and health-related documents independently from the healthcare organization that generated the document itself. This goal, in a region with almost 10 millions citizens, was achieved through a twofold approach: first, the political and operative push towards the adoption of the Health Level 7 (HL7) standard within single hospitals and, second, providing a technological infrastructure for data sharing based on interoperability specifications recognized at the regional level for messages transmitted from healthcare providers to the central domain. The adoption of such regional interoperability specifications enabled the communication among heterogeneous systems placed in different hospitals in Lombardy. Integrating the Healthcare Enterprise (IHE) integration profiles which refer to HL7 standards are adopted within hospitals for message exchange and for the definition of integration scenarios. The IHE patient administration management (PAM) profile with its different workflows is adopted for patient management, whereas the Scheduled Workflow (SWF), the Laboratory Testing Workflow (LTW), and the Ambulatory Testing Workflow (ATW) are adopted for order management. At present, the system manages 4,700,000 pharmacological e-prescriptions, and 1,700,000 e-prescriptions for laboratory exams per month. It produces, monthly, 490,000 laboratory medical reports, 180,000 radiology medical reports, 180

  17. Harnessing the privatisation of China's fragmented health-care delivery.

    Science.gov (United States)

    Yip, Winnie; Hsiao, William

    2014-08-30

    Although China's 2009 health-care reform has made impressive progress in expansion of insurance coverage, much work remains to improve its wasteful health-care delivery. Particularly, the Chinese health-care system faces substantial challenges in its transformation from a profit-driven public hospital-centred system to an integrated primary care-based delivery system that is cost effective and of better quality to respond to the changing population needs. An additional challenge is the government's latest strategy to promote private investment for hospitals. In this Review, we discuss how China's health-care system would perform if hospital privatisation combined with hospital-centred fragmented delivery were to prevail--population health outcomes would suffer; health-care expenditures would escalate, with patients bearing increasing costs; and a two-tiered system would emerge in which access and quality of care are decided by ability to pay. We then propose an alternative pathway that includes the reform of public hospitals to pursue the public interest and be more accountable, with public hospitals as the benchmarks against which private hospitals would have to compete, with performance-based purchasing, and with population-based capitation payment to catalyse coordinated care. Any decision to further expand the for-profit private hospital market should not be made without objective assessment of its effect on China's health-policy goals. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2012-02-03

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

  19. Acupuncture in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Norheim AJ

    2015-09-01

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

  20. [Comparative analysis of efficiency indicators in ambulatory surgery].

    Science.gov (United States)

    Rodríguez Ortega, María; Porrero Carro, José Luis; Aranaz Andrés, Jesús María; Castillo Fe, María José; Alonso García, María Teresa; Sánchez-Cabezudo Díaz-Guerra, Carlos

    2017-05-25

    To find comparative elements for quality control in major ambulatory surgery (MAS) units. Descriptive and comparative study of the Ambulatory Care Index (AI) and Substitution Index (SI) in the Santa Cristina Hospital Surgery Service (Madrid, Spain) compared to Key Indicators (KI) of the National Health Service (NHS). 7,817 MAS procedures (between 2006 and 2014) were analysed. The average annual AI was 54%, higher (p <0.0001) than «ambulatory surgery» KI. The hernia outpatient procedures (average 72%) were also superior to the national KI (p <0.0001), but ambulatory haemorrhoidectomy (average 33.6%) was clearly lower (p <0.0001). KI of the NHS are useful and allow to establish a proper development in the global AI and hernia outpatient surgery with opportunities for improvement in haemorrhoidectomy. Their collection should be careful, not including minor surgeries. Also, their usefulness could be increased if data was broken down by speciality and by complexity. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Kent C

    2014-06-01

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

  2. Interorganisational Integration: Healthcare Professionals’ Perspectives on Barriers and Facilitators within the Danish Healthcare System

    Directory of Open Access Journals (Sweden)

    Anne Marie Lyngsø

    2016-03-01

    Full Text Available Introduction: Despite many initiatives to improve coordination of patient pathways and intersectoral cooperation, Danish health care is still fragmented, lacking intra- and interorganisational integration. This study explores barriers to and facilitators of interorganisational integration as perceived by healthcare professionals caring for patients with chronic obstructive pulmonary disease within the Danish healthcare system. Methods: Seven focus groups were conducted in January through July 2014 with 21 informants from general practice, local healthcare centres and a pulmonary department at a university hospital in the Capital Region of Denmark. Results and discussion: Our results can be grouped into five influencing areas for interorganisational integration: communication/information transfer, committed leadership, patient engagement, the role and competencies of the general practitioner and organisational culture. Proposed solutions to barriers in each area hold the potential to improve care integration as experienced by individuals responsible for supporting and facilitating it. Barriers and facilitators to integrating care relate to clinical, professional, functional and normative integration. Especially, clinical, functional and normative integration seems fundamental to developing integrated care in practice from the perspective of healthcare professionals.

  3. Flexible technologies and smart clothing for citizen medicine, home healthcare, and disease prevention.

    Science.gov (United States)

    Axisa, Fabrice; Schmitt, Pierre Michael; Gehin, Claudine; Delhomme, Georges; McAdams, Eric; Dittmar, André

    2005-09-01

    Improvement of the quality and efficiency of healthcare in medicine, both at home and in hospital, is becoming more and more important for patients and society at large. As many technologies (micro technologies, telecommunication, low-power design, new textiles, and flexible sensors) are now available, new user-friendly devices can be developed to enhance the comfort and security of the patient. As clothes and textiles are in direct contact with about 90% of the skin surface, smart sensors and smart clothes with noninvasive sensors are an attractive solution for home-based and ambulatory health monitoring. Moreover, wearable devices or smart homes with exosensors are also potential solutions. All these systems can provide a safe and comfortable environment for home healthcare, illness prevention, and citizen medicine.

  4. MEMS sensor technologies for human centred applications in healthcare, physical activities, safety and environmental sensing: a review on research activities in Italy.

    Science.gov (United States)

    Ciuti, Gastone; Ricotti, Leonardo; Menciassi, Arianna; Dario, Paolo

    2015-03-17

    Over the past few decades the increased level of public awareness concerning healthcare, physical activities, safety and environmental sensing has created an emerging need for smart sensor technologies and monitoring devices able to sense, classify, and provide feedbacks to users' health status and physical activities, as well as to evaluate environmental and safety conditions in a pervasive, accurate and reliable fashion. Monitoring and precisely quantifying users' physical activity with inertial measurement unit-based devices, for instance, has also proven to be important in health management of patients affected by chronic diseases, e.g., Parkinson's disease, many of which are becoming highly prevalent in Italy and in the Western world. This review paper will focus on MEMS sensor technologies developed in Italy in the last three years describing research achievements for healthcare and physical activity, safety and environmental sensing, in addition to smart systems integration. Innovative and smart integrated solutions for sensing devices, pursued and implemented in Italian research centres, will be highlighted, together with specific applications of such technologies. Finally, the paper will depict the future perspective of sensor technologies and corresponding exploitation opportunities, again with a specific focus on Italy.

  5. MEMS Sensor Technologies for Human Centred Applications in Healthcare, Physical Activities, Safety and Environmental Sensing: A Review on Research Activities in Italy

    Directory of Open Access Journals (Sweden)

    Gastone Ciuti

    2015-03-01

    Full Text Available Over the past few decades the increased level of public awareness concerning healthcare, physical activities, safety and environmental sensing has created an emerging need for smart sensor technologies and monitoring devices able to sense, classify, and provide feedbacks to users’ health status and physical activities, as well as to evaluate environmental and safety conditions in a pervasive, accurate and reliable fashion. Monitoring and precisely quantifying users’ physical activity with inertial measurement unit-based devices, for instance, has also proven to be important in health management of patients affected by chronic diseases, e.g., Parkinson’s disease, many of which are becoming highly prevalent in Italy and in the Western world. This review paper will focus on MEMS sensor technologies developed in Italy in the last three years describing research achievements for healthcare and physical activity, safety and environmental sensing, in addition to smart systems integration. Innovative and smart integrated solutions for sensing devices, pursued and implemented in Italian research centres, will be highlighted, together with specific applications of such technologies. Finally, the paper will depict the future perspective of sensor technologies and corresponding exploitation opportunities, again with a specific focus on Italy.

  6. Redesigning the regulatory framework for ambulatory care services in New York.

    Science.gov (United States)

    Chokshi, Dave A; Rugge, John; Shah, Nirav R

    2014-12-01

    Policy Points: The landscape of ambulatory care services in the United States is rapidly changing on account of payment reform, primary care transformation, and the rise of convenient care options such as retail clinics. New York State has undertaken a redesign of regulatory policy for ambulatory care rooted in the Triple Aim (better health, higher-quality care, lower costs)-with a particular emphasis on continuity of care for patients. Key tenets of the regulatory approach include defining and tracking the taxonomy of ambulatory care services as well as ensuring that convenient care options do not erode continuity of care for patients. While hospitals remain important centers of gravity in the health system, services are increasingly being delivered through ambulatory care. This shift to ambulatory care is giving rise to new delivery structures, such as retail clinics and urgent care centers, as well as reinventing existing ambulatory care capacity, as seen with the patient-centered medical home model and the movement toward team-based care. To protect the public's interests, oversight of ambulatory care services must keep pace with these rapid changes. With this purpose, in January 2013 the New York Public Health and Health Planning Council undertook a redesign of the regulatory framework for the state's ambulatory care services. This article describes the principles undergirding the framework as well as the regulatory recommendations themselves. We explored and analyzed the regulation of ambulatory care services in New York in accordance with the available gray and peer-reviewed literature and legislative documents. The deliberations of the Public Health and Health Planning Council informed our review. The vision of high-performing ambulatory care should be rooted in the Triple Aim (better health, higher-quality care, lower costs), with a particular emphasis on continuity of care for patients. There is a pressing need to better define the taxonomy of ambulatory

  7. Performance measurement for ambulatory care: moving towards a new agenda.

    Science.gov (United States)

    Roski, J; Gregory, R

    2001-12-01

    Despite a shift in care delivery from inpatient to ambulatory care, performance measurement efforts for the different levels in ambulatory care settings such as individual physicians, individual clinics and physician organizations have not been widely instituted in the United States (U.S.). The Health Plan Employer Data and Information Set (HEDIS), the most widely used performance measurement set in the U.S., includes a number of measures that evaluate preventive and chronic care provided in ambulatory care facilities. While HEDIS has made important contributions to the tracking of ambulatory care quality, it is becoming increasingly apparent that the measurement set could be improved by providing quality of care information at the levels of greatest interest to consumers and purchasers of care, namely for individual physicians, clinics and physician organizations. This article focuses on the improvement opportunities for quality performance measurement systems in ambulatory care. Specific challenges to creating a sustainable performance measurement system at the level of physician organizations, such as defining the purpose of the system, the accountability logic, information and reporting needs and mechanisms for sustainable implementation, are discussed.

  8. Interprofessional experiences of recent healthcare graduates: A social psychology perspective on the barriers to effective communication, teamwork, and patient-centred care.

    Science.gov (United States)

    Thomson, Krist; Outram, Sue; Gilligan, Conor; Levett-Jones, Tracy

    2015-01-01

    Achieving safe, quality health care is highly dependent on effective communication between all members of the healthcare team. This study explored the attitudes and experiences of recent healthcare graduates regarding interprofessional teamwork and communication within a clinical setting. A total of 68 pharmacy, nursing, and medicine graduates participated in 12 semi-structured focus group discussions in clinical workplaces across three Australian states. Discussion focussed on graduates' experiences of interprofessional education and its impact on their capacity for interprofessional teamwork and communication. The Social Identity and Realistic Conflict theories were used as a framework for qualitative data analysis. A consistent pattern of profession-focussed, rather than patient- or team-focussed goals was revealed along with reports of negative stereotyping, hierarchical communication, and competition for time with the patient. Graduates acknowledged the importance of communication, teamwork, and patient-centred care and felt a better understanding of the roles of other health professionals would assist them to work together for patients' wellbeing. Identifying workplace identities and differential goals has uncovered possible motivations underlying health professionals' behaviour. These insights may help improve interprofessional collaboration by focusing attention on common team goals, increasing feelings of worth and being valued among different professionals, and decreasing the need for competition.

  9. Factors influencing early stage healthcare-academia partnerships.

    Science.gov (United States)

    Uvhagen, Håkan; von Knorring, Mia; Hasson, Henna; Øvretveit, John; Hansson, Johan

    2018-02-12

    Purpose The purpose of this paper is to explore factors influencing early implementation and intermediate outcomes of a healthcare-academia partnership in a primary healthcare setting. Design/methodology/approach The Academic Primary Healthcare Network (APHN) initiative was launched in 2011 in Stockholm County, Sweden and included 201 primary healthcare centres. Semi-structured interviews were conducted in 2013-2014 with all coordinating managers ( n=8) and coordinators ( n=4). A strategic change model framework was used to collect and analyse data. Findings Several factors were identified to aid early implementation: assignment and guidelines that allowed flexibility; supportive management; dedicated staff; facilities that enabled APHN actions to be integrated into healthcare practice; and positive experiences from research and educational activities. Implementation was hindered by: discrepancies between objectives and resources; underspecified guidelines that trigger passivity; limited research and educational activities; a conflicting non-supportive reimbursement system; limited planning; and organisational fragmentation. Intermediate outcomes revealed that various actions, informed by the APHN assignment, were launched in all APHNs. Practical implications The findings can be rendered applicable by preparing stakeholders in healthcare services to optimise early implementation of healthcare-academia partnerships. Originality/value This study increases understanding of interactions between factors that influence early stage partnerships between healthcare services and academia in primary healthcare settings.

  10. Trust in the early chain of healthcare: lifeworld hermeneutics from the patient’s perspective

    Science.gov (United States)

    Norberg Boysen, Gabriella; Nyström, Maria; Christensson, Lennart; Herlitz, Johan; Wireklint Sundström, Birgitta

    2017-01-01

    ABSTRACT Purpose: Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for a non-urgent condition and been referred to the healthcare centre. Method: A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patients participated: seven female and three male. The setting is the early chain of healthcare in south-western Sweden. Results: The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient’s lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the “voice of the lifeworld” enables the patient to feel trust. Conclusion: Trust in the early chain of healthcare entails caregivers’ ability to pay attention to both medical and existential issues in compliance with the patient’s information and questions. Thus, the patient must be invited to participate in assessments and decisions concerning his or her own healthcare, in a credible manner and using everyday language. PMID:28793852

  11. Ambulatory arterial stiffness index during pregnancy in type 1 diabetes mellitus

    DEFF Research Database (Denmark)

    Lauszus, Finn; Al-Far, Hanine M; Tjessem, Ingvild

    2016-01-01

    The ambulatory arterial stiffness index (AASI) and pulse pressure (PP) was analyzed during pregnancy and three months after delivery in type 1 diabetes mellitus (T1DM) compared to non-diabetic, pregnant controls. The study was performed prospectively in 176 women with T1DM and 54 control women...... at a tertiary centre. Blood pressure (BP) was measured using a portable oscillometry monitor and AASI was calculated as 1 minus the regression slope of diastolic BP on systolic BP obtained from 24-hour monitoring. Main outcome measures were AASI and PP associated with diabetes vasculopathy and blood pressure...... measurements during and after pregnancy. We found that AASI and PP were higher in 2nd and 3rd trimester during pregnancy in T1DM compared to post partum and significantly associated with albumin excretion rate. The AASI was positively correlated with night-day ratio during and outside pregnancy in diastolic BP...

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

    Directory of Open Access Journals (Sweden)

    Mia Skov-Madsen

    2008-11-01

    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

  13. Clinical value of ambulatory blood pressure: evidence and limits.

    Science.gov (United States)

    Mancia, Giuseppe; Verdecchia, Paolo

    2015-03-13

    This article reviews the clinical value of ambulatory blood pressure (BP) vis-à-vis the traditional BP measurements taken in the physician's office or in the hospital. Mention is initially made that longitudinal studies conducted in the general population or in hypertensive cohorts have shown that ambulatory BP provides a more accurate prediction of outcome than office BP. Namely, that (1) the risk of cardiovascular events increases in a less steep fashion with office than with 24-hour mean BP, (2) the 24-hour BP-dependent prediction is maintained after adjustment for office BP values, and (3) among individuals with normal office BP, those with increased ambulatory BP (masked hypertension) have an increased prevalence of organ damage, a more frequent unfavorable metabolic profile and a higher risk of new onset sustained hypertension, diabetes mellitus, and cardiovascular events than those with normal ambulatory BP. It is further mentioned, however, that more recently similar observations have been made for individuals with high office but normal ambulatory BP (white coat hypertension) suggesting a complementary role of out-of-office and office BP values in the determination of patients' prognosis. The evidence in favor of an independent prognostic value also of some within 24-hour BP phenomena (night BP reduction or absolute values, short-term BP variations, and morning BP surge) is then critically appraised for its elements of strength and weakness. Finally, whether the clinical advantages of ambulatory BP make this approach necessary for all patients with hypertension is discussed. The conclusion is that this is at present still premature because crucial evidence pro or against routine use of this approach in untreated and treated hypertensives is not yet available. It will be crucial for future studies to determine whether, compared with a treatment guided by office BP, a treatment tailored on ambulatory BP allows to improve prevention or regression of organ

  14. Preanalytical errors in primary healthcare: a questionnaire study of information search procedures, test request management and test tube labelling.

    Science.gov (United States)

    Söderberg, Johan; Brulin, Christine; Grankvist, Kjell; Wallin, Olof

    2009-01-01

    Most errors in laboratory medicine occur in the preanalytical phase and are the result of human mistakes. This study investigated information search procedures, test request management and test tube labelling in primary healthcare compared to the same procedures amongst clinical laboratory staff. A questionnaire was completed by 317 venous blood sampling staff in 70 primary healthcare centres and in two clinical laboratories (response rate = 94%). Correct procedures were not always followed. Only 60% of the primary healthcare staff reported that they always sought information in the updated, online laboratory manual. Only 12% reported that they always labelled the test tubes prior to drawing blood samples. No major differences between primary healthcare centres and clinical laboratories were found, except for test tube labelling, whereby the laboratory staff reported better practices. Re-education and access to documented routines were not clearly associated with better practices. The preanalytical procedure in the surveyed primary healthcare centres was associated with a risk of errors which could affect patient safety. To improve patient safety in laboratory testing, all healthcare providers should survey their preanalytical procedures and improve the total testing process with a systems perspective.

  15. Situation Analysis of Healthcare Service Delivery using ...

    African Journals Online (AJOL)

    ISML5

    Geography plays an important role in planning and allocation of healthcare resources for an effective and efficient ... utilization and gaps in resource allocation, and to develop propositions to support the health policy. Facility survey and .... Figure 2. Location of health centres against population density in Sironko district ...

  16. Beyond the clinic: redefining hospital ambulatory care.

    Science.gov (United States)

    Rogut, L

    1997-07-01

    Responding to changes in health care financing, government policy, technology, and clinical judgment, and the rise of managed care, hospitals are shifting services from inpatient to outpatient settings and moving them into the community. Institutions are evolving into integrated delivery systems, developing the capacity to provide a continuum of coordinated services in an array of settings and to share financial risk with physicians and managed care organizations. Over the past several years, hospitals in New York City have shifted considerable resources into ambulatory care. In their drive to expand and enhance services, however, they face serious challenges, including a well-established focus on hospitals as inpatient centers of tertiary care and medical education, a heavy reliance upon residents as providers of medical care, limited access to capital, and often inadequate physical plants. In 1995, the United Hospital Fund awarded $600,000 through its Ambulatory Care Services Initiative to support hospitals' efforts to meet the challenges of reorganizing services, compete in a managed care environment, and provide high-quality ambulatory care in more efficient ways. Through the initiative, 12 New York City hospitals started projects to reorganize service delivery and build an infrastructure of systems, technology, and personnel. Among the projects undertaken by the hospitals were:--broad-based reorganization efforts employing primary care models to improve and expand existing ambulatory care services, integrate services, and better coordinate care;--projects to improve information management, planning and testing new systems for scheduling appointments, registering patients, and tracking ambulatory care and its outcomes;--training programs to increase the supply of primary care providers (both nurse practitioners and primary care physicians), train clinical and support staff in the skills needed to deliver more efficient and better ambulatory care, prepare staff

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

    Science.gov (United States)

    Allen, Juliet Walshe

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Eng MR

    2015-07-01

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

  19. Maximising value from a United Kingdom Biomedical Research Centre: study protocol

    OpenAIRE

    Greenhalgh, Trisha; Ovseiko, Pavel V.; Fahy, Nick; Shaw, Sara; Kerr, Polly; Rushforth, Alexander D.; Channon, Keith M.; Kiparoglou, Vasiliki

    2017-01-01

    Background Biomedical Research Centres (BRCs) are partnerships between healthcare organisations and universities in England. Their mission is to generate novel treatments, technologies, diagnostics and other interventions that increase the country’s international competitiveness, to rapidly translate these innovations into benefits for patients, and to improve efficiency and reduce waste in healthcare. As NIHR Oxford BRC (Oxford BRC) enters its third 5-year funding period, we seek to (1) a...

  20. Healthcare information technology and medical-surgical nurses: the emergence of a new care partnership.

    Science.gov (United States)

    Moore, An'Nita; Fisher, Kathleen

    2012-03-01

    Healthcare information technology in US hospitals and ambulatory care centers continues to expand, and nurses are expected to effectively and efficiently utilize this technology. Researchers suggest that clinical information systems have expanded the realm of nursing to integrate technology as an element as important in nursing practice as the patient or population being served. This study sought to explore how medical surgical nurses make use of healthcare information technology in their current clinical practice and to examine the influence of healthcare information technology on nurses' clinical decision making. A total of eight medical surgical nurses participated in the study, four novice and four experienced. A conventional content analysis was utilized that allowed for a thematic interpretation of participant data. Five themes emerged: (1) healthcare information technology as a care coordination partner, (2) healthcare information technology as a change agent in the care delivery environment, (3) healthcare information technology-unable to meet all the needs, of all the people, all the time, (4) curiosity about healthcare information technology-what other bells and whistles exist, and (5) Big Brother is watching. The results of this study indicate that a new care partnership has emerged as the provision of nursing care is no longer supplied by a single practitioner but rather by a paired team, consisting of nurses and technology, working collaboratively in an interdependent relationship to achieve established goals.

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

    Science.gov (United States)

    Viera, Anthony J.; Shimbo, Daichi

    2016-01-01

    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 can be segmented into time windows of particular interest, e.g., mean daytime and nighttime values. During sleep, blood pressure typically decreases, or dips, such that mean sleep blood pressure is lower than mean awake blood pressure. A non-dipping pattern and nocturnal hypertension are strongly associated with increased cardiovascular morbidity and mortality. Approximately 70% of individuals dip ≥10% at night, while 30% have non-dipping patterns, when blood pressure remains similar to daytime average, or occasionally rises above daytime average. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure since they increase accuracy for diagnosis and the prediction of cardiovascular risk. PMID:25107387

  2. Distribution and utilization of curative primary healthcare services in Lahej, Yemen.

    Science.gov (United States)

    Bawazir, A A; Bin Hawail, T S; Al-Sakkaf, K A Z; Basaleem, H O; Muhraz, A F; Al-Shehri, A M

    2013-09-01

    No evidence-based data exist on the availability, accessibility and utilization of healthcare services in Lahej Governorate, Yemen. The aim of this study was to assess the distribution and utilization of curative services in primary healthcare units and centres in Lahej. Cross-sectional study (clustering sample). This study was conducted in three of the 15 districts in Lahej between December 2009 and August 2010. Household members were interviewed using a questionnaire to determine sociodemographic characteristics and types of healthcare services available in the area. The distribution of health centres, health units and hospitals did not match the size of the populations or areas of the districts included in this study. Geographical accessibility was the main obstacle to utilization. Factors associated with the utilization of curative services were significantly related to the time required to reach the nearest facility, seeking curative services during illness and awareness of the availability of health facilities (P < 0.01). There is an urgent need to look critically and scientifically at the distribution of healthcare services in the region in order to ensure accessibility and quality of services. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  3. Management of comorbidities in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Dabu-Bondoc S

    2015-06-01

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

  4. ICT applications as e-health solutions in rural healthcare in the Eastern Cape Province of South Africa.

    Science.gov (United States)

    Ruxwana, Nkqubela L; Herselman, Marlien E; Conradie, D Pieter

    Information and Communication Technology (ICT) solutions (e.g. e-health, telemedicine, e-education) are often viewed as vehicles to bridge the digital divide between rural and urban healthcare centres and to resolve shortcomings in the rural health sector. This study focused on factors perceived to influence the uptake and use of ICTs as e-health solutions in selected rural Eastern Cape healthcare centres, and on structural variables relating to these facilities and processes. Attention was also given to two psychological variables that may underlie an individual&s acceptance and use of ICTs: usefulness and ease of use. Recommendations are made with regard to how ICTs can be used more effectively to improve health systems at fi ve rural healthcare centres where questionnaire and interview data were collected: St. Lucy&s Hospital, Nessie Knight Hospital, the Tsilitwa Clinic, the Madzikane Ka-Zulu Memorial Hospital and the Nelson Mandela General Hospital.

  5. A Community Standard: Equivalency of Healthcare in Australian Immigration Detention.

    Science.gov (United States)

    Essex, Ryan

    2017-08-01

    The Australian government has long maintained that the standard of healthcare provided in its immigration detention centres is broadly comparable with health services available within the Australian community. Drawing on the literature from prison healthcare, this article examines (1) whether the principle of equivalency is being applied in Australian immigration detention and (2) whether this standard of care is achievable given Australia's current policies. This article argues that the principle of equivalency is not being applied and that this standard of health and healthcare will remain unachievable in Australian immigration detention without significant reform. Alternate approaches to addressing the well documented issues related to health and healthcare in Australian immigration detention are discussed.

  6. Special report. Twin Cities hospital breaks down ambulatory care, overcomes fears of outpatient care.

    Science.gov (United States)

    1995-01-06

    With payers pushing for shorter hospital stays and outpatient services generating growing shares of hospitals' revenues, experts everywhere are projecting the end of the traditional inpatient-oriented hospital. Those predictions have triggered a scramble by many hospital managers to adapt their organizations and empty beds to the expected predominance of same-day services. One Minnesota facility that surveyed the outpatient trend, however, found that its strategic options weren't limited to becoming a jumbo-sized outpatient clinic, explain David Allen, a partner with The Chancellor Group, Bloomington, Minn., and Daniel Weber, vice president of Fairview Southdale Hospital, Edina, Minn., in this special report. By understanding the multidimensional nature of ambulatory services and focusing its efforts on becoming a regional hub of healthcare services, Fairview Southdale has carved its own niche in a changing provider market.

  7. Contextualisation of patient-centred care

    DEFF Research Database (Denmark)

    Dencker, Annemarie; Kristiansen, Maria; Andreassen Rix, Bo

    2018-01-01

    . In this qualitative comparative study, we explore the influence of medical contexts in three Danish hospital wards, haematology, oncological gynaecology and neuro-intensive care, on communication with patients about their children. In exploring the degree to which the inclusion of children in clinical encounters......Patients' family relations play an important part in the provision of patient-centred cancer care, not least when healthcare professionals encounter seriously ill patients with dependent children. Little is known about how children are perceived and dealt with in clinical encounters....... The thematic analysis was based on Bateson's conceptualisation of communication. We found that healthcare professionals' approach to children in clinical encounters and the ways in which children were positioned on each ward were influenced by aspects specific to the ward, including the diagnosis...

  8. Relationship Between 24-Hour Ambulatory Blood Pressure and Cognitive Function in Community-Living Older Adults: The UCSD Ambulatory Blood Pressure Study.

    Science.gov (United States)

    Conway, Kyle S; Forbang, Nketi; Beben, Tomasz; Criqui, Michael H; Ix, Joachim H; Rifkin, Dena E

    2015-12-01

    Twenty-four-hour ambulatory blood pressure (BP) patterns have been associated with diminished cognitive function in hypertensive and very elderly populations. The relationship between ambulatory BP patterns and cognitive function in community-living older adults is unknown. We conducted a cross-sectional study in which 24-hour ambulatory BP, in-clinic BP, and cognitive function measures were obtained from 319 community-living older adults. The mean age was 72 years, 66% were female, and 13% were African-American. We performed linear regression with performance on the Montreal Cognitive Assessment (MoCA) as the primary outcome and 24-hour BP patterns as the independent variable, adjusting for age, sex, race/ethnicity, education, and comorbidities. Greater nighttime systolic dipping (P = 0.046) and higher 24-hour diastolic BP (DBP; P = 0.015) were both significantly associated with better cognitive function, whereas 24-hour systolic BP (SBP), average real variability, and ambulatory arterial stiffness were not. Higher 24-hour DBP and greater nighttime systolic dipping were significantly associated with improved cognitive function. Future studies should examine whether low 24-hour DBP and lack of nighttime systolic dipping predict future cognitive impairment. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  9. Preliminary study of percutaneous nephrolithotomy on an ambulatory basis.

    Science.gov (United States)

    El-Tabey, Magdy Ahmed; Abd-Allah, Osama Abdel-Wahab; Ahmed, Ahmed Sebaey; El-Barky, Ehab Mohammed; Noureldin, Yasser Abdel-Sattar

    2013-02-01

    Preliminary study to assess the feasibility and safety of percutaneous nephrolithotomy (PCNL) as an ambulatory procedure. Between February 2011 and September 2012, 84 patients with renal calculi fulfilling the inclusion criteria were admitted to the Urology Department of Benha University Hospitals for PCNL. All patients were subjected to a full medical history, clinical, laboratory and radiological examinations. Tubeless PCNLs were done in the supine position, and an antegrade double-J stent was inserted. Operative time and intraoperative complications were recorded. Postoperatively, the hematocrit value, postoperative pain and analgesics, need of blood transfusion, stone-free rate, and length of hospital stay were recorded. Stable patients that could be safely discharged within 24 hours after surgery were considered ambulatory. All cases of tubeless PCNL were successfully done and no cases converted to open surgery. The overall stone-free rate was 91.7%, the mean postoperative pain score measured by the visual analog scale was 4.4 ± 1.2, the mean overall hematocrit deficit was 4.8 ± 2.2% and the mean hospital stay was 33.4 ± 17.5 hours. Ambulatory PCNL was accomplished in 60 out of 84 patients (71.4%) and double-J stents were removed 7-10 days postoperatively. In the non-ambulatory cases, double-J stents were removed after auxillary procedures were done according to each case. PCNL can be safely done on an ambulatory basis under strict criteria, but further studies are needed to confirm and expand these findings.

  10. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Shah U

    2015-04-01

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

  11. Needs and concerns of transgender individuals regarding interdisciplinary transgender healthcare: A non-clinical online survey.

    Directory of Open Access Journals (Sweden)

    Jana Eyssel

    Full Text Available This study investigates the needs and concerns transgender (short: trans individuals have concerning trans healthcare (THC in interdisciplinary THC centres. Trans individuals' gender does not (fully/constantly match their sex assigned at birth. To be able to live in their gender role and to prevent or minimise gender dysphoria, they might require a multidisciplinary set of transition related healthcare services. The current shift from the traditionally highly regulated, hierarchical and pathologising approach to THC towards a more patient-centred approach has highlighted the importance of trans patients' satisfaction with treatment processes and results. As the still influential regulations have a negative effect on patient satisfaction, and might also keep trans individuals from seeking transition related treatment, it is crucial to investigate what trans individuals, whether patients or not, need and fear regarding transition related healthcare. Against the backdrop of mixed reactions received from the local trans community regarding the foundation of the Interdisciplinary Transgender Healthcare Centre Hamburg (ITHCCH, Germany, this study seeks to determine what trans individuals need with respect to THC in order to guarantee for high quality service provision at the ITHCCH. To this end, an online questionnaire was developed. The researchers employed a participatory approach to questionnaire development by involving a working group consisting of local trans support group representatives and (THC specialists (N = 4. The sample consisted of N = 415 trans-identified individuals aged between 16 and 76. Most of them were based in Germany. 85.2% (n = 382 reported experience with transition related healthcare and 72.5% (n = 301 had (additional treatments planned. Analysis revealed a need for communication and feedback opportunities. Furthermore, during the treatment process, addressing individual needs was considered crucial by participants. They

  12. Needs and concerns of transgender individuals regarding interdisciplinary transgender healthcare: A non-clinical online survey

    Science.gov (United States)

    Koehler, Andreas; Dekker, Arne; Sehner, Susanne; Nieder, Timo O.

    2017-01-01

    This study investigates the needs and concerns transgender (short: trans) individuals have concerning trans healthcare (THC) in interdisciplinary THC centres. Trans individuals’ gender does not (fully/constantly) match their sex assigned at birth. To be able to live in their gender role and to prevent or minimise gender dysphoria, they might require a multidisciplinary set of transition related healthcare services. The current shift from the traditionally highly regulated, hierarchical and pathologising approach to THC towards a more patient-centred approach has highlighted the importance of trans patients’ satisfaction with treatment processes and results. As the still influential regulations have a negative effect on patient satisfaction, and might also keep trans individuals from seeking transition related treatment, it is crucial to investigate what trans individuals, whether patients or not, need and fear regarding transition related healthcare. Against the backdrop of mixed reactions received from the local trans community regarding the foundation of the Interdisciplinary Transgender Healthcare Centre Hamburg (ITHCCH), Germany, this study seeks to determine what trans individuals need with respect to THC in order to guarantee for high quality service provision at the ITHCCH. To this end, an online questionnaire was developed. The researchers employed a participatory approach to questionnaire development by involving a working group consisting of local trans support group representatives and (THC) specialists (N = 4). The sample consisted of N = 415 trans-identified individuals aged between 16 and 76. Most of them were based in Germany. 85.2% (n = 382) reported experience with transition related healthcare and 72.5% (n = 301) had (additional) treatments planned. Analysis revealed a need for communication and feedback opportunities. Furthermore, during the treatment process, addressing individual needs was considered crucial by participants. They agreed

  13. Exploitation of Clustering Techniques in Transactional Healthcare Data

    Directory of Open Access Journals (Sweden)

    Naeem Ahmad Mahoto

    2014-03-01

    Full Text Available Healthcare service centres equipped with electronic health systems have improved their resources as well as treatment processes. The dynamic nature of healthcare data of each individual makes it complex and difficult for physicians to manually mediate them; therefore, automatic techniques are essential to manage the quality and standardization of treatment procedures. Exploratory data analysis, patternanalysis and grouping of data is managed using clustering techniques, which work as an unsupervised classification. A number of healthcare applications are developed that use several data mining techniques for classification, clustering and extracting useful information from healthcare data. The challenging issue in this domain is to select adequate data mining algorithm for optimal results. This paper exploits three different clustering algorithms: DBSCAN (Density-Based Clustering, agglomerative hierarchical and k-means in real transactional healthcare data of diabetic patients (taken as case study to analyse their performance in large and dispersed healthcare data. The best solution of cluster sets among the exploited algorithms is evaluated using clustering quality indexes and is selected to identify the possible subgroups of patients having similar treatment patterns

  14. Development of quality metrics for ambulatory pediatric cardiology: Infection prevention.

    Science.gov (United States)

    Johnson, Jonathan N; Barrett, Cindy S; Franklin, Wayne H; Graham, Eric M; Halnon, Nancy J; Hattendorf, Brandy A; Krawczeski, Catherine D; McGovern, James J; O'Connor, Matthew J; Schultz, Amy H; Vinocur, Jeffrey M; Chowdhury, Devyani; Anderson, Jeffrey B

    2017-12-01

    In 2012, the American College of Cardiology's (ACC) Adult Congenital and Pediatric Cardiology Council established a program to develop quality metrics to guide ambulatory practices for pediatric cardiology. The council chose five areas on which to focus their efforts; chest pain, Kawasaki Disease, tetralogy of Fallot, transposition of the great arteries after arterial switch, and infection prevention. Here, we sought to describe the process, evaluation, and results of the Infection Prevention Committee's metric design process. The infection prevention metrics team consisted of 12 members from 11 institutions in North America. The group agreed to work on specific infection prevention topics including antibiotic prophylaxis for endocarditis, rheumatic fever, and asplenia/hyposplenism; influenza vaccination and respiratory syncytial virus prophylaxis (palivizumab); preoperative methods to reduce intraoperative infections; vaccinations after cardiopulmonary bypass; hand hygiene; and testing to identify splenic function in patients with heterotaxy. An extensive literature review was performed. When available, previously published guidelines were used fully in determining metrics. The committee chose eight metrics to submit to the ACC Quality Metric Expert Panel for review. Ultimately, metrics regarding hand hygiene and influenza vaccination recommendation for patients did not pass the RAND analysis. Both endocarditis prophylaxis metrics and the RSV/palivizumab metric passed the RAND analysis but fell out during the open comment period. Three metrics passed all analyses, including those for antibiotic prophylaxis in patients with heterotaxy/asplenia, for influenza vaccination compliance in healthcare personnel, and for adherence to recommended regimens of secondary prevention of rheumatic fever. The lack of convincing data to guide quality improvement initiatives in pediatric cardiology is widespread, particularly in infection prevention. Despite this, three metrics were

  15. Center of mass movement estimation using an ambulatory measurement sytem

    NARCIS (Netherlands)

    Schepers, H. Martin; Veltink, Petrus H.

    2007-01-01

    Center of Mass (CoM) displacement, an important variable to characterize human walking, was estimated in this study using an ambulatory measurement system. The ambulatory system was compared to an optical reference system. Root-mean-square differences between the magnitudes of the CoM appeared to be

  16. A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol.

    Science.gov (United States)

    Hafskjold, Linda; Sundler, Annelie J; Holmström, Inger K; Sundling, Vibeke; van Dulmen, Sandra; Eide, Hilde

    2015-04-15

    This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of the COMHOME study is to generate knowledge on person-centred communication with older people (>65 years) in home healthcare services, radiographic and optometric practice. This study will explore the communication between care providers and older persons in home care services. Home healthcare visits will be audiorecorded (n=500) in Norway, the Netherlands and Sweden. Analyses will be performed with the Verona Coding Definitions for Emotional Sequences (VR-CoDES), the Roter Interaction Analysis System (RIAS) and qualitative methods. The content of the communication, communicative challenging situations as well as empathy, power distance, decision-making, preservation of dignity and respect will be explored. In Norway, an additional 100 encounters, 50 in optometric practice (video recorded) and 50 in radiographic practice (audiorecorded), will be analysed. Furthermore, healthcare providers' self-reported communication skills, empathy, mindfulness and emotional intelligence in relation to observed person-centred communication skills will be assessed using well-established standardised instruments. Depending on national legislation, approval of either the central ethical committees (eg, nation or university), the national data protection officials or the local ethical committees (eg, units of home healthcare) was obtained. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. The research findings will add knowledge to improve services provided to this vulnerable group of patients. Additionally, the findings will underpin a training programme for healthcare students and care providers focusing on communication with older people

  17. Constructions of the patient in healthcare communications: six patient figures.

    Science.gov (United States)

    Pors, Anja Svejgaard

    2016-01-01

    The purpose of this paper is to examine how strategic, patient-centred communication plays a part in the discursive management of expectations posed to patients and healthcare organizations. The paper provides an analysis of four documents collected as part of an ethnographic case study regarding "The Perspective of the Patient" - a Danish Hospital's patient-centred communication programme. Mapping methods inspired by Grounded Theory are used to qualify the analysis. The paper shows that strategic patient-centred communication addresses both a care-oriented approach to the patient and deploys market perceptions of patients. Market and care is seen as co-existing organizing modes that entail expectations to the patient. In the communication programme the patient is constructed in six information-seeking patient figures: affective patient; target group patient; citizen with rights; patient as a competent resource; user as active partner; and consumer. As a result, the patient-centred communication programme renders the patient as a flexible figure able to fit organizational demands of both care orientation and market concerns. This study contributes to qualitative research in organizational health communication by combining two subfields - patient-centredness and health communication - in an empirical study of how market and care are intertwined in a patient-centred communication programme. The argument goes beyond the prevalent prescriptive approaches to patient-centredness and healthcare communication, instead providing a critical analytical perspective on strategic communication and patient-centredness and showing how expectations are posed to both patient and organization.

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

    Directory of Open Access Journals (Sweden)

    Yvonne Ying Ru Ng

    2014-01-01

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

  19. Caregiver experiences of racism and child healthcare utilisation: cross-sectional analysis from New Zealand.

    Science.gov (United States)

    Paine, Sarah-Jane; Harris, Ricci; Stanley, James; Cormack, Donna

    2018-03-23

    Children's exposure to racism via caregiver experience (vicarious racism) is associated with poorer health and development. However, the relationship with child healthcare utilisation is unknown. We aimed to investigate (1) the prevalence of vicarious racism by child ethnicity; (2) the association between caregiver experiences of racism and child healthcare utilisation; and (3) the contribution of caregiver socioeconomic position and psychological distress to this association. Cross-sectional analysis of two instances of the New Zealand Health Survey (2006/2007: n=4535 child-primary caregiver dyads; 2011/2012: n=4420 dyads). Children's unmet need for healthcare, reporting no usual medical centre and caregiver-reported dissatisfaction with their child's medical centre. The prevalence of reporting 'any' experience of racism was higher among caregivers of indigenous Māori and Asian children (30.0% for both groups in 2006/2007) compared with European/Other children (14.4% in 2006/2007). Vicarious racism was independently associated with unmet need for child's healthcare (OR=2.30, 95% CI 1.65 to 3.20) and dissatisfaction with their child's medical centre (OR=2.00, 95% CI 1.26 to 3.16). Importantly, there was a dose-response relationship between the number of reported experiences of racism and child healthcare utilisation (eg, unmet need: 1 report of racism, OR=1.89, 95% CI 1.34 to 2.67; 2+ reports of racism, OR=3.06, 95% CI 1.27 to 7.37). Adjustment for caregiver psychological distress attenuated the association between caregiver experiences of racism and child healthcare utilisation. Vicarious racism is a serious health problem in New Zealand disproportionately affecting Māori and Asian children and significantly impacting children's healthcare utilisation. Tackling racism may be an important means of improving inequities in child healthcare utilisation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All

  20. Patient-centredness in integrated healthcare delivery systems - needs, expectations and priorities for organised healthcare systems.

    Science.gov (United States)

    Juhnke, Christin; Mühlbacher, Axel C

    2013-01-01

    Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems. A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales. Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser-Meyer-Olkin of 0.914 for the patients (experts: 38.427%, Kaiser-Meyer-Olkin = 0.797). Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination. The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

  1. US National Practice Patterns in Ambulatory Operative Management of Lateral Epicondylitis.

    Science.gov (United States)

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

    2015-12-01

    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.

  2. Developing a business-practice model for pharmacy services in ambulatory settings.

    Science.gov (United States)

    Harris, Ila M; Baker, Ed; Berry, Tricia M; Halloran, Mary Ann; Lindauer, Kathleen; Ragucci, Kelly R; McGivney, Melissa Somma; Taylor, A Thomas; Haines, Stuart T

    2008-02-01

    A business-practice model is a guide, or toolkit, to assist managers and clinical pharmacy practitioners in the exploration, proposal, development and implementation of new clinical pharmacy services and/or the enhancement of existing services. This document was developed by the American College of Clinical Pharmacy Task Force on Ambulatory Practice to assist clinical pharmacy practitioners and administrators in the development of business-practice models for new and existing clinical pharmacy services in ambulatory settings. This document provides detailed instructions, examples, and resources on conducting a market assessment and a needs assessment, types of clinical services, operations, legal and regulatory issues, marketing and promotion, service development and exit plan, evaluation of service outcomes, and financial considerations in the development of a clinical pharmacy service in the ambulatory environment. Available literature is summarized, and an appendix provides valuable citations and resources. As ambulatory care practices continue to evolve, there will be increased knowledge of how to initiate and expand the services. This document is intended to serve as an essential resource to assist in the growth and development of clinical pharmacy services in the ambulatory environment.

  3. Accessibility and use of primary healthcare for immigrants living in the Niagara Region.

    Science.gov (United States)

    Lum, Irene D; Swartz, Rebecca H; Kwan, Matthew Y W

    2016-05-01

    Although the challenges of accessing and using primary healthcare for new immigrants to Canada have been fairly well documented, the focus has primarily been on large cities with significant immigrant populations. The experiences of immigrants living in smaller, less diverse urban centres remain largely unknown. The purpose of this study was to examine the lived experiences of immigrants living in a small urban centre with regards to the primary healthcare system. A total of 13 immigrants living in the Greater Niagara Region participated in semi-structured interviews. All interviews were recorded, transcribed, and then coded and analyzed for emergent themes using NVivo. Five factors were found to impact primary care access and use: lack of social contacts, lack of universal healthcare coverage during their initial arrival, language as a barrier, treatment preferences, and geographic distance to primary care. Overall findings suggest that immigrants moving to smaller areas such as the Niagara Region face similar barriers to primary care as those moving into large cities. Some barriers, however, appear to be specific to the context of smaller urban centres, further exacerbated by living in a small city due to a smaller immigrant population, fewer services for immigrants, and less diversity in practicing physicians. More research is required to understand the contextual factors inhibiting primary care access and use among immigrants moving to smaller urban centres, and determine effective strategies to overcome these barriers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Office blood pressure or ambulatory blood pressure for the prediction of cardiovascular events

    DEFF Research Database (Denmark)

    Mortensen, Rikke Nørmark; Gerds, Thomas Alexander; Jeppesen, Jørgen Lykke

    2017-01-01

    Aims: To determine the added value of (i) 24-h ambulatory blood pressure relative to office blood pressure and (ii) night-time ambulatory blood pressure relative to daytime ambulatory blood pressure for 10-year person-specific absolute risks of fatal and non-fatal cardiovascular events. Methods...... and results: A total of 7927 participants were included from the International Database on Ambulatory blood pressure monitoring in relation to Cardiovascular Outcomes. We used cause-specific Cox regression to predict 10-year person-specific absolute risks of fatal and non-fatal cardiovascular events....... Discrimination of 10-year outcomes was assessed by time-dependent area under the receiver operating characteristic curve (AUC). No differences in predicted risks were observed when comparing office blood pressure and ambulatory blood pressure. The median difference in 10-year risks (1st; 3rd quartile) was -0...

  5. The evolution of ambulatory ECG monitoring.

    Science.gov (United States)

    Kennedy, Harold L

    2013-01-01

    Ambulatory Holter electrocardiographic (ECG) monitoring has undergone continuous technological evolution since its invention and development in the 1950s era. With commercial introduction in 1963, there has been an evolution of Holter recorders from 1 channel to 12 channel recorders with increasingly smaller storage media, and there has evolved Holter analysis systems employing increasingly technologically advanced electronics providing a myriad of data displays. This evolution of smaller physical instruments with increasing technological capacity has characterized the development of electronics over the past 50 years. Currently the technology has been focused upon the conventional continuous 24 to 48 hour ambulatory ECG examination, and conventional extended ambulatory monitoring strategies for infrequent to rare arrhythmic events. However, the emergence of the Internet, Wi-Fi, cellular networks, and broad-band transmission has positioned these modalities at the doorway of the digital world. This has led to an adoption of more cost-effective strategies to these conventional methods of performing the examination. As a result, the emergence of the mobile smartphone coupled with this digital capacity is leading to the recent development of Holter smartphone applications. The potential of point-of-care applications utilizing the Holter smartphone and a vast array of new non-invasive sensors is evident in the not too distant future. The Holter smartphone is anticipated to contribute significantly in the future to the field of global health. © 2013.

  6. A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol.

    NARCIS (Netherlands)

    Hafskjold, L.; Sundler, A.J.; Holmström, I.K.; Sundling, V.; Dulmen, S. van; Eide, H.

    2015-01-01

    Introduction: This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of

  7. A cross-sectional study on person-centred communication in the care of older people: the COMHOME study protocol

    NARCIS (Netherlands)

    Hafskjold, L.; Sundler, A.J.; Holmstrom, I.K.; Sundling, V.; Dulmen, S. van; Eide, H.

    2015-01-01

    INTRODUCTION: This paper presents an international cross-sectional study on person-centred communication with older people receiving healthcare (COMHOME). Person-centred care relies on effective communication, but few studies have explored this with a specific focus on older people. The main aim of

  8. Ambulatory intravenous ceftriaxone in paediatric A&E: a useful alternative to hospital admission?

    Science.gov (United States)

    Smith, Jennifer K; Alexander, Saji; Abrahamson, Ed

    2011-10-01

    Treatment of children with intravenous ceftriaxone on an ambulatory basis is described. This allows a child to remain at home, but also be reviewed regularly when attending the Emergency Department for antibiotics. Indications for, and length of, treatment and laboratory parameters were recorded. Also, a survey of children's parents was undertaken to ascertain opinions regarding ambulatory treatment. 36 patients were treated with ambulatory ceftriaxone over 4 months. Indications included fever without focus, tonsillitis, periorbital cellulitis, urinary tract infection, petechial rash and lymphadenitis. Median duration of treatment was 2.3 days. There was no occult bacteraemia but five positive urine cultures. There was one failure of treatment with subsequent admission for alternative intravenous antibiotics. Parental opinion favours ambulatory treatment, with 94% of parents acknowledging they would choose it again in similar circumstances. Cost analysis favours ambulatory treatment based on predicted costs of a similar length of inpatient stay.

  9. Politics, policy and payment--facilitators or barriers to person-centred rehabilitation?

    Science.gov (United States)

    Turner-Stokes, Lynne

    This paper explores the tensions between politics and payment in providing affordable services that satisfy the public demand for patient-centred care. The two main approaches taken by the UK Government to curtail the spiralling costs of healthcare have been to focus development in priority areas and to cap spending through the introduction of a fixed-tariff episode-based funding system. The National Service Framework for Long Term Neurological Conditions embraces many laudable principles of person-centred management, but the 'one-size-fits all' approach to reimbursement potentially cuts right across these. A series of tools have been developed to determine complexity of rehabilitation needs that will support the development of banded tariffs. A practical approach is also offered to demonstrate the cost-efficiency of rehabilitation services for people with complex needs, and help to ensure that they are not excluded from treatment because of their higher treatment costs. Whilst responding to public demand for person-centred care, we must recognize the current financial pressure on healthcare systems. Clinicians will have greater credibility if they routinely collect and share outcomes that demonstrate the economic benefits of intervention, as well the impact on health, function and quality of life.

  10. Ambulatory gait analysis in stroke patients using ultrasound and inertial sensors

    NARCIS (Netherlands)

    Weenk, D.; van Meulen, Fokke; van Beijnum, Bernhard J.F.; Veltink, Petrus H.

    2014-01-01

    Objective ambulatory assessment of movements of patients is important for an optimal recovery. In this study an ambulatory system is used for assessing gait parameters in stroke patients. Ultrasound range estimates are fused with inertial sensors using an extended Kalman filter to estimate 3D

  11. Infection management following ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Chin AB

    2015-10-01

    Full Text Available Anne B Chin, Elizabeth C Wick Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Surgical site infections (SSIs are frequent postoperative complications that are linked to measures of surgical quality and payment determinations. As surgical procedures are increasingly performed in the ambulatory setting, management of SSIs must transition with this trend. Prevention of SSIs should include optimization of patient comorbidities, aggressive infection control policies including appropriate skin decontamination, maintenance of normothermia, and appropriate antibiotic prophylaxis. Systems must also be set in place to provide adequate surveillance for identification of SSIs when they do occur as well as provide direct feedback to surgeons regarding SSI rates. This may require utilization of claims-based surveillance. Patient education and close follow-up with the clinical team are essential for early identification and management of SSIs. Therapy should remain focused on source control and appropriate antibiotic therapy. Keywords: ambulatory surgery, SSI, infection

  12. National Ambulatory Medical Care Survey (NAMCS)

    Data.gov (United States)

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

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

    Science.gov (United States)

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

    2014-04-01

    The appearance of electronic health records has led to the need to strengthen the security of personal health data in order to ensure privacy. Despite the large number of technical security measures and recommendations that exist to protect the security of health data, there is an increase in violations of the privacy of patients' personal data in healthcare organizations, which is in many cases caused by the mistakes or oversights of healthcare professionals. In this paper, we present a guide to good practice for information security in the handling of personal health data by health personnel, drawn from recommendations, regulations and national and international standards. The material presented in this paper can be used in the security audit of health professionals, or as a part of continuing education programs in ambulatory care facilities. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  14. Prescribing Safety in Ambulatory Care: Physician Perspectives

    National Research Council Canada - National Science Library

    Rundall, Thomas G; Hsu, John; Lafata, Jennifer E; Fung, Vicki; Paez, Kathryn A; Simpkins, Jan; Simon, Steven R; Robinson, Scott B; Uratsu, Connie; Gunter, Margaret J; Soumerai, Stephen B; Selby, Joseph V

    2005-01-01

    .... We asked about current safety practices, perceptions of ambulatory prescribing safety. Using a content analysis approach, three investigators independently coded responses into thematic categories...

  15. Ambulatory blood pressure monitoring: Is 24 hours necessary?

    Science.gov (United States)

    Vornovitsky, Michael; McClintic, Benjamin R; Beck, G Ronald; Bisognano, John D

    2013-01-01

    The variability of blood pressure (BP) makes any single measurement a poor indicator of a patient's true BP. Multiple studies have confirmed the superiority of ambulatory BP measurements over clinic BP measurements in predicting cardiovascular risk; however, this method presents the problem of patient acceptance as it causes frequent arm discomfort and sleep disturbance. We hypothesized that 6 h of daytime BP measurements would result in slightly higher BP readings, yet reveal similar clinical decision making when compared to 24 h of BP measurements. The source for writing this article was a retrospective analysis of 30 patients who underwent ambulatory BP monitoring. Data obtained included: age, sex, ethnicity, baseline medical problems, medications, laboratory values, reason given for ordering 24-h ambulatory BP measurements, ambulatory BP measurements, and a subsequent decision to change medication. The average BP of the 24-h measurements was 127/75 mm Hg and the average BP of the 6-h daytime measurements was 131/79 mm Hg (SD 15, p = 0.009). Twenty-six out of 30 patients were at goal or pre-hypertensive. Two out of 30 patients had stage 1 hypertension and 2 out of 30 patients had stage 2 hypertension. Thirteen out of 30 patients had nocturnal dipping. Twelve out of 30 patients had a change in medication, but those changes were not associated with the presence or absence of nocturnal dipping (p = 0.5) or other factors beyond mean BP. Although there was a statistically significant, 4 mm Hg systolic difference between 24-h and 6-h average BP readings, there was no evidence that this difference led to changes in clinical management. The presence or absence of nocturnal dipping was not associated with a change in medication. We conclude that 6-h daytime ambulatory BP measurements provide sufficient information to guide clinical decision making without the problems of patient acceptance, arm discomfort, and sleep disturbance associated with 24-h BP measurements.

  16. The value of registered nurses in ambulatory care settings: a survey.

    Science.gov (United States)

    Mastal, Margaret; Levine, June

    2012-01-01

    Ambulatory care settings employ 25% of the three million registered nurses in the United States. The American Academy of Ambulatory Care Nursing (AAACN) is committed to improving the quality of health care in ambulatory settings, enhancing patient outcomes, and realizing greater health care efficiencies. A survey of ambulatory care registered nurses indicates they are well positioned to lead and facilitate health care reform activities with organizational colleagues. They are well schooled in critical thinking, triage, advocating for patients, educating patients and families, collaborating with medical staff and other professionals, and care coordination. The evolving medical home concept and other health care delivery models reinforces the critical need for registered nurses to provide chronic disease management, care coordination, health risk appraisal, care transitions, health promotion, and disease prevention services. Recommendations are offered for organizational leaders, registered nurses, and AAACN to utilize nursing knowledge and skills in the pursuit of leading change and advancing health.

  17. 76 FR 66929 - Medicare and Medicaid Programs; The American Association for Accreditation of Ambulatory Surgery...

    Science.gov (United States)

    2011-10-28

    ...] Medicare and Medicaid Programs; The American Association for Accreditation of Ambulatory Surgery Facilities... receipt of a deeming application from the American Association for Accreditation of Ambulatory Surgery... of Ambulatory Surgery Facilities (AAAASF's) request for deeming authority for RHCs. This notice also...

  18. Patient-centeredness in Integrated healthcare delivery systems - Needs, expectations and priorities for organized healthcare systems

    Directory of Open Access Journals (Sweden)

    Christin Juhnke

    2013-11-01

    Full Text Available Introduction: Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems. Methods: A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales. Results: Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser–Meyer–Olkinof 0.914 for the patients (experts: 38.427%, Kaiser–Meyer–Olkin = 0.797. Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination. Conclusion and Discussion: The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

  19. Patient-centeredness in Integrated healthcare delivery systems - Needs, expectations and priorities for organized healthcare systems

    Directory of Open Access Journals (Sweden)

    Christin Juhnke

    2013-11-01

    Full Text Available Introduction: Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems.Methods: A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales.Results: Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser–Meyer–Olkinof 0.914 for the patients (experts: 38.427%, Kaiser–Meyer–Olkin = 0.797. Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination.Conclusion and Discussion: The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

  20. Ambulatory oral surgery: 1-year experience with 11680 patients from Zagreb district, Croatia.

    Science.gov (United States)

    Jokić, Dražen; Macan, Darko; Perić, Berislav; Tadić, Marinka; Biočić, Josip; Đanić, Petar; Brajdić, Davor

    2013-02-01

    To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia. Sociodemographic and clinical data on 11680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess the frequency of diagnoses and differences in sex and age. The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (PZagreb than in patients residing in rural areas. The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients' awareness of the importance of oral health.

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

    Science.gov (United States)

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

    2016-01-01

    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.

  2. The structure, organisation and perioperative management of ambulatory surgery and anaesthesia in France: Methodology of the SFAR-OPERA study.

    Science.gov (United States)

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

    2017-10-01

    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. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  3. The Influence of Ambulatory Aid on Lower-Extremity Muscle Activation During Gait.

    Science.gov (United States)

    Sanders, Michael; Bowden, Anton E; Baker, Spencer; Jensen, Ryan; Nichols, McKenzie; Seeley, Matthew K

    2018-05-10

    Foot and ankle injuries are common and often require a nonweight-bearing period of immobilization for the involved leg. This nonweight-bearing period usually results in muscle atrophy for the involved leg. There is a dearth of objective data describing muscle activation for different ambulatory aids that are used during the aforementioned nonweight-bearing period. To compare activation amplitudes for 4 leg muscles during (1) able-bodied gait and (2) ambulation involving 3 different ambulatory aids that can be used during the acute phase of foot and ankle injury care. Within-subject, repeated measures. University biomechanics laboratory. Sixteen able-bodied individuals (7 females and 9 males). Each participant performed able-bodied gait and ambulation using 3 different ambulatory aids (traditional axillary crutches, knee scooter, and a novel lower-leg prosthesis). Muscle activation amplitude quantified via mean surface electromyography amplitude throughout the stance phase of ambulation. Numerous statistical differences (P < .05) existed for muscle activation amplitude between the 4 observed muscles, 3 ambulatory aids, and able-bodied gait. For the involved leg, comparing the 3 ambulatory aids: (1) knee scooter ambulation resulted in the greatest vastus lateralis activation, (2) ambulation using the novel prosthesis and traditional crutches resulted in greater biceps femoris activation than knee scooter ambulation, and (3) ambulation using the novel prosthesis resulted in the greatest gastrocnemius activation (P < .05). Generally speaking, muscle activation amplitudes were most similar to able-bodied gait when subjects were ambulating using the knee scooter or novel prosthesis. Type of ambulatory aid influences muscle activation amplitude. Traditional axillary crutches appear to be less likely to mitigate muscle atrophy during the nonweighting, immobilization period that often follows foot or ankle injuries. Researchers and clinicians should consider

  4. Institutional profile: the London Centre for Nanotechnology.

    Science.gov (United States)

    Weston, David; Bontoux, Thierry

    2009-12-01

    Located in the London neighborhoods of Bloomsbury and South Kensington, the London Centre for Nanotechnology is a UK-based multidisciplinary research center that operates at the forefront of science and technology. It is a joint venture between two of the world's leading institutions, UCL and Imperial College London, uniting their strong capabilities in the disciplines that underpin nanotechnology: engineering, the physical sciences and biomedicine. The London Centre for Nanotechnology has a unique operating model that accesses and focuses the combined skills of the Departments of Chemistry, Physics, Materials, Medicine, Electrical and Electronic Engineering, Mechanical Engineering, Chemical Engineering, Biochemical Engineering and Earth Sciences across the two universities. It aims to provide the nanoscience and nanotechnology required to solve major problems in healthcare, information processing, energy and the environment.

  5. The effects of the spleen tyrosine kinase inhibitor fostamatinib on ambulatory blood pressure in patients with active rheumatoid arthritis: results of the OSKIRA-ABPM (ambulatory blood pressure monitoring) randomized trial.

    Science.gov (United States)

    Kitas, George D; Abreu, Gabriel; Jedrychowicz-Rosiak, Krystyna; Miller, Jeffrey L; Nakov, Roumen; Panfilov, Seva; Vencovsky, Jiri; Wang, Millie; Weinblatt, Michael E; White, William B

    2014-11-01

    Clinical trials of fostamatinib in patients with rheumatoid arthritis showed blood pressure (BP) elevation using clinic measurements. The OSKIRA-ambulatory BP monitoring trial assessed the effect of fostamatinib on 24-hour ambulatory systolic BP (SBP) in patients with active rheumatoid arthritis. One hundred thirty-five patients were randomized to fostamatinib 100 mg twice daily (bid; n = 68) or placebo bid (n = 67) for 28 days. Ambulatory, clinic, and home BPs were measured at baseline and after 28 days of therapy. Primary end point was change from baseline in 24-hour mean SBP. Fostamatinib increased 24-hour mean SBP by 2.9 mm Hg (P = .023) and diastolic BP (DBP) by 3.5 mm Hg (P < .001) versus placebo. Clinic/home-measured BPs were similar to those observed with ambulatory BP monitoring. After treatment discontinuation (1 week), clinic BP values returned to baseline levels. Fostamatinib induced elevations in 24-hour mean ambulatory SBP and DBP. BP elevations resolved with fostamatinib discontinuation. Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

  6. Improving adherence to the Epic Beacon ambulatory workflow.

    Science.gov (United States)

    Chackunkal, Ellen; Dhanapal Vogel, Vishnuprabha; Grycki, Meredith; Kostoff, Diana

    2017-06-01

    Computerized physician order entry has been shown to significantly improve chemotherapy safety by reducing the number of prescribing errors. Epic's Beacon Oncology Information System of computerized physician order entry and electronic medication administration was implemented in Henry Ford Health System's ambulatory oncology infusion centers on 9 November 2013. Since that time, compliance to the infusion workflow had not been assessed. The objective of this study was to optimize the current workflow and improve the compliance to this workflow in the ambulatory oncology setting. This study was a retrospective, quasi-experimental study which analyzed the composite workflow compliance rate of patient encounters from 9 to 23 November 2014. Based on this analysis, an intervention was identified and implemented in February 2015 to improve workflow compliance. The primary endpoint was to compare the composite compliance rate to the Beacon workflow before and after a pharmacy-initiated intervention. The intervention, which was education of infusion center staff, was initiated by ambulatory-based, oncology pharmacists and implemented by a multi-disciplinary team of pharmacists and nurses. The composite compliance rate was then reassessed for patient encounters from 2 to 13 March 2015 in order to analyze the effects of the determined intervention on compliance. The initial analysis in November 2014 revealed a composite compliance rate of 38%, and data analysis after the intervention revealed a statistically significant increase in the composite compliance rate to 83% ( p < 0.001). This study supports a pharmacist-initiated educational intervention can improve compliance to an ambulatory, oncology infusion workflow.

  7. Theory-based practice in a major medical centre.

    Science.gov (United States)

    Alligood, Martha Raile

    2011-11-01

    This project was designed to improve care quality and nursing staff satisfaction. Nursing theory structures thought and action as demonstrated by evidence of improvement in complex health-care settings. Nursing administrators selected Modelling and Role-Modelling (MRM) for the theory-based practice goal in their strategic plan. An action research approach structured implementation of MRM in a 1-year consultation project in 2001-2002. Quality of health care improved according to national quality assessment ratings, as well as patient satisfaction and nurse satisfaction. Modelling and Role-Modelling demonstrated capacity to structure nursing thought and action in patient care in a major medical centre. Uniformity of patient care language was valued by nurses as well as by allied health providers who wished to learn the holistic MRM style of practice. The processes of MRM and action research contributed to project success. A positive health-care change project was carried out in a large medical centre with action research. Introducing MRM theory-based practice was a beneficial decision by nursing administration that improved care and nurse satisfaction. Attention to nursing practice stimulated career development among the nurses to pursue bachelors, masters, and doctoral degrees. © 2011 Blackwell Publishing Ltd.

  8. Effect of ambulatory medicine tutorial on clinical performance of 5th year medical students.

    Science.gov (United States)

    Phisalprapa, Pochamana; Pandejpong, Denla

    2013-02-01

    The present study provided a group learning activity called "Ambulatory Medicine Tutorial-AMT" for 5th year medical students in order to facilitate learning experience at ambulatory setting and to improve medical students' clinical performance. This research aimed specifically to study the effect of AMT. Two groups of twenty 5th-year medical students were enrolled during their ambulatory medicine blocks. Each medical student was assigned to have 8 ambulatory sessions. AMT was assigned to one group while the other group only used conventional learning activity. At the end of the present study, total internal medicine scores, patient satisfaction surveys, and data on average time spent on each clinical encounter were collected and compared. The AMT group received a higher total internal medicine score as compared to the conventional group (76.2 +/- 3.6 vs. 72.9 +/- 2.8, p = 0.003). The AMT group could reduce average time spent on each clinical encounter within their first-6 ambulatory sessions while the conventional group could acquire the same skill later in their last 2 ambulatory sessions. There was no significant difference found on comparing patient satisfaction scores between the 2 groups. AMT helped improving medical students' outcomes as shown from higher total internal medicine score as well as quicker improvement during real-life clinical encounters, AMT could be a good alternative learning activity for medical students at ambulatory setting.

  9. Active ambulatory care management supported by short message services and mobile phone technology in patients with arterial hypertension.

    Science.gov (United States)

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

    2012-01-01

    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. Copyright © 2012 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

  10. Ambulatory care visits by Taiwanese dentists

    Directory of Open Access Journals (Sweden)

    Ying-Hwa Su

    2013-06-01

    Conclusion: There were inequalities in risks of ambulatory care use among Taiwan's dentists. Further studies should be conducted to investigate the causes responsible for the observed geographic and institutional variations in the risk of morbidity among dentists in Taiwan.

  11. The long-term effect of ambulatory oxygen in normoxaemic COPD patients

    DEFF Research Database (Denmark)

    Ringbaek, Thomas; Martinez, Gerd; Lange, Peter

    2013-01-01

    To study the long-term benefits of ambulatory oxygen (AO) in combination with pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) patients experiencing exertional desaturation.......To study the long-term benefits of ambulatory oxygen (AO) in combination with pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) patients experiencing exertional desaturation....

  12. Lean healthcare from a change management perspective.

    Science.gov (United States)

    van Rossum, Lisa; Aij, Kjeld Harald; Simons, Frederique Elisabeth; van der Eng, Niels; Ten Have, Wouter Dirk

    2016-05-16

    Purpose - Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation of change initiatives due to an implementation gap: the gap between strategy and execution. From a change management perspective, the purpose of this paper is to increase scientific knowledge regarding factors that diminish the implementation gap and make the transition from the "toolbox lean" toward an actual transformation to lean healthcare. Design/methodology/approach - A cross-sectional study was executed in an operating theatre of a Dutch University Medical Centre. Transformational leadership was expected to ensure the required top-down commitment, whereas team leadership creates the required active, bottom-up behavior of employees. Furthermore, professional and functional silos and a hierarchical structure were expected to impede the workforce flexibility in adapting organizational elements and optimize the entire process flow. Findings - The correlation and regression analyses showed positive relations between the transformational leadership and team leadership styles and lean healthcare implementation. The results also indicated a strong relation between workforce flexibility and the implementation of lean healthcare. Originality/value - With the use of a recently developed change management model, the Change Competence Model, the authors suggest leadership and workforce flexibility to be part of an organization's change capacity as crucial success factor for a sustainable transformation to lean healthcare.

  13. [Healthcare promotion in primary care: if Hippocrates were alive today…].

    Science.gov (United States)

    Cabeza, Elena; March, Sebastià; Cabezas, Carmen; Segura, Andreu

    2016-11-01

    This article argues for the need to implement community healthcare promotion initiatives in medical practice. Some of the community initiatives introduced in primary care, as well as scientific evidence and associated implementation factors are described. The need for effective coordination between primary care and public health services, working with the community, is underlined. Two specific coordination initiatives are explained by way of example. The first is a project to develop healthcare plans in health centres in the Balearic Islands, by means of a participatory process with the collaboration of citizens, local organisations and the town council (urban planning, mobility, social services, etc.). The second is the Interdepartmental Public Health Plan of Catalonia, which was established to coordinate cross-sectoral healthcare. A specific part of this plan is the COMSalud project, the purpose of which is to introduce a community perspective to health centres and which is currently being piloted in 16 health areas. We review the proposals of a 2008 research study to implement healthcare promotion in primary care, assessing its achievements and shortfalls. The Disease Prevention and Health Promotion Strategy of the Spanish Ministry of Health is recognised as an opportunity to coordinate primary and public health. It is concluded that this change of mentality will require both financial and human resources to come to fruition. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Clinical Assessment Applications of Ambulatory Biosensors

    Science.gov (United States)

    Haynes, Stephen N.; Yoshioka, Dawn T.

    2007-01-01

    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…

  15. Keeping it real--building an ROI model for an ambulatory EMR initiative that the physician practices espouse.

    Science.gov (United States)

    Mullen, Rńee; Donnelly, John T

    2006-01-01

    The ambulatory electronic medical record initiative at Magic Valley Regional Medical Center (MVRMC) in South Central Idaho underwent a rigorous product evaluation process that resulted in one of the market-leading EMR products being selected for implementation. MVRMC includes four business entities, including a 213-bed regional hospital and a 19-practice management services organization. Early in the process, the organization viewed buy-in from its physicians as a critical success factor. The physicians had been integral to product selection, and it was equally important for them to trust the economic model for its acquisition-especially because it was likely that they would be asked to put "some skin in the game." To make this initiative economically feasible, MVRMC received a grant from Agency for Healthcare Research and Quality based on the potential impact of the endeavor on healthcare delivery in the region. However, because the functional analysis did not result in the selection of the least expensive product, the AHRQ grant would only help defray the startup expenses, but not ongoing support and maintenance expenses after implementation; these costs would be borne by anticipated increases in the practice's revenue or reduction in its operating expenses. The ROI model would need to explain how each practice, from the single physician specialist to an almost 20-physician family practice, could pay for the desirable outcomes discussed during the selection phase of the project. The physicians, who had participated in technology initiatives in the past, were skeptical that cost-justifying an IT system was realistic, even though they recognized the potential benefits it could have on the quality and consistency of the care. Because some process standardization within and between practices would be needed to use electronic charting effectively, it was important that the ROI model did not outweigh the benefits of an as-yet untested operational workflow that

  16. National estimates of healthcare utilization by individuals with hepatitis C virus infection in the United States.

    Science.gov (United States)

    Galbraith, James W; Donnelly, John P; Franco, Ricardo A; Overton, Edgar T; Rodgers, Joel B; Wang, Henry E

    2014-09-15

    Hepatitis C virus (HCV) infection is a major public health problem in the United States. Although prior studies have evaluated the HCV-related healthcare burden, these studies examined a single treatment setting and did not account for the growing "baby boomer" population (individuals born during 1945-1965). Data from the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the Nationwide Inpatient Sample were analyzed. We sought to characterize healthcare utilization by individuals infected with HCV in the United States, examining adult (≥18 years) outpatient, emergency department (ED), and inpatient visits among individuals with HCV diagnosis for the period 2001-2010. Key subgroups included persons born before 1945 (older), between 1945 and 1965 (baby boomer), and after 1965 (younger). Individuals with HCV infection were responsible for >2.3 million outpatient, 73 000 ED, and 475 000 inpatient visits annually. Persons in the baby boomer cohort accounted for 72.5%, 67.6%, and 70.7% of care episodes in these settings, respectively. Whereas the number of outpatient visits remained stable during the study period, inpatient admissions among HCV-infected baby boomers increased by >60%. Inpatient stays totaled 2.8 million days and cost >$15 billion annually. Nonwhites, uninsured individuals, and individuals receiving publicly funded health insurance were disproportionately affected in all healthcare settings. Individuals with HCV infection are large users of outpatient, ED, and inpatient health services. Resource use is highest and increasing in the baby boomer generation. These observations illuminate the public health burden of HCV infection in the United States. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  17. Research into person-centred healthcare technology: a plea for considering humanization dimensions.

    NARCIS (Netherlands)

    Jacobs, G.; Zijpp, T. van der; Lieshout, F. van; Dulmen, S. van

    2017-01-01

    Changes in demographics, financial and time constraints and the on‐going shift towards greater responsibility for health and illness for the patient, have increased the speed of development of innovative, information and communications technology‐guided solutions and tools within healthcare

  18. 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

    2016-06-01

    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

  19. Using drawings to understand the child's experience of child-centred care on admission to a paediatric high dependency unit.

    Science.gov (United States)

    Foster, Mandie; Whitehead, Lisa

    2018-01-01

    Family- and child-centred care are philosophies of care used within paediatrics where the family and/or the child are central to healthcare delivery. This study explored the lived experience of hospitalized school-aged children admitted to a paediatric high dependency unit in New Zealand to gain insight into child-centred care from a child's perspective. An interpretive thematic approach was used where the child was asked to draw a picture of 'a person in the hospital' that was further explored through interviews. The interviews were recorded and transcribed verbatim with an inductive thematic analysis completed, drawing on the child-centred care framework. Twenty-six school-aged children participated. The pictures included drawings of family, staff, children and themselves. The themes generated from the interviews were relationships with themselves, family and staff and psychosocial, emotional and physical support. Children described themselves as co-creators of their own healthcare experience, consistent with child-centred care, while drawing on the principles of family-centred care. Further exploration of the concepts of 'participation versus protection' and 'child as becoming versus child as being' will contribute to translation and integration of child-centred care and family-centred care principles into practice, theory, research and policy.

  20. Pros and cons of the ambulatory surgery center joint venture.

    Science.gov (United States)

    Giannini, Deborah

    2008-01-01

    If a physician group has determined that it has a realistic patient base to establish an ambulatory surgery center, it may be beneficial to consider a partner to share the costs and risks of this new joint venture. Joint ventures can be a benefit or liability in the establishment of an ambulatory surgery center. This article discusses the advantages and disadvantages of a hospital physician-group joint venture.

  1. Relationship between systemic hemodynamics and ambulatory blood pressure level are sex dependent.

    Science.gov (United States)

    Alfie, J; Waisman, G D; Galarza, C R; Magi, M I; Vasvari, F; Mayorga, L M; Cámera, M I

    1995-12-01

    Sex-related differences in systemic hemodynamics were analyzed by means of cardiac index and systemic vascular resistance according to the level of daytime ambulatory blood pressure. In addition, we assessed the relations between ambulatory blood pressure measurements and systemic hemodynamics in male and female patients. We prospectively included 52 women and 53 men referred to our unit for evaluation of arterial hypertension. Women and men were grouped according to the level of daytime mean arterial pressure: or = 110 mm Hg. Patients underwent noninvasive evaluation of resting hemodynamics (impedance cardiography) and 24-hour ambulatory blood pressure monitoring. Compared with women men with lower daytime blood pressure had a 12% higher systemic vascular resistance index (P = NS) and a 14% lower cardiac index (P < .02), whereas men with higher daytime blood pressure had a 25% higher vascular resistance (P < .003) and a 21% lower cardiac index (P < .0004). Furthermore, in men systemic vascular resistance correlated positively with both daytime and nighttime systolic and diastolic blood pressures, whereas cardiac index correlated negatively only with daytime diastolic blood pressure. In contrast, women did not exhibit any significant correlation between hemodynamic parameters and ambulatory blood pressure measurements. In conclusion, sex-related differences in systemic hemodynamics were more pronounced in the group with higher daytime hypertension. The relations between systemic hemodynamics and ambulatory blood pressure level depended on the sex of the patient. In men a progressive circulatory impairment underlies the increasing level of ambulatory blood pressure, but this was not observed in women.

  2. Disease Management Plus Recommended Care versus Recommended Care Alone for Ambulatory COPD Patients.

    Science.gov (United States)

    Kalter-Leibovici, Ofra; Benderly, Michal; Freedman, Laurence S; Kaufman, Galit; Molcho Falkenberg Luft, Tchiya; Murad, Havi; Olmer, Liraz; Gluch, Meri; Segev, David; Gilad, Avi; Elkrinawi, Said; Cukierman-Yaffe, Tali; Chen, Baruch; Jacobson, Orit; Key, Calanit; Shani, Mordechai; Fink, Gershon

    2018-03-01

    The efficacy of disease management programs in the treatment of patients with chronic obstructive pulmonary disease (COPD) remains uncertain. To study the effect of disease management (DM) added to recommended care (RC) in ambulatory COPD patients. In this trial, 1,202 COPD patients (age >40 years), with moderate to very severe airflow limitation were randomly assigned either to DM plus RC (study intervention) or to RC alone (control intervention). RC included follow-up by pulmonologists; inhaled long-acting bronchodilators and corticosteroids; smoking cessation intervention; nutritional advice and psychosocial support when indicated, and supervised physical activity sessions. DM, delivered by trained nurses during patients' visits to the designated COPD centers and remote contacts with the patients between these visits, included patient self-care education; monitoring patients' symptoms and adherence to treatment; provision of advice in case of acute disease exacerbation, and coordination of care vis-à-vis other healthcare providers. The primary composite endpoint was first hospital admission for respiratory symptoms or death from any cause. During 3,537 patient-years, 284 (47.2%) patients in the control group and 264 (44.0%) in the study intervention group had a primary endpoint event. The median (range) time elapsed until a primary endpoint event was 1.0 (0-4.0) years among patients assigned to the study intervention and 1.1 (0-4.1) years among patients assigned to the control intervention; adjusted hazard ratio, 0.92 (95%CI: 0.77 to 1.08). DM added to RC was not superior to RC alone in delaying first hospital admission or death among ambulatory COPD patients. Clinical trial registration available at www.clinicaltrials.gov, ID NCT00982384.

  3. Facilitating person-centred after-death care: unearthing assumptions, tradition and values through practice development

    Directory of Open Access Journals (Sweden)

    Barbara Anderson

    2017-05-01

    Full Text Available Background: West Park Healthcare Centre, a complex continuing care and rehabilitation setting in Ontario, Canada has implemented practice development as one method of facilitating person-centred, evidence-informed practices. West Park is planning the construction of a new hospital, with a target construction timeline of 2018-21. Practice development is an internationally established transformation model (Manley et al., 2008 that can breathe life into the necessary but often burdensome process of policy revision in healthcare settings. Aims: The aim of this article is to share how practice development was used to review and revise West Park’s after-death care policy. The process entailed an integration of a broad span of evidence and intentional challenge of ‘habit-based’ ways. Such an approach to policy revision is needed if practice leaders are to use evidence to help achieve transformative changes in practice. Conclusions: Our after death-care policy involved processes that were antithetical to our shared vision for person-centred practices. Unquestioned, longstanding traditional approaches to after-death care needed to be questioned. Through the transformative journey at personal and organisational levels of applying practice development principles to this process, we were successful in bringing forward a policy that supports end-of-life plans of care, choice and person-centred after-death care practices and language. Implications for practice: •\tHealthcare organisations can review after-death care by exploring different sources of evidence, including research, clinical experience, local audit and patient experience, to challenge taken-for-granted practices •\tConsultation with funeral professionals will be valuable in terms of establishing what they do and do not need from a healthcare organisation •\tFellow patients do not need to be ‘protected’ from the after-death care process and appreciate having a voice on how it is

  4. Sources of motivation and frustration among healthcare workers administering antiretroviral treatment for HIV in rural Zimbabwe.

    Science.gov (United States)

    Campbell, C; Scott, K; Madenhire, C; Nyamukapa, C; Gregson, S

    2011-07-01

    The roll-out of accessible and affordable antiretroviral (ARV) drugs for people living with HIV in low-income countries is drastically changing the nature of HIV-related healthcare. The Zimbabwean Ministry of Health has renewed efforts to make antiretroviral treatment (ART) for HIV free and publically available across the country. This paper describes the findings from a multi-method qualitative study including interviews and a focus group with healthcare workers (mostly nurses), totalling 25 participants, and field notes from over 100 hours of ethnographic observation in three rural Zimbabwean health centres. These health centres began providing free ARV drugs to HIV-positive people over one year prior to the research period. We examined sources of motivation and frustration among nurses administering ART in these resource-poor health centres. The findings suggest that healthcare workers administering ART in challenging circumstances are adept at drawing strength from the dramatic physical and emotional recoveries made possible by ART and from their personal memories of the suffering caused by HIV/AIDS among close friends or family. However, healthcare staff grappled with extreme resource shortages, which led to exhaustion and frustration. Surprisingly, only one year into ART provision, healthcare workers did not reference the professional challenges of their HIV work before ART became available, suggesting that medical breakthroughs such as ART rapidly come to be seen as a standard element of nursing. Our findings provide a basis for optimism that medical breakthroughs such as ART can reinvigorate healthcare workers in the short term. However, we caution that the daily challenges of nursing in poor environments, especially administering an ongoing and resource-intensive regime such as ART, must be addressed to enable nurses to continue delivering high-quality ART in sub-Saharan Africa.

  5. Medication adherence among ambulatory patients with type 2 diabetes in a tertiary healthcare setting in Southwestern Nigeria

    Directory of Open Access Journals (Sweden)

    Adisa R

    2011-06-01

    Full Text Available Objective: To assess adherence to medication among ambulatory patients with type 2 diabetes, ascertain the level of glycemic control, and evaluate patients’ opinions on probable reasons for non-adherence with a view to identify areas of intervention to improve adherence.Methods: A prospective cross-sectional study was carried out at a 900-bed tertiary teaching hospital in Ibadan, Southwestern Nigeria between June and August, 2009. Out of 140 consented patients, 114 (81.4% properly responded to the validated and pre-tested data collection tool and these were subsequently considered for analysis. Descriptive statistics were used to summarize the data. Means and proportions were compared using student t-test and chi-square or Kruskal-Wallis test as appropriate, with p<0.05 considered statistical significant.Results: Approximately sixty percent of the patients were adjudged adherent with prescribed medication. Out of 58.8% of the cohort who gave their recent fasting plasma glucose (FPG values, 59.7% had FPG above 110mg/dL. The mean FPG for patients was 139.05 (SD=70.5mg/dL, males and females significantly differed in their mean FPG, 146.55 (SD=85.0mg/dL versus 133.33 (SD=57.6mg/dL respectively (p=0.032. Also, the mean FPG values for adherent patients, 137.09 (SD=59.3mg/dL was lower than their non-adherent counterparts, 143.92 (SD=87.6 mg/dL, but the difference was not statistically significant (p=0.095. Financial constraint (34.4% was the major barrier to optimal adherence with medication. A significant association exist between genders and opinions on physician’s mode of approach during patient-physician interaction as a contributory factor for non-adherence (p=0.038.Conclusion: Medication adherence of ambulatory type 2 diabetes patients is considerable. However, the relatively high level of adherence did not appear to have significantly impacted on patients’ glycemic status due to a substantial number who had plasma glucose above the

  6. The care-planning conference: Exploring aspects of person-centred interactions.

    Science.gov (United States)

    Jobe, Ingela; Lindberg, Birgitta; Nordmark, Sofi; Engström, Åsa

    2018-04-01

    The aim of this study was to describe the care-planning conference from the participants' and researchers' perspectives, focusing on exploring aspects of person-centred interactions. A single-instrumental, qualitative case study design was used describing a care-planning conference taking place in the home of an older woman and her daughter. Data collection consisted of observation and digital recording of the care-planning conference and individual interviews with all the participants before and after the conference. Data were analysed in several phases: first, a narrative description followed by a general description and, thereafter, qualitative content analysis. The findings revealed that the care-planning conference conducted had no clear purpose and did not fulfil all parts of the planning process. Three themes emerged related to aspects of person-centred interactions. The theme "expectations meet reality" showed different expectations, and participants could not really connect during the conference. The theme "navigate without a map" revealed health professionals' lack of knowledge about the care-planning process. The theme "lose the forest for the trees" described that the conference was conducted only as part of the health professionals' duties. Management and healthcare professionals cannot automatically assume that they are delivering person-centred care. Healthcare professionals need to be sensitive to the context, use the knowledge and tools available and continuously evaluate and reassess the work carried out.

  7. Relationship Between 24-Hour Ambulatory Central Systolic Blood Pressure and Left Ventricular Mass: A Prospective Multicenter Study.

    Science.gov (United States)

    Weber, Thomas; Wassertheurer, Siegfried; Schmidt-Trucksäss, Arno; Rodilla, Enrique; Ablasser, Cornelia; Jankowski, Piotr; Lorenza Muiesan, Maria; Giannattasio, Cristina; Mang, Claudia; Wilkinson, Ian; Kellermair, Jörg; Hametner, Bernhard; Pascual, Jose Maria; Zweiker, Robert; Czarnecka, Danuta; Paini, Anna; Salvetti, Massimo; Maloberti, Alessandro; McEniery, Carmel

    2017-12-01

    We investigated the relationship between left ventricular mass and brachial office as well as brachial and central ambulatory systolic blood pressure in 7 European centers. Central systolic pressure was measured with a validated oscillometric device, using a transfer function, and mean/diastolic pressure calibration. M-mode images were obtained by echocardiography, and left ventricular mass was determined by one single reader blinded to blood pressure. We studied 289 participants (137 women) free from antihypertensive drugs (mean age: 50.8 years). Mean office blood pressure was 145/88 mm Hg and mean brachial and central ambulatory systolic pressures were 127 and 128 mm Hg, respectively. Mean left ventricular mass was 93.3 kg/m 2 , and 25.6% had left ventricular hypertrophy. The correlation coefficient between left ventricular mass and brachial office, brachial ambulatory, and central ambulatory systolic pressure was 0.29, 0.41, and 0.47, respectively ( P =0.003 for comparison between brachial office and central ambulatory systolic pressure and 0.32 for comparison between brachial and central ambulatory systolic pressure). The results were consistent for men and women, and young and old participants. The areas under the curve for prediction of left ventricular hypertrophy were 0.618, 0.635, and 0.666 for brachial office, brachial, and central ambulatory systolic pressure, respectively ( P =0.03 for comparison between brachial and central ambulatory systolic pressure). In younger participants, central ambulatory systolic pressure was superior to both other measurements. Central ambulatory systolic pressure, measured with an oscillometric cuff, shows a strong trend toward a closer association with left ventricular mass and hypertrophy than brachial office/ambulatory systolic pressure. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01278732. © 2017 American Heart Association, Inc.

  8. Measuring the educational environment in ambulatory settings

    Directory of Open Access Journals (Sweden)

    Arnoldo Riquelme

    2015-04-01

    Conclusions: The 50-item ACLEEM inventory is a multidimensional and valid instrument requiring only 15 respondents for reliable results. We recommend using it to measure the EE in the ambulatory postgraduate Spanish-speaking programs.

  9. Ambulatory blood pressure monitoring - comparison with office ...

    African Journals Online (AJOL)

    ambulatory blood pressure recordings in private practice ... position according to established guidelines. ... white-coat effect was defined as a difference of at least 20 .... patients with hypertension: Importance of blood pressure response to ...

  10. Preparing for the primary care clinic: an ambulatory boot camp for internal medicine interns

    Science.gov (United States)

    Esch, Lindsay M.; Bird, Amber-Nicole; Oyler, Julie L.; Lee, Wei Wei; Shah, Sachin D.; Pincavage, Amber T.

    2015-01-01

    Introduction Internal medicine (IM) interns start continuity clinic with variable ambulatory training. Multiple other specialties have utilized a boot camp style curriculum to improve surgical and procedural skills, but boot camps have not been used to improve interns’ ambulatory knowledge and confidence. The authors implemented and assessed the impact of an intern ambulatory boot camp pilot on primary care knowledge, confidence, and curricular satisfaction. Methods During July 2014, IM interns attended ambulatory boot camp. It included clinically focused case-based didactic sessions on common ambulatory topics as well as orientation to the clinic and electronic medical records. Interns anonymously completed a 15-question pre-test on topics covered in the boot camp as well as an identical post-test after the boot camp. The interns were surveyed regarding their confidence and satisfaction. Results Thirty-eight interns participated in the boot camp. Prior to the boot camp, few interns reported confidence managing common outpatient conditions. The average pre-test knowledge score was 46.3%. The average post-test knowledge score significantly improved to 76.1% (pinterns reported that the boot camp was good preparation for clinics and 97% felt that the boot camp boosted their confidence. Conclusions The ambulatory boot camp pilot improved primary care knowledge, and interns thought it was good preparation for clinic. The ambulatory boot camp was well received and may be an effective way to improve the preparation of interns for primary care clinic. Further assessment of clinical performance and expansion to other programs and specialties should be considered. PMID:26609962

  11. 42 CFR 419.31 - Ambulatory payment classification (APC) system and payment weights.

    Science.gov (United States)

    2010-10-01

    ... 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... of resource use into APC groups. Except as specified in paragraph (a)(2) of this section, items and...

  12. Effects of an incinerator project on a healthcare-waste management system.

    Science.gov (United States)

    Khammaneechan, Patthanasak; Okanurak, Kamolnetr; Sithisarankul, Pornchai; Tantrakarnapa, Kraichat; Norramit, Poonsup

    2011-10-01

    This evaluative research study aimed to assess the effects of the central healthcare incinerator project on waste management in Yala Province. The study data were collected twice: at baseline and during the operational phase. A combination of structured interview and observation were used during data collection. The study covered 127 healthcare facilities: government hospitals, healthcare centres, and private clinics. The results showed 63% of healthcare risk waste (HCRW) handlers attended the HCRW management training. Improvements in each stage of the HCRW management system were observed in all groups of facilities. The total cost of the HCRW management system did not change, however; the costs for hospitals decreased, whereas those for clinics increased significantly. It was concluded that the central healthcare waste incinerator project positively affected HCRW management in the area, although the costs of management might increase for a particular group. However, the benefits of changing to a more appropriately managed HCRW system will outweigh the increased costs.

  13. Characteristics and significance of ischemia detected by ambulatory electrocardiographic monitoring

    International Nuclear Information System (INIS)

    Nabel, E.G.; Rocco, M.B.; Selwyn, A.B.

    1987-01-01

    Ambulatory electrocardiographic (ECG) monitoring of ischemia in patients with coronary artery disease (CAD) provides a new technique for the assessment of ischemic activity and the evaluation of therapies outside of the hospital. Numerous studies have demonstrated that the majority of patients with CAD have episodes of symptomatic and asymptomatic ST segment depression during routine daily activities. Rubidium-82 positron-emission tomographic studies have provided evidence for decreased myocardial perfusion during these episodes of ST segment depression. The prognostic importance of asymptomatic ischemia has been shown in patients with unstable angina to be a marker for early unfavorable cardiac events. Preliminary results suggest a poorer outcome for those patients with chronic stable angina who show episodes of ischemia as well. Ambulatory monitoring studies suggest that total ischemic activity may be underestimated by conventional testing. Whether all ischemic activity detected by ambulatory monitoring requires treatment awaits further study. 69 references

  14. Ambulatory versus home versus clinic blood pressure: the association with subclinical cerebrovascular diseases: the Ohasama Study.

    Science.gov (United States)

    Hara, Azusa; Tanaka, Kazushi; Ohkubo, Takayoshi; Kondo, Takeo; Kikuya, Masahiro; Metoki, Hirohito; Hashimoto, Takanao; Satoh, Michihiro; Inoue, Ryusuke; Asayama, Kei; Obara, Taku; Hirose, Takuo; Izumi, Shin-Ichi; Satoh, Hiroshi; Imai, Yutaka

    2012-01-01

    The usefulness of ambulatory, home, and casual/clinic blood pressure measurements to predict subclinical cerebrovascular diseases (silent cerebrovascular lesions and carotid atherosclerosis) was compared in a general population. Data on ambulatory, home, and casual/clinic blood pressures and brain MRI to detect silent cerebrovascular lesions were obtained in 1007 subjects aged ≥55 years in a general population of Ohasama, Japan. Of the 1007 subjects, 583 underwent evaluation of the extent of carotid atherosclerosis. Twenty-four-hour, daytime, and nighttime ambulatory and home blood pressure levels were closely associated with the risk of silent cerebrovascular lesions and carotid atherosclerosis (all Ppressure values were simultaneously included in the same regression model, each of the ambulatory blood pressure values remained a significant predictor of silent cerebrovascular lesions, whereas home blood pressure lost its predictive value. Of the ambulatory blood pressure values, nighttime blood pressure was the strongest predictor of silent cerebrovascular lesions. The home blood pressure value was more closely associated with the risk of carotid atherosclerosis than any of the ambulatory blood pressure values when home and one of the ambulatory blood pressure values were simultaneously included in the same regression model. The casual/clinic blood pressure value had no significant association with the risk of subclinical cerebrovascular diseases. Although the clinical indications for ambulatory blood pressure monitoring and home blood pressure measurements may overlap, the clinical significance of each method for predicting target organ damage may differ for different target organs.

  15. Ambulatory Measurement of Ground Reaction Forces

    NARCIS (Netherlands)

    Veltink, Peter H.; Liedtke, Christian; Droog, Ed

    2004-01-01

    The measurement of ground reaction forces is important in the biomechanical analysis of gait and other motor activities. It is the purpose of this study to show the feasibility of ambulatory measurement of ground reaction forces using two six degrees of freedom sensors mounted under the shoe. One

  16. Ambulatory movements, team dynamics and interactions during robot-assisted surgery.

    Science.gov (United States)

    Ahmad, Nabeeha; Hussein, Ahmed A; Cavuoto, Lora; Sharif, Mohamed; Allers, Jenna C; Hinata, Nobuyuki; Ahmad, Basel; Kozlowski, Justen D; Hashmi, Zishan; Bisantz, Ann; Guru, Khurshid A

    2016-07-01

    To analyse ambulatory movements and team dynamics during robot-assisted surgery (RAS), and to investigate whether congestion of the physical space associated with robotic technology led to workflow challenges or predisposed to errors and adverse events. With institutional review board approval, we retrospectively reviewed 10 recorded robot-assisted radical prostatectomies in a single operating room (OR). The OR was divided into eight zones, and all movements were tracked and described in terms of start and end zones, duration, personnel and purpose. Movements were further classified into avoidable (can be eliminated/improved) and unavoidable (necessary for completion of the procedure). The mean operating time was 166 min, of which ambulation constituted 27 min (16%). A total of 2 896 ambulatory movements were identified (mean: 290 ambulatory movements/procedure). Most of the movements were procedure-related (31%), and were performed by the circulating nurse. We identified 11 main pathways in the OR; the heaviest traffic was between the circulating nurse zone, transit zone and supply-1 zone. A total of 50% of ambulatory movements were found to be avoidable. More than half of the movements during RAS can be eliminated with an improved OR setting. More studies are needed to design an evidence-based OR layout that enhances access, workflow and patient safety. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

  17. Why (just) information is not enough: The contributions of information services in the management of healthcare information

    Science.gov (United States)

    Kostagiolas, P.; Lappa, E.

    2015-02-01

    Information is at the centre of every hospital activity including clinical decisions and healthcare service delivery systems. Although information is an important hospital asset, several issues related to its management and organization needs to be addressed within the hospitals. The management of healthcare information is a strategic goal related to the reduction of healthcare service provision costs, and to the improvement of quality and safety of healthcare services. By discussing the rather obvious necessity for information organization and management in the healthcare domain, this work aims at the role of healthcare information services, i.e. hospital libraries and patient medical records. Finally, a typology of information services' contributions to hospital environment is presented.

  18. Why (just) information is not enough: The contributions of information services in the management of healthcare information

    Energy Technology Data Exchange (ETDEWEB)

    Kostagiolas, P., E-mail: pkostagiolas@ionio.gr [Assistant Professor Department of Archives, Library Science and Museology, Ionian University, CORFU 49100 (Greece); Lappa, E., E-mail: evlappa@med.uoa.gr [Director of Medical Library of General Hospital Attikis KAT, Nikis 2 str, 14564 KIFFISIA-ATHENS (Greece)

    2015-02-09

    Information is at the centre of every hospital activity including clinical decisions and healthcare service delivery systems. Although information is an important hospital asset, several issues related to its management and organization needs to be addressed within the hospitals. The management of healthcare information is a strategic goal related to the reduction of healthcare service provision costs, and to the improvement of quality and safety of healthcare services. By discussing the rather obvious necessity for information organization and management in the healthcare domain, this work aims at the role of healthcare information services, i.e. hospital libraries and patient medical records. Finally, a typology of information services’ contributions to hospital environment is presented.

  19. Why (just) information is not enough: The contributions of information services in the management of healthcare information

    International Nuclear Information System (INIS)

    Kostagiolas, P.; Lappa, E.

    2015-01-01

    Information is at the centre of every hospital activity including clinical decisions and healthcare service delivery systems. Although information is an important hospital asset, several issues related to its management and organization needs to be addressed within the hospitals. The management of healthcare information is a strategic goal related to the reduction of healthcare service provision costs, and to the improvement of quality and safety of healthcare services. By discussing the rather obvious necessity for information organization and management in the healthcare domain, this work aims at the role of healthcare information services, i.e. hospital libraries and patient medical records. Finally, a typology of information services’ contributions to hospital environment is presented

  20. Ambulatory orthopaedic surgery patients' emotions when using different patient education methods.

    Science.gov (United States)

    Heikkinen, Katja; Salanterä, Sanna; Leppänen, Tiina; Vahlberg, Tero; Leino-Kilpi, Helena

    2012-07-01

    A randomised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients' emotions during internet-based patient education or face-to-face education with a nurse. The internet-based patient education was designed for this study and patients used websites individually based on their needs. Patients in the control group participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit. The theoretical basis for both types of education was the same. Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process, though their scores also changed during the surgical process. Emotion scores did not decrease after patient education. No differences in patients' emotions were found to result from either of the two different patient education methods.

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

    Directory of Open Access Journals (Sweden)

    Fenwick Angela

    2011-02-01

    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

  2. Relationships of muscle strength and bone mineral density in ambulatory children with cerebral palsy.

    Science.gov (United States)

    Chen, C-L; Lin, K-C; Wu, C-Y; Ke, J-Y; Wang, C-J; Chen, C-Y

    2012-02-01

    This work explores the relationships of muscle strength and areal bone mineral density (aBMD) in ambulatory children with cerebral palsy (CP). The knee extensor strength, but not motor function, was related to aBMD. Thus, muscle strength, especially antigravity muscle strength, was more associated with aBMD in these children than motor function. Muscle strength is related to bone density in normal children. However, no studies have examined these relationships in ambulatory children with CP. This work explores the relationships of muscle strength and aBMD in ambulatory children with CP. Forty-eight ambulatory children with spastic CP, aged 5-15 years, were classified into two groups based on Gross Motor Function Classification System levels: I (n = 28) and II (n = 20). Another 31 normal development (ND) children were recruited as the comparison group for the aBMD. Children with CP underwent assessments of growth, lumbar and distal femur aBMD, Gross Motor Function Measure-66 (GMFM-66), and muscle strength of knee extensor and flexor by isokinetic dynamometer. The distal femur aBMD, but not lumbar aBMD, was lower in children with CP than in ND children (p antigravity muscle strength, were more associated with the bone density of ambulatory children with CP than motor function. The data may allow clinicians for early identifying the ambulatory CP children of potential low bone density.

  3. Ambulatory Melanoma Care Patterns in the United States

    International Nuclear Information System (INIS)

    Ji, A. L.; Davis, S. A.; Feldman, S. R.; Fleischer, A. B.; Baze, M. R.; Feldman, S. R.; Feldman, S. R.; Fleischer, A. B.

    2013-01-01

    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 (ρ< 0.0001) 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, ρ< 0.0001) of the population increase in age (0.23 year per interval year). There was a nonsignificant(ρ=0.19) 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

  4. [Epidemiology of the medico-legal risk associated with the practice of ambulatory surgery in France: a study based on insurance data].

    Science.gov (United States)

    Theissen, A; Fuz, F; Catineau, J; Sultan, W; Beaussier, M; Carles, M; Raucoules-Aimé, M; Niccolai, P

    2014-03-01

    The medico-legal risk specifically associated with the practice of ambulatory surgery is still not well studied. SHAM insurances are the biggest French provider of medical liability insurances. The study of the insurance claims provided by this insurer is therefore a relevant source of data on the complications related to ambulatory surgery. The aim of this study was to compare the claim rate related to ambulatory surgery with non-ambulatory surgery. We did a retrospective study on insurance claims provided by SHAM insurances between 2007 and 2011 to compare the claim rate related to ambulatory surgery with non-ambulatory surgery. We searched the files in the SHAM database, and then analyzed them. On the study period, out of a total of 29565 registered claims, 467 (1.6%) originated from ambulatory surgery. On the total of 29,098 registered claims for non-ambulatory surgery, 2151 (7.4%) led to a condemnation whereas the rate was 7% (33 out of 467 claims) for ambulatory surgery. The condemnations linked to ambulatory surgery amounted to 1.5% of the total (33 out of 2184), for a cost of 1.7 M€ (versus 400,3 M€ for non-ambulatory surgery). The average cost of a compensation is therefore 50,500 € for ambulatory surgery and 186,000 € for non-ambulatory surgery. The medical specialties concerned are primarily ophthalmology, abdominal and orthopedics surgery. The main identified causes were medical errors (n=16) and nosocomial infections (n=13). The claim rate in ambulatory surgery is proportionally less frequent with compensations three times less and were related to the most frequent type of surgery done in ambulatory settings. These data should help strengthen quality approach in ambulatory surgery. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  5. Home-based versus centre-based cardiac rehabilitation.

    Science.gov (United States)

    Taylor, Rod S; Dalal, Hayes; Jolly, Kate; Moxham, Tiffany; Zawada, Anna

    2010-01-20

    ; HDL-cholesterol; LDL-cholesterol) or proportion of smokers at follow up or health-related quality of life. There was no consistent difference in the healthcare costs of the two forms of cardiac rehabilitation. Home- and centre-based cardiac rehabilitation appear to be equally effective in improving the clinical and health-related quality of life outcomes in acute MI and revascularisation patients. This finding, together with an absence of evidence of difference in healthcare costs between the two approaches, would support the extension of home-based cardiac rehabilitation programmes such as the Heart Manual to give patients a choice in line with their preferences, which may have an impact on uptake of cardiac rehabilitation in the individual case.

  6. Effective teamwork in primary healthcare through a structured patient-sorting system - a qualitative study on staff members' conceptions.

    Science.gov (United States)

    Maun, Andy; Engström, Miriam; Frantz, Anna; Brämberg, Elisabeth Björk; Thorn, Jörgen

    2014-11-28

    Primary healthcare meets increased demands from an aging population concerning quality and availability while concurrently dealing with a growing shortage of general practitioners and imperfect efficiency in healthcare processes. Reorganization and team development can improve quality and performance but projects in primary care frequently do not attain the targeted results. By developing and introducing a structured patient-sorting system a primary healthcare centre in Western Sweden increased its access rate significantly and employed its medical professionals more efficiently. The aim of this study was to explore staff members' conceptions of the structured patient-sorting system in order to gain an inside perspective on this project. In this qualitative study 16 interviews were conducted over a period of two years and data was analysed using a phenomenographic approach to identify the various conceptions of the eleven participants. Three categories of description were identified: The system was conceptualized as 1) a framework for the development of patient-centred processes that were clear and consistent, 2) a promotor of professional development and a shared ideal of cooperative practice and 3) a common denominator and catalyst in conflict management. This study demonstrates that the introduction of a structured patient-sorting system makes it possible for several important change processes to take place concurrently: improvement of healthcare processes, empowerment of professionals and team development. It therefore indicates the importance of an appropriate, contextualized framework to support multiple concomitant quality improvement processes. Knowledge from this study can be used to assist and improve future implementations in primary healthcare centres.

  7. Infection Prevention and Control in Pediatric Ambulatory Settings.

    Science.gov (United States)

    Rathore, Mobeen H; Jackson, Mary Anne

    2017-11-01

    Since the American Academy of Pediatrics published its statement titled "Infection Prevention and Control in Pediatric Ambulatory Settings" in 2007, there have been significant changes that prompted this updated statement. Infection prevention and control is an integral part of pediatric practice in ambulatory medical settings as well as in hospitals. Infection prevention and control practices should begin at the time the ambulatory visit is scheduled. All health care personnel should be educated regarding the routes of transmission and techniques used to prevent the transmission of infectious agents. Policies for infection prevention and control should be written, readily available, updated every 2 years, and enforced. Many of the recommendations for infection control and prevention from the Centers for Disease Control and Prevention for hospitalized patients are also applicable in the ambulatory setting. These recommendations include requirements for pediatricians to take precautions to identify and protect employees likely to be exposed to blood or other potentially infectious materials while on the job. In addition to emphasizing the key principles of infection prevention and control in this policy, we update those that are relevant to the ambulatory care patient. These guidelines emphasize the role of hand hygiene and the implementation of diagnosis- and syndrome-specific isolation precautions, with the exemption of the use of gloves for routine diaper changes and wiping a well child's nose or tears for most patient encounters. Additional topics include respiratory hygiene and cough etiquette strategies for patients with a respiratory tract infection, including those relevant for special populations like patients with cystic fibrosis or those in short-term residential facilities; separation of infected, contagious children from uninfected children when feasible; safe handling and disposal of needles and other sharp medical devices; appropriate use of personal

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

    DEFF Research Database (Denmark)

    Conen, David; Aeschbacher, Stefanie; Thijs, Lutgarde

    2014-01-01

    Mean daytime ambulatory blood pressure (BP) values are considered to be lower than conventional BP values, but data on this relation among younger individuals ... 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...

  9. Ambulatory blood pressure monitoring in daily clinical practice - the Spanish ABPM Registry experience.

    Science.gov (United States)

    Gorostidi, Manuel; Banegas, José R; de la Sierra, Alejandro; Vinyoles, Ernest; Segura, Julián; Ruilope, Luis M

    2016-01-01

    Many patients are hypertensive at the medical settings but show normal blood pressure out of the doctor's office, and are classified as white-coat hypertensives. On the other hand, many patients with controlled hypertension at the clinic show ambulatory blood pressure levels above the thresholds considered for an adequate blood pressure control, known as having masked hypertension. Using data from the Spanish Ambulatory Blood Pressure Monitoring Registry (Spanish ABPM Registry), a national program developed to promote the use of the ambulatory technique for hypertension management in daily practice, we have reviewed the main strengths of this approach, that is the ability to detect discrepancies of blood pressure status with respect to office blood pressure measurement, and to better assess accurate rates of hypertension control. White-coat hypertension within patients with elevated office blood pressure, and masked hypertension within office-controlled patients affected one of three patients in each office status. On the other hand, rates of ambulatory blood pressure control (50%) doubled those of office blood pressure control (25%), still remaining half the patients uncontrolled. We think that a systematic use of ambulatory blood pressure monitoring, and strategies to improve blood pressure control constitute key priorities in hypertension management. © 2015 Stichting European Society for Clinical Investigation Journal Foundation.

  10. The internal medicine clerkship and ambulatory learning experiences: results of the 2010 clerkship directors in internal medicine survey.

    Science.gov (United States)

    Shaheen, Amy; Papp, Klara K; Torre, Dario

    2013-01-01

    Education in the ambulatory setting should be an integral part of undergraduate medical education. However, previous studies have shown education in this setting has been lacking in medical school. Ambulatory education occurs on some internal medicine clerkships. The extent of this education is unclear. The purpose of this survey was to assess the structure, curriculum, assessment methods, and barriers to implementation of ambulatory education on the internal medicine clerkship. An annual survey of institutional members of the Clerkship Directors in Internal Medicine (CDIM) was done in April 2010. The data were anonymous and descriptive statistics were used to summarize responses. Free text results were analyzed using qualitative techniques. The response rate was 75%. The majority of respondents had a required ambulatory component to the clerkship. Ambulatory experiences distinct from the inpatient internal medicine experience were common (46%). Integration with either the inpatient experiences or other departmental clerkships also occurred. The majority of ambulatory educational experiences were with generalists (74%) and/or subspecialists (45%). The most common assessment tool was the National Board of Medical Examiners (NBME) ambulatory shelf exam. Thematic analysis of the question about how practice based learning was taught elicited four major themes: Not taught; taught in the context of learning evidence based medicine; taught while learning chronic disease management with quality improvement; taught while learning about health care finance. Barriers to implementation included lack of faculty and financial resources. There have been significant increases in the amount of time dedicated to ambulatory internal medicine. The numbers of medical schools with ambulatory internal medicine education has increased. Integration of the ambulatory experiences with other clerkships such as family medicine occurs. Curriculum was varied but difficulties with dissemination

  11. Polynomial analysis of ambulatory blood pressure measurements

    NARCIS (Netherlands)

    Zwinderman, A. H.; Cleophas, T. A.; Cleophas, T. J.; van der Wall, E. E.

    2001-01-01

    In normotensive subjects blood pressures follow a circadian rhythm. A circadian rhythm in hypertensive patients is less well established, and may be clinically important, particularly with rigorous treatments of daytime blood pressures. Polynomial analysis of ambulatory blood pressure monitoring

  12. Family-centred care: a qualitative study of Chinese and South Asian immigrant parents' experiences of care in paediatric oncology.

    Science.gov (United States)

    Watt, L; Dix, D; Gulati, S; Sung, L; Klaassen, R J; Shaw, N T; Klassen, A F

    2013-03-01

    Over the past two decades, there is increasing emphasis being placed upon providing family-centred care (FCC) in paediatric oncology settings. However, there is a lack of knowledge of FCC in paediatric oncology from the perspectives of immigrant parents. The purpose of this paper is to describe Chinese and South Asian immigrant parents' experiences of FCC in paediatric oncology settings in Canada. This study adopted a constructivist grounded theory approach. Fifty first generation Chinese and South Asian parents of children with cancer who were at least 6 months post-diagnosis were recruited from six Canadian paediatric oncology centres. Interviews were conducted in English, Cantonese, Mandarin, Urdu, Punjabi or Hindi, and transcribed into English. Analysis involved line-by-line, focused and theoretical coding, and the use of the constant comparison method. Findings indicated that overall parents were highly satisfied with the care and services they received, and their experiences were reflective of the key elements of FCC. However, there were some areas of concern identified by participants: parents not perceiving themselves as a member of the medical team; inconsistency in the quality and co-ordination of services among healthcare providers; disrespectful and mechanical manner of a few healthcare providers; and parents' discomfort with healthcare providers communicating sensitive health-related information directly with their child. In order to successfully provide family-centred services to immigrant parents of children with cancer, better communication of the elements of FCC between healthcare staff and families is needed to negotiate a clear role for the parents as partners of the healthcare team. Moreover, a better understanding of how family relationships are structured in immigrant families will assist healthcare providers to balance the best interests of the child with that of the family as a unit. © 2011 Blackwell Publishing Ltd.

  13. Do-it-yourself healthcare: the current landscape, prospects and consequences.

    Science.gov (United States)

    Carrera, Pricivel M; Dalton, Andrew R H

    2014-01-01

    The wider availability and increasing use of mHealth tools - covering health applications, smartphone plug-ins and gadgets is significant for healthcare. This trend epitomises broader trajectories in access to and delivery of healthcare, with greater consumer involvement and decentralisation. This shift may be conceptualised as 'do-it-yourself Healthcare' - allowing consumers to monitor and manage their health, and guide their healthcare consumption. Technology that enables data collection by patients informs them about vital health metrics, giving them more control over experiences of health or illness. The information can be used alone as empowered consumers or together with healthcare professionals in an environment of patient-centred care. Current evidence suggests a large scope for do-it-yourself Healthcare, given the availability of technologies, whilst mHealth tools enhance diagnostics, improve treatment, increase access to services and lower costs. There are, however, limitations to do-it-yourself Healthcare. Notably, its evidence base is less well developed than the availability of technologies to facilitate it. A more complex model and understanding is needed to explain motivations for and consequences of engaging in do-it-yourself Healthcare. That said, its introduction alongside existing medicine may improve quality and reduce costs - potentially improving health system sustainability whilst future generations - tomorrow's middle-aged and the elderly, will become more conducive to its spread. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  14. Links among high-performance work environment, service quality, and customer satisfaction: an extension to the healthcare sector.

    Science.gov (United States)

    Scotti, Dennis J; Harmon, Joel; Behson, Scott J

    2007-01-01

    Healthcare managers must deliver high-quality patient services that generate highly satisfied and loyal customers. In this article, we examine how a high-involvement approach to the work environment of healthcare employees may lead to exceptional service quality, satisfied patients, and ultimately to loyal customers. Specifically, we investigate the chain of events through which high-performance work systems (HPWS) and customer orientation influence employee and customer perceptions of service quality and patient satisfaction in a national sample of 113 Veterans Health Administration ambulatory care centers. We present a conceptual model for linking work environment to customer satisfaction and test this model using structural equations modeling. The results suggest that (1) HPWS is linked to employee perceptions of their ability to deliver high-quality customer service, both directly and through their perceptions of customer orientation; (2) employee perceptions of customer service are linked to customer perceptions of high-quality service; and (3) perceived service quality is linked with customer satisfaction. Theoretical and practical implications of our findings, including suggestions of how healthcare managers can implement changes to their work environments, are discussed.

  15. Transforming Healthcare Delivery: Integrating Dynamic Simulation Modelling and Big Data in Health Economics and Outcomes Research.

    Science.gov (United States)

    Marshall, Deborah A; Burgos-Liz, Lina; Pasupathy, Kalyan S; Padula, William V; IJzerman, Maarten J; Wong, Peter K; Higashi, Mitchell K; Engbers, Jordan; Wiebe, Samuel; Crown, William; Osgood, Nathaniel D

    2016-02-01

    In the era of the Information Age and personalized medicine, healthcare delivery systems need to be efficient and patient-centred. The health system must be responsive to individual patient choices and preferences about their care, while considering the system consequences. While dynamic simulation modelling (DSM) and big data share characteristics, they present distinct and complementary value in healthcare. Big data and DSM are synergistic-big data offer support to enhance the application of dynamic models, but DSM also can greatly enhance the value conferred by big data. Big data can inform patient-centred care with its high velocity, volume, and variety (the three Vs) over traditional data analytics; however, big data are not sufficient to extract meaningful insights to inform approaches to improve healthcare delivery. DSM can serve as a natural bridge between the wealth of evidence offered by big data and informed decision making as a means of faster, deeper, more consistent learning from that evidence. We discuss the synergies between big data and DSM, practical considerations and challenges, and how integrating big data and DSM can be useful to decision makers to address complex, systemic health economics and outcomes questions and to transform healthcare delivery.

  16. Influences on patient satisfaction in healthcare centers: a semi-quantitative study over 5 years.

    Science.gov (United States)

    Thornton, Ruth D; Nurse, Nicole; Snavely, Laura; Hackett-Zahler, Stacey; Frank, Kenice; DiTomasso, Robert A

    2017-05-19

    Knowledge of ambulatory patients' satisfaction with clinic visits help improve communication and delivery of healthcare. The goal was to examine patient satisfaction in a primary care setting, identify how selected patient and physician setting and characteristics affected satisfaction, and determine if feedback provided to medical directors over time impacted patient satisfaction. A three-phase, semi-quantitative analysis was performed using anonymous, validated patient satisfaction surveys collected from 889 ambulatory outpatients in 6 healthcare centers over 5-years. Patients' responses to 21 questions were analyzed by principal components varimax rotated factor analysis. Three classifiable components emerged: Satisfaction with Physician, Availability/Convenience, and Orderly/Time. To study the effects of several independent variables (location of clinics, patients' and physicians' age, education level and duration at the clinic), data were subjected to multivariate analysis of variance (MANOVA).. Changes in the healthcare centers over time were not significantly related to patient satisfaction. However, location of the center did affect satisfaction. Urban patients were more satisfied with their physicians than rural, and inner city patients were less satisfied than urban or rural on Availability/Convenience and less satisfied than urban patients on Orderly/Time. How long a patient attended a center most affected satisfaction, with patients attending >10 years more satisfied in all three components than those attending 60 years old. Patients were significantly more satisfied with their 30-40 year-old physicians compared with those over 60. On Orderly/Time, patients were more satisfied with physicians who were in their 50's than physicians >60. Improvement in patient satisfaction includes a need for immediate, specific feedback. Although Medical Directors received feedback yearly, we found no significant changes in patient satisfaction over time. Our results

  17. Learner-centred medical education: Improved learning or increased stress?

    Science.gov (United States)

    McLean, Michelle; Gibbs, Trevor J

    2009-12-01

    Globally, as medical education undergoes significant reform towards more "learner-centred" approaches, specific implications arise for medical educators and learners. Although this learner-centredness is grounded in educational theory, a point of discussion would be whether the application and practice of these new curricula alleviate or exacerbate student difficulties and levels of stress. This commentary will argue that while this reform in medical education is laudable, with positive implications for learning, medical educators may not have understood or perhaps not embraced "learner-centredness" in its entirety. During their training, medical students are expected to be "patient-centred". They are asked to apply a biopsychosocial model, which takes cognisance of all aspects of a patient's well-being. While many medical schools profess that their curricula reflect these principles, in reality, many may not always practice what they preach. Medical training all too often remains grounded in the biomedical model, with the cognitive domain overshadowing the psychosocial development and needs of learners. Entrusted by parents and society with the education and training of future healthcare professionals, medical education needs to move to a "learner-centred philosophy", in which the "whole" student is acknowledged. As undergraduate and post-graduate students increasingly apply their skills in an international arena, this learner-centredness should equally encapsulate the gender, cultural and religious diversity of both patients and students. Appropriate support structures, role models and faculty development are required to develop skills, attitudes and professional behaviour that will allow our graduates to become caring and sensitive healthcare providers.

  18. Centre of Excellence For Simulation Education and Innovation (CESEI).

    Science.gov (United States)

    Qayumi, A Karim

    2010-01-01

    Simulation is becoming an integral part of medical education. The American College of Surgeons (ACS) was the first organization to recognize the value of simulation-based learning, and to award accreditation for educational institutions that aim to provide simulation as part of the experiential learning opportunity. Centre of Excellence for Simulation Education and Innovation (CESEI) is a multidisciplinary and interprofessional educational facility that is based at the University of British Columbia (UBC) and Vancouver Costal Health Authority (VCH). Centre of Excellence for Simulation Education and Innovation's goal is to provide excellence in education, research, and healthcare delivery by providing a technologically advanced environment and learning opportunity using simulation for various groups of learners including undergraduate, postgraduate, nursing, and allied health professionals. This article is an attempt to describe the infrastructure, services, and uniqueness of the Centre of Excellence for Simulation Education and Innovation. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  19. Pediatric ambulatory anesthesia.

    Science.gov (United States)

    August, David A; Everett, Lucinda L

    2014-06-01

    Pediatric patients often undergo anesthesia for ambulatory procedures. This article discusses several common preoperative dilemmas, including whether to postpone anesthesia when a child has an upper respiratory infection, whether to test young women for pregnancy, which children require overnight admission for apnea monitoring, and the effectiveness of nonpharmacological techniques for reducing anxiety. Medication issues covered include the risks of anesthetic agents in children with undiagnosed weakness, the use of remifentanil for tracheal intubation, and perioperative dosing of rectal acetaminophen. The relative merits of caudal and dorsal penile nerve block for pain after circumcision are also discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Emergent risk factors associated with eyeball loss and ambulatory vision loss after globe injuries.

    Science.gov (United States)

    Hyun Lee, Seung; Ahn, Jae Kyoun

    2010-07-01

    The objective of this study was to evaluate risk factors associated with eyeball loss and ambulatory vision loss on emergent examination of patients with ocular trauma. We reviewed the medical records of 1,875 patients hospitalized in a single tertiary referral center between January 2003 and December 2007. Emergent examinations included a history of trauma, elapsed time between injury and hospital arrival, visible intraocular tissues, and initial visual acuity (VA) using a penlight. The main outcome measures were ocular survival and ambulatory vision survival (>20/200) at 1 year after trauma using univariate and multivariate regression analysis. The ocular trauma scores were significantly higher in open globe injuries than in closed globe injuries (p eyeball loss. Elapsed time more than 12 hours and visible intraocular tissues were the significant risk factors associated with ambulatory vision loss. The most powerful predictor of eyeball loss and ambulatory vision loss was eyeball rupture. In closed globe injuries, there were no significant risk factors of eyeball loss, whereas initial vision less than LP and the presence of relative afferent pupillary defect were the significant risk factors associated with ambulatory vision loss. An initial VA less than LP using a penlight, a history of golf ball injury, and elapsed time more than 12 hours between ocular trauma and hospital arrival were associated with eyeball loss and ambulatory vision loss. Physicians should bear these factors in mind so that they can more effectively counsel patients with such injuries.

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

    Science.gov (United States)

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

    1997-04-01

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

  2. Postoperative pain management following ambulatory anesthesia: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Schug SA

    2015-01-01

    Full Text Available Stephan A Schug,1,2 Chandani Chandrasena2 1School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia; 2Department of Anesthesia and Pain Medicine, Royal Perth Hospital, Perth, WA, Australia Abstract: Worldwide, there is an increasing trend toward performing more and more complex surgery in an ambulatory setting, partially driven by economic considerations. Provision of appropriate pain relief is still often inadequate in this setting; poor pain control and adverse effects of opioids provided for pain control are common reasons for readmission, with human and economic consequences. Therefore, improved analgesia after ambulatory surgery is an important goal; appropriate strategies include identification of at-risk patients, provision of multimodal analgesia, and early use of rescue strategies. Multimodal analgesia is based on the combined use of multiple medications or techniques for pain control, which have different mechanisms of action or act on different sites at the pain pathways. Thereby, such an approach improves analgesia, reduces opioid requirements, and reduces adverse effects of opioids. Important components of multimodal analgesia are nonopioids (acetaminophen and anti-inflammatory drugs, corticosteroids, and alpha-2-delta modulators (gabapentin, pregabalin, but most importantly the use of local and regional anesthesia techniques. Here, the use of adjuvants is one way to increase the duration of pain relief, but, increasingly, continuous peripheral nerve blocks via catheters are used in ambulatory patients, too. Finally, the planning of discharge medications needs a balancing act between the requirements for provision of good analgesia and the risk of opioids going out into the community. Keywords: ambulatory surgery, short-stay surgery, multimodal analgesia, nonopioids, local anesthetics, regional anesthesia

  3. [Predicting individual risk of high healthcare cost to identify complex chronic patients].

    Science.gov (United States)

    Coderch, Jordi; Sánchez-Pérez, Inma; Ibern, Pere; Carreras, Marc; Pérez-Berruezo, Xavier; Inoriza, José M

    2014-01-01

    To develop a predictive model for the risk of high consumption of healthcare resources, and assess the ability of the model to identify complex chronic patients. A cross-sectional study was performed within a healthcare management organization by using individual data from 2 consecutive years (88,795 people). The dependent variable consisted of healthcare costs above the 95th percentile (P95), including all services provided by the organization and pharmaceutical consumption outside of the institution. The predictive variables were age, sex, morbidity-based on clinical risk groups (CRG)-and selected data from previous utilization (use of hospitalization, use of high-cost drugs in ambulatory care, pharmaceutical expenditure). A univariate descriptive analysis was performed. We constructed a logistic regression model with a 95% confidence level and analyzed sensitivity, specificity, positive predictive values (PPV), and the area under the ROC curve (AUC). Individuals incurring costs >P95 accumulated 44% of total healthcare costs and were concentrated in ACRG3 (aggregated CRG level 3) categories related to multiple chronic diseases. All variables were statistically significant except for sex. The model had a sensitivity of 48.4% (CI: 46.9%-49.8%), specificity of 97.2% (CI: 97.0%-97.3%), PPV of 46.5% (CI: 45.0%-47.9%), and an AUC of 0.897 (CI: 0.892 to 0.902). High consumption of healthcare resources is associated with complex chronic morbidity. A model based on age, morbidity, and prior utilization is able to predict high-cost risk and identify a target population requiring proactive care. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  4. Ambulatory orthopaedic surgery patients' knowledge with internet-based education.

    Science.gov (United States)

    Heikkinen, Katja; Leino-Kilpi, H; Salanterä, S

    2012-01-01

    There is a growing need for patient education and an evaluation of its outcomes. The aim of this study was to compare ambulatory orthopaedic surgery patients' knowledge with Internet-based education and face-to-face education with a nurse. The following hypothesis was proposed: Internet-based patient education (experiment) is as effective as face-to-face education with a nurse (control) in increasing patients' level of knowledge and sufficiency of knowledge. In addition, the correlations of demographic variables were tested. The patients were randomized to either an experiment group (n = 72) or a control group (n = 75). Empirical data were collected with two instruments. Patients in both groups showed improvement in their knowledge during their care. Patients in the experiment group improved their knowledge level significantly more in total than those patients in the control group. There were no differences in patients' sufficiency of knowledge between the groups. Knowledge was correlated especially with patients' age, gender and earlier ambulatory surgeries. As a conclusion, positive results concerning patients' knowledge could be achieved with the Internet-based education. The Internet is a viable method in ambulatory care.

  5. Improving client-centred care and services: the role of front/back-office configurations.

    Science.gov (United States)

    Broekhuis, Manda; de Blok, Carolien; Meijboom, Bert

    2009-05-01

    This paper is a report of a study conducted to explore the application of designing front- and back-office work resulting in efficient client-centred care in healthcare organizations that supply home care, welfare and domestic services. Front/back-office configurations reflect a neglected domain of design decisions in the development of more client-centred processes and structures without incurring major cost increases. Based on a literature search, a framework of four front/back-office configurations was constructed. To illustrate the usefulness of this framework, a single, longitudinal case study was performed in a large organization, which provides home care, welfare and domestic services for a sustained period (2005-2006). The case study illustrates how front/back-office design decisions are related to the complexity of the clients' demands and the strategic objectives of an organization. The constructed framework guides the practical development of front/back-office designs, and shows how each design contributes differently to such performance objectives as quality, speed and efficiency. The front/back-office configurations presented comprise an important first step in elaborating client-centred care and service provision to the operational level. It helps healthcare organizations to become more responsive and to provide efficient client-centred care and services when approaching demand in a well-tuned manner. In addition to its applicability in home care, we believe that a deliberate front/back-office configuration also has potential in other fields of health care.

  6. Attractiveness of people-centred and integrated Dutch home care: a nationwide survey among nurses.

    NARCIS (Netherlands)

    Maurits, E.E.M.; Veer, A.J.E. de; Groenewegen, P.P.; Francke, A.L.

    2018-01-01

    The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people‐centred and integrated health services. This includes providing integrated care around people′s needs that is effectively co‐ordinated across providers and co‐produced by professionals,

  7. Development of healthcare quality indicators for rheumatoid arthritis in Europe: the eumusc.net project.

    Science.gov (United States)

    Petersson, Ingemar F; Strömbeck, Britta; Andersen, Lene; Cimmino, Marco; Greiff, Rolf; Loza, Estibaliz; Sciré, Carlo; Stamm, Tanja; Stoffer, Michaela; Uhlig, Till; Woolf, Anthony D; Vliet Vlieland, Theodora P M

    2014-05-01

    Eumusc.net (http://www.eumusc.net) is a European project supported by the EU and European League Against Rheumatism to improve musculoskeletal care in Europe. To develop patient-centred healthcare quality indicators (HCQIs) for healthcare provision for rheumatoid arthritis (RA) patients. Based on a systematic literature search, existing HCQIs for RA were identified and their contents analysed and categorised referring to a list of 16 standards of care developed within the eumusc.net. An international expert panel comprising 14 healthcare providers and two patient representatives added topics and during repeated Delphi processes by email ranked the topics and rephrased suggested HCQIs with the preliminary set being established during a second expert group meeting. After an audit process by rheumatology units (including academic centres) in six countries (The Netherlands, Norway, Romania, Italy, Austria and Sweden), a final version of the HCQIs was established. 56 possible topics for HCQIs were processed resulting in a final set of HCQIs for RA (n=14) including two for structure (patient information and calculation of composite scores), 11 for process (eg, access to care, assessments, and pharmacological and non-pharmacological treatments) and one for outcome (effect of treatment on disease activity). They included definitions to be used in clinical practice and also by patients. Further, the numerators and the denominators for each HCQI were defined. A set of 14 patient-centred HCQIs for RA was developed to be used in quality improvement and bench marking in countries across Europe.

  8. Ambulatory oral surgery: 1-year experience with 11 680 patients from Zagreb district, Croatia

    Science.gov (United States)

    Jokić, Dražen; Macan, Darko; Perić, Berislav; Tadić, Marinka; Biočić, Josip; Đanić, Petar; Brajdić, Davor

    2013-01-01

    Aim To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia. Methods Sociodemographic and clinical data on 11 680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess the frequency of diagnoses and differences in sex and age. Results The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (P Zagreb than in patients residing in rural areas. Conclusion The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients’ awareness of the importance of oral health. PMID:23444246

  9. [The state of quality management implementation in ambulatory care nursing and inpatient nursing].

    Science.gov (United States)

    Farin, E; Hauer, J; Schmidt, E; Kottner, J; Jäckel, W H

    2013-02-01

    The demands being made on quality assurance and quality management in ambulatory care nursing and inpatient nursing facilities continue to grow. As opposed to health-care facilities such as hospitals and rehabilitation centres, we know of no other empirical studies addressing the current state of affairs in quality management in nursing institutions. The aim of this investigation was, by means of a questionnaire, to analyse the current (as of spring 2011) dissemination of quality management and certification in nursing facilities using a random sample as representative as possible of in- and outpatient institutions. To obtain our sample we compiled 800 inpatient and 800 outpatient facilities as a stratified random sample. Federal state, holder and, for inpatient facilities, the number of beds were used as stratification variables. 24% of the questionnaires were returned, giving us information on 188 outpatient and 220 inpatient institutions. While the distribution in the sample of outpatient institutions is equivalent to the population distribution, we observed discrepancies in the inpatient facilities sample. As they do not seem to be related to any demonstrable bias, we assume that our data are sufficiently representative. 4 of 5 of the responding facilities claim to employ their own quality management system, however the degree to which the quality management mechanisms are actually in use is an estimated 75%. Almost 90% of all the facilities have a quality management representative who often possesses specific additional qualifications. Many relevant quality management instruments (i. e., nursing standards of care, questionnaires, quality circles) are used in 75% of the responding institutions. Various factors in our data give the impression that quality management and certification efforts have made more progress in the inpatient facilities. Although 80% of the outpatient institutions claim to have a quality management system, only 32.1% of them admit to

  10. The clinical utility of ambulatory blood pressure monitoring (ABPM): a review.

    Science.gov (United States)

    Harianto, Harry; Valente, Michael; Hoetomo, Soenarno; Anpalahan, Mahesan

    2014-01-01

    The current evidence suggests that ambulatory blood pressure monitoring (ABPM) should be an integral part of the diagnosis and management of hypertension. However, its uptake in routine clinical practice has been variable. This paper reviews the current evidence for the role of ABPM in clinical practice, including in hypotensive disorders and in specific comorbidities. It further discusses the clinical significance of abnormal ambulatory blood pressure patterns and hypertensive syndromes such as white coat, masked and resistant hypertension.

  11. Ambulatory Antibiotic Stewardship through a Human Factors Engineering Approach: A Systematic Review.

    Science.gov (United States)

    Keller, Sara C; Tamma, Pranita D; Cosgrove, Sara E; Miller, Melissa A; Sateia, Heather; Szymczak, Julie; Gurses, Ayse P; Linder, Jeffrey A

    2018-01-01

    In the United States, most antibiotics are prescribed in ambulatory settings. Human factors engineering, which explores interactions between people and the place where they work, has successfully improved quality of care. However, human factors engineering models have not been explored to frame what is known about ambulatory antibiotic stewardship (AS) interventions and barriers and facilitators to their implementation. We conducted a systematic review and searched OVID MEDLINE, Embase, Scopus, Web of Science, and CINAHL to identify controlled interventions and qualitative studies of ambulatory AS and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2.0 model. This model describes how a work system (ambulatory clinic) contributes to a process (antibiotic prescribing) that leads to outcomes. The work system consists of 5 components, tools and technology, organization, person, tasks, and environment, within an external environment. Of 1,288 abstracts initially identified, 42 quantitative studies and 17 qualitative studies met inclusion criteria. Effective interventions focused on tools and technology (eg, clinical decision support and point-of-care testing), the person (eg, clinician education), organization (eg, audit and feedback and academic detailing), tasks (eg, delayed antibiotic prescribing), the environment (eg, commitment posters), and the external environment (media campaigns). Studies have not focused on clinic-wide approaches to AS. A human factors engineering approach suggests that investigating the role of the clinic's processes or physical layout or external pressures' role in antibiotic prescribing may be a promising way to improve ambulatory AS. © Copyright 2018 by the American Board of Family Medicine.

  12. Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives

    Directory of Open Access Journals (Sweden)

    Robinson H

    2017-04-01

    Full Text Available Hal Robinson, Thomas Engelhardt Department of Anaesthesia, Royal Aberdeen Children’s Hospital, Aberdeen, UK Purpose: Myringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction.Recent findings: This review summarizes recently published studies about the long-term effects of general anesthesia in young children, novel approaches to preoperative fasting and simplified approaches to the assessment and management of emergence delirium (ED and emergence agitation (EA. New developments in perioperative ambulatory care, including management of comorbidities and day care unit logistics, are discussed.Summary: Long-term follow-up of children exposed to general anesthesia before the age of 4 years has limited impact on academic achievement or cognitive performance and should not delay the treatment of common ENT pathology, which can impair speech and language development. A more liberal approach to fasting, employing a 6–4–0 regime allowing children fluids up until theater, may become an accepted practice in future. ED and EA should be discriminated from pain in recovery and, where the child is at risk of harm, should be treated promptly. Postoperative pain at home remains problematic in ambulatory surgery and better parental education is needed. Effective ambulatory care ultimately requires a well-coordinated team approach from effective preassessment to postoperative follow-up. Keywords: myringotomy, ventilation tubes, anesthesia, pediatrics, ambulatory, day case

  13. Side effects of ambulatory blood pressure monitoring.

    NARCIS (Netherlands)

    Steen, M.S. van der; Lenders, J.W.M.; Thien, Th.

    2005-01-01

    OBJECTIVE: To study the experiences and complaints of patients who underwent 24 h blood pressure monitoring. METHODS: Two groups of hypertensive patients of a tertiary outpatient clinic were asked to fill in a nine-item questionnaire about the side effects of ambulatory blood pressure monitoring

  14. Ambulatory assessment of ankle and foot dynamics

    NARCIS (Netherlands)

    Schepers, H. Martin; Koopman, Hubertus F.J.M.; Veltink, Petrus H.

    Ground reaction force (GRF) measurement is important in the analysis of human body movements. The main drawback of the existing measurement systems is the restriction to a laboratory environment. This paper proposes an ambulatory system for assessing the dynamics of ankle and foot, which integrates

  15. Pathway to Best Practice in Spirometry in the Ambulatory Setting.

    Science.gov (United States)

    Peracchio, Carol

    2016-01-01

    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.

  16. Office blood pressure or ambulatory blood pressure for the prediction of cardiovascular events.

    Science.gov (United States)

    Mortensen, Rikke Nørmark; Gerds, Thomas Alexander; Jeppesen, Jørgen Lykke; Torp-Pedersen, Christian

    2017-11-21

    To determine the added value of (i) 24-h ambulatory blood pressure relative to office blood pressure and (ii) night-time ambulatory blood pressure relative to daytime ambulatory blood pressure for 10-year person-specific absolute risks of fatal and non-fatal cardiovascular events. A total of 7927 participants were included from the International Database on Ambulatory blood pressure monitoring in relation to Cardiovascular Outcomes. We used cause-specific Cox regression to predict 10-year person-specific absolute risks of fatal and non-fatal cardiovascular events. Discrimination of 10-year outcomes was assessed by time-dependent area under the receiver operating characteristic curve (AUC). No differences in predicted risks were observed when comparing office blood pressure and ambulatory blood pressure. The median difference in 10-year risks (1st; 3rd quartile) was -0.01% (-0.3%; 0.1%) for cardiovascular mortality and -0.1% (-1.1%; 0.5%) for cardiovascular events. The difference in AUC (95% confidence interval) was 0.65% (0.22-1.08%) for cardiovascular mortality and 1.33% (0.83-1.84%) for cardiovascular events. Comparing daytime and night-time blood pressure, the median difference in 10-year risks was 0.002% (-0.1%; 0.1%) for cardiovascular mortality and -0.01% (-0.5%; 0.2%) for cardiovascular events. The difference in AUC was 0.10% (-0.08 to 0.29%) for cardiovascular mortality and 0.15% (-0.06 to 0.35%) for cardiovascular events. Ten-year predictions obtained from ambulatory blood pressure are similar to predictions from office blood pressure. Night-time blood pressure does not improve 10-year predictions obtained from daytime measurements. For an otherwise healthy population sufficient prognostic accuracy of cardiovascular risks can be achieved with office blood pressure. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  17. Low bone mineral density in ambulatory persons with cerebral palsy? A systematic review.

    Science.gov (United States)

    Mus-Peters, Cindy T R; Huisstede, Bionka M A; Noten, Suzie; Hitters, Minou W M G C; van der Slot, Wilma M A; van den Berg-Emons, Rita J G

    2018-05-22

    Non-ambulatory persons with cerebral palsy are prone to low bone mineral density. In ambulatory persons with cerebral palsy, bone mineral density deficits are expected to be small or absent, but a consensus conclusion is lacking. In this systematic review bone mineral density in ambulatory persons with cerebral palsy (Gross Motor Function Classification Scales I-III) was studied. Medline, Embase, and Web of Science were searched. According to international guidelines, low bone mineral density was defined as Z-score ≤ -2.0. In addition, we focused on Z-score ≤ -1.0 because this may indicate a tendency towards low bone mineral density. We included 16 studies, comprising 465 patients aged 1-65 years. Moderate and conflicting evidence for low bone mineral density (Z-score ≤ -2.0) was found for several body parts (total proximal femur, total body, distal femur, lumbar spine) in children with Gross Motor Function Classification Scales II and III. We found no evidence for low bone mineral density in children with Gross Motor Function Classification Scale I or adults, although there was a tendency towards low bone mineral density (Z-score ≤ -1.0) for several body parts. Although more high-quality research is needed, results indicate that deficits in bone mineral density are not restricted to non-ambulatory people with cerebral palsy. Implications for Rehabilitation Although more high-quality research is needed, including adults and fracture risk assessment, the current study indicates that deficits in bone mineral density are not restricted to non-ambulatory people with CP. Health care professionals should be aware that optimal nutrition, supplements on indication, and an active lifestyle, preferably with weight-bearing activities, are important in ambulatory people with CP, also from a bone quality point-of-view. If indicated, medication and fall prevention training should be prescribed.

  18. Accuracy of home versus ambulatory blood pressure monitoring in the diagnosis of white-coat and masked hypertension.

    Science.gov (United States)

    Kang, Yuan-Yuan; Li, Yan; Huang, Qi-Fang; Song, Jie; Shan, Xiao-Li; Dou, Yu; Xu, Xin-Juan; Chen, Shou-Hong; Wang, Ji-Guang

    2015-08-01

    We investigated accuracy of home blood pressure (BP) monitoring in the diagnosis of white-coat and masked hypertension in comparison with ambulatory BP monitoring. Our study participants were enrolled in the China Ambulatory and Home BP Registry, and underwent clinic, home, and 24-h ambulatory BP measurements. We defined white-coat hypertension as an elevated clinic SBP/DBP (≥140/90 mmHg) and a normal 24-h ambulatory (coat hypertension (13.1 vs. 19.9%), masked hypertension (17.8 vs. 13.1%), and sustained hypertension (46.4 vs. 39.6%) significantly (P ≤ 0.02) differed between 24-h ambulatory and home BP monitoring. In treated patients (n = 1201), only the prevalence of masked hypertension differed significantly (18.7 vs. 14.5%; P = 0.005). Regardless of the treatment status, home compared with 24-h ambulatory BP had low sensitivity (range 47-74%), but high specificity (86-94%), and accordingly low positive (41-87%), but high negative predictive values (80-94%), and had moderate diagnostic agreement (82-85%) and Kappa statistic (0.41-0.66). In untreated and treated patients, age advancing was associated with a higher prevalence of white-coat hypertension and a lower prevalence of masked hypertension defined by 24-h ambulatory (P ≤ 0.03) but not home BP (P ≥ 0.10). Home BP monitoring has high specificity, but low sensitivity in the diagnosis of white-coat and masked hypertension, and may therefore behave as a complementary to, but not a replacement of, ambulatory BP monitoring.

  19. Differences in Treatment of Chlamydia trachomatis by Ambulatory Care Setting.

    Science.gov (United States)

    Pearson, William S; Gift, Thomas L; Leichliter, Jami S; Jenkins, Wiley D

    2015-12-01

    Chlamydia trachomatis (CT) is the most commonly reported sexually transmitted infection (STI) in the US and timely, correct treatment can reduce CT transmission and sequelae. Emergency departments (ED) are an important location for diagnosing STIs. This study compared recommended treatment of CT in EDs to treatment in physician offices. Five years of data (2006-2010) were analyzed from the National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Care Surveys (NHAMCS), including the Outpatient survey (NHAMCS-OPD) and Emergency Department survey (NHAMCS-ED). All visits with a CT diagnosis and those with a diagnosis of unspecified venereal disease were selected for analysis. Differences in receipt of recommended treatments were compared between visits to physician offices and emergency departments using Chi square tests and logistic regression models. During the 5 year period, approximately 3.2 million ambulatory care visits had diagnosed CT or an unspecified venereal disease. A greater proportion of visits to EDs received the recommended treatment for CT compared to visits to physician offices (66.1 vs. 44.9 %, p < .01). When controlling for patients' age, sex and race/ethnicity, those presenting to the ED with CT were more likely to receive the recommended antibiotic treatment than patients presenting to a physician's office (OR 2.16; 95 % CI 1.04-4.48). This effect was attenuated when further controlling for patients' expected source of payment. These analyses demonstrate differences in the treatment of CT by ambulatory care setting as well as opportunities for increasing use of recommended treatments for diagnosed cases of this important STI.

  20. Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from the European Centre for Disease Prevention and Control

    Directory of Open Access Journals (Sweden)

    A. P. Magiorakos

    2017-11-01

    Full Text Available Abstract Background Infections with carbapenem-resistant Enterobacteriaceae (CRE are increasingly being reported from patients in healthcare settings. They are associated with high patient morbidity, attributable mortality and hospital costs. Patients who are “at-risk” may be carriers of these multidrug-resistant Enterobacteriaceae (MDR-E. The purpose of this guidance is to raise awareness and identify the “at-risk” patient when admitted to a healthcare setting and to outline effective infection prevention and control measures to halt the entry and spread of CRE. Methods The guidance was created by a group of experts who were functioning independently of their organisations, during two meetings hosted by the European Centre for Disease Prevention and Control. A list of epidemiological risk factors placing patients “at-risk” for carriage with CRE was created by the experts. The conclusions of a systematic review on the prevention of spread of CRE, with the addition of expert opinion, were used to construct lists of core and supplemental infection prevention and control measures to be implemented for “at-risk” patients upon admission to healthcare settings. Results Individuals with the following profile are “at-risk” for carriage of CRE: a a history of an overnight stay in a healthcare setting in the last 12 months, b dialysis-dependent or cancer chemotherapy in the last 12 months, c known previous carriage of CRE in the last 12 months and d epidemiological linkage to a known carrier of a CRE. Core infection prevention and control measures that should be considered for all patients in healthcare settings were compiled. Preliminary supplemental measures to be implemented for “at-risk” patients on admission are: pre-emptive isolation, active screening for CRE, and contact precautions. Patients who are confirmed positive for CRE will need additional supplemental measures. Conclusions Strengthening the microbiological

  1. Knowledge Translation of Interprofessional Collaborative Patient-Centred Practice: The Working Together Project Experience

    Science.gov (United States)

    MacDonald, Colla J.; Archibald, Douglas; Stodel, Emma; Chambers, Larry W.; Hall, Pippa

    2008-01-01

    The Working Together (WT) project involved the design and delivery of an online learning resource for healthcare teams in long-term care (LTC) so that knowledge regarding interprofessional collaborative patient-centred practice (ICPCP) could be readily accessed and then transferred to the workplace. The purpose of this paper is to better…

  2. Ambulatory blood pressure and adherence monitoring: diagnosing pseudoresistant hypertension.

    Science.gov (United States)

    Burnier, Michel; Wuerzner, Gregoire

    2014-01-01

    A small proportion of the treated hypertensive population consistently has a blood pressure greater than 140/90 mm Hg despite a triple therapy including a diuretic, a calcium channel blocker, and a blocker of the renin-angiotensin system. According to guidelines, these patients have so-called resistant hypertension. The prevalence of this clinical condition is higher in tertiary than primary care centers and often is associated with chronic kidney disease, diabetes, obesity, and sleep apnea syndrome. Exclusion of pseudoresistant hypertension using ambulatory or home blood pressure monitoring is a crucial step in the investigation of patients with resistant hypertension. Thus, among the multiple factors to consider when investigating patients with resistant hypertension, ambulatory blood pressure monitoring should be performed very early. Among other factors to consider, physicians should investigate patient adherence to therapy, assess the adequacy of treatment, exclude interfering factors, and, finally, look for secondary forms of hypertension. Poor adherence to therapy accounts for 30% to 50% of cases of resistance to therapy depending on the methodology used to diagnose adherence problems. This review discusses the clinical factors implicated in the pathogenesis of resistant hypertension with a particular emphasis on pseudoresistance, drug adherence, and the use of ambulatory blood pressure monitoring for the diagnosis and management of resistant hypertension.

  3. Human-centred methods in the design of an e-health solution for patients undergoing weight loss treatment

    DEFF Research Database (Denmark)

    Das, Anita; Svanæs, Dag

    2013-01-01

    Background and objective Patients undergoing weight loss treatment require follow-up as part of the treatment process. E-health solutions may be used for this purpose. We have used an iterative design approach to develop a patient-centred e-health solution for patients undergoing weight loss...... in the design process. Our findings imply that involving stakeholders separately during specific human-centred activities is important in order to capture subtle, but critical aspects of the users’ requirements. Conclusion Applying human-centred methods in the design of e-health solutions requires...... that designers must take particular considerations when patients and healthcare professionals are involved in the design process. Keywords E-health; Participatory design; User-centred design; Obesity; Weight loss treatment...

  4. Can information technology improve my ambulatory practice ...

    African Journals Online (AJOL)

    eHealth is the use of information and communication technologies for health. mHealth is the use of mobile technology in health. As with all information technology (IT), advances in development are rapidly taking place. The application of such technology to individual ambulatory anaesthesia practice should improve the ...

  5. Determinants of between-country differences in ambulatory antibiotic use and antibiotic resistance in Europe: a longitudinal observational study.

    Science.gov (United States)

    Blommaert, A; Marais, C; Hens, N; Coenen, S; Muller, A; Goossens, H; Beutels, P

    2014-02-01

    To identify key determinants explaining country-year variations in antibiotic use and resistance. Ambulatory antibiotic use data [in defined daily doses per 1000 inhabitants per day (DIDs)] for 19 European countries from 1999 to 2007 were collected, along with 181 variables describing countries in terms of their agriculture, culture, demography, disease burden, education, healthcare organization and socioeconomics. After assessing data availability, overlap and relevance, multiple imputation generalized estimating equations were applied with a stepwise selection procedure to select significant determinants of global antibiotic use (expressed in DIDs), relative use of subgroups (amoxicillin and co-amoxiclav) and resistance of Escherichia coli and Streptococcus pneumoniae. Relative humidity, healthcare expenditure proportional to gross domestic product, feelings of distrust, proportion of population aged >65 years and availability of treatment guidelines were associated with higher total antibiotic use expressed in DIDs. Restrictions on marketing activities towards prescribers, population density, number of antibiotics, educational attainment and degree of atheism were associated with a lower number of total DIDs used. Relative prescribing of amoxicillin and co-amoxiclav was mainly determined by healthcare system choices [e.g. general practitioner (GP) registration and restricted marketing]. Specific antibiotic use was found to be a significant determinant of resistance for some but not all drug/organism combinations. Incentives to stimulate GP gatekeeping were associated with lower levels of resistance, and life expectancy at age 65+ and atheism were associated with more resistance. Myriad factors influence antibiotic use and resistance at the country level and an important part of these can be modified by policy choices.

  6. Unanticipated hospital admission in pediatric patients with congenital heart disease undergoing ambulatory noncardiac surgical procedures.

    Science.gov (United States)

    Yuki, Koichi; Koutsogiannaki, Sophia; Lee, Sandra; DiNardo, James A

    2018-05-18

    An increasing number of surgical and nonsurgical procedures are being performed on an ambulatory basis in children. Analysis of a large group of pediatric patients with congenital heart disease undergoing ambulatory procedures has not been undertaken. The objective of this study was to characterize the profile of children with congenital heart disease who underwent noncardiac procedures on an ambulatory basis at our institution, to determine the incidence of adverse cardiovascular and respiratory adverse events, and to determine the risk factors for unscheduled hospital admission. This is a retrospective study of children with congenital heart disease who underwent noncardiac procedures on an ambulatory basis in a single center. Using the electronic preoperative anesthesia evaluation form, we identified 3010 patients with congenital heart disease who underwent noncardiac procedures of which 1028 (34.1%) were scheduled to occur on an ambulatory basis. Demographic, echocardiographic and functional status data, cardiovascular and respiratory adverse events, and reasons for postprocedure admission were recorded. Univariable analysis was conducted. The unplanned hospital admission was 2.7% and univariable analysis demonstrated that performance of an echocardiogram within 6 mo of the procedure and procedures performed in radiology were associated with postoperative admission. Cardiovascular adverse event incidence was 3.9%. Respiratory adverse event incidence was 1.8%. Ambulatory, noncomplex procedures can be performed in pediatric patients with congenital heart disease and good functional status with a relatively low unanticipated hospital admission rate. © 2018 John Wiley & Sons Ltd.

  7. 3rd August 2010 - CEO Siemens Healthcare Sector, Chief Technology Officer, Head of Corporate Technology, Member of Siemens AG Managing Board, Germany, H. Requardt, signing the guest book with CERN Director-General R. Heuer

    CERN Multimedia

    Maximilien Brice

    2010-01-01

    CERN-HI-1008148 11: H. von Dewitz in the ATLAS Visitor centre with Collaboration member M. Hauschild (left) and Former IT Department Head W. von Rüden (right) CERN-HI-1008148 18 : Head of Innovation and Systems Projects, Siemens Healthcare Sector O. Heid (left) in the ATLAS Visitor centre with Collaboration member M. Hauschild. CERN-HI-1008148: in the ATLAS visitor centre, from left to right: Former IT Department Head W. von Rüden; ATLAS Collaboration P. Mättig; CEO Siemens Healthcare Sector, Chief Technology Officer, Head of Corporate Technology, Member of Siemens AG Managing Board, Germany, H. Requardt; Head of Innovation and Systems Projects, Siemens Healthcare Sector O. Heid; H. von Dewitz; ATLAS Collaboration member M. Hauschild.

  8. Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives.

    Science.gov (United States)

    Robinson, Hal; Engelhardt, Thomas

    2017-01-01

    Myringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT) surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction. This review summarizes recently published studies about the long-term effects of general anesthesia in young children, novel approaches to preoperative fasting and simplified approaches to the assessment and management of emergence delirium (ED) and emergence agitation (EA). New developments in perioperative ambulatory care, including management of comorbidities and day care unit logistics, are discussed. Long-term follow-up of children exposed to general anesthesia before the age of 4 years has limited impact on academic achievement or cognitive performance and should not delay the treatment of common ENT pathology, which can impair speech and language development. A more liberal approach to fasting, employing a 6-4-0 regime allowing children fluids up until theater, may become an accepted practice in future. ED and EA should be discriminated from pain in recovery and, where the child is at risk of harm, should be treated promptly. Postoperative pain at home remains problematic in ambulatory surgery and better parental education is needed. Effective ambulatory care ultimately requires a well-coordinated team approach from effective preassessment to postoperative follow-up.

  9. Auricular Acupuncture for Pain Relief after Ambulatory Knee Arthroscopy—A Pilot Study

    Directory of Open Access Journals (Sweden)

    Taras I. Usichenko

    2005-01-01

    Full Text Available Auricular acupuncture (AA is effective in treating various pain conditions, but there have been no analyses of AA for the treatment of pain after ambulatory knee surgery. We assessed the range of analgesic requirements under AA after ambulatory knee arthroscopy. Twenty patients randomly received a true AA procedure (Lung, Shenmen and Knee points or sham procedure (three non-acupuncture points on the auricular helix before ambulatory knee arthroscopy. Permanent press AA needles were retained in situ for one day after surgery. Post-operative pain was treated with non-steroidal anti-inflammatory ibuprofen, and weak oral opioid tramadol was used for rescue analgesic medication. The quantity of post-operative analgesics and pain intensity were used to assess the effect of AA. The incidence of analgesia-related side effects, time to discharge from the anesthesia recovery room, heart rate and blood pressure were also recorded. Ibuprofen consumption after surgery in the AA group was lower than in the control group: median 500 versus 800 mg, P = 0.043. Pain intensity on a 100 mm visual analogue scale for pain measurement and other parameters were similar in both groups. Thus AA might be useful in reducing the post-operative analgesic requirement after ambulatory knee arthroscopy.

  10. Evaluation of current care effectiveness: a survey of hypertension guideline implementation in Finnish health centres

    DEFF Research Database (Denmark)

    Alanen, Seija I; Johannala-Kemppainen, Riitta; Ijäs, Jarja J

    2007-01-01

    OBJECTIVE: To assess the extent and style of implementation of the Hypertension Guideline (HT Guideline) in Finnish primary health centres, and to identify a scale of contrasting implementation styles in the health centres (with the two ends of the scale being referred to as information...... implementers or disseminators respectively). DESIGN: A cross-sectional study. Development of a questionnaire and criteria for assessing the extent and style of implementation of the HT Guideline. SETTING: Primary healthcare. SUBJECTS: All head physicians and senior nursing officers in Finnish health centres (n...... =290). MAIN OUTCOME MEASURES: The extent of adoption of the HT Guideline in health centres and the characteristics associated with the implementation style. RESULTS: Responses were received from 410 senior medical staff (246 senior nursing officers and 164 head physicians) representing altogether 264...

  11. The Use of the Ambulatory Arterial Stiffness Index in Patients Suspected of Secondary Hypertension

    NARCIS (Netherlands)

    Verbakel, J.R.; Adiyaman, A.; Kraayvanger, N.; Dechering, D.G.; Postma, C.T.

    2016-01-01

    The ambulatory arterial stiffness index (AASI) is a marker of arterial stiffness and is derived from ambulatory 24-h blood pressure registration. We studied whether the AASI could be used as a predictive factor for the presence of renal artery stenosis (RAS) in patients with a suspicion of secondary

  12. Attractiveness of people-centred and integrated Dutch Home Care: A nationwide survey among nurses.

    Science.gov (United States)

    Maurits, Erica E M; de Veer, Anke J E; Groenewegen, Peter P; Francke, Anneke L

    2018-03-05

    The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people-centred and integrated health services. This includes providing integrated care around people's needs that is effectively co-ordinated across providers and co-produced by professionals, the patient, the family and the community. At the same time, healthcare policies aim to scale back hospital and residential care in favour of home care. This is one reason for the home-care nursing staff shortages in Europe. Therefore, this study aimed to examine whether people-centred, integrated home care appeals to nurses with different levels of education in home care and hospitals. A questionnaire survey was held among registered nurses in Dutch home-care organisations and hospitals in 2015. The questionnaire addressed the perceived attractiveness of different aspects of people-centred, integrated home care. In total 328 nurses filled in the questionnaire (54% response rate). The findings showed that most home-care nurses (70% to 97%) and 36% to 76% of the hospital nurses regard the different aspects of people-centred, integrated home care as attractive. Specific aspects that home-care nurses find attractive are promoting the patient's self-reliance and having a network in the community. Hospital nurses are mainly attracted to health-related prevention and taking control in complex situations. No clear differences between the educational levels were found. It is concluded that most home-care nurses and a minority of hospital nurses feel attracted to people-centred, integrated home care, irrespective of their educational level. The findings are relevant to policy makers and home-care organisations who aim to expand the home-care nursing workforce. © 2018 John Wiley & Sons Ltd.

  13. Ambulatory care pavilion takes its place out front by solving multiple needs.

    Science.gov (United States)

    Saukaitis, C A

    1994-09-01

    In sum, this structure exemplifies the fact that high-tech tertiary care medical centers can be user-friendly to the ambulatory health care consumer by serving their routine needs conveniently and efficiently. Says Gerald Miller, president of Crozer-Chester: "The ambulatory care pavilion has enabled Crozer to successfully and efficiently merge physicians' offices with institutional-based services and inpatient services. We are pleased with how the pavilion positions our medical center for the next century.

  14. 75 FR 73088 - Medicare Program; Application by the American Association for Accreditation of Ambulatory Surgery...

    Science.gov (United States)

    2010-11-29

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare and Medicaid Services [CMS-2332-PN] Medicare Program; Application by the American Association for Accreditation of Ambulatory Surgery... Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) for recognition as a national...

  15. 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

    2004-01-01

    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...

  16. The challenges of leading change in health-care delivery from the front-line.

    Science.gov (United States)

    Byers, Vivienne

    2017-09-01

    The public sector is facing turbulent times and this challenges nurses, who are expected to serve both patient interests and the efficiency drives of their organisations. In the context of implementing person-centred health policy, this paper explores the evolving role of front-line nurses as leaders and champions of change. Nurses can be seen to have some autonomy in health-care delivery. However, they are subject to systems of social control. In implementing person-centred policy, nurses can be seen to be doing the best they can within a constrained environment. A survey of nursing practice in person-centred health-policy implementation is presented. Despite much being written about managing health-professional resistance to policy implementation, there is a gap between what is being asked of nurses and the resources made available to them to deliver. In this milieu, nurses are utilising their discretion and leading from the front-line in championing change. Empowering nurses who seek to lead patient involvement could be the key to unlocking health-care improvement. Health services tend to be over-managed and under-led and there is a need to harness the potential of front-line nurses by facilitating leadership development through appropriate organisational support. © 2015 John Wiley & Sons Ltd.

  17. Comparison of ambulatory blood pressure monitoring and office blood pressure measurements in obese children and adolescents.

    Science.gov (United States)

    Renda, Rahime

    2018-04-01

    Obesity in adults has been related to hypertension and abnormal nocturnal dipping of blood pressure, which are associated with poor cardiovascular and renal outcomes. Here, we aimed to resolve the relationship between the degree of obesity, the severity of hypertension and dipping status on ambulatory blood pressure in obese children. A total 72 patients with primary obesity aged 7 to 18 years (mean: 13.48 ± 3.25) were selected. Patients were divided into three groups based on body mass index (BMİ) Z-score. Diagnosis and staging of ambulatory hypertension based on 24-h blood pressure measurements, obtained from ambulatory blood pressure monitoring. Based on our ambulatory blood pressure data, 35 patients (48.6%) had hypertension, 7 (20%) had ambulatory prehypertension, 21 (60%) had hypertension, and 7 patients (20%) had severe ambulatory hypertension. There was a significant relationship between severity of hypertension and the degree of obesity (p lood pressure results and loads were similar between groups. Diastolic and mean arterial blood pressure levels during the night, diastolic blood pressure loads, and heart rate during the day were significantly higher in Group 3 (p lood pressure at night, mean arterial pressure at night, diastolic blood pressure loads and heart rate at day. Increase in BMI Z-score does not a significant impact on daytime blood pressure and nocturnal dipping status.

  18. Exploring healthcare communication models in private physiotherapy practice.

    Science.gov (United States)

    Hiller, Amy; Guillemin, Marilys; Delany, Clare

    2015-10-01

    This project explored whether models of healthcare communication are evident within patient-physiotherapist communication in the private practice setting. Using qualitative ethnographic methods, fifty-two patient-physiotherapist treatment sessions were observed and interviews with nine physiotherapists were undertaken. Data were analyzed using thematic analysis. In these clinical encounters physiotherapists led the communication. The communication was structured and focussed on physical aspects of the patient's presentation. These features were mediated via casual conversation and the use of touch to respond to the individual patient. Physiotherapists did not explicitly link their therapeutic communication style to established communication models. However, they described a purposeful approach to how they communicated within the treatment encounter. The communication occurring in the private practice physiotherapy treatment encounter is predominantly representative of a 'practitioner-centred' model. However, the subtle use of touch and casual conversation implicitly communicate competence and care, representative of a patient-centred model. Physiotherapists do not explicitly draw from theories of communication to inform their practice. Physiotherapists may benefit from further education to achieve patient-centred communication. Equally, the incorporation of casual conversation and the use of touch into theory of physiotherapy patient-centred communication would highlight these specific skills that physiotherapists already utilize in practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. Human Centred Design Considerations for Connected Health Devices for the Older Adult

    Directory of Open Access Journals (Sweden)

    Richard P. Harte

    2014-06-01

    Full Text Available Connected health devices are generally designed for unsupervised use, by non-healthcare professionals, facilitating independent control of the individuals own healthcare. Older adults are major users of such devices and are a population significantly increasing in size. This group presents challenges due to the wide spectrum of capabilities and attitudes towards technology. The fit between capabilities of the user and demands of the device can be optimised in a process called Human Centred Design. Here we review examples of some connected health devices chosen by random selection, assess older adult known capabilities and attitudes and finally make analytical recommendations for design approaches and design specifications.

  20. How to practice person-centred care: A conceptual framework.

    Science.gov (United States)

    Santana, Maria J; Manalili, Kimberly; Jolley, Rachel J; Zelinsky, Sandra; Quan, Hude; Lu, Mingshan

    2018-04-01

    Globally, health-care systems and organizations are looking to improve health system performance through the implementation of a person-centred care (PCC) model. While numerous conceptual frameworks for PCC exist, a gap remains in practical guidance on PCC implementation. Based on a narrative review of the PCC literature, a generic conceptual framework was developed in collaboration with a patient partner, which synthesizes evidence, recommendations and best practice from existing frameworks and implementation case studies. The Donabedian model for health-care improvement was used to classify PCC domains into the categories of "Structure," "Process" and "Outcome" for health-care quality improvement. The framework emphasizes the structural domain, which relates to the health-care system or context in which care is delivered, providing the foundation for PCC, and influencing the processes and outcomes of care. Structural domains identified include: the creation of a PCC culture across the continuum of care; co-designing educational programs, as well as health promotion and prevention programs with patients; providing a supportive and accommodating environment; and developing and integrating structures to support health information technology and to measure and monitor PCC performance. Process domains describe the importance of cultivating communication and respectful and compassionate care; engaging patients in managing their care; and integration of care. Outcome domains identified include: access to care and Patient-Reported Outcomes. This conceptual framework provides a step-wise roadmap to guide health-care systems and organizations in the provision PCC across various health-care sectors. © 2017 The Authors Health Expectations published by John Wiley & Sons Ltd.

  1. Management of abnormal uterine bleeding – focus on ambulatory hysteroscopy

    Directory of Open Access Journals (Sweden)

    Kolhe S

    2018-03-01

    Full Text Available Shilpa Kolhe Ambulatory Gynaecology Unit, Royal Derby Hospital, Derby, UK Abstract: The rapid evolution in ambulatory hysteroscopy (AH has transformed the approach to diagnose and manage abnormal uterine bleeding (AUB. The medical management in primary care remains the mainstay for initial treatment of this common presentation; however, many women are referred to secondary care for further evaluation. To confirm the diagnosis of suspected intrauterine pathology, the traditional diagnostic tool of day case hysteroscopy and dilatation and curettage in a hospital setting under general anesthesia is now no longer required. The combination of ultrasound diagnostics and modern AH now allows thorough evaluation of uterine cavity in an outpatient setting. Advent of miniature hysteroscopic operative systems has revolutionized the ways in which clinicians can not only diagnose but also treat menstrual disorders such as heavy menstrual bleeding, intermenstrual bleeding and postmenopausal bleeding in most women predominantly in a one-stop clinic. This review discussed the approach to manage women presenting with AUB with a focus on the role of AH in the diagnosis and treatment of this common condition in an outpatient setting. Keywords: abnormal uterine bleeding, ambulatory hysteroscopy, endometrial polyps, one-stop clinic, vaginoscopic approach

  2. The impact of compulsory drug detention exposure on the avoidance of healthcare among injection drug users in Thailand.

    Science.gov (United States)

    Kerr, Thomas; Hayashi, Kanna; Ti, Lianping; Kaplan, Karyn; Suwannawong, Paisan; Wood, Evan

    2014-01-01

    Although Thailand has relied on the use of compulsory drug detention centres as a strategy to try to address problematic drug use, little is known about the effects of exposure to these centres on people who inject drugs (IDU). Therefore, we undertook this study to explore whether exposure to compulsory drug detention was associated with avoiding healthcare among Thai IDU. Using Poisson regression analyses, we examined the relationship between compulsory drug detention exposure and avoiding healthcare among participants in the Mitsampan Community Research Project based in Bangkok. 435 IDU participated in this study, including 111 (25.5%) participants who reported avoiding healthcare. In multivariate analyses, avoiding healthcare was positively associated with exposure to compulsory drug detention (adjusted prevalence ratio [APR]=1.60; 95% confidence interval [CI]: 1.16-2.21), having been refused healthcare (APR=3.46; 95% CI: 2.61-4.60), and experiencing shame associated with one's drug use (APR=1.93; 95% CI: 1.21-3.09). Exposure to compulsory drug detention was associated with avoiding healthcare among Thai IDU, suggesting that this system of detention may be contributing to the burden of preventable morbidity among IDU in this setting. Although further research is needed to confirm these findings, the results of this study reinforce previous calls to replace the system of compulsory drug detention with evidence-based public health interventions for IDU. Copyright © 2013 Elsevier B.V. All rights reserved.

  3. Ambulatory blood pressure and urinary albumin excretion in clinically healthy subjects

    DEFF Research Database (Denmark)

    Clausen, Peter Vilhelm; Jensen, J S; Borch-Johnsen, K

    1998-01-01

    UAER. Because 24-hour ambulatory blood pressure is a superior predictor of hypertensive target organ involvement, we aimed to investigate blood pressure profile in clinically healthy subjects with elevated UAER. Ambulatory blood pressure monitoring was performed with a portable recorder in 27 subjects...... loss of albumin could not be solely related to the higher blood pressure. In conclusion, apparently healthy subjects with elevated UAER had slightly but significantly higher 24-hour systolic and diastolic blood pressure levels in addition to increased blood pressure loads but normal circadian variation...

  4. New concepts and technologies in home care and ambulatory monitoring.

    Science.gov (United States)

    Dittmar, A; Axisa, F; Delhomme, G; Gehin, C

    2004-01-01

    The world is becoming more and more health conscious. Society, health policy and patients' needs are all changing dramatically. The challenges society is currently facing are related to the increase in the aging population, changes in lifestyle, the need for healthcare cost containment and the need for improvement and monitoring of healthcare quality. The emphasis is put on prevention rather than on treatment. In addition, patients and health consumers are waiting for non-invasive or minimally-invasive diagnosis and treatment methods, for home care, short stays in hospital, enhancement of rehabilitation, information and involvement in their own treatment. Progress in science and technology offers, today, miniaturization, speed, intelligence, sophistication and new materials at lower cost. In this new landscape, microtechnologies, information technologies and telecommunications are key factors. Telemedicine has also evolved. Used initially to exchange patients' files, radiographic data and other information between health providers, today telemedicine contributes to new trends in "hospital extension" through all-day monitoring of vital signs, professional activities, entertainment and home-based activities. The new possibilities for home care and ambulatory monitoring are provided at 4 levels: a) Microsensors. Microtechnologies offer the possibility of small size, but also of intelligent, active devices, working with low energy, wireless and non-invasive or minimally-invasive; b) Wrist devices are particularly user friendly and combine sensors, circuits, supply, display and wireless transmission in a single box, very convenient for common physical activities; c) Health smart clothes make contact with 90 % of the skin and offer many possibilities for the location of sensors. These sensors have to be thin, flexible and compatible with textiles, or made using textile technologies, such as new fibers with specific (mechanical, electrical and optical) properties; d

  5. Person-centred Leadership: a relational approach to leadership derived through action research.

    Science.gov (United States)

    Cardiff, Shaun; McCormack, Brendan; McCance, Tanya

    2018-04-21

    How does person-centred leadership manifest in clinical nursing. Person-centred practice fosters healthful relationships and is gaining increasing attention in nursing and healthcare, but nothing is known about the influence of a person-centred approach to leadership practice. Most leadership models used in nursing were originally developed outside of nursing. A three year participatory action research study where participant leaders planned, researched and learned from their practice development. After an orientation phase, four action spirals focused on: critical and creative reflective inquiries into leadership practice change; leading the implementation and evaluation of a new nursing system; facilitating storytelling sessions with staff and annually reflecting on personal leadership change. Multiple data gathering methods offered insight into leadership development from several perspectives. Critical and creative thematic data analysis revealed a set of attributes, relational processes and contextual factors that influenced the being and becoming of a person-centred leader. Comparing the findings with nursing leadership literature supports a conceptual framework for person-centred leadership. Person-centred leadership is a complex, dynamic, relational and contextualised practice that aims to enable associates and leaders achieve self-actualisation, empowerment and wellbeing. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  6. [Evidence-based clinical oral healthcare guidelines 4. Adherence requires an implementation strategy].

    Science.gov (United States)

    Braspenning, J C C; Mettes, T G P H; van der Sanden, W J M; Wensing, M J P

    2015-03-01

    Adherence to clinical guidelines requires support in practice. However, systematic implementation of evidence-based guidelines is not common practice in oral healthcare. The Knowledge Institute Oral Care (KiMo) offers the opportunity to take into account potential barriers and facilitators during the development of evidence-based clinical practice guidelines. These factors which are relevant to the guideline and the oral healthcare practice provide the ingredients for a tailor-made programme of implementation that has a scientific basis. Elements of any implementation programme are the quality indicators derived from the oral healthcare guidelines. These indicators should fit, on the one hand, the specific goals of the guidelines (patient safety, effectiveness, efficiency, patient-centred, timeliness, accessibility) and, onthe other hand, the various perspectives of the different stakeholders, such as patients, caregivers, health insurers and inspectorate. These quality indicators provide information on adherence to the guidelines, the results of a certain treatment and the success of the implementation strategy, all with the aim to improve the quality of oral healthcare.

  7. Antroduodenal manometry: 24-hour ambulatory monitoring versus short-term stationary manometry in patients with functional dyspepsia

    NARCIS (Netherlands)

    Jebbink, R. J.; vanBerge-Henegouwen, G. P.; Akkermans, L. M.; Smout, A. J.

    1995-01-01

    OBJECTIVES: To examine the interdigestive and postprandial antroduodenal motility patterns of patients with functional dyspepsia using prolonged ambulatory antroduodenal manometry and to compare these findings with conventional stationary manometry. METHODS: Prolonged ambulatory and short-term

  8. [Considerations on local-regional anesthesia for ambulatory tooth extractions in patients with heart disease].

    Science.gov (United States)

    Debernardi, G; Borgogna, E

    1975-01-01

    Ambulatory dental extraction was performed on 150 patients with various forms of heart disease. No serious complications were noted with an anaesthetic without vasoconstriction (plain 3% carbocaine). The prior history was carefully studied and pressure values were determined. It is felt that heart disease does not form an absolute contraindication to ambulatory dental extraction.

  9. Anesthesia for Ambulatory Pediatric Surgery in Sub-Saharan Africa: A Pilot Study in Burkina Faso.

    Science.gov (United States)

    Kabré, Yvette B; Traoré, Idriss S S; Kaboré, Flavien A R; Ki, Bertille; Traoré, Alain I; Ouédraogo, Isso; Bandré, Emile; Wandaogo, Albert; Ouédraogo, Nazinigouba

    2017-02-01

    Long surgical wait times and limited hospital capacity are common obstacles to surgical care in many countries in Sub-Saharan Africa (SSA). Introducing ambulatory surgery might contribute to a solution to these problems. The purpose of this study was to evaluate the safety and feasibility of introducing ambulatory surgery into a pediatric hospital in SSA. This is a cross-sectional descriptive study that took place over 6 months. It includes all patients assigned to undergo ambulatory surgery in the Pediatric University Hospital in Ouagadougou, Burkina Faso. Eligibility criteria for the ambulatory surgery program included >1 year of age, American Society of Anesthesiologists (ASA) 1 status, surgery with a low risk of bleeding, lasting anesthesia with halothane. Sixty-five percent also received regional or local anesthesia consisting of caudal block in 79.23% or nerve block in 20.77%. The average duration of surgery was 33 ± 17.47 minutes. No intraoperative complications were noted. All the patients received acetaminophen and a nonsteroidal anti-inflammatory drug in the recovery room. Twelve (11.7%) patients had complications in recovery, principally nausea and vomiting. Eight (7.8%) patients were admitted to the hospital. No serious complications were associated with ambulatory surgery. Its introduction could possibly be a solution to improving pediatric surgical access in low-income countries.

  10. Cognitive assessment on elderly people under ambulatory care

    Directory of Open Access Journals (Sweden)

    Bruna Zortea

    2015-04-01

    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.

  11. Ambulatory Assessment.

    Science.gov (United States)

    Carpenter, Ryan W; Wycoff, Andrea M; Trull, Timothy J

    2016-08-01

    In recent years, significant technological advances have changed our understanding of dynamic processes in clinical psychology. A particularly important agent of change has been ambulatory assessment (AA). AA is the assessment of individuals in their daily lives, combining the twin benefits of increased ecological validity and minimized retrospective biases. These benefits make AA particularly well-suited to the assessment of dynamic processes, and recent advancements in technology are providing exciting new opportunities to understand these processes in new ways. In the current article, we briefly detail the capabilities currently offered by smartphones and mobile physiological devices, as well as some of the practical and ethical challenges of incorporating these new technologies into AA research. We then provide several examples of recent innovative applications of AA methodology in clinical research, assessment, and intervention and provide a case example of AA data generated from a study utilizing multiple mobile devices. In this way, we aim to provide a sense of direction for researchers planning AA studies of their own.

  12. Nutritional status of adults participating in ambulatory rehabilitation.

    Science.gov (United States)

    Kaur, Supreet; Miller, Michelle D; Halbert, Julie; Giles, Lynne C; Crotty, Maria

    2008-01-01

    To assess the overall nutritional status of older adults participating in ambulatory rehabilitation and determine its association with relevant outcomes including physical function and quality of life. Cross-sectional. Ambulatory rehabilitation service in the Southern region of Adelaide, Australia. A total of 229 participants recruited as part of a RCT between June 2005 and June 2006, stroke (n=83), elective orthopedic procedure (n=44) and other medical condition (n=102). Nutritional status was measured using Mini Nutritional Assessment (MNA), Simplified Nutrition Appetite Questionnaire (SNAQ) and Body Mass Index. Functional performance was assessed using the Modified Barthel Index (MBI) and quality of life was measured using the Short Form-36 (SF-36). Sixty-three percent of participants were malnourished or at risk of malnutrition according to the MNA and a third had a risk of >or= 5% weight loss in the subsequent six months, according to the SNAQ. Participants with a diagnosis other than stroke or elective orthopedic procedure were the most vulnerable, with 53% (n=74/140) classified as at risk of malnutrition or malnourished and a longer length of stay in hospital. Functional performance was no different for participants assessed as at risk of malnutrition or malnourished compared to the well nourished, but the SF-36 mental component score was significantly higher for those who were well nourished (p=0.003). Findings emphasise the magnitude of the malnutrition problem in ambulatory rehabilitation settings. Further research is required to evaluate the resource implications against expected benefits of providing nutrition interventions at this point.

  13. "Someone's rooting for you": continuity, advocacy and street-level bureaucracy in UK maternal healthcare.

    Science.gov (United States)

    Finlay, Susanna; Sandall, Jane

    2009-10-01

    Continuity and advocacy are widely held to be important elements in maternal healthcare, yet they are often lacking from the care women receive. In order to understand this disparity, we draw upon interviews and ethnographic observational findings from The One-to-One Caseload Project, a study exploring the impacts of a caseload model of maternity care within an urban National Health Service provider in Britain. Drawing on Lipsky's (1980) and Prottas's (1979) theories of street-level bureaucracy, this paper attempts to understand how midwives, working on the frontline within caseload and standard care models, manage the competing demands of delivering a personalised service within a bureaucratic organisation. The caseload care model serves as a case study for how a client-centred model of working can assist street-level bureaucrats to manage the administrative pressures of public service organisations and provide their clients with a personalised, responsive service. Nevertheless, despite such benefits, client-centred models of working may have unintended consequences for both health carers and healthcare systems.

  14. Challenges of healthcare administration: optimizing quality and value at an affordable cost in pediatric cardiology.

    Science.gov (United States)

    Cohen, Mitchell I; Frias, Patricio A

    2018-01-01

    The purpose of this review is to explore the paradigm shift in healthcare delivery that will need to take place over the next few years away from an emphasis on supply-driven health care to better quality transparent-driven health care whose focus is on the consumer's best interest. The current healthcare system is fragmented and costs continue to rise. The best way to contain costs is to improve quality to the consumer, the patient. Physicians and hospitals need to align in a team-based approach that allows physicians to understand current costs and how to strive toward a focus on healthcare outcomes. Pediatric cardiology is a unique discipline that cares for patients with complex congenital conditions that will span their lifetime and also involves not just cardiology but surgery, intensive care, anesthesia, nursing, and a host of inpatient and ambulatory services. Understanding what matters to the patient and his/her family and presenting quality outcomes in a transparent fashion will gradually allow a shift to take place away from physician visits, tests ordered, and procedures performed. This can only be achieved with physicians, given the appropriate tools to understand costs, value, and outcomes and models where the hospitals and physicians are aligned. The transformation to a value-based healthcare system is beginning and pediatric cardiologists need to be educated, given the appropriate resources, receive appropriate feedback, and patients need to be part of the solution so that care providers can understand what matters most to them.

  15. Perceptions of healthcare quality in Ghana: Does health insurance status matter?

    Science.gov (United States)

    Duku, Stephen Kwasi Opoku; Nketiah-Amponsah, Edward; Janssens, Wendy; Pradhan, Menno

    2018-01-01

    This study's objective is to provide an alternative explanation for the low enrolment in health insurance in Ghana by analysing differences in perceptions between the insured and uninsured of the non-technical quality of healthcare. It further explores the association between insurance status and perception of healthcare quality to ascertain whether insurance status matters in the perception of healthcare quality. Data from a survey of 1,903 households living in the catchment area of 64 health centres were used for the analysis. Two sample independent t-tests were employed to compare the average perceptions of the insured and uninsured on seven indicators of non-technical quality of healthcare. A generalised ordered logit regression, controlling for socio-economic characteristics and clustering at the health facility level, tested the association between insurance status and perceived quality of healthcare. The perceptions of the insured were found to be significantly more negative than the uninsured and those of the previously insured were significantly more negative than the never insured. Being insured was associated with a significantly lower perception of healthcare quality. Thus, once people are insured, they tend to perceive the quality of healthcare they receive as poor compared to those without insurance. This study demonstrated that health insurance status matters in the perceptions of healthcare quality. The findings also imply that perceptions of healthcare quality may be shaped by individual experiences at the health facilities, where the insured and uninsured may be treated differently. Health insurance then becomes less attractive due to the poor perception of the healthcare quality provided to individuals with insurance, resulting in low demand for health insurance in Ghana. Policy makers in Ghana should consider redesigning, reorganizing, and reengineering the National Healthcare Insurance Scheme to ensure the provision of better quality healthcare

  16. The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial.

    OpenAIRE

    Whitty, Jennifer A; McInnes, Elizabeth; Bucknall, Tracey; Webster, Joan; Gillespie, Brigid M; Banks, Merrilyn; Thalib, Lukman; Wallis, Marianne; Cumsille, Jose; Roberts, Shelley; Chaboyer, Wendy

    2017-01-01

    Pressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare. To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care. Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial. Eight tertiary hospitals in Australia. Adult patients receiving either a patient-centred pressure ulcer prev...

  17. Ambulatory Estimation of Relative Foot Positions using Ultrasound

    NARCIS (Netherlands)

    Weenk, D.; van der Coelen, Michiel; Geessink, Arno A.G.; van der Hoek, Frank J.; Verstoep, Bart; Kortier, H.G.; van Meulen, Fokke; van Beijnum, Bernhard J.F.; Veltink, Petrus H.

    2013-01-01

    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

  18. [Ambulatory pediatrics: a challenge].

    Science.gov (United States)

    Ransy, V; Gevers, B; Landsberg, M

    2006-01-01

    Ambulatory paediatrics in University hospitals has remarkably evolved during the past decade, along with technological progress and the current need for undelayed information and attention; demand for hospital medical advice increases consequently, either directly in outpatients wards or indirectly by phone or e-mails. Specific medico-social aspects linked essentially to populations' migration, poverty, chronic stress and family splitting are regularly encountered. Hospital architecture and adequacy of medical and nursing staff must both be adjusted to these changing medical demands including medical teaching. We now face the ever-growing challenge of providing an adequate management of actual medico-psycho-social aspects and integrating up-to-date paediatrics in our daily practices.

  19. Participation restrictions in ambulatory amyotrophic lateral sclerosis patients: Physical and psychological factors.

    Science.gov (United States)

    Van Groenestijn, Annerieke C; Schröder, Carin D; Kruitwagen-Van Reenen, Esther T; Van Den Berg, Leonard H; Visser-Meily, Johanna M A

    2017-11-01

    The aim of this study was to assess the prevalence of participation restrictions in ambulatory patients with amyotrophic lateral sclerosis (ALS) and to identify physical and psychological contributory factors. In this cross-sectional study, self-reported participation restrictions of 72 ambulatory ALS patients were assessed using the social health status dimension (SIPSOC) of the Sickness Impact Profile (SIP-68). Associations between SIPSOC and physical functioning, psychological factors, and demographic factors were analyzed using hierarchical regression analyses. Ninety-two percent of the patients reported participation restrictions; 54.9% could be explained by physical functioning; psychological factors accounted for 8.1% of the variance. Lung capacity, functional mobility, fatigue, and helplessness were independently associated with participation restrictions. Ambulatory ALS patients have participation restrictions, which may be influenced if early ALS care is directed toward lung capacity, functional mobility, fatigue, and feelings of helplessness. Muscle Nerve 56: 912-918, 2017. © 2017 Wiley Periodicals, Inc.

  20. Compensatory movements during functional activities in ambulatory children with Duchenne muscular dystrophy

    Directory of Open Access Journals (Sweden)

    Joyce Martini

    2014-01-01

    Full Text Available Objective: During the transitional phase (ambulatory to non-ambulatory, synergies characterize the evolution of Duchenne muscular dystrophy (DMD. This study was performed to describe and quantify compensatory movements while sitting down on/rising from the floor and climbing up/down steps. Method: Eighty videos (5 children × 4 assessments × 4 tasks were recorded quarterly in the year prior to gait loss. Compensatory movements from the videos were registered based on the Functional Evaluation Scale for DMD. Results: The most frequently observed compensatory movements were upper limb support on lower limbs/floor/handrail during all the tasks and lumbar hyperlordosis, trunk support on handrail, equinus foot, increased base of support, non-alternated descent, and pauses while climbing up/down steps. Conclusion: Climbing up/down steps showed a higher number of compensatory movements than sitting down on/rising from the floor, which seemed to be lost before climbing up/down steps in ambulatory children with DMD.

  1. From an expert-driven paper guideline to a user-centred decision support system: a usability comparison study

    NARCIS (Netherlands)

    Kilsdonk, Ellen; Peute, Linda W.; Riezebos, Rinke J.; Kremer, Leontien C.; Jaspers, Monique W. M.

    2013-01-01

    To assess whether a user-centred prototype clinical decision support system (CDSS) providing patient-specific advice better supports healthcare practitioners in terms of (a) types of usability problems detected and (b) effective and efficient retrieval of childhood cancer survivor's follow-up

  2. Can a Discrete Choice Experiment contribute to person-centred healthcare?

    DEFF Research Database (Denmark)

    Kaltoft, Mette Kjer; Nielsen, Jesper Bo; Salkeld, Glenn

    2015-01-01

    In person-centred decision making the relative importance of the considerations that matter to the person is elicited and combined, at the point of decision, with the best estimates available on the performance of the available options on those criteria. Whatever procedure is used to implement...... this in a clinical decision, average preferences emerging from group or subgroup research cannot contribute directly, since they can have only a statistical relationship with the preferences of the individual person. The precise relationship is knowable by eliciting those of the individual concerned, but there would...... of how this could happen, the ambiguity often arising from the use and positioning of the apostrophe in the words persons and patients. Only when the person opts out of preference provision and asks to be treated as ‘average’, can the results of a DCE have clinical relevance in genuinely person...

  3. Medical Students and Patient-Centred Clinical Practice: The Case for More Critical Work in Medical Schools

    Science.gov (United States)

    Donetto, Sara

    2012-01-01

    In the last two decades, undergraduate medical education in the United Kingdom has undergone several important changes. Many of these have revolved around a paradigmatic shift from "paternalistic" to "patient-centred" approaches to healthcare. Adopting a Foucauldian understanding of power and borrowing from Freire's critical…

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

    Science.gov (United States)

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

    2010-12-01

    Relative to outpatient surgery in hospital settings, ambulatory surgery centers (ASCs) are more efficient and associated with a lower cost per case. However, these facilities may also spur higher overall procedure utilization and thus lead to greater overall health care costs. The authors used the State Ambulatory Surgery Database from the State of Florida to identify Medicare-aged patients undergoing 4 common ambulatory procedures in 2006, including knee arthroscopy, cystoscopy, cataract removal, and colonoscopy. Hospital service areas (HSAs) were characterized according to ASC market share, that is, the proportion of residents undergoing outpatient surgery in these facilities. The authors then examined relationships between ASC market share and rates of each procedure. Age-adjusted rates of ambulatory surgery ranged from 190.5 cases per 1000 to 320.8 cases per 1000 in HSAs with low and high ASC market shares, respectively (P 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 elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear.

  5. 75 FR 78246 - Medicare Program; Re-Chartering of the Advisory Panel on Ambulatory Payment Classification (APC...

    Science.gov (United States)

    2010-12-15

    ...] Medicare Program; Re-Chartering of the Advisory Panel on Ambulatory Payment Classification (APC) Groups... announces the re-chartering of the Advisory Panel on Ambulatory Payment Classification (APC) Groups (the... (APC) groups and their associated weights established under the Medicare hospital Outpatient...

  6. Consumer choice among Mutual Healthcare Purchasers: a feasible option for China?

    Science.gov (United States)

    Xu, Weiwei; van de Ven, Wynand P M M

    2013-11-01

    In its 2009 blue print of healthcare reform, the Chinese government aimed to create a competitive health insurance market in order to increase efficiency in the health insurance sector. A major advantage of a competitive health insurance market is that insurers are stimulated to act as well-motivated prudent purchasers of healthcare on behalf of their enrolees, and that consumers can choose among these purchasers. To emphasize the insurers' role of purchasers of care we denote them, as well as other entities that can fulfil this role (e.g. fundholding community health centres), as 'Mutual Healthcare Purchasers' (MHPs). As feasible proposals for creating competition in China's health insurance sector have yet to be made, we suggest two potential approaches to create competition among MHPs: (1) separating finance and operation of social health insurance and allowing consumer choice among operators of social health insurance schemes; (2) allowing consumer choice among fund-holding community health centres. Although the benefits of competition are widely accepted in China, the problematic consequences of a free competitive health insurance market - especially in relation to affordability and accessibility - are generally neglected. To solve the problems of lack of affordability and inaccessibility that would occur in the case of unregulated competition among MHPs, at least the following regulations are proposed to the Chinese policy makers: a 'standard benefit package' for basic health insurance, a 'risk-equalization scheme', and 'open enrolment'. Potential obstacles for implementing a risk equalization scheme are examined based on theoretical arguments and international experiences. We conclude that allowing consumer choice among MHPs and implementing a risk equalization scheme in China is politically and technically complex. Therefore, the Chinese government should prepare carefully for a market-oriented reform in its healthcare sector and adopt a strategic approach

  7. Biofilm antifungal susceptibility of Candida urine isolated from ambulatory patients

    Directory of Open Access Journals (Sweden)

    Débora da Luz Becker

    2016-07-01

    Full Text Available Background and Objectives: the association between the biofilm formations an antifungal resistance has been suggested to be an important factor in the pathogenesis of several Candida species. Besides, studies have included invasive candidiasis from hospitalized patients; however there are few studies that evaluated the species distribution, antifungal susceptibility and biofilm formation of Candida species isolated from ambulatory patients. Thus, the aim of this study was to evaluate whether biofilm producing contributes to antifungal resistance in Candida isolates from urine sample obtained from ambulatory patients. Methods: During one year, 25 urine samples positive for yeast were collected, stored and plated on agar supplemented with chloramphenicol and Sabouread left at room temperature for 5 days for subsequent: 52% (13/25 were C. albicans, 36% (9/25 C. tropicalis, 8% (2/25 C. krusei and 4% (1/25 C. parapsilosis. Results: The ability to form biofilm was detected in 23 (92% of the yeast studied and 15.4% (2/13 of C. albicans were fluconazole (FLU and ketoconazole (KET resistant, while 11.1% (1/9 of C. tropicalis were ketoconazole resistant and were anidulafungin (ANI non-susceptible. Conclusion: our results showed the high capacity for biofilm formation among Candida isolates from ambulatory patients.

  8. Economic and Environmental Impact of Energy Saving in Healthcare Buildings

    Directory of Open Access Journals (Sweden)

    Justo García-Sanz-Calcedo

    2018-03-01

    Full Text Available The purpose of this article is to estimate the economic and environmental impacts of energy consumption derived from healthcare buildings and proposes several energy-saving options in the sector. An experimental energy consumption study was development between 2005 and 2013 in 12 hospitals and 70 healthcare centres in Spain, built between 1980 and 2005 through audits carried out between 2005 and 2012, performed by the Extremadura Energy Agency. The study focused on electric energy, HVAC, DWH, lighting systems, renewable energies, maintenance strategy, thermal insulation, and optimal building size. Specifically, the following parameters were evaluated: energy savings, investment emission of CO2, NO2, and SO2 gases, and payback. The results revealed that through an appropriate energy management of healthcare buildings it is possible to save up to 8.60 kWh/m2 per year, for buildings of less than 5000 m2 (with no beds, which represents an expense of 1.55 €/m2. In healthcare buildings larger than 5000 m2 (with beds, it was possible to save up to 6.88 kWh/m2 per year, which represents an expense of 1.25 €/m2.

  9. Watsu approach for improving spasticity and ambulatory function in hemiparetic patients with stroke.

    Science.gov (United States)

    Chon, Seung Chul; Oh, Duck Won; Shim, Jae Hun

    2009-06-01

    This study reports the effect of Watsu as rehabilitation method for hemiparetic patients with stroke. Watsu consisted of 40 treatment sessions for 8 weeks, delivered underwater or at water surface level, it applied in three patients. Outcome measures included tools for assessing spasticity and ambulatory function. All patients showed decreased scores in the TAS and RVGA after Watsu application. Watsu was helpful in controlling spasticity and improving ambulatory function of the patients with hemiparesis.

  10. Tuberculosis and latent tuberculosis infection among healthcare workers in Kisumu, Kenya.

    Science.gov (United States)

    Agaya, Janet; Nnadi, Chimeremma D; Odhiambo, Joseph; Obonyo, Charles; Obiero, Vincent; Lipke, Virginia; Okeyo, Elisha; Cain, Kevin; Oeltmann, John E

    2015-12-01

    To assess prevalence and occupational risk factors of latent TB infection and history of TB disease ascribed to work in a healthcare setting in western Kenya. We conducted a cross-sectional survey among healthcare workers in western Kenya in 2013. They were recruited from dispensaries, health centres and hospitals that offer both TB and HIV services. School workers from the health facilities' catchment communities were randomly selected to serve as the community comparison group. Latent TB infection was diagnosed by tuberculin skin testing. HIV status of participants was assessed. Using a logistic regression model, we determined the adjusted odds of latent TB infection among healthcare workers compared to school workers; and among healthcare workers only, we assessed work-related risk factors for latent TB infection. We enrolled 1005 healthcare workers and 411 school workers. Approximately 60% of both groups were female. A total of 22% of 958 healthcare workers and 12% of 392 school workers tested HIV positive. Prevalence of self-reported history of TB disease was 7.4% among healthcare workers and 3.6% among school workers. Prevalence of latent TB infection was 60% among healthcare workers and 48% among school workers. Adjusted odds of latent TB infection were 1.5 times higher among healthcare workers than school workers (95% confidence interval 1.2-2.0). Healthcare workers at all three facility types had similar prevalence of latent TB infection (P = 0.72), but increasing years of employment was associated with increased odds of LTBI (P Kenya which offer TB and HIV services are at increased risk of latent TB infection, and the risk is similar across facility types. Implementation of WHO-recommended TB infection control measures are urgently needed in health facilities to protect healthcare workers. © 2015 John Wiley & Sons Ltd.

  11. Healthcare in Canada's North: Are We Getting Value for Money?

    Science.gov (United States)

    Young, T Kue; Chatwood, Susan; Marchildon, Gregory P

    2016-08-01

    To determine if Canadians are getting value for money in providing health services to our northern residents. Secondary analyses of data from Statistics Canada, the Canadian Institute of Health Information and territorial government agencies on health status, health expenditures and health system performance indicators. Per capita health expenditures in Canada's northern territories are double that of Canada as a whole and are among the highest in the world. The North lags behind the rest of the country in preventable mortality, hospitalization for ambulatory care sensitive conditions and other performance indicators. The higher health expenditure in the North is to be expected from its unique geography and demography. If the North is not performing as well as Canada, it is not due to lack of money, and policy makers should be concerned about whether healthcare can be as good as it could be. Copyright © 2016 Longwoods Publishing.

  12. Perfect match? Generation Y as change agents for information communication technology implementation in healthcare.

    Science.gov (United States)

    Yee, Kwang Chien; Miils, Erin; Airey, Caroline

    2008-01-01

    The current healthcare delivery model will not meet future healthcare demands. The only sustainable healthcare future is one that best leverages advances in technology to improve productivity and efficiency. Information communication technology (ICT) has, therefore, been touted as the panacea of future healthcare challenges. Many ICT projects in healthcare, however, fail to deliver on their promises to transform the healthcare system. From a technologist's perspective, this is often due to the lack of socio-technical consideration. From a socio-cultural perspective, however, there is often strong inertia to change. While the utilisation of user-centred design principles will generate a new wave of enthusiasm among technologists, this has to be matched with socio-cultural changes within the healthcare system. Generation Y healthcare workers might be the socio-cultural factor required, in combination with new technology, to transform the healthcare system. Generation Y has generated significant technology-driven changes in many other industries. The socio-cultural understanding of generation Y healthcare workers is essential to guide the design and implementation of ICT solutions for a sustainable healthcare future. This paper presents the initial analysis of our qualitative study which aims to generate in-depth conceptual insights of generation Y healthcare workers and their view of ICT in healthcare. Our results show that generation Y healthcare workers might assist future ICT implementation in healthcare. This paper, however, argues that significant changes to the current healthcare organisation will be required in order to unleash the full potential of generation Y workers and ICT implementation. Finally, this paper presents some strategies to empower generation Y workers as change agents for a sustainable future healthcare system.

  13. Building personal and professional resources of resilience and agility in the healthcare workplace.

    Science.gov (United States)

    Pipe, Teresa Britt; Buchda, Vicki L; Launder, Susan; Hudak, Barb; Hulvey, Lynne; Karns, Katherine E; Pendergast, Debra

    2012-02-01

    This article describes the rationale, implementation and results of a pilot study evaluating the personal and organizational impact of an educational intervention on the stress of health team members. The compelling imperative for the project was to find a positive and effective way to address the documented stress levels of healthcare workers. Pilot study of oncology staff (n=29) and healthcare leaders (n=15) exploring the impact of a positive coping approach on Personal and Organizational Quality Assessment-Revised (POQA-R) scores at baseline and 7 months using paired t-tests. Personal and organizational indicators of stress decreased in the expected directions in both groups over the time intervals. The majority of POQA-R categories were statistically significantly improved in the oncology staff, and many of the categories were statistically significantly improved in the leadership group. The findings from this project demonstrate that stress and its symptoms are problematic issues for hospital and ambulatory clinic staff as evidenced by baseline measures of distress. Further, a workplace intervention was feasible and effective in promoting positive strategies for coping and enhancing well-being, personally and organizationally. Copyright © 2011 John Wiley & Sons, Ltd.

  14. Ambulatory diffuse optical tomography and multimodality physiological monitoring system for muscle and exercise applications

    Science.gov (United States)

    Hu, Gang; Zhang, Quan; Ivkovic, Vladimir; Strangman, Gary E.

    2016-09-01

    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.

  15. The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use.

    Science.gov (United States)

    Zarb, P; Coignard, B; Griskeviciene, J; Muller, A; Vankerckhoven, V; Weist, K; Goossens, Mm; Vaerenberg, S; Hopkins, S; Catry, B; Monnet, Dl; Goossens, H; Suetens, C

    2012-11-15

    A standardised methodology for a combined point prevalence survey (PPS) on healthcare-associated infections (HAIs) and antimicrobial use in European acute care hospitals developed by the European Centre for Disease Prevention and Control was piloted across Europe. Variables were collected at national, hospital and patient level in 66 hospitals from 23 countries. A patient-based and a unit-based protocol were available. Feasibility was assessed via national and hospital questionnaires. Of 19,888 surveyed patients, 7.1% had an HAI and 34.6% were receiving at least one antimicrobial agent. Prevalence results were highest in intensive care units, with 28.1% patients with HAI, and 61.4% patients with antimicrobial use. Pneumonia and other lower respiratory tract infections (2.0% of patients; 95% confidence interval (CI): 1.8–2.2%) represented the most common type (25.7%) of HAI. Surgical prophylaxis was the indication for 17.3% of used antimicrobials and exceeded one day in 60.7% of cases. Risk factors in the patient-based protocol were provided for 98% or more of the included patients and all were independently associated with both presence of HAI and receiving an antimicrobial agent. The patient-based protocol required more work than the unit-based protocol, but allowed collecting detailed data and analysis of risk factors for HAI and antimicrobial use.

  16. Collaborative user-centred textile design research for healthcare: improving wellbeing and increasing performance

    OpenAIRE

    McLaren, A; Stevenson, F; Valentine, L

    2017-01-01

    It has been widely acknowledged that collaboration across disciplines is required in order to develop innovative, sustainable textile solutions that address complex societal problems (Kane & Philpott, 2013; Igoe, 2010). Potential to develop life-changing innovations in the field of advanced textiles for medical and healthcare has been identified as a key growth sector within Scotland, with collaborative cross- disciplinary user-focused design approaches recognised as central to developing new...

  17. Transforming Healthcare Delivery: Integrating Dynamic Simulation Modelling and Big Data in Health Economics and Outcomes Research

    NARCIS (Netherlands)

    Marshall, Deborah A.; Burgos-Liz, Lina; Pasupathy, Kalyan S.; Padula, William V.; IJzerman, Maarten Joost; Wong, Peter K.; Higashi, Mitchell K.; Engbers, Jordan; Wiebe, Samuel; Crown, William; Osgood, Nathaniel D.

    2016-01-01

    In the era of the Information Age and personalized medicine, healthcare delivery systems need to be efficient and patient-centred. The health system must be responsive to individual patient choices and preferences about their care, while considering the system consequences. While dynamic simulation

  18. Nutritional status and food habits of drug addicts in an ambulatory treatment

    OpenAIRE

    Ferreira, Isadora Borne; Paiva, Camila Bosse; Narvaez, Joana Corrêa de Magalhães; Bosa, Vera Lucia

    2015-01-01

    Objetivo: Identificar o estado nutricional e hábitos alimentares de pacientes masculinos em recuperação de dependência química em acompanhamento ambulatorial de uma unidade de adição. Métodos: Estudo transversal com 25 pacientes adultos em tratamento ambulatorial para dependência química. Foram aferidos parâmetros antropométricos (peso, estatura, circunferência da cintura e índice de massa corporal) e de composição corporal (bioimpedância elétrica), e foram investigados hábitos alimentares (Q...

  19. Person-centred care in nursing documentation.

    LENUS (Irish Health Repository)

    Broderick, Margaret C

    2012-12-07

    BACKGROUND: Documentation is an essential part of nursing. It provides evidence that care has been carried out and contains important information to enhance the quality and continuity of care. Person-centred care (PCC) is an approach to care that is underpinned by mutual respect and the development of a therapeutic relationship between the patient and nurse. It is a core principle in standards for residential care settings for older people and is beneficial for both patients and staff (International Practice Development in Nursing and Healthcare, Chichester, Blackwell, 2008 and The Implementation of a Model of Person-Centred Practice in Older Person Settings, Dublin, Health Service Executive, 2010a). However, the literature suggests a lack of person-centredness within nursing documentation (International Journal of Older People Nursing 2, 2007, 263 and The Implementation of a Model of Person-Centred Practice in Older Person Settings, Dublin, Health Service Executive, 2010a). AIMS AND OBJECTIVES: To explore nursing documentation in long-term care, to determine whether it reflected a person-centred approach to care and to describe aspects of PCC as they appeared in nursing records. METHOD: A qualitative descriptive study using the PCN framework (Person-centred Nursing; Theory and Practice, Oxford, Wiley-Blackwell, 2010) as the context through which nursing assessments and care plans were explored. RESULTS: Findings indicated that many nursing records were incomplete, and information regarding psychosocial aspects of care was infrequent. There was evidence that nurses engaged with residents and worked with their beliefs and values. However, nursing documentation was not completed in consultation with the patient, and there was little to suggest that patients were involved in decisions relating to their care. IMPLICATIONS FOR PRACTICE: The structure of nursing documentation can be a major obstacle to the recording of PCC and appropriate care planning. Documentation

  20. Difficult airway management of children in ambulatory anesthesia: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Huang AS

    2016-11-01

    Full Text Available Andrea S Huang,1 Lindsey Rutland,2 John Hajduk,1 Narasimhan Jagannathan1,2 1Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children’s Hospital of Chicago, 2Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Abstract: As the field of pediatric ambulatory anesthesia expands, anesthesiologists can anticipate encountering an increasing number of patients with expected and unexpected difficult airways. This unique setting and patient population both present challenges in making a decision whether and how to safely proceed in the case of a child with a difficult airway. A host of patient, provider, procedure, and facility-specific factors should be considered. Providers should understand the differences between the pediatric and adult airway, recognize common features and syndromes associated with difficult airways, and be comfortable with different airway equipment and techniques available in the ambulatory setting. Early anticipation, a comprehensive patient assessment, and a clear decision-making algorithm with multiple airway management plans are all critical in safely and effectively managing these patients. These issues and recommendations will be discussed in this comprehensive narrative review. Keywords: difficult airway, pediatrics, ambulatory surgery, airway devices, children

  1. Ambulatory blood pressure monitoring and microalbuminuria in normotensive subjects with insulin-dependent diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Cohen Cesar Nissan

    2000-01-01

    Full Text Available OBJECTIVE: To assess the association between microalbuminuria with ambulatory blood pressure monitoring in normotensive individuals with insulin-dependent diabetes mellitus. METHODS: Thirty-seven patients underwent determination of the rate of urinary excretion of albumin through radioimmunoassay and ambulatory blood pressure monitoring. Their mean age was 26.5±6.7 years, and the mean duration of their disease was 8 (1-34 years. Microalbuminuria was defined as urinary excretion of albumin > or = 20 and 50% and diastolic pressure load > 30% during sleep was associated with microalbuminuria (p=0.008. The pressure drop during sleep did not differ between the groups. CONCLUSION: Microalbuminuric normotensive insulin-dependent diabetic patients show greater mean pressure value and pressure load during ambulatory blood pressure monitoring, and these variables correlate with urinary excretion of albumin.

  2. Patients' subjective concepts about primary healthcare utilisation: the study protocol of a qualitative comparative study between Norway and Germany.

    Science.gov (United States)

    Herrmann, Wolfram J; Haarmann, Alexander; Flick, Uwe; Bærheim, Anders; Lichte, Thomas; Herrmann, Markus

    2013-06-20

    In Germany, utilisation of ambulatory healthcare services is high compared with other countries: While a study based on the process data of German statutory health insurances showed an average of 17.1 physician-patient-contacts per year, the comparable figure for Norway is about five. The usual models of healthcare utilisation, such as Rosenstock's Health Belief Model and Andersen's Behavioural Model, cannot explain these differences adequately. Organisational factors of the healthcare system, such as gatekeeping, do not explain the magnitude of the differences. Our hypothesis is that patients' subjective concepts about primary healthcare utilisation play a major role in explaining different healthcare utilisation behaviour in different countries. Hence, the aim of this study is to explore these subjective concepts comparatively, between Germany and Norway. With that aim in mind, we chose a comparative qualitative study design. In Norway and Germany, we are going to interview 20 patients each with qualitative episodic interviews. In addition, we are going to conduct participant observation in four German and four Norwegian primary care practices. The data will be analysed by thematic coding. Using selected categories, we are going to conduct comparative case and group analyses. The study adheres to the Declaration of Helsinki. All interviewees will sign informed consent forms and all patients will be observed during consultation. Strict rules for data security will apply. Developed theory and policy implications are going to be disseminated by a workshop, presentations for experts and laypersons and publications.

  3. How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

    Science.gov (United States)

    Bronkhorst, Babette

    2017-08-01

    Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

  4. The case of value-based healthcare for people living with complex long-term conditions.

    Science.gov (United States)

    Elf, Marie; Flink, Maria; Nilsson, Marie; Tistad, Malin; von Koch, Lena; Ytterberg, Charlotte

    2017-01-11

    There is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient's experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions. Achieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient's individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation. The shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient's perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.

  5. Added Healthcare Charges Conferred by Smoking in Outpatient Plastic Surgery.

    Science.gov (United States)

    Sieffert, Michelle R; Johnson, R Michael; Fox, Justin P

    2018-01-31

    A history of smoking confers additional risk of complications following plastic surgical procedures, which may require hospital-based care to address. To determine if patients with a smoking history experience higher rates of complications leading to higher hospital-based care utilization, and therefore greater healthcare charges, after common outpatient plastic surgeries. Using ambulatory surgery data from California, Florida, Nebraska, and New York, we identified adult patients who underwent common facial, breast, or abdominal contouring procedures from January 2009 to November 2013. Our primary outcomes were hospital-based, acute care (hospital admissions and emergency department visits), serious adverse events, and cumulative healthcare charges within 30 days of discharge. Multivariable regression models were used to compare outcomes between patients with and without a smoking history. The final sample included 214,761 patients, of which 10,426 (4.9%) had a smoking history. Compared to patients without, those with a smoking history were more likely to have a hospital-based, acute care encounter (3.4% vs 7.1%; AOR = 1.36 [1.25-1.48]) or serious adverse event (0.9% vs 2.2%; AOR = 1.38 [1.18-1.60]) within 30 days. On average, these events added $1826 per patient with a smoking history. These findings were consistent when stratified by specific procedure and controlled for patient factors. Patients undergoing common outpatient plastic surgery procedures who have a history of smoking are at risk for more frequent complications, and incur higher healthcare charges than patients who are nonsmokers. © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  6. New antithrombotic agents in the ambulatory setting.

    Science.gov (United States)

    Gibbs, Neville M; Weightman, William M; Watts, Stephen A

    2014-12-01

    Many patients presenting for surgical or other procedures in an ambulatory setting are taking new antiplatelet or anticoagulant agents. This review assesses how the novel features of these new agents affect the management of antithrombotic therapy in the ambulatory setting. There have been very few studies investigating the relative risks of continuing or ceasing new antithrombotic agents. Recent reviews indicate that the new antithrombotic agents offer greater efficacy or ease of administration but are more difficult to monitor or reverse. They emphasize the importance of assessing the bleeding risk of the procedure, the thrombotic risk if the agent is ceased, and patient factors that increase the likelihood of bleeding. The timing of cessation of the agent, if required, depends on its pharmacokinetics and patients' bleeding risks. Patients at high risk of thrombotic complications may require bridging therapy. Once agreed upon, the perioperative plan should be made clear to all involved. As there are few clinical studies to guide management, clinicians must make rational decisions in relation to continuing or ceasing new antithrombotic agents. This requires knowledge of their pharmacokinetics, and a careful multidisciplinary assessment of the relative thrombotic and bleeding risks in individual patients.

  7. Attitude of clinical faculty members in Shiraz Medical University towards private practice physicians' participation in ambulatory care education

    Directory of Open Access Journals (Sweden)

    Khatereh Mahori

    2002-04-01

    Full Text Available Background: Improvement of medical education is necessary for meeting health care demands. Participation of private practice physicians in ambulatory care training is an effective method for enhancing medical students' skills. Purpose This study was undertaken to determine clinical professors' views about participation of physicians with private office in ambulatory care training. Methods: Participants composed of 162 Shiraz Medical University faculty members from 12 disciplines. A questionnaire requesting faculty members' views on different aspects of ambulat01y care teaching and interaction of community-based organizations was distributed. Results: Of 120 (74.1% respondents, 64 (54.2% believed that clinical settings of medical university are appropriate for ambulatory care training. Private practice physicians believed more than academic physicians without private office that private offices have wider range of patients, more common cases, and better follow up chance; and is also a better setting for learning ambulatory care compared with medical university clinical centers. Overall, 32 (29.1% respondent’s found the participation of physicians with private practice on medical education positive. Key words medical education, ambulatory medicine, private practice

  8. Patient Satisfaction with Kimbrough Ambulatory Care Center

    Science.gov (United States)

    1997-02-01

    few are going to opt to change health plans. 14. SUBJECT TERMS PATIENT SATISFACTION; CONSUMER SATISFACTION; SURVEY 15. NUMBER OF PAGES 57 16...to address is overall patient satisfaction with Kimbrough’s current health care system. I surveyed customers on: how satisfied or dissatisfied they...research project was designed to determine how satisfied customers are with Kimbrough Ambulatory Care Center. A patient satisfaction survey developed by

  9. Multiple sclerosis in Germany: data analysis of administrative prevalence and healthcare delivery in the statutory health system.

    Science.gov (United States)

    Höer, Ariane; Schiffhorst, Guido; Zimmermann, Anne; Fischaleck, Johann; Gehrmann, Luise; Ahrens, Henrik; Carl, Gunther; Sigel, Karl-Otto; Osowski, Ulrike; Klein, Maria; Bleß, Hans-Holger

    2014-09-10

    Healthcare-utilization data for multiple sclerosis (MS) are scarce in Germany. The Purpose of the study was to analyse administrative prevalence of MS, medication use and type of specialists involved in MS treatment in the outpatient setting in Bavaria. Pseudonymized claims data from Bavarian Statutory Health Insurance (SHI)-accredited physicians were used. Administrative prevalence of MS was defined as having ≥1 MS diagnosis (International Classification of Diseases, 10th edition, code G35) documented by a neurologist or psychiatrist, or ≥1 prescription for disease-modifying drugs (DMDs)). The administrative prevalence calculated for Bavaria was projected to Germany. DMD prescription and involvement of different specialities in health care service for MS patients was analysed. Administrative prevalence of MS in Bavaria increased from 0.123% to 0.175% of insured persons between 2005 and 2009; when projected, this yielded ~102,000-143,000 patients with MS in the German population. The percentage of patients receiving ≥1 DMD prescription increased from 45.5% to 50.5%. Patients with MS were mainly treated by neurologists in the ambulatory care setting. These results provide important information on the administrative prevalence of MS in Bavaria and on healthcare provision for patients, which is relevant for resource planning in the healthcare sector.

  10. Technical and clinical view on ambulatory assessment in Parkinson's disease.

    Science.gov (United States)

    Hobert, M A; Maetzler, W; Aminian, K; Chiari, L

    2014-09-01

    With the progress of technologies of recent years, methods have become available that use wearable sensors and ambulatory systems to measure aspects of--particular axial--motor function. As Parkinson's disease (PD) can be considered a model disorder for motor impairment, a significant number of studies have already been performed with these patients using such techniques. In general, motion sensors such as accelerometers and gyroscopes are used, in combination with lightweight electronics that do not interfere with normal human motion. A fundamental advantage in comparison with usual clinical assessment is that these sensors allow a more quantitative, objective, and reliable evaluation of symptoms; they have also significant advantages compared to in-lab technologies (e.g., optoelectronic motion capture) as they allow long-term monitoring under real-life conditions. In addition, based on recent findings particularly from studies using functional imaging, we learned that non-motor symptoms, specifically cognitive aspects, may be at least indirectly assessable. It is hypothesized that ambulatory quantitative assessment strategies will allow users, clinicians, and scientists in the future to gain more quantitative, unobtrusive, and everyday relevant data out of their clinical evaluation and can also be designed as pervasive (everywhere) and intensive (anytime) tools for ambulatory assessment and even rehabilitation of motor and (partly) non-motor symptoms in PD. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Community health workers: a bridge to healthcare for people who inject drugs.

    Science.gov (United States)

    Morgan, Kirsty; Lee, Jessica; Sebar, Bernadette

    2015-04-01

    Although people who inject drugs (PWIDs) have increased healthcare needs, their poor access and utilisation of mainstream primary healthcare services is well documented. To address this situation, community health workers (CHWs) who have personal experience of drug injecting in addition to healthcare training or qualifications are sometimes utilised. However, the role peer workers play as members of clinical primary healthcare teams in Australia and how they manage the healthcare needs of PWID, has been poorly documented. A qualitative ethnomethodological approach was used to study the methods used by CHWs. Data was collected using participant observation of CHWs in a PWID-targeted primary healthcare centre. CHW healthcare consultations with PWID were audio-recorded and transcribed verbatim. Transcripts along with field notes were analysed using membership categorisation and conversation analysis techniques to reveal how CHWs' personal and professional experience shapes their healthcare interactions with PWID clients. CHWs' personal experience of injecting drug use is an asset they utilise along with their knowledge of clinical practice and service systems. It provides them with specialised knowledge and language--resources that they draw upon to build trust with clients and accomplish transparent, non-judgmental interactions that enable PWID clients to be active participants in the management of their healthcare. Existing literature often discusses these principles at a theoretical level. This study demonstrates how CHWs achieve them at a micro-level through the use of indexical language and displays of the membership categories 'PWID' and 'healthcare worker'. This research explicates how CHWs serve as an interface between PWID clients and conventional healthcare providers. CHWs deployment of IDU-specific language, membership knowledge, values and behaviours, enable them to interact in ways that foster transparent communication and client participation in

  12. Collaborative Care in Ambulatory Psychiatry: Content Analysis of Consultations to a Psychiatric Pharmacist

    Science.gov (United States)

    Gotlib, Dorothy; Bostwick, Jolene R.; Calip, Seema; Perelstein, Elizabeth; Kurlander, Jacob E.; Fluent, Thomas

    2017-01-01

    Objectives To determine the volume and nature (or topic) of consultations submitted to a psychiatric pharmacist embedded in an ambulatory psychiatry clinic, within a tertiary care academic medical center and to increase our understanding about the ways in which providers consult with an available psychiatric pharmacist. Experimental Design Authors analyze and describe the ambulatory psychiatric pharmacist consultation log at an academic ambulatory clinic. All consultation questions were submitted between July 2012 and October 2014. Principal Observations Psychiatry residents, attending physicians, and advanced practice nurse practitioners submitted 280 primary questions. The most common consultation questions from providers consulted were related to drug-drug interactions (n =70), drug formulations/dosing (n =48), adverse effects (n =43), and pharmacokinetics/lab monitoring/cross-tapering (n =36). Conclusions This is a preliminary analysis that provides information about how psychiatry residents, attending physicians, and advanced practice nurse practitioners at our health system utilize a psychiatric pharmacist. This collaborative relationship may have implications for the future of psychiatric care delivery. PMID:28936009

  13. Collaborative Care in Ambulatory Psychiatry: Content Analysis of Consultations to a Psychiatric Pharmacist.

    Science.gov (United States)

    Gotlib, Dorothy; Bostwick, Jolene R; Calip, Seema; Perelstein, Elizabeth; Kurlander, Jacob E; Fluent, Thomas

    2017-09-15

    To determine the volume and nature (or topic) of consultations submitted to a psychiatric pharmacist embedded in an ambulatory psychiatry clinic, within a tertiary care academic medical center and to increase our understanding about the ways in which providers consult with an available psychiatric pharmacist. Authors analyze and describe the ambulatory psychiatric pharmacist consultation log at an academic ambulatory clinic. All consultation questions were submitted between July 2012 and October 2014. Psychiatry residents, attending physicians, and advanced practice nurse practitioners submitted 280 primary questions. The most common consultation questions from providers consulted were related to drug-drug interactions (n =70), drug formulations/dosing (n =48), adverse effects (n =43), and pharmacokinetics/lab monitoring/cross-tapering (n =36). This is a preliminary analysis that provides information about how psychiatry residents, attending physicians, and advanced practice nurse practitioners at our health system utilize a psychiatric pharmacist. This collaborative relationship may have implications for the future of psychiatric care delivery.

  14. An Anesthetist’s Experience and the Incidence of Critical Cases in Ambulatory Surgery

    Directory of Open Access Journals (Sweden)

    R. V. Bolshedvorov

    2009-01-01

    Full Text Available Objective: to evaluate the impact of experience on the quality of anesthesia in ambulatory surgery. Materials and methods. The authors undertook a study of the role of experience and specialization on the occurrence of complications in ambulatory anesthesia care. By using the internal audit and calculating the frequency of critical cases, they examined the results of the work of two groups of anesthetists: 1 medical beginners after 2-year adjunct practice and 2 one-day hospital specialists having an at least 7-year practice length. Results. In the beginner group, the number of critical cases per operation was twice higher than that in the experienced specialists. The paper shows the detrimental pattern of the residual principle in selecting anesthetists for work at a one-day hospital and provides evidence that specialization is required in the area under discussion. Key words: ambulatory anesthesiology, role of an anesthetist’s experience, critical cases.

  15. Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing interprofessional learning across healthcare practice settings.

    Science.gov (United States)

    Reedy, Gabriel B; Lavelle, Mary; Simpson, Thomas; Anderson, Janet E

    2017-10-01

    A central feature of clinical simulation training is human factors skills, providing staff with the social and cognitive skills to cope with demanding clinical situations. Although these skills are critical to safe patient care, assessing their learning is challenging. This study aimed to develop, pilot and evaluate a valid and reliable structured instrument to assess human factors skills, which can be used pre- and post-simulation training, and is relevant across a range of healthcare professions. Through consultation with a multi-professional expert group, we developed and piloted a 39-item survey with 272 healthcare professionals attending training courses across two large simulation centres in London, one specialising in acute care and one in mental health, both serving healthcare professionals working across acute and community settings. Following psychometric evaluation, the final 12-item instrument was evaluated with a second sample of 711 trainees. Exploratory factor analysis revealed a 12-item, one-factor solution with good internal consistency (α=0.92). The instrument had discriminant validity, with newly qualified trainees scoring significantly lower than experienced trainees ( t (98)=4.88, pSkills for Healthcare Instrument provides a reliable and valid method of assessing trainees' human factors skills self-efficacy across acute and mental health settings. This instrument has the potential to improve the assessment and evaluation of human factors skills learning in both uniprofessional and interprofessional clinical simulation training.

  16. Utilisation of information technologies in ambulatory care in Switzerland.

    Science.gov (United States)

    Rosemann, Thomas; Marty, Franz; Bhend, Heinz; Wagner, Judith; Brunner, Lorenzo; Zoller, Marco

    2010-09-13

    The importance of electronic medical records for the healthcare system is well documented. IT enables easy storage, communication and decision support and can provide important tools in the care of chronically ill patients in the form of a reminder system. A questionnaire was developed and send out to 1200 physicians extracted from the official data base. After four weeks the non-responders received a written reminder. Data collection started in December 2007 and was completed in February 2008. 719 questionnaires were received back, representing a response rate of 59.9%. The data revealed a significant underuse of electronic medical records (EMRs) and IT compared to other European countries. Smaller practices, older physicians and especially primary care physicians tended to use less EMR. Only 10.2% of all physicians declared an interest in considering investment in IT in the next three years, 66.9% expressly denied wishing to do so. The most important barriers were the costs, the unclear benefit and a feared worsening of the doctor-patient-communication during consultation. IT and especially EMRs are underused in daily ambulatory care in Switzerland. To increase the use of EMRs, several approaches could be helpful. First of all, the benefit of EMRs in daily routine care have to be increased as, for example, by decision support systems, tools to avoid pharmaceutical interactions and reminder systems to enable a proactive treatment of chronically ill patients. Furthermore, adequate approaches to offer appropriate reimbursement for the financial investments have to considered such as an additional payment for electronically generated, evidence based quality indicators.

  17. Determinants of patient satisfaction in ambulatory oncology: a cross sectional study based on the OUT-PATSAT35 questionnaire

    International Nuclear Information System (INIS)

    Nguyen, Thanh Vân France; Bosset, Jean-François; Monnier, Alain; Fournier, Jacqueline; Perrin, Valérie; Baumann, Cédric; Brédart, Anne; Mercier, Mariette

    2011-01-01

    The aim of this study was to identify factors associated with satisfaction with care in cancer patients undergoing ambulatory treatment. We investigated associations between patients' baseline clinical and socio-demographic characteristics, as well as self-reported quality of life, and satisfaction with care. Patients undergoing ambulatory chemotherapy or radiotherapy in 2 centres in France were invited, at the beginning of their treatment, to complete the OUT-PATSAT35, a 35 item and 13 scale questionnaire evaluating perception of doctors, nurses and aspects of care organisation. Additionally, for each patient, socio-demographic variables, clinical characteristics and self-reported quality of life using the EORTC QLQ-C30 questionnaire were recorded. Among 692 patients included between January 2005 and December 2006, only 6 were non-responders. By multivariate analysis, poor perceived global health strongly predicted dissatisfaction with care (p < 0.0001). Patients treated by radiotherapy (vs patients treated by chemotherapy) reported lower levels of satisfaction with doctors' technical and interpersonal skills, information provided by caregivers, and waiting times. Patients with primary head and neck cancer (vs other localisations), and those living alone were less satisfied with information provided by doctors, and younger patients (< 55 years) were less satisfied with doctors' availability. A number of clinical of socio-demographic factors were significantly associated with different scales of the satisfaction questionnaire. However, the main determinant was the patient's global health status, underlining the importance of measuring and adjusting for self-perceived health status when evaluating satisfaction. Further analyses are currently ongoing to determine the responsiveness of the OUT-PATSAT35 questionnaire to changes over time

  18. [Implementation of good quality and safety practices. Descriptive study in a occupational mutual health centre].

    Science.gov (United States)

    Manzanera, R; Plana, M; Moya, D; Ortner, J; Mira, J J

    2016-01-01

    To describe the level of implementation of quality and safety good practice elements in a Mutual Society health centre. A Cross-sectional study was conducted to assess the level of implementation of good practices using a questionnaire. Some quality dimensions were also assessed (scale 0 to 10) by a set of 87 quality coordinators of health centres and a random sample of 54 healthcare professionals working in small centres. Seventy quality coordinators and 27 professionals replied (response rates 80% and 50%, respectively. There were no differences in the assessment of quality attributes between both groups. They identified as areas for improvement: use of practice guidelines (7.6/10), scientific and technical skills (7.5/10), and patient satisfaction (7.7/10). Availability and accessibility to clinical reports, informed consent, availability of hydro-alcoholic solution, and to record allergies, were considered of high importance to be implemented, with training and research, improvements in equipment and technology plans, adherence to clinical practice guidelines and the preparation of risk maps, being of less importance. The good practices related to equipment and resources have a higher likelihood to be implemented, meanwhile those related to quality and safety attitudes have more barriers before being implemented. The mutual has a similar behaviour than other healthcare institutions. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Pek CH

    2016-08-01

    Full Text Available Chong Han Pek,1 John Tey,2 Ern Yu Tan1 1Department of General Surgery, 2Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore Abstract: Ambulatory breast cancer surgery is well accepted and is the standard of care at many tertiary centers. Rather than being hospitalized after surgery, patients are discharged on the day of surgery or within 23 hours. Such early discharge does not adversely affect patient outcomes and has the added benefits of better psychological adjustment for the patient, economic savings, and a more efficient utilization of health care resources. The minimal care needed post-discharge also means that the caregiver is not unduly burdened. Unplanned conversions to inpatient admission and readmission rates are low. Wound complications are infrequent and no issues with drain care have been reported. Because the period of postoperative observation is short and monitoring is not as intensive, ambulatory surgery is only suitable for low-risk procedures such as breast cancer surgery and in patients without serious comorbidities, where the likelihood of major perioperative events is low. Optimal management of pain, nausea, and vomiting is essential to ensure a quick recovery and return to normal function. Regional anesthesia such as the thoracic paravertebral block has been employed to improve pain control during the surgery and in the immediate postoperative period. The block provides excellent pain relief and reduces the need for opiates, which also consequently reduces the incidence of nausea and vomiting. The increasing popularity of total intravenous anesthesia with propofol has also helped reduce the incidence of nausea and vomiting in the postoperative period. Ambulatory surgery can be safely carried out in centers where there is a well-designed workflow to ensure proper patient selection, counseling, and education, and where patients and caregivers have easy access to

  20. 45. Ezetimibe and statins yields on silent holter ambulatory myocardial ischemia

    Directory of Open Access Journals (Sweden)

    W. Kadro

    2016-07-01

    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.

  1. Measuring hot flash phenomenonology using ambulatory prospective digital diaries

    Science.gov (United States)

    Fisher, William I.; Thurston, Rebecca C.

    2016-01-01

    Objective This study provides the description, protocol, and results from a novel prospective ambulatory digital hot flash phenomenon diary. Methods This study included 152 midlife women with daily hot flashes who completed an ambulatory electronic hot flash diary continuously for the waking hours of 3 consecutive days. In this diary, women recorded their hot flashes and accompanying characteristics and associations as the hot flashes occurred. Results Self-reported hot flash severity on the digital diaries indicated that the majority of hot flashes were rated as mild (41.3%) or moderate (43.7%). Severe (13.1%) and very severe (1.8%) hot flashes were less common. Hot flash bother ratings were rated as mild (43%), or moderate (33.5%), with fewer hot flashes reported bothersome (17.5%) or very bothersome (6%). The majority of hot flashes were reported as occurring on the on the face (78.9%), neck (74.7%), and chest (61.3%). Prickly skin was reported concurrently with 32% of hot flashes, 7% with anxiety and 5% with nausea. A novel finding, 38% of hot flashes were accompanied by a premonitory aura. Conclusion A prospective electronic digital hot flash diary allows for a more precise quantitation of hot flashes while overcoming many of the limitations of commonly employed retrospective questionnaires and paper diaries. Unique insights into the phenomenology, loci and associated characteristics of hot flashes were obtained using this device. The digital hot flash phenomenology diary is recommended for future ambulatory studies of hot flashes as a prospective measure of the hot flash experience. PMID:27404030

  2. Blood Pressure Measurement: Clinic, Home, Ambulatory, and Beyond

    Science.gov (United States)

    Drawz, Paul E.; Abdalla, Mohamed; Rahman, Mahboob

    2014-01-01

    Blood pressure has traditionally been measured in the clinic setting using the auscultory method and a mercury sphygmomanometer. Technological advances have led to improvements in measuring clinic blood pressure and allowed for measuring blood pressures outside the clinic. This review outlines various methods for evaluating blood pressure and the clinical utility of each type of measurement. Home blood pressures and 24 hour ambulatory blood pressures have improved our ability to evaluate risk for target organ damage and hypertension related morbidity and mortality. Measuring home blood pressures may lead to more active participation in health care by patients and has the potential to improve blood pressure control. Ambulatory blood pressure monitoring enables the measuring nighttime blood pressures and diurnal changes, which may be the most accurate predictors of risk associated with elevated blood pressure. Additionally, reducing nighttime blood pressure is feasible and may be an important component of effective antihypertensive therapy. Finally, estimating central aortic pressures and pulse wave velocity are two of the newer methods for assessing blood pressure and hypertension related target organ damage. PMID:22521624

  3. Multidisciplinary family-centred psychosocial care for patients with CHD: consensus recommendations from the AEPC Psychosocial Working Group.

    Science.gov (United States)

    Utens, Elisabeth M W J; Callus, Edward; Levert, Eveline M; Groote, Katya De; Casey, Frank

    2018-02-01

    Because of the enormous advances in the medical treatment of CHD, the long-term survival of patients suffering from this disease has increased significantly. Currently, about 90% of patients reach adulthood, which entails many new challenges both for patients and their families and for healthcare professionals. The main objective of family-centred psychosocial care is to strengthen the emotional resilience of chronically ill patients and their families by adopting a holistic approach. During the biannual meeting of the psychosocial working group in 2012, participants expressed the need for general European guidelines. The present recommendations were written to support medical staff and psychosocial healthcare professionals to provide the best care for children and adolescents with CHD as well as for their families. This article describes in detail how the integrated family-centred psychological care modules work, involving different healthcare specialists, including a paediatric/congenital cardiologist or a general paediatrician. The different clinical implications and specific needs have been taken into account and recommendations have been provided on the following: structured follow-up screening; identification of stressful periods related to cardiac surgery or invasive medical procedures; evidence-based, disease-specific, and family-oriented psychosocial interventions; and interactive media links to medical and psychosocial information.

  4. Effects of telmisartan on office and 24-hour ambulatory blood pressure: an observational study in hypertensive patients managed in primary care

    Directory of Open Access Journals (Sweden)

    Frederic Kontny

    2010-01-01

    Full Text Available Frederic Kontny1, Terje Risanger2, Arne Bye3, Øyvind Arnesen4, Odd Erik Johansen4 for the TELMIMORE Study Investigators51Dept of Cardiology, Volvat Medical Centre, Oslo, Norway; 2Prinsdal Health Centre, Oslo, Norway; 3Frosta Health Centre, Frosta, Norway; 4Medical Department, Boehringer-Ingelheim Norway KS, Asker, Norway; 5The TELMIMORE Study Investigators are listed at the end of the paperPurpose: Although elevated blood pressure (BP predicts future cardiovascular events, recommended BP targets often is not reached in the general community. In a clinical real-life setting we evaluated BP impact and tolerability of the angiotensin-II receptor blocker telmisartan in patients with essential hypertension.Patients and methods: Patients in this observational study not at target BP started or switched to telmisartan monotherapy (40 or 80 mg or a fixed-dose combination of telmisartan and hydrochlorothiazide (HCT 80 mg/12.5 mg. Office and 24-hour ambulatory BP (AMBP were measured before and after 8 weeks of treatment and physicians reported perceived drug efficacy and tolerability as “Very good”, “Good”, “Moderate” or “Bad”.Results: 100 patients (34% female, 60 years, BMI 29.4 kg/m2, mean office BP 159/92 mmHg of whom 38% were treatment naïve and 30%, 17%, 9% and 6% respectively were on 1, 2, 3 or 4 BP-lowering drugs, completed 8 weeks of treatment. The proportion of patients with office BP < 140/90 mmHg increased from 3% to 54% for systolic (P < 0.001, 38% to 75% for diastolic (P < 0.001, and 2% to 45% for systolic and diastolic BP (P < 0.001. A significant effect on BP levels was seen in patients being either treatment naïve or on 1 to 3 BP-lowering drugs at study entry, whereas no BP improvement occurred in those who switched from 4 drugs. Overall, mean 24-hour AMBP was reduced from 141/85 to 131/79 mmHg (P < 0.001. Drug efficacy and tolerability were perceived as “Very good” or “Good” by 44%/34% and 66%/27%, respectively

  5. A novel methodology for energy performance benchmarking of buildings by means of Linear Mixed Effect Model: The case of space and DHW heating of out-patient Healthcare Centres

    International Nuclear Information System (INIS)

    Capozzoli, Alfonso; Piscitelli, Marco Savino; Neri, Francesco; Grassi, Daniele; Serale, Gianluca

    2016-01-01

    Highlights: • 100 Healthcare Centres were analyzed to assess energy consumption reference values. • A novel robust methodology for energy benchmarking process was proposed. • A Linear Mixed Effect estimation Model was used to treat heterogeneous datasets. • A nondeterministic approach was adopted to consider the uncertainty in the process. • The methodology was developed to be upgradable and generalizable to other datasets. - Abstract: The current EU energy efficiency directive 2012/27/EU defines the existing building stocks as one of the most promising potential sector for achieving energy saving. Robust methodologies aimed to quantify the potential reduction of energy consumption for large building stocks need to be developed. To this purpose, a benchmarking analysis is necessary in order to support public planners in determining how well a building is performing, in setting credible targets for improving performance or in detecting abnormal energy consumption. In the present work, a novel methodology is proposed to perform a benchmarking analysis particularly suitable for heterogeneous samples of buildings. The methodology is based on the estimation of a statistical model for energy consumption – the Linear Mixed Effects Model –, so as to account for both the fixed effects shared by all individuals within a dataset and the random effects related to particular groups/classes of individuals in the population. The groups of individuals within the population have been classified by resorting to a supervised learning technique. Under this backdrop, a Monte Carlo simulation is worked out to compute the frequency distribution of annual energy consumption and identify a reference value for each group/class of buildings. The benchmarking analysis was tested for a case study of 100 out-patient Healthcare Centres in Northern Italy, finally resulting in 12 different frequency distributions for space and Domestic Hot Water heating energy consumption, one for

  6. Risk Factors for new accidental falls in elderly patients at traumatology ambulatory center.

    Science.gov (United States)

    Porto Gautério, Daiane; Zortea, Bruna; Costa Santos, Silvana Sidney; da Silva Tarouco, Bárbara; Lopes, Manoel José; João Fonseca, Cesar

    2015-01-01

    To identify the risks factors for new accidental falls in elderly patients attended in the Traumatology Ambulatory of a University hospital in Rio Grande do Sul, Brazil. Quantitative study of the type of multiple cases. Performed at the traumatology ambulatory, amongst fifteen elders that attended the inclusion criteria: age of sixty or more; patient at the traumatology ambulatory because of a fall motivated by accident, oriented and in conditions of answer an interview of data collectors. The data collection was made between April and June, 2013, with the Elderly Nursing Core Set scale (Lopes & Fonseca). The data analysis was made by a descriptive structure, which helped identify the existence of relation patterns among the cases. The risk factors for new accidental falls identified with larger incidence amongst the elders studied were: impaired balance (15/15), age above 65 (11/15), use of antihypertensive drugs (9/15), absence of non-slip material at home environment (7/15), in seven cases; rugs scattered at the floor of the house (6/15). The combination of intrinsic and extrinsic factors that include the environmental risks is considered a much more relevant cause to occur the new falls. The minimization of the home dangers, allied to the control of the elder intrinsic factors, may reduce the risks of causes. In that sense, is necessary that the nursing team make available more attention to the elderly assisted at the ambulatories, mainly those with sequelae due to fall accidents.

  7. Effects of an isocaloric healthy Nordic diet on ambulatory blood pressure in metabolic syndrome

    DEFF Research Database (Denmark)

    Brader, Lea Johanne; Uusitupa, M; Dragsted, Lars Ove

    2014-01-01

    Background/objectives:Dietary pattern is central in the prevention of hypertension and blood pressure (BP)-related diseases. A diet based on healthy Nordic foods may have a favourable impact on BP. The objective was to clarify whether a Nordic alternative for a healthy food pattern would have...... 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...... weeks of intervention.Results:After 12 weeks, ambulatory diastolic BP (-4.4 mm Hg; P=0.001) and mean arterial pressure (-4.2 mm Hg; P=0.006) were lowered by the healthy Nordic diet compared with the control diet, whereas changes in ambulatory systolic BP did not differ significantly between diets (-3...

  8. Assessment of pedometer-determined physical activity in Danish adults: the importance of non-ambulatory activities

    DEFF Research Database (Denmark)

    Rothausen, Berit Worm; Gille, Maj-Britt; Biltoft-Jensen, Anja Pia

    and Physical Activity 2007-08, wore a pedometer (Yamax SW-200 Tokyo, Japan) and recorded daily steps and non-ambulatory activities for seven consecutive days. Time spent on non-ambulatory activities was converted to step equivalents using 1) a simple conversion method (SCM) adding 200 step equivalents...... assessing pedometer-determined physical activity. Adding activity-specific step equivalents/min, or simply adding 200 step equivalents/min, provides very similar results. Furthermore, when accounting for cycling an adjustment for double-counting should be considered.......Purpose To estimate mean values of steps/day in a representative sample of Danish adults (15-75 years) using two different conversion methods for non-ambulatory (non-step) activities. Methods A simple random sample comprising 229 adults (52% men) from the Danish National Survey of Dietary Habits...

  9. Innovating Healthcare Processes for Speed and Effectiveness

    Directory of Open Access Journals (Sweden)

    Maryline Margueritte

    2013-12-01

    Full Text Available For several years, health networks have developed devices enabling coordinated care of patients in France, regarding both medical plans as well as medico-psycho-social and human care. Some have developed computerized health records for sharing useful information for the coordination and continuity of care. Since the 2009 hospital reform, cooperative operating modes between health system professionals and users are being installed. The implementation of a health information system permits, on one hand, to ensure the transversality of the business process with the patient and, on the other hand, to measure the results of the medical and economic evolution of a complex system of information. The possibilities offered by new technologies of information and communication enable the development of applications supporting increased "on line" participation for citizens. The "ambulatory approach" exports healthcare outside hospital walls. This is an innovative medicine allowing the patient to stay at his home. In France, this re-engineering is based on four areas: a medical record, a collective ownership by the medical and paramedical professions, empowerment of patients and networking in the health sector.Keywords: Health; Networks; Information System; Innovation; Medicine; Patients; Science.

  10. Assessing the management of healthcare waste in Hawassa city, Ethiopia.

    Science.gov (United States)

    Israel Deneke Haylamicheal; Mohamed Aqiel Dalvie; Biruck Desalegn Yirsaw; Hanibale Atsbeha Zegeye

    2011-08-01

    Inadequate management of healthcare waste is a serious concern in many developing countries due to the risks posed to human health and the environment. This study aimed to evaluate healthcare waste management in Hawassa city, Ethiopia. The study was conducted in nine healthcare facilities (HCFs) including hospitals (four), health centres (two) and higher clinics (three) in two phases, first to assess the waste management aspect and second to determine daily waste generation rate. The result showed that the median quantity of waste generated at the facilities was 3.46 kg bed(-1) day(-1) (range: 1.48-8.19 kg bed(-1) day(-1)). The quantity of waste per day generated at a HCF increased as occupancy increased (p waste generated at government HCFs was more than at private HCFs (p waste (20-63.1%) generated at the different HCFs was much higher than the WHO recommendation (10-25%). There was no waste segregation in most HCFs and only one used a complete color coding system. Solid waste and wastewater were stored, transported, treated and disposed inappropriately at all HCFs. Needle-stick injuries were prevalent in 25-100% of waste handlers employed at these HCFs. Additionally, low levels of training and awareness of waste legislation was prevalent amongst staff. The study showed that management of healthcare waste at HCFs to be poor. Waste management practices need to be improved through improved legislation and enforcement, and training of staff in the healthcare facilities in Hawassa.

  11. The demand for ambulatory mental health services from specialty providers.

    Science.gov (United States)

    Horgan, C M

    1986-01-01

    A two-part model is used to examine the demand for ambulatory mental health services in the specialty sector. In the first equation, the probability of having a mental health visit is estimated. In the second part of the model, variations in levels of use expressed in terms of visits and expenditures are examined in turn, with each of these equations conditional on positive utilization of mental health services. In the second part of the model, users are additionally grouped into those with and without out-of-pocket payment for services. This specification accounts for special characteristics regarding the utilization of ambulatory mental health services: (1) a large part of the population does not use these services; (2) of those who use services, the distribution of use is highly skewed; and (3) a large number of users have zero out-of-pocket expenditures. Cost-sharing does indeed matter in the demand for ambulatory mental health services from specialty providers; however, the decision to use mental health services is affected by the level of cost-sharing to a lesser degree than is the decision regarding the level of use of services. The results also show that price is only one of several important factors in determining the demand for services. The lack of significance of family income and of being female is notable. Evidence is presented for the existence of bandwagon effects. The importance of Medicaid in the probability of use equations is noted. PMID:3721874

  12. Prevalence, Treatment, and Control Rates of Conventional and Ambulatory Hypertension Across 10 Populations in 3 Continents.

    Science.gov (United States)

    Melgarejo, Jesus D; Maestre, Gladys E; Thijs, Lutgarde; Asayama, Kei; Boggia, José; Casiglia, Edoardo; Hansen, Tine W; Imai, Yutaka; Jacobs, Lotte; Jeppesen, Jørgen; Kawecka-Jaszcz, Kalina; Kuznetsova, Tatiana; Li, Yan; Malyutina, Sofia; Nikitin, Yuri; Ohkubo, Takayoshi; Stolarz-Skrzypek, Katarzyna; Wang, Ji-Guang; Staessen, Jan A

    2017-07-01

    Hypertension is a major global health problem, but prevalence rates vary widely among regions. To determine prevalence, treatment, and control rates of hypertension, we measured conventional blood pressure (BP) and 24-hour ambulatory BP in 6546 subjects, aged 40 to 79 years, recruited from 10 community-dwelling cohorts on 3 continents. We determined how between-cohort differences in risk factors and socioeconomic factors influence hypertension rates. The overall prevalence was 49.3% (range between cohorts, 40.0%-86.8%) for conventional hypertension (conventional BP ≥140/90 mm Hg) and 48.7% (35.2%-66.5%) for ambulatory hypertension (ambulatory BP ≥130/80 mm Hg). Treatment and control rates for conventional hypertension were 48.0% (33.5%-74.1%) and 38.6% (10.1%-55.3%) respectively. The corresponding rates for ambulatory hypertension were 48.6% (30.5%-71.9%) and 45.6% (18.6%-64.2%). Among 1677 untreated subjects with conventional hypertension, 35.7% had white coat hypertension (23.5%-56.2%). Masked hypertension (conventional BP hypertension rates. Higher social and economic development, measured by the Human Development Index, was associated with lower rates of conventional and ambulatory hypertension. In conclusion, high rates of hypertension in all cohorts examined demonstrate the need for improvements in prevention, treatment, and control. Strategies for the management of hypertension should continue to not only focus on preventable and modifiable risk factors but also consider societal issues. © 2017 American Heart Association, Inc.

  13. Prevalence and Risk of Polypharmacy Among Elderly Cancer Patients Receiving Chemotherapy in Ambulatory Oncology Setting.

    Science.gov (United States)

    Goh, Ivy; Lai, Olive; Chew, Lita

    2018-03-26

    This was a single center, retrospective cross-sectional study looking into the incidence and types of drug-related problems (DRPs) detected among elderly cancer patients receiving at least three long-term medications concurrent with IV chemotherapy, and the types of intervention taken to address these DRPs. This paper serves to elucidate the prevalence and risk of polypharmacy in our geriatric oncology population in an ambulatory care setting, to raise awareness on this growing issue and to encourage more resource allocation to address this healthcare phenomenon. DRP was detected in 77.6% of elderly cancer patients receiving at least three long-term medications concurrent with IV chemotherapy, with an average incidence of three DRPs per patient. Approximately half of DRPs were related to long-term medications. Forty percent of DRPs required interventions at the prescriber level. The use of five or more medications was shown to almost double the risk of DRP occurrence (OR 1.862, P = 0.039). Out of the eight predefined categories of DRPs, underprescribing was the most common (26.7%), followed by adverse drug reaction (25.0%) and drug non-adherence (16.2%). Polypharmacy leading to DRPs is a common occurrence in elderly cancer patients receiving outpatient IV chemotherapy. There should be systematic measures in place to identify patients who are at greater risk of inappropriate polypharmacy and DRPs, and hence more frequent drug therapy optimization and monitoring. The identification of DRPs is an important step to circumvent serious drug-related harm. Future healthcare interventions directed at reducing DRPs should aim to assess the clinical and economic impact of such interventions.

  14. Closing the gender leadership gap: a multi-centre cross-country comparison of women in management and leadership in academic health centres in the European Union.

    Science.gov (United States)

    Kuhlmann, Ellen; Ovseiko, Pavel V; Kurmeyer, Christine; Gutiérrez-Lobos, Karin; Steinböck, Sandra; von Knorring, Mia; Buchan, Alastair M; Brommels, Mats

    2017-01-06

    Women's participation in medicine and the need for gender equality in healthcare are increasingly recognised, yet little attention is paid to leadership and management positions in large publicly funded academic health centres. This study illustrates such a need, taking the case of four large European centres: Charité - Universitätsmedizin Berlin (Germany), Karolinska Institutet (Sweden), Medizinische Universität Wien (Austria), and Oxford Academic Health Science Centre (United Kingdom). The percentage of female medical students and doctors in all four countries is now well within the 40-60% gender balance zone. Women are less well represented among specialists and remain significantly under-represented among senior doctors and full professors. All four centres have made progress in closing the gender leadership gap on boards and other top-level decision-making bodies, but a gender leadership gap remains relevant. The level of achieved gender balance varies significantly between the centres and largely mirrors country-specific welfare state models, with more equal gender relations in Sweden than in the other countries. Notably, there are also similar trends across countries and centres: gender inequality is stronger within academic enterprises than within hospital enterprises and stronger in middle management than at the top level. These novel findings reveal fissures in the 'glass ceiling' effects at top-level management, while the barriers for women shift to middle-level management and remain strong in academic positions. The uneven shifts in the leadership gap are highly relevant and have policy implications. Setting gender balance objectives exclusively for top-level decision-making bodies may not effectively promote a wider goal of gender equality. Academic health centres should pay greater attention to gender equality as an issue of organisational performance and good leadership at all levels of management, with particular attention to academic enterprises

  15. Point-of-Care Healthcare Databases Are an Overall Asset to Clinicians, but Different Databases May Vary in Usefulness Based on Personal Preferences. A Review of: Chan, R. & Stieda, V. (2011). Evaluation of three point-of-care healthcare databases: BMJ Point-of-Care, Clin-eguide and Nursing Reference Centre. Health and Information Libraries Journal, 28(1), 50-58. doi: 10.1111/j.1471-1842.2010.00920.x

    OpenAIRE

    Carol D. Howe

    2011-01-01

    Objective – To evaluate the usefulness of three point-of-care healthcare databases (BMJ Point-of-Care, Clin-eguide, and Nursing Reference Centre) in clinical practice.Design – A descriptive study analyzing questionnaire results.Setting – Hospitals within Alberta, Canada’s two largest health regions (at the time of this study), with a third health region submitting a small number of responses.Subjects – A total of 46 Alberta hospital personnel answered the questionnaire, including 19 clinician...

  16. Devices for Ambulatory Monitoring of Sleep-Associated Disorders in Children with Neurological Diseases.

    Science.gov (United States)

    Ulate-Campos, Adriana; Tsuboyama, Melissa; Loddenkemper, Tobias

    2017-12-25

    Good sleep quality is essential for a child's wellbeing. Early sleep problems have been linked to the later development of emotional and behavioral disorders and can negatively impact the quality of life of the child and his or her family. Sleep-associated conditions are frequent in the pediatric population, and even more so in children with neurological problems. Monitoring devices can help to better characterize sleep efficiency and sleep quality. They can also be helpful to better characterize paroxysmal nocturnal events and differentiate between nocturnal seizures, parasomnias, and obstructive sleep apnea, each of which has a different management. Overnight ambulatory detection devices allow for a tolerable, low cost, objective assessment of sleep quality in the patient's natural environment. They can also be used as a notification system to allow for rapid recognition and prompt intervention of events like seizures. Optimal monitoring devices will be patient- and diagnosis-specific, but may include a combination of modalities such as ambulatory electroencephalograms, actigraphy, and pulse oximetry. We will summarize the current literature on ambulatory sleep devices for detecting sleep disorders in children with neurological diseases.

  17. Health professionals' beliefs related to parental involvement in ambulatory care: an international inquiry.

    Science.gov (United States)

    Tourigny, Jocelyne; Chartrand, Julie; Massicotte, Julie

    2008-01-01

    Changes in health care delivery in Canada and Europe, especially the shift to ambulatory care, have modified the care that children and parents receive and have prompted the need for a partnership alliance. The objectives of this exploratory study were to identify Canadian and Belgian health professionals' beliefs and attitudes towards parental involvement in their child's ambulatory care and to determine if these beliefs varied according to cultural background. Health professionals from both countries generally were in favor of parental involvement in their child's care, but are uncertain about its advantages and disadvantages. Facilitators and barriers mentioned by the health care providers were related to parents' abilities or their attitudes toward partnership, and they also expressed a need for more education on the subject. Results of this study indicate that health professionals working in ambulatory care are not fully ready to utilize parents as true partners in their interventions with children and families. Staff education is an important step towards the establishment and maintenance of a real partnership.

  18. How does a shortage of physicians impact on the job satisfaction of health centre staff?

    Science.gov (United States)

    Saxén, Ulla; Jaatinen, Pekka T; Kivelä, Sirkka-Liisa

    2008-01-01

    The aim was to determine how a shortage of physicians at Finnish health centres has affected the job satisfaction of the entire staff. A questionnaire was posted to 2848 employees working with patients at health centres in the Finnish provinces of Satakunta and Varsinais-Suomi. The information concerning the shortage of physicians at health centres was taken from research undertaken by the Finnish Medical Association in October 2003. The health centres were divided into four groups according to the severity of the shortage. The questionnaire was returned by 1447 employees. The staff at health centres with the most severe shortage of physicians were less satisfied with the management of the organization. Employees at health centres with a minor shortage of physicians were more satisfied with the quality of services in their operational unit. The shortage of physicians had no impact on staff satisfaction regarding the operation of their work unit, the strain of dealing with issues within their work environment, feelings of stress, the strain of working under pressure that they experienced, or interest in finding a new job. The majority of healthcare employees are satisfied and motivated in their work. The shortage of physicians has only a slightly negative impact on their satisfaction.

  19. Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial.

    Science.gov (United States)

    Freeman, Jennifer; Fox, Esther; Gear, Margaret; Hough, Alan

    2012-04-05

    and after intervention to assess changes in abdominal musculature at one of the four centres (Plymouth). This pragmatic trial will assess the effect of these exercise programmes on ambulatory people with MS. It may not be possible to extrapolate the conclusions to those who are non-ambulatory. ClinicalTrials.gov: NCT01414725.

  20. Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Freeman Jennifer

    2012-04-01

    abdominal muscles will be performed before and after intervention to assess changes in abdominal musculature at one of the four centres (Plymouth. Discussion This pragmatic trial will assess the effect of these exercise programmes on ambulatory people with MS. It may not be possible to extrapolate the conclusions to those who are non-ambulatory. Trial registration ClinicalTrials.gov: NCT01414725

  1. Exploring Health System Responsiveness in Ambulatory Care and Disease Management and its Relation to Other Dimensions of Health System Performance (RAC) - Study Design and Methodology.

    Science.gov (United States)

    Röttger, Julia; Blümel, Miriam; Engel, Susanne; Grenz-Farenholtz, Brigitte; Fuchs, Sabine; Linder, Roland; Verheyen, Frank; Busse, Reinhard

    2015-05-20

    The responsiveness of a health system is considered to be an intrinsic goal of health systems and an essential aspect in performance assessment. Numerous studies have analysed health system responsiveness and related concepts, especially across different countries and health systems. However, fewer studies have applied the concept for the evaluation of specific healthcare delivery structures and thoroughly analysed its determinants within one country. The aims of this study are to assess the level of perceived health system responsiveness to patients with chronic diseases in ambulatory care in Germany and to analyse the determinants of health system responsiveness as well as its distribution across different population groups. The target population consists of chronically ill people in Germany, with a focus on patients suffering from type 2 diabetes and/or from coronary heart disease (CHD). Data comes from two different sources: (i) cross-sectional survey data from a postal survey and (ii) claims data from a German sickness fund. Data from both sources will be linked at an individual-level. The postal survey has the purpose of measuring perceived health system responsiveness, health related quality of life, experiences with disease management programmes (DMPs) and (subjective) socioeconomic background. The claims data consists of information on (co)morbidities, service utilization, enrolment within a DMP and sociodemographic characteristics, including the type of residential area. RAC is one of the first projects linking survey data on health system responsiveness at individual level with claims data. With this unique database, it will be possible to comprehensively analyse determinants of health system responsiveness and its relation to other aspects of health system performance assessment. The results of the project will allow German health system decision-makers to assess the performance of nonclinical aspects of healthcare delivery and their determinants in two

  2. Ambulatory blood pressure monitoring-derived short-term blood pressure variability in primary hyperparathyroidism.

    Science.gov (United States)

    Concistrè, A; Grillo, A; La Torre, G; Carretta, R; Fabris, B; Petramala, L; Marinelli, C; Rebellato, A; Fallo, F; Letizia, C

    2018-04-01

    Primary hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk. The aim of our study was to investigate the ambulatory blood pressure monitoring-derived short-term blood pressure variability in patients with primary hyperparathyroidism, in comparison with patients with essential hypertension and normotensive controls. Twenty-five patients with primary hyperparathyroidism (7 normotensive,18 hypertensive) underwent ambulatory blood pressure monitoring at diagnosis, and fifteen out of them were re-evaluated after parathyroidectomy. Short-term-blood pressure variability was derived from ambulatory blood pressure monitoring and calculated as the following: 1) Standard Deviation of 24-h, day-time and night-time-BP; 2) the average of day-time and night-time-Standard Deviation, weighted for the duration of the day and night periods (24-h "weighted" Standard Deviation of BP); 3) average real variability, i.e., the average of the absolute differences between all consecutive BP measurements. Baseline data of normotensive and essential hypertension patients were matched for age, sex, BMI and 24-h ambulatory blood pressure monitoring values with normotensive and hypertensive-primary hyperparathyroidism patients, respectively. Normotensive-primary hyperparathyroidism patients showed a 24-h weighted Standard Deviation (P blood pressure higher than that of 12 normotensive controls. 24-h average real variability of systolic BP, as well as serum calcium and parathyroid hormone levels, were reduced in operated patients (P blood pressure variability is increased in normotensive patients with primary hyperparathyroidism and is reduced by parathyroidectomy, and may potentially represent an additional cardiovascular risk factor in this disease.

  3. Risk Factors for new accidental falls in elderly patients at traumatology ambulatory center

    Directory of Open Access Journals (Sweden)

    Daiane Porto Gautério

    2015-04-01

    Full Text Available Objective. To identify the risks factors for new accidental falls in elderly patients attended in the Traumatology Ambulatory of a University hospital in Rio Grande do Sul, Brazil. Methodology. Quantitative study of the type of multiple cases. Performed at the traumatology ambulatory, amongst fifteen elders that attended the inclusion criteria: age of sixty or more; patient at the traumatology ambulatory because of a fall motivated by accident, oriented and in conditions of answer an interview of data collectors. The data collection was made between April and June, 2013, with the Elderly Nursing Core Set scale (Lopes & Fonseca. The data analysis was made by a descriptive structure, which helped identify the existence of relation patterns among the cases. Results. The risk factors for new accidental falls identified with larger incidence amongst the elders studied were: impaired balance (15/15, age above 65 (11/15, use of antihypertensive drugs (9/15, absence of non-slip material at home environment (7/15, in seven cases; rugs scattered at the floor of the house (6/15. Conclusion. The combination of intrinsic and extrinsic factors that include the environmental risks is considered a much more relevant cause to occur the new falls. The minimization of the home dangers, allied to the control of the elder intrinsic factors, may reduce the risks of causes. In that sense, is necessary that the nursing team make available more attention to the elderly assisted at the ambulatories, mainly those with sequelae due to fall accidents.

  4. Falls in ambulatory individuals with spinal cord injury : incidence, risk factors and perceptions of falls

    OpenAIRE

    Jørgensen, Vivien

    2016-01-01

    Background: Falls in ambulatory individuals with chronic spinal cord injury (SCI) are common and may have adverse consequences. Little and inconclusive research has been done in this population, and there is a need for more knowledge in order to develop prevention strategies appropriate for this population. Aim: The overall aim of this thesis was to study the incidence of and identify the risk factors for recurrent (>2) and injurious falls in ambulatory individuals with SCI...

  5. National ambulatory antibiotic prescribing patterns for pediatric urinary tract infection, 1998-2007.

    Science.gov (United States)

    Copp, Hillary L; Shapiro, Daniel J; Hersh, Adam L

    2011-06-01

    The goal of this study was to investigate patterns of ambulatory antibiotic use and to identify factors associated with broad-spectrum antibiotic prescribing for pediatric urinary tract infections (UTIs). We examined antibiotics prescribed for UTIs for children aged younger than 18 years from 1998 to 2007 using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Amoxicillin-clavulanate, quinolones, macrolides, and second- and third-generation cephalosporins were classified as broad-spectrum antibiotics. We evaluated trends in broad-spectrum antibiotic prescribing patterns and performed multivariable logistic regression to identify factors associated with broad-spectrum antibiotic use. Antibiotics were prescribed for 70% of pediatric UTI visits. Trimethoprim-sulfamethoxazole was the most commonly prescribed antibiotic (49% of visits). Broad-spectrum antibiotics were prescribed one third of the time. There was no increase in overall use of broad-spectrum antibiotics (P = .67); however, third-generation cephalosporin use doubled from 12% to 25% (P = .02). Children younger than 2 years old (odds ratio: 6.4 [95% confidence interval: 2.2-18.7, compared with children 13-17 years old]), females (odds ratio: 3.6 [95% confidence interval: 1.6-8.5]), and temperature ≥ 100.4°F (odds ratio: 2.9 [95% confidence interval: 1.0-8.6]) were independent predictors of broad-spectrum antibiotic prescribing. Race, physician specialty, region, and insurance status were not associated with antibiotic selection. Ambulatory care physicians commonly prescribe broad-spectrum antibiotics for the treatment of pediatric UTIs, especially for febrile infants in whom complicated infections are more likely. The doubling in use of third-generation cephalosporins suggests that opportunities exist to promote more judicious antibiotic prescribing because most pediatric UTIs are susceptible to narrower alternatives.

  6. Feasibility of ambulatory, continuous 24-hour finger arterial pressure recording

    NARCIS (Netherlands)

    Imholz, B. P.; Langewouters, G. J.; van Montfrans, G. A.; Parati, G.; van Goudoever, J.; Wesseling, K. H.; Wieling, W.; Mancia, G.

    1993-01-01

    We tested Portapres, an innovative portable, battery-operated device for the continuous, noninvasive, 24-hour ambulatory measurement of blood pressure in the finger. Portapres is based on Finapres, a stationary device for the measurement of finger arterial pressure. Systems were added to record

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

    LENUS (Irish Health Repository)

    Uzochukwu, I

    2016-06-01

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

  8. Headache service quality: evaluation of quality indicators in 14 specialist-care centres.

    Science.gov (United States)

    Schramm, Sara; Uluduz, Derya; Gouveia, Raquel Gil; Jensen, Rigmor; Siva, Aksel; Uygunoglu, Ugur; Gvantsa, Giorgadze; Mania, Maka; Braschinsky, Mark; Filatova, Elena; Latysheva, Nina; Osipova, Vera; Skorobogatykh, Kirill; Azimova, Julia; Straube, Andreas; Eren, Ozan Emre; Martelletti, Paolo; De Angelis, Valerio; Negro, Andrea; Linde, Mattias; Hagen, Knut; Radojicic, Aleksandra; Zidverc-Trajkovic, Jasna; Podgorac, Ana; Paemeleire, Koen; De Pue, Annelien; Lampl, Christian; Steiner, Timothy J; Katsarava, Zaza

    2016-12-01

    The study was a collaboration between Lifting The Burden (LTB) and the European Headache Federation (EHF). Its aim was to evaluate the implementation of quality indicators for headache care Europe-wide in specialist headache centres (level-3 according to the EHF/LTB standard). Employing previously-developed instruments in 14 such centres, we made enquiries, in each, of health-care providers (doctors, nurses, psychologists, physiotherapists) and 50 patients, and analysed the medical records of 50 other patients. Enquiries were in 9 domains: diagnostic accuracy, individualized management, referral pathways, patient's education and reassurance, convenience and comfort, patient's satisfaction, equity and efficiency of the headache care, outcome assessment and safety. Our study showed that highly experienced headache centres treated their patients in general very well. The centres were content with their work and their patients were content with their treatment. Including disability and quality-of-life evaluations in clinical assessments, and protocols regarding safety, proved problematic: better standards for these are needed. Some centres had problems with follow-up: many specialised centres operated in one-touch systems, without possibility of controlling long-term management or the success of treatments dependent on this. This first Europe-wide quality study showed that the quality indicators were workable in specialist care. They demonstrated common trends, producing evidence of what is majority practice. They also uncovered deficits that might be remedied in order to improve quality. They offer the means of setting benchmarks against which service quality may be judged. The next step is to take the evaluation process into non-specialist care (EHF/LTB levels 1 and 2).

  9. Impact of renal denervation on 24-hour ambulatory blood pressure: results from SYMPLICITY HTN-3.

    Science.gov (United States)

    Bakris, George L; Townsend, Raymond R; Liu, Minglei; Cohen, Sidney A; D'Agostino, Ralph; Flack, John M; Kandzari, David E; Katzen, Barry T; Leon, Martin B; Mauri, Laura; Negoita, Manuela; O'Neill, William W; Oparil, Suzanne; Rocha-Singh, Krishna; Bhatt, Deepak L

    2014-09-16

    Prior studies of catheter-based renal artery denervation have not systematically performed ambulatory blood pressure monitoring (ABPM) to assess the efficacy of the procedure. SYMPLICITY HTN-3 (Renal Denervation in Patients With Uncontrolled Hypertension) was a prospective, blinded, randomized, sham-controlled trial. The current analysis details the effect of renal denervation or a sham procedure on ABPM measurements 6 months post-randomization. Patients with resistant hypertension were randomized 2:1 to renal denervation or sham control. Patients were on a stable antihypertensive regimen including maximally tolerated doses of at least 3 drugs including a diuretic before randomization. The powered secondary efficacy endpoint was a change in mean 24-h ambulatory systolic blood pressure (SBP). Nondipper to dipper (nighttime blood pressure [BP] 10% to 20% lower than daytime BP) conversion was calculated at 6 months. The 24-h ambulatory SBP changed -6.8 ± 15.1 mm Hg in the denervation group and -4.8 ± 17.3 mm Hg in the sham group: difference of -2.0 mm Hg (95% confidence interval [CI]: -5.0 to 1.1; p = 0.98 with a 2 mm Hg superiority margin). The daytime ambulatory SBP change difference between groups was -1.1 (95% CI: -4.3 to 2.2; p = 0.52). The nocturnal ambulatory SBP change difference between groups was -3.3 (95 CI: -6.7 to 0.1; p = 0.06). The percent of nondippers converted to dippers was 21.2% in the denervation group and 15.0% in the sham group (95% CI: -3.8% to 16.2%; p = 0.30). Change in 24-h heart rate was -1.4 ± 7.4 in the denervation group and -1.3 ± 7.3 in the sham group; (95% CI: -1.5 to 1.4; p = 0.94). This trial did not demonstrate a benefit of renal artery denervation on reduction in ambulatory BP in either the 24-h or day and night periods compared with sham (Renal Denervation in Patients With Uncontrolled Hypertension [SYMPLICITY HTN-3]; NCT01418261). Copyright © 2014 American College of Cardiology Foundation. Published by

  10. The epidemiology and type of medication errors reported to the National Poisons Information Centre of Ireland.

    Science.gov (United States)

    Cassidy, Nicola; Duggan, Edel; Williams, David J P; Tracey, Joseph A

    2011-07-01

    Medication errors are widely reported for hospitalised patients, but limited data are available for medication errors that occur in community-based and clinical settings. Epidemiological data from poisons information centres enable characterisation of trends in medication errors occurring across the healthcare spectrum. The objective of this study was to characterise the epidemiology and type of medication errors reported to the National Poisons Information Centre (NPIC) of Ireland. A 3-year prospective study on medication errors reported to the NPIC was conducted from 1 January 2007 to 31 December 2009 inclusive. Data on patient demographics, enquiry source, location, pharmaceutical agent(s), type of medication error, and treatment advice were collated from standardised call report forms. Medication errors were categorised as (i) prescribing error (i.e. physician error), (ii) dispensing error (i.e. pharmacy error), and (iii) administration error involving the wrong medication, the wrong dose, wrong route, or the wrong time. Medication errors were reported for 2348 individuals, representing 9.56% of total enquiries to the NPIC over 3 years. In total, 1220 children and adolescents under 18 years of age and 1128 adults (≥ 18 years old) experienced a medication error. The majority of enquiries were received from healthcare professionals, but members of the public accounted for 31.3% (n = 736) of enquiries. Most medication errors occurred in a domestic setting (n = 2135), but a small number occurred in healthcare facilities: nursing homes (n = 110, 4.68%), hospitals (n = 53, 2.26%), and general practitioner surgeries (n = 32, 1.36%). In children, medication errors with non-prescription pharmaceuticals predominated (n = 722) and anti-pyretics and non-opioid analgesics, anti-bacterials, and cough and cold preparations were the main pharmaceutical classes involved. Medication errors with prescription medication predominated for adults (n = 866) and the major medication

  11. The epidemiology and type of medication errors reported to the National Poisons Information Centre of Ireland.

    LENUS (Irish Health Repository)

    Cassidy, Nicola

    2012-02-01

    INTRODUCTION: Medication errors are widely reported for hospitalised patients, but limited data are available for medication errors that occur in community-based and clinical settings. Epidemiological data from poisons information centres enable characterisation of trends in medication errors occurring across the healthcare spectrum. AIM: The objective of this study was to characterise the epidemiology and type of medication errors reported to the National Poisons Information Centre (NPIC) of Ireland. METHODS: A 3-year prospective study on medication errors reported to the NPIC was conducted from 1 January 2007 to 31 December 2009 inclusive. Data on patient demographics, enquiry source, location, pharmaceutical agent(s), type of medication error, and treatment advice were collated from standardised call report forms. Medication errors were categorised as (i) prescribing error (i.e. physician error), (ii) dispensing error (i.e. pharmacy error), and (iii) administration error involving the wrong medication, the wrong dose, wrong route, or the wrong time. RESULTS: Medication errors were reported for 2348 individuals, representing 9.56% of total enquiries to the NPIC over 3 years. In total, 1220 children and adolescents under 18 years of age and 1128 adults (>\\/= 18 years old) experienced a medication error. The majority of enquiries were received from healthcare professionals, but members of the public accounted for 31.3% (n = 736) of enquiries. Most medication errors occurred in a domestic setting (n = 2135), but a small number occurred in healthcare facilities: nursing homes (n = 110, 4.68%), hospitals (n = 53, 2.26%), and general practitioner surgeries (n = 32, 1.36%). In children, medication errors with non-prescription pharmaceuticals predominated (n = 722) and anti-pyretics and non-opioid analgesics, anti-bacterials, and cough and cold preparations were the main pharmaceutical classes involved. Medication errors with prescription medication predominated for

  12. AMBULATORY BLOOD PRESSURE PATTERNS IN CHILDREN WITH CHRONIC KIDNEY DISEASE

    Science.gov (United States)

    Samuels, Joshua; Ng, Derek; Flynn, Joseph T.; Mitsnefes, Mark; Poffenbarger, Tim; Warady, Bradley A.; Furth, Susan

    2012-01-01

    Ambulatory blood pressure monitoring (ABPM) is the best method of detecting abnormal blood pressure (BP) in patients with chronic kidney disease (CKD), whose hypertension may be missed with office BP measurements. We report ABPM findings in 332 children 1 year after entry in the Chronic Kidney Disease in Children (CKiD) cohort study. All subjects underwent casual and ambulatory BP measurement. BP was categorized based on casual and ABPM results into normal, white coat, masked, and ambulatory hypertension. Only half of the subjects had a normal ABPM. BP load was elevated (>25%) in 52% (n= 172) while mean BP was elevated in 32% (n= 105). In multivariate analysis, those using an ACE inhibitor (ACEi) were 89% more likely to have a normal ABPM than those who did not report using an ACEi (OR: 1.89, 95%CI: 1.17, 3.04). For every 20% faster decline in annualized GFR change, the odds of an abnormal ABPM increased 26% (OR: 1.26, 95%CI: 0.97, 1.64; p= 0.081). A 2.25 fold increase in urine protein:creatinine ratio annualized change was associated with a 39% higher odds of an abnormal ABPM (OR: 1.39, 95%CI: 1.06, 1.82; p= 0.019). Abnormalities on ABPM are common in children with CKD, and are strongly associated with known risk factors for end stage renal disease. Individuals on ACEi were less likely to have abnormal ABPM, suggesting a possible therapeutic intervention. ABPM should be used to monitor risk and guide therapy in children with CKD. PMID:22585950

  13. Improving outpatient access and patient experiences in academic ambulatory care.

    Science.gov (United States)

    O'Neill, Sarah; Calderon, Sherry; Casella, Joanne; Wood, Elizabeth; Carvelli-Sheehan, Jayne; Zeidel, Mark L

    2012-02-01

    Effective scheduling of and ready access to doctor appointments affect ambulatory patient care quality, but these are often sacrificed by patients seeking care from physicians at academic medical centers. At one center, Beth Israel Deaconess Medical Center, the authors developed interventions to improve the scheduling of appointments and to reduce the access time between telephone call and first offered appointment. Improvements to scheduling included no redirection to voicemail, prompt telephone pickup, courteous service, complete registration, and effective scheduling. Reduced access time meant being offered an appointment with a physician in the appropriate specialty within three working days of the telephone call. Scheduling and access were assessed using monthly "mystery shopper" calls. Mystery shoppers collected data using standardized forms, rated the quality of service, and transcribed their interactions with schedulers. Monthly results were tabulated and discussed with clinical leaders; leaders and frontline staff then developed solutions to detected problems. Eighteen months after the beginning of the intervention (in June 2007), which is ongoing, schedulers had gone from using 60% of their registration skills to over 90%, customer service scores had risen from 2.6 to 4.9 (on a 5-point scale), and average access time had fallen from 12 days to 6 days. The program costs $50,000 per year and has been associated with a 35% increase in ambulatory volume across three years. The authors conclude that academic medical centers can markedly improve the scheduling process and access to care and that these improvements may result in increased ambulatory care volume.

  14. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-11-01

    Full Text Available Daniela Ghisi, Stefano Bonarelli Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy Abstract: Spinal anesthesia is a reliable and safe technique for procedures of the lower extremities. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The current availability of short-acting local anesthetics has renewed interest for this technique also in the context of short- and ultra-short procedures. Chloroprocaine (CP is an amino-ester local anesthetic with a very short half-life. It was introduced and has been successfully used for spinal anesthesia since 1952. Sodium bisulfite was then added as a preservative after 1956. The drug was then abandoned in the 1980s for several reports of neurological deficits in patients receiving accidentally high doses of intrathecal CP during epidural labor analgesia. Animal studies have proven the safety of the preservative-free formulation, which has been extensively evaluated in volunteer studies as well as in clinical practice with a favorable profile in terms of both safety and efficacy. In comparison with bupivacaine, 2-chloroprocaine (2-CP showed faster offset times to end of anesthesia, unassisted ambulation, and discharge from hospital. These findings suggests that 2-CP may be a suitable alternative to low doses of long-acting local anesthetics in ambulatory surgery. Its safety profile also suggests that 2-CP could be a valid substitute for intrathecal short- and intermediate-acting local anesthetics, such as lidocaine and mepivacaine – often causes of transient neurological symptoms. In this context, literature suggests a dose ranging between 30 and 60 mg of 2-CP for procedures lasting 60 minutes or less, while 10 mg is considered the no-effect dose. The present review describes recent evidence about 2-CP as an anesthetic agent for

  15. Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID)

    DEFF Research Database (Denmark)

    Zimakoff, J; Bangsgaard Pedersen, F; Bergen, L

    1996-01-01

    A three-month prospective surveillance study was undertaken in four dialysis centres to establish the prevalence of Staphylococcus aureus carriage in a Danish population of patients on haemodialysis (HD) or on continuous ambulatory peritoneal dialysis (CAPD). General data such as sex, age.......4 and 4.7%). Approximately one third (36.6 and 40.7%) of infections were caused by S. aureus. Although diabetics were not significantly more frequent carriers (60.5%) than non-diabetics (55.0%), the incidence of infection was much higher (26.3% vs. 10.3%, P = 0.004). In CAPD, peritonitis and tunnel...

  16. Pain Management in Ambulatory Surgery—A Review

    Directory of Open Access Journals (Sweden)

    Jan G. Jakobsson

    2014-07-01

    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.

  17. Social support and ambulatory blood pressure in older people.

    Science.gov (United States)

    Sanchez-Martínez, Mercedes; López-García, Esther; Guallar-Castillón, Pilar; Cruz, Juan J; Orozco, Edilberto; García-Esquinas, Esther; Rodríguez-Artalejo, Fernando; Banegas, José R

    2016-10-01

    Social support has been associated with greater nocturnal decline (dipping) in blood pressure (BP) in younger and middle-aged individuals. However, it is uncertain if aggregated measures of social support are related to ambulatory SBP in older adults, where high SBP is frequent and clinically challenging. We studied 1047 community-living individuals aged at least 60 years in Spain. Twenty-four-hour ambulatory BP was determined under standardized conditions. Social support was assessed with a seven-item questionnaire on marital status, cohabitation, frequency of contact with relatives, or with friends and neighbors, emotional support, instrumental support, and outdoor companionship. A social support score was built by summing the values of the items that were significantly associated with SBP variables, such that the higher the score, the better the support. Participants' mean age was 71.7 years (50.8% men). Being married, cohabiting, and being accompanied when out of home were the support items significantly associated with SBP variables. After adjustment for sociodemographic (age, sex, education), behavioral (BMI, alcohol, tobacco, salt consumption, physical activity, Mediterranean diet score), and clinical variables [sleep quality, mental stress, comorbidity, BP medication, and ambulatory BP levels and heart rate (HR)], one additional point in the social support score built with the abovementioned three support variables, was associated with a decrease of 0.93 mmHg in night-time SBP (P = 0.039), totaling 2.8 mmHg decrease for a score of 3 vs. 0. The three-item social support score was also inversely associated with the night/day SBP ratio (β = -0.006, P = 0.010). In older adults, social support is independently associated with lower nocturnal SBP and greater SBP dipping. Further research is needed in prospective studies to confirm these results.

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

    Science.gov (United States)

    ... Your Care Ambulatory Care To prevent health care errors, patients are urged to... SpeakUP TM Everyone has a ... he or she has confused you with another patient. P ay attention to the ... for their identification (ID) badges. • Notice whether your caregivers have washed ...

  19. Ambulatory blood pressure monitoring in clinical trials with antihypertensive agents

    NARCIS (Netherlands)

    A.H. van den Meiracker (Anton)

    1995-01-01

    textabstractAmbulatory blood pressure monitoring (ABPM) is being used increasingly for the evaluation of antihypertensive agents in clinical trials. In this brief review several aspects of ABPM are discussed. In particular, attention is paid to the extent to which ABPM is subject to a placebo

  20. Outcome-driven thresholds for ambulatory pulse pressure in 9938 participants recruited from 11 populations

    DEFF Research Database (Denmark)

    Gu, Yu-Mei; Thijs, Lutgarde; Li, Yan

    2014-01-01

    Evidence-based thresholds for risk stratification based on pulse pressure (PP) are currently unavailable. To derive outcome-driven thresholds for the 24-hour ambulatory PP, we analyzed 9938 participants randomly recruited from 11 populations (47.3% women). After age stratification (... interval of the HRs associated with stepwise increasing PP levels crossed unity at 64 mm Hg. While accounting for all covariables, the top tenth of PP contributed less than 0.3% (generalized R(2) statistic) to the overall risk among the elderly. Thus, in randomly recruited people, ambulatory PP does...

  1. Acceptance of Ambulatory Laparoscopic Cholecystectomy in Central Switzerland.

    Science.gov (United States)

    Widjaja, Sandra P; Fischer, Henning; Brunner, Alexander R; Honigmann, Philipp; Metzger, Jürg

    2017-11-01

    Currently, most patients undergoing laparoscopic cholecystectomy (LC) in Switzerland are inpatients for 2-3 days. Due to a lack of available hospital beds, we asked whether day-case surgery would be an option for patients in central Switzerland. The questions of acceptability of outpatient LC and factors contributing to the acceptability thus arose. Hundred patients suffering from symptomatic cholecystolithiasis, capable of communicating in German, and between 18 and 65 years old, were included. Patients received a pre-operative questionnaire on medical history and social situation when informed consent on surgery and participation in the study was obtained. Exclusion criteria were patients suffering from acute cholecystitis or any type of cancer; having a BMI >40 kg/m 2 ; needing conversion to open cholecystectomy or an intraoperative drainage; and non-German speakers. Surgery was performed laparoscopically. Both surgeon and patient filled in a postoperative questionnaire. The surgeon's questionnaire listed medical and technical information, and the patients' questionnaire listed medical information, satisfaction with the treatment and willingness to be released on the same day. These data from both questionnaires were grouped into social and medical factors and analysed on their influence upon willingness to accept an ambulatory procedure. No outpatient follow-up apart from checking for readmission to our hospital within 1 month after discharge was performed. Of the 100 participants, one-third was male. More than two-thirds were Swiss citizens. Only one participant was ineligible for rapid release evaluation due to need of a drainage. Among the social factors contributing to the acceptability of ambulatory care, we found nationality to be relevant; Swiss citizens preferred an inpatient procedure, whereas non-Swiss citizens were significantly more willing to return home on the same day. Household size, sex and age did not correlate with a preference for

  2. Tratamento ambulatorial da endocardite bacteriana estreptocócica Tratamiento clínico de la endocarditis bacteriana estreptocócica Ambulatory treatment of streptococcal bacterial endocarditis

    Directory of Open Access Journals (Sweden)

    Sirio Hassem Sobrinho

    2010-04-01

    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.

  3. Trends in Ambulatory Prescribing of Antiplatelet Therapy among US Ischemic Stroke Patients: 2000–2007

    Directory of Open Access Journals (Sweden)

    Sudeep Karve

    2012-01-01

    Full Text Available Objective. Study objectives were to assess temporal trends and identify patient- and practice-level predictors of the prescription of antiplatelet medications in a national sample of ischemic stroke (IS patients seeking ambulatory care. Methods. IS-related outpatient visits by adults were identified using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey for the years 2000–2007. We assessed prescribing of antiplatelet medications using the generic drug code and drug entry codes in these data. Temporal trends in antiplatelet prescribing were assessed using the Cochran-Mantel-Haenszel test for trend. Results. We identified 9.5 million IS-related ambulatory visits. Antiplatelet medications were prescribed at 35.5% of visits. Physician office prescribing of the clopidogrel-aspirin combination increased significantly from 0.5% in 2000 to 22.0% in 2007 (P=0.05, whereas prescribing of aspirin decreased from 17.9% to 7.0% (P=0.50 during the same period. Conclusion. We observed a continued increase in prescription of the aspirin-clopidogrel combination from 2000 to 2007. Clinical trial evidence suggests that the aspirin-clopidogrel combination does not provide any additional benefit compared with clopidogrel alone; however, our study findings indicate that even with lack of adequate clinical evidence physician prescribing of this combination has increased in real-world community settings.

  4. Skeletal muscle mass and exercise performance in stable ambulatory patients with heart failure.

    Science.gov (United States)

    Lang, C C; Chomsky, D B; Rayos, G; Yeoh, T K; Wilson, J R

    1997-01-01

    The purpose of this study was to determine whether skeletal muscle atrophy limits the maximal exercise capacity of stable ambulatory patients with heart failure. Body composition and maximal exercise capacity were measured in 100 stable ambulatory patients with heart failure. Body composition was assessed by using dual-energy X-ray absorption. Peak exercise oxygen consumption (VO2peak) and the anaerobic threshold were measured by using a Naughton treadmill protocol and a Medical Graphics CardioO2 System. VO2peak averaged 13.4 +/- 3.3 ml.min-1.kg-1 or 43 +/- 12% of normal. Lean body mass averaged 52.9 +/- 10.5 kg and leg lean mass 16.5 +/- 3.6 kg. Leg lean mass correlated linearly with VO2peak (r = 0.68, P < 0.01), suggesting that exercise performance is influences by skeletal muscle mass. However, lean body mass was comparable to levels noted in 1,584 normal control subjects, suggesting no decrease in muscle mass. Leg muscle mass was comparable to levels noted in 34 normal control subjects, further supporting this conclusion. These findings suggest that exercise intolerance in stable ambulatory patients with heart failure is not due to skeletal muscle atrophy.

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

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Vieira

    1999-04-01

    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.

  6. Successful Semi-Ambulatory Veno-Arterial Extracorporeal Membrane Oxygenation Bridge to Heart-Lung Transplantation in a Very Small Child.

    Science.gov (United States)

    Wong, J Y W; Buchholz, H; Ryerson, L; Conradi, A; Adatia, I; Dyck, J; Rebeyka, I; Lien, D; Mullen, J

    2015-08-01

    Lung transplantation (LTx) may be denied for children on extracorporeal membrane oxygenation (ECMO) due to high risk of cerebral hemorrhage. Rarely has successful LTx been reported in children over 10 years of age receiving awake or ambulatory veno-venous ECMO. LTx following support with ambulatory veno-arterial ECMO (VA ECMO) in children has never been reported to our knowledge. We present the case of a 4-year-old, 12-kg child with heritable pulmonary artery hypertension and refractory right ventricular failure. She was successfully bridged to heart-lung transplantation (HLTx) using ambulatory VA ECMO. Initial resuscitation with standard VA ECMO was converted to an ambulatory circuit using Berlin heart cannulae. She was extubated and ambulating around her bed while on VA ECMO for 40 days. She received an HLTx from an oversized marginal lung donor. Despite a cardiac arrest and Grade 3 primary graft dysfunction, she made a full recovery without neurological deficits. She achieved 104% force expiratory volume in 1 s 33 months post-HLTx. Ambulatory VA ECMO may be a useful strategy to bridge very young children to LTx or HLTx. Patient tailored ECMO cannulation, minimization of hemorrhage, and thrombosis risks while on ECMO contributed to a successful HLTx in our patient. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  7. Nurse-measured or ambulatory blood pressure in routine hypertension care

    NARCIS (Netherlands)

    Veerman, D. P.; van Montfrans, G. A.

    1993-01-01

    Nurses are considered to evoke less white-coat hypertension, and might therefore be able to estimate average blood pressure as well as and more conveniently than ambulatory monitoring. The objective of the present study was to determine the correspondence between blood pressure measured by a doctor

  8. Comparison of valsartan and amlodipine on ambulatory blood pressure variability in hypertensive patients.

    Science.gov (United States)

    Eguchi, Kazuo; Imaizumi, Yuki; Kaihara, Toshiki; Hoshide, Satoshi; Kario, Kazuomi

    We tested the hypothesis that calcium channel blockers (CCBs: amlodipine group, n = 38)) are superior to angiotensin receptor blockers (ARBs: valsartan group, n = 38) against ambulatory blood pressure variability (BPV) in untreated Japanese hypertensive patients. Both drugs significantly reduced ambulatory systolic and diastolic BP values. With regard to BPV, standard deviation (SD) in SBP did not change with the administration of either drug, but the ARB significantly increased SD in awake DBP (12 ± 4-14 ± 4 mmHg). The ARB also significantly increased the coefficients of variation (CVs)in awake and 24-h SBP/DBP (all P valsartan, especially in reducing maximum BP levels.

  9. Organizational culture in the primary healthcare setting of Cyprus.

    Science.gov (United States)

    Zachariadou, Theodora; Zannetos, Savvas; Pavlakis, Andreas

    2013-03-24

    The concept of organizational culture is important in understanding the behaviour of individuals in organizations as they manage external demands and internal social changes. Cyprus healthcare system is under restructuring and soon a new healthcare scheme will be implemented starting at the Primary Healthcare (PHC) level. The aim of the study was to investigate the underlying culture encountered in the PHC setting of Cyprus and to identify possible differences in desired and prevailing cultures among healthcare professionals. The population of the study included all general practitioners (GPs) and nursing staff working at the 42 PHC centres throughout the island. The shortened version of the Organizational Culture Profile questionnaire comprising 28 statements on organizational values was used in the study. The instrument was already translated and validated in Greek and cross-cultural adaptation was performed. Participants were required to indicate the organization's characteristic cultural values orientation along a five-point Likert scale ranging from "Very Much = 1" to "Not at all= 5". Statistical analysis was performed using SPSS 16.0. Student t-test was used to compare means between two groups of variables whereas for more than two groups analysis of variance (ANOVA) was applied. From the total of 306 healthcare professionals, 223 participated in the study (72.9%). The majority of participants were women (75.3%) and mean age was 42.6 ± 10.7 years. Culture dimension "performance orientation" was the desired culture among healthcare professionals (mean: 1.39 ± 0.45). "Supportiveness" and "social responsibility" were the main cultures encountered in PHC (means: 2.37 ± 0.80, 2.38 ± 0.83). Statistical significant differences were identified between desired and prevailing cultures for all culture dimensions (p= 0.000). This was the first study performed in Cyprus assessing organizational culture in the PHC setting. In the forthcoming health system reform

  10. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres.

    Science.gov (United States)

    Simoens, Steven; Dunselman, Gerard; Dirksen, Carmen; Hummelshoj, Lone; Bokor, Attila; Brandes, Iris; Brodszky, Valentin; Canis, Michel; Colombo, Giorgio Lorenzo; DeLeire, Thomas; Falcone, Tommaso; Graham, Barbara; Halis, Gülden; Horne, Andrew; Kanj, Omar; Kjer, Jens Jørgen; Kristensen, Jens; Lebovic, Dan; Mueller, Michael; Vigano, Paola; Wullschleger, Marcel; D'Hooghe, Thomas

    2012-05-01

    This study aimed to calculate costs and health-related quality of life of women with endometriosis-associated symptoms treated in referral centres. A prospective, multi-centre, questionnaire-based survey measured costs and quality of life in ambulatory care and in 12 tertiary care centres in 10 countries. The study enrolled women with a diagnosis of endometriosis and with at least one centre-specific contact related to endometriosis-associated symptoms in 2008. The main outcome measures were health care costs, costs of productivity loss, total costs and quality-adjusted life years. Predictors of costs were identified using regression analysis. Data analysis of 909 women demonstrated that the average annual total cost per woman was €9579 (95% confidence interval €8559-€10 599). Costs of productivity loss of €6298 per woman were double the health care costs of €3113 per woman. Health care costs were mainly due to surgery (29%), monitoring tests (19%) and hospitalization (18%) and physician visits (16%). Endometriosis-associated symptoms generated 0.809 quality-adjusted life years per woman. Decreased quality of life was the most important predictor of direct health care and total costs. Costs were greater with increasing severity of endometriosis, presence of pelvic pain, presence of infertility and a higher number of years since diagnosis. Our study invited women to report resource use based on endometriosis-associated symptoms only, rather than drawing on a control population of women without endometriosis. Our study showed that the economic burden associated with endometriosis treated in referral centres is high and is similar to other chronic diseases (diabetes, Crohn's disease, rheumatoid arthritis). It arises predominantly from productivity loss, and is predicted by decreased quality of life.

  11. Perceptions of telecare training needs in home healthcare services: a focus group study.

    Science.gov (United States)

    Guise, Veslemøy; Wiig, Siri

    2017-02-23

    The implementation and use of telecare requires significant changes to healthcare service organisation and delivery, including new ways of working for staff. Competency development and training for healthcare professionals is therefore required to enable necessary adaptation of clinical practice and ensure competent provision of telecare services. It is however unclear what skills healthcare staff need when providing care at a distance and there is little empirical evidence on effective training strategies for telecare practice. Training should however emphasise the experiences and preferences of prospective trainees to ensure its relevance to their educational needs. The aim of this study was to explore healthcare professionals' perceptions of training related to the general use of telecare, and to identify specific training needs associated with the use of virtual visits in the home healthcare services. Six focus group interviews were held with a total of 26 participants working in the home healthcare services in Norway, including registered nurses, enrolled nurses, physiotherapists, occupational therapists, social workers, health workers, and healthcare assistants. The data material was analysed by way of systematic text condensation. The analysis resulted in five categories relevant to telecare training for healthcare professionals: Purposeful training creates confidence and changes attitudes; Training needs depend on ability to cope with telecare; The timing of training; Training must facilitate practical insight into the patients' perspective; and Training content must focus on the telecare process. Findings are discussed in light of implications for the form and content of a training program for healthcare professionals on how to undertake virtual home healthcare visits. Appropriate preparation and training for telecare use is important for healthcare professionals and must be taken seriously by healthcare organisations. To facilitate the knowledge, skills

  12. Sensitivity and specificity of obesity diagnosis in pediatric ambulatory care in the United States.

    Science.gov (United States)

    Walsh, Carolyn O; Milliren, Carly E; Feldman, Henry A; Taveras, Elsie M

    2013-09-01

    We examined the sensitivity and specificity of an obesity diagnosis in a nationally representative sample of pediatric outpatient visits. We used the 2005 to 2009 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care surveys. We included visits with children 2 to 18 years, yielding a sample of 48 145 database visits. We determined 3 methods of identifying obesity: documented body mass index (BMI) ≥95th percentile; International Classification of Diseases, Ninth Revision (ICD-9) code; and positive answer to the question, "Does the patient now have obesity?" Using BMI as the gold standard, we calculated the sensitivity and specificity of a clinical obesity diagnosis. Among the 19.5% of children who were obese by BMI, 7.0% had an ICD-9 code and 15.2% had a positive response to questioning. The sensitivity of an obesity diagnosis was 15.4%, and the specificity was 99.2%. The sensitivity of the obesity diagnosis in pediatric ambulatory visits is low. Efforts are needed to increase identification of obese children.

  13. Data Accuracy of the Bubble Sheet Ambulatory Data System and the KG-Ambulatory Data System in the Internal Medicine Clinic, Bayne-Jones Army Community Hospital, Fort Polk, Louisiana

    National Research Council Canada - National Science Library

    MacLaren, Lisa

    2000-01-01

    ...) and Ambulatory Patient Group (APG) outpatient prospective payment system (OPPS). Three data sets were examined at different points in time based on type of ADS used and implementation of data quality management efforts...

  14. Ambulatory hysteroscopy and its role in the management of abnormal uterine bleeding.

    Science.gov (United States)

    Cooper, Natalie A M; Robinson, Lynne L L; Clark, T Justin

    2015-10-01

    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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Ear Acupuncture for Post-Operative Pain Associated with Ambulatory Arthroscopic Knee Surgery: A Randomized Controlled Trial

    Science.gov (United States)

    2014-01-14

    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

  16. Quality of life in automated and continuous ambulatory peritoneal dialysis

    NARCIS (Netherlands)

    Michels, Wieneke M.; van Dijk, Sandra; Verduijn, Marion; le Cessie, Saskia; Boeschoten, Elisabeth W.; Dekker, Friedo W.; Krediet, Raymond T.; Apperloo, A. J.; Bijlsma, J. A.; Boekhout, M.; Boer, W. H.; van der Boog, P. J. M.; Büller, H. R.; van Buren, M.; de Charro, F. Th; Doorenbos, C. J.; van den Dorpel, M. A.; van Es, A.; Fagel, W. J.; Feith, G. W.; de Fijter, C. W. H.; Frenken, L. A. M.; Grave, W.; van Geelen, J. A. C. A.; Gerlag, P. G. G.; Gorgels, J. P. M. C.; Huisman, R. M.; Jager, K. J.; Jie, K.; Koning-Mulder, W. A. H.; Koolen, M. I.; Kremer Hovinga, T. K.; Lavrijssen, A. T. J.; Luik, A. J.; van der Meulen, J.; Parlevliet, K. J.; Raasveld, M. H. M.; van der Sande, F. M.; Schonck, M. J. M.; Schuurmans, M. M. J.; Siegert, C. E. H.; Stegeman, C. A.; Stevens, P.; Thijssen, J. G. P.; Valentijn, R. M.; Vastenburg, G. H.; Verburgh, C. A.; Vincent, H. H.; Vos, P. F.

    2011-01-01

    Despite a lack of strong evidence, automated peritoneal dialysis (APD) is often prescribed on account of an expected better quality of life (QoL) than that expected with continuous ambulatory peritoneal dialysis (CAPD). Our aim was to analyze differences in QoL in patients starting dialysis on APD

  17. User-centered applications: Use of mobile information technologies to promote sustainable school healthcare services

    Directory of Open Access Journals (Sweden)

    Alida Veldsman

    2015-07-01

    Full Text Available The youth, especially school going children, are the future of any society. It is therefore important that children should receive adequate healthcare support at an early age in order to strive to preserve and ensure better education and welfare of the children and continuity in societal success. Despite the strategic initiatives that aim at improving the general health of school going children, such as South Africa’s Integrated School Health Policy, there still exist challenges in support programmes meant to alleviate the barriers to effective healthcare towards improved education for the school children. Advances in ICT enable a fundamental redesign of healthcare processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to user-centric applications. This paper defines key principles and challenges for designers, policy makers, and evaluators of user-centred technologies for healthcare in schools. The paper employs the User Experience Management Model (UXM2 to review the current and emerging trends, and highlights challenges related to the design of a typical m-ICT application that supports delivery of healthcare in schools. The paper reaches conclusions for next steps that will advance the domain.

  18. Combining patient journey modelling and visual multi-agent computer simulation: a framework to improving knowledge translation in a healthcare environment.

    Science.gov (United States)

    Curry, Joanne; Fitzgerald, Anneke; Prodan, Ante; Dadich, Ann; Sloan, Terry

    2014-01-01

    This article focuses on a framework that will investigate the integration of two disparate methodologies: patient journey modelling and visual multi-agent simulation, and its impact on the speed and quality of knowledge translation to healthcare stakeholders. Literature describes patient journey modelling and visual simulation as discrete activities. This paper suggests that their combination and their impact on translating knowledge to practitioners are greater than the sum of the two technologies. The test-bed is ambulatory care and the goal is to determine if this approach can improve health services delivery, workflow, and patient outcomes and satisfaction. The multidisciplinary research team is comprised of expertise in patient journey modelling, simulation, and knowledge translation.

  19. The features of 24-hour ambulatory blood pressure in patients with diabetes mellitus depending on endothelial dysfunction

    Directory of Open Access Journals (Sweden)

    N.O. Pertseva

    2018-03-01

    Full Text Available Background. Arterial hypertension in patients with diabetes mellitus (DM plays a main role in the earlier formation of diabetic kidney disease (DKD. Endothelial dysfunction is considered to be a process based on the development of diabetic complications. It is important to study the markers, which gives the opportunity to identify DKD in early stage. Objective: to evaluate 24-h ambulatory blood pressure data in patients with DM and its correlation with estimated glomerular filtration rate and endothelial dysfunction. Materials and methods. The endothelial function was determined by the levels of transforming growth factor-beta 1 (TGF-b1 and vascular cell adhesion molecule 1 (VCAM-1. There were 124 patients with DM (66 with type 1 and 58 with type 2 under observation. Results. Levels of endothelial function (TGF-b1 and VCAM-1 indexes in patients with type 1 and type 2 DM depended on glomerular filtration rate. Between the indexes of endothelial function (TGF-b1, VCAM-1 and the 24-hour ambulatory blood pressure, there is strong and average correlation, therefore, parameters of 24-hour ambulatory blood pressure and presence of endothelial dysfunction can be considered as early signs of DKD progression in patients with DM. Conclusions. 24-hour ambulatory blood pressure in patients with DM on the early stages of diabetic nephropathy is characterized by significant circadian rhythm disorders. The insufficient night decline of blood pressure in patients with type 1 and type 2 DM characterizes the presence of diabetic nephropathy progression according to the indexes of 24-h ambulatory blood pressure.

  20. Health centres' view of the services provided by a university hospital laboratory: Use of satisfaction surveys

    Science.gov (United States)

    Oja, Paula; Kouri, Timo; Pakarinen, Arto

    2010-01-01

    Customer orientation has gained increasing attention in healthcare. A customer satisfaction survey is one way to raise areas and topics for quality improvement. However, it seems that customer satisfaction surveys have not resulted in quality improvement in healthcare. This article reports how the authors' university hospital laboratory has used customer satisfaction surveys targeted at the health centres in their hospital district. Closed-ended statements of the questionnaire were planned to cover the essential aspects of laboratory services. In addition, an open-ended question asked what was considered to be the most important problem in services. The questionnaires were sent to the medical directors of the health centres. The open-ended question proved to be very useful because the responses specified the main problems in service. Based on the responses, selected dissatisfied customers were contacted to specify their responses and possible corrective actions were taken. It is concluded that a satisfaction survey can be used as a screening tool to identify topics of dissatisfaction. In addition, further clarifications with selected customers are needed to specify the causes for their dissatisfaction and to undertake proper corrective actions. PMID:20205616

  1. Interspecialty communication supported by health information technology associated with lower hospitalization rates for ambulatory care-sensitive conditions.

    Science.gov (United States)

    O'Malley, Ann S; Reschovsky, James D; Saiontz-Martinez, Cynthia

    2015-01-01

    Practice tools such as health information technology (HIT) have the potential to support care processes, such as communication between health care providers, and influence care for "ambulatory care-sensitive conditions" (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization. To date, associations between such primary care practice capabilities and hospitalizations for ambulatory care-sensitive conditions have been primarily limited to smaller, local studies or unique delivery systems rather than nationally representative studies of primary care physicians in the United States. We analyzed a nationally representative sample of 1,819 primary care physicians who responded to the Center for Studying Health System Change's Physician Survey. We linked 3 years of Medicare claims (2007 to 2009) with these primary care physician survey respondents. This linkage resulted in the identification of 123,760 beneficiaries with one or more of 4 ambulatory care-sensitive chronic conditions (diabetes, chronic obstructive pulmonary disease, asthma, and congestive heart failure) for whom these physicians served as the usual provider. Key independent variables of interest were physicians' practice capabilities, including communication with specialists, use of care managers, participation in quality and performance measurement, use of patient registries, and HIT use. The dependent variable was a summary measure of ambulatory care-sensitive hospitalizations for one or more of these 4 conditions. Higher provider-reported levels of communication between primary care and specialist physicians were associated with lower rates of potentially avoidable hospitalizations. While there was no significant main effect between HIT use and ACSC hospitalizations, the associations between interspecialty communication and ACSC hospitalizations were magnified in the presence of higher HIT use. For example, patients in practices with both the

  2. Associations of ambulatory blood pressure with urinary caffeine and caffeine metabolite excretions.

    Science.gov (United States)

    Guessous, Idris; Pruijm, Menno; Ponte, Belén; Ackermann, Daniel; Ehret, Georg; Ansermot, Nicolas; Vuistiner, Philippe; Staessen, Jan; Gu, Yumei; Paccaud, Fred; Mohaupt, Markus; Vogt, Bruno; Pechère-Bertschi, Antoinette; Pechère-Berstchi, Antoinette; Martin, Pierre-Yves; Burnier, Michel; Eap, Chin B; Bochud, Murielle

    2015-03-01

    Intake of caffeinated beverages might be associated with reduced cardiovascular mortality possibly via the lowering of blood pressure. We estimated the association of ambulatory blood pressure with urinary caffeine and caffeine metabolites in a population-based sample. Families were randomly selected from the general population of Swiss cities. Ambulatory blood pressure monitoring was conducted using validated devices. Urinary caffeine, paraxanthine, theophylline, and theobromine excretions were measured in 24 hours urine using ultrahigh performance liquid chromatography tandem mass spectrometry. We used mixed models to explore the associations of urinary excretions with blood pressure although adjusting for major confounders. The 836 participants (48.9% men) included in this analysis had mean age of 47.8 and mean 24-hour systolic and diastolic blood pressure of 120.1 and 78.0 mm Hg. For each doubling of caffeine excretion, 24-hour and night-time systolic blood pressure decreased by 0.642 and 1.107 mm Hg (both P values theobromine excretion was not associated with blood pressure. Anti-hypertensive therapy, diabetes mellitus, and alcohol consumption modify the association of caffeine urinary excretion with systolic blood pressure. Ambulatory systolic blood pressure was inversely associated with urinary excretions of caffeine and other caffeine metabolites. Our results are compatible with a potential protective effect of caffeine on blood pressure. © 2014 American Heart Association, Inc.

  3. Effects of an isocaloric healthy Nordic diet on ambulatory blood pressure in metabolic syndrome: a randomized SYSDIET sub-study.

    Science.gov (United States)

    Brader, L; Uusitupa, M; Dragsted, L O; Hermansen, K

    2014-01-01

    Dietary pattern is central in the prevention of hypertension and blood pressure (BP)-related diseases. A diet based on healthy Nordic foods may have a favourable impact on BP. The objective was to clarify whether a Nordic alternative for a healthy food pattern would have beneficial effects on ambulatory BP in subjects with metabolic syndrome (MetS). 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 products of Nordic origin. The mean nutrient intake in the Nordic countries formed the control diet, embracing wheat products, dairy fat-based spread and a lower intake of fruits, vegetables and fish. Diets were isoenergetic. Ambulatory BP was monitored and 24-h urine was collected before and after 12 weeks of intervention. After 12 weeks, ambulatory diastolic BP (-4.4 mm Hg; P=0.001) and mean arterial pressure (-4.2 mm Hg; P=0.006) were lowered by the healthy Nordic diet compared with the control diet, whereas changes in ambulatory systolic BP did not differ significantly between diets (-3.5 mm Hg; P=0.122). Heart rate tended to be lower in those on the healthy Nordic diet (P=0.057). Urinary sodium and potassium excretions were unaffected by diets and consequently not associated with the healthy Nordic diet-induced lowering of BP. Consumption of Nordic varieties of health-enhancing foods for 12 weeks decreased diastolic ambulatory BP and mean arterial pressure in subjects with features of MetS during weight-stable condition, suggesting beneficial effects of a healthy Nordic dietary pattern on ambulatory BP.

  4. National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

    Science.gov (United States)

    Shapiro, Daniel J.; Hersh, Adam L.

    2011-01-01

    OBJECTIVE: The goal of this study was to investigate patterns of ambulatory antibiotic use and to identify factors associated with broad-spectrum antibiotic prescribing for pediatric urinary tract infections (UTIs). METHODS: We examined antibiotics prescribed for UTIs for children aged younger than 18 years from 1998 to 2007 using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Amoxicillin-clavulanate, quinolones, macrolides, and second- and third-generation cephalosporins were classified as broad-spectrum antibiotics. We evaluated trends in broad-spectrum antibiotic prescribing patterns and performed multivariable logistic regression to identify factors associated with broad-spectrum antibiotic use. RESULTS: Antibiotics were prescribed for 70% of pediatric UTI visits. Trimethoprim-sulfamethoxazole was the most commonly prescribed antibiotic (49% of visits). Broad-spectrum antibiotics were prescribed one third of the time. There was no increase in overall use of broad-spectrum antibiotics (P = .67); however, third-generation cephalosporin use doubled from 12% to 25% (P = .02). Children younger than 2 years old (odds ratio: 6.4 [95% confidence interval: 2.2–18.7, compared with children 13–17 years old]), females (odds ratio: 3.6 [95% confidence interval: 1.6–8.5]), and temperature ≥100.4°F (odds ratio: 2.9 [95% confidence interval: 1.0–8.6]) were independent predictors of broad-spectrum antibiotic prescribing. Race, physician specialty, region, and insurance status were not associated with antibiotic selection. CONCLUSIONS: Ambulatory care physicians commonly prescribe broad-spectrum antibiotics for the treatment of pediatric UTIs, especially for febrile infants in whom complicated infections are more likely. The doubling in use of third-generation cephalosporins suggests that opportunities exist to promote more judicious antibiotic prescribing because most pediatric UTIs are susceptible to narrower

  5. 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 There is an unmet need for disease-modifying therapies to improve ambulatory function in disabled subjects with multiple sclerosis.Assess the effects of natalizumab on ambulatory function in disabled subjects with relapsing-remitting multiple sclerosis (RRMS or secondary progressive multiple sclerosis (SPMS.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.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.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.

  6. Geographic information system-based healthcare waste management planning for treatment site location and optimal transportation routeing.

    Science.gov (United States)

    Shanmugasundaram, Jothiganesh; Soulalay, Vongdeuane; Chettiyappan, Visvanathan

    2012-06-01

    In Lao People's Democratic Republic (Lao PDR), a growth of healthcare centres, and the environmental hazards and public health risks typically accompanying them, increased the need for healthcare waste (HCW) management planning. An effective planning of an HCW management system including components such as the treatment plant siting and an optimized routeing system for collection and transportation of waste is deemed important. National government offices at developing countries often lack the proper tools and methodologies because of the high costs usually associated with them. However, this study attempts to demonstrate the use of an inexpensive GIS modelling tool for healthcare waste management in the country. Two areas were designed for this study on HCW management, including: (a) locating centralized treatment plants and designing optimum travel routes for waste collection from nearby healthcare facilities; and (b) utilizing existing hospital incinerators and designing optimum routes for collecting waste from nearby healthcare facilities. Spatial analysis paved the way to understand the spatial distribution of healthcare wastes and to identify hotspots of higher waste generating locations. Optimal route models were designed for collecting and transporting HCW to treatment plants, which also highlights constraints in collecting and transporting waste for treatment and disposal. The proposed model can be used as a decision support tool for the efficient management of hospital wastes by government healthcare waste management authorities and hospitals.

  7. A system dynamics approach for healthcare waste management: a case study in Istanbul Metropolitan City, Turkey.

    Science.gov (United States)

    Ciplak, Nesli; Barton, John R

    2012-06-01

    Healthcare waste consists of various types of waste materials generated at hospitals, medical research centres, clinics and laboratories. Although 75-90% of this waste is classified as 'domestic' in nature, 20-25% is deemed to be hazardous, which if not disposed of appropriately, poses a risk to healthcare workers, patients, the environment and even the whole community. As long as healthcare waste is mixed with municipal waste and not segregated prior to disposal, costs will increase substantially. In this study, healthcare waste increases along with the potential to decrease the amounts by implementing effective segregation at healthcare facilities are projected to 2040. Our long-term aim is to develop a system to support selection and planning of the future treatment capacity. Istanbul in Turkey was used as the case study area. In order to identify the factors affecting healthcare waste generation in Istanbul, observations were made and interviews conducted in Istanbul over a 3 month period. A system dynamics approach was adopted to build a healthcare waste management model using a software package, Vensim Ple Plus. Based on reported analysis, the non-hazardous municipal fraction co-disposed with healthcare waste is around 65%. Using the projected waste generation flows, reducing a municipal fraction to 30% has the potential to avoid some 8000 t year(-1) of healthcare waste by 2025 and almost 10 000 t year(-1) by 2035. Furthermore, if segregation practices ensured healthcare waste requiring incineration was also selectively managed, 77% of healthcare waste could be diverted to alternative treatment technologies. As the throughput capacity of the only existing healthcare waste treatment facility in Istanbul, Kemerburgaz Incinerator, has already been exceeded, it is evident that improved management could not only reduce overall flows and costs but also permit alternative and cheaper treatment systems (e.g. autoclaving) to be adopted for the healthcare waste.

  8. Assessment of ambulatory blood pressure monitoring: better reproducibility with polynomial analysis

    NARCIS (Netherlands)

    Cleophas, A. F.; Zwinderman, A. H.; Cleophas, T. J.

    2000-01-01

    Objective: Ambulatory blood pressure monitoring (ABPM) data using values of arbitrarily separated day- and nighttime hours are poorly reproducible, undermining the validity of this diagnostic tool. Previous studies from our group have demonstrated that polynomial curves can be produced of ABPM data

  9. Preventable hospitalizations among adult Medicaid beneficiaries with concurrent substance use disorders

    Directory of Open Access Journals (Sweden)

    Kit Sang Leung

    2015-01-01

    Conclusions: Substance use disorder is statistically associated with hospitalizations for most Ambulatory Care Sensitive Conditions but not with length of hospital stay for Ambulatory Care Sensitive Conditions, after adjusting for covariates. The significant associations between substance use disorder and Ambulatory Care Sensitive Condition admissions suggest unmet primary health care needs for substance use disorder beneficiaries and a need for integrated primary/behavioral healthcare.

  10. An ethnographic investigation of healthcare providers' approaches to facilitating person-centredness in group-based diabetes education.

    Science.gov (United States)

    Stenov, Vibeke; Hempler, Nana Folmann; Reventlow, Susanne; Wind, Gitte

    2017-08-22

    To investigate approaches among healthcare providers (HCPs) that support or hinder person-centredness in group-based diabetes education programmes targeting persons with type 2 diabetes. Ethnographic fieldwork in a municipal and a hospital setting in Denmark. The two programmes included 21 participants and 10 HCPs and were observed over 5 weeks. Additionally, 10 in-depth semi-structured interviews were conducted with patients (n = 7) and HCPs (n = 3). Data were analysed using systematic text condensation. Hindering approaches included a teacher-centred focus on delivering disease-specific information. Communication was dialog based, but HCPs primarily asked closed-ended questions with one correct answer. Additional hindering approaches included ignoring participants with suboptimal health behaviours and a tendency to moralize that resulted in feelings of guilt among participants. Supporting approaches included letting participants set the agenda using broad, open-ended questions. Healthcare providers are often socialized into a biomedical approach and trained to be experts. However, person-centredness involves redefined roles and responsibilities. Applying person-centredness in practice requires continuous training and supervision, but HCPs often have minimum support for developing person-centred communication skills. Techniques based on motivational communication, psychosocial methods and facilitating group processes are effective person-centred approaches in a group context. Teacher-centredness undermined person-centredness because HCPs primarily delivered disease-specific recommendations, leading to biomedical information overload for participants. © 2017 Nordic College of Caring Science.

  11. Healthcare Use for Pain in Women Waiting for Gynaecological Surgery

    Directory of Open Access Journals (Sweden)

    Sarah Walker

    2016-01-01

    Full Text Available Background. Pain while waiting for surgery may increase healthcare utilization (HCU preoperatively. Objective. Examine the association between preoperative pain and HCU in the year prior to gynecological surgery. Methods. 590 women waiting for surgery in a Canadian tertiary care centre were asked to report on HCU in the year before surgery. Pain was assessed using the Brief Pain Inventory. Results. 33% reported moderate to severe pain intensity and interference in the week before surgery. Sixty-one percent (n=360 reported a total of 2026 healthcare visits, with 21% (n=126 reporting six or more visits in the year before surgery. After controlling for covariates, women with moderate to severe (>3/10 pain intensity/interference reported higher odds of overall HCU (≥3 pain-related visits to family doctor or specialist in the past year or ≥1 to emergency/walk-in clinic compared to women with no or mild pain. Lower body mass index (BMI < 30 versus ≥30 and anxiety and/or depression were associated with emergency department or walk-in visits but not visits to family doctors or specialists. Conclusions. There is a high burden of pain in women awaiting gynecological surgery. Decisions about resource allocation should consider the impact of pain on individuals and the healthcare system.

  12. Persistent high job demands and reactivity to mental stress predict future ambulatory blood pressure.

    Science.gov (United States)

    Steptoe, A; Cropley, M

    2000-05-01

    To test the hypothesis that work stress (persistent high job demands over 1 year) in combination with high reactivity to mental stress predict ambulatory blood pressure. Assessment of cardiovascular responses to standardized behavioural tasks, job demands, and ambulatory blood pressure over a working day and evening after 12 months. We studied 81 school teachers (26 men, 55 women), 36 of whom experienced persistent high job demands over 1 year, while 45 reported lower job demands. Participants were divided on the basis of high and low job demands, and high and low systolic pressure reactions to an uncontrollable stress task. Blood pressure and concurrent physical activity were monitored using ambulatory apparatus from 0900 to 2230 h on a working day. Cardiovascular stress reactivity was associated with waist/hip ratio. Systolic and diastolic pressure during the working day were greater in high job demand participants who were stress reactive than in other groups, after adjustment for age, baseline blood pressure, body mass index and negative affectivity. The difference was not accounted for by variations in physical activity. Cardiovascular stress reactivity and sustained psychosocial stress may act in concert to increase cardiovascular risk in susceptible individuals.

  13. European society of hypertension position paper on ambulatory blood pressure monitoring

    NARCIS (Netherlands)

    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

    2013-01-01

    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

  14. 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

    2010-01-01

    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...

  15. Parents' satisfaction with pediatric ambulatory anesthesia in northeast of Thailand.

    Science.gov (United States)

    Boonmak, Suhattaya; Boonmak, Polpun; Pothiruk, Kittawan; Hoontanee, Nattakhan

    2009-12-01

    Study the satisfaction of parents with ambulatory anesthesia and associated factors, including characteristics of the patients and their parents. This was a prospective, descriptive, observation study. The authors included children who were scheduled for ambulatory anesthetic service between birth and 14 years of age and attended at Srinagarind Hospital, Khon Kaen, Thailand. The authors excluded patients whose parents could not be reached by telephone. Before anesthesia, the authors recorded the patients and parents' characteristics, level of information perception (pre-, peri- and post-anesthesia and complications). After anesthesia, the anesthesia technique and any complications were recorded. The day after anesthesia, the authors made phone calls to the patients to record the parents' satisfaction score (viz, of overall, pre-, peri- and post-anesthesia care, and information about the level of patient care at home), and any anesthesia related complications. Ninety-two patients and their parents were included in the present study. Overall parents 'satisfaction with the anesthesia service was 96.7% (i.e., 89/92) (95% CI 90.8-99.3). Parents' satisfaction with pre- and peri-anesthesia care was 100% (95% CI 96.1-100) and 97.9% (95% CI 92.4-99.7), respectively. Parents' satisfaction with the PACU care and information of patient care at home was 96.7% (95% CI 90.8-99.3) and 91.3% (95% CI 83.6-96.2), respectively. Associated factors where parents were dissatisfied included PACU care satisfaction (i.e., relative risk 22.5 (95% CI 3.2-158)) and patient care information at home (i.e., relative risk 13.3 (95% CI 1.3-136.0)). The present study showed a high level of parents' satisfaction. Parents' dissatisfaction associated with PACU care and information about post anesthesia care at home. Additionally information on parents' characteristics provides invaluable data for improving pediatric ambulatory anesthesia in Srinagarind Hospital.

  16. Ambulatory anesthesia and postoperative nausea and vomiting: predicting the probability

    Directory of Open Access Journals (Sweden)

    Hegarty AT

    2016-08-01

    Full Text Available Aoife T Hegarty,1 Muiris A Buckley,1 Conan L McCaul1–3 1Department of Anaesthesia, The Rotunda Hospital, 2Mater Misericordiae University Hospital, 3School of Medicine and Medical Science, University College Dublin, Dublin, Ireland Abstract: Nausea and vomiting are distinctly unpleasant symptoms that may occur after surgery and anesthesia, and high priority is given to their prevention by patients. Research in this area is plentiful and has focused on event prediction and pharmacological prophylaxis but despite this, postoperative nausea and vomiting (PONV typically occurs in 20%–30% of patients in contemporary practice. Prediction of postoperative and postdischarge nausea and vomiting is particularly important in the ambulatory surgical population as these symptoms may occur following discharge from hospital and continue for up to one week when access to antiemetic therapies is limited. Many of the existing predictive scoring systems are based on data from inpatient populations and limited to the first 24 hours after surgery. Scoring systems based on data from ambulatory surgical populations to predict PONV are only moderately good. The best-performing systems in ambulatory patients are those of Sinclair and Sarin with an area under the receiver operating characteristic curve of 0.78 and 0.74, respectively, but are limited by the short duration of follow-up and a greater emphasis on nausea than vomiting. Given that the ability to predict both PONV and postdischarge nausea and vomiting is clearly limited, emphasis has been placed on prophylactic strategies that incorporate antiemetic medication, intravenous hydration, and nonnarcotic analgesia. PONV has been reduced to <10% in institutions using multimodal approaches. Scoring systems may facilitate “risk tailoring” in which patient risk profile is used as a stratification method for pharmacointervention. Keywords: postoperative nausea and vomiting, prediction, antiemetics, anesthesia

  17. The Anxiolytic Effect of Aromatherapy on Patients Awaiting Ambulatory Surgery: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Cheng-Hua Ni

    2013-01-01

    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.

  18. The comprehensive care project: measuring physician performance in ambulatory practice.

    Science.gov (United States)

    Holmboe, Eric S; Weng, Weifeng; Arnold, Gerald K; Kaplan, Sherrie H; Normand, Sharon-Lise; Greenfield, Sheldon; Hood, Sarah; Lipner, Rebecca S

    2010-12-01

    To investigate the feasibility, reliability, and validity of comprehensively assessing physician-level performance in ambulatory practice. Ambulatory-based general internists in 13 states participated in the assessment. We assessed physician-level performance, adjusted for patient factors, on 46 individual measures, an overall composite measure, and composite measures for chronic, acute, and preventive care. Between- versus within-physician variation was quantified by intraclass correlation coefficients (ICC). External validity was assessed by correlating performance on a certification exam. Medical records for 236 physicians were audited for seven chronic and four acute care conditions, and six age- and gender-appropriate preventive services. Performance on the individual and composite measures varied substantially within (range 5-86 percent compliance on 46 measures) and between physicians (ICC range 0.12-0.88). Reliabilities for the composite measures were robust: 0.88 for chronic care and 0.87 for preventive services. Higher certification exam scores were associated with better performance on the overall (r = 0.19; pmeasures and by sampling feasible numbers of patients for each condition. © Health Research and Educational Trust.

  19. An elective course on current concepts in adult ambulatory care.

    Science.gov (United States)

    Vincent, Ashley H; Weber, Zachary A

    2014-12-15

    To design and evaluate a doctor of pharmacy course exploring disease states commonly encountered in ambulatory care, while applying literature to clinical practice and promoting a continual learning mindset. This elective incorporated a learner-centered teaching approach. Each week, 2 groups of students were assigned a clinical trial to present to their peers. The focus was on clinical application and impact, rather than literature evaluation. A social networking group on Facebook was used to expose students to pharmacy information outside the classroom. Student grades were determined by multiple activities: presentations, participation and moderation of the Facebook group, class participation, quiz scores, and quiz question development. Course evaluations served as a qualitative assessment of student learning and perceptions, quizzes were the most objective assessment of student learning, and presentation evaluations were the most directed assessment of course goals. This elective was an innovative approach to teaching ambulatory care that effectively filled a curricular void. Successful attainment of the primary course goals and objectives was demonstrated through course evaluations, surveys, and quiz and presentation scores.

  20. Improving accountability through alignment: the role of academic health science centres and networks in England.

    Science.gov (United States)

    Ovseiko, Pavel V; Heitmueller, Axel; Allen, Pauline; Davies, Stephen M; Wells, Glenn; Ford, Gary A; Darzi, Ara; Buchan, Alastair M

    2014-01-20

    As in many countries around the world, there are high expectations on academic health science centres and networks in England to provide high-quality care, innovative research, and world-class education, while also supporting wealth creation and economic growth. Meeting these expectations increasingly depends on partnership working between university medical schools and teaching hospitals, as well as other healthcare providers. However, academic-clinical relationships in England are still characterised by the "unlinked partners" model, whereby universities and their partner teaching hospitals are neither fiscally nor structurally linked, creating bifurcating accountabilities to various government and public agencies. This article focuses on accountability relationships in universities and teaching hospitals, as well as other healthcare providers that form core constituent parts of academic health science centres and networks. The authors analyse accountability for the tripartite mission of patient care, research, and education, using a four-fold typology of accountability relationships, which distinguishes between hierarchical (bureaucratic) accountability, legal accountability, professional accountability, and political accountability. Examples from North West London suggest that a number of mechanisms can be used to improve accountability for the tripartite mission through alignment, but that the simple creation of academic health science centres and networks is probably not sufficient. At the heart of the challenge for academic health science centres and networks is the separation of accountabilities for patient care, research, and education in different government departments. Given that a fundamental top-down system redesign is now extremely unlikely, local academic and clinical leaders face the challenge of aligning their institutions as a matter of priority in order to improve accountability for the tripartite mission from the bottom up. It remains to be

  1. A designated centre for people with disabilities operated by Peamount Healthcare, Co. Dublin

    LENUS (Irish Health Repository)

    Roche, Catherine

    2012-01-01

    The Haemovigilance speciality defines itself as nursing and subscribes to the overall purpose, functions and ethical standards of nursing. The clinical practice role may be divided into direct and indirect care. Direct care comprises the assessment, planning, delivery and evaluation of care to patients. Indirect care relates to activities that influence others in their provision of direct care. The Haemovigilance Officer as a clinical professional in the Irish healthcare environment is required to maintain professional competency and this is achieved through continuous ongoing education and training, attending in-service study days, conferences locally and nationally. While attending various conferences numerous posters have been presented which have showcased the hospital’s work. Evidence of continuous professional development is contained in Appendix 1.\\r\

  2. Knee Muscle Strength at Varying Angular Velocities and Associations with Gross Motor Function in Ambulatory Children with Cerebral Palsy

    Science.gov (United States)

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

    2012-01-01

    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 =…

  3. Interprofessional patient-centred practice in oncology teams: utopia or reality?

    Science.gov (United States)

    Bilodeau, Karine; Dubois, Sylvie; Pepin, Jacinthe

    2015-03-01

    Studies on interprofessional practice usually report professionals' viewpoints and document organizational, procedural and relational factors influencing that practice. Considering the importance of interprofessional patient-centred (IPPC) practice, it seems necessary to describe it in detail in an actual context of care, from the perspective of patients, their families and health-care professionals. The goal of this study was to describe IPPC practice throughout the continuum of cancer care. A qualitative multiple case study was completed with two interprofessional teams from a Canadian teaching hospital. Interviews were conducted with patients, their families and professionals, and observation was carried out. Three themes were illustrated by current team practice: welcoming the person as a unique individual, but still requiring the patient to comply; the paradoxical coexistence of patient-centred discourse and professional-centred practice; and triggering team collaboration with the culmination of the patient's situation. Several influential factors were described, including the way the team works; the physical environment; professionals' and patients'/family members' stance on the collaboration; professionals' stance on patients and their families; and patients' stance on professionals. Finally, themes describing the desired IPPC practice reflect the wish of most participants to be more involved. They were: providing support in line with the patient's experience and involvement; respecting patients by not imposing professionals' values and goals; and consistency and regularity in the collaboration of all members.

  4. A novel ambulatory closed circuit breathing system for use during exercise

    NARCIS (Netherlands)

    McMorrow, R. C. N.; Windsor, J. S.; Mythen, M. G.; Grocott, M. P. W.; Ahuja, V.; Aref-Adib, G.; Burnham, R.; Chisholm, A.; Clarke, K.; Coates, D.; Coates, M.; Cook, D.; Cox, M.; Dhillon, S.; Dougall, C.; Doyle, P.; Duncan, P.; Edsell, M.; Edwards, L.; Evans, L.; Gardiner, P.; Grocott, M.; Gunning, P.; Hart, N.; Harrington, J.; Harvey, J.; Holloway, C.; Howard, D.; Hurlbut, D.; Imray, C.; Ince, C.; Jonas, M.; van der Kaaij, J.; Khosravi, M.; Kolfschoten, N.; Levett, D.; Luery, H.; Luks, A.; Martin, D.; McMorrow, R.; Meale, P.; Mitchell, K.; Montgomery, H.; Morgan, G.; Morgan, J.; Murray, A.; Mythen, M.; Newman, S.; O'Dwyer, M.; Pate, J.

    2011-01-01

    P>We describe a unique ambulatory closed circuit for delivering high fractions of inspired oxygen to an exercising user who does not require isolation from their environment. We describe the major components and their function and suggest potential applications for such a circuit. This circuit may

  5. Injectable loop recorder implantation in an ambulatory setting by advanced practice providers: Analysis of outcomes.

    Science.gov (United States)

    Kipp, Ryan; Young, Natasha; Barnett, Anne; Kopp, Douglas; Leal, Miguel A; Eckhardt, Lee L; Teelin, Thomas; Hoffmayer, Kurt S; Wright, Jennifer; Field, Michael

    2017-09-01

    Implantable loop recorder (ILR) insertion has historically been performed in a surgical environment such as the electrophysiology (EP) lab. The newest generation loop recorder (Medtronic Reveal LINQ™, Minneapolis, MN, USA) is injectable with potential for implantation in a non-EP lab setting by advanced practice providers (APPs) facilitating improved workflow and resource utilization. We report the safety and efficacy of injectable ILR placement in the ambulatory care setting by APPs. A retrospective review was performed including all patients referred for injectable ILR placement from March 2014 to November 2015. All device placement procedures were performed in an ambulatory care setting using the standard manufacturer deployment kit with sterile technique and local anesthetic following a single dose of intravenous antibiotics. Acute procedural success and complication rates following injectable ILR placement in the ambulatory setting were reviewed. During the study period, 125 injectable ILRs were implanted. Acute procedural success with adequate sensing (R-waves ≥ 0.2 mV) occurred in 100% of patients. There were no acute procedural complications. Subacute complications occurred in two patients (1.6% of implantations), including one possible infection treated with oral antibiotics and one device removal due to pain at the implant site. In this retrospective single-center study, implantation of injectable ILR in an ambulatory care setting by APPs following a single dose of intravenous antibiotics and standard manufacturer technique yielded a low complication rate with high acute procedural success. Use of this implantation strategy may improve EP lab workflow while providing a safe and effective technique for device placement. © 2017 Wiley Periodicals, Inc.

  6. Use of Team-Based Learning Pedagogy for Internal Medicine Ambulatory Resident Teaching.

    Science.gov (United States)

    Balwan, Sandy; Fornari, Alice; DiMarzio, Paola; Verbsky, Jennifer; Pekmezaris, Renee; Stein, Joanna; Chaudhry, Saima

    2015-12-01

    Team-based learning (TBL) is used in undergraduate medical education to facilitate higher-order content learning, promote learner engagement and collaboration, and foster positive learner attitudes. There is a paucity of data on the use of TBL in graduate medical education. Our aim was to assess resident engagement, learning, and faculty/resident satisfaction with TBL in internal medicine residency ambulatory education. Survey and nominal group technique methodologies were used to assess learner engagement and faculty/resident satisfaction. We assessed medical learning using individual (IRAT) and group (GRAT) readiness assurance tests. Residents (N = 111) involved in TBL sessions reported contributing to group discussions and actively discussing the subject material with other residents. Faculty echoed similar responses, and residents and faculty reported a preference for future teaching sessions to be offered using the TBL pedagogy. The average GRAT score was significantly higher than the average IRAT score by 22%. Feedback from our nominal group technique rank ordered the following TBL strengths by both residents and faculty: (1) interactive format, (2) content of sessions, and (3) competitive nature of sessions. We successfully implemented TBL pedagogy in the internal medicine ambulatory residency curriculum, with learning focused on the care of patients in the ambulatory setting. TBL resulted in active resident engagement, facilitated group learning, and increased satisfaction by residents and faculty. To our knowledge this is the first study that implemented a TBL program in an internal medicine residency curriculum.

  7. Transient myocardial ischaemia during ambulatory monitoring out of hospital in patients with chronic stable angina pectoris

    DEFF Research Database (Denmark)

    Egstrup, K

    1988-01-01

    monitoring was significantly lower than heart rate at the onset of ST-segment change during exercise testing (100.2 +/- 14.6 vs. 115.8 +/- 19.6 beats/min, p less than 0.01), which may indicate different pathophysiological mechanisms. Transient impairment in coronary oxygen supply seems to be of importance......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...

  8. Development of an advanced mechanised gait trainer, controlling movement of the centre of mass, for restoring gait in non-ambulant subjects.

    Science.gov (United States)

    Hesse, S; Sarkodie-Gyan, T; Uhlenbrock, D

    1999-01-01

    The study aimed at further development of a mechanised gait trainer which would allow non-ambulant people to practice a gait-like motion repeatedly. To simulate normal gait, discrete stance and swing phases, lasting 60% and 40% of the gait cycle respectively, and the control of the movement of the centre of mass were required. A complex gear system provided the gait-like movement of two foot plates with a ratio of 60% to 40% between the stance and swing phases. A controlled propulsion system adjusted its output according to patient's efforts. Two eccenters on the central gear controlled phase-adjusted the vertical and horizontal position of the centre of mass. The patterns of sagittal lower limb joint kinematics and of muscle activation of a normal subject were similar when using the mechanised trainer and when walking on a treadmill. A non-ambulatory hemiparetic subject required little help from one therapist on the gait trainer, while two therapists supported treadmill walking. Gait movements on the trainer were highly symmetrical, impact-free, and less spastic. The weight-bearing muscles were activated in a similar fashion during both conditions. The vertical displacement of the centre of mass was bi-instead of mono-phasic during each gait cycle on the new device. In conclusion, the gait trainer allowed wheelchair-bound subjects the repetitive practice of a gait-like movement without overstraining therapists.

  9. Healthcare waste management: current practices in selected healthcare facilities, Botswana.

    Science.gov (United States)

    Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

    2008-01-01

    Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

  10. Channel Selection and Feature Projection for Cognitive Load Estimation Using Ambulatory EEG

    Directory of Open Access Journals (Sweden)

    Tian Lan

    2007-01-01

    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.

  11. The Cuban National Healthcare System: Characterization of primary healthcare services.

    Directory of Open Access Journals (Sweden)

    Keli Regina DAL PRÁ

    2015-10-01

    Full Text Available This article presents a report on the experience of healthcare professionals in Florianópolis, who took the course La Atención Primaria de Salud y la Medicina Familiar en Cuba [Primary Healthcare and Family Medicine in Cuba], in 2014. The purpose of the study is to characterize the healthcare units and services provided by the Cuban National Healthcare System (SNS and to reflect on this experience/immersion, particularly on Cuba’s Primary Healthcare Service. The results found that in comparison with Brazil’s Single Healthcare System (SUS Cuba’s SNS Family Healthcare (SF service is the central organizing element of the Primary Healthcare Service. The number of SF teams per inhabitant is different than in Brazil; the programs given priority in the APS are similar to those in Brazil and the intersectorial nature and scope of the services prove to be effective in the resolution of healthcare problems.

  12. An integrative review of supports, facilitators and barriers to patient-centred nursing in the intensive care unit.

    Science.gov (United States)

    Jakimowicz, Samantha; Perry, Lin; Lewis, Joanne

    2017-12-01

    To systematically review the literature describing factors perceived by nurses as impacting the provision of patient-centred nursing in the intensive care unit. Patient-centred nursing in critical care differs from other healthcare areas, and the aggressive curative environment of the ICU has potential to compromise some of its elements. Understanding critical care, nurses' perceptions of promoting and deterrent factors may inform development of strategies to support effective patient-centred nursing and job satisfaction in this workforce. An integrative literature review. Whittemore and Knafl's method was used with "best-fit" framework synthesis. CINAHL, PsycINFO, Medline and EMBASE were searched for 2000-2016 literature using search terms drawn from the ICU patient-centred framework. In total, 3,079 papers were identified, with 23 retained after applying eligibility criteria. Five themes were identified: Nurse identity; Organisation; Communication; Relationships; and Ideology of ICU. Almost every theme and related categories referred to factors acting as barriers to patient-centred nursing in the ICU; only four referred to supports/facilitators. Findings showed that provision of patient-centred nursing may be compromised by some factors of the critical care environment, and illustrate the challenges and complexity of providing effective patient-centred nursing in this environment. Findings should be applied to address barriers and to enhance facilitators of effective patient-centred nursing in critical care. The emotional and physical demands of critical care nursing are major considerations; supporting these nurses to fulfil their challenging role may empower them in their professional quality of life and provide a basis for workforce retention as well as delivery of effective patient-centred nursing. Measures to enhance patient-centred nursing could promote critical care nurses' job satisfaction and workforce retention, and be applied more broadly and

  13. Use of information on the shared customers of healthcare services to support care pathway planning

    Directory of Open Access Journals (Sweden)

    Olli Nylander

    2002-09-01

    Conclusions The level of integration in the Finnish social welfare and healthcare system is high and seems to be increasing, especially in health centres. Within one year a client uses many kinds of inpatient services. This may at best represent a functioning system of care pathways and at worst mean overlapping work and lack of coordination. This information is of great importance to senior officers in care pathway planning.

  14. Endurance exercise beneficially affects ambulatory blood pressure: a systematic review and meta-analysis.

    Science.gov (United States)

    Cornelissen, Véronique A; Buys, Roselien; Smart, Neil A

    2013-04-01

    Exercise is widely recommended as one of the key preventive lifestyle changes to reduce the risk of hypertension and to manage high blood pressure (BP), but individual studies investigating the effect of exercise on ambulatory BP have remained inconclusive. Therefore, the primary purpose of this systematic review and meta-analysis was to determine the effect of aerobic endurance training on daytime and night-time BP in healthy adults. A systematic literature search was conducted using PubMed and Cochrane Controlled Clinical trial registry from their inception to May 2012. Randomized controlled trials of at least 4 weeks investigating the effects of aerobic endurance training on ambulatory BP in healthy adults were included. Inverse weighted random effects models were used for analyses, with data reported as weighted means and 95% confidence limits. We included 15 randomized controlled trials, involving 17 study groups and 633 participants (394 exercise participants and 239 control participants). Overall, endurance training induced a significant reduction in daytime SBP [-3.2 mmHg, 95% confidence interval (CI), -5.0 to-1.3] and daytime DBP (-2.7 mmHg, 95% CI, -3.9 to -1.5). No effect was observed on night-time BP. The findings from this meta-analysis suggest that aerobic endurance exercise significantly decreases daytime, but not night-time, ambulatory BP.

  15. AI based HealthCare Platform for Real Time, Predictive and Prescriptive Analytics using Reactive Programming

    Science.gov (United States)

    Kaur, Jagreet; Singh Mann, Kulwinder, Dr.

    2018-01-01

    AI in Healthcare needed to bring real, actionable insights and Individualized insights in real time for patients and Doctors to support treatment decisions., We need a Patient Centred Platform for integrating EHR Data, Patient Data, Prescriptions, Monitoring, Clinical research and Data. This paper proposes a generic architecture for enabling AI based healthcare analytics Platform by using open sources Technologies Apache beam, Apache Flink Apache Spark, Apache NiFi, Kafka, Tachyon, Gluster FS, NoSQL- Elasticsearch, Cassandra. This paper will show the importance of applying AI based predictive and prescriptive analytics techniques in Health sector. The system will be able to extract useful knowledge that helps in decision making and medical monitoring in real-time through an intelligent process analysis and big data processing.

  16. Provider and patient satisfaction with the integration of ambulatory and hospital EHR systems.

    Science.gov (United States)

    Meyerhoefer, Chad D; Sherer, Susan A; Deily, Mary E; Chou, Shin-Yi; Guo, Xiaohui; Chen, Jie; Sheinberg, Michael; Levick, Donald

    2018-05-16

    The installation of EHR systems can disrupt operations at clinical practice sites, but also lead to improvements in information availability. We examined how the installation of an ambulatory EHR at OB/GYN practices and its subsequent interface with an inpatient perinatal EHR affected providers' satisfaction with the transmission of clinical information and patients' ratings of their care experience. We collected data on provider satisfaction through 4 survey rounds during the phased implementation of the EHR. Data on patient satisfaction were drawn from Press Ganey surveys issued by the healthcare network through a standard process. Using multivariable models, we determined how provider satisfaction with information transmission and patient satisfaction with their care experience changed as the EHR system allowed greater information flow between OB/GYN practices and the hospital. Outpatient OB/GYN providers became more satisfied with their access to information from the inpatient perinatal triage unit once system capabilities included automatic data flow from triage back to the OB/GYN offices. Yet physicians were generally less satisfied with how the EHR affected their work processes than other clinical and non-clinical staff. Patient satisfaction dropped after initial EHR installation, and we find no evidence of increased satisfaction linked to system integration. Dissatisfaction of providers with an EHR system and difficulties incorporating EHR technology into patient care may negatively impact patient satisfaction. Care must be taken during EHR implementations to maintain good communication with patients while satisfying documentation requirements.

  17. What specifications for a centre or network of excellence in clinical research?

    Science.gov (United States)

    Diebolt, Vincent; Lang, Marie; Thoby, Frédérique

    2016-02-01

    The Giens 2015 Workshop Round Table entitled "What specifications for a centre or network of excellence in clinical research?" took a viewpoint distinct from earlier work and studies on changes in clinical research activities in France. The purpose of the present work was to identify, starting from concrete examples, the main strengths and advantages of clinical research activity in France related, in part, to the background environment and also to the specific characteristics of the investigation centres considered to be among the most high-performance units in activity. The criteria retained were grouped into a set of specifications that could be used to establish a "label of excellence" upon which the different teams and clinical research centres could model themselves. It was thus considered that belonging to a centre or structured network with at least a national configuration, when this is possible for the medial topic in question, constitutes a real advantage. Four benchmarks were identified: the scientific and clinical expertise of the head investigator, as well as the qualification and operational capacity of the centre's team; definition and measurement of performance using clearly displayed indicators and evaluation procedures; the quality of the overall trial "process" and of each of its component steps; communication, because know-how and promotion go hand in hand, with the main objective of informing the professional and general public about the value of the research centre meeting the above-mentioned criteria, about its networks of competencies, and more generally, about the important assets of the background of clinical research in France. This sector of research is funded by the public authorities via calls for public grants, financial aids for structures supporting clinical research in the University Hospital Centres and other healthcare institutions allowing for a professionalization of the research occupations, and the national public health

  18. "A small cog in a large wheel": an exploratory study into the experiences of porters, ward clerks and domestics working in an English Cancer Centre.

    Science.gov (United States)

    Mack, Hazel; Froggatt, Katherine; McClinton, Pam

    2003-09-01

    The effect of working in an oncology environment on nurses has been widely researched but the experiences of non-clinical staff such as ancillary workers in the oncology environment have rarely been examined. This exploratory study had three aims: to explore ancillary workers' understandings of cancer, their experiences of working in a Cancer Centre and their training and support needs. Working within a naturalistic paradigm, a descriptive exploratory design was utilised employing in-depth interviews and drawing on aspects of grounded theory for data analysis. Findings indicated that these ancillary workers lacked an in-depth understanding of cancer. The experience of working in a Cancer Centre appeared to bring both costs and benefits to these ancillary workers. These ancillary workers enjoyed the level of contact they have with patients in a Cancer Centre and subsequently ascribed great value to their jobs. However, they felt that health-care professional colleagues did not always value their contribution to the care of patients. There are implications for nurses and other health-care staff working in oncology alongside these ancillary staff in terms of valuing and supporting them in the work that they do.

  19. The health of healthcare, Part II: patient healthcare has cancer.

    Science.gov (United States)

    Waldman, Deane

    2013-01-01

    In this article, we make the etiologic diagnosis for a sick patient named Healthcare: the cancer of greed. When we explore the two forms of this cancer--corporate and bureaucratic--we find the latter is the greater danger to We the Patients. The "treatments" applied to patient Healthcare by the Congressional "doctors" have consistently made the patient worse, not better. At the core of healthcare's woes is the government's diversion of money from healthcare services to healthcare bureaucracy. As this is the root cause, it is what we must address in order to cure, not sedate or palliate, patient Healthcare.

  20. quality of glycaemic control in ambulatory diabetics at the out-patient

    African Journals Online (AJOL)

    hi-tech

    2003-08-08

    Aug 8, 2003 ... Conclusion: The majority of ambulatory diabetic patients attending the out-patient diabetic clinic had poor glycaemic control. The group with the poorest level of glycaemic control were on OHA-only, while best control was observed amongst patients on diet-only, because of possible fair endogenous insulin ...

  1. A pilot audit of a protocol for ambulatory investigation of predicted low-risk patients with possible pulmonary embolism.

    Science.gov (United States)

    McDonald, A H; Murphy, R

    2011-09-01

    Patients with possible pulmonary embolism (PE) commonly present to acute medical services. Research has led to the identification of low-risk patients suitable for ambulatory management. We report on a protocol designed to select low-risk patients for ambulatory investigation if confirmatory imaging is not available that day. The protocol was piloted in the Emergency Department and Medical Assessment Area at the Royal Infirmary of Edinburgh. We retrospectively analysed electronic patient records in an open observational audit of all patients managed in the ambulatory arm over five months of use. We analysed 45 patients' records. Of these, 91.1% required imaging to confirm or refute PE, 62.2% received a computed tomography pulmonary angiogram (CTPA). In 25% of patients, PE was confirmed with musculoskeletal pain (22.7%), and respiratory tract infection (15.9%) the next most prevalent diagnoses. Alternative diagnoses was provided by CTPA in 32% of cases. We identified no adverse events or readmissions but individualised follow-up was not attempted. The data from this audit suggests this protocol can be applied to select and manage low-risk patients suitable for ambulatory investigation of possible PE. A larger prospective comparative study would be required to accurately define the safety and effectiveness of this protocol.

  2. The Åstrand-Ryhming Test is not a Feasible Measure in Ambulatory Patients with Amyotrophic Lateral Sclerosis.

    Science.gov (United States)

    van Groenestijn, Annerieke C; Verschuren, Olaf; Schröder, Carin D; van den Berg, Leonard H; Visser-Meily, Johanna M A

    2016-11-29

    Ambulatory patients with Amyotrophic Lateral Sclerosis (ALS) show a decreased aerobic capacity which may hamper the ability to perform activities of daily living. A standardized measure, however, for assessing aerobic capacity in patients with ALS during the disease course, is lacking. To examine the feasibility of the Åstrand-Ryhming (ÅR) test protocol longitudinally in ambulatory patients with amyotrophic lateral sclerosis (ALS). Seven ambulatory male patients with spinal ALS onset were assessed at baseline and at 4, 7 and 10 months' follow-up. Feasibility of the ÅR test protocol was analysed using percentage of: a) completed ÅR tests; b) achieved steady states; and c) predefined heart rates. Test completion decreased from 7/7 at baseline to 10/21 at follow-up due to ALS-related symptoms as fatigue, muscle weakness and cramps. Steady states and predefined heart rates were achieved in 12/17 and 17/17 of the completed tests, respectively. Overall, the feasibility of the ÅR test protocol declines from 5/7 at baseline to 7/21 at follow-up. The results suggest that changes in aerobic capacity in ambulatory patients with ALS could not be successfully monitored due to a diminished feasibility of the ÅR test protocol.

  3. Challenges in pediatric ambulatory anesthesia: kids are different.

    Science.gov (United States)

    Collins, Corey E; Everett, Lucinda L

    2010-06-01

    The care of the child having ambulatory surgery presents a specific set of challenges to the anesthesia provider. This review focuses on areas of clinical distinction that support the additional attention children often require, and on clinical controversies that require providers to have up-to-date information to guide practice and address parental concerns. These include perioperative risk; obstructive sleep apnea; obesity; postoperative nausea and vomiting; neurocognitive outcomes; and specific concerns regarding common ear, nose, and throat procedures. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  4. Providers' perceptions of communication with patients in primary healthcare in Rwanda.

    Science.gov (United States)

    Cubaka, Vincent Kalumire; Schriver, Michael; Cotton, Philip; Nyirazinyoye, Laetitia; Kallestrup, Per

    2018-01-01

    Delivery of effective healthcare is contingent on the quality of communication between the patient and the healthcare provider. Little is known about primary healthcare providers' perceptions of communication with patients in Rwanda. To explore providers' perceptions of patient-provider communication (PPC) and analyse the ways in which providers present and reflect on communication practice and problems. Qualitative, in-depth, semi structured interviews with nine primary health care providers. An abductive analysis supplemented by the framework method was applied. A narrative approach allowed the emergence of archetypical narratives on PPC. Providers shared rich reflections on the importance of proper communication with patients and appeared committed to making their interaction work optimally. Still, providers had difficulty critically analysing limitations of their communication in practice. Reported communication issues included lack of communication training as well as time and workload issues. Two archetypes of narratives on PPC issues and practice emerged and are discussed. While providers' narratives put patients at the centre of care, there were indications that patient-provider communication training and practice need further development. In-depth exploration of highlighted issues and adapted strategies to tackle communication drawbacks are prerequisites to improvement. This study contributes to the advancement of knowledge related to communication between the patient and the provider in a resource-limited setting.

  5. Person-centred web-based support--development through a Swedish multi-case study.

    Science.gov (United States)

    Josefsson, Ulrika; Berg, Marie; Koinberg, Ingalill; Hellström, Anna-Lena; Nolbris, Margaretha Jenholt; Ranerup, Agneta; Lundin, Carina Sparud; Skärsäter, Ingela

    2013-10-19

    Departing from the widespread use of the internet in modern society and the emerging use of web applications in healthcare this project captures persons' needs and expectations in order to develop highly usable web recourses. The purpose of this paper is to outline a multi-case research project focused on the development and evaluation of person-centred web-based support for people with long-term illness. To support the underlying idea to move beyond the illness, we approach the development of web support from the perspective of the emergent area of person-centred care. The project aims to contribute to the ongoing development of web-based supports in health care and to the emerging field of person-centred care. The research design uses a meta-analytical approach through its focus on synthesizing experiences from four Swedish regional and national cases of design and use of web-based support in long-term illness. The cases include children (bladder dysfunction and urogenital malformation), young adults (living close to persons with mental illness), and two different cases of adults (women with breast cancer and childbearing women with type 1 diabetes). All of the cases are ongoing, though in different stages of design, implementation, and analysis. This, we argue, will lead to a synthesis of results on a meta-level not yet described. To allow valid comparisons between the four cases we explore and problematize them in relation to four main aspects: 1) The use of people's experiences and needs; 2) The role of use of theories in the design of person-centred web-based supports; 3) The evaluation of the effects of health outcomes for the informants involved and 4) The development of a generic person-centred model for learning and social support for people with long-term illness and their significant others. Person-centred web-based support is a new area and few studies focus on how web-based interventions can contribute to the development of person-centred care. In

  6. [Healthcare value chain: a model for the Brazilian healthcare system].

    Science.gov (United States)

    Pedroso, Marcelo Caldeira; Malik, Ana Maria

    2012-10-01

    This article presents a model of the healthcare value chain which consists of a schematic representation of the Brazilian healthcare system. The proposed model is adapted for the Brazilian reality and has the scope and flexibility for use in academic activities and analysis of the healthcare sector in Brazil. It places emphasis on three components: the main activities of the value chain, grouped in vertical and horizontal links; the mission of each link and the main value chain flows. The proposed model consists of six vertical and three horizontal links, amounting to nine. These are: knowledge development; supply of products and technologies; healthcare services; financial intermediation; healthcare financing; healthcare consumption; regulation; distribution of healthcare products; and complementary and support services. Four flows can be used to analyze the value chain: knowledge and innovation; products and services; financial; and information.

  7. Effects of health information exchange adoption on ambulatory testing rates.

    Science.gov (United States)

    Ross, Stephen E; Radcliff, Tiffany A; Leblanc, William G; Dickinson, L Miriam; Libby, Anne M; Nease, Donald E

    2013-01-01

    To determine the effects of the adoption of ambulatory electronic health information exchange (HIE) on rates of laboratory and radiology testing and allowable charges. Claims data from the dominant health plan in Mesa County, Colorado, from 1 April 2005 to 31 December 2010 were matched to HIE adoption data on the provider level. Using mixed effects regression models with the quarter as the unit of analysis, the effect of HIE adoption on testing rates and associated charges was assessed. Claims submitted by 306 providers in 69 practices for 34 818 patients were analyzed. The rate of testing per provider was expressed as tests per 1000 patients per quarter. For primary care providers, the rate of laboratory testing increased over the time span (baseline 1041 tests/1000 patients/quarter, increasing by 13.9 each quarter) and shifted downward with HIE adoption (downward shift of 83, prates or imputed charges in either provider group. Ambulatory HIE adoption is unlikely to produce significant direct savings through reductions in rates of testing. The economic benefits of HIE may reside instead in other downstream outcomes of better informed, higher quality care.

  8. Rethinking capacity building for knowledge mobilisation: developing multilevel capabilities in healthcare organisations.

    Science.gov (United States)

    Kislov, Roman; Waterman, Heather; Harvey, Gill; Boaden, Ruth

    2014-11-15

    Knowledge mobilisation in healthcare organisations is often carried out through relatively short-term projects dependent on limited funding, which raises concerns about the long-term sustainability of implementation and improvement. It is becoming increasingly recognised that the translation of research evidence into practice has to be supported by developing the internal capacity of healthcare organisations to engage with and apply research. This process can be supported by external knowledge mobilisation initiatives represented, for instance, by professional associations, collaborative research partnerships and implementation networks. This conceptual paper uses empirical and theoretical literature on organisational learning and dynamic capabilities to enhance our understanding of intentional capacity building for knowledge mobilisation in healthcare organisations. The discussion is structured around the following three themes: (1) defining and classifying capacity building for knowledge mobilisation; (2) mechanisms of capability development in organisational context; and (3) individual, group and organisational levels of capability development. Capacity building is presented as a practice-based process of developing multiple skills, or capabilities, belonging to different knowledge domains and levels of complexity. It requires an integration of acquisitive learning, through which healthcare organisations acquire knowledge and skills from knowledge mobilisation experts, and experience-based learning, through which healthcare organisations adapt, absorb and modify their knowledge and capabilities through repeated practice. Although the starting point for capability development may be individual-, team- or organisation-centred, facilitation of the transitions between individual, group and organisational levels of learning within healthcare organisations will be needed. Any initiative designed to build capacity for knowledge mobilisation should consider the

  9. Lean healthcare.

    Science.gov (United States)

    Weinstock, Donna

    2008-01-01

    As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

  10. Management and cost analysis of cancer patients treated with G-CSF: a cohort study based on the French national healthcare insurance database.

    Science.gov (United States)

    Tilleul, Patrick; Jacot, William; Emery, Corinne; Lafuma, Antoine; Gourmelen, Julie

    2017-12-01

    To describe the management and costs associated with G-CSF therapy in cancer patients in France. This study analyzed a representative random population sample from the French national healthcare insurance database, focusing on 1,612 patients with hematological or solid malignancies who were reimbursed in 2013 or 2014 for at least one G-CSF treatment dispensed in a retail pharmacy. Patient characteristics and treatment costs were analyzed according to the type of cancer. Then the costs and characteristics of patients associated with the use of different G-CSF products were analyzed in the sub-set of breast cancer patients. The most frequent malignancies in the database population were breast cancer (23.3%), hematological malignancies (22.2%), and lung cancer (12.4%). The reimbursed G-CSF was pegfilgrastim in 34.1% of cases, lenograstim in 26.7%, and filgrastim in 17.9%. More than one G-CSF product was reimbursed to 21.3% of patients. The total annual reimbursed health expenses per patient, according to the type of G-CSF, were €27,001, €24,511, and €20,802 for patients treated with filgrastim, lenograstim, and pegfilgrastim, respectively. Ambulatory care accounted for, respectively, 35%, 38%, and 41% of those costs. In patients with breast cancer, ambulatory care cost was €7,915 with filgrastim, €7,750 with lenograstim, and €6,989 with pegfilgrastim, and the respective cost of G-CSF was €1,733, €1,559, and €3,668. All available G-CSF products have been shown to be effective in cancer patients, and both daily G-CSFs and pegylated G-CSF are recommended in international guidelines. Nevertheless, this analysis of G-CSF reimbursement indicates that the choice of product can markedly affect the total cost of ambulatory care.

  11. The effects of oral amino acid intake on ambulatory capacity in elderly subjects.

    Science.gov (United States)

    Scognamiglio, Roldano; Avogaro, Angelo; Negut, Christian; Piccolotto, Roberto; de Kreutzenberg, Saula Vigili; Tiengo, Antonio

    2004-12-01

    The combination of high prevalence of inactivity in the older population, and high risk of ill-health and disability associated with inactivity, suggests that interventions that are successful in increasing levels of activity may have a great impact on population health in later life. With advancing age, the risk of developing serious nutritional deficiencies also increases. This study was designed to assess the effects of dietary amino acid supplementation on effort tolerance in healthy elderly subjects with reduced physical activity. Forty-four subjects (age > 65 years) with sedentary life-style and lower health-related quality of life were studied. Subjects, in an open-label fashion, received an oral amino acid mixture (AAM, 12 g/day) containing essential and non-essential amino acids for a 3-month period. Ambulatory dysfunction resulting in sedentary life-style was assessed by a 6-min walk test. A walking impairment questionnaire (WIQ) was used to evaluate self-perceived ambulatory dysfunction. Maximal isometric muscular strength of the right hand was measured during isometric exercise by a handgrip dynamometer. The 6-min walk distance increased from 214.5 +/- 32 to 262.8 +/- 34.8 m (p oral amino acid supplement, as used in this pilot study, improves ambulatory capacity and maximal isometric muscle strength in elderly subjects without affecting the main metabolic parameters. Amino acid supplementation may thus represent useful non-pharmacological intervention to maintain physical fitness in these subjects.

  12. Do general radiographic examinations resemble a person-centred environment?

    International Nuclear Information System (INIS)

    Hayre, C.M.; Blackman, S.; Eyden, A.

    2016-01-01

    Aim and objective: It is argued whether general radiographic examinations adhere to a person-centred approach within the direct digital radiography (DDR) environment. General radiographic examinations continue to increase and constitute approximately 90% of all examinations undertaken in the clinical environment. This study explored the potential impact patients experience whilst undergoing general imaging examinations. Method: An ethnographic methodology provided insight of two general radiography environments in the United Kingdom (UK) using participant observation and semi-structured interviews. Findings: The findings highlighted an ‘in and out’ culture whereby patients are ‘hurried’ and ‘rushed’ out of X-ray rooms in response to increasing time pressures experienced by diagnostic radiographers. In addition, this study challenged that patients may begin to rank ‘speed’ and ‘waiting times’ above other elements of radiographic care thus presenting new challenges for radiographers within the clinical environment. Conclusion: It is asserted that radiographers should remain holistic healthcare professionals and not begin to resemble operators on the production line. Further, it challenges whether patients are beginning to rank aspects of radiographic care within contemporary practices. Advances in knowledge: Few studies have explored the radiographer–patient relationship within the DDR environment, yet this study provides insight of person-centred practices within contemporary practices. - Highlights: • Challenges whether the use of DDR conforms to a person-centred approach. • Challenges whether radiographers are ‘treating patients as persons’ using DDR. • Patients may begin to rank ‘speed’ and ‘waiting times’ above other aspects of radiographic care.

  13. Ambulatory blood pressure monitoring for hypertension in general practice.

    OpenAIRE

    Taylor, R S; Stockman, J; Kernick, D; Reinhold, D; Shore, A C; Tooke, J E

    1998-01-01

    Ambulatory blood pressure monitoring (ABPM) is being increasingly used in general practice. There is at present little published evidence regarding the clinical utility of ABPM in the care of patients with established hypertension in this setting. We examined this issue by undertaking ABPM in a group of patients with established hypertension. 40 patients (aged 33-60 years) currently being treated for hypertension were randomly selected from a general practice list and underwent a single 24-ho...

  14. 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.

    2014-01-01

    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

  15. Architecture of personal healthcare information system in ubiquitous healthcare

    NARCIS (Netherlands)

    Bhardwaj, S.; Sain, M.; Lee, H.-J.; Chung, W.Y.; Slezak, D.; et al., xx

    2009-01-01

    Due to recent development in Ubiquitous Healthcare now it’s time to build such application which can work independently and with less interference of Physician. In this paper we are try to build the whole architecture of personal Healthcare information system for ubiquitous healthcare which also

  16. Improving the effectiveness of service delivery in the public healthcare sector: the case of ophthalmology services in Malaysia.

    Science.gov (United States)

    Foo, Chee Yoong; Lim, Ka Keat; Sivasampu, Sheamini; Dahian, Kamilah Binti; Goh, Pik Pin

    2015-08-28

    Rising demand of ophthalmology care is increasingly straining Malaysia's public healthcare sector due to its limited human and financial resources. Improving the effectiveness of ophthalmology service delivery can promote national policy goals of population health improvement and system sustainability. This study examined the performance variation of public ophthalmology service in Malaysia, estimated the potential output gain and investigated several factors that might explain the differential performance. Data for 2011 and 2012 on 36 ophthalmology centres operating in the Ministry of Health hospitals were used in this analysis. We first consulted a panel of ophthalmology service managers to understand the production of ophthalmology services and to verify the production model. We then assessed the relative performance of these centres using Data Envelopment Analysis (DEA). Efficiency scores (ES) were decomposed into technical, scale, and congestion component. Potential increase in service output was estimated. Sensitivity analysis of model changes was performed and stability of the result was assessed using bootstrap approach. Second stage Tobit regression was conducted to determine if hospital type, availability of day services and population characteristics were related to the DEA scores. In 2011, 33% of the ophthalmology centres were found to have ES > 1 (mean ES = 1.10). Potential output gains were 10% (SE ± 2.92), 7.4% (SE ± 2.06), 6.9% (SE ± 1.97) if the centres could overcome their technical, scale and congestion inefficiencies. More centres moved to the performance frontier in 2012 (mean ES = 1.07), with lower potential output gain. The model used has good stability. Robustness checks show that the DEA correctly identified low performing centres. Being in state hospital was significantly associated with better performance. Using DEA to benchmarking service performance of ophthalmology care could provide insights for policy

  17. Innovation in managing the referral process at a Canadian pediatric hospital.

    Science.gov (United States)

    MacGregor, Daune; Parker, Sandra; MacMillan, Sharon; Blais, Irene; Wong, Eugene; Robertson, Chris J; Bruce-Barrett, Cindy

    2009-01-01

    The provision of timely and optimal patient care is a priority in pediatric academic health science centres. Timely access to care is optimized when there is an efficient and consistent referral system in place. In order to improve the patient referral process and, therefore, access to care, an innovative web-based system was developed and implemented. The Ambulatory Referral Management System enables the electronic routing for submission, review, triage and management of all outpatient referrals. The implementation of this system has provided significant metrics that have informed how processes can be improved to increase access to care. Use of the system has improved efficiency in the referral process and has reduced the work associated with the previous paper-based referral system. It has also enhanced communication between the healthcare provider and the patient and family and has improved the security and confidentiality of patient information management. Referral guidelines embedded within the system have helped to ensure that referrals are more complete and that the patient being referred meets the criteria for assessment and treatment in an ambulatory setting. The system calculates and reports on wait times, as well as other measures.

  18. [Beyond the horizon of health-care delivery - medical marketing].

    Science.gov (United States)

    Hoffmann, M; Großterlinden, L G; Rueger, J M; Ruecker, A H

    2014-12-01

    The progress in medical health care and demographic changes cause increasing financial expenses. The rising competitive environment on health-care delivery level calls for economisation and implementation of a professional marketing set-up in order to ensure long-term commercial success. The survey is based on a questionnaire-analysis of 100 patients admitted to a trauma department at a university hospital in Germany. Patients were admitted either for emergency treatment or planned surgical procedures. Competence and localisation represent basic criteria determing hospital choice with a varying focus in each collective. Both collectives realise a trend toward economisation, possibly influencing medical care decision-making. Patients admitted for planned surgical treatment are well informed about their disease, treatment options and specialised centres. The main source of information is the internet. Both collectives claim amenities during their in-hospital stay. Increasing economisation trends call for a sound and distinct marketing strategy. The marketing has to be focused on the stakeholders needs. Concomitant factors are patient satisfaction, the establishment of cooperation networks and maintenance/improvement of medical health-care quality. Georg Thieme Verlag KG Stuttgart · New York.

  19. Mentor experiences of international healthcare students' learning in a clinical environment: A systematic review.

    Science.gov (United States)

    Mikkonen, Kristina; Elo, Satu; Tuomikoski, Anna-Maria; Kääriäinen, Maria

    2016-05-01

    Globalisation has brought new possibilities for international growth in education and professional mobility among healthcare professionals. There has been a noticeable increase of international degree programmes in non-English speaking countries in Europe, creating clinical learning challenges for healthcare students. The aim of this systematic review was to describe mentors' experiences of international healthcare students' learning in a clinical environment. The objective of the review was to identify what influences the success or failure of mentoring international healthcare students when learning in the clinical environment, with the ultimate aim being to promote optimal mentoring practice. A systematic review was conducted according to the guidelines of the Centre for Reviews and Dissemination. Seven electronic databases were used to search for the published results of previous research: CINAHL, Medline Ovid, Scopus, the Web of Science, Academic Search Premiere, Eric, and the Cochrane Library. Search inclusion criteria were planned in the PICOS review format by including peer-reviewed articles published in any language between 2000 and 2014. Five peer-reviewed articles remained after the screening process. The results of the original studies were analysed using a thematic synthesis. The results indicate that a positive intercultural mentor enhanced reciprocal learning by improving the experience of international healthcare students and reducing stress in the clinical environment. Integrating international healthcare students into work with domestic students was seen to be important for reciprocal learning and the avoidance of discrimination. Many healthcare students were found to share similar experiences of mentoring and learning irrespective of their cultural background. However, the role of a positive intercultural mentor was found to make a significant difference for international students: such mentors advocated and mediated cultural differences and

  20. The development of a consensus definition for healthcare improvement science (HIS) in seven European countries: A consensus methods approach.

    Science.gov (United States)

    Skela-Savič, Brigita; Macrae, Rhoda; Lillo-Crespo, Manuel; Rooney, Kevin D

    2017-06-01

    There is a limited body of research in the field of healthcare improvement science (HIS). Quality improvement and 'change making' should become an intrinsic part of everyone's job, every day in all parts of the healthcare system. The lack of theoretical grounding may partly explain the minimal transfer of health research into health policy. This article seeks to present the development of the definition for healthcare improvement science. A consensus method approach was adopted with a two-stage Delphi process, expert panel and consensus group techniques. A total of 18 participants were involved in the expert panel and consensus group, and 153 answers were analysed as a part of the Delphi survey. Participants were researchers, educators and healthcare professionals from Scotland, Slovenia, Spain, Italy, England, Poland, and Romania. A high level of consensus was achieved for the broad definition in the 2nd Delphi iteration (86%). The final definition was agreed on by the consensus group: 'Healthcare improvement science is the generation of knowledge to cultivate change and deliver person-centred care that is safe, effective, efficient, equitable and timely. It improves patient outcomes, health system performance and population health.' The process of developing a consensus definition revealed different understandings of healthcare improvement science between the participants. Having a shared consensus definition of healthcare improvement science is an important step forward, bringing about a common understanding in order to advance the professional education and practice of healthcare improvement science.

  1. High Prevalence of Obesity in Ambulatory Children and Adolescents with Intellectual Disability

    Science.gov (United States)

    Stewart, L.; Van de Ven, L.; Katsarou, V.; Rentziou, E.; Doran, M.; Jackson, P.; Reilly, J. J.; Wilson, D.

    2009-01-01

    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…

  2. Manche centre

    International Nuclear Information System (INIS)

    1997-05-01

    After a general presentation of radioactivity and radioactive wastes and of the French national agency for the management of radioactive wastes (ANDRA), this brochure gives a general overview of the Manche low- and medium-level radioactive waste disposal centre: principles of storage safety, waste containers (first confinement barrier), storage facility and cover (second confinement barrier), the underground (third confinement barrier), the impact of the centre on its environment, and the control of radioactivity in the vicinity of the centre. (J.S.)

  3. Current state of continuous ambulatory peritoneal dialysis in Egypt

    Directory of Open Access Journals (Sweden)

    Khaled Mohamed Amin Elzorkany

    2017-01-01

    Full Text Available Patients with end-stage renal disease (ESRD continue to increase in number worldwide, especially in developing countries. Although continuous ambulatory peritoneal dialysis (CAPD has comparable survival advantages as hemodialysis (HD, it is greatly underutilized in many regions worldwide. The prevalence of use of CAPD in Egypt is 0.29/million population in 2017. The aim of this study is to describe the current state and practice of CAPD in Egypt and included 22 adult patients who were treated by CAPD. All the study patients were switched to CAPD after treatment with HD failed due to vascular access problems. Patients were mainly female (68.2 % with the mean age of 49.77 ± 11.41 years. The average duration on CAPD was 1.76 ± 1.30 years. Hypertension was the main cause of end-stage renal disease (ESRD constituting 36.4%, followed by diabetes (27.3 %, and toxic nephropathy (4.5%. Of importance is that about 31.8% of patients had ESRD of unknown etiology. The mean weekly Kt/V urea of patients on PD was 1.92 ± 0.18. The mean hemoglobin, serum calcium, phosphorus, parathormone, and albumin levels were 10.27 ± 1.98 g/dL, 8.36 ± 1.19 mg/dL, 5.70 ± 1.35 mg/dL, 541.18 ± 230.12 pg/mL, and 2.98 ± 0.73 g/dL, respectively. There was no significant difference between diabetic and nondiabetic CAPD patients regarding demographic and laboratory data. Our data indicate that there is continuing underutilization of CAPD in Egypt which may be related to nonavailability of CAPD fluid, patient factors (education and motivation, gradual decline of the efficiency of health-care professionals, and lack of a national program to start PD as the first modality for renal replacement therapy. It is advised to start an organized program to make CAPD widespread and encourage local production of PD fluids to reduce the cost of CAPD.

  4. Optimizing the design of preprinted orders for ambulatory chemotherapy: combining oncology, human factors, and graphic design.

    Science.gov (United States)

    Jeon, Jennifer; White, Rachel E; Hunt, Richard G; Cassano-Piché, Andrea L; Easty, Anthony C

    2012-03-01

    To establish a set of guidelines for developing ambulatory chemotherapy preprinted orders. Multiple methods were used to develop the preprinted order guidelines. These included (A) a comprehensive literature review and an environmental scan; (B) analyses of field study observations and incident reports; (C) critical review of evidence from the literature and the field study observation analyses; (D) review of the draft guidelines by a clinical advisory group; and (E) collaboration with graphic designers to develop sample preprinted orders, refine the design guidelines, and format the resulting content. The Guidelines for Developing Ambulatory Chemotherapy Preprinted Orders, which consist of guidance on the design process, content, and graphic design elements of ambulatory chemotherapy preprinted orders, have been established. Health care is a safety critical, dynamic, and complex sociotechnical system. Identifying safety risks in such a system and effectively addressing them often require the expertise of multiple disciplines. This study illustrates how human factors professionals, clinicians, and designers can leverage each other's expertise to uncover commonly overlooked patient safety hazards and to provide health care professionals with innovative, practical, and user-centered tools to minimize those hazards.

  5. Redefining the Core Competencies of Future Healthcare Executives under Healthcare Reform

    Science.gov (United States)

    Love, Dianne B.; Ayadi, M. Femi

    2015-01-01

    As the healthcare industry has evolved over the years, so too has the administration of healthcare organizations. The signing into law of the Patient Protection and Affordable Care Act (ACA) has brought additional changes to the healthcare industry that will require changes to the healthcare administration curriculum. The movement toward a…

  6. Surgery of the hallux valgus in an ambulatory setting: a liability risk?

    Science.gov (United States)

    Galois, L; Serwier, J-M; Arashvand, A D

    2017-05-01

    The primary objective of the study is to make an inventory of malpractice in hallux valgus surgery in an ambulatory setting and to identify the patient characteristics for a higher risk of malpractice. The secondary objective is creating a methodology for analyzing the medicolegal aspects of a surgery in day case comparing with hospitalization. The database of the Branchet insurance company was used. A total of 11,000 claims for a period of 11 years (2002-2013) have been investigated. The files of the patients with hallux valgus surgery were isolated from the insurer's database using CCAM codes. The medical director, a medical officer, the legal expert and finally the judge had already analyzed all these cases. The authors reviewed the various documents with a specific questionnaire. We identified 14 cases of claims in relation with hallux valgus 1-day surgery among a total of 138 claims for hallux valgus including all techniques (10%). All patients were female. The mean age was 42.6 years (19-64) in ambulatory patients (AG group) in comparison with 49.5 years (19-73) in hospitalized patients (HG group). Percutaneous techniques were significantly more represented in the AG group (p = 0.002) and scarfs osteotomies in the HG group (p = 0.004). The use of tourniquet seemed to be lower in the AG group, but it was a not significant trend (p = 0.085). In term of anesthesia procedures, no significant differences were seen between the two groups. The comparison of the complications common to both groups showed no significant difference except for insufficient results which were more frequent in the AG group (p = 0.026). The rate of insufficient informed consent seemed to be higher in the AG group, but it was a not significant trend (p = 0.084). No specific data regarding claims in relation with hallux valgus 1-day surgery are available to our knowledge in the literature. We did not identify in our study specific complications related to ambulatory procedures

  7. A contrast between DEMATEL-ANP and ANP methods for six sigma project selection: a case study in healthcare industry.

    Science.gov (United States)

    Ortíz, Miguel A; Felizzola, Heriberto A; Nieto Isaza, Santiago

    2015-01-01

    The project selection process is a crucial step for healthcare organizations at the moment of implementing six sigma programs in both administrative and caring processes. However, six-sigma project selection is often defined as a decision making process with interaction and feedback between criteria; so that it is necessary to explore different methods to help healthcare companies to determine the Six-sigma projects that provide the maximum benefits. This paper describes the application of both ANP (Analytic Network process) and DEMATEL (Decision Making trial and evaluation laboratory)-ANP in a public medical centre to establish the most suitable six sigma project and finally, these methods were compared to evaluate their performance in the decision making process. ANP and DEMATEL-ANP were used to evaluate 6 six sigma project alternatives under an evaluation model composed by 3 strategies, 4 criteria and 15 sub-criteria. Judgement matrixes were completed by the six sigma team whose participants worked in different departments of the medical centre. The improving of care opportunity in obstetric outpatients was elected as the most suitable six sigma project with a score of 0,117 as contribution to the organization goals. DEMATEL-ANP performed better at decision making process since it reduced the error probability due to interactions and feedback. ANP and DEMATEL-ANP effectively supported six sigma project selection processes, helping to create a complete framework that guarantees the prioritization of projects that provide maximum benefits to healthcare organizations. As DEMATEL- ANP performed better, it should be used by practitioners involved in decisions related to the implementation of six sigma programs in healthcare sector accompanied by the adequate identification of the evaluation criteria that support the decision making model. Thus, this comparative study contributes to choosing more effective approaches in this field. Suggestions of further work are also

  8. Ambulatory Arterial Stiffness Indexes in Cushing's Syndrome.

    Science.gov (United States)

    Battocchio, Marialberta; Rebellato, Andrea; Grillo, Andrea; Dassie, Francesca; Maffei, Pietro; Bernardi, Stella; Fabris, Bruno; Carretta, Renzo; Fallo, Francesco

    2017-03-01

    Long-standing exposure to endogenous cortisol excess is associated with high cardiovascular risk. The aim of our study was to investigate arterial stiffness, which has been recognized as an independent predictor of adverse cardiovascular outcome, in a group of patients with Cushing's syndrome. Twenty-four patients with Cushing's syndrome (3 males, mean age 49±13 years; 20 pituitary-dependent Cushing's disease and 4 adrenal adenoma) underwent 24-h ambulatory blood pressure monitoring (ABPM) and evaluation of cardiovascular risk factors. The Ambulatory Arterial Stiffness Index (AASI) and symmetric AASI (sAASI) were derived from ABPM tracings. Cushing patients were divided into 8 normotensive (NOR-CUSH) and 16 hypertensive (HYP-CUSH) patients, and were compared with 8 normotensive (NOR-CTR) and 16 hypertensive (HYP-CTR) control subjects, matched for demographic characteristics, 24-h ABPM and cardiometabolic risk factors. The AASI and sAASI indexes were significantly higher in Cushing patients than in controls, either in the normotensive (p=0.048 for AASI and p=0.013 for sAASI) or in the hypertensive (p=0.004 for AASI and p=0.046 for sAASI) group. No difference in metabolic parameters was observed between NOR-CUSH and NOR-CTR or between HYP-CUSH and HYP-CTR groups. AASI and sAASI were both correlated with urinary cortisol in patients with endogenous hypercortisolism (Spearman's rho=0.40, p=0.05, and 0.61, p=0.003, respectively), while no correlation was found in controls. Both AASI and sAASI are increased in Cushing syndrome, independent of BP elevation, and may represent an additional cardiovascular risk factor in this disease. The role of excess cortisol in arterial stiffness has to be further clarified. © Georg Thieme Verlag KG Stuttgart · New York.

  9. An eConsent-based System Architecture Supporting Cooperation in Integrated Healthcare Networks.

    Science.gov (United States)

    Bergmann, Joachim; Bott, Oliver J; Hoffmann, Ina; Pretschner, Dietrich P

    2005-01-01

    The economical need for efficient healthcare leads to cooperative shared care networks. A virtual electronic health record is required, which integrates patient related information but reflects the distributed infrastructure and restricts access only to those health professionals involved into the care process. Our work aims on specification and development of a system architecture fulfilling these requirements to be used in concrete regional pilot studies. Methodical analysis and specification have been performed in a healthcare network using the formal method and modelling tool MOSAIK-M. The complexity of the application field was reduced by focusing on the scenario of thyroid disease care, which still includes various interdisciplinary cooperation. Result is an architecture for a secure distributed electronic health record for integrated care networks, specified in terms of a MOSAIK-M-based system model. The architecture proposes business processes, application services, and a sophisticated security concept, providing a platform for distributed document-based, patient-centred, and secure cooperation. A corresponding system prototype has been developed for pilot studies, using advanced application server technologies. The architecture combines a consolidated patient-centred document management with a decentralized system structure without needs for replication management. An eConsent-based approach assures, that access to the distributed health record remains under control of the patient. The proposed architecture replaces message-based communication approaches, because it implements a virtual health record providing complete and current information. Acceptance of the new communication services depends on compatibility with the clinical routine. Unique and cross-institutional identification of a patient is also a challenge, but will loose significance with establishing common patient cards.

  10. Use of ambulatory blood pressure measurement in the definition of resistant hypertension: a review of the evidence.

    Science.gov (United States)

    Persu, Alexandre; O'Brien, Eoin; Verdecchia, Paolo

    2014-11-01

    Resistant hypertension as defined by the European Society of Hypertension and American Heart Association is a blood pressure that remains uncontrolled despite concomitant intake of at least three antihypertensive drugs (one of them preferably being a diuretic) at full doses. This definition is still based on office rather than out-of-office blood pressure measurement. In this review we propose a new, stricter definition of resistant hypertension based on ambulatory blood pressure measurement. The main arguments in favor of this are: (1) in patients with resistant hypertension, ambulatory blood pressure is an independent predictor of cardiovascular morbidity whereas, after adjustment for conventional risk factors, conventional blood pressure has little added value; (2) white-coat resistant hypertension (uncontrolled office with normal ambulatory blood pressure) is frequent (30-40% of patients with apparently resistant hypertension) carrying a prognosis similar to that of controlled hypertension, and intensification of blood pressure lowering treatment, or the use of nondrug treatment strategies such as renal denervation or carotid baroreceptor stimulation, is not justified; (3) masked resistant hypertension (controlled office with elevated ambulatory blood pressure) is frequent (approximately one-third of patients with controlled office blood pressure on triple antihypertensive therapy) and associated with an increased risk of cardiovascular events; in such patients, treatment intensification should be considered; (4) the current definition of resistant hypertension (office blood pressure ⩾ 140/90 mm Hg on triple antihypertensive therapy) allows a substantial proportion of patients with spurious or white-coat resistant hypertension to undergo renal denervation in the absence of proven long-term benefits.

  11. Organisational culture and change: implementing person-centred care.

    Science.gov (United States)

    Carlström, Eric D; Ekman, Inger

    2012-01-01

    The purpose of this paper is to explore the connection between organisational cultures and the employee's resistance to change at five hospital wards in Western Sweden. Staff had experienced extensive change during a research project implementing person-centred care (PCC) for patients with chronic heart failure. Surveys were sent out to 170 nurses. The survey included two instruments--the Organisational Values Questionnaire (OVQ) and the Resistance to Change Scale (RTC). The results indicate that a culture with a dominating focus on social competence decreases "routine seeking behaviour", i.e. tendencies to uphold stable routines and a reluctance to give up old habits. The results indicate that a culture of flexibility, cohesion and trust negatively covariate with the overall need for a stable and well-defined framework. An instrument that pinpoints the conditions of a particular healthcare setting can improve the results of a change project. Managers can use instruments such as the ones used in this study to investigate and plan for change processes. Earlier studies of organisational culture and its impact on the performance of healthcare organisations have often investigated culture at the highest level of the organisation. In this study, the culture of the production units--i.e. the health workers in different hospital wards--was described. Hospital wards develop their own culture and the cultures of different wards are mirrored in the hospital.

  12. The ideal Atomic Centre; Le Centre Atomique ideal

    Energy Technology Data Exchange (ETDEWEB)

    Mas, R [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

    1965-07-01

    The author presents considerations which should prove to be of interest to all those who have to design, to construct and to operate a nuclear research centre. A large number of the ideas presented can also be applied to non-nuclear scientific research centres. In his report the author reviews: various problems with which the constructor is faced: ground-plan, infrastructure, buildings and the large units of scientific equipment in the centre, and those problems facing the director: maintenance, production, supplies, security. The author stresses the relationship which ought to exist between the research workers and the management. With this aim in view he proposes the creation of National School for Administration in Research which would train administrative executives for public or private organisations; they would be specialised in the fields of fundamental or applied research. (author) [French] L'auteur propose une base de reflexions a tous ceux qui doivent concevoir, realiser et faire vivre un Centre d'Etudes Nucleaires. Un grand nombre des idees exprimees peut d'ailleurs s'appliquer a un Centre d'Etudes Scientifiques non nucleaires. Dans son ouvrage, l'auteur passe en revue les differents problemes qui se posent au constructeur: plan, masse, infrastructure, batiments et grands appareils du Centre, et ceux qu'a a resoudre le directeur: entretien, fabrication, approvisionnements, securite. L'auteur insiste sur l'aspect des rapports qui doivent exister entre les chercheurs et ceux qui les administrent. Il propose a cette fin la creation d'une Ecole Nationale d'Administration de la Recherche qui formerait des cadres administratifs pour les organismes publics ou prives, specialises dans la Recherche fondamentale ou appliquee. (auteur)

  13. A designated centre for people with disabilities operated by Nua Healthcare Services, Limerick

    LENUS (Irish Health Repository)

    Colleran, Gabrielle C

    2009-01-01

    BACKGROUND: Anterior triangle masses pose an important clinical dilemma. It is very difficult to distinguish the potential pathologies pre operatively by clinical and radiological assessment. CASE REPORT: The first case highlights the management of a bilateral chemodectoma, the second case is a presentation of castleman\\'s disease and the third is that of metastatic tonsillar adenocarcinoma. All three cases had a similar presentation and radiological appearance pre-operatively. CONCLUSION: Anterior triangle masses span the clinical spectrum of pathologies from chemodectoma to castleman\\'s disease to carcinoma. Expert vascular and radiological management is required for optimum patient care and should take place in a tertiary referral centre. Duplex US, CTA and MRA are important pre operative assessment tools to ensure that adequate information regarding the relationship of the lesion to the carotid artery is available to the operating surgeon who should have vascular expertise as deliberate practice volume has been repeatedly shown to result in improved patient outcome.

  14. Ethics in human resource management: potential for burnout among healthcare workers in ART and community care centres.

    Science.gov (United States)

    Mala, Ramanathan; Santhosh, Kumar M; Anshul, Avijit; Aarthy, R

    2010-01-01

    This paper examines ethical dilemmas in providing care for people with HIV/AIDS. Healthcare providers in this sector are overworked, particularly in the high prevalence states. They are faced with the dual burden of the physical and the emotional risks of providing this care. The emotional risks result from their inability to control their work environment, while having to deal with the social and cultural dimensions of patients' experiences. The physical risk is addressed to some extent by post exposure prophylaxis. But the emotional risk is largely left to the individual and there is little by way of institutional responsibility for minimising this. The guidelines for training workers in care and support programmes do not include any detailed institutional mechanisms for reducing workplace stress. This aspect of the programme needs to be examined for its ethical justification. The omission of institutional mechanisms to reduce the emotional risks experienced by healthcare providers in the HIV/AIDS sector could be a function of lack of coordination across different stakeholders in programme development. This can be addressed in further formulations of the programme. Whatever the reasons may be for overlooking these needs, the ethics of this choice need to be carefully reviewed.

  15. Healthcare

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…

  16. Interactive multimodal ambulatory monitoring to investigate the association between physical activity and affect

    Directory of Open Access Journals (Sweden)

    Ulrich W. Ebner-Priemer

    2013-01-01

    Full Text Available Although there is a wealth of evidence that physical activity has positive effects on psychological health, a large proportion of people are inactive. Data regarding counts, steps, and movement patterns are limited in their ability to explain why people remain inactive. We propose that multimodal ambulatory monitoring, which combines the assessment of physical activity with the assessment of psychological variables, helps to elucidate real world physical activity. Whereas physical activity can be monitored continuously, psychological variables can only be assessed at discrete intervals, such as every hour. Moreover, the assessment of psychological variables must be linked to the activity of interest. For example, if an inactive and overweight person is physically active once a week, psychological variables should be assessed during this episode. Linking the assessment of psychological variables to episodes of an activity of interest can be achieved with interactive monitoring. The primary aim of our interactive multimodal ambulatory monitoring approach was to intentionally increase the number of e-diary assessments during active episodes.We developed and tested an interactive monitoring algorithm that continuously monitors physical activity in everyday life. When predefined thresholds are surpassed, the algorithm triggers a signal for participants to answer questions in their electronic diary.Using data from 70 participants wearing an accelerative device for 24 hours each, we found that our algorithm quadrupled the frequency of e-diary assessments during the activity episodes of interest compared to random sampling. Multimodal interactive ambulatory monitoring appears to be a promising approach to enhancing our understanding of real world physical activity and movement.

  17. How to improve healthcare? Identify, nurture and embed individuals and teams with "deep smarts".

    Science.gov (United States)

    Eljiz, Kathy; Greenfield, David; Molineux, John; Sloan, Terry

    2018-03-19

    Purpose Unlocking and transferring skills and capabilities in individuals to the teams they work within, and across, is the key to positive organisational development and improved patient care. Using the "deep smarts" model, the purpose of this paper is to examine these issues. Design/methodology/approach The "deep smarts" model is described, reviewed and proposed as a way of transferring knowledge and capabilities within healthcare organisations. Findings Effective healthcare delivery is achieved through, and continues to require, integrative care involving numerous, dispersed service providers. In the space of overlapping organisational boundaries, there is a need for "deep smarts" people who act as "boundary spanners". These are critical integrative, networking roles employing clinical, organisational and people skills across multiple settings. Research limitations/implications Studies evaluating the barriers and enablers to the application of the deep smarts model and 13 knowledge development strategies proposed are required. Such future research will empirically and contemporary ground our understanding of organisational development in modern complex healthcare settings. Practical implications An organisation with "deep smarts" people - in managerial, auxiliary and clinical positions - has a greater capacity for integration and achieving improved patient-centred care. Originality/value In total, 13 developmental strategies, to transfer individual capabilities into organisational capability, are proposed. These strategies are applicable to different contexts and challenges faced by individuals and teams in complex healthcare organisations.

  18. [The determination of arterial pressure by the physician or the nurse: its relation to ambulatory pressure and left ventricular mass. The MAPA-Madrid Group. Monitorización Ambulatoria de la Presión Arterial (Ambulatory Monitoring of Arterial Pressure)].

    Science.gov (United States)

    Martínez, M A; Aguirre, A; Sánchez, M; Nevado, A; Laguna, I; Torre, A; Manuel, E; Villar, C; García-Puig, J

    1999-12-11

    In the present study we evaluated the influence of the observer's status--physician or nurse--on blood pressure levels and the relationship among clinic blood pressure measurement with ambulatory blood pressure and left ventricle mass. Cross sectional study performed in seven primary care centers. Participating physicians and nurses were trained for blood pressure measurement prior to the study and subsequently retrained at 3 month intervals during the study. Patients included in the study were 122 subjects with mild to moderate hypertension who underwent the following study protocol: a) measurement of clinic blood pressure by physician and nurse, in an independent fashion, on 3 visits; b) clinic-epidemiologic questionnaire; c) conventional hematological and biochemical study; d) electrocardiogram; e) 24-hour ambulatory blood pressure monitoring, f) M-mode and Doppler echocardiography (only in 58 subjects). Nurse-measured blood pressure levels were higher than those determined by physicians (mean differences: 3.9 [6.7] mmHg in systolic blood pressure and 2.6 [5.4] mmHg in diastolic blood pressure). The blood pressure level differences between the two observers were higher in female patients and subjects with low educational level, independently of the observer's gender. Nurse-measured blood pressure was more closely related to ambulatory blood pressure and left ventricle mass than physician-measured blood pressure. Nurse-measured blood pressure levels are lower than those determined by physicians and more closely related to ambulatory blood pressure and left ventricle mass than physician-measured blood pressure. These data support that nurses, instead of doctors, should routinely measure blood pressure in primary care centers.

  19. A systematic review of risk factors associated with accidental falls, outcome measures and interventions to manage fall risk in non-ambulatory adults.

    Science.gov (United States)

    Rice, Laura A; Ousley, Cherita; Sosnoff, Jacob J

    2015-01-01

    To systematically review peer-reviewed literature pertaining to risk factors, outcome measures and interventions managing fall risk in non-ambulatory adults. Twenty-one papers were selected for inclusion from databases including PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Scopus, Consumer Health Complete and Web of Science. Selected studies involved a description of fall related risk factors, outcomes to assess fall risk and intervention studies describing protocols to manage fall risk in non-ambulatory adults. Studies were selected by two reviewers and consultation provided by a third reviewer. The most frequently cited risk factors/characteristics associated with falls included: wheelchair related characteristics, transfer activities, impaired seated balance and environmental factors. The majority of the outcomes were found to evaluate seated postural control. One intervention study was identified describing a protocol targeting specific problems of individual participants. A global fall prevention program was not identified. Several risk factors associated with falls were identified and must be understood by clinicians to better serve their clients. To improve objective assessment, a comprehensive outcome assessment specific to non-ambulatory adults is needed. Finally, additional research is needed to examine the impact of structured protocols to manage fall risk in non-ambulatory adults. Falls are a common health concern for non-ambulatory adults. Risk factors commonly associated with falls include wheelchair related characteristics, transfer activities, impaired seated balance and environmental factors. Limited outcome measures are available to assess fall risk in non-ambulatory adults. Clinicians must be aware of the known risk factors and provide comprehensive education to their clients on the potential for falls. Additional research is needed to develop and evaluate protocols to clinically manage fall

  20. Improving Healthcare through Lean Management: Experiences from the Danish healthcare system

    DEFF Research Database (Denmark)

    Edwards, Kasper; Nielsen, Anders Paarup

    still is in its infancy and it is just a matter of letting sufficient time pass in order have a successful implementation of lean in all areas of healthcare. The second hypothesis states that a major barrier to lean management in healthcare simply is lacking understanding of the lean concepts leading......The ideas and principles from lean management are now widely being adopted within the healthcare sector. The analysis in this paper shows that organizations within healthcare most often only implement a limited set of tools and methods from the lean tool-box. Departing from a theoretical analysis...... of the well-known and universal lean management principles in the context of the healthcare this paper will attempt to formulate and test four hypotheses about possible barriers to the successful implementation of lean management in healthcare. The first hypothesis states that lean management in healthcare...