Sample records for asia medical center

  1. Satellite medical centers project (United States)

    Aggarwal, Arvind


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

  2. Asia's First Bat Research Center Established in Beijing

    Institute of Scientific and Technical Information of China (English)


    @@ In cooperation with a local government, the CAS Institute of Zoology (IOZ) has established Asia's first bat research and protection center in Fangshan, a southwest suburb of Beijing. Its opening ceremony was held on November 16, 2004.

  3. Compulsory drug detention centers in East and Southeast Asia. (United States)

    Kamarulzaman, Adeeba; McBrayer, John L


    Over the last three decades in response to a rise in substance use in the region, many countries in East and Southeast Asia responded by establishing laws and policies that allowed for compulsory detention in the name of treatment for people who use drugs. These centers have recently come under international scrutiny with a call for their closure in a Joint Statement from United Nations entities in March 2012. The UN's response was a result of concern for human rights violations, including the lack of consent for treatment and due process protections for compulsory detention, the lack of general healthcare and evidence based drug dependency treatment and in some centers, of forced labor and physical and sexual abuse (United Nations, 2012). A few countries have responded to this call with evidence of an evolving response for community-based voluntary treatment; however progress is likely going to be hampered by existing laws and policies, the lack of skilled human resource and infrastructure to rapidly establish evidence based community treatment centers in place of these detention centers, pervasive stigmatization of people who use drugs and the ongoing tensions between the abstinence-based model of treatment as compared to harm reduction approaches in many of these affected countries.

  4. Malpractice Issues in the Academic Medical Center. (United States)

    Rich, Ben A.


    A discussion of legal issues in the academic medical center focuses on standards of care applicable to practitioners, special problems of patient care delivery, and the special status of public academic medical centers. Informed consent to care, relations with affiliated institutions, and private/non-private patient status are also considered.…

  5. Skylab Medical Data Center and Archives (United States)

    Spross, F. R.


    The founding of the Skylab medical data center and archives as a central area to house medical data from space flights is described. Skylab program strip charts, various daily reports and summaries, experiment reports and logs, status report on Skylab data quality, raw data digital tapes, processed data microfilm, and other Skylab documents are housed in the data center. In addition, this memorandum describes how the data center acted as a central point for the coordination of preflight and postflight baseline data and how it served as coordinator for all data processing through computation and analysis. Also described is a catalog identifying Skylab medical experiments and all related data currently archived in the data center.

  6. Asia-Pacific Center for Security Studies Annual Report 2010 (United States)


    police, government crisis agency, and civil society, as well as from the U.S. Embassy. Keynote speakers included Dr. Orlando Mercado , former e...Virginia Watson was quoted in an article by Juan Mercado entitled “Morning-after Sisyphus,” Philippine Inquirer (May 11, 2010) Appeared on “Asia in...Alumni as well as to the general public. e Library section and Faculty Publications continue to be popular with our Fellows and academics from other

  7. Marketing the academic medical center group practice. (United States)

    Eudes, J A; Divis, K L


    From a marketing perspective, there are many differences between private and academic medical center (AMC) group practices. Given the growing competition between the two, write John Eudes and Kathy Divis, it is important for the AMC group practice to understand and use these differences to develop a competitive market advantage.

  8. The Biomedical Engineer in the Medical Center (United States)

    Furst, Emanuel


    Discusses the roles of engineers in medical centers, including technical support, instrument control and safety for the hospital, and teaching and research tasks. Indicates that engineering education should take responsibilities to prepare them to understand the human relations and organizational characteristics of their environment through course…

  9. Relevance of the Flexner Report to contemporary medical education in South Asia. (United States)

    Amin, Zubair; Burdick, William P; Supe, Avinash; Singh, Tejinder


    A century after the publication of Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching (the Flexner Report), the quality of medical education in much of Asia is threatened by weak regulation, inadequate public funding, and explosive growth of private medical schools. Competition for students' fees and an ineffectual accreditation process have resulted in questionable admission practices, stagnant curricula, antiquated learning methods, and dubious assessment practices. The authors' purpose is to explore the relevance of Flexner's observations, as detailed in his report, to contemporary medical education in South Asia, to analyze the consequences of growth, and to recommend pragmatic changes. Major drivers for growth are the supply-demand mismatch for medical school positions, weak governmental regulation, private sector participation, and corruption. The consequences are urban-centric growth, shortage of qualified faculty, commercialization of postgraduate education, untenable assessment practices, emphasis on rote learning, and inadequate clinical exposure. Recommendations include strengthening accreditation standards and processes possibly by introducing regional or national student assessment, developing defensible student assessment systems, recognizing health profession education as a field of scholarship, and creating a tiered approach to faculty development in education. The relevance of Flexner's recommendations to the current status of medical education in South Asia is striking, in terms of both the progressive nature of his thinking in 1910 and the need to improve medical education in Asia today. In a highly connected world, the improvement of Asian medical education will have a global impact.

  10. Asia-Pacific Center for Security Studies Annual Report 2008 (United States)


    reducing system interdiction risks, and educa- tional technology upgrades permeate all learning spaces within the Center, as well as at the condominium ...analy- ses – in some cases reducing cycle- times from days to minutes. EKMS will be comprised of a suite of modern software applications that will

  11. Jackson Park Hospital Green Building Medical Center

    Energy Technology Data Exchange (ETDEWEB)

    William Dorsey; Nelson Vasquez


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

  12. Assistance Focus: Asia/Pacific Region; Clean Energy Solutions Center (CESC)

    Energy Technology Data Exchange (ETDEWEB)



    The Clean Energy Solutions Center Ask an Expert service connects governments seeking policy information and advice with one of more than 30 global policy experts who can provide reliable and unbiased quick-response advice and information. The service is available at no cost to government agency representatives from any country and the technical institutes assisting them. This publication presents summaries of assistance provided to governments in the Asia/Pacific region, including the benefits of that assistance.

  13. 75 FR 22438 - Proposed Information Collection (Health Resource Center Medical Center Payment Form) Activity... (United States)


    ... AFFAIRS Proposed Information Collection (Health Resource Center Medical Center Payment Form) Activity... information technology. Title: Health Resource Center Medical Center Payment Form, VA Form 10-0505. OMB... proposed collection of certain information by the agency. Under the Paperwork Reduction Act (PRA) of...

  14. Medical diplomacy and global mental health: from community and national institutions to regional centers of excellence. (United States)

    Aggarwal, Neil Krishan; Kohrt, Brandon A


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

  15. [Medical controlling as medical economical service center. Successful concept for orthopedics and trauma surgery centers?]. (United States)

    Auhuber, T C; Hoffmann, R


    The management of patients from administrative admission through the orthopedic-surgical treatment to completion of the billing is complex. Additional challenges originate from the necessity to treat patients in both outpatient and inpatient departments and in more than one medical sector. A superior coordination is essential for a successful cooperation of the various procedures of controlling. The model of a medical controlling department as a service center with effective competence in the management of service and cost, functions as a successful solution to the problem. Central elements of a successful medical economical case management are a well-defined assignment of tasks and definitions of intersections, the integration of health professionals and administrative employees, the utilization of software for process control and the implementation of inlier controlling.

  16. Deaths in an academic medical center. (United States)

    Lagman, Ruth L; Walsh, Declan; Kunkle, Chad; LeGrand, Susan B; Davis, Mellar P


    The number of inpatient deaths in a calendar year in an academic medical center was reviewed from a computerized database. The total number was 1222. The median length of hospital stay for those who died was 7 days (range, 1-190); 404 (33%) were 75 years or older. There were 678 (55%) males and 544 (45%) females. The pulmonary medicine service had the most deaths with 290 (24%) followed by hematology/oncology 230 (18%). The most common primary diagnoses in the decedents were subendocardial infarction 58 (5%), congestive heart failure 57 (5%), and pneumonia 45 (4%). The most common diagnostic-related groups (DRGs) were respiratory system disorders (475), 98 (8%); tracheostomy (483), 75 (6%); and heart surgery (110), 65 (5%). Frequent procedures done prior to death were mechanical ventilation (96 hours) 55 (5%), and tracheostomy 54 (4%). Invasive procedures were common. Forty-five percent of the predeath patient days were spent in intensive care units. Palliative medicine was involved in the care of 20% of all the decedents.

  17. New England Medical Center Posterior Circulation registry. (United States)

    Caplan, Louis R; Wityk, Robert J; Glass, Thomas A; Tapia, Jorge; Pazdera, Ladislav; Chang, Hui-Meng; Teal, Phillip; Dashe, John F; Chaves, Claudia J; Breen, Joan C; Vemmos, Kostas; Amarenco, Pierre; Tettenborn, Barbara; Leary, Megan; Estol, Conrad; Dewitt, L Dana; Pessin, Michael S


    Among 407 New England Medical Center Posterior Circulation registry patients, 59% had strokes without transient ischemic attacks (TIAs), 24% had TIAs then strokes, and 16% had only TIAs. Embolism was the commonest stroke mechanism (40% of patients including 24% cardiac origin, 14% intraarterial, 2% cardiac and arterial sources). In 32% large artery occlusive lesions caused hemodynamic brain ischemia. Infarcts most often included the distal posterior circulation territory (rostral brainstem, superior cerebellum and occipital and temporal lobes); the proximal (medulla and posterior inferior cerebellum) and middle (pons and anterior inferior cerebellum) territories were equally involved. Severe occlusive lesions (>50% stenosis) involved more than one large artery in 148 patients; 134 had one artery site involved unilaterally or bilaterally. The commonest occlusive sites were: extracranial vertebral artery (52 patients, 15 bilateral) intracranial vertebral artery (40 patients, 12 bilateral), basilar artery (46 patients). Intraarterial embolism was the commonest mechanism of brain infarction in patients with vertebral artery occlusive disease. Thirty-day mortality was 3.6%. Embolic mechanism, distal territory location, and basilar artery occlusive disease carried the poorest prognosis. The best outcome was in patients who had multiple arterial occlusive sites; they had position-sensitive TIAs during months to years.

  18. Clinical career ladders: Hamot Medical Center. (United States)

    Meyer, J D; Chrymko, M M; Kelly, W N


    The clinical career ladder program for pharmacists at Hamot Medical Center (HMC), a 500-bed not-for-profit community teaching hospital, is described. Between 1980 and 1989 a career ladder at HMC evolved from an idea to an established program with parallel administrative, business, and clinical tracks. The development of the career ladder mirrored the growth of clinical programs and the diversification of pharmaceutical services. A formal plan for a clinical ladder was developed when the first satellite pharmacy opened in 1984. An entry-level pharmacist at HMC starts with a six-month period during which he or she learns the drug distribution system and prepares for several certification tests. The employee is then promoted to staff pharmacist. Staff pharmacists are promoted to clinical pharmacist II (CP II) upon meeting requirements for competence in a broad range of clinical skills and knowledge. Candidates for the position of clinical pharmacist specialist (CP I) must have either a minimum of three years of experience as a CP II or a Pharm.D. degree and have established an area of clinical expertise. A CP I can progress to assistant and associate director positions as vacancies occur. The clinical ladder has enhanced job satisfaction and encouraged the development of clinical practitioners who provide improved care. Problems have included time constraints, competition for positions, and management of incentives. A parallel career ladder program with a clinical track has enhanced the growth of pharmacy practice at HMC and improved the quality of pharmaceutical care.

  19. Challenges and solutions in medically managed ACS in the Asia-Pacific region: expert recommendations from the Asia-Pacific ACS Medical Management Working Group. (United States)

    Huo, Yong; Thompson, Peter; Buddhari, Wacin; Ge, Junbo; Harding, Scott; Ramanathan, Letchuman; Reyes, Eugenio; Santoso, Anwar; Tam, Li-Wah; Vijayaraghavan, Govindan; Yeh, Hung-I


    Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.

  20. [Medical centers--methods, purpose and benefits]. (United States)

    Schrappe, Matthias


    The German hospital sector is characterized by a profound deficit in organizational integration. The implementation of centers as one way to improve the situation is complicated by the heterogeneity of the concept and understanding of the term "center". The author proposes to distinguish between functional, divisional and process-oriented centers. In German hospitals where the transition from functional to divisional organization is under way matrix elements can be expected to be introduced into organizational practice. Process-oriented centers like breast centers represent matrix components by simultaneously applying functional and process-oriented perspectives. Matrix components map the complexity of clinical structures, but increase coordination and management load and should be applied only to a limited number of care processes.

  1. Lessons learned: mobile device encryption in the academic medical center. (United States)

    Kusche, Kristopher P


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


    Davidson, Ehud; Sheiner, Eyal


    Soroka University Medical Center is a tertiary hospital, and the sole medical center in the Negev, the southern part of Israel. Soroka has invested in quality, service and research. The region has developed joint programs in order to advance the quality of medical care whilst optimizing the utilization of available resources. In this editorial we describe the path to leadership in quality of medical care, service and research.

  3. Defining the medical imaging requirements for a rural health center

    CERN Document Server


    This book establishes the criteria for the type of medical imaging services that should be made available to rural health centers, providing professional rural hospital managers with information that makes their work more effective and efficient. It also offers valuable insights into government, non-governmental and religious organizations involved in the planning, establishment and operation of medical facilities in rural areas. Rural health centers are established to prevent patients from being forced to travel to distant urban medical facilities. To manage patients properly, rural health centers should be part of regional and more complete systems of medical health care installations in the country on the basis of a referral and counter-referral program, and thus, they should have the infrastructure needed to transport patients to urban hospitals when they need more complex health care. The coordination of all the activities is only possible if rural health centers are led by strong and dedicated managers....

  4. Medical Informatics in Academic Health Science Centers. (United States)

    Frisse, Mark E.


    An analysis of the state of medical informatics, the application of computer and information technology to biomedicine, looks at trends and concerns, including integration of traditionally distinct enterprises (clinical information systems, financial information, scholarly support activities, infrastructures); informatics career choice and…

  5. A Medical Center Network for Optimized Lung Cancer Biospecimen Banking (United States)


    1 Award Number: W81XWH-10-1-0818 TITLE: A Medical Center Network for Optimized Lung Cancer Biospecimen Banking PRINCIPAL...Biospecimen Resource Network: A medical center network for optimized lung cancer biospecimen banking 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-10-1-0818... audit sampling the source forms of 15 randomly selected patients from each Resource Site. The purpose of the audit was make certain required clinical

  6. DOE Center of Excellence in Medical Laser Applications. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Jacques, S.L. (Oregon Medical Laser Center, Portland, OR (United States))


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

  7. Jackson Park Hospital Green Building Medical Center

    Energy Technology Data Exchange (ETDEWEB)

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


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

  8. [Pediatric emergencies in the Grenoble Medical Center]. (United States)

    Lebrun, E; Bost, M


    In the Grenoble Medical Centre, pediatric emergency admissions have been drastically influenced by the opening of an Emergency Unit in May 1983. Our work was carried out one year after the opening in order to study the characteristics of the admitted children. The enquiry was done over 4 months, one month for each season of that year. A total of 1,382 children were included in the study. Thirty-four percent were seen for a medical advice (66% hospitalized). Children seen for medical advice are younger and mostly migrants. They live close to the hospital and are brought most often for fever. Fifty one per cent directly brought to the hospital by their parents for a first pediatric advice (49% were sent by their personal physician). Children directly brought by their parents are in majority infants and migrants. They are mostly admitted at night and morning and during the week-end. They are more frequently followed within the public mother-child health protection system ("Service de Protection Maternelle et Infantile", PMI).

  9. Connecticut Children's Medical Center multi-year branding campaign. (United States)

    Botvin, J


    As the only children's hospital in the state, Connecticut Children's Medical Center was challenged by the inherent complacency of parents. It met the challenge through a multi-level marketing effort which included television and radio, community outreach and strong media relations. By emphasizing the unique nature of children, the campaign affirms the need for a specialized children's health center.

  10. Mike O’Callaghan Federal Medical Center Campus Environmental Assessment (United States)


    Center Campus Final EA Departments to the basement, outpatient clinics and medical center diagnostics to the first floor, surgical services to the...Center Campus Final EA 3.8.1 Vegetation The Integrated Natural Resource Management Plan (INRMP) describes the desert scrub creosote bush/white bursage...domestic geese and ducks. The areas with the most diverse wildlife are those containing native desert scrub vegetation, mostly located in clear

  11. Mental health issues amongst medical students in Asia: a systematic review [2000–2015 (United States)

    Sayampanathan, Andrew Arjun; Ho, Roger Chun-Man


    Background Studies have shown that the stress experienced by medical students is far greater than that experienced by other university students. In this study, we aim to understand the consequent mental health issues that are experienced by medical students, particularly in Asia, via a systematic review of the current literature. Methods Initial searches on MEDLINE, Embase and SpringerLink came up with a total of 1,033 unique articles. Studies not focusing on medical students alone, not mentioning mental health issues or not containing prevalence values were excluded. Results We included 14 articles in our analysis. ADs had a prevalence of 7.04% (100/1,420). Depression was prevalent in 11.0% (1,115/10,147) of students. A total of 12.9% (54/420) and 12.9% (41/319) of male and female medical students respectively were screened for depression. Preclinical students were also 1.63 times more likely to be depressed compared to clinical students, with 98.0% (48/49) pre-clinical students having screened for depression, compared to 60% (27/45) clinical students. Home staying medical students are 1.33 times more likely to be depressed compared to hostel-stayers, with 12.1% (29/239) of home stayers being depressed compared to 9.2% (37/402) of hostel stayers. Conclusions We found that mental health issues affect a significant proportion of medical students and they are more prevalent in certain subpopulations of medical students. Our data revealed that preclinical and home staying students can be more susceptible to depression. More research should be done regarding this issue. With such information, it is hoped that appropriate interventions can be designed to improve the mental health of medical students. PMID:27004219

  12. The impact of managed care on graduate medical education and academic medical centers. (United States)

    Bolognia, J L; Wintroub, B U


    The goal of this article is to examine the present and future impact of managed care on graduate medical education (GME) and academic medical centers. Obviously, the later 2 entities are closely intertwined and will share in the consequences of changes in our medical care systems. However, there are differences in the funding of medical schools as compared with GME provided by teaching hospitals, and an appreciation of the vital issues and concerns requires that each be discussed separately.

  13. [Promoting research in a medical center--the management narrative]. (United States)

    Halevy, Jonathan; Turner, Dan


    Promoting research within a medical institute is a delicate balance between the importance of facilitating academia and maximizing resources towards the primary goal of a hospital--healing sick people. Shaare Zedek Medical Center have successfully adopted a "niche" approach to research in which the hospital invests in selected talented clinicians-scientists rather than futile expectation that all clinicians would be engaged in high impact research. Moreover, these research excellence centers are developing into a driving force to also foster research endeavors of other clinicians and residents in the hospital. In this special issue of Harefuah honoring Shaare Zedek investigators, 18 manuscripts included reflect the diversity of research projects performed in the medical center. We believe that this project will assist and encourage clinicians to be engaged in research, at all levels and disciplines.

  14. Consumerism: forcing medical practices toward patient-centered care. (United States)

    Ozmon, Jeff


    Consumerism has been apart of many industries over the years; now consumerism may change the way many medical practices deliver healthcare. With the advent of consumer-driven healthcare, employers are shifting the decision-making power to their employees. Benefits strategies like health savings accounts and high-deductible insurance plans now allow the patients to control how and where they spend their money on medical care. Practices that seek to attract the more affluent and informed consumers are beginning to institute patient-centered systems designs that invite patients to actively participate in their healthcare. This article will outline the changes in the healthcare delivery system facing medical practices, the importance of patient-centered care, and six strategies to implement to change toward more patient-centered care.

  15. The Six Sigma initiative at Mount Sinai Medical Center. (United States)

    Chassin, Robert


    Lean Six Sigma, in various forms, has been used widely in many Fortune 500 companies. Motorola, General Electric, Sony, American Express, and Bechtel all use Six Sigma to improve quality and performance. While the impact of this methodology has been documented extensively by the press in manufacturing and transactional settings, less evidence is available regarding its utility in health care environments. Mount Sinai Medical Center initiated a Six Sigma program in 2000 to determine its applicability and value in a large academic medical center. This article discusses Mount Sinai Medical Center's experience adapting this methodology to improve both patient care and business processes and outcomes. We present an overview of Six Sigma, and offer examples of projects undertaken using this data-driven approach to performance improvement. Lastly, the article provides insights and lessons learned regarding this organization-wide experience.

  16. 75 FR 39622 - Proposed Information Collection (Health Resource Center Medical Center Payment Form) Activity... (United States)


    ... AFFAIRS Proposed Information Collection (Health Resource Center Medical Center Payment Form) Activity... collection of information abstracted below to the Office of Management and Budget (OMB) for review and comment. The PRA submission describes the nature of the information collection and its expected cost...

  17. Developing a user-centered voluntary medical incident reporting system. (United States)

    Hua, Lei; Gong, Yang


    Medical errors are one of leading causes of death among adults in the United States. According to the Institute of Medicine, reporting of medical incidents could be a cornerstone to learn from errors and to improve patient safety, if incident data are collected in a properly structured format which is useful for the detection of patterns, discovery of underlying factors, and generation of solutions. Globally, a number of medical incident reporting systems were deployed for collecting observable incident data in care delivery organizations (CDO) over the past several years. However, few researches delved into design of user-centered reporting system for improving completeness and accuracy of medical incident collection, let alone design models created for other institutes to follow. In this paper, we introduce the problems identified in a current using voluntary reporting system and our effort is being made towards complete, accurate and useful user-centered new reporting system through a usability engineering process.

  18. Crisis prevention centers as confidence building measures: Suggestions for Northeast Asia

    Energy Technology Data Exchange (ETDEWEB)

    Pregenzer, A.L.


    Relationships between countries generally exist somewhere in the grey area between war and peace. Crisis prevention activities are particularly important and should have two goals: stabilizing tense situations that could push countries toward war, and supporting or reinforcing efforts to move countries toward peace. A Crisis Prevention Center (CPC) should facilitate efforts to achieve these goals. Its functions can be grouped into three broad, inter-related categories: establishing and facilitating communication among participating countries; supporting negotiations and consensus-building on regional security issues; and supporting implementation of agreed confidence and security building measures. Technology will play a critical role in a CPC. First, technology is required to establishing communication systems and to provide the means for organizing and analyzing this information. Second, technically-based cooperative monitoring can provide an objective source of information on mutually agreed issues. In addition, technology can be a neutral subject of interaction and collaboration between technical communities from different countries. Establishing a CPC in Northeast Asia does not require the existence of an Asian security regime. Potential first steps for such a CPC should include establishing communication channels and a dedicated communications center in each country, together with an agreement to use the system as a {open_quotes}Hot Line{close_quotes} in bilateral and multilateral emergency situations. A central CPC could also be established as a regional communications hub. The central CPC could coordinate a number of functions aimed at stabilizing regional tensions and supporting confidence building activities, perhaps initially in an unofficial capacity. Specific recommendations for confidence building measures are discussed.

  19. Delinquent Medical Service Accounts at Naval Medical Center Portsmouth Need Additional Management Oversight (United States)


    H 4 , 2 0 1 5 Delinquent Medical Service Accounts at Naval Medical Center Portsmouth Need Additional Management Oversight Report No. DODIG-2015...04 MAR 2015 2. REPORT TYPE 3. DATES COVERED 00-00-2015 to 00-00-2015 4. TITLE AND SUBTITLE Delinquent Medical Service Accounts at Naval...of Defense that supports the warfighter; promotes accountability , integrity, and efficiency; advises the Secretary of Defense and Congress; and

  20. Early experiences with big data at an academic medical center. (United States)

    Halamka, John D


    Beth Israel Deaconess Medical Center (BIDMC), an academic health care institution affiliated with Harvard University, has been an early adopter of electronic applications since the 1970s. Various departments of the medical center and the physician practice groups affiliated with it have implemented electronic health records, filmless imaging, and networked medical devices to such an extent that data storage at BIDMC now amounts to three petabytes and continues to grow at a rate of 25 percent a year. Initially, the greatest technical challenge was the cost and complexity of data storage. However, today the major focus is on transforming raw data into information, knowledge, and wisdom. This article discusses the data growth, increasing importance of analytics, and changing user requirements that have shaped the management of big data at BIDMC.

  1. Pioneers in trauma care at Harborview Medical Center. (United States)

    Whalen, Eileen; Hecker, Cynthia J; Butler, Steven


    Harborview Medical Center in Seattle has been home to the pioneering work of University of Washington (UW) Medicine physicians and staff who have led innovations to improve trauma care for more than 40 years. As the only level I adult and pediatric trauma center and regional burn center for Washington, Alaska, Montana, and Idaho, Harborview provides cares for more than 6500 critically injured trauma and burn patients per year. Our physicians, researchers and staff are recognized as national experts and as collaborative partners with nursing in the delivery of outstanding clinical care, research, and education. Beginning with the establishment of Seattle Medic One in the late 1960s, a groundbreaking program to train firefighters as paramedics, Harborview and the work of UW Medicine has been recognized locally and globally as a leader in every component of the ideal trauma system, as defined by the American College of Surgeons: prevention, access, acute hospital care, rehabilitation, education, and research activities.

  2. Learning of medical pharmacology via innovation:a personal experience at McMaster and in Asia

    Institute of Scientific and Technical Information of China (English)

    Chiu-yin KWAN


    Pharmacology in the traditional medical curriculum has been treated as a discrete "preclinical" discipline identifying itself distinctly different from the other preclinical sciences or clinical subjects in knowledge base as well as learning/teaching instructions. It is usually run in series with other pre-clinical courses (eg, anatomy, biochemistry,physiology etc), but in parallel with other paraclinical courses such as pathology, microbiology and community medicine. Clinical pharmacology was only introduced relatively recently designed to overcome the perceived deficiency in "preclinical" pharmacology regarding its therapeutic relevance and application to medicine. In many universities, both preclinical and clinical pharmacology courses co-exist, usually independently offered by two separate, sometimes non-interacting Departments of Pharmacology and Clinical Pharmacology. In this model,pharmacology is generally taught in a teacher-centered, discipline-oriented, and knowledge-based curriculum.Furthermore, pharmacology courses are commonly taught by "expert" teachers, who usually engage in excessiveteaching, often adopt a knowledge-based approach in both instruction and assessment, and frequently evade or ignore clinical relevance. The clinical relevance of the pharmacological sciences is sometimes also taught in a didactic and problem-solving manner, although it is usually case-oriented. In recent years, problem-based medical curricula have emerged, in varying forms, as a platform in which pharmacology is viewed as an integrated component in a holistic approach to medical education. In this problem-based learning (PBL) model, pharmacology is learned in a student-centered environment, based on self-directed, clinically relevant and case-oriented approach,usually in a small-group tutorial format. In PBL, pharmacology is learned in concert with other subject issues relevant to the case-problem in question, such as anatomy, physiology, pathology, microbiology

  3. An Architecture for Continuous Data Quality Monitoring in Medical Centers. (United States)

    Endler, Gregor; Schwab, Peter K; Wahl, Andreas M; Tenschert, Johannes; Lenz, Richard


    In the medical domain, data quality is very important. Since requirements and data change frequently, continuous and sustainable monitoring and improvement of data quality is necessary. Working together with managers of medical centers, we developed an architecture for a data quality monitoring system. The architecture enables domain experts to adapt the system during runtime to match their specifications using a built-in rule system. It also allows arbitrarily complex analyses to be integrated into the monitoring cycle. We evaluate our architecture by matching its components to the well-known data quality methodology TDQM.

  4. Task centered visualization of Electronic Medical Record flow sheet. (United States)

    Xie, Zhong; Gregg, Peggy; Zhang, Jiajie


    Usability problem of Electronic Medical Record (EMR) systems is a major hurdle for their acceptance. In this study we used the methodology of Human-Centered Distributed Information Design (HCDID) to compare and evaluate Flow Sheet module of two commercial EMR systems. After which we tried to develop usable interface of a flow sheet using visualization, focusing on task-representation mapping during design and development.

  5. Energy use baselining study for the National Naval Medical Center

    Energy Technology Data Exchange (ETDEWEB)

    Parker, G.B.; Halverson, M.A.


    This report provides an energy consumption profile for fourteen buildings at the National Naval Medical Center (NNMC) in Bethesda, Maryland. Recommendations are also made for viable energy efficiency projects funded with assistance from the servicing utility (Potomic Electric Power Company) in the form of rebates and incentives available in their Demand Side Management (DSM) program and through Shared Energy Savings (SES) projects. This report also provides estimates of costs and potential energy savings of the recommended projects.

  6. Succession planning in an academic medical center nursing service. (United States)

    Barginere, Cynthia; Franco, Samantha; Wallace, Lynne


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

  7. Project of international science-education center and integration problems of nano science education in far eastern region of Asia

    Energy Technology Data Exchange (ETDEWEB)

    Plusnin, N I; Lazarev, G I [Vladivostok State University of Economics and Service, 41 Gogolya Str., Vladivostok (Russian Federation)], E-mail:


    Some conception of international science-education center on nano science in Vladivostok is presented. The conception is based on internal and external prerequisites. Internal one is high intellectual potential of institutes of Russian Academy of Sciences and universities of Vladivostok and external one is need of countries of Far Eastern region of Asia in high level manpower. The conception takes into account a specific distribution of science and education potential between Russian Academy of Sciences and Russian universities and a specific their dislocation in Vladivostok. First specific dictates some similarity of organization structure and function of international science-education center to typical science-education center in Russia. But as for dislocation of the international science-education center in Vladivostok, it should be near dislocation of institutes of Far Eastern Brunch of Russian Academy of Sciences in Vladivostok, which are dislocated very compactly in suburb zone of Vladivostok.

  8. Decline of clinical research in academic medical centers. (United States)

    Meador, Kimford J


    Marked changes in US medical school funding began in the 1960s with progressively increasing revenues from clinical services. The growth of clinical revenues slowed in the mid-1990s, creating a funding crisis for US academic health care centers, who responded by having their faculty increase their clinical duties at the expense of research activities. Surveys document the resultant stresses on the academic clinician researcher. The NIH provides greater funding for basic and translational research than for clinical research, and the new Patient-Centered Outcomes Research Institute is inadequately funded to address the scope of needed clinical research. An increasing portion of clinical research is funded by industry, which leaves many important clinical issues unaddressed. There is an inadequate supply of skilled clinical researchers and a lack of external support for clinical research. The impact on the academic environment in university medical centers is especially severe on young faculty, who have a shrinking potential to achieve successful academic careers. National health care research funding policies should encourage the right balance of life-science investigations. Medical universities need to improve and highlight education on clinical research for students, residents, fellows, and young faculty. Medical universities also need to provide appropriate incentives for clinical research. Without training to ensure an adequate supply of skilled clinical researchers and a method to adequately fund clinical research, discoveries from basic and translational research cannot be clinically tested and affect patient care. Thus, many clinical problems will continue to be evaluated and treated with inadequate or even absent evidence-based knowledge.

  9. Evaluating community engagement in an academic medical center. (United States)

    Szilagyi, Peter G; Shone, Laura P; Dozier, Ann M; Newton, Gail L; Green, Theresa; Bennett, Nancy M


    From the perspective of academic medical centers (AMCs), community engagement is a collaborative process of working toward mutually defined goals to improve the community's health, and involves partnerships between AMCs, individuals, and entities representing the surrounding community. AMCs increasingly recognize the importance of community engagement, and recent programs such as Prevention Research Centers and Clinical and Translational Science Awards have highlighted community engagement activities. However, there is no standard or accepted metric for evaluating AMCs' performance and impact of community engagement activities.In this article, the authors present a framework for evaluating AMCs' community engagement activities. The framework includes broad goals and specific activities within each goal, wherein goals and activities are evaluated using a health services research framework consisting of structure, process, and outcome criteria. To illustrate how to use this community engagement evaluation framework, the authors present specific community engagement goals and activities of the University of Rochester Medical Center to (1) improve the health of the community served by the AMC; (2) increase the AMC's capacity for community engagement; and (3) increase generalizable knowledge and practices in community engagement and public health.Using a structure-process-outcomes framework, a multidisciplinary team should regularly evaluate an AMC's community engagement program with the purpose of measurably improving the performance of the AMC and the health of its surrounding community.

  10. 78 FR 74163 - Harrison Medical Center, a Subsidiary of Franciscan Health System Bremerton, Washington; Notice... (United States)


    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF LABOR Employment and Training Administration Harrison Medical Center, a Subsidiary of Franciscan Health System... Adjustment Assistance (TAA), applicable to workers and former workers of Harrison Medical Center,...

  11. An Integrated Model of Care: A Visit to The SPARK Center, a Program of Boston Medical Center (United States)

    Griest, Christa


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

  12. Case study: a data warehouse for an academic medical center. (United States)

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


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

  13. Photodynamic research at Baylor University Medical Center Dallas, Texas (United States)

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


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

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

    Directory of Open Access Journals (Sweden)

    Ortiz G


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

  15. Promoting Data Reuse and Collaboration at an Academic Medical Center

    Directory of Open Access Journals (Sweden)

    Kevin Read


    Full Text Available A need was identified by the Department of Population Health (DPH for an academic medical center to facilitate research using large, externally funded datasets. Barriers identified included difficulty in accessing and working with the datasets, and a lack of knowledge about institutional licenses. A need to facilitate sharing and reuse of datasets generated by researchers at the institution (internal datasets was also recognized. The library partnered with a researcher in the DPH to create a catalog of external datasets, which provided detailed metadata and access instructions. The catalog listed researchers at the medical center and the main campus with expertise in using these external datasets in order to facilitate research and cross-campus collaboration. Data description standards were reviewed to create a set of metadata to facilitate access to both externally generated datasets, as well as the internally generated datasets that would constitute the next phase of development of the catalog. Interviews with a range of investigators at the institution identified DPH researchers as most interested in data sharing, therefore targeted outreach to this group was undertaken. Initial outreach resulted in additional external datasets being described, new local experts volunteering, proposals for additional functionality, and interest from researchers in inclusion of their internal datasets in the catalog. Despite limited outreach, the catalog has had ~250 unique page views in the three months since it went live. The establishment of the catalog also led to partnerships with the medical center’s data management core and the main university library. The Data Catalog in its present state serves a direct user need from the Department of Population Health to describe large, externally funded datasets. The library will use this initial strong community of users to expand the catalog and include internally generated research datasets. Future expansion

  16. Publications in academic medical centers: technology-facilitated culture clash. (United States)

    Berner, Eta S


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

  17. Spectrum of tablet computer use by medical students and residents at an academic medical center

    Directory of Open Access Journals (Sweden)

    Robert Robinson


    Full Text Available Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians.Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM in July and August of 2012.Results. There were 76 medical student responses (26% response rate and 66 resident/fellow responses to this survey (21% response rate. Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035. The most common reported uses were for accessing medical reference applications (46%, e-Books (45%, and board study (32%. Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010, review radiology images (27% vs. 12%, p = 0.019, and enter patient care orders (26% vs. 3%, p < 0.001.Discussion. This study shows a high prevalence and frequency of tablet computer use among physicians in training at this academic medical center. Most residents and students use tablet computers to access medical references, e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks.Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on

  18. An academic medical center's response to widespread computer failure. (United States)

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


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

  19. Lessons Learned from Implementing the Patient-Centered Medical Home

    Directory of Open Access Journals (Sweden)

    Ellen P. Green


    Full Text Available The Patient-Centered Medical Home (PCMH is a primary care model that provides coordinated and comprehensive care to patients to improve health outcomes. This paper addresses practical issues that arise when transitioning a traditional primary care practice into a PCMH recognized by the National Committee for Quality Assurance (NCQA. Individual organizations' experiences with this transition were gathered at a PCMH workshop in Alexandria, Virginia in June 2010. An analysis of their experiences has been used along with a literature review to reveal common challenges that must be addressed in ways that are responsive to the practice and patients’ needs. These are: NCQA guidance, promoting provider buy-in, leveraging electronic medical records, changing office culture, and realigning workspace in the practice to accommodate services needed to carry out the intent of PCMH. The NCQA provides a set of standards for implementing the PCMH model, but these standards lack many specifics that will be relied on in location situations. While many researchers and providers have made critiques, we see this vagueness as allowing for greater flexibility in how a practice implements PCMH.

  20. Centers of excellence: a medical measurement or marketing myth? (United States)

    Meyer, L C


    Managed care organizations, physician groups and hospital systems are all increasingly pressured to identify new modes of treatment that produce verifiable outcomes while reducing the revolving door pattern of health care for the chronically ill. Providers are also faced with creating systems of care to differentiate themselves from the competition in the marketplace. Disease-specific health management programs are being used to address both issues. When used properly, they can be promising tools in the battle to maintain health care quality while containing costs. Skillful balancing of these two important factors can ensure maximum value for both patients and payers. Are centers of excellence the critical pathway of the future? Or are they merely a marketing ploy to generate incremental growth and profitability for savvy business executives and medical group management entrepreneurs? This article provides an overview of the center of excellence concept, addresses its misuse in the industry and discusses the strategic and marketing implications for organizations considering this approach as a tool to demonstrate full accountability and meritorious outcomes.

  1. Development and implementation of a comprehensive strategic plan for medical education at an academic medical center. (United States)

    Schwartzstein, Richard M; Huang, Grace C; Coughlin, Christine M


    Despite their vital contributions to the training of future physicians, many academic teaching hospitals have grown operationally and financially distinct from affiliated medical schools because of divergent missions, contributing to the erosion of clinical training. Some institutions have responded by building hybrid organizations; others by creating large health care networks with variable relationships with the affiliated medical school. In this case, the authors wished to establish the future educational mission of their medical center as a core element of the institution by creating data-driven recommendations for reorganization, programs, and financing. They conducted a self-study of all constituents, the results of which confirmed the importance of education at their institution but also revealed the insufficiency of incentives for teaching. They underwent an external review by a committee of prominent educators, and they involved administrators at the hospital and the medical school. Together, these inputs composed an informed assessment of medical education at their teaching hospital, from which they developed and actualized an institution-wide strategic plan for education. Over the course of three years, they centralized the administrative structure for education, implemented programs that cross departments and reinforce the UME-GME continuum, and created transparency in the financing of medical education. The plan was purposefully aligned with the clinical and research strategic plans by supporting patient safety in programs and the professional development of faculty. The application of a rigorous strategic planning process to medical education at an academic teaching hospital can focus the mission, invigorate faculty, and lead to innovative programs.

  2. 78 FR 16679 - Center for Drug Evaluation and Research Medical Policy Council; Request for Comments (United States)


    ... HUMAN SERVICES Food and Drug Administration Center for Drug Evaluation and Research Medical Policy... interested organizations, on medical policy issues that may be considered by the CDER Medical Policy Council (Council) in FDA's Center for Drug Evaluation and Research (CDER). These comments will help the...

  3. Cooperative Monitoring Center Occasional Paper/12: ENTNEA: A Concept for Enhancing Nuclear Transparency for Confidence Building in Northeast Asia

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Man-Kwon; Shin, Sung-Tack


    Nuclear energy continues to be a strong and growing component of economic development in Northeast Asia. A broad range of nuclear energy systems already exists across the region and vigorous growth is projected. Associated with these capabilities and plans are various concerns about operational safety, environmental protection, and accumulation of spent fuel and other nuclear materials. We consider cooperative measures that might address these concerns. The confidence building measures suggested here center on the sharing of information to lessen concerns about nuclear activities or to solve technical problems. These activities are encompassed by an Enhanced Nuclear Transparency in Northeast Asia (ENTNEA) concept that would be composed of near-term, information-sharing activities and an eventual regional institution. The near-term activities would address specific concerns and build a tradition of cooperation; examples include radiation measurements for public safety and emergency response, demonstration of safe operations at facilities and in transportation, and material security in the back end of the fuel cycle. Linkages to existing efforts and organizations would be sought to maximize the benefits of cooperation. In the longer term, the new cooperative tradition might evolve into an ENTNEA institution. In institutional form, ENTNEA could combine the near-term activities and new cooperative activities, which might require an institutional basis, for the mutual benefit and security of regional parties.

  4. Design strategy and implementation of the medical diagnostic image support system at two large military medical centers (United States)

    Smith, Donald V.; Smith, Stan M.; Sauls, F.; Cawthon, Michael A.; Telepak, Robert J.


    The Medical Diagnostic Imaging Support (MDIS) system contract for federal medical treatment facilities was awarded to Loral/Siemens in the Fall of 1991. This contract places ''filmless'' imaging in a variety of situations from small clients to large medical centers. The MDIS system approach is a ''turn-key'', performance based specification driven by clinical requirements.

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

    Directory of Open Access Journals (Sweden)

    Shah M


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

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

    Directory of Open Access Journals (Sweden)

    Chih-Sheng Chen


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

  7. Patient-centered medical home cyberinfrastructure current and future landscape. (United States)

    Finkelstein, Joseph; Barr, Michael S; Kothari, Pranav P; Nace, David K; Quinn, Matthew


    The patient-centered medical home (PCMH) is an approach that evolved from the understanding that a well-organized, proactive clinical team working in a tandem with well-informed patients is better able to address the preventive and disease management needs in a guideline-concordant manner. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality at the Informatics for Consumer Health Summit. The goal of this article is to summarize the panel discussions along the four major domains presented at the summit: (1) PCMH as an Evolving Model of Healthcare Delivery; (2) Health Information Technology (HIT) Applications to Support the PCMH; (3) Current HIT Landscape of PCMH: Challenges and Opportunities; and (4) Future HIT Landscape of PCMH: Federal Initiatives on Health Informatics, Legislation, and Standardization.

  8. Cooperative Mmonitoring Center Occasional Paper/5: Propspects of Conventional Arms Control in South Asia

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, Amit; Kamal, Nazir


    The intensely adversarial relationship between India and Pakistan is marked by military rivalry, mutual distrust, and suspicion. The most dividing disagreement has been over the Kashmir region. An inability to discuss the Kashmir issue has prevented discussion on other important issues. Since there is little prospect of detente, at least in the near-term, the question is whether this rivalry can be contained by other means, such as arms control approaches. Conventional arms control has been applied flexibly and successfully in some regions to reduce threat-perceptions and achieve reassuring military stability. Some lessons from other international models might be applied to the India/Pakistan context. This paper discusses the status of conventional arms control in South Asia, the dominant Indian and Pakistani perceptions about arms control, the benefits that could be derived from arms control, as well as the problems and prospects of arms control. It also discusses existing conventional arms control agreements at the regional and global levels as well as the potential role of cooperative monitoring technology.

  9. Walking the Tightrope: Directing a Student Health Center at a Research Institution with an Academic Medical Center (United States)

    Christmas, William A.


    Reporting lines for directors of student health centers (SHCs) at colleges and universities are a matter of continuing interest for those of us who must follow them. SHC directors at institutions with academic medical centers face a greater number of reporting choices that also have the potential of being more politically charged. The author…

  10. Creating multi-modal logistics centers: Prospect for development in Central Asia

    Directory of Open Access Journals (Sweden)

    Nodir Jumaniyazov


    Full Text Available All we have witnessed several summits of the so-called G-20 to overcome the crisis and attempt to delineate the ”look” of new rules of the emerging new world economic system. However, according to many experts, these rules will not be able to radically change the current system of economic relations, which is based on the processes of globalization and economic interpenetration of the world. One can list the many elements of the system. Among them, as a manifestation of a growing specialization of production, and deepening of cooperative relations in the world the special role is played by multi-modal logistics centers (MLC, of both regional and global concern. If stock and commodity exchanges are the link in the global economy, meanwhile a multimodal logistics centers serve as their practical and technical support.

  11. Accountable care organization readiness and academic medical centers. (United States)

    Berkowitz, Scott A; Pahira, Jennifer J


    As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices.

  12. 78 FR 10610 - TRICARE; Demonstration Project for Participation in Maryland Multi-Payer Patient Centered Medical... (United States)


    ... Department of Defense (DoD) Enhanced Access to Patient Centered Medical Home (PCMH): Participation in Maryland Multi-payer Patient Centered Medical Home Program (MMPCMHP). DATES: The demonstration program will... strengthen the provider-patient relationship by replacing episodic care with coordinated care and a...

  13. Crozer-Chester Medical Center Burn Research Project (United States)


    dermatotoxidt:y following treatment for diabetic nephropathy . Although other members of the dihydropyridine c.’llcium channel blockers have been reported to... Treatment Center has been under contract with the U.S. Army Institute for Surgical Research in conjunction with the Army Burn Center since 2007 to...research in civilian populations to combat populations. The Nathan Speare Regional Burn Treatment Center was under contract with the U. S. Army

  14. A Service-Oriented Healthcare Message Alerting Architecture in an Asia Medical Center: A Case Study

    Directory of Open Access Journals (Sweden)

    Jin-Shin Lai


    Full Text Available This paper illustrates how our development team has used some information technologies to let physicians obtain an instant abnormal laboratory result report for critical patient care services. We have implementeda healthcare message alerting system (HMAS on a healthcare short message service (HSMS engine and the distributed healthcare-oriented service environment (DiHOSE in the National Taiwan University Hospital (NTUH. The HSMS engine has a general interface for all applications which could easily send any kind of alerting messages. Fundamentally, the DiHOSE uses HL7 standard formats to process the information exchange behaviors and can be flexibly extended for reasonable user requirements. The disease surveillance subsystem is an integral part of NTUH new hospital information system which is based on DiHOSE and the disease surveillance subsystem would send alerting messages through the HSMS engine. The latest cell phone message alerting subsystem, a case study, in NTUH proved that the DiHOSE could integrate the user required functions without much work. We concluded that both HSMS and DiHOSE can generalize and extend application demands efficiently.

  15. Roles of Medical Record and Statistic Staff on Research at the Tawanchai Center. (United States)

    Pattaranit, Rumpan; Chantachum, Vasana; Lekboonyasin, Orathai; Pradubwong, Suteera


    The medical record and statistic staffs play a crucial role behind the achievements of treatment and research of physicians, nurses and other health care professionals. The medical record and statistic staff are in charge of keeping patient medical records; creating databases; presenting information; sorting patient's information; providing patient medical records and related information for various medical teams and researchers; Besides, the medical record and statistic staff have collaboration with the Center of Cleft Lip-Palate, Khon Kaen University in association with the Tawanchai Project. The Tawanchai Center is an organization, involving multidisciplinary team which aims to continuing provide care for patients with cleft lip and palate and craniofacial deformities who need a long term of treatment since newborns until the age of 19 years. With support and encouragement from the Tawanchai team, the medical record and statistic staff have involved in research under the Tawanchai Centre since then and produced a number of publications locally and internationally.

  16. Primitive robotic procedures: Automotions for medical liquids in 12th century Asia minor

    Directory of Open Access Journals (Sweden)

    Necmettin Penbegul


    Full Text Available In recent years, day by day, robotic surgery applications have increase their role in our medical life. In this article, we reported the discovery of the first primitive robotic applications as automatic machines for the sensitive calculation of liquids such as blood in the literature. Al-Jazari who wrote the book “Elcâmi ‘Beyne’l - ‘ilm ve’l - ‘amel en-nâfi ‘fi es-sınaâ ‘ti’l - hiyel”, lived in Anatolian territory between 1136 and 1206. In this book that was written in the twelfth century, Al-Jazari described nearly fifty graphics of robotic machines and six of them that were designed for medical purposes. We found that some of the robots mentioned in this book are related to medical applications. This book reviews approximately 50 devices, including water clocks, candle clocks, ewers, various automata used for amusement in drink assemblies, automata used for ablution, blood collection tanks, fountains, music devices, devices for water lifting, locks, a protractor, a boat-shaped water clock, and the gate of Diyarbakir City in south-east of Turkey, actually in northern Mesopotamia. We found that automata used for ablution and blood collection tanks were related with medical applications; therefore, we will describe these robots.

  17. Primitive robotic procedures: automotions for medical liquids in 12th century Asia minor. (United States)

    Penbegul, Necmettin; Atar, Murat; Kendirci, Muammer; Bozkurt, Yasar; Hatipoglu, Namık Kemal; Verit, Ayhan; Kadıoglu, Ates


    In recent years, day by day, robotic surgery applications have increase their role in our medical life. In this article, we reported the discovery of the first primitive robotic applications as automatic machines for the sensitive calculation of liquids such as blood in the literature. Al-Jazari who wrote the book "Elcâmi 'Beyne'l - 'ilm ve'l - 'amel en-nâfi 'fi es-sınaâ 'ti'l - hiyel", lived in Anatolian territory between 1136 and 1206. In this book that was written in the twelfth century, Al-Jazari described nearly fifty graphics of robotic machines and six of them that were designed for medical purposes. We found that some of the robots mentioned in this book are related to medical applications. This book reviews approximately 50 devices, including water clocks, candle clocks, ewers, various automata used for amusement in drink assemblies, automata used for ablution, blood collection tanks, fountains, music devices, devices for water lifting, locks, a protractor, a boat-shaped water clock, and the gate of Diyarbakir City in south-east of Turkey, actually in northern Mesopotamia. We found that automata used for ablution and blood collection tanks were related with medical applications; therefore, we will describe these robots.

  18. Aprepitant and Fosaprepitant Use in Children and Adolescents at an Academic Medical Center



    OBJECTIVE: To describe the use of aprepitant and fosaprepitant, a neurokinin 1 (NK-1) receptor inhibitor, in children and adolescents at a large academic medical center, for the prevention and management of chemotherapy-induced nausea and vomiting (CINV).

  19. Master's Level Graduate Training in Medical Physics at the University of Colorado Health Sciences Center. (United States)

    Ibbott, Geoffrey S.; Hendee, William R.


    Describes the master's degree program in medical physics developed at the University of Colorado Health Sciences Center. Required courses for the program, and requirements for admission are included in the appendices. (HM)

  20. National Imperative to Establish a Domestic Medical Intelligence Center (United States)


    Quality Reports Human and Veterinarian Health Surveillance Indicators Coordination with other TEW Cells Exploring Medical and Public Health...and territorial governments, animal shelters, the American Society for the Prevention of Cruelty to Animals, veterinarians , and other sources...General medicine/family practice 63 • Hematology • Infectious disease • Internal medicine • Nephrology • Nuclear medicine o In-vivo

  1. Development of a Patient-Centered Antipsychotic Medication Adherence Intervention (United States)

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


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

  2. Implications of Surgical Training on Operating Room Throughput at Wilford Hall Medical Center (United States)


    its physician specialists, 85 percent of dental specialists, and a full spectrum of other training. The medical center’s fourth mission is clinical...dedicated to training dental officers of the three services in one facility. The medical center’s support of San Antonio’s emergency medicine structure...P. (2006). Resident teaching versus the operating room schedule: An independent observer- based study of 1558 cases. Anesthesia and Analgesia , 103

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

    Directory of Open Access Journals (Sweden)

    Karim Zarour


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

  4. Utilization of a Marketing Strategy at Naval Regional Medical Center Great Lakes, Great Lakes, Illinois (United States)


    UTILIZATION OF A MARKETING STRATEGY AToNAVAL REGIONAL MEDICAL CENTER GREAT LAKES NGREAT LAKES, ILLINOIS I DTIC S1 ELECTE I A Graduate Research...IWORK UNIT ELEMENT NO. NO. NO. rCCESSION NO. 11. TITLE (bw* u S.wufty asification) Utilization of A Marketing Strategy At Naval Regional Medical Center...Applied Research Question. ........ 37 Summary of the Steps of a Marketing Strategy .. ..... 38 Applicability to the Military Health Care System

  5. Patient Workload Profile: National Naval Medical Center (NNMC), Bethesda, MD. (United States)


    Special Chemistry) * Microbiology (including Bacteriology, Mycology , Serology, and Virology) * Hematology 0 Blood Bank (including Blood Donor, poultry , meats, milk, bread, canned goods, etc.); labor, overhead, and expendable non-food items are excluded. The current food budget is

  6. A Policy Analysis for the Implementation of the Generic Inventory Package in a Medical Center Engineering Supply Warehouse (United States)


    194,600 veterans in a primary service area that includes 49 counties in Utah, Idaho, Nevada , and Wyoming. The VASLCHCS provides medical, surgical...20 Med Center Profile - Northport ------------ 23 Med Center Profile - John J. Pershing ----- 27 Med Center Profile - Muskogee ------------- 29 Med...John J. Pershing VA Medical Center in Popular Bluff, Missouri, and the Muskogee VA Medical Center in Muskogee, Oklahoma. The Veteran’s Affairs

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

    Energy Technology Data Exchange (ETDEWEB)

    Jacques, S.L.


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

  8. Bone marrow transplantation at the University of Nebraska Medical Center. (United States)

    Bierman, P J; Armitage, J O


    The bone marrow transplant program at UNMC is currently one of the most active programs in the country. The benefits to patients who are cured of disease by transplantation cannot be measured. The large volume of clinical and basic science research related to transplantation has enhanced the academic stature of UNMC. The combination of patient care, education, clinical research, and basic science research provides an excellent model for the operation of an academic medical institution.

  9. Complicated eclampsia: fifteen years' experience in a referral medical center. (United States)

    Lopez-Llera, M


    The statistical study of a large number of eclamptic patients (n = 704), divided into five successive 3-year periods, was undertaken at the Hospital de Gineco-Obstetricia No. 2 del Centro Médico Nacional in Mexico City in orders to detect significant changes in therapeutic results and/or in the basic character of the disease, as it occurs in a large referral medical complex. The following variables were studied: maternal and perinatal deaths, obstetric profile, main clinical data of the eclamptic episode, frequency of cesarean operation, timing of delivery after admission, main therapeutic changes, frequency of complications in survivors of ante- and intrapartum eclampsia, and cause of death with associated complications. The study showed (1) a continuous increment in the number of cases from the first to the last period, (2) averages for maternal age (24.9 +/- 0.45 years) and for previous parity (1.7 +/- 0.19) unlike those commonly accepted, (3) a significant progression in the severity of the disease in recent years, (4) a frequency of 22.9% of important complications in survivors of ante- and intrapartum eclampsia, and (5) a very limited overall influence of some therapeutic changes on the final outcome of complicated eclampsia, and (6) the impossibility of improving morbidity figures significantly during the 15 years of the study. It was concluded that prevention, early diagnosis, and timely simple medical care offer the only perspective for true medical progress in this particular problem.


    Borisova, E A; Savvina, N V; Lutskan, I P; Timofeev, L F


    The article considers issue of implementation of employment agreement by way of effective contract exemplified by the Yakutsk medical center of the Republic Sakha (Yakutia). The new job descriptions, criteria of effectiveness, ratings of implementation of functions of medical job position were developed. At that, mechanisms of registration and implementation of social guarantees in respect of health workers were proposed.

  11. Pharmacy Automation in Navy Medicine: A Study of Naval Medical Center San Diego (United States)


    medication, dispensing errors, Navy Medicine, Bureau of Medicine and Surgery , BUMED, Naval Medical Center San Diego, NMCSD 15. NUMBER OF PAGES pharmacist verification. ...............................................................7  Figure 3.  Robotic Delivery System Installed at Naval...processes tend to happen when there is a complication . Only the eight processes outline in Chapter III are specifically relevant to this study

  12. Prevalence of hyponatremia in acute medical admissions in tropical Asia Pacific Australia

    Institute of Scientific and Technical Information of China (English)

    Usman H Malabu; David Porter; Venkat N Vangaveti; Monsur Kazi; R Lee Kennedy


    Objective: To determine prevalence of hyponatremia in acute medical admissions in Northern Australasia. Methods: We studied 469 consecutive acute medical admissions to a hospital in Australia’s Far North Queensland during the colder months of June and July 2012. Prevalence of hyponatremia and its relationship with gender, age, diagnosis and prognosis in acute medical admissions were investigated. Results: On admission, hyponatremia (plasma sodium <136 mmol/L) was present in 39.4% of patients, with mild (130-135 mmol/L), moderate (126-129 mmol/L) and severe (<126 mmol/L) hyponatremia being present in 25.2%, 10.7% and 3.6% respectively. Overall, adding together admission hyponatremia with that developing during admission, 45.2% of patients were affected with 11.5% moderate hyponatremia cases and 4.1% severe ones. Hypokalemia and hyperkalemia were present in 17.0% and 18.1%, respectively. Overall, 275/469 patients (58.6%) presented with an electrolyte abnormality. There were significant correlations of hyponatremia with age but not with gender and in-hospital mortality. Prevalence of hyponatremia was high across all diagnostic categories. Conclusions: The prevalence of hyponatremia appears to be high in the tropical North Australian population, being the highest prevalence reported amongst acute hospital admissions. The previously reported correlations with age and mortality do appear to hold good for this population with a high prevalence of electrolyte disorders. Further prospective analysis on a larger population in the area is needed to confirm our findings.

  13. 76 FR 31340 - Medicare Program; Notification of Closure of St. Vincent's Medical Center (United States)


    ... a process to increase the full time equivalent (FTE) resident caps for other hospitals based upon... application process for hospitals to apply to the Centers for Medicare & Medicaid Services (CMS) to receive St. Vincent's Medical Center's full time equivalent (FTE) resident cap slots. DATES: We will...

  14. The Balanced Scorecard: A Management System for Wilford Hall Medical Center - The Premier Air Force Medical Enterprise (United States)


    The Balanced Scorecard Management System (BSMS) at Wilford Hall Medical Center (WHMC) is a strategic management and measurement system that...prompted the study to a look at the statement of the problem, the author explores the history and use of the balanced scorecard concept in civilian...was an Intranet-based, database automated, Balanced Scorecard Management System.

  15. Factors associated with a patient-centered medical home among children with behavioral health conditions. (United States)

    Knapp, Caprice; Woodworth, Lindsey; Fernandez-Baca, Daniel; Baron-Lee, Jacqueline; Thompson, Lindsay; Hinojosa, Melanie


    At some point in their lives, nearly one-half of all American children will have a behavioral health condition. Many will not receive the care they need from a fragmented health delivery system. The patient-centered medical home is a promising model to improve their care; however, little evidence exists. Our study aim was to examine the association between several behavioral health indicators and having a patient-centered medical home. 91,642 children's parents or guardians completed the 2007 National Survey of Children's Health. An indicator for patient-centered medical home was included in the dataset. Descriptive statistics, bivariate tests, and multivariate regression models were used in the analyses. Children in the sample were mostly Male (52 %), White (78 %), non-Hispanic (87 %), and did not have a special health care need (80 %). 6.2 % of the sample had at least one behavioral health condition. Conditions ranged from ADHD (6 %) to Autism Spectrum Disorder (ASD) (1 %). Frequency of having a patient-centered medical home also varied for children with a behavioral health condition (49 % of children with ADHD and 33 % of children with ASD). Frequency of having a patient-centered medical home decreased with multiple behavioral health conditions. Higher severity of depression, anxiety, and conduct disorder were associated with a decreased likelihood of a patient-centered medical home. Results from our study can be used to target patient-centered medical home interventions toward children with one or more behavioral health conditions and consider that children with depression, anxiety, and conduct disorder are more vulnerable to these disparities.

  16. [Research code at the Academic Medical Center in Amsterdam: useful]. (United States)

    Vermeulen, M


    At the Academic Medical Centre (AMC) of the University of Amsterdam, the Netherlands, it was decided to set up a research code committee. The first thing that was done was to define what were considered the most relevant types of scientific misconduct: falsification, plagiarism and invasion of privacy. The committee decided that prevention is better than cure and therefore developed a guideline for desirable behaviour, i.e. how to act scientifically with care and integrity, instead of a guideline on what not to do. The committee also proposed an ombudsman whose services are available to all participants in research in the AMC, and to whom misconduct can be reported. The research code is a loose-leaf system, since new issues will come to the fore and included issues will need to be changed. This committee has created a code that provides a firm basis for scientific integrity within the AMC.

  17. Spectrum of tablet computer use by medical students and residents at an academic medical center. (United States)

    Robinson, Robert


    Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians. Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM) in July and August of 2012. Results. There were 76 medical student responses (26% response rate) and 66 resident/fellow responses to this survey (21% response rate). Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035). The most common reported uses were for accessing medical reference applications (46%), e-Books (45%), and board study (32%). Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010), review radiology images (27% vs. 12%, p = 0.019), and enter patient care orders (26% vs. 3%, p students use tablet computers to access medical references, e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks. Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on resident physicians. Further study is needed better understand how tablet computers and other mobile devices may assist in medical education and patient care.

  18. Outsourcing your medical practice call center: how to choose a vendor to ensure regulatory compliance. (United States)

    Johnson, Bill


    Medical practices receive hundreds if not thousands of calls every week from patients, payers, pharmacies, and others. Outsourcing call centers can be a smart move to improve efficiency, lower costs, improve customer care, ensure proper payer management, and ensure regulatory compliance. This article discusses how to know when it's time to move to an outsourced call center, the benefits of making the move, how to choose the right call center, and how to make the transition. It also provides tips on how to manage the call center to ensure the objectives are being met.

  19. Teaching East Asia in Middle Schools: Lesson Plans Contributed at the 1998 East Asian Studies Center Summer Workshop. (United States)

    Indiana Univ., Bloomington. East Asian Studies Center.

    This document contains five middle school lesson plans that teach about East Asia, focusing on Japan, China, and Korea. Lessons deal with geography, history, cultural comparisons, and trade relations. Lesson plans include background information, materials needed, extension and enrichment ideas, a lesson script, a rubric, a list of resources, and…

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

    NARCIS (Netherlands)

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


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

  1. Results of an Institutional LGBT Climate Survey at an Academic Medical Center. (United States)

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


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

  2. The Current Practices in Injury Prevention and Safety Helmet Use in an Air Force Medical Center (United States)


    Clinic at Malcom Grow Medical Center, Andrews Air Force Base, Maryland. Preventive counseling Preventing the occurrence of both mental and physical ...of their care. The primary care provider assumes ongoing responsibility for health maintenance and therapy for illness, including consultation with...PA) or a Medical Doctor (M.D.). Doctor of Osteopathy (D.O.), or Registered Nurse (R.N.). Safety helmet For the purpose of this study, the safety

  3. Patient centered primary care is associated with patient hypertension medication adherence. (United States)

    Roumie, Christianne L; Greevy, Robert; Wallston, Kenneth A; Elasy, Tom A; Kaltenbach, Lisa; Kotter, Kristen; Dittus, Robert S; Speroff, Theodore


    There is increasing evidence that patient centered care, including communication skills, is an essential component to chronic illness care. Our aim was to evaluate patient centered primary care as a determinant of medication adherence. We mailed 1,341 veterans with hypertension the Short Form Primary Care Assessment Survey (PCAS) which measures elements of patient centered primary care. We prospectively collected each patient's antihypertensive medication adherence for 6 months. Patients were characterized as adherent if they had medication for >80%. 654 surveys were returned (50.7%); and 499 patients with complete data were analyzed. Antihypertensive adherence increased as scores in patient centered care increased [RR 3.18 (95% CI 1.44, 16.23) bootstrap 5000 resamples] for PCAS score of 4.5 (highest quartile) versus 1.5 (lowest quartile). Future research is needed to determine if improving patient centered care, particularly communication skills, could lead to improvements in health related behaviors such as medication adherence and health outcomes.

  4. A Human-Centered Approach to Medical Informatics for Medical Students, Residents, and Practicing Clinicians. (United States)

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


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

  5. A division of medical communications in an academic medical center's department of medicine. (United States)

    Drazen, Jeffrey M; Shields, Helen M; Loscalzo, Joseph


    Excellent physician communication skills (physician-to-patient and patient-to-physician) have been found to have a positive impact on patient satisfaction and may positively affect patient health behaviors and health outcomes. Such skills are also essential for accurate, succinct, and clear peer-to-peer (physician-to-physician), physician-to-lay-public, and physician-to-media communications. These skills are not innate, however; they must be learned and practiced repeatedly. The Division of Medical Communications (DMC) was created within the Department of Medicine at Brigham and Women's Hospital as an intellectual home for physicians who desire to learn and teach the wide variety of skills needed for effective communication.In this Perspective, the authors provide an overview of the key types of medical communications and share the DMC model as an innovative approach to providing expert guidance to physicians and physicians-in-training as they develop, practice, and refine their communication skills. Current DMC projects and programs include a Volunteer Patient Teaching Corps, which provides feedback to medical students, residents, and faculty on communication skills; a controlled trial of a modified team-based learning method for attending rounds; expert coaching in preparation for presentations of all types (e.g., grand rounds; oral presentations or poster presentations on basic science, clinical, or medical education research); sessions on speaking to the media and running a meeting well; and courses on writing for publication. Objective assessment of the impact of each of these interventions is planned.

  6. The Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight (United States)


    E M B E R 1 8 , 2 0 1 3 The Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More...Department of Defense and Veteran Affairs Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight 5a. CONTRACT NUMBER...Health Care Joint Venture at Tripler Army Medical Center Needs More Management Oversight Objective Our audit objective was to determine whether the

  7. Mathematical modeling for selecting center locations for medical and health supplies reserve in Hainan Province

    Institute of Scientific and Technical Information of China (English)

    Xiao-Hua Hu; Chuan-Zhu Lu; Min Li; Cai-Hong Zhang; Hua Zhang


    Objective:To explore how to choose the center locations to build the medical and health supplies reserve among many island towns.Methods:The center locations were selected from18 towns HainanProvince, it’s maximum service range(distance) was required to reach the minimum, or to minimize.Results:Three scenarios were considered, the center locations included only one town, two towns, three towns.By the use of graph theory andMATLAB programming, a mathematical model was established to obtain the shortest distance and the shortest path between arbitrary two towns.Conclusions:We find out the center sites under certain conditions, and determine the specific service ranges of the center sites.

  8. Delinquent Medical Service Accounts at David Grant Air Force Medical Center Need Additional Management Oversight (United States)


    17 counties. DGMC Uniform Business Office (UBO) uses MSAs to record billing and fee collection for medical and dental services from Uniformed...personnel processed new accounts, the process used by DGMC did not manage or prioritize the aging MSAs or alert clerks of delinquent accounts...have been applied to other valid requirements such as administrative, operating, and equipment costs; readiness training; or trauma consortium

  9. Impact of 5 years of Lean Six Sigma in a university medical center

    NARCIS (Netherlands)

    G.C. Niemeijer; A. Trip; L.J. de Jong; K.W. Wendt; R.J.M.M. Does


    Lean Six Sigma (LSS) is an originally industry-based methodology for cost reduction and quality improvement. In more recent years, LSS was introduced in health care as well. This article describes the experiences of the University Medical Center Groningen, the second largest hospital in the Netherla

  10. Establishment of a Separate Psychology Service at Walter Reed Army Medical Center (United States)


    Sheila Forsythe, Barbara J. Morgan); the Department of Psychology at the National Naval Medical Center, Bethesda, Maryland (CAPT Frank Mullins and...Services w2 1l have to be configured to specific staffs, available resources, and missions. To enhance leadership opportunities and carper rr𔄁-0ssion fe

  11. Program review of the USDA Center for Medical, Agricultural and Veterinary Entomology (United States)

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

  12. Is there a role for academic medical centers in emerging markets? (United States)

    Wiener, Charles M; Thompson, Steven J; Wu, Sandford; Chellappa, Mohan; Hasham, Salim


    Governments in emerging markets face mounting challenges in managing health spending, building capability and capacity, modernizing ageing infrastructure, and investing in skills and resources. One path to overcoming these challenges is to establish new public-private models of health care development and delivery based on United States academic medical centers, whose missions are to advance medical education and clinical delivery. Johns Hopkins Medicine is a participant in the collaboration developing between the Perdana University Hospital and the Perdana University Graduate School of Medicine in Malaysia. These two organizations comprise an academic health science center based on the United States model. The Perdana project provides constructive insights into the opportunities and challenges that governments, universities, and the private sector face when introducing new models of patient care that are integrated with medical education, clinical training, and biomedical research.

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

    Directory of Open Access Journals (Sweden)

    Linda Thomas-Hemak


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

  14. My personal experiences at the BEST Medical Center: A day in the clinic-the afternoon. (United States)

    Cohen, Philip R; Kurzrock, Razelle


    Dr. Ida Lystic is a gastroenterologist who recently began her new faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. After completing her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School), she did her internal medicine residency and fellowship training at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center. Her morning in gastroenterology clinic was highlighted by: (1) being reprimanded by the clinic nurse manager for a patient who not only arrived early, before clinic had opened, but also neglected to schedule the anesthesiologist for his colonoscopy; (2) the continued challenges of LEGEND (also known as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues), the new electronic medical record system after the BEST discarded the SIMPLE (Succinct Input Making Patient's Lives Electronic) system; (3) a nurse's interruption of an office visit-once the egg timer on the examination room door ran out-because she had exceeded the allocated time for the appointment; and (4) her chairman's unanticipated arrival in the clinic to visit with the clinic nurse manager. In addition to seeing her patients, Dr. Lystic's afternoon is occupied by attending a LOST (Laboratory OverSight and Testing) Committee meeting and a visit from a wayfinding and signage specialist to depersonalize the doorpost plaques of the examination rooms. Her day ends with a demeaning email from her chairman regarding the poor results of the most recent patient satisfaction survey and being personally held accountable to develop solutions to improve not only her performance but also that of the clinic. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes mentioned in this essay are based on individual patients and their physicians, clinics in medical centers and their administration

  15. 亚洲地区勃起功能障碍的发病率及治疗%Prevalence and medical management of erectile dysfunction in Asia

    Institute of Scientific and Technical Information of China (English)

    Kwangsung Park; Eu Chang Hwang; Sun-Ouck Kim


    Erectile dysfunction (ED) is an important worldwide health issue that has a significant negative impact on the quality of life and life satisfaction of both the affected individual and his partner. Here we review the prevalence of ED in Asia, associated factors that may influence sexual attitudes and sexual behaviours, and randomized clinical trials (RCTs) of phosphodiesterase-5 (PDE-5) inhibitors to evaluate the clinical efficacy and safety of PDE-5 inhibitors in Asian men. We searched for English-language articles in MEDLINE and PubMed from January 2000 to September 2010. Our results showed that the overall reported prevalence rate of ED in Asia ranged widely, from 2% to 88%. This finding indicates that ED is a common and major health problem in this region. However, sociocultural and economic factors in Asia prevent people from seeking and obtaining appropriate medical care. We found reports on five kinds of PDE-5 inhibitors for the management of ED: sildenafil, vardenafil, tadalafil, udenafil and mirodenafil. The results of RCTs showed that these five PDE-5 inhibitors are more effective than placebo in improving erectile function in Asian men with ED and that these drugs have similar efficacy and safety profiles.

  16. Introduction of a learning management system for medical education at the University Medical Center Hamburg-Eppendorf

    Directory of Open Access Journals (Sweden)

    Handels, Heinz


    Full Text Available Connected with the introduction of a learning management system at the University Medical Center Hamburg-Eppendorf three different learning management systems were evaluated. Based on the purposes and demands of modern medical education the systems WebCT CE 4.0, ILIAS 3.6 and Moodle 1.5.3 were testet and evaluated.This comparison led to an installation of the learning management system Moodle, which is now used by pilot projects and is getting prepared for normal student access in autumn 2006. First experiences under practical conditions are denoted. Finally prospective subjects like the concept of support and further options of use, even in the research domain, are discussed.

  17. Implementing PDA technology in a medical library: experiences in a hospital library and an academic medical center library. (United States)

    Morgen, Evelyn Breck


    Personal digital assistants (PDAs) have grown from being a novelty in the late 1990s to an essential tool for healthcare professionals in the 2000s. This paper describes the experiences of a librarian who implemented PDA technology first in a hospital library, and then at an academic medical center library. It focuses on the role of the library in supporting PDA technology and resources. Included are programmatic issues such as training for library staff and clinicians, and technical issues such as Palm and Windows operating systems. This model could be used in either a hospital or academic health sciences library.

  18. Towards Interactive Medical Content Delivery Between Simulated Body Sensor Networks and Practical Data Center. (United States)

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


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

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

    Directory of Open Access Journals (Sweden)

    Yair Granot

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

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

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    Hala Abdulateef


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

  1. [E-learning in ENT: Usage in University Medical Centers in Germany]. (United States)

    Freiherr von Saß, Peter; Klenzner, Thomas; Scheckenbach, Kathrin; Chaker, Adam


    E-learning is an essential part of innovative medical teaching concepts. The challenging anatomy and physiology in ENT is considered particularly suitable for self-assessed and adaptive e-learning. Usage and data on daily experience with e-learning in German ENT-university hospitals are currently unavailable and the degree of implementation of blended learning including feed-back from medical students are currently not known. We investigated the current need and usage of e-learning in academic ENT medical centers in Germany. We surveyed students and chairs for Otorhinolaryngology electronically and paperbased during the summer semester 2015. Our investigation revealed an overall heterogenous picture on quality and quantity of offered e-learning applications. While the overall amount of e-learning in academic ENT in Germany is rather low, at least half of the ENT-hospitals in medical faculties reported that e-learning had improved their own teaching activities. More collaboration among medical faculties and academic ENT-centers may help to explore new potentials, overcome technical difficulties and help to realize more ambitious projects.

  2. United States academic medical centers: priorities and challenges amid market transformation. (United States)

    Thompson, Irene M; Anason, Barbara


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

  3. Technology complementing military behavioral health efforts at tripler army medical center. (United States)

    Stetz, Melba C; Folen, Raymond A; Yamanuha, Bronson K


    The purpose of this article is to provide a short narrative on the ways that behavioral health professionals and their patients are currently benefitting from the use of technology. Examples stem from applications of technology to patients/research participants at the Tripler Army Medical Center. The paper also discusses how current use of this technology has made it possible to serve individuals in their own cultural environment, providing a cost-effective means of providing mental health services.

  4. Critical limits (alert values) for physician notification: universal or medical center specific limits? (United States)

    Lum, G


    The concept of critical limits (alert values), defined as an imminent life threatening laboratory result requiring immediate physician notification, has been widely adopted as a standard of good laboratory practice. Although virtually all laboratories have tests with critical limits, surveys have shown that there is no universal alert value list. Recently, nine VA medical centers in the New England region, which now constitute one consolidated entity, were surveyed with the objective of summarizing critical limits. Universal (100 percent) critical limit tests for clinical chemistry were: Calcium; mean low/high, 6.5/12.4 mg/dL: Glucose 48/432 mg/dL: Potassium 2.8/6.1 mmol/L: Sodium 121/159 mmol/L. Universal hematology tests included: Hematocrit 22.2/59.7 percent: Platelet count 61K/983K: white blood count 1.9K/29K. Although there was universal agreement that abnormal coagulation tests (PT, PTT) should be included on the hematology critical limit list, there was wide variation in the reporting of coagulation tests (seconds and INR) and patient therapeutic status (anticoagulant or no-anticoagulant). Universal alert values for microbiology were: Positive blood culture: Positive cerebral spinal fluid (CSF) culture: Positive CSF Gram stain. There was no universal agreement regarding critically high (potentially toxic) therapeutic drugs, with two medical centers declining to notify physicians of any abnormally high therapeutic drug level. No other qualitative critical limits for other laboratory sections, such as physician notification of an unexpected malignancy (surgical pathology) were universal. Medical center specific critical limits, designed to meet the clinical needs of each facility, are the norm in the nine medical centers. Laboratories do need periodically to review their critical limit lists with appropriate clinical input to avoid including critical limits for laboratory tests not required for urgent physician notification and patient evaluation and treatment.

  5. Annual Research Progress Report (William Beaumont Army Medical Center) FY 1983 (United States)


    101 Napolitano, P: 92/69 (C) (PR) Pregnancy After Failed Tubal Ligations : A Review of William Beaumont Army Medical Center’s Experience...Failed Tubal Ligation : A Review of WBAMCs Deparbent of Pedi•ics Experience. Armed Forces District Atkinson AW Attention Deficit Meeting of the American...carcinoma, post -venography infarction, etc.; (4) to detect functioning adrenal remnant after adrenalectomy for Cushing’s syndrome ; (5) to aid In

  6. A Study of Civilian Registered Nurse Recruitment at Madigan Army Medical Center, Tacoma, Washington. (United States)


    127 H. A MARKETING MIX FOR CIVILIAN REGISTERED NURSE *RECRUITMENT AT MADIGAN ARMY MEDICAL CENTER ... ... 131 SELECTED BIBLIOGRAPHY...employement should be promoted to this market. RN Recruitment Marketing Mix for Madigan The major finding in the market analysis of civilian RN...should be targeted; all gain their impetus from MAMC nursing management. A sumimary of the marketing mix is tabulated at Appendix H. This brief listing of

  7. Midbrain infarction: associations and aetiologies in the New England Medical Center Posterior Circulation Registry


    Martin, P.; Chang, H.; Wityk, R; CAPLAN, L.


    Most reports of midbrain infarction have described clinicoanatomical correlations rather than associations and aetiologies. Thirty nine patients with midbrain infarction (9.4%) are described out of a series of 415 patients with vertebrobasilar ischaemic lesions in the New England Medical Center Posterior Circulation Registry. Patients were categorised according to the rostral-caudal extent of infarction. The "proximal" vertebrobasilar territory includes the medulla and po...

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

    Directory of Open Access Journals (Sweden)

    Riddle MC


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

  9. Characterizing complexity in socio-technical systems: a case study of a SAMU Medical Regulation Center. (United States)

    Righi, Angela Weber; Wachs, Priscila; Saurin, Tarcísio Abreu


    Complexity theory has been adopted by a number of studies as a benchmark to investigate the performance of socio-technical systems, especially those that are characterized by relevant cognitive work. However, there is little guidance on how to assess, systematically, the extent to which a system is complex. The main objective of this study is to carry out a systematic analysis of a SAMU (Mobile Emergency Medical Service) Medical Regulation Center in Brazil, based on the core characteristics of complex systems presented by previous studies. The assessment was based on direct observations and nine interviews: three of them with regulator of emergencies medical doctor, three with radio operators and three with telephone attendants. The results indicated that, to a great extent, the core characteristics of complexity are magnified) due to basic shortcomings in the design of the work system. Thus, some recommendations are put forward with a view to reducing unnecessary complexity that hinders the performance of the socio-technical system.

  10. Perspective: Malpractice in an academic medical center: a frequently overlooked aspect of professionalism education. (United States)

    Hochberg, Mark S; Seib, Carolyn D; Berman, Russell S; Kalet, Adina L; Zabar, Sondra R; Pachter, H Leon


    Understanding how medical malpractice occurs and is resolved is important to improving patient safety and preserving the viability of a physician's career in academic medicine. Every physician is likely to be sued by a patient, and how the physician responds can change his or her professional life. However, the principles of medical malpractice are rarely taught or addressed during residency training. In fact, many faculty at academic medical centers know little about malpractice.In this article, the authors propose that information about the inciting causes of malpractice claims and their resolution should be incorporated into residency professionalism curricula both to improve patient safety and to decrease physician anxiety about a crucial aspect of medicine that is not well understood. The authors provide information on national trends in malpractice litigation and residents' understanding of malpractice, then share the results of their in-depth review of surgical malpractice claims filed during 2001-2008 against their academic medical center. The authors incorporated those data into an evidence-driven curriculum for residents, which they propose as a model for helping residents better understand the events that lead to malpractice litigation, as well as its process and prevention.

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

    Energy Technology Data Exchange (ETDEWEB)


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

  12. Analysis of 10-Year Training Results of Medical Students Using the Microvascular Research Center Training Program. (United States)

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


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

  13. Creating and sustainable development of specialized centers as a way to improve quality of medical care

    Directory of Open Access Journals (Sweden)

    V. I. Guzeva


    Full Text Available Quality of care is evaluated on the completeness of the survey, the correct diagnosis, treatment efficacy, and its duration. Improving the quality and efficiency of medical care for children with paroxysmal disorders of consciousness is one of topical problems of neurology.Aim. The aim of the work is to justify the relationship between improving the quality of health care and sustainable development in the modern conditions of specialized medical centers on the example of the work on the identification and treatment of children with paroxysmal disorders of consciousness of the Center for diagnosis and treatment of epilepsy, and sleep disorders in children and adolescents at the department neurology, neurosurgery and medical genetics SPbGPMU.Materials and methods. For more accurate diagnosis and treatment at the Center conducted a comprehensive examination, including video-EEG оf 527 children aged 1 month to 18 years. A clinical trial study included medical cases, assessment of neurological and somatic status, the study of seizure types and forms of the disease. Instrumental methods of examination were determined by EEG and MRI studies of the brain.Main results. Comprehensive survey of sick children with monitoring video-EEG revealed that 317 children (60,1% had epileptic paroxysms and 210 children (39,8% – non-epileptic paroxysms. Correction treatment was performed in 284 (89,5% children with epileptic paroxysms and altered the treatment in 190 (90,4% children with epileptic paroxysms.Conclusion. The presented clinical data show the high effectiveness of the Centre in the diagnosis and treatment of children with paroxysmal disorders of consciousness. The accumulated experience in the Center confirms the relevance of the creation of the structure of scientific and educational institutions specialized centers in which patients will be given to high-quality medical care.

  14. Multimedia-based courseware in the Virtual Learning Center at the Hannover Medical School. (United States)

    Matthies, H K; von Jan, U; Porth, A J; Tatagiba, M; Stan, A C; Walter, G F


    The commercial use of the World Wide Web causes an extensive change in information technology. Web browser are becoming the universal front-end for all kinds of client-server applications. The possibilities of telematics offer a base for multimedia applications, for instance telelearning. Learning is not limited by geography and does not cause pressure of time by the user. The development of such multimedia information and communication systems demands cooperative working teams of authors, who are able to master several areas of medical knowledge as well as the presentation of these using different multimedia facilities. A very important part of graphic design in the context of multimedia applications is the creation and interactive use of images (still, moving). The growth and the complexity of medical knowledge as well as the need for continuous, fast, and economically feasible maintenance impose requirements on the media used for medical education and training. Web-based courseware in the Virtual Learning Center at the Hannover Medical School is an innovative education resource for medical students and professionals.

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

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    H Zare Ahmadabadi


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

  16. [Bioethics in medical institutions--new custom or help? The example of clinical ethics consultation at a University Medical Center]. (United States)

    Richter, G


    Although ethics committees are well established in the medical sciences for human clinical trials, animal research and scientific integrity, the development of clinical ethics in German hospitals started much later during the first decade of the twenty-first century. Clinical ethics consultation should be pragmatic and problem-centered and can be defined as an ethically qualified and informed conflict management within a given legal framework to deal with and resolve value-driven, normative problems in the care of patients. Clinical ethics consultations enable shared clinical decision-making of all parties (e.g. clinicians, patients, family and surrogates) involved in a particular patient's care. The clinical ethicist does not act as an ethics expert by making independent recommendations or decisions; therefore, the focus is different from other medical consultants. Ethics consultation was first established by healthcare ethics committees (HEC) or clinical ethics consultation (CEC) groups which were called in to respond to an ethically problematic situation. To avoid ethical dilemmas or crises and to act preventively with regard to ethical issues in individual patients, an ethics liaison service is an additional option to ethics case consultations which take place on a regular basis by scheduled ethics rounds during the normal ward rounds. The presence of the ethicist offers some unique advantages: it allows early recognition of even minor ethical problems and accommodates the dynamics of ethical and clinical goal-setting in the course of patient care. Most importantly, regular and non-authoritative participation of the ethicist in normal ward rounds allows continuous ethical education of the staff within the everyday clinical routine. By facilitating clinical ethical decision-making, the ethicist seeks to empower physicians and medical staff to deal appropriately with ethical problems by themselves. Because of this proactive approach, the ethics liaison service

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

    Directory of Open Access Journals (Sweden)

    F. Shobeiri


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

  18. Dialysis vascular access management by interventional nephrology programs at University Medical Centers in the United States. (United States)

    Vachharajani, Tushar J; Moossavi, Shahriar; Salman, Loay; Wu, Steven; Dwyer, Amy C; Ross, Jamie; Dukkipati, Ramanath; Maya, Ivan D; Yevzlin, Alexander S; Agarwal, Anil; Abreo, Kenneth D; Work, Jack; Asif, Arif


    The development of interventional nephrology has undoubtedly led to an improvement in patient care at many facilities across the United States. However, these services have traditionally been offered by interventional nephrologists in the private practice arena. While interventional nephrology was born in the private practice setting, several academic medical centers across the United States have now developed interventional nephrology programs. University Medical Centers (UMCs) that offer interventional nephrology face challenges, such as smaller dialysis populations, limited financial resources, and real or perceived political "turf" issues." Despite these hurdles, several UMCs have successfully established interventional nephrology as an intricate part of a larger nephrology program. This has largely been accomplished by consolidating available resources and collaborating with other specialties irrespective of the size of the dialysis population. The collaboration with other specialties also offers an opportunity to perform advanced procedures, such as application of excimer laser and endovascular ultrasound. As more UMCs establish interventional nephrology programs, opportunities for developing standardized training centers will improve, resulting in better quality and availability of nephrology-related procedures, and providing an impetus for research activities.


    Directory of Open Access Journals (Sweden)

    I. V. Tolmachyov


    Full Text Available There is the big issue in medical education which is students don’t have enough skills. Often even with theoretical knowledge graduate medical students need to improve their skills by working with patients. Obviously it can be a risk for patients and takes quite long time. This situation could be changed with applying simulation technologies in medical education. Medical education with virtual simulators allows reducing the time of skills development and improving the quality of training. The aims of this work are developing informational model and creating clinical scenarios of emergency states in the Medical Simulation Center.Objectives:– to analyze the process of scenario conducting;– to create clinical scenarios of emergency states (anaphylactic shock, hypovolemic shock, obstructive shock with specialist’s help.The scenarios consist of sections such as main aim, skills, required mannequins, preparation of the mannequins, preparation of medical equipment and instruments for the scenario, preparation of special materials, scenario description, guide for operator, information for trainees.By analyzing the process of scenario conducting the key participants were defined who are operator, assistant, trainer, trainees. Also the main scenario stages were defined. Based on the stages diagram of variants of scenario conducting was designed.As an example there are fragments of scenario “Obstructive shock – a pulmonary embolism” in this article. Learn skills are cognitive, technical, social ones.Results. This paper presents an analysis of the clinical scenario conducting. Information model was developed which based on object-oriented decomposition. The model is the diagram of variants of scenario conducting. Scenario’s structure for emergency states was formulated. The scenarios are anaphylactic shock, hypovolemic shock, obstructive shock (pulmonary embolism, tension pneumothorax, pulmonary edema, hypertensive crisis, respiratory

  20. Putting patients first: a novel patient-centered model for medical enterprise success. (United States)

    Dhawan, Naveen


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

  1. Time course and predictors of use of erectile dysfunction treatment in a Veterans Affairs medical center. (United States)

    Clavijo, R I; Daskivich, T; Kwan, L; Bassett, J; Keller, T; Bennett, C


    The objective of this study was to define the pattern and time course of use of ED treatments in a Veterans Affairs (VA) medical center and to identify clinical or demographic variables that are associated with the use of second- or third-line ED treatments. We identified 702 men treated for ED at the Greater Los Angeles Veterans Affairs between 2007 and 2013. We extracted demographics, Charlson co-morbidity score, pertinent surgical/medication history as well as use of ED treatments from medical records. On multivariate analysis, age over 65 (OR 1.83, 95% CI: 1.31-2.56) and Charlson co-morbidity score of 1 (OR 1.77, 95% CI: 1.13-2.77) and 2+ (OR 2.07, 95% CI: 1.28-3.36) were significantly associated with use of medicated urethral suppositories for erection (MUSE)/intracorporal injections (ICI) compared with PDE5i/erection devices. Across all men who used second- or third-line treatments, median time until receiving MUSE was 0.6 years and median time until receiving ICI/implant was 2 years. We conclude that men who will ultimately use more invasive ED treatments, such as men with more co-morbidities, tend to have a prolonged treatment course. This information may be incorporated into a shared decision-making model for more efficient treatment of ED.

  2. Medical Image Resource Center--making electronic teaching files from PACS. (United States)

    Lim, C C Tchoyoson; Yang, Guo Liang; Nowinski, Wieslaw L; Hui, Francis


    A picture archive and communications system (PACS) is a rich source of images and data suitable for creating electronic teaching files (ETF). However, the potential for PACS to support nonclinical applications has not been fully realized: at present there is no mechanism for PACS to identify and store teaching files; neither is there a standardized method for sharing such teaching images. The Medical Image Resource Center (MIRC) is a new central image repository that defines standards for data exchange among different centers. We developed an ETF server that retrieves digital imaging and communication in medicine (DICOM) images from PACS, and enables users to create teaching files that conform to the new MIRC schema. We test-populated our ETF server with illustrative images from the clinical case load of the National Neuroscience Institute, Singapore. Together, PACS and MIRC have the potential to benefit radiology teaching and research.

  3. Spreading a patient-centered medical home redesign: a case study. (United States)

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


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

  4. Accelerating change: Fostering innovation in healthcare delivery at academic medical centers. (United States)

    Ostrovsky, Andrey; Barnett, Michael


    Academic medical centers (AMCs) have the potential to be leaders in the era of healthcare delivery reform, but most have yet to display a commitment to delivery innovation on par with their commitment to basic research. Several institutional factors impede delivery innovation including the paucity of adequate training in design and implementation of new delivery models and the lack of established pathways for academic career advancement outside of research. This paper proposes two initiatives to jumpstart disruptive innovation at AMCs: an institutional "innovation incubator" program and a clinician-innovator career track coupled with innovation training programs.

  5. The house of gastrointestinal medicine: how academic medical centers can build a sustainable economic clinical model. (United States)

    Rustgi, Anil K; Allen, John I


    Academic Medical Centers (AMCs) have been given unique responsibilities to care for patients, educate future clinicians, and bring innovative research to the bedside. Over the last few decades, this tripartite mission has served the United States well, and payers (Federal, State, and commercial) have been willing to underwrite these missions with overt and covert financial subsidies. As cost containment efforts have escalated, the traditional business model of AMCs has been challenged. In this issue, Dr Anil Rustgi and I offer some insights into how AMCs must alter their business model to be sustainable in our new world of accountable care, cost containment, and clinical integration.

  6. mHealth tools for the pediatric patient-centered medical home. (United States)

    Slaper, Michael R; Conkol, Kimberly


    The concept of the pediatric patient-centered medical home (PCMH) as a theory has been evolving since it was initially conceived more than 40 years ago. When the American Academy of Pediatrics' (AAP) Council on Pediatric Practice first wrote about this model, "medical home" was defined solely as the central location of a pediatric patient's medical records. Approximately two decades later, the AAP published its inaugural policy statement on this topic. Through this policy statement, the medical home was defined as a place where care for pediatric patients would be accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. Although the lack of access to providers, especially in rural communities, may inhibit the adoption of the PCMH or chronic care models, technology has evolved to the point where many of the gaps in care can be bridged. mHealth, defined by the National Institutes of Health (NIH) as the use of mobile and wireless devices to improve health outcomes, health care services, and health research, can be one specific example of how technology can address these issues. One early study has shown that patients who use mHealth tools are more likely to adhere to self-monitoring requirements and, in turn, have significantly improved outcomes. A rapidly evolving and scalable mHealth technology that has the ability to address these issues are self-management mobile applications, or apps. It has been estimated that there are currently more than 40,000 health care-related apps available. Furthermore, use of these apps is growing, as more than 50% of smartphone users surveyed responded that they have used their device to gather health information, and almost 20% of this population has at least one health care app on their device.

  7. Set up and operation for medical radiation exposure quality control system of health promotion center

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    Kim, Jung Su; Kim, Jung Min [Korea University,Seoul (Korea, Republic of); Jung, Hae Kyoung [Dept. of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Sungnam (Korea, Republic of)


    In this study, standard model of medical radiation dosage quality control system will be suggested and the useful of this system in clinical field will be reviewed. Radiation dosage information of modalities are gathered from digital imaging and communications in medicine(DICOM) standard data(such as DICOM dose SR and DICOM header) and stored in database. One CT scan, two digital radiography modalities and two mammography modalities in one health promotion center in Seoul are used to derive clinical data for one month. After 1 months research with 703 CT scans, the study shows CT 357.9 mGy·cm in abdomen and pelvic CT, 572.4 mGy·cm in brain without CT, 55.9 mGy·cm in calcium score/heart CT, screening CT at 54 mGy·cm in chest screening CT(low dose screening CT scan), 284.99 mGy·cm in C-spine CT and 341.85 mGy·cm in L-spine CT as health promotion center reference level of each exam. And with 1955 digital radiography cases, it shows 274.0 mGy·cm{sup 2} and for mammography 6.09 mGy is shown based on 536 cases. The use of medical radiation shall comply with the principles of justification and optimization. This quality management of medical radiation exposure must be performed in order to follow the principle. And the procedure to reduce the radiation exposure of patients and staff can be achieved through this. The results of this study can be applied as a useful tool to perform the quality control of medical radiation exposure.

  8. Conformity of pediatric/adolescent HIV clinics to the patient-centered medical home care model. (United States)

    Yehia, Baligh R; Agwu, Allison L; Schranz, Asher; Korthuis, P Todd; Gaur, Aditya H; Rutstein, Richard; Sharp, Victoria; Spector, Stephen A; Berry, Stephen A; Gebo, Kelly A


    The patient-centered medical home (PCMH) has been introduced as a model for providing high-quality, comprehensive, patient-centered care that is both accessible and coordinated, and may provide a framework for optimizing the care of youth living with HIV (YLH). We surveyed six pediatric/adolescent HIV clinics caring for 578 patients (median age 19 years, 51% male, and 82% black) in July 2011 to assess conformity to the PCMH. Clinics completed a 50-item survey covering the six domains of the PCMH: (1) comprehensive care, (2) patient-centered care, (3) coordinated care, (4) accessible services, (5) quality and safety, and (6) health information technology. To determine conformity to the PCMH, a novel point-based scoring system was devised. Points were tabulated across clinics by domain to obtain an aggregate assessment of PCMH conformity. All six clinics responded. Overall, clinics attained a mean 75.8% [95% CI, 63.3-88.3%] on PCMH measures-scoring highest on patient-centered care (94.7%), coordinated care (83.3%), and quality and safety measures (76.7%), and lowest on health information technology (70.0%), accessible services (69.1%), and comprehensive care (61.1%). Clinics moderately conformed to the PCMH model. Areas for improvement include access to care, comprehensive care, and health information technology. Future studies are warranted to determine whether greater clinic PCMH conformity improves clinical outcomes and cost savings for YLH.

  9. An Analysis of a VA/DoD High-Tech Joint Venture at Womack Army Medical Center. (United States)


    interest groups to expand the ’ joint venture ’ concept have intensified with the expectation that cost savings will be realized by participating...organizations (Tokarski, 1989). Using a specific example of a local Magnetic Resonance Imager (MRI) joint venture between the Fayetteville Veterans...Administration Medical Center (FVAMC) and Womack Army Medical Center (WAMC), the management problem was to determine how effective this joint venture has been at improving patient access to MRI technology.

  10. Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use


    Jones, AL; Cochran, SD; Leibowitz, A.; Wells, KB; Kominski, G; Mays, VM


    © 2015 Society of General Internal Medicine BACKGROUND: The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. OBJECTIVE: To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services...

  11. Swine flu in Asia

    Institute of Scientific and Technical Information of China (English)

    Viroj Wiwanitkit


    Emerging swine flu (variant H1N1 influenza virus infection)is a new problem in medicine.The outbreaks in Mexico,USA and Canada bring attention to medical scientists that thing infection might finalize in the global pandemic situation.In this specific paper,the author hereby discusses on the situation of swine flu in Asia.

  12. A Problem Solving Curriculum for Active Learning at the Northwest Center for Medical Education, Indiana University School of Medicine. (United States)

    Iatridis, Panayotis G.

    An innovative curriculum called the "Regional Center Alternative Pathway," recently adopted by the Northwest Center for Medical Education (part of Indiana University's School of Medicine), is presented. The curriculum combines the traditional structure's didactic approach with a new problem-based tutorial curriculum. In this curriculum…

  13. Needs Assessment for Research Use of High-Throughput Sequencing at a Large Academic Medical Center.

    Directory of Open Access Journals (Sweden)

    Albert Geskin

    Full Text Available Next Generation Sequencing (NGS methods are driving profound changes in biomedical research, with a growing impact on patient care. Many academic medical centers are evaluating potential models to prepare for the rapid increase in NGS information needs. This study sought to investigate (1 how and where sequencing data is generated and analyzed, (2 research objectives and goals for NGS, (3 workforce capacity and unmet needs, (4 storage capacity and unmet needs, (5 available and anticipated funding resources, and (6 future challenges. As a precursor to informed decision making at our institution, we undertook a systematic needs assessment of investigators using survey methods. We recruited 331 investigators from over 60 departments and divisions at the University of Pittsburgh Schools of Health Sciences and had 140 respondents, or a 42% response rate. Results suggest that both sequencing and analysis bottlenecks currently exist. Significant educational needs were identified, including both investigator-focused needs, such as selection of NGS methods suitable for specific research objectives, and program-focused needs, such as support for training an analytic workforce. The absence of centralized infrastructure was identified as an important institutional gap. Key principles for organizations managing this change were formulated based on the survey responses. This needs assessment provides an in-depth case study which may be useful to other academic medical centers as they identify and plan for future needs.

  14. Information technology leadership in academic medical centers: a tale of four cultures. (United States)

    Friedman, C P


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

  15. Needs Assessment for Research Use of High-Throughput Sequencing at a Large Academic Medical Center. (United States)

    Geskin, Albert; Legowski, Elizabeth; Chakka, Anish; Chandran, Uma R; Barmada, M Michael; LaFramboise, William A; Berg, Jeremy; Jacobson, Rebecca S


    Next Generation Sequencing (NGS) methods are driving profound changes in biomedical research, with a growing impact on patient care. Many academic medical centers are evaluating potential models to prepare for the rapid increase in NGS information needs. This study sought to investigate (1) how and where sequencing data is generated and analyzed, (2) research objectives and goals for NGS, (3) workforce capacity and unmet needs, (4) storage capacity and unmet needs, (5) available and anticipated funding resources, and (6) future challenges. As a precursor to informed decision making at our institution, we undertook a systematic needs assessment of investigators using survey methods. We recruited 331 investigators from over 60 departments and divisions at the University of Pittsburgh Schools of Health Sciences and had 140 respondents, or a 42% response rate. Results suggest that both sequencing and analysis bottlenecks currently exist. Significant educational needs were identified, including both investigator-focused needs, such as selection of NGS methods suitable for specific research objectives, and program-focused needs, such as support for training an analytic workforce. The absence of centralized infrastructure was identified as an important institutional gap. Key principles for organizations managing this change were formulated based on the survey responses. This needs assessment provides an in-depth case study which may be useful to other academic medical centers as they identify and plan for future needs.

  16. Collaborating to improve the global competitiveness of US academic medical centers. (United States)

    Allen, Molly; Garman, Andrew; Johnson, Tricia; Hohmann, Samuel; Meurer, Steve


    President Obama announced the National Export Initiative in his 2010 State of the Union address and set the ambitious goal of doubling US exports by the end of 2014 to support millions of domestic jobs. Understanding the competitive position of US health care in the global market for international patients, University Health System Consortium (UHC), an alliance of 116 academic medical centers and 272 of their affiliated hospitals, representing 90 percent of the nation's non-profit academic medical centers partnered with Rush University, a private University in Chicago, IL and the International Trade Administration of the US Department of Commerce International Trade Administration (ITA) to participate in the Market Development Cooperator Program. The goal of this private-public partnership is to increase the global competitiveness of the US health care industry, which represents over 16 percent of the GDP, amongst foreign health care providers. This article provides an overview of the US health care market and outlines the aims of the US Cooperative for International Patient Programs, the end result of the partnership between UHC, ITA and Rush University.

  17. Family-centered rounds and medical student performance on the NBME pediatrics subject (shelf) examination: a retrospective cohort study


    Kimbrough, Tiffany N.; Heh, Victor; Wijesooriya, N. Romesh; Ryan, Michael S.


    Objective: To determine the association between family-centered rounds (FCR) and medical student knowledge acquisition as assessed by the National Board of Medical Examiners (NBME) pediatric subject (shelf) exam.Methods: A retrospective cohort study was conducted of third-year medical students who graduated from Virginia Commonwealth University School of Medicine between 2009 and 2014. This timeframe represented the transition from ‘traditional’ rounds to FCR on the pediatric inpatient unit. ...

  18. OCLC in Asia Pacific. (United States)

    Chang, Min-min


    Discusses the Online Computer Library Center (OCLC) and the changing Asia Pacific library scene under the broad headings of the three phases of technology innovation. Highlights include WorldCat and the OCLC shared cataloging system; resource sharing and interlibrary loan; enriching OCLC online catalog with Asian collections; and future outlooks.…

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

    Directory of Open Access Journals (Sweden)

    Simindokht Shoaee


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

  20. Optimal scheduling of logistical support for medical resources order and shipment in community health service centers

    Directory of Open Access Journals (Sweden)

    Ming Liu


    Full Text Available Purpose: This paper aims to propose an optimal scheduling for medical resources order and shipment in community health service centers (CHSCs.Design/methodology/approach: This paper presents two logistical support models for scheduling medical resources in CHSCs. The first model is a deterministic planning model (DM, which systematically considers the demands for various kinds of medical resources, the lead time of supplier, the storage capacity and other constraints, as well as the integrated shipment planning in the dimensions of time and space. The problem is a multi-commodities flow problem and is formulated as a mixed 0-1 integer programming model. Considering the demand for medical resources is always stochastic in practice, the second model is constructed as a stochastic programming model (SM. A solution procedure is developed to solve the proposed two models and a simulation-based evaluation method is proposed to compare the performances of the proposed models. Findings andFindings: The main contributions of this paper includes the following two aspects: (1 While most research on medical resources optimization studies a static problem taking no consideration of the time evolution and especially the dynamic demand for such resources, the proposed models in our paper integrate time-space network technique, which can find the optimal scheduling of logistical support for medical resources order and shipment in CHSCs effectively. (2 The logistics plans in response to the deterministic demand and the time-varying demand are constructed as 0-1 mixed integer programming model and stochastic integer programming model, respectively. The optimal solutions not only minimize the operation cost of the logistics system, but also can improve the order and shipment operation in practice.Originality/value: Currently, medical resources in CHSCs are purchased by telephone or e-mail. The important parameters in decision making, i.e. order/shipment frequency


    Directory of Open Access Journals (Sweden)

    Gurendro Putro


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

  2. Policies pertaining to complementary and alternative medical therapies in a random sample of 39 academic health centers. (United States)

    Cohen, Michael H; Sandler, Lynne; Hrbek, Andrea; Davis, Roger B; Eisenberg, David M


    This research documents policies in 39 randomly selected academic medical centers integrating complementary and alternative medical (CAM) services into conventional care. Twenty-three offered CAM services-most commonly, acupuncture, massage, dietary supplements, mind-body therapies, and music therapy. None had written policies concerning credentialing practices or malpractice liability. Only 10 reported a written policy governing use of dietary supplements, although three sold supplements in inpatient formularies, one in the psychiatry department, and five in outpatient pharmacies. Thus, few academic medical centers have sufficiently integrated CAM services into conventional care by developing consensus-written policies governing credentialing, malpractice liability, and dietary supplement use.

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

    Directory of Open Access Journals (Sweden)

    Yunbo Qing


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

  4. Theming Asia

    NARCIS (Netherlands)

    Erb, Maribeth; Ong, Chin Ee


    This paper introduces a special issue on Theme Parks in Asia with reflections on how the various theoretical ideas on theming and theme parks that are found in the social science literature can help us to understand the proliferation of theming and theme parks in contemporary Asia. How does theming

  5. The first private-hospital based proton therapy center in Korea; Status of the proton therapy center at Samsung Medical Center

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Kwang Zoo; Han, Young Yih; Kim, Jin Sung [Dept. of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); and others


    The purpose of this report is to describe the proton therapy system at Samsung Medical Center (SMC-PTS) including the proton beam generator, irradiation system, patient positioning system, patient position verification system, respiratory gating system, and operating and safety control system, and review the current status of the SMC-PTS. The SMC-PTS has a cyclotron (230 MeV) and two treatment rooms: one treatment room is equipped with a multi-purpose nozzle and the other treatment room is equipped with a dedicated pencil beam scanning nozzle. The proton beam generator including the cyclotron and the energy selection system can lower the energy of protons down to 70 MeV from the maximum 230 MeV. The multi-purpose nozzle can deliver both wobbling proton beam and active scanning proton beam, and a multi-leaf collimator has been installed in the downstream of the nozzle. The dedicated scanning nozzle can deliver active scanning proton beam with a helium gas filled pipe minimizing unnecessary interactions with the air in the beam path. The equipment was provided by Sumitomo Heavy Industries Ltd., RayStation from RaySearch Laboratories AB is the selected treatment planning system, and data management will be handled by the MOSAIQ system from Elekta AB. The SMC-PTS located in Seoul, Korea, is scheduled to begin treating cancer patients in 2015.

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

    Directory of Open Access Journals (Sweden)

    Lewis NJW


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

  7. Thinking outside the classroom: providing student-centered informatics instruction to first- and second-year medical students. (United States)

    Shurtz, Suzanne


    With the increasing amount of health information available, the Association of American Medical Colleges recommends that medical students be proficient in information management. Librarians can and should play a role in teaching students these skills. Medical information management instruction is most effective if integrated into the curriculum. However, if options are limited for librarians to teach within courses, there are ways to reach students outside the classroom. This article describes strategies librarians are implementing, outside the curriculum, to teach Texas A & M Health Science Center's first- and second-year medical students how to use library resources.

  8. A Demonstration of PROMIS. The Problem-Oriented Medical Information System at the Medical Center Hospital of Vermont. (United States)

    Stratmann, William C.

    A study was conducted to evaluate the impact of the Problem-Oriented Medical Information System (PROMIS), which is based on an automated problem-oriented medical record, by comparing the records for two generally comparable medical wards, one using the computerized PROMIS record and the other using its manual prototype. This report provides a…


    Directory of Open Access Journals (Sweden)

    Fahmi Hakam


    Full Text Available Klinik muhammadiyah medical center membutuhkan sistim pencatatan dan pelaporan yang tepat dan akurat. Saat ini, pencatatan dan pemrosesan data berjalan kurang optimal, karena dijalankan dengan sistem manual dengan menggunakan sreadsheet. jadi ketika petugas akan membuat laporan mereka mengalami kesulitan dalam mencari dan menyusun data yang dibutuhkan. Tujuan dari penelitian ini adalah untuk mengembangkan draf dari sistim pencatatan dan pelaporan data registrasi. Jenis penelitian ini adalah pengembangan penelitian dengan menggunakan pendekatan kualitatif . Dalam penelitian ini, pengumpulan dan pengambilan data menggunakan teknik purposive sampling . Dari hasil identifikasi pengguna , peneliti mulai merancang diagram alir data ( DFD , diagram hubungan entitas ( ERD , database dan desain antarmuka sistem , serta yang dicetak dari laporan yang dihasilkan . Dengan desain sistem ini , diharapkan menjadi masukan yang berguna bagi lembaga . Tapi desain sistem ini masih banyak kekurangan , seperti subsistem tidak lain dan integrasi antara desain yang ada terbatas pada bagian pendaftaran saja

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

    DEFF Research Database (Denmark)

    Tolsgaard, Martin Grønnebæk


    development initiatives are required before implementation in large and dispersed settings. In conclusion, this thesis demonstrated different aspects of student-centered approaches to clinical skills learning. Whereas self-directed learning is difficult in clinical clerkship, the experimental studies......This thesis focuses on how to engage students in self-directed learning and in peer-learning activities to improve clinical skills training in undergraduate medical education. The first study examined the clinical skills teaching provided by student teachers compared to that provided by associate...... professors. This study showed that student teachers performed as good as or even better than associate professors when teaching simple clinical skills. The second study of this thesis examined how complex clinical skills--such as patient management skills--develop with increasing levels of competence...

  11. [Significance of Multi-center Obstetrics Perioperative Team Training Including Various Medical Staffs]. (United States)

    Komasawa, Nobuyasu; Fujita, Daisuke; Nakayama, Mai; Fujiwara, Shunsuke; Mihara, Ryosuke; Okada, Daisuke; Omoto, Haruka; Tanaka, Motoshige; Nishihara, Isao; Minami, Toshiaki


    We report the development of a multi-center/multispecialist obstetrics perioperative team training program. Participants were members of the team, including anesthesiologists, obstetricians, and operation nurses. A questionnaire survey was conducted prior to course participation to clarify any questions team members had. The courses included a lecture and simulation training with scenario-based discussions or the use of a simulator. Scenarios included massive bleeding during cesarean section, massive bleeding after vaginal delivery, and emergency cesarean section for premature placental abruption. After each course, participants discussed problems associated with obstetrics medical safety in the context of each theme. Simulation-based perioperative team training with anesthesiologists, obstetricians, and operation nurses may serve as a vehicle to promote perioperative obstetrics patient safety.

  12. Bariatric Surgery and Liver Cancer in a Consortium of Academic Medical Centers. (United States)

    Yang, Baiyu; Yang, Hannah P; Ward, Kristy K; Sahasrabuddhe, Vikrant V; McGlynn, Katherine A


    Obesity is implicated as an important factor in the rising incidence of liver cancer in the USA. Bariatric surgery is increasingly used for treating morbid obesity and comorbidities. Using administrative data from UHC, a consortium of academic medical centers in the USA, we compared the prevalence of liver cancer among admissions with and without a history of bariatric surgery within a 3-year period. Admissions with a history of bariatric surgery had a 61 % lower prevalence of liver cancer compared to those without a history of bariatric surgery (prevalence ratio 0.39, 95 % confidence interval 0.35-0.44), and these inverse associations persisted within strata of sex, race, and ethnicity. This hospital administrative record-based analysis suggests that bariatric surgery could play a role in liver cancer prevention.

  13. Molecular epidemiology of carbapenem non-susceptible Acinetobacter nosocomialis in a medical center in Taiwan. (United States)

    Yang, Ya-Sung; Lee, Yi-Tzu; Wang, Yung-Chih; Chiu, Chun-Hsiang; Kuo, Shu-Chen; Sun, Jun-Ren; Yin, Ti; Chen, Te-Li; Lin, Jung-Chung; Fung, Chang-Phone; Chang, Feng-Yee


    The mechanism by which carbapenem non-susceptible Acinetobacter nosocomialis (CNSAN) is disseminated is rarely described in the literature. In this study, we delineated the molecular epidemiology of CNSAN isolated from patients in a medical center in Taiwan. Fifty-four non-duplicate bloodstream isolates of CNSAN were collected at the Taipei Veterans General Hospital between 2001 and 2007. Pulsed-field gel electrophoresis (PFGE) was performed to determine their clonal relationship. Carbapenem-resistance genes and associated genetic structures were detected by polymerase chain reaction (PCR) mapping. Southern hybridization was performed to determine the plasmid location of carbapenem-resistance genes. Transmissibility of these genes to Acinetobacterbaumannii was demonstrated by conjugation tests. The overall carbapenem non-susceptibility rate among A. nosocomialis isolates during the study period was 21.6% (54/250). PFGE revealed three major pulsotypes: H (n=23), I (n=10), and K (n=8). The most common carbapenem-resistance gene was blaOXA-58 (43/54, 79.6%), containing an upstream insertion sequence IS1006 and a truncated ISAba3 (IS1006-ΔISAba3-like-blaOXA-58). All isolates belonging to the pulsotypes H, I, and K carried plasmid located IS1006-ΔISAba3-like-blaOXA-58. A common plasmid carrying ISAba1-blaOXA-82 was found in six isolates, which belonged to five pulsotypes. A type 1 integron that carried blaIMP-1 was detected in different plasmids of seven isolates, which belonged to five pulsotypes. Plasmids carrying these carbapenem-resistant determinants were transmissible from A. nosocomialis to A. baumannii via conjugation. In this medical center, CNSAN mainly emerged through clonal dissemination; propagation of plasmids and integrons carrying carbapenem-resistant determinants played a minor role. This study showed that plasmids carrying carbapenem-resistant determinants are transmissible from A. nosocomialis to A. baumannii.

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

    Directory of Open Access Journals (Sweden)

    Matthew D Krasowski


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

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

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


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

  16. Integration of footprints information systems in palliative care: the case of Medical Center of Central Georgia. (United States)

    Tsavatewa, Christopher; Musa, Philip F; Ramsingh, Isaac


    Healthcare in America continues to be of paramount importance, and one of the most highly debated public policy issues of our time. With annual expenditures already exceeding $2.4 trillion, and yielding less than optimal results, it stands to reason that we must turn to promising tools and solutions, such as information technology (IT), to improve service efficiency and quality of care. Presidential addresses in 2004 and 2008 laid out an agenda, framework, and timeline for national health information technology investment and development. A national initiative was long overdue. This report we show that advancements in both medical technologies and information systems can be capitalized upon, hence extending information systems usage beyond data collection to include administrative and decision support, care plan development, quality improvement, etc. In this paper we focus on healthcare services for palliative patients. We present the development and preliminary accounts of a successful initiative in the Medical Center of Central Georgia where footprints information technology was modified and integrated into the hospital's palliative care service and existing EMR systems. The project provides evidence that there are a plethora of areas in healthcare in which innovative application of information systems could significantly enhance the care delivered to loved ones, and improve operations at the same time..

  17. Teaching while learning while practicing: reframing faculty development for the patient-centered medical home. (United States)

    Clay, Michael A; Sikon, Andrea L; Lypson, Monica L; Gomez, Arthur; Kennedy-Malone, Laurie; Bussey-Jones, Jada; Bowen, Judith L


    Soaring costs of health care, patients living longer with chronic illnesses, and continued attrition of interest in primary care contribute to the urgency of developing an improved model of health care delivery. Out of this need, the concept of the team-based, patient-centered medical home (PCMH) has developed. Amidst implementation in academic settings, clinical teachers face complex challenges not previously encountered: teaching while simultaneously learning about the PCMH model, redesigning clinical delivery systems while simultaneously delivering care within them, and working more closely in expanded interprofessional teams.To address these challenges, the authors reviewed three existing faculty development models and recommended four important adaptations for preparing clinical teachers for their roles as system change agents and facilitators of learning in these new settings. First, many faculty find themselves in the awkward position of teaching concepts they have yet to master themselves. Professional development programs must recognize that, at least initially, health professions learners and faculty will be learning system redesign content and skills together while practicing in the evolving workplace. Second, all care delivery team members influence learning in the workplace. Thus, the definition of faculty must expand to include nurses, pharmacists, social workers, medical assistants, patients, and others. These team members will need to accept their roles as educators. Third, learning to deliver health care in teams will require support of both interprofessional collaboration and intraprofessional identity development. Fourth, learning to manage change and uncertainty should be part of the core content of any faculty development program within the PCMH.

  18. Nurses and Psychologists Advancing the Patient-Centered Medical Home Model. (United States)

    Corso, Kent A; Gage, Donna


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

  19. The proton therapy nozzles at Samsung Medical Center: A Monte Carlo simulation study using TOPAS (United States)

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


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

  20. Improving the Safety of Oral Chemotherapy at an Academic Medical Center (United States)

    Casella, Erica; Capozzi, Donna; McGettigan, Suzanne; Gangadhar, Tara C.; Schuchter, Lynn; Myers, Jennifer S.


    Purpose: Over the last decade, the use of oral chemotherapy (OC) for the treatment of cancer has dramatically increased. Despite their route of administration, OCs pose many of the same risks as intravenous agents. In this quality improvement project, we sought to examine our current process for the prescription of OC at the Abramson Cancer Center of the University of Pennsylvania and to improve on its safety. Methods: A multidisciplinary team that included oncologists, advanced-practice providers, and pharmacists was formed to analyze the current state of our OC practice. Using Lean Six Sigma quality improvement tools, we identified a lack of pharmacist review of the OC prescription as an area for improvement. To address these deficiencies, we used our electronic medical system to route OC orders placed by treating providers to an oncology-specific outpatient pharmacist at the Abramson Cancer Center for review. Results: Over 7 months, 63 orders for OC were placed for 45 individual patients. Of the 63 orders, all were reviewed by pharmacists, and, as a result, 22 interventions were made (35%). Types of interventions included dosage adjustment (one of 22), identification of an interacting drug (nine of 22), and recommendations for additional drug monitoring (12 of 22). Conclusion: OC poses many of the same risks as intravenous chemotherapy and should be prescribed and reviewed with the same oversight. At our institution, involvement of an oncology-trained pharmacist in the review of OC led to meaningful interventions in one third of the orders. PMID:26733627

  1. Disruptive innovation in academic medical centers: balancing accountable and academic care. (United States)

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


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

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

    CERN Document Server

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


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

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  4. To recognize the use of international standards for making harmonized regulation of medical devices in Asia-pacific. (United States)

    Anand, K; Saini, Ks; Chopra, Y; Binod, Sk


    'Medical Devices' include everything from highly sophisticated, computerized, medical equipment, right down to simple wooden tongue depressors. Regulations embody the public expectations for how buildings and facilities are expected to perform and as such represent public policy. Regulators, who develop and enforce regulations, are empowered to act in the public's interest to set this policy and are ultimately responsible to the public in this regard. Standardization contributes to the basic infrastructure that underpins society including health and environment, while promoting sustainability and good regulatory practice. The international organizations that produce International Standards are the International Electrotechnical Commission (IEC), the International Organization for Standardization (ISO), and the International Telecommunication Union (ITU). With the increasing globalization of markets, International Standards (as opposed to regional or national standards) have become critical to the trading process, ensuring a level playing field for exports, and ensuring that imports meet the internationally recognized levels of performance and safety. The development of standards is done in response to sectors and stakeholders that express a clearly established need for them. An industry sector or other stakeholder group typically communicates its requirement for standards to one of the national members. To be accepted for development, a proposed work item must receive a majority support of the participating members, who verify the global relevance of the proposed item. The regulatory authority (RA) should provide a method for the recognition of international voluntary standards and for public notification of such recognition. The process of recognition may vary from country to country. Recognition may occur by periodic publication of lists of standards that a regulatory authority has found will meet the Essential Principles. In conclusion, International standards

  5. Excel Center

    Institute of Scientific and Technical Information of China (English)


    Citigroup,one of the World top 500 companies,has now settled in Excel Center,Financial Street. The opening ceremony of Excel Center and the entry ceremony of Citigroup in the center were held on March 31.Government leaders of Xicheng District,the Excel CEO and the heads of Asia-Pacific Region leaders of Citibank all participated in the ceremony.

  6. An Observational Study to Evaluate the Medication Errors by Nursing Staff Working in Bushehr Medical Centers during one Year Interval (1385-1386

    Directory of Open Access Journals (Sweden)

    Nasrin Zahmatkeshan


    Full Text Available Background: Medication errors refer to inappropriate use of drugs, can lead to harmful and serious consequent. Many factors contribute to incidence of these errors. To investigate this factors a descriptive analytic study was done that assess clinical staff medication errors in Bushehr medical centers. Methods: The participants were 400 clinical staff, including nurses, midwives and nurse assistances to complete designed medication errors questionnaire. This questionnaire include 2 parts, part one was demographic data and part two, assess influencing factors of medication errors in six domain. Results: Results showed that the half of participants (49.9% had medication errors in acquaintance and the most error in dosage (37.7% and then type of drugs(27.7%. 73.3% of participants reported their errors and in unreported cases the most cause was fear of managers. According to participants attitude factors that interfering to medication errors were physicians factor, including illegible order in patient file (24.94%, nurses factors including, incorrect documentation (24.38%, interpersonal relationship (19.45%, inappropriate environment (15.3%, knowledge deficit and lack of experience (11.23% and stressful events (4.66%. No statistical significant correlation between situation of job and shift work. Conclusion: Results show that medication errors are common and human factors are the most factors in these errors.

  7. Prevalence of intestinal parasites in referred individuals to the medical centers of Tonekabon city, Mazandaran province (United States)

    Shahdoust, Samira; Niyyati, Maryam; Haghighi, Ali; Azargashb, Eznoallah; Khataminejad, Mohammad Reza


    Aim: The aim of the present study was to determine the prevalence of intestinal parasites and their relation with socio-demographic data in referred individuals to the medical centers in Tonekabon, Mazandaran province, 2015. Background: Due to the climatic and ecological conditions in Mazandaran province, determination of the status of intestinal parasites among referred individuals to the medical centers of Tonekabon city can help researchers and healthcare services to prevent and/or control of parasitic infection in this region. Methods: This cross sectional study was conducted with randomized sampling in 2015 on 820 stool samples. Stool samples were assessed using direct slide smear with saline and Lugol, formalin-ether concentration, Ziehl-Neelsen and trichrome staining. Polymerase Chain Reaction (PCR) using specific primers was conducted for the samples suspected for Entamoeba histolytica/E. dispar and Cryptosporidium spp. One Cryptosporidium positive sample in this study was submitted for sequencing. Results: A total of 444 (54.1%) and 376 (45.9%) were male and female, respectively. Furthermore, 495 (60.4%) and 325 (39.6%) of participants had lived in the urban and rural areas, respectively. Overall, 222 participants (27.1%) were infected with at least one intestinal parasites. Prevalence of pathogenic protozoa (Giardia lamblia and Cryptosporidium spp.) and helminthes parasites was calculated as 3.1 and 1.2%, respectively. The most common intestinal parasites in this area were: Blastocystis 153 (18.7%), Endolymax nana 44 (5.4%), Entamoeba coli 40 (4.9%), Giardia lamblia 25 (3%), Iodamoeba butschlii 22 (2.7%), Ascaris 5 (0.6%), Enterobius vermicularis 4 (0.5%), Trichostrongylus 1 (0.1%) and Cryptosporidium 1 (0.1%). By sequencing of the positive Cryptosporidium isolate using Gp60 gene, Cryptosporidium parvum subtype ΠaA16G2R1 was diagnosed. Conclusion: Protozoa were more abundant than helminthes and Giardia lamblia was the most common protozoan pathogen. In

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

    Directory of Open Access Journals (Sweden)

    Michal Hemmo-Lotem


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

  9. Human-centered risk management for medical devices - new methods and tools. (United States)

    Janß, Armin; Plogmann, Simon; Radermacher, Klaus


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

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  11. Survey on prevalence and causes of self-medication in women referring to health centers in Ahwaz, in 2013

    Directory of Open Access Journals (Sweden)

    Pourandoght Afshary


    Full Text Available Background: Today, considerable advances achieved in different scientific fields have led to an ever-increasing access of people to various medications and their unauthorized consumption, which negatively affects the healthcare and treatment system. Thus, this study was conducted to determine the Prevalence and causes of this phenomenon in the female population of Ahwaz. Material and Methods: In this Cross-sectional study364 Women referring to seven health centers in Ahwaz were selected randomly and based on the family medical file number and by proportional distribution to each center and semi-structured questionnaires were completed through interviews. The data were analyzed by Chi square test and logistic regression. P<0.05 was considered significant. Results: Self-medication was observed in 70.1% of women. The most frequent group  was those above the age of 30. The most common self-medication case was urogenitaldisorders (58.7%. there was a significant relation between education (p<0.003 and number of births (p=0.003 and unauthorized drug consumption. The most causes for synthetic drug use were previous illness background (48.6% and high medication costs (50.6%, and about herbal drugs were high medication costs (41.1%, and the effectiveness of these products about medicinal herbs (38.1 %. Conclusion: High rate of self-medication in the studied society necessitates training on proper use of drugs through the use of social media.

  12. Geospatial Modeling and Disease Insect Vector Management at the USDA-ARS Center for Medical, Agricultural, and Veterinary Entomology (United States)

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

  13. 76 FR 3209 - West Los Angeles VA Medical Center Veterans Programs Enhancement Act of 1998; Draft Master Plan (United States)


    ... AFFAIRS West Los Angeles VA Medical Center Veterans Programs Enhancement Act of 1998; Draft Master Plan... an opportunity for public comment on the West Los Angeles (WLA) Department of Veterans Affairs (VA... is part of the larger VA Greater Los Angeles (GLA) Healthcare System, serving Veterans in Los...

  14. Survey of 5 European countries suggests that more elements of patient-centered medical homes could improve primary care

    NARCIS (Netherlands)

    Faber, M.J.; Voerman, G.E.; Erler, A.; Eriksson, T.; Baker, R.; Lepeleire, J. De; Grol, R.P.T.M.; Burgers, J.S.


    The patient-centered medical home is a US model for comprehensive care. This model features a personal physician or registered nurse who is augmented by a proactive team and information technology. Such a model could prove useful for advanced European systems as they strive to improve primary care,

  15. Impact of 5 years of lean six sigma in a University Medical Center. (United States)

    Niemeijer, Gerard C; Trip, Albert; de Jong, Laura J; Wendt, Klaus W; Does, Ronald J M M


    Lean Six Sigma (LSS) is an originally industry-based methodology for cost reduction and quality improvement. In more recent years, LSS was introduced in health care as well. This article describes the experiences of the University Medical Center Groningen, the second largest hospital in the Netherlands, with LSS. It was introduced in 2007 to create the financial possibility to develop innovations. In this article, we describe how LSS was introduced, and how it developed in the following years. We zoom in at the traumatology department, where all main processes have been analyzed and improved. An evaluation after 5 years shows that LSS helped indeed reducing cost and improving quality. Moreover, it aided the transition of the organization from purely problem oriented to more process oriented, which in turn is helpful in eliminating waste and finding solutions for difficult problems. A major benefit of the program is that own employees are trained to become project leaders for improvement. Several people from the primary process were thus stimulated and equipped to become role models for continuous improvement.

  16. Good Neighbors: Shared Challenges and Solutions Toward Increasing Value at Academic Medical Centers and Universities. (United States)

    Clancy, Gerard P


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

  17. Subtypes of Alpha Thalassemia Diagnosed at a Medical Center in Jordan

    Directory of Open Access Journals (Sweden)

    Mohammed wael Abu-Ghoush


    Full Text Available BACKGROUND: This retrospective analysis study provides the molecular genetics of α-Thalassemia Mutations and identify the genotype of HbH disease in a group of patients at a Medical Center in Jordan. METHODS: A total of 430 subjects were studied. HbH disease was confirmed by Electrophoresis, HPLC and the demonstration of HbH inclusion bodies by supra vital staining. DNA analysis was performed using polymerase chain reaction, restriction enzyme digestion, followed by agarose gel electrophoresis and by reverse- hybridization assay to diagnose and confirm cases suspected α-thalassemia. RESULTS: Four hundred and thirty cases were found to be α-thalassemia trait and this was confirmed by Polymerase Chain Reaction, five different α- thalassemia determinants were observed. Thirty three cases were diagnosed as HbH disease. CONCLUSION: This study helps in the prediction of the phenotype severity by identifying the genotype of HbH patients .The results of the study can be also applied for the genetic counseling to prospective patients with HbH disease, since in severe cases the need may be arise for prenatal diagnosis in population. [TAF Prev Med Bull 2008; 7(5.000: 373-376

  18. [Using SWOT to analyze breastfeeding education results in a medical center]. (United States)

    Lee, Pei-Shan; Huang, Chiu-Mieh


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

  19. Salt Intake Among Women Refer to Medical Health Centers, Yazd, Iran, 2011

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    M Morowatisharifabad


    Full Text Available Introduction: Excessive salt consumption is associated with the severity of arterial hypertension and various related complications such as ventricular hypertrophy. Regarding the importance of awareness of salt intake in women, this study was conducted with purpose of the estimation of salt intake. Methods: This descriptive– analytic cross-sectional study was conducted with participation of 247 women referred to Yazd medical health centers. Sampling was done by multistage method. Daily salt intake was evaluated by measurement of urine salt and Kawasaki formula. Data was analyzed by SPSS and Student t- test, Chi –square and one way ANOVA. Results: Participants with mean age of 29/91±6.75 years, consumed on the average 10/09±2.97g salt per day. Daily salt intake of 4.1% (10 persons of participants was less than 5g. Results did not show any significant association between salt intake and demographic variables including job (p=0.451, educational level (p=0.162 and husband job (p=0.178. Conclusion: Considering high salt intake among participants, it is suggested designing and performing suitable educational programs based on theories and models of health education in order to reduce salt intake.

  20. Sports hernia: the experience of Baylor University Medical Center at Dallas. (United States)

    Preskitt, John T


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

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

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    Norakhoda Sadeghifard


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


    Diaz, Rafael; Behr, Joshua; Kumar, Sameer; Britton, Bruce

    Chronic Disease is defined as a long lasting health condition, which can develop and/or worsen over an extended time, but which can also be controlled. The monetary and budgetary toll due to its persistent nature has become unsustainable and requires pressing actions to limit their incidence and burden. This paper demonstrates the utility of the System Dynamics approach to simulate the behavior of key factors involved in the implementation of chronic disease management. We model the patient flow diversion from emergency departments (ED) to patient-centered medical homes (PCMH), with emphasis on the visit rates, as well as the effect of insurance coverage, in an effort to assure continuity of quality care for Asthma patients at lower costs. The model is used as an evaluative method to identify conditions of a maintained health status through adequate policy planning, in terms of resources and capacity. This approach gives decision makers the ability to track the level of implementation of the intervention and generate knowledge about dynamics between population demands and the intervention effectiveness. The functionality of the model is demonstrated through the consideration of hypothetical scenarios executed using sensitivity analysis.

  3. The impact of interhospital transfers on surgical quality metrics for academic medical centers. (United States)

    Crippen, Cristina J; Hughes, Steven J; Chen, Sugong; Behrns, Kevin E


    The emergence of pay-for-performance systems pose a risk to an academic medical center's (AMC) mission to provide care for interhospital surgical transfer patients. This study examines quality metrics and resource consumption for a sample of these patients from the University Health System Consortium (UHC) and our Department of Surgery (DOS). Standard benchmarks, including mortality rate, length of stay (LOS), and cost, were used to evaluate the impact of interhospital surgical transfers versus direct admission (DA) patients from January 2010 to December 2012. For 1,423,893 patients, the case mix index for transfer patients was 38 per cent (UHC) and 21 per cent (DOS) greater than DA patients. Mortality rates were 5.70 per cent (UHC) and 6.93 per cent (DOS) in transferred patients compared with 1.79 per cent (UHC) and 2.93 per cent (DOS) for DA patients. Mean LOS for DA patients was 4 days shorter. Mean total costs for transferred patients were greater $13,613 (UHC) and $13,356 (DOS). Transfer patients have poorer outcomes and consume more resources than DA patients. Early recognition and transfer of complex surgical patients may improve patient rescue and decrease resource consumption. Surgeons at AMCs and in the community should develop collaborative programs that permit collective assessment and decision-making for complicated surgical patients.

  4. Asia Pacific Mangrove Information Network (APMIN): A conceptual model

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    Chavan, V.S.; Jagtap, T.G.; Untawale, A.G.

    Asia Pacific Mangrove Information Network (APMIN), its structure and scope, is discussed in this paper. Establishment of National Mangrove Information Centers (NMIC) in 20 Asia-Pacific countries, would contribute towards development of databases...

  5. [Pica: a descriptive study of patients in a speciality medical center]. (United States)

    Haoui, R; Gautie, L; Puisset, F


    According to the DSM IV, pica is a trouble of alimentary behavior, which is characterized by the ingestion of non-nutriment substances during at least on the month. The main objective of this study conducted at the Clermont-de-l'Oise Interdepartmental Medical Center is to evaluate pica's prevalence for hospitalized patients. Secondary objectives are to describe clinical characteristics, complications and outcome upon the different therapeutic approaches. The patients hospitalized in the Adult and/or Pediatric Department of Psychiatry, which fulfilled the 4 criteria of the DSM IV, were considered eligible for the study. In order to better evaluate the severity of behavioral troubles evoked by item D of DSM IV definition, we elaborated specific severity and preoccupation scales. The severity scale reflects the complications due to the ingestion of the non-nutriment substances, the encountered risks in the case of persistence of these troubles as well as the patient's management. The preoccupation scale reflects the medical team's involvement towards the patient in order to prevent life-threatening complications. The two scales are graded from 0 to 5 according to the severity or to the degree of preoccupation, respectively. Only patients with scores 3 were considered as fulfilling the severity criteria. Among the 943 hospitalized patients at a selected time period, 23 adult patients have been considered eligible. According to these data, prevalence of pica was estimated at 2.44%. This value may seem an underestimation when compared to the values reported in the medical literature, which range from 9 to 25%. Additionally, among the 108 hospitalized infant patients, none fulfilled DSM IV criteria, which is surprising, as pica is relatively common in childhood. These results may be explained by the use of the more restrictive criteria of the DSM IV and also by the difficulties encountered in considering pica as an independent medical condition. Indeed, pica is often a

  6. [Medical care for asylum seekers and refugees at the University Medical Center Hamburg-Eppendorf--A case series]. (United States)

    Sothmann, Peter; Schmedt auf der Günne, Nina; Addo, Marylyn; Lohse, Ansgar; Schmiedel, Stefan


    As the number of refugees rises, medical care for refugees, asylum seekers and people with unclear residence status becomes a priority task for our health system. While access to health care is restricted for these groups of people in many German states, Hamburg provides unrestricted access to healthcare for refugees by handing out health insurance cards on arrival. Daily practice shows, however, that adequate medical care is still not always easy to achieve. In this case series we demonstrate that barriers to health care still exist on many levels. We discuss these barriers and further propose strategies to improve and to secure access to adequate health care.

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

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    Anger KE


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

  8. Prevalence of comorbid retinal disease in patients with glaucoma at an academic medical center

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    Griffith JF


    Full Text Available Joseph F Griffith,1 Jeffrey L Goldberg2 1Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, 2Shiley Eye Center, University of California San Diego, La Jolla, CA, USA Background: Patients with various retinal diseases and patients who have undergone retinal procedures and surgeries have an increased risk of developing ocular hypertension and glaucoma. Little is known about the epidemiology of comorbid retinal diseases in glaucoma patients. This study evaluated the prevalence of retinal comorbidities in a population of patients with five types of glaucoma.Methods: A longitudinal, retrospective study was conducted using International Classification of Disease (ICD-9 billing records from 2003 to 2010 at an academic medical center. Patients were classified as having primary open-angle glaucoma (POAG, low tension open-angle glaucoma (NTG, pigmentary open-angle glaucoma, chronic-angle closure glaucoma (CACG, or pseudoexfoliation glaucoma (PXG if they had at least three clinic visits with the same ICD-9 code. Patients were classified as having a retinal comorbidity if they had two visits with the same code. Variables were analyzed with the independent t-test, χ2 test, analysis of variance, or Fisher’s exact test.Results: A total of 5,154 patients had glaucoma, and 14.8% of these had a retinal comorbidity. The prevalence of comorbid retinal disease was higher in patients with POAG (15.7% than in those with NTG (10.7%, PXG (10.1%, or pigmentary open-angle glaucoma (3.7%; P<0.05. Two hundred and two patients had diabetic retinopathy, with POAG patients (4.5% having a higher prevalence than those with CACG (1.4% or PXG (0.6%; P<0.001. There were 297 patients who had macular degeneration and both POAG (2.0% and PXG patients (2.9% had a higher prevalence of nonexudative macular degeneration than those with CACG (0%; P<0.01. Patients with comorbid retinal disease had a higher prevalence of blindness and low vision than those without comorbid

  9. The OCHIN community information network: bringing together community health centers, information technology, and data to support a patient-centered medical village. (United States)

    Devoe, Jennifer E; Sears, Abigail


    Creating integrated, comprehensive care practices requires access to data and informatics expertise. Information technology (IT) resources are not readily available to individual practices. One model of shared IT resources and learning is a "patient-centered medical village." We describe the OCHIN Community Health Information Network as an example of this model; community practices have come together collectively to form an organization that leverages shared IT expertise, resources, and data, providing members with the means to fully capitalize on new technologies that support improved care. This collaborative facilitates the identification of "problem sheds" through surveillance of network-wide data, enables shared learning regarding best practices, and provides a "community laboratory" for practice-based research. As an example of a community of solution, OCHIN uses health IT and data-sharing innovations to enhance partnerships between public health leaders, clinicians in community health centers, informatics experts, and policy makers. OCHIN community partners benefit from the shared IT resource (eg, a linked electronic health record, centralized data warehouse, informatics, and improvement expertise). This patient-centered medical village provides (1) the collective mechanism to build community-tailored IT solutions, (2) "neighbors" to share data and improvement strategies, and (3) infrastructure to support innovations based on electronic health records across communities, using experimental approaches.

  10. Experience with multimodality telepathology at the University of Pittsburgh Medical Center

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    Liron Pantanowitz


    Full Text Available Several modes of telepathology exist including static (store-and-forward, dynamic (live video streaming or robotic microscopy, and hybrid technology involving whole slide imaging (WSI. Telepathology has been employed at the University of Pittsburgh Medical Center (UPMC for over a decade at local, national, and international sites. All modes of telepathology have been successfully utilized to exploit our institutions subspecialty expertise and to compete for pathology services. This article discusses the experience garnered at UPMC with each of these teleconsultation methods. Static and WSI telepathology systems have been utilized for many years in transplant pathology using a private network and client-server architecture. Only minor clinically significant differences of opinion were documented. In hematopathology, the CellaVision® system is used to transmit, via email, static images of blood cells in peripheral blood smears for remote interpretation. While live video streaming has remained the mode of choice for providing immediate adequacy assessment of cytology specimens by telecytology, other methods such as robotic microscopy have been validated and shown to be effective. Robotic telepathology has been extensively used to remotely interpret intra-operative neuropathology consultations (frozen sections. Adoption of newer technology and increased pathologist experience has improved accuracy and deferral rates in teleneuropathology. A digital pathology consultation portal ( was recently created at our institution to facilitate digital pathology second opinion consults, especially for WSI. The success of this web-based tool is the ability to handle vendor agnostic, large image files of digitized slides, and ongoing user-friendly customization for clients and teleconsultants. It is evident that the practice of telepathology at our institution has evolved in concert with advances in technology and user experience

  11. Experience with multimodality telepathology at the University of Pittsburgh Medical Center. (United States)

    Pantanowitz, Liron; Wiley, Clayton A; Demetris, Anthony; Lesniak, Andrew; Ahmed, Ishtiaque; Cable, William; Contis, Lydia; Parwani, Anil V


    Several modes of telepathology exist including static (store-and-forward), dynamic (live video streaming or robotic microscopy), and hybrid technology involving whole slide imaging (WSI). Telepathology has been employed at the University of Pittsburgh Medical Center (UPMC) for over a decade at local, national, and international sites. All modes of telepathology have been successfully utilized to exploit our institutions subspecialty expertise and to compete for pathology services. This article discusses the experience garnered at UPMC with each of these teleconsultation methods. Static and WSI telepathology systems have been utilized for many years in transplant pathology using a private network and client-server architecture. Only minor clinically significant differences of opinion were documented. In hematopathology, the CellaVision(®) system is used to transmit, via email, static images of blood cells in peripheral blood smears for remote interpretation. While live video streaming has remained the mode of choice for providing immediate adequacy assessment of cytology specimens by telecytology, other methods such as robotic microscopy have been validated and shown to be effective. Robotic telepathology has been extensively used to remotely interpret intra-operative neuropathology consultations (frozen sections). Adoption of newer technology and increased pathologist experience has improved accuracy and deferral rates in teleneuropathology. A digital pathology consultation portal ( was recently created at our institution to facilitate digital pathology second opinion consults, especially for WSI. The success of this web-based tool is the ability to handle vendor agnostic, large image files of digitized slides, and ongoing user-friendly customization for clients and teleconsultants. It is evident that the practice of telepathology at our institution has evolved in concert with advances in technology and user experience. Early and

  12. [Complications with peripherally inserted central catheters - observations and nursing experiences at one medical center in Chengdu]. (United States)

    Yue, Zhi-Ying; Li, Jun-Ying; Yu, Chun-Hua; Zhao, Shu-Zhen; Fu, Yan


    Its peripheral vein puncture point, safe insertion procedure and high rate of success have made the peripherally inserted central catheter (PICC) a particularly suitable medical device for cancer patients who require long-term intravenous chemotherapy. PICC can help avoid the pain of repeat punctures as well as reduce incidence of cytotoxic drug extravasation-induced phlebitis and tissue necrosis. With PICC, patient activity is not limited, which improves quality of life. This paper reported on complications and subsequent nursing care provided to 400 cancer patients who received PICC in our center between September 2007 and October 2008. A total of 395 cases had successful PICC insertion on the first attempt and 5 cases achieved success immediately following the second insertion attempt (overall success rate: 98.8%). The average catheter dwell-in time was 122 days (range 2-350 days), during which time no patient required repeat puncture. During the insertion process, arrhythmia occurred in 1.5% (6/400), difficult catheter propelling in 3.75% (15/400), and excessive oozing of blood in 0.3% (1/400) of subjects. During the catheter dwell-in period, sensitizing dermatitis occurred in 8% (38/400), mechanical phlebitis in 7.5% (30/400), catheter occlusion in 9.5% (38/400) (including 2% [8/400] complete and 7.5% [30/400] partial occlusions), catheter associated hematogenous infection in 3% (12/400) and venous thrombosis in 2% (8/400) of subjects. All complications were well controlled with active and effective management. In conclusion, the safety of PICC can be maximized and complications reduced when nurses fully evaluate patients prior to their operation, strictly adhere to PICC operating guidelines, detect complications early, and manage problems promptly.

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

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    Dietrich eLehmann‡


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

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

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    Amin Talebi BezminAbadi


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

  15. A historical perspective on the University of Nebraska Medical Center's College of Dentistry Class of 1961. (United States)

    Willis, Mary S; Badakhsh, Roshan A


    We conducted a retrospective analysis of the University of Nebraska Medical Center (UNMC) College of Dentistry (COD) Class of 1961 to glean information that might be useful in the design of dental education programs in Nebraska and elsewhere. We scanned annual class newsletters, demographic statistics for students entering the UNMC dental program for each decade from 1961 to 2001, and UNMC COD alumni data for patterns and themes among thirty-two dental professionals. Eighty-four percent of those contacted provided responses to a survey. We found that, like current dental cohorts nationwide, the UNMC COD Class of 1961 is mostly of European ancestry (non-Hispanic) and male. But in contrast to current dental college graduates, the UNMC Class of '61 were able to rely upon self-employment and spousal and/or military support (GI Bill) to cover the costs of their dental education. They also were more likely to enter dental school before completion of an undergraduate degree and have a substantial work history before entering the UNMC dental program. Although the most common reason for attending dental school related to independence and financial security, "time with family" and "family vacations" were the next most important reasons cited for becoming dental professionals. Among '61 graduates, the average number of years spent in the dental profession is thirty-seven years. Despite the notable changes in dental technology and the continual need for updating knowledge and skill, eight members of the UNMC COD Class of 1961 continue to practice dentistry. Most maintain contact with other class members, providing support to former classmates and maintaining an identity with their alma mater, the University of Nebraska.

  16. An evaluation of snake bites and antivenin use at a regional medical center. (United States)

    Watson, Larry I; Spivey, Christy; Menon, Cen Rema; Kotwall, Cyrus A; Clancy, Thomas V; Hope, William W


    Snake bites are a rare but challenging problem for surgeons. The purpose of our study was to evaluate our experience with snake bites at a regional medical center. We reviewed patients treated for snake bites from 2004 to July 2008. Demographics, clinical information, and outcomes were documented. Descriptive statistics were used, and chi2, t test, and Fisher exact test were used to compare patients based on antivenin use. A P value < 0.05 was considered significant. Over the study period, 126 patients presented to the emergency department with 44 (35%) requiring hospital admission. The average age was 38 years (range, 2 to 76 years); 66 per cent were male and 95 per cent white. Bites most commonly occurred in the summer and fall months with none from December through March. Copperhead bites accounted for 50 per cent of bites. An average of 4.8 vials of antivenin was given to 61 per cent of admitted patients with 93 per cent receiving the drug within 6 hours. Minor reactions to antivenin occurred in three patients (11%). Two patients required surgery (5%), and the readmission rate was 7 per cent. There was no known morbidity or mortality. When comparing patients who received antivenin with patients who did not, the only significant clinical variables were an increased prothrombin time (12.1 vs. 11.7, respectively; P = 0.048) and a longer length of hospital stay (3 vs. 1.8 days, P = 0.0006) in patients receiving antivenin. The majority of patients with snake bites can be treated with supportive care and antivenin when indicated. Antivenin use at our institution is largely based on physical findings and not related to laboratory values.

  17. Tumors of the liver; a ten year study in Children Medical Center

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    Farahmand F


    Full Text Available Background: The aim of this study was to review the frequency, histopathology and outcome in children with tumors of the liver. Methods: Included in this retrospective/descriptive study were 30 children treated for liver tumors from 1375-1384 (ca. 1996-2005, at Children’s Hospital Medical Center, Tehran, Iran. We included the clinical, radiologic, and pathologic data of our patients, focusing on the frequency, etiology and outcome. Results: Patient ages ranged from three months to 12 years (median 3.8 years, with 18 males (60% and 12 females (40%. Of these, 17 patients had hepatoblastoma (55.66%, including 13 males and four females, with an age range of six months to five years. Four cases (13.33% had neuroblastoma. Hepatocellular carcinoma (HCC was found in three cases (10%, all of whom were carriers of hepatitis B. Two cases (6.66% were diagnosed with mesenchymal hamartoma, two cases (6.66% with hemangioendothelioma and two cases (6.66% with rhabdomyosarcoma and leiomyosarcoma of the biliary tract. Abdominal swelling and hepatomegaly were seen in all of patients. Jaundice was observed in two cases. Serum alpha-fetoprotein levels greater than 500 ng/ml were seen in 17 cases (56.66%. All patients were receiving specific treatment. The three-year survival rate was 65% for hepatoblastoma and 2% for HCC Conclusion: With the introduction of specific treatment, the survival rate for children with tumors of the liver has significantly increased. Further improvement can be achieved using diagnostic biopsy for hepatoblastoma, although it may result in complications, and preoperative chemotherapy followed by complete surgical excision (per International Society of Pediatric Oncology guidelines, yielding an outstanding survival rate of 80%.

  18. Continuity in a VA patient-centered medical home reduces emergency department visits.

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    Krisda H Chaiyachati

    Full Text Available One major goal of the Patient-Centered Medical Home (PCMH is to improve continuity of care between patients and providers and reduce the utilization of non-primary care services like the emergency department (ED.To characterize continuity under the Veterans Health Administration's PCMH model--the Patient Aligned Care Team (PACT, at one large Veterans Affair's (VA's primary care clinic, determine the characteristics associated with high levels of continuity, and assess the association between continuity and ED visits.Retrospective, observational cohort study of patients at the West Haven VA (WHVA Primary Care Clinic from March 2011 to February 2012.The 13,495 patients with established care at the Clinic, having at least one visit, one year before March 2011.Our exposure variable was continuity of care--a patient seeing their assigned primary care provider (PCP at each clinic visit. The outcome of interest was having an ED visit.The patients encompassed 42,969 total clinic visits, and 3185 (24% of them had 15,458 ED visits. In a multivariable logistic regression analysis, patients with continuity of care--at least one visit with their assigned PCP--had lower ED utilization compared to individuals without continuity (adjusted odds ratio [AOR] 0.54; 95% CI: 0.41, 0.71, controlling for frequency of primary care visits, comorbidities, insurance, distance from the ED, and having a trainee PCP assigned. Likewise, the adjusted rate of ED visits was 544/1000 person-year (PY for patients with continuity vs. 784/1000 PY for patients without continuity (p = 0.001. Compared to patients with low continuity (50% continuity were less likely to utilize the ED.Strong continuity of care is associated with decreased ED utilization in a PCMH model and improving continuity may help reduce the utilization of non-primary care services.

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

    Directory of Open Access Journals (Sweden)

    HamidReza Mirzaee


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

  20. The drug thief at Georgetown University Medical Center: anatomy of a $2 billion class-action lawsuit. (United States)


    Separate lawsuits filed on behalf of plaintiff patients at Georgetown University Medical Center, Washington, DC, have been consolidated under a District of Columbia judge who is scheduled to rule soon on whether to certify them as a class-action suit against the medical center. The case involves a drug-abusing worker in the interventional radiology unit at Georgetown University Hospital who may have exposed up to 500 patients to HIV, hepatitis, and other viruses during his period of employment from September 8, 1999 to February 2, 2000. The lawsuits allege that the med center failed to protect patients by not adopting American Hospital Association guidelines that call for universal pre-employment drug screening. The hospital currently is in the final stages of being sold to Medstar Health, Columbia, MD, which may eventually change the drug-screening policy. The episode not only has been embarrassing for the prestigious medical center, but also has focused attention on the potential consequences for hospitals that do not screen employees for drug use.

  1. Model for a merger: New York-Presbyterian's use of service lines to bring two academic medical centers together. (United States)

    Corwin, Steven J; Cooper, Mary Reich; Leiman, Joan M; Stein, Dina E; Pardes, Herbert; Berman, Michael A


    NewYork-Presbyterian Hospital is the result of the 1998 merger of two large New York City academic medical centers, the former New York and Presbyterian Hospitals, and is affiliated with two independent medical schools, the Columbia University College of Physicians and Surgeons and the Joan and Sanford J. Weill Medical College of Cornell University. At the time of the merger, the hospital faced a number of significant challenges, chief among them the clinical integration of the two medical centers. Size, separate medical schools, geography, and different histories and cultures all presented barriers to collaboration. To bring about the needed clinical alignment, the hospital turned to service lines as a way to realize the benefits of clinical integration without forcing the consolidation of departments. In this article, members of the hospital's senior management review the thinking behind the hospital's use of the service lines, their development and operation, and the significant, positive effects they have had on volume, clinical quality, clinical efficiency, best practices, and revenue management. They discuss how the service lines were used to bring together the two clinical cultures, the impact they have had on the way the hospital is operated and managed, and why service lines have worked at NewYork-Presbyterian in contrast to other hospitals that tried and abandoned them. Service lines play an increasingly central role in the hospital's clinical and business strategies, and are being extended into the NewYork-Presbyterian health care system.

  2. Effects of internal marketing on nurse job satisfaction and organizational commitment: example of medical centers in Southern Taiwan. (United States)

    Chang, Ching-Sheng; Chang, Hsin-Hsin


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

  3. Toward integrated laser-driven ion accelerator systems at the photo-medical research center in Japan

    Energy Technology Data Exchange (ETDEWEB)

    Bolton, P.R., E-mail: bolton.paul@jaea.go.j [Photo-Medical Research Center, Japan Atomic Energy Agency, 8-1-7 Umemidai Kizugawa-shi, Kyoto 619-0215 (Japan); Hori, T.; Kiriyama, H.; Mori, M.; Sakaki, H. [Photo-Medical Research Center, Japan Atomic Energy Agency, 8-1-7 Umemidai Kizugawa-shi, Kyoto 619-0215 (Japan); Sutherland, K. [Hokkaido University, School of Medicine, Sapporo-shi, Kita-ku, Kita 12 Jo, Nishi 5 Chome 060-0812 (Japan); Suzuki, M. [Photo-Medical Research Center, Japan Atomic Energy Agency, 8-1-7 Umemidai Kizugawa-shi, Kyoto 619-0215 (Japan); Wu, J. [SLAC National Accelerator Laboratory, Stanford University, Menlo Park, CA (United States); Yogo, A. [Photo-Medical Research Center, Japan Atomic Energy Agency, 8-1-7 Umemidai Kizugawa-shi, Kyoto 619-0215 (Japan)


    Goals and early progress at the Photo-Medical Research Center are summarized. Laser-driven ion beam radiotherapy can require compact repetition-rated laser systems with peak powers approaching the PW level. Laser development at PMRC is outlined. Our parallel experimental and simulation efforts aimed at the development of a prototype ion beamline as an integrated laser-driven ion accelerator system are presented. In addition some of our first medical and radiobiological experimental investigations, proton-induced double strand breaking in human cancer cells and simulations of optimum dose distributions for ocular melanoma are discussed. Recommended components of a balanced and comprehensive PMRC agenda are given.

  4. Nurses’ knowledge of blood transfusion in medical training centers of Shahrekord University of Medical Science in 2004


    Aslani, Yosef; Etemadyfar, Shahram; Noryan, Kobra


    BACKGROUND: Using blood and blood components is a common therapeutic procedure in hospitals. Nurses have an important role in a safe blood transfusion. Therefore, it is crucial for nurses to have sufficient knowledge of situations, amount and methods of using blood components, possible side effects and necessary cares. This study investigated nurses’ knowledge of blood transfusion. METHODS: This was a cross-sectional descriptive study on 117 nurses in medical training hospitals of Shahrekord ...

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

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


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

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

    CERN Document Server

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


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

  7. An analysis of clinical process measures for acute healthcare delivery in Appalachia: The Roane Medical Center experience


    Sills Eric; Hancock John S; Pope Karla


    Abstract Objective To survey management of selected emergency healthcare needs in a Tennessee community hospital. Materials and methods In this descriptive report, discharges and associated standard process measures were retrospectively studied for Roane Medical Center (RMC) in Harriman, Tennessee (pop. 6,757). Hospital data were extracted from a nationwide database of short-term acute care hospitals to measure 16 quality performance measures in myocardial infarction (MI), heart failure, and ...

  8. The Development of a Total Quality Management Plan for David Grant USAF Medical Center Travis Air Force Base, California (United States)


    Ralston, F. (Summer, 1984). Total quality management: A revolutionary management philosophy. S.A.M. Advanced Management Journal , 24-33. Ryan, M. 3...Care" that appeared in the 5 January 1989 edition of The New England Journal of Medicine. In this article he lists six steps that lead to continuous...pathology, endodontics, pediatrics, periodontics, and prosthodontics . In addition to the basic allied specialties, David Grant USAF Medical Center

  9. AMEDD Clinical Psychology Short Course Held at Madigan Army Medical Center, in Tacoma, Washington on 13-17 June 1988 (United States)


    medical care (such as high-risk newborns or patients who have recently had cancer surgery) should be enrolled. D. Any patient requiring even a minimal...the Memorial Sloan-Kettering Cancer Center. In 1986, they reported a prospective study of 121 AIDS patients who were followed over the course of...valued, while behaving in a " childish " fashion is not (Harter, 1983, pp. 275-385). In a satirical article The EtioloQgy and Treatment of Childhood

  10. Defense Infrastructure: Documentation Lacking to Fully Support How DOD Determined Specifications for the Landstuhl Replacement Medical Center (United States)


    additional environmental and efficiency features into the design of the replacement medical center and expects to exceed the U.S. Green Building Council’s...Leadership in Energy and Environmental Design (LEED) green building standards, which have been adopted by several federal agencies.25 The...benchmark for the design, construction, and operation of high-performance green buildings, according to the nonprofit U.S. Green Building Council

  11. A decade of building massage therapy services at an academic medical center as part of a healing enhancement program. (United States)

    Rodgers, Nancy J; Cutshall, Susanne M; Dion, Liza J; Dreyer, Nikol E; Hauschulz, Jennifer L; Ristau, Crystal R; Thomley, Barb S; Bauer, Brent A


    The use of complementary and integrative medicine therapies is steadily becoming an integral part of health care. Massage therapy is increasingly offered to hospitalized patients for various conditions to assist with the management of common symptoms such as pain, anxiety, and tension. This article summarizes a decade of building the massage therapy service at a large tertiary care medical center, from the early pilot studies and research to the current program offerings, and the hopes and dreams for the future.

  12. Empirical Study of the Construction of Distributing Center of Northeast Asia in Hunchun%关于珲春构建东北亚贸易集散地的现实论证

    Institute of Scientific and Technical Information of China (English)

    赵月峰; 孙书洋


    周边国家对图们江区域合作开发的支持以及珲春独特的区位优势、较为完备的现实基础、繁荣的对外贸易是其构建东北亚贸易集散地的有利条件。相关国家经济发展目标和政策差异,朝鲜半岛及相关国家政治形势的变化起伏是制约珲春构建东北亚贸易集散地的重要变量。珲春只有善于利用现实的有利条件,正确面对和克服不利因素,才能成为东北亚贸易集散地。%Hunchun has favorable conditions to construct a distributing center of Northeast Asia with the support of neighboring countries in the regional cooperation of Tumen River and its unique geographical advantages,sufficient facilities as well as prosperous foreign trades.However,different economic targets and policies of countries concerned and the changing political situations on Korean Peninsular as well as in relevant countries can greatly influence the construction.Only by utilizing the favorable conditions and overcoming the disadvantages,a distributing center of Northeast Asia could be constructed in Hunchun.


    Directory of Open Access Journals (Sweden)

    Lyubomira Koeva-Dimitrova


    Full Text Available The production and financial performance of one company depend on the size of its assets and the aptness of the assets� proportion. The aim of this article is urged to make an external analysis of the asset structure of medical diagnostic and consultative centers (DCC in Varna and on this basis to draw conclusions regarding their property structure. Subject of the study is the annual financial statements, published in the Commercial Register, of all 9 in number DCCs that are registered in Varna. The names of DCC's are encoded with numbers from 1 to 9, with numbers from 1 to 7 are 6 DCCs, owned by the Municipality of Varna, one of them is a subsidiary of staterun hospital, with number 8 and 9 are private DCC's. Subject of the study are the assets and their proportion in the studied hospitals. The study covers 7 years - from year 2008 to year 2014. In the study are calculated and compared the indicators for intensity of the property as well as the relative share of the fixed assets obtained as an average value of the relative shares of all nine in number hospitals for the entire studied period. The following important conclusions have been made: 1 The average relative share of fixed assets of Varna DCCs for the period 2008 � 2014 is 56.85%. 2 The proportion of FA calculated only for municipal DCC's (average value is significantly higher - 72.75% compared to the overall average of 56.85%. 3 Private hospitals invest a lot less money in fixed assets than the municipal ones. 4 Since 2013 there is a slight increase of FA share in the private and the state-run DCC, and a slight decrease in the municipal ones (71.93. 5 The creation of an online database comprising of average indicators of the financial and property status of Bulgarian companies is essential and necessary condition for improving their competitiveness by providing reliable, accurate and usable information for comparison.

  14. David Grant Medical Center energy use baseline and integrated resource assessment

    Energy Technology Data Exchange (ETDEWEB)

    Richman, E.E.; Hoshide, R.K.; Dittmer, A.L.


    The US Air Mobility Command (AMC) has tasked Pacific Northwest Laboratory (PNL) with supporting the US Department of Energy (DOE) Federal Energy Management Program's (FEMP) mission to identify, evaluate, and assist in acquiring all cost-effective energy resource opportunities (EROs) at the David Grant Medical Center (DGMC). This report describes the methodology used to identify and evaluate the EROs at DGMC, provides a life-cycle cost (LCC) analysis for each ERO, and prioritizes any life-cycle cost-effective EROs based on their net present value (NPV), value index (VI), and savings to investment ratio (SIR or ROI). Analysis results are presented for 17 EROs that involve energy use in the areas of lighting, fan and pump motors, boiler operation, infiltration, electric load peak reduction and cogeneration, electric rate structures, and natural gas supply. Typical current energy consumption is approximately 22,900 MWh of electricity (78,300 MBtu), 87,600 kcf of natural gas (90,300 MBtu), and 8,300 gal of fuel oil (1,200 MBtu). A summary of the savings potential by energy-use category of all independent cost-effective EROs is shown in a table. This table includes the first cost, yearly energy consumption savings, and NPV for each energy-use category. The net dollar savings and NPV values as derived by the life-cycle cost analysis are based on the 1992 federal discount rate of 4.6%. The implementation of all EROs could result in a yearly electricity savings of more than 6,000 MWh or 26% of current yearly electricity consumption. More than 15 MW of billable load (total billed by the utility for a 12-month period) or more than 34% of current billed demand could also be saved. Corresponding natural gas savings would be 1,050 kcf (just over 1% of current consumption). Total yearly net energy cost savings for all options would be greater than $343,340. This value does not include any operations and maintenance (O M) savings.

  15. David Grant Medical Center energy use baseline and integrated resource assessment

    Energy Technology Data Exchange (ETDEWEB)

    Richman, E.E.; Hoshide, R.K.; Dittmer, A.L.


    The US Air Mobility Command (AMC) has tasked Pacific Northwest Laboratory (PNL) with supporting the US Department of Energy (DOE) Federal Energy Management Program`s (FEMP) mission to identify, evaluate, and assist in acquiring all cost-effective energy resource opportunities (EROs) at the David Grant Medical Center (DGMC). This report describes the methodology used to identify and evaluate the EROs at DGMC, provides a life-cycle cost (LCC) analysis for each ERO, and prioritizes any life-cycle cost-effective EROs based on their net present value (NPV), value index (VI), and savings to investment ratio (SIR or ROI). Analysis results are presented for 17 EROs that involve energy use in the areas of lighting, fan and pump motors, boiler operation, infiltration, electric load peak reduction and cogeneration, electric rate structures, and natural gas supply. Typical current energy consumption is approximately 22,900 MWh of electricity (78,300 MBtu), 87,600 kcf of natural gas (90,300 MBtu), and 8,300 gal of fuel oil (1,200 MBtu). A summary of the savings potential by energy-use category of all independent cost-effective EROs is shown in a table. This table includes the first cost, yearly energy consumption savings, and NPV for each energy-use category. The net dollar savings and NPV values as derived by the life-cycle cost analysis are based on the 1992 federal discount rate of 4.6%. The implementation of all EROs could result in a yearly electricity savings of more than 6,000 MWh or 26% of current yearly electricity consumption. More than 15 MW of billable load (total billed by the utility for a 12-month period) or more than 34% of current billed demand could also be saved. Corresponding natural gas savings would be 1,050 kcf (just over 1% of current consumption). Total yearly net energy cost savings for all options would be greater than $343,340. This value does not include any operations and maintenance (O&M) savings.

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

    Directory of Open Access Journals (Sweden)

    Matthew D Krasowski


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

  17. The volume and mix of inpatient services provided by academic medical centers. (United States)

    Moy, E; Valente, E; Levin, R J; Bhak, K J; Griner, P F


    This is the first in a series of AAMC Papers that analyze the clinical spectrum of patients treated in the nation's teaching hospitals. As stated in the separate Introduction, "The Transformation of Data into Knowledge," subsequent papers will examine trends in the provision of care to the indigent and make comparisons of quality of care among teaching and non-teaching hospitals. These analyses, carried out by the AAMC's Center for the Assessment and Management of Change in Academic Medicine (CAMCAM), are made possible by a reorganization of the AAMC's information infrastructure, in which many formerly separate databases have been linked. The Introduction concludes with a description of specific AAMC-CAMCAM initiatives that are being planned. This initial analysis examines the volume and mix of clinical services provided by AMCs, examines trends in these services over time, and compares services provided at different AMCs, in different markets, and between AMCs and non-teaching hospitals. Data from a variety of sources were used in these secondary analyses. The American Hospital Association's Annual Survey of Hospitals database was used to analyze volumes of inpatient services provided in AMCs and other hospitals. The AAMC's Clinical-Administrative Data Service database was used to analyze the volume and mix of clinical services provided in individual AMCs. The Agency for Health Care Policy and Research's Nationwide Inpatient Sample was used to compare the mix of clinical services provided in AMCs and other hospitals. Volumes of inpatient services in AMCs changed little between 1991 and 1994 and totaled six million hospitalizations, 41 million inpatient days, and two million inpatient surgeries in 1994. The mix of inpatient services in AMCs also showed little variation over time among individual AMCs, in markets with both high and low managed care penetrations, between public and private AMCs, or between AMCs and non-teaching hospitals, with the ten most frequent

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

    Institute of Scientific and Technical Information of China (English)

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


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

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

    Energy Technology Data Exchange (ETDEWEB)

    Khosrow Behbehani


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

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

    Institute of Scientific and Technical Information of China (English)

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


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

  1. Family-centered rounds and medical student performance on the NBME pediatrics subject (shelf) examination: a retrospective cohort study (United States)

    Kimbrough, Tiffany N.; Heh, Victor; Wijesooriya, N. Romesh; Ryan, Michael S.


    Objective To determine the association between family-centered rounds (FCR) and medical student knowledge acquisition as assessed by the National Board of Medical Examiners (NBME) pediatric subject (shelf) exam. Methods A retrospective cohort study was conducted of third-year medical students who graduated from Virginia Commonwealth University School of Medicine between 2009 and 2014. This timeframe represented the transition from ‘traditional’ rounds to FCR on the pediatric inpatient unit. Data collected included demographics, United States Medical Licensing Examination (USMLE) Step 1 and 2 scores, and NBME subject examinations in pediatrics (PSE), medicine (MSE), and surgery (SSE). Results Eight hundred and sixteen participants were included in the analysis. Student performance on the PSE could not be statistically differentiated from performance on the MSE for any year except 2011 (z-score=−0.17, p=0.02). Average scores on PSE for years 2009, 2010, 2013, and 2014 were significantly higher than for SSE, but not significantly different for all other years. The PSE was highly correlated with USMLE Step 1 and Step 2 examinations (correlation range 0.56–0.77) for all years. Conclusions Our results showed no difference in PSE performance during a time in which our institution transitioned to FCR. These findings should be reassuring for students, attending physicians, and medical educators. PMID:27087016

  2. Family-centered rounds and medical student performance on the NBME pediatrics subject (shelf examination: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Tiffany N. Kimbrough


    Full Text Available Objective: To determine the association between family-centered rounds (FCR and medical student knowledge acquisition as assessed by the National Board of Medical Examiners (NBME pediatric subject (shelf exam. Methods: A retrospective cohort study was conducted of third-year medical students who graduated from Virginia Commonwealth University School of Medicine between 2009 and 2014. This timeframe represented the transition from ‘traditional’ rounds to FCR on the pediatric inpatient unit. Data collected included demographics, United States Medical Licensing Examination (USMLE Step 1 and 2 scores, and NBME subject examinations in pediatrics (PSE, medicine (MSE, and surgery (SSE. Results: Eight hundred and sixteen participants were included in the analysis. Student performance on the PSE could not be statistically differentiated from performance on the MSE for any year except 2011 (z-score=−0.17, p=0.02. Average scores on PSE for years 2009, 2010, 2013, and 2014 were significantly higher than for SSE, but not significantly different for all other years. The PSE was highly correlated with USMLE Step 1 and Step 2 examinations (correlation range 0.56–0.77 for all years. Conclusions: Our results showed no difference in PSE performance during a time in which our institution transitioned to FCR. These findings should be reassuring for students, attending physicians, and medical educators.

  3. Medical Mysteries: NIH Clinical Center: There's No Other Hospital Like It (United States)

    ... clinician-scientists. The innovative curriculum includes courses in pharmacology, principles and practice of clinical research, and bioethics. ... health,” says Dr. Gallin. Read More "Medical Mysteries" Articles The NIH Undiagnosed Diseases Program / “Thankful They Found ...

  4. [Computerized medical register of venous thromboembolic disease at the Grenoble University Hospital Center: description and evaluation]. (United States)

    Michoud, E; Bosson, J L; Pichot, O; Vidal, F; Rossignol, S; Schwartzmann, J; Carpentier, P H


    The number of vascular exams for venous thromboembolic disease increases dramatically in the vascular medicine unit at the Grenoble University Hospital (France). In order to improve the efficiency and the homogeneity of all the medical staff involved, a computerized register has been created. It automatically provides a letter for the prescriber of the consultation. This database, working on a computer network, has three main functions: office automation (medical folder, report), education, and clinical research. The office automation evaluation is performed after a 6 month experience, comparing 100 medical reports about venous thrombosis assisted by the computer to 100 medical reports written before the installation of the system. The introduction of digitized register is real, still this evaluation has induced some modification in the system in order to be more efficient.

  5. The effect of organizational climate on patient-centered medical home implementation. (United States)

    Reddy, Ashok; Shea, Judy A; Canamucio, Anne; Werner, Rachel M


    Organizational climate is a key determinant of successful adoption of innovations; however, its relation to medical home implementation is unknown. This study examined the association between primary care providers' (PCPs') perception of organization climate and medical home implementation in the Veterans Health Administration. Multivariate regression was used to test the hypothesis that organizational climate predicts medical home implementation. This analysis of 191 PCPs found that higher scores in 2 domains of organizational climate (communication and cooperation, and orientation to quality improvement) were associated with a statistically significantly higher percentage (from 7 to 10 percentage points) of PCPs implementing structural changes to support the medical home model. In addition, some aspects of a better organizational climate were associated with improved organizational processes of care, including a higher percentage of patients contacted within 2 days of hospital discharge (by 2 to 3 percentage points) and appointments made within 3 days of a patient request (by 2 percentage points).

  6. NHSC Jobs Center for Primary Care Medical, Dental and Mental Health Providers (United States)

    U.S. Department of Health & Human Services — The National Health Service Corps (NHSC) Jobs Center helps doctors and nurses who are interested in working at areas where there is the highest need find out more...

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

    Directory of Open Access Journals (Sweden)

    Xiaoming Sun

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

  8. Faecal incontinence and health related quality of life in inflammatory bowel disease patients: Findings from a tertiary care center in South Asia (United States)

    Subasinghe, Duminda; Navarathna, Navarathna Mudiyanselage Meththananda; Samarasekera, Dharmabandhu Nandadeva


    AIM: To analyze the frequency and severity of faecal incontinence (FI) and its effect on the quality of life (QOL) in inflammatory bowel disease (IBD) patients. METHODS: All patients who attended surgical and medical gastroenterology outpatient clinics in a tertiary care center with an established diagnosis of either ulcerative colitis (UC) or Crohn’s disease (CD) over a period of 10 mo were included in this study. Before enrollment into the study, the patients were explained about the study and informed consent was obtained. The patients with unidentified colitis were excluded. The data on demographics, disease characteristics, FI (Vaizey score), and quality of life (IBD-Q) were collected. Data were analyzed using SPSS version 21. RESULTS: There were 184 patients (women = 101, 54.9%; UC = 153, 83.2%) with a female preponderance for UC (male/female ratio = 1:1.5) and a male preponderance for CD (male/female = 2:1). Forty-eight (26%) patients reported symptoms of FI. Among the patients with FI, 70.8% were women (n = 34) and 29.2% were men (n = 14) with an average age of 52.7 years (range, 20-78 years). Average age of onset of FI was 48.6 (range, 22-74) years. Ten percent (n = 5) reported regular FI. Incontinence to flatus was seen in 33.3% (n = 16), to liquid faeces in 56.2% (n = 27), to solid faeces in 6.2% (n = 3) and to all three in 4.1% (n = 2). Twenty-one percent (n = 10) complained of disruption of their physical and social activity. There was no association between FI and type of IBD. Significant associations were found between FI and age (P = 0.005) and gender (P < 0.001). QOL in our cohort of patients was significantly affected by FI. CONCLUSION: In our study, nearly a quarter of patients reported FI. There was a significant correlation between FI and QOL. Therefore, enquiring about FI in IBD patients can lead to identification of this debilitating condition. This will enable early referral for continence care in this group of patients. PMID:27602247

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

    Directory of Open Access Journals (Sweden)

    Thomas Rotthoff


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

  10. New Dimensions in Patient–Physician Interaction: Values, Autonomy, and Medical Information in the Patient-Centered Clinical Encounter (United States)

    Agarwal, Aakash Kumar; Murinson, Beth Brianna


    Patient–physician interactions are increasingly influenced by the extraordinary diversification of populations and rapid expansion of medical knowledge that characterize our modern era. By contrast, the patient–physician interaction models currently used to teach medical trainees have little capacity to address these twin challenges. We developed a new model of patient–physician interaction to explicitly address these problems. Historically, models of patient–physician interaction viewed patient autonomy and the manifestation of clearly defined health care-related values as tightly linked, and it was assumed that patients’ medical knowledge was low. Unfortunately, this does not adequately represent patients such as 1) the highly educated non-medical specialist who possesses little familiarity with health-related values but is highly autonomous, and 2) the patient from a non-Western background who may have well-established health care-related values but a low sense of personal independence. In addition, it is evident to us that the assumption that all patients possess little medical knowledge can create alienation between patient and physician, e.g. the well-informed patient with a rare disease. We propose a paradigm that models autonomy, health care-related values formation, and medical knowledge as varying from patient to patient. Four examples of patient types are described within the context of the model based on clinical experience. We believe that adopting this model will have implications for optimizing patient–physician interactions and teaching about patient-centered care. Further research is needed to identify relevant patient types within this framework and to assess the impact on health care outcomes. PMID:23908841

  11. Acute inpatient palliative medicine in a cancer center: clinical problems and medical interventions--a prospective study. (United States)

    Lagman, Ruth; Rivera, Nilo; Walsh, Declan; LeGrand, Susan; Davis, Mellar P


    The clinical characteristics and medical interventions of the 100 consecutive cancer admissions to the acute care inpatient palliative medicine unit at the Cleveland Clinic for 2 months are described. Median age was 62 years (range, 31 to 92 years). The male-female ratio was 1:1. Most admissions were referred by hematology-oncology and had prior antineoplastic therapy. Reasons for admission were symptom control and cancer-related complications. Patients underwent invasive diagnostic and therapeutic procedures, hydration, transfusions, radiation, or chemotherapy, or a combination, during their admission. Most were discharged home with hospice care or had outpatient clinic follow-up. The mortality rate was 20%. Aggressive multidisciplinary management of symptoms, disease complications, comorbid conditions, and psychosocial problems were provided. Palliative medicine physicians provided continuity of care in the outpatient clinic and at home. An acute inpatient palliative medicine unit within a tertiary level medical center has a definable and important role in comprehensive cancer care.

  12. A systematic strategic planning process focused on improved community engagement by an academic health center: the University of Kansas Medical Center's story. (United States)

    Cook, David C; Nelson, Eve-Lynn; Ast, Cori; Lillis, Teresa


    A growing number of academic health centers (AHCs) are considering approaches to expand collaboration with their communities in order to address complex and multisystem health concerns. In 2010, internal leaders at the University of Kansas Medical Center undertook a strategic planning process to enhance both community engagement activities and the scholarship resulting from these engagement activities. The authors describe the strategic planning process, recommendations, and actions associated with elevating community engagement within the AHC's mission and priorities. The strategic planning process included conducting an inventory of community engagement activities within the AHC; analyzing strengths, weaknesses, opportunities, and threats for community engagement work; and identifying goals and strategies to improve future community engagement activities and scholarship. The resulting road map for enhancing community engagement at their institution through 2015 consists of four main strategies: emphasize scholarship in community engagement, revise organizational structures to better facilitate community engagement, prioritize current engagement activities to ensure appropriate use of resources, and enhance communication of engagement initiatives to further develop stakeholder relationships.The authors also discuss implementation of the plan to date and highlight lessons learned that may inform other AHCs as they enhance and expand similar endeavors.

  13. 76 FR 59407 - Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and... (United States)


    ... study methods. Provided objective and evaluable data. For skin test data in the studies: Obtained... scientific and medical literature and other data sources for each extract in order to identify those studies that used acceptable alternative testing methods. FDA also collected information from studies...

  14. 76 FR 71045 - Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and... (United States)


    ... Scientific and Medical Literature and Information on Non-Standardized Allergenic Extracts in the Diagnosis... literature and information concerning the use of non- standardized allergenic extracts in the diagnosis and... Literature and Information on Non-Standardized Allergenic Extracts in the Diagnosis and Treatment of...

  15. Report of chronic myeloid leukemia from Indira Gandhi Institute of Medical Sciences, Regional Cancer Center, 2002-2009. (United States)

    Prasad, Rajiv Ranjan; Singh, Pritanjali


    Indira Gandhi Institute of Medical Sciences, Regional Cancer Center was established in 1993. It's one of the main Health-Care Institution in the state of Bihar. The data of 205 patients was presented in the ICON meeting and 98% of patients were diagnosed in chronic phase. Complete hematological response was seen in 91% of patients in 3 months. A total of 197 (96%) patients were alive at the time of analysis of which 179 (87%) were still in chronic phase with hematological remission.

  16. [New perspective in liaison psychiatry. Experience at the Pediatric Hospital of the National Medical Center Siglo XXI]. (United States)

    Sauceda García, J M; Maldonado Durán, J M; Angel Montoya Cabrera, M


    In hospitalized and chronically ill children, the prevalence of psychopathology is very high. It is necessary that in its prevention, diagnosis and treatment not only professionals of the mental health disciplines intervene but also that the pediatricians, nurses and the family of the patient himself participate actively. Consultation Liaison Child Psychiatry activities at the Pediatric Hospital of the National Medical Center "Siglo XXI" are described. Its goal is to incorporate the mental health professional to the team of hospital care and promote that pediatricians gain a greater conscience of psychological and social factors that are crucial for the sick child.

  17. 75 FR 6401 - Medical Devices Regulated by the Center for Biologics Evaluation and Research; Availability of... (United States)


    ... Evaluation and Research; Availability of Summaries of Safety and Effectiveness Data for Premarket Approval... safety and effectiveness data to the Division of Dockets Management (HFA-305), Food and Drug... the Center for Biologics Evaluation and Research (CBER). This list is intended to inform the public...

  18. Patient Centered Medical Home: Creating a Blueprint for Quality Healthcare through Illustrative Simulation (United States)

    Sheingold, Brenda Helen; Chapa, Deborah W.; Ekmekci, Ozgur; Emard, Esther


    The advent of healthcare reform in the U.S. presents an unprecedented challenge to academic institutions that are striving to prepare a workforce to interact with individuals needing care in a variety of new practice settings. Patient-centered care is a core objective of these evolving settings which enhance access to a variety professionals and…

  19. Sentinel node biopsy for early-stage oral cavity cancer: the VU University Medical Center experience

    NARCIS (Netherlands)

    Den Toom, I.J.; Heuveling, D.A.; Flach, G.B.; van Weert, S.; Karagozoglu, K.H.; van Schie, A.; Bloemena, E.; Leemans, C.R.; de Bree, R.


    Background Sentinel node biopsy (SNB) in head and neck cancer is recently introduced as the staging technique of oral squamous cell carcinoma. We report the results of SNB in patients diagnosed with a T1-T2 oral squamous cell carcinoma and clinically negative (N0) neck in a single center. Methods A

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

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


    Safe medication management and use of high-alert narcotics should arouse concern. Risk management experiences in this respect in a large-scale Joint Commission International (JCI)-accredited academic medical center hospital in the People's Republic of China during 2011-2015, focusing on organizational, educational, motivational, and information technological measures in storage, prescribing, preparing, dispensing, administration, and monitoring of medication are summarized. The intensity of use of meperidine in hospitalized patients in 2015 was one-fourth that in 2011. A 100% implementation rate of standard storage of narcotics has been achieved in the hospital since December 2012. A "Plan, Do, Check, Act" cycle was efficient because the ratio of number of inappropriate narcotics prescriptions to total number of narcotics prescriptions for inpatients decreased from August 2014 to December 2014 (28.22% versus 2.96%, P=0.0000), and it was controlled below 6% from then on. During the journey to good pain management ward accreditation by the Ministry of Health, People's Republic of China, (April 2012-October 2012), the medical oncology ward successfully demonstrated an increase in the pain screening rate at admission from 43.5% to 100%, cancer pain control rate from 85% to 96%, and degree of satisfaction toward pain nursing from 95.4% to 100% (all P-values <0.05). Oral morphine equivalent dosage in the good pain management ward increased from 2.3 mg/patient before June 2012 to 54.74 mg/patient in 2014. From 2011 to 2015, the oral morphine equivalent dose per discharged patient increased from 8.52 mg/person to 20.36 mg/person. A 100% implementation rate of independent double-check prior to narcotics dosing has been achieved since January 2013. From 2014 to 2015, the ratio of number of narcotics-related medication errors to number of discharged patients significantly decreased (6.95% versus 0.99%, P=0.0000). Taken together, continuous quality improvements have been

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

    Directory of Open Access Journals (Sweden)

    Fang X


    Full Text Available Xu Fang,1,2 Ling-ling Zhu,3 Sheng-dong Pan,4 Ping Xia,4 Meng Chen,5 Quan Zhou51Office of Hospital Administration, 2Office of Party and Administration Council, 3Geriatric VIP Care Ward, Division of Nursing, 4Division of Medical Administration, 5Department of Pharmacy, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of ChinaAbstract: Safe medication management and use of high-alert narcotics should arouse concern. Risk management experiences in this respect in a large-scale Joint Commission International (JCI-accredited academic medical center hospital in the People’s Republic of China during 2011–2015, focusing on organizational, educational, motivational, and information technological measures in storage, prescribing, preparing, dispensing, administration, and monitoring of medication are summarized. The intensity of use of meperidine in hospitalized patients in 2015 was one-fourth that in 2011. A 100% implementation rate of standard storage of narcotics has been achieved in the hospital since December 2012. A “Plan, Do, Check, Act” cycle was efficient because the ratio of number of inappropriate narcotics prescriptions to total number of narcotics prescriptions for inpatients decreased from August 2014 to December 2014 (28.22% versus 2.96%, P=0.0000, and it was controlled below 6% from then on. During the journey to good pain management ward accreditation by the Ministry of Health, People’s Republic of China, (April 2012–October 2012, the medical oncology ward successfully demonstrated an increase in the pain screening rate at admission from 43.5% to 100%, cancer pain control rate from 85% to 96%, and degree of satisfaction toward pain nursing from 95.4% to 100% (all P-values <0.05. Oral morphine equivalent dosage in the good pain management ward increased from 2.3 mg/patient before June 2012 to 54.74 mg/patient in 2014. From 2011 to 2015, the oral morphine

  2. Medical Services: Armed Forces Institute of Pathology and Armed Forces Histopathology Centers (United States)


    request additional material and data of special inter- est and importance for forwarding from the contributor on any patient. Legal medicine, forensic ...display: a. Gross specimens in the fields of medicine, dentistry , and veter- inary medicine. b. Exhibits on specific health topics or specific medical...Education for residency training in forensic pa- thology, neuropathology, and dermatopathology. (2) The AFIP has a residency program in veterinary

  3. Rehabilitation centers and their role in medical tourism development in latvia

    Directory of Open Access Journals (Sweden)

    Muiznieks A.


    Full Text Available The theme of the research is the possible development of rehabilitation centres in medical tourism. The paper analyses the financial situation of rehabilitation centres in Latvia, the correlation with economical situation in Latvia as well as the comparison of services and prices in Latvian and European rehabilitation centres. A visitors’ survey in order to investigate their satisfaction regarding services was conducted in the rehabilitation centre “Jaunkemeri”. The findings of the survey are summarized as guidelines (proposals for the development of Latvian rehabilitation centres in the context of medical tourism. The main research results are as follows: Latvian rehabilitation centres offer a wide variety of services, the prices of the services are competitive with European ones, and the clients are satisfied with the quality of services and believe that the quality corresponds with the price. However, Latvian rehabilitation centres depend on the economical situation of the country and its financial support, there is a lack of unified standards in Latvia, the Soviet infrastructure dominates and the leisure time activities are limited. The aim of the guidelines is to offer a solution of the problem regarding the possibility to develop rehabilitation centres in order to foster the medical tourism and the ways how to do it.


    Directory of Open Access Journals (Sweden)

    M. Haghi-Ashteiani


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

  5. Strong leadership and teamwork drive culture and performance change: Ohio State University Medical Center 2000-2006. (United States)

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


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

  6. Marital and job satisfaction among non-resident physicians at a Hispanic academic medical center, 2006-2007. (United States)

    Colón-de Martí, Luz N; Acevedo, Luis F; Céspedes-Gómez, Wayca R


    Marital satisfaction has been previously associated with job satisfaction although few studies have addressed this issue among Hispanic physicians. Marital and job satisfaction were assessed in a sample of 92 legally married non-residents physicians working at a Hispanic Academic Medical Center during the 2006-2007 academic year. Marital satisfaction was assessed using the Dyadic Adjustment Scale (DAS) and job satisfaction was measured using a 18-item scale. Response rate was 34.8%. Most (70.7%) of the subjects were males. Forty- five percent (45.0%) belonged to the surgical specialties group. The mean scale value for marital satisfaction was found to be in the average range. Almost all (88.7%) the participants reported being "satisfied "to "very satisfied" with their job. Ninety percent (90.0%) of the surgical specialists and 86.9% of the non-surgical specialists reported being satisfied with their job. The percentage of participants that reported to be "very satisfied" with their job, was higher among the group of surgical specialists (23.3%) than among the non-surgical specialists (13.0%) There was no significant relationship between marital satisfaction and job satisfaction. Also, no statistically significant difference was observed in the level of marital satisfaction and job satisfaction when surgical and non-surgical physicians were compared. The findings on marital satisfaction obtained in this sample were similar to those observed in a previous study of resident physicians at the same academic medical center.

  7. A survey of nuclear-related agreements and possibilities for nuclear cooperation in South Asia: Cooperative Monitoring Center Occasional Paper/15

    Energy Technology Data Exchange (ETDEWEB)



    Several existing nuclear-related agreements already require India and Pakistan, as members, to share information. The agreements are bilateral, regional, and international. Greater nuclear transparency between India and Pakistan could be promoted by first understanding the information flows required by existing agreements. This understanding is an essential step for developing projects that can incrementally advance the sensitivity of the information being shared. This paper provides a survey of existing nuclear-related agreements involving India and Pakistan, and suggests future confidence-building projects using the frameworks provided by these agreements. The Bilateral Agreement on the Prohibition of Attack against Nuclear Reactors and Nuclear Facilities is discussed as a basis for creating further agreements on restricting the use and deployment of nuclear weapons. The author suggests options for enhancing the value of the list of nuclear facilities exchanged annually as a part of this agreement. The International Atomic Energy Agency's regional cooperation agreement among countries in the Asia-Pacific region is an opportunity for greater subregional nuclear cooperation in South Asia. Linking the regional agreement with South Asian environmental cooperation and marine pollution protection efforts could provide a framework for projects involving Indian and Pakistani coastal nuclear facilities. Programs of the Food and Agriculture Organization of the United Nations that use nuclear techniques to increase food and crop production and optimize water management in arid areas also provide similar opportunities for nuclear cooperation. Other frameworks for nuclear cooperation originate from international conventions related to nuclear safety, transportation of nuclear wastes, worker protection against ionizing radiation, and the nondeployment of nuclear weapons in certain areas. The information shared by existing frameworks includes: laws and regulations

  8. Clinical Profile, Predictors of Mortality, and Treatment of Patients after Myocardial Infarction, in an Academic Medical Center Hospital

    Directory of Open Access Journals (Sweden)

    Zornoff Leonardo A. M.


    Full Text Available OBJECTIVE: To evaluate clinical profiles, predictors of 30-day mortality, and the adherence to international recommendations for the treatment of myocardial infarction in an academic medical center hospital. METHODS: We retrospectively studied 172 patients with acute myocardial infarction, admitted in the intensive care unit from January 1992 to December 1997. RESULTS: Most patients were male (68%, white (97%, and over 60 years old (59%. The main risk factor for coronary atherosclerotic disease was systemic blood hypertension (63%. Among all the variables studied, reperfusion therapy, smoking, hypertension, cardiogenic shock, and age were the predictors of 30-day mortality. Most commonly used medications were: acetylsalicylic acid (71%, nitrates (61%, diuretics (51%, angiotensin-converting enzyme inhibitors (46%, thrombolytic therapy (39%, and beta-blockers (35%. CONCLUSION: The absence of reperfusion therapy, smoking status, hypertension, cardiogenic shock, and advanced age are predictors of 30-day mortality in patients with acute myocardial infarction. In addition, some medications that are undoubtedly beneficial have been under-used after acute myocardial infarction.

  9. Environmental Baseline Survey, Fitzsimmons Army Medical Center, Aurora, Colorado. Volume II - Appendices A-G. (United States)


    QUENTIN ST 128 F104 80011 1.28 NNW FINDS C00000710681 ALPHA MFG 3250 QUENTIN ST STE 136 F105 80011 1.28 NNW FINDS m 0000902 CHIPS DISTRIBUTING 2290...COD100711514 CRAWFORD ELEMENTARY SCHOOL 1600 FLORENCE ST AURORA 3 80010 COD149382491 DAISY FABRICARE CENTER 9677 MONTVIEW BLVD AURORA 3 80010 C00000077180... FABRICARE CTR 1,3 9677 MONTVIEW BLVD AURORA 80010 COD149382491 ALKE’S LAUNDRY & DRY CLEANING INC. 1,3 8935 E COLFAX AVE AURORA 80010 CO0000077180 DD

  10. Iterative user-centered design of a next generation patient monitoring system for emergency medical response. (United States)

    Gao, Tia; Kim, Matthew I; White, David; Alm, Alexander M


    We have developed a system for real-time patient monitoring during large-scale disasters. Our system is designed with scalable algorithms to monitor large numbers of patients, an intuitive interface to support the overwhelmed responders, and ad-hoc mesh networking capabilities to maintain connectivity to patients in the chaotic settings. This paper describes an iterative approach to user-centered design adopted to guide development of our system. This system is a part of the Advanced Health and Disaster Aid Network (AID-N) architecture.

  11. Advancing LGBT Health at an Academic Medical Center: A Case Study. (United States)

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


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

  12. Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals (United States)

    Dimitrov, Nikolay; Koenig, William; Bosson, Nichole; Song, Sarah; Saver, Jeffrey L.; Mack, William J.; Sanossian, Nerses


    Introduction Comprehensive stroke systems of care include routing to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols. Methods Each county’s local emergency medical services agency (LEMSA) was queried for the presence of a stroke routing protocol. We reviewed these protocols for method of stroke identification and criteria for patient transport to a stroke center. Results Thirty-three LEMSAs serve 58 counties in California with populations ranging from 1,175 to nearly 10 million. Fifteen LEMSAs (45%) had stroke routing protocols, covering 23 counties (40%) and 68% of the state population. Counties with protocols had higher population density (1,500 vs. 140 persons per square mile). In the six counties without designated stroke centers, patients meeting criteria were transported out of county. Stroke identification in the field was achieved using the Cincinnati Prehospital Stroke Screen in 72%, Los Angeles Prehospital Stroke Screen in 7% and a county-specific protocol in 22%. Conclusion California EMS prehospital acute stroke routing protocols cover 68% of the state population and vary in characteristics including activation by symptom onset time and destination facility features, reflecting matching of system design to local geographic resources. PMID:26587100

  13. Variability in Criteria for Emergency Medical Services Routing of Acute Stroke Patients to Designated Stroke Center Hospitals

    Directory of Open Access Journals (Sweden)

    Nikolay Dimitrov


    Full Text Available Introduction: Comprehensive stroke systems of care include routing to the nearest designated stroke center hospital, bypassing non-designated hospitals. Routing protocols are implemented at the state or county level and vary in qualification criteria and determination of destination hospital. We surveyed all counties in the state of California for presence and characteristics of their prehospital stroke routing protocols. Methods: Each county’s local emergency medical services agency (LEMSA was queried for the presence of a stroke routing protocol. We reviewed these protocols for method of stroke identification and criteria for patient transport to a stroke center. Results: Thirty-three LEMSAs serve 58 counties in California with populations ranging from 1,175 to nearly 10 million. Fifteen LEMSAs (45% had stroke routing protocols, covering 23 counties (40% and 68% of the state population. Counties with protocols had higher population density (1,500 vs. 140 persons per square mile. In the six counties without designated stroke centers, patients meeting criteria were transported out of county. Stroke identification in the field was achieved using the Cincinnati Prehospital Stroke Screen in 72%, Los Angeles Prehospital Stroke Screen in 7% and a county-specific protocol in 22%. Conclusion: California EMS prehospital acute stroke routing protocols cover 68% of the state population and vary in characteristics including activation by symptom onset time and destination facility features, reflecting matching of system design to local geographic resources.

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

    Directory of Open Access Journals (Sweden)

    M Mohagheghi


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

  15. Radiation protection in medical centers : teletherapy service; Proteccion radiologica en centros hospitalarios : servicio de teleterapia

    Energy Technology Data Exchange (ETDEWEB)

    Resendiz G, G.; Perez P, M.; Figueroa M, E. [Clinica Medica Sur, Servicio de Radioterapia, Puente de Piedra No. 150, Col. Toriello Guerra, Mexico 14050 D. F. (Mexico)


    The General Regulation of Radiation Safety, it clearly provides the classification, requirements and obligations of the various figures relating to a radiation protection system, i.e., the occupationally exposed personnel, the radiation safety responsible, the legal representative, the type of installation, etc. For new installations, the shieldings calculation should be contained in the analytical report with due consideration of factors, such as those surrounding the areas classification based on the occupation type, the work load of the equipment and others. The operation license involves requirements such as the Report and the Radiation Safety Handbook, the Emergencies Plan, the establishment of register levels, investigation and intervention, the way it is carried out medical surveillance of the occupationally exposed personnel, and the description of the protection mechanisms and detection instrumentation and radiation measurement. Deserves mention the case when high readings are recorded in the personal dosimeters, which must submit to an interrogation to the employee, you must determine if it is an incorrect reading to the service provider, you must perform a medical exam blood cell count with relevant to the dose determination, may eventually can lead to a cytogenetic study and the determination to do if confirmed an unexpectedly high dose. Moreover, the technology evolution also implies the development of adaptation measures. For example, the Intensity Modulated Radiation Therapy, which is an advanced high-precision radiotherapy that uses X-ray accelerators for computer-controlled radiation doses precisely to a malignant tumor or specific areas within the tumor, taking into account requires regard to equipment, and space and shielding, time and staff hours for treatment, personnel training, materials for making images (such as two-dimensional arrangements of integrated circuits or diodes, films or portal images), the attention given by the engineers of

  16. An information model to support user-centered design of medical devices. (United States)

    Hagedorn, Thomas J; Krishnamurty, Sundar; Grosse, Ian R


    The process of engineering design requires the product development team to balance the needs and limitations of many stakeholders, including those of the user, regulatory organizations, and the designing institution. This is particularly true in medical device design, where additional consideration must be given for a much more complex user-base that can only be accessed on a limited basis. Given this inherent challenge, few projects exist that consider design domain concepts, such as aspects of a detailed design, a detailed view of various stakeholders and their capabilities, along with the user-needs simultaneously. In this paper, we present a novel information model approach that combines a detailed model of design elements with a model of the design itself, customer requirements, and of the capabilities of the customer themselves. The information model is used to facilitate knowledge capture and automated reasoning across domains with a minimal set of rules by adopting a terminology that treats customer and design specific factors identically, thus enabling straightforward assessments. A uniqueness of this approach is that it systematically provides an integrated perspective on the key usability information that drive design decisions towards more universal or effective outcomes with the very design information impacted by the usability information. This can lead to cost-efficient optimal designs based on a direct inclusion of the needs of customers alongside those of business, marketing, and engineering requirements. Two case studies are presented to show the method's potential as a more effective knowledge management tool with built-in automated inferences that provide design insight, as well as its overall effectiveness as a platform to develop and execute medical device design from a holistic perspective.

  17. Changes in Enterococcal and E coli populations and related antibiotic resistance from medical center to receiving environment (United States)

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


    The spread of antibiotic-resistant faecal bacteria and their corresponding genes in water environment, as a result of the overuse of antibiotics, have become an ecological and a public problem. The aim of this multidisciplinary research program (FLASH) -associating chemists, hydrologists, clinical and environmental microbiologists- was to determine to what extent the hospital effluent have an ecological impact on the downstream aquatic environment. For this purpose, fate of Escherichia coli (distribution of phylogenetic groups, antibiotic resistance, integrons- 342 strains) and Enterococci (diversity, antibiotic resistance, genes ermB, mefA, clonal complex 17- 235 strains ) was analyzed in water and sediments along a medical center - WWTP - river - estuary continuum, during a high epidemiologic period in the North west of France. A multi-residue chemical methodology was developed in order to detect low levels of 34 antibiotics in water. To link occurrence of antibiotic-resistant bacteria in water and antibiotic prescription, we use the data collection from the hospital and the antibiotics sales information. In the medical center, the main prescribed antibiotic (amoxicillin) was weakly found in effluents. Along the continuum, contamination of water by antibiotics decreased from 160μg.L-1 (cefotaxim) in hospital effluents to 1ng.L-1 (ofloxacin) in the river. These concentrations were too low to exert a selective pressure (mg.L-1) on antibiotic-resistant bacteria. In same samples, occurrences of antibiotic-resistant E. coli and those harboring a class 1 integrons decreased significantly (p-value Enterococcus populations, E. faecium was mainly isolated (from 89% to 98%). All E. faecium isolates from medical center effluents were multiply antibiotic-resistant, contained erm(B) and mef(A) genes, and belonged to the hospital adapted CC17. The relative proportion of CC17 decreased in favor of other subpopulations, less resistant to antibiotics along the continuum. In the

  18. Evaluation of a Worksite Diabetes Education Program at a Large Urban Medical Center. (United States)

    Renda, Susan; Baernholdt, Marianne; Becker, Kathleen


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

  19. Presentation and treatment of venomous snakebites at a northern academic medical center. (United States)

    Cowles, Robert A; Colletti, Lisa M


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

  20. Pharmacovigilance in Asia

    Directory of Open Access Journals (Sweden)

    Pipasha Biswas


    Full Text Available An increase in drug safety concerns in recent years with some high profile drug withdrawals have led to raising the bar by various stakeholders more importantly by the regulatory authorities. The number of Adverse Drug Reactions (ADRs reported have also resulted in an increase in the volume of data handled and to understand pharmacovigilance a high level of expertise is required to rapidly detect drug risks as well as to defend the product against an inappropriate removal. Proactive pharmacovigilance throughout the product life cycle is the way forward and the future direction for drug safety in Asia. It has been a constant challenge to standardize pharmacovigilance in Asia, in the context of clinical trials and post-marketing pharmacovigilance due to varied geaographical, cultural and medical practices in these regioon. While major advancements of the discipline of pharmacovigilance have taken place in the West, not much has been achieved in Asian countries, though several attempts have been taken. However, with more clinical trials and clinical research activity being conducted in the Asian continent, there is an immense need to understand and implement pharmacovigilance. For this to happen, the mind set of people working in regulatory agencies, the Pharmaceutical companies, prescribers and patients/consumers need to change.

  1. Clonal distribution and associated characteristics of Escherichia coli clinical and surveillance isolates from a military medical center. (United States)

    Manges, Amee R; Mende, Katrin; Murray, Clinton K; Johnston, Brian D; Sokurenko, Evgeni V; Tchesnokova, Veronika; Johnson, James R


    Antimicrobial-resistant Escherichia coli are a concern for military health services. We studied 100 extended-spectrum beta-lactamase (ESBL)-producing and non-producing E. coli clinical and surveillance isolates from military personnel and civilians at Brooke Army Medical Center (2007-2011). Major E. coli lineages, most prominently ST10 (24%), ST131 (16%), and ST648 (8%), were distributed much as reported for other North American populations. ST131, represented mainly by its resistance-associated ST131-H30 clonal subset, was uniquely associated with a clinical origin, regardless of ESBL status. Thus, clonal background predicted resistance phenotype and clinical versus surveillance origin, and these findings could assist military clinicians and epidemiologists.

  2. Colleague interactions and new drug prescribing behavior: the case of the initial prescription of antidepressants in Taiwanese medical centers. (United States)

    Lin, Shu-Jou; Jan, Kuan-An; Kao, Jen-Tse


    This research explores the social factors influencing hospital physicians' initial adoption of duloxetine hydrochloride, with a focus on colleague interactions. The study analyzes archival data compiled by the National Health Insurance Research Database of Taiwan to examine how the prescribing decisions made by psychiatrists' colleagues influence the likelihood of the psychiatrists' initial prescription. The results show that the adoption ratio of a physician's colleagues in a medical center is positively associated with the likelihood of a physician's adoption of the new drug. Specifically, colleague groups with similar and longer tenure as well as similar and older age have significantly positive effects. Colleague groups with the same and different gender also have positive effects. In summary, tenure and age, rather than gender, are vital sources of heterogeneous colleague interactions.

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

    Energy Technology Data Exchange (ETDEWEB)

    Gottschalk, A.


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

  4. Getting past the accident: explosive devices, limb loss, and refashioning a life in a military medical center. (United States)

    Messinger, Seth D


    I describe the refashioning of a sense of self and identity of a junior officer in the U.S. Army who was injured in Iraq. Ethnographic data for this article were collected between July 2006 and January 2008. The setting for this article is the U.S. Armed Forces Amputee Patient Care Program at Walter Reed Army Medical Center. Two models of rehabilitation are contrasted in the rehabilitation program. The first focuses on the refashioning of identity through a sports model of rehabilitation emphasizing physical functioning. The second approaches rehabilitation by emphasizing individual interests and the concern of a person who has a future life to develop. I conclude by arguing that understanding the process of rehabilitation from traumatic injury would benefit from a perspective that melds multiple dimensions, taking into account both the physical body and the social world that patients have inhabited and will inhabit.

  5. Collaborative work between the West and Asia. (United States)

    Hser, Yih-Ing; Bart, Gavin; Li, Li; Giang, Le Minh


    The "Collaborative Work between the West and Asia" session was chaired by Dr. Yih-Ing Hser and had three speakers. The speakers (and their topics) were: Dr. Gavin Bart (Collaborative Addiction Research in Asian Populations Home and Abroad), Dr. Li Li (Implementing Intervention Research Projects in Asia), and Dr. Le Minh Giang (Building Research Infrastructure for International Collaborative Studies on Substance Use Disorder and HIV: The Case of Hanoi Medical University/Vietnam).

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

    Directory of Open Access Journals (Sweden)

    Reach G


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

  7. The Academic Medical Center Linear Disability Score (ALDS) item bank: item response theory analysis in a mixed patient population (United States)

    Holman, Rebecca; Weisscher, Nadine; Glas, Cees AW; Dijkgraaf, Marcel GW; Vermeulen, Marinus; de Haan, Rob J; Lindeboom, Robert


    Background Currently, there is a lot of interest in the flexible framework offered by item banks for measuring patient relevant outcomes. However, there are few item banks, which have been developed to quantify functional status, as expressed by the ability to perform activities of daily life. This paper examines the measurement properties of the Academic Medical Center linear disability score item bank in a mixed population. Methods This paper uses item response theory to analyse data on 115 of 170 items from a total of 1002 respondents. These were: 551 (55%) residents of supported housing, residential care or nursing homes; 235 (23%) patients with chronic pain; 127 (13%) inpatients on a neurology ward following a stroke; and 89 (9%) patients suffering from Parkinson's disease. Results Of the 170 items, 115 were judged to be clinically relevant. Of these 115 items, 77 were retained in the item bank following the item response theory analysis. Of the 38 items that were excluded from the item bank, 24 had either been presented to fewer than 200 respondents or had fewer than 10% or more than 90% of responses in the category 'can carry out'. A further 11 items had different measurement properties for younger and older or for male and female respondents. Finally, 3 items were excluded because the item response theory model did not fit the data. Conclusion The Academic Medical Center linear disability score item bank has promising measurement characteristics for the mixed patient population described in this paper. Further studies will be needed to examine the measurement properties of the item bank in other populations. PMID:16381611

  8. The Academic Medical Center Linear Disability Score (ALDS item bank: item response theory analysis in a mixed patient population

    Directory of Open Access Journals (Sweden)

    Vermeulen Marinus


    Full Text Available Abstract Background Currently, there is a lot of interest in the flexible framework offered by item banks for measuring patient relevant outcomes. However, there are few item banks, which have been developed to quantify functional status, as expressed by the ability to perform activities of daily life. This paper examines the measurement properties of the Academic Medical Center linear disability score item bank in a mixed population. Methods This paper uses item response theory to analyse data on 115 of 170 items from a total of 1002 respondents. These were: 551 (55% residents of supported housing, residential care or nursing homes; 235 (23% patients with chronic pain; 127 (13% inpatients on a neurology ward following a stroke; and 89 (9% patients suffering from Parkinson's disease. Results Of the 170 items, 115 were judged to be clinically relevant. Of these 115 items, 77 were retained in the item bank following the item response theory analysis. Of the 38 items that were excluded from the item bank, 24 had either been presented to fewer than 200 respondents or had fewer than 10% or more than 90% of responses in the category 'can carry out'. A further 11 items had different measurement properties for younger and older or for male and female respondents. Finally, 3 items were excluded because the item response theory model did not fit the data. Conclusion The Academic Medical Center linear disability score item bank has promising measurement characteristics for the mixed patient population described in this paper. Further studies will be needed to examine the measurement properties of the item bank in other populations.

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

    Directory of Open Access Journals (Sweden)

    Matthew D Krasowski


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

  10. Incidence of sepsis following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon

    Directory of Open Access Journals (Sweden)

    Mohammed Shahait


    Full Text Available ABSTRACT Background Urosepsis is a rare but life-threatening complication following transrectal ultrasound (TRUS guided needle prostate biopsy. Despite the technological and pharmacological improvements, the problem of bacterial urosepsis after prostate biopsy remains. A strategy for preventing urosepsis following TRUS prostate biopsy in areas with high prevalence of resistant strains or patients presenting risk factors is lacking. Objectives The aim of this study was to assess the prevalence of urosepsis, as well its predictors, following TRUS guided needle biopsy of the prostate in a tertiary care medical center in Lebanon. Materials and Methods We carried out a retrospective study on all patients who underwent TRUS prostate biopsy at the American University of Beirut Medical Center between January 1, 2011 and June 31, 2013. Patients’ hospital charts were reviewed. Data collected included demographic information, pre-procedure disease specific information, as well as post-procedure information. Predictors of urosepsis following TRUS were assessed. Results In total, 265 patients were included in this study, where the prevalence of urosepsis following TRUS prostate biopsy was found to be 9.4%. The significant independent predictors of urosepsis were found to be: age with an OR=0.93 (95% CI: 0.88–1.00, p-value=0.03, and hypertension comorbidity with an OR=3.25 (95% CI: 1.19–8.85, p-value=0.02. Conclusion We found a high prevalence of urosepsis among patients who have undergone TRUS prostate biopsy, and identified two significant risk factors. The results of this study highlight the importance of implementing strategies for prevention of urosepsis following TRUS prostate biopsy.

  11. Rating and Classification of Incident Reporting in Radiology in a Large Academic Medical Center. (United States)

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


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

  12. More Trade with Northeast Asia

    Institute of Scientific and Technical Information of China (English)


    @@ To establish a long-term platform where China and other Northeast Asian countries could enjoy mutual benefits, interchange and communica-tion, NAITE faithfully plays its role. This Sep-tember 2 to 6, Changchun International Confer-ence & Exhibition Center welcomes again the NAITE, China Jilin-Northeast Asia Investment and Trade Expo, and it was the fourth session in Changchun, Jilin Province in the northeast of China. The impact is accumulating.

  13. Implementation of a Prolonged Infusion Guideline for Time-Dependent Antimicrobial Agents at a Tertiary Academic Medical Center. (United States)

    Hohlfelder, Benjamin; Kubiak, David W; Degrado, Jeremy R; Reardon, David P; Szumita, Paul M

    Administration of time-dependent beta-lactam antibiotic as a prolonged infusion may maximize the pharmacodynamic target of time above the minimum inhibitory concentration. We describe the implementation of a prolonged infusion at a tertiary academic medical center, and a 1-year compliance analysis with the guideline. After performing a thorough literature search, a guideline was developed by members of the Department of Infectious Diseases and Department of Pharmacy. Approval and endorsement of the guideline was obtained by the Antimicrobial Subcommittee and Pharmacy and Therapeutics Committee. Physical champions were instrumental in the implementation of the guideline institution-wide. We then performed a 1-year retrospective analysis of guideline compliance from January 1, 2011 to December 31, 2011. Noncompliant administrations were obtained from smart infusion pumps. The total number of doses administered was taken from pharmacy information resources. In total, nearly 85,000 time-dependent doses were administered. Compliance with the prolonged infusion guideline was 89%. Rates of compliance did not significantly differ between medications (P = 0.555). Obtaining support from key stakeholders in collateral services and institutional leadership was vital for the success of this guideline. Compliance with the guideline 1 year after implementation was high. Implementation of a prolonged infusion guideline is feasible with institutional support and motivation.

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

    Directory of Open Access Journals (Sweden)

    Diana L. Franco


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

  15. New constraints on the formation and evolution of the Andaman Sea, a sedimented back arc spreading center in the South East Asia, from seismic reflection studies. (United States)

    Jourdain, A.; Singh, S. C.; Klinger, Y.


    The Andaman Sea is an enigmatic feature in the Indian Ocean region. To the west, it is bounded by a near arc parallel Andaman subduction system and to the east by the Malaya Peninsula. It hosts volcanic provinces like Alcock and Sewell Rises and the Andaman Sea Spreading Center (ASSC) that connects the sliver strike-slip Sagaing Fault in the north with the Andaman Nicobar and Great Sumatra Faults in the south. The actual spreading center follows a succession of basins, starting by the spreading of the Mergui basin in the south-east, 32 Ma ago, that shifted to the actual position of the spreading closer to the subduction trench. Several hypotheses have been proposed for the formation of the Andaman Sea basins: (a) Pull-apart basin along the Sagaing-Sumatra fault system, driven by the collision-extrusion mechanism and/or by the slip-partitioning induced by the oblique subduction, (b) Back-arc spreading due to the subduction. There is a debate about the orientation of the present spreading/extension between the North-South motion along the strike-slip faults and the NW-SE opening of the ASSC. We have access to 7000 km of high-resolution deep seismic reflection data, and high-resolution bathymetry data, which we combine with relocated earthquake data to shed light upon the formation and evolution of the Andaman Sea Basin. The central basin contains up to 4 km thick sediments. The crustal thickness is about 5-8 km in the central basin and increases to 13-15 km beneath the Alcock and Sewell Rises, which are devoid of sediments. Here we show how both the collision and the subduction play a role in the position and orientation of the extension in the Andaman Sea Basin, and how they influence the accretion at the spreading center.

  16. There is no "i" in teamwork in the patient-centered medical home: defining teamwork competencies for academic practice. (United States)

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


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

  17. Tissue procurement system in Japan: the role of a tissue bank in medical center for translational research, Osaka University Hospital. (United States)

    Ohkawara, H; Fukushima, N; Kitagawa, T; Ito, T; Masutani, Y; Sawa, Y


    Although organ procurement has been regulated by The Organ Transplantation Law (brain-dead donors since 1997, donors after cardiac death since 1979), there has been no law or governmental procurement network (except for cornea) in Japan. Since the late 1980s, some university hospitals have developed original banks. Finally, in 2001 guidelines for tissue procurement were established by The Japanese Society of Tissue Transplantation and Japan Tissue Transplant Network (JTTN) to coordinate tissue harvesting. Five tissue banks were joined to the tissue transplant network (skin in one, heart valves in two, and bone in two). As the number of tissue banks is small, each bank cooperates on procurement, but cannot cover the entire country. With regard to skin transplantation, only one skin bank-The Japan Skin Bank Network (JSBN), which is located in Tokyo-has organized skin procurement. Therefore, it has been difficult to procure skin in areas distant from Tokyo, especially around Osaka. In order to improve such a situation, a tissue bank collaborating with the JSBN was established at The Medical Center for Translational Research (MTR), Osaka University Hospital in April 2008. The bank has played a role in skin procurement center in western Japan and supported procurement and preservation at the time of the skin procurement. Between April 2008 and September 2009, the bank participated in eight tissue procurements in the western area. In the future, the bank is planning to procure and preserve pancreatic islets and bones. Moreover, there is a plan to set up an induced pluripotent stem cells center and stem cell bank in MTR. This tissue bank may play a role to increase tissue procurement in Japan, especially in the western area.


    Institute of Scientific and Technical Information of China (English)



    The article overviews national and international integrated medical center; explains development model, strategy and planning of integrated medical center; defines the marketing positioning and economic model of integrated medical center based on local situation and scientific systematic analysis.%  介绍了国内外集成式医疗中心概况,阐述了集成式医疗中心发展模式及其策划和规划,并建议按照当地的实际情况,经过详细科学系统化的分析,确定集成式医疗中心的市场定位和经济模式。

  19. ASIAS - Some History (United States)

    National Aeronautics and Space Administration — The ASIAS effort builds on demonstrations that an open exchange of information contributes to improved aviation safety. ASIAS is a comprehensive effort, covering the...

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

    Directory of Open Access Journals (Sweden)

    Ana Helena Rotta Soares


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

  1. 大连建设东北亚国际物流中心的思考%Thinking On Construction of The Northeast Asia International Logistics Center in Dalian

    Institute of Scientific and Technical Information of China (English)



    It is necessary for Dalian to set up The Northeast Asia International Logistics Center to achieve its goals: to enhance city competitiveness,to promote the development of regional economy in Northeast China,to implement the national strategies of development.The following composition introduces the available advantages that Dalian has as well as posers that Dalian needs to fight against.Insightful advice to promote development of this logistics center is also provided in the following part in the line of policy and service system,port resources,network system of logistics,logistics market and the main body of logistics,logistics information network and platform.%大连建设东北亚国际物流中心是实现国家发展战略和东北区域经济发展的客观要求,也是提升大连城市竞争力的有效途径。本文分析了大连建设东北亚国际物流中心过程中已具备的优势和面临的问题,并从政策和服务体系、港口资源和物流网络体系、物流市场及主体、物流信息化网络和平台等方面提出了推进大连东北亚国际物流中心的建议。

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

    Directory of Open Access Journals (Sweden)

    Quigley DD


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

  3. Use of RE-AIM to develop a multi-media facilitation tool for the patient-centered medical home

    Directory of Open Access Journals (Sweden)

    Glasgow Russell E


    Full Text Available Abstract Background Much has been written about how the medical home model can enhance patient-centeredness, care continuity, and follow-up, but few comprehensive aids or resources exist to help practices accomplish these aims. The complexity of primary care can overwhelm those concerned with quality improvement. Methods The RE-AIM planning and evaluation model was used to develop a multimedia, multiple-health behavior tool with psychosocial assessment and feedback features to facilitate and guide patient-centered communication, care, and follow-up related to prevention and self-management of the most common adult chronic illnesses seen in primary care. Results The Connection to Health Patient Self-Management System, a web-based patient assessment and support resource, was developed using the RE-AIM factors of reach (e.g., allowing input and output via choice of different modalities, effectiveness (e.g., using evidence-based intervention strategies, adoption (e.g., assistance in integrating the system into practice workflows and permitting customization of the website and feedback materials by practice teams, implementation (e.g., identifying and targeting actionable priority behavioral and psychosocial issues for patients and teams, and maintenance/sustainability (e.g., integration with current National Committee for Quality Assurance recommendations and clinical pathways of care. Connection to Health can work on a variety of input and output platforms, and assesses and provides feedback on multiple health behaviors and multiple chronic conditions frequently managed in adult primary care. As such, it should help to make patient-healthcare team encounters more informed and patient-centered. Formative research with clinicians indicated that the program addressed a number of practical concerns and they appreciated the flexibility and how the Connection to Health program could be customized to their office. Conclusions This primary care practice

  4. Patient and primary care provider attitudes and adherence towards lung cancer screening at an academic medical center. (United States)

    Duong, Duy K; Shariff-Marco, Salma; Cheng, Iona; Naemi, Harris; Moy, Lisa M; Haile, Robert; Singh, Baldeep; Leung, Ann; Hsing, Ann; Nair, Viswam S


    Low dose CT (LDCT) for lung cancer screening is an evidence-based, guideline recommended, and Medicare approved test but uptake requires further study. We therefore conducted patient and provider surveys to elucidate factors associated with utilization. Patients referred for LDCT at an academic medical center were questioned about their attitudes, knowledge, and beliefs on lung cancer screening. Adherent patients were defined as those who met screening eligibility criteria and completed a LDCT. Referring primary care providers within this same medical system were surveyed in parallel about their practice patterns, attitudes, knowledge and beliefs about screening. Eighty patients responded (36%), 48 of whom were adherent. Among responders, non-Hispanic patients (p = 0.04) were more adherent. Adherent respondents believed that CT technology is accurate and early detection is useful, and they trusted their providers. A majority of non-adherent patients (79%) self-reported an intention to obtain a LDCT in the future. Of 36 of 87 (41%) responding providers, only 31% knew the correct lung cancer screening eligibility criteria, which led to a 37% inappropriate referral rate from 2013 to 2015. Yet, 75% had initiated lung cancer screening discussions, 64% thought screening was at least moderately effective, and 82% were interested in learning more of the 33 providers responding to these questions. Overall, patients were motivated and providers engaged to screen for lung cancer by LDCT. Non-adherent patient "procrastinators" were motivated to undergo screening in the future. Additional follow through on non-adherence may enhance screening uptake, and raising awareness for screening eligibility through provider education may reduce inappropriate referrals.

  5. Clinical characteristics and outcomes of patients admitted with presumed microbial keratitis to a tertiary medical center in Israel

    Directory of Open Access Journals (Sweden)

    Fabio Lavinsky


    Full Text Available PURPOSES: Microbial keratitis is commonly diagnosed worldwide, and continues to cause significant ocular morbidity, requiring prompt and appropriate treatment. The objective of this study is to describe the clinical characteristics and outcomes of patients with presumed microbial keratitis admitted to The Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel. METHODS: A cross-sectional study was conducted, in which the medical records of patients with presumed microbial keratitis admitted during a period of 3 years were reviewed. RESULTS: Keratitis was diagnosed in 276 patients (51% males and 48.9% females. The mean age was 39.29 ± 22.30 years. The hospital length of stay ranged from 1 to 65 days (mean 5.69 ± 5.508. Fortified antibiotics were still used at discharge in 72% of the cases. Overall visual acuity improved significantly from the time of admission to the 1st-week follow up visit showing a p0.05. The degree of hypopyon and cells in the anterior chamber was significantly related to the hospital length of stay (r Spearman=0.31; p<0.001 and r Spearman=0.21; p<.001, respectively as well as to a worse visual outcome (r Spearman=0.32; p<0.01 and r Spearman=0.18; p=0.01, respectively. Of all patients, 2.3% required an urgent therapeutic penetrating keratoplasty, and 1% underwent evisceration. There was no enucleation. CONCLUSION: Treating keratitis aggressively and assuring patient compliance is imperative for a good final visual outcome. Inpatient treatment may have a positive impact on this outcome.

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

    Directory of Open Access Journals (Sweden)

    Karpa Kelly


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

  7. Clinical and Paraclinical Findings of Cerebrovascular Accidents in Children Admitted to Pediatric Medical Center from 1993 till 2003

    Directory of Open Access Journals (Sweden)

    M Dehghani


    Full Text Available Introduction: Stroke is a clinical diagnosis which brings up cerebrovascular diseases. Stroke includes any cerebrovascular accident which leads to local neural defect and lasts more than 24 hours. Stroke has severe and irreversible complications and high rates of recurrence after first episode, therefore we decided to study clinical and paraclinical findings of this disease for better diagnosis and prevention of it. Methods: We prepared a case series study to review medical files of the patients admitted to pediatric medical center with the diagnosis of CVA between 1993 and 2003. 19 patients were assessed in this study. Results: Their mean age was 5.72 (SD=3.801. Among clinical signs hemiparesis was the most common finding (89.5%. Vital signs were normal except for two patients with low-grade fever or hypertension. Such cardiac diseases as cardiomyopathy, valvular disorder, d-TGA, and congestive heart failure were common predisposing factors. According to CT scan reports, 6 patients (31.6% suffered from deep ischemic stroke, and 5 (21.3%, and 2 patients (10.5% suffered from superficial ischemic stroke and and hemorrhagic stroke, respectively. 2 patients manifested signs of both superficial and deep ischemic stroke. One of them suffered from Moyamoys syndrome and the other was a known case of MELAS (mitochondrial encepholomyopaty lactic acidosis syndrome. CBC was the most important abnormal test. Conclusion: According to this study, congenital heart diseases are the most common cause of stroke in children. Stroke in children is not frequently associated with vital signs change, and deep ischemic stroke is the most common type of the stroke in children.

  8. An analysis of clinical process measures for acute healthcare delivery in Appalachia: The Roane Medical Center experience

    Directory of Open Access Journals (Sweden)

    Sills Eric


    Full Text Available Abstract Objective To survey management of selected emergency healthcare needs in a Tennessee community hospital. Materials and methods In this descriptive report, discharges and associated standard process measures were retrospectively studied for Roane Medical Center (RMC in Harriman, Tennessee (pop. 6,757. Hospital data were extracted from a nationwide database of short-term acute care hospitals to measure 16 quality performance measures in myocardial infarction (MI, heart failure, and pneumonia during the 14 month interval ending March 2005. The data also permitted comparisons with state and national reference groups. Results Of RMC patients with myocardial infarction (MI, 94% received aspirin on arrival, a figure higher than both state (85% and national (91% averages. Assessment of left ventricular dysfunction among heart failure patients was also higher at RMC (98% than the state (74% or national (79% average. For RMC pneumonia patients, 79% received antibiotics within 4 h of admission, which compared favorably with State (76% and national (75% average. RMC scored higher on 13 of 16 clinical process measures (p95% CI compared to state and national averages. Discussion Although acute health care needs are often met with limited resources in medically underserved regions, RMC performed above state and national average for most process measures assessed in this review. Our data were derived from one facility and the associated findings may not be applicable in other healthcare settings. Further studies are planned to track other parameters and specific clinical outcomes at RMC, as well as to identify specific institutional policies that facilitate attainment of target quality measures.

  9. [Perinatal mortality at the Medical Care Units of the IMSS (Mexico Social Security Institute), National Medical Center of Torreón]. (United States)

    Rodríguez y Enríquez de Rivera, F C; Velázquez Trejo, M L; Roís Hernández, J


    To describe the situation of perinatal mortality during 1994 year in General Hospitals with Family Medicine number 16 and 18 of IMSS (Social Security Mexican Institut) National Medical Center in Torreón Coah. It was realized a retrospective study, were included 199 files of perinatal deaths occurred from January 1st to December 31 of 1994. The variables obtained were number of death for step, period, age, sex, weight and the cause of the cause of the death. Were eliminated the files without data of interest. For the analysis our utilized descriptive statistics. The rate of perinatal mortality was 20.17 per 1000 live birth, fetal death rate 9.58 by 1000 and the rate of neonatal death 12.97 per 1,000 live birth, fetal death rate 8.68 and neonatal death rate 12.30. The majority were in the perinatal period one with a rate of 16.71 by 1,000 live birth. Were most common in a male sex (53%) in pregnancies from 28 to 32 weeks (33.91%) and in babies with less of 1000 gr of weight (33.86%). The causes more frequents of deaths were the respiratory difficult syndrome (41.77%), the anomalies (19.62%) and hypoxia (9.49%). The perinatal mortality in our study was similar that in the rest of the country and is acorde with the literature. The perinatal mortality were in the perinatal period one. Is important to conduce a prospective studies.

  10. The Collaborative Production of Responses and Dispatching on the Radio: Video Analysis in a Medical Emergency Call Center

    Directory of Open Access Journals (Sweden)

    Giolo Fele


    Full Text Available What happens when someone rings an emergency hotline for help? How is the emergency handled? How does the emergency service swing into action? Prompt and competent intervention and assessment of the gravity of the situation in a few crucial seconds: these are the quality standards that regulate the organization of emergency operations centers. For a number of years various groups of social science researchers have carried forward a program for the systematic study of work using ethnographic and naturalistic methods of analysis. An interest in work is certainly nothing new in the social sciences, and in sociology in particular. What is new, though, is the particular analytical viewpoint from which such research is now conducted. This program has dispensed with large-scale theorization and has concentrated on the empirical study of activities and practices, achieving an unprecedented level of detail and analytical fineness. Indeed, only by proceeding at this fine level of detail—made possible by the use of videorecordings—has it been possible to document the extraordinary and subtle collaborative production of work, and to do so at a level which extends well beyond the conscious awareness of people in their everyday routine. This aspect concerns in particular the capacity of the latest generation of studies of work to document the tacit procedures and forms of common-sense reasoning involved in the performance of tasks in concrete work settings. This paper focuses on the ways in which the dispatch is done in a medical emergency operation center. Although we know a great deal about the interaction between caller and call-taker from previous research, we know much less about the social organization that makes the dispatch possible. The data analyzed in this paper derive from a research project in which I have been engaged for a number of years on operation centers for the 118 emergency telephone number in Italy. Contrasting the data obtained

  11. The Erasmus Computing Grid - Building a Super-Computer Virtually for Free at the Erasmus Medical Center and the Hogeschool Rotterdam

    NARCIS (Netherlands)

    T.A. Knoch (Tobias); L.V. de Zeeuw (Luc)


    textabstractThe Set-Up of the 20 Teraflop Erasmus Computing Grid: To meet the enormous computational needs of live- science research as well as clinical diagnostics and treatment the Hogeschool Rotterdam and the Erasmus Medical Center are currently setting up one of the largest desktop computing

  12. The Phenomenon of Collaboration: A Phenomenologic Study of Collaboration between Family Medicine and Obstetrics and Gynecology Departments at an Academic Medical Center (United States)

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


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

  13. 5 years of experience implementing a methicillin-resistant Staphylococcus aureus search and destroy policy at the largest university medical center in the Netherlands

    NARCIS (Netherlands)

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


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

  14. Genotypic and Phenotypic Correlations of Multidrug-Resistant Acinetobacter baumannii-A. calcoaceticus Complex Strains Isolated from Patients at the National Naval Medical Center (United States)

    Acinetobacter baumannii-calcoaceticus complex (ABC) infections have complicated the care of U.S. combat casualties. In this study, 102 ABC isolates from wounded soldiers treated at National Naval Medical Center (NNMC) were characterized by phenotype and genotype to identify clones in this population...

  15. Assessment of microbiological monitoring for the evaluation of GMP-compliance at a department of Nuclear Medicine and Molecular Imaging of the University Medical Center Groningen

    NARCIS (Netherlands)

    Beugeling, M.; Ekoume, F.; Woerdenbag, H.J.; Luurtsema, G.; Lub-de Hooge, M.N.; Touw, D.J.; Rubow, S.M.; Boersma, H.H.


    Objective: The purpose of our study was to assess trends and deviations from microbiological monitoring in De cleanroom facilities at the department of Nuclear Medicine and Molecular Imaging of the University Medical Center Groningen over the past five years. This was done to evaluate the status of

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

    Harris-Hollingsworth, Nicole Rosella


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

  17. Characterization of methicillin-resistant Staphylococcus aureus isolated at Tripoli Medical Center, Libya, between 2008 and 2014. (United States)

    BenDarif, Elloulu; Khalil, Asma; Rayes, Abdunnabi; Bennour, Emad; Dhawi, Abdulgader; Lowe, John J; Gibbs, Shawn; Goering, Richard V


    Bacterial pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) represent a well-known public health problem affecting both healthcare-associated and community populations. Past studies have clearly shown the value of characterizing problem organisms including MRSA through the use of molecular techniques (i.e. strain typing), with the aim of informing local, regional and national efforts in epidemiological analysis and infection control. The country of Libya represents a challenge for such analysis due to limited historical infectious disease information and major political unrest culminating in the Libyan Civil War (Libyan Revolution) in 2011. A MRSA study population of 202 isolates, cultured from patients in Tripoli Medical Center through this historical period (2008-2014), was characterized by both phenotypic and molecular methods. The results revealed a diversification of epidemic MRSA strains over time with generally increasing resistance to fluoroquinolone antibiotics. The study identified prevalent MRSA in comparison to known global epidemic types, providing unique insight into the change of strains and/or characteristics over time especially with reference to the potential influence of the political revolution (i.e. pre- and post-2011).

  18. The empowerment paradox as a central challenge to patient centered medical home implementation in the veteran's health administration. (United States)

    Solimeo, Samantha L; Ono, Sarah S; Lampman, Michelle A M; Paez, Monica B W; Stewart, Gregory L


    In this paper we present results of a mixed methods study conducted to identify barriers to team function among staff implementing patient aligned care teams - the Department of Veterans Affairs' patient centered medical home (PCMH) model. Using a convergent mixed methods design, we administered a standardized survey measure (Team and Individual Role Perception Survey) to assess work role challenge and engagement; and conducted discussion groups to gather context pertaining to role change. We found that the role of primary care providers is highly challenging and did not become less difficult over the initial year of implementation. Unexpectedly over the course of the first year nurse care managers reported a decrease in their perceptions of empowerment and clerical associates reported less skill variety. Qualitative data suggest that more skilled team members fail to delegate and share tasks within their teams. We characterize this interprofessional knowledge factor as an empowerment paradox where team members find it difficult to share tasks in ways that are counter to traditionally structured hierarchical roles. Health care systems seeking to implement PCMH should dedicate resources to facilitating within-team role knowledge and negotiation.

  19. A framework for improving access and customer service times in health care: application and analysis at the UCLA Medical Center. (United States)

    Duda, Catherine; Rajaram, Kumar; Barz, Christiane; Rosenthal, J Thomas


    There has been an increasing emphasis on health care efficiency and costs and on improving quality in health care settings such as hospitals or clinics. However, there has not been sufficient work on methods of improving access and customer service times in health care settings. The study develops a framework for improving access and customer service time for health care settings. In the framework, the operational concept of the bottleneck is synthesized with queuing theory to improve access and reduce customer service times without reduction in clinical quality. The framework is applied at the Ronald Reagan UCLA Medical Center to determine the drivers for access and customer service times and then provides guidelines on how to improve these drivers. Validation using simulation techniques shows significant potential for reducing customer service times and increasing access at this institution. Finally, the study provides several practice implications that could be used to improve access and customer service times without reduction in clinical quality across a range of health care settings from large hospitals to small community clinics.

  20. Veteran family reintegration, primary care needs, and the benefit of the patient-centered medical home model. (United States)

    Hinojosa, Ramon; Hinojosa, Melanie Sberna; Nelson, Karen; Nelson, David


    Men and women returning from the wars in Afghanistan and Iraq face a multitude of difficulties while integrating back into civilian life, but the importance of their veteran status is often overlooked in primary care settings. Family physicians have the potential to be the first line of defense to ensure the well-being of veterans and their families because many will turn to nonmilitary and non-Veterans Affairs providers for health care needs. An awareness of the unique challenges faced by this population is critical to providing care. A patient-centered medical home orientation can help the family physician provide veterans and their families the care they need. Specific recommendations for family physicians include screening their patient population; providing timely care; treating the whole family; and integrating care from multiple disciplines and specialties, providing veterans and families with "one-stop shopping" care. An awareness of the unique challenges faced by veterans and their families translates into better overall outcomes for this population.

  1. Thirty Years of Pancreas Transplantation at Leiden University Medical Center : Long-Term Follow-Up in a Large Eurotransplant Center

    NARCIS (Netherlands)

    Kopp, Wouter H; Verhagen, Merel J J; Blok, Joris J; Huurman, Volkert A L; de Fijter, Johan W; de Koning, Eelco J; Putter, Hein; Baranski, Andzrej G; Schaapherder, Alexander F M; Braat, Andries E; Ringers, Jan


    BACKGROUND: An overview of 30 years of pancreas transplantation at a high volume center. Analysis of patient survival- and graft survival-associated risk factors. METHODS: All pancreas transplantations performed in our center from January 1, 1984, till December 31, 2012, were evaluated. Covariates i


    Directory of Open Access Journals (Sweden)

    S. V. Gautier


    Full Text Available Aim. To estimate the requirement of the population of the Russian Federation for an organ transplantation and donor resource, to offer approach to planning of an effective network of the medical organizations (the centers of transplantation. Materials and methods. The analysis and comparison of statistical data on population, number of the patients receiving a dialysis, data about medical care on an organ transplantation in Russia and foreign countries is made. Results. On the basis of what the assessment of requirement of the population of the Russian Federation in an organ transplantation and donor resource is carried out, approach to planning of an effective network of the medical organizations (the centers of transplantation and scenarios of development of organ do- nation and transplantation in Russia is offered. Conclusion. To provide the population of the Russian Federation with medical care on an organ transplantation according to real requirement and donor resource, in each region of the Russian Federation have to be organized deceased organ donation and transplantation of a cadaveric kidney. But the transplantation of extrarenal organs is better to develop in the federal centers of hi-tech medical care with donor providing from territories of adjacent regions. 

  3. Improving communication skill training in patient centered medical practice for enhancing rational use of laboratory tests: The core of bioinformation for leveraging stakeholder engagement in regulatory science. (United States)

    Moura, Josemar de Almeida; Costa, Bruna Carvalho; de Faria, Rosa Malena Delbone; Soares, Taciana Figueiredo; Moura, Eliane Perlatto; Chiappelli, Francesco


    Requests for laboratory tests are among the most relevant additional tools used by physicians as part of patient's health problemsolving. However, the overestimation of complementary investigation may be linked to less reflective medical practice as a consequence of a poor physician-patient communication, and may impair patient-centered care. This scenario is likely to result from reduced consultation time, and a clinical model focused on the disease. We propose a new medical intervention program that specifically targets improving the patient-centered communication of laboratory tests results, the core of bioinformation in health care. Expectations are that medical students training in communication skills significantly improve physicians-patient relationship, reduce inappropriate use of laboratorial tests, and raise stakeholder engagement.

  4. Disbursement of $65 million to the State of Texas for construction of a Regional Medical Technology Center at the former Superconducting Super Collider Site, Waxahachie, Texas

    Energy Technology Data Exchange (ETDEWEB)



    As part of a settlement agreement between the US DOE and the State of Texas, DOE proposes to transfer $65 million of federal funds to the Texas National Research Laboratory Commission (TNLRC) for construction of the Regional Medical Technology Center (RMTC) to be located in Ellis County, Texas. The RMTC would be a state-of-the-art medical facility for proton cancer therapy, operated by the State of Texas in conjunction with the University of Texas Southwestern Medical Center. The RMTC would use the linear accelerator assets of the recently terminated DOE Superconducting Super Collider Project to accelerate protons to high energies for the treatment of cancer patients. The current design provides for treatment areas, examination rooms, support laboratories, diagnostic imaging equipment, and office space as well as the accelerators (linac and synchrotron) and beam steering and shaping components. The potential environmental consequences of the proposed action are expected to be minor.

  5. JPRS Report, East Asia, Southeast Asia. (United States)


    volumes: China, East Europe, Soviet Union, East Asia, Near East & South Asia, Sub- Saharan Africa, Latin America , and West Europe. Supplements to...Foreign Aid, Corporate Acceptance of Land Reform Law [WEEKLY AGRIBUSINESS 18-24 Nov] ... 9 10 THAILAND Commerce Ministry Official Views...Land Reform Law 42000042 Manila WEEKLY AGRIBUSINESS in English 18-24 Nov 88 p 15 [Article under the rubric "ON THE BEAT" by Jake Espino] [Text

  6. 体检中心精细化管理探索%Investigation on the Meticulous Management of Medical Examination Center

    Institute of Scientific and Technical Information of China (English)

    吴伟晴; 唐铭坚; 廖淑萍; 林小兰; 黄琼芳; 陶红; 王明飞


    Objective Meticulous management system was introduced in medical examination centers in a large hospital , The regulations of center were summarized according to practical experience , with which to enhance service capabilities and satisfy the requirements of sustainable development .Methods The advanced meticulous management system was applied on the basis of the traditional hospital management , which would help to set up and manage every keys , and conduct reasonable allocation of medical resources .Results Through the introduction of meticulous management system in medical centers , the internal management of the medical center was improved , physical examination and the health management were integrated well , and the medical capability as well as the service quality were improved .The customer satisfaction was improved greatly .Discussion It is necessary , feasi-ble and beneficial for the medical centers in large hospitals to carry out meticulous management , which is a trend in the development of medical center management .%目的:在三甲医院体检中心引进精细化管理体系,通过实践总结出本中心的规范化管理经验,提升服务能力,满足体检中心获得可持续性发展的需要。方法在传统医院管理基础上合理应用精细化管理体系在体检工作中,设置和管理好每个环节,合理利用医疗资源。结果通过运用精细化管理体系,加强体检中心内部管理,将体检和健康管理有机结合,使医疗质量、服务水平和能力都得到全面提升,提高客户满意度。讨论三甲医院体检中心开展精细化管理是必要的、可行的、有效的,是体检中心在管理发展上的趋势。

  7. Characteristics and trends of pediatric traumatic brain injuries treated at a large pediatric medical center in China, 2002-2011.

    Directory of Open Access Journals (Sweden)

    Jianbo Shao

    Full Text Available BACKGROUND: Pediatric traumatic brain injuries (TBIs have not been well studied in China. This study investigated characteristics and trends of hospitalized TBIs sustained by Chinese children. METHODS AND FINDINGS: We analyzed 2002-2011 hospitalized TBI patients (0-17 years of age treated at a large pediatric medical center in China. TBIs were defined using the International Classification of Diseases, Tenth Revision (ICD-10 codes. We examined age patterns across external causes of TBIs. We reported the trend of traffic-related TBIs for each year from 2002 to 2011. Of 4,230 TBI patients, 67.1% (95% CI: 65.4%-68.8% were city residents and 28.8% (95% CI: 26.3%-31.3% came from rural villages. Males had disproportionately more TBIs than females (65.2% vs. 34.8%. Falls, struck by/against objects, and traffic collisions were the top three external causes of TBIs for all age groups. Falls were the leading cause of TBI for all ages but peaked at 2 years of age. There were 125 TBIs in 0-2 year olds (5.9% of all TBIs in this age group that were caused by suspected child abuse. Suspected child abuse was significantly more likely to occur in 0-1 year olds. The proportion of traffic -related TBIs increased significantly from 12.99% in 2002 to 19.68% in 2008 but dropped each subsequent year until it reached a level of 8.91% in 2011. CONCLUSIONS: Our study confirms that falls, struck by/against objects and traffic collisions are the top external causes of TBIs in Chinese children. When compared with national data from the developed countries, gender patterns are similar, but the ranking of external causes is different. This is the first study to highlight the important role of suspected child abuse in causing TBIs in infants in China. TBIs caused by child abuse warrant further research and government attention as a social and medical problem in China.

  8. The Patient-Centered Medical Home: How Is It Related to Quality and Equity Among the General Adult Population? (United States)

    Reibling, Nadine


    This study investigates whether patient-reported characteristics of the medical home are associated with improved quality and equity of preventive care, advice on health habits, and emergency department use. We used adjusted risk ratios to examine the association between medical home characteristics and care measures based on the 2010 Medical Expenditure Panel Survey. Medical home characteristics are associated with 6 of the 11 outcome measures, including flu shots, smoking advice, exercise advice, nutrition advice, all advice, and emergency department visits. Educational and income groups benefit relatively equally from medical home characteristics. However, compared with insurance and access to a provider, medical home characteristics have little influence on overall disparities in care. In sum, our findings support that medical home characteristics can improve quality and reduce emergency visits but we find no evidence that medical home characteristics alleviate disparities in care.

  9. Evaluating the Imbalance Between Increasing Hemodialysis Patients and Medical Staff Shortage After the Great East Japan Earthquake: Report From a Hemodialysis Center Near the Fukushima Nuclear Power Plants. (United States)

    Koshiba, Takaaki; Nishiuchi, Takamitsu; Akaihata, Hidenori; Haga, Nobuhiro; Kojima, Yoshiyuki; Kubo, Hajime; Kasahara, Masato; Hayashi, Masayuki


    The Great East Japan Earthquake in 2011 caused an unprecedented imbalance between an increasing number of hemodialysis patients and medical staff shortage in the Sousou area, the site of the Fukushima nuclear power plants. In 2014, capacity of our hemodialysis center reached a critical limit due to such an imbalance. We attempted to evaluate the effort of medical staff to clarify to what extent their burden had increased post-disaster. The ratio of total dialysis sessions over total working days of medical staff was determined as an approximate indicator of effort per month. The mean value of each year was compared. Despite fluctuations of the ratio, the mean value did not differ from 2010 to 2013. However, the ratio steadily increased in 2014, and there was a significant increase in the mean value. This proposed indicator of the effort of medical staff appears to reflect what we experienced, although its validity must be carefully examined in future studies.

  10. A Novel Approach to Supporting Relationship-Centered Care Through Electronic Health Record Ergonomic Training in Preclerkship Medical Education (United States)

    Silverman, Howard; Ho, Yun-Xian; Kaib, Susan; Ellis, Wendy Danto; Moffitt, Marícela P.; Chen, Qingxia; Nian, Hui; Gadd, Cynthia S.


    Problem How can physicians incorporate the electronic health record (EHR) into clinical practice in a relationship-enhancing fashion (“EHR ergonomics”)? Approach Three convenience samples of 40 second-year medical students with varying levels of EHR ergonomic training were compared in the 2012 spring semester. All participants first received basic EHR training and completed a pre-survey. Two study groups were then instructed to use the EHR during the standardized patient (SP) encounter in each of four regularly scheduled Doctoring (clinical skills) course sessions. One group received additional ergonomic training in each session. Ergonomic assessment data were collected from students, faculty, and SPs in each session. A post-survey was administered to all students, and data were compared across all three groups to assess the impact of EHR use and ergonomic training. Outcomes There was a significant positive effect of EHR ergonomics skills training on students’ relationship-centered EHR use (P < .005). Students who received training reported that they were able to use the EHR to engage with patients more effectively, better articulate the benefits of using the EHR, better address patient concerns, more appropriately position the EHR device, and more effectively integrate the EHR into patient encounters. Additionally, students’ self-assessments were strongly corroborated by SP and faculty assessments. A minimum of three ergonomic training sessions was needed to see an overall improvement in EHR use. Next Steps In addition to replication of these results, further effectiveness studies of this educational intervention need to be carried out in GME, practice, and other environments. PMID:24826851

  11. Spinal Epidural Abscess in Adults: A 10-Year Clinical Experience at a Tertiary Care Academic Medical Center. (United States)

    Artenstein, Andrew W; Friderici, Jennifer; Holers, Adam; Lewis, Deirdre; Fitzgerald, Jan; Visintainer, Paul


    Background.  Delayed recognition of spinal epidural abscess (SEA) contributes to poor outcomes from this highly morbid and potentially lethal infection. We performed a case-control study in a regional, high-volume, tertiary care, academic medical center over the years 2005-2015 to assess the potential changing epidemiology, clinical and laboratory manifestations, and course of this disorder and to identify factors that might lead to early identification of SEA. Methods.  Diagnostic billing codes consistent with SEA were used to identify inpatient admissions for abstraction. Subjects were categorized as cases or controls based on the results of spinal imaging studies. Characteristics were compared using Fisher's exact or Kruskal-Wallis tests. All P values were 2-sided with a critical threshold of <.05. Results.  We identified 162 cases and 88 controls during the study period. The incidence of SEA increased from 2.5 to 8.0 per 10 000 admissions, a 3.3-fold change from 2005 to 2015 (P < .001 for the linear trend). Compared with controls, cases were significantly more likely to have experienced at least 1 previous healthcare visit or received antimicrobials within 30 days of admission; to have comorbidities of injection drug use, alcohol abuse, or obesity; and to manifest fever or rigors. Cases were also more likely to harbor coinfection at a noncontiguous site. When available, inflammatory markers were noted to be markedly elevated in cases. Focal neurologic deficits were seen with similar frequencies in both groups. Conclusions.  Based on our analysis, it appears that selected factors noted at the time of clinical presentation may facilitate early recognition of SEA.

  12. SU-E-J-137: Image Registration Tool for Patient Setup in Korea Heavy Ion Medical Accelerator Center

    Energy Technology Data Exchange (ETDEWEB)

    Kim, M; Suh, T [Department of Biomedical Engineering, Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul (Korea, Republic of); Cho, W [Borame Medical Center, Seoul National University Hospital, Seoul, Seoul (Korea, Republic of); Jung, W [Korea Institute of Radiological & Medical Sciences, Seoul, Seoul (Korea, Republic of)


    Purpose: A potential validation tool for compensating patient positioning error was developed using 2D/3D and 3D/3D image registration. Methods: For 2D/3D registration, digitally reconstructed radiography (DRR) and three-dimensional computed tomography (3D-CT) images were applied. The ray-casting algorithm is the most straightforward method for generating DRR. We adopted the traditional ray-casting method, which finds the intersections of a ray with all objects, voxels of the 3D-CT volume in the scene. The similarity between the extracted DRR and orthogonal image was measured by using a normalized mutual information method. Two orthogonal images were acquired from a Cyber-Knife system from the anterior-posterior (AP) and right lateral (RL) views. The 3D-CT and two orthogonal images of an anthropomorphic phantom and head and neck cancer patient were used in this study. For 3D/3D registration, planning CT and in-room CT image were applied. After registration, the translation and rotation factors were calculated to position a couch to be movable in six dimensions. Results: Registration accuracies and average errors of 2.12 mm ± 0.50 mm for transformations and 1.23° ± 0.40° for rotations were acquired by 2D/3D registration using an anthropomorphic Alderson-Rando phantom. In addition, registration accuracies and average errors of 0.90 mm ± 0.30 mm for transformations and 1.00° ± 0.2° for rotations were acquired using CT image sets. Conclusion: We demonstrated that this validation tool could compensate for patient positioning error. In addition, this research could be the fundamental step for compensating patient positioning error at the first Korea heavy-ion medical accelerator treatment center.

  13. University of Pittsburgh Medical Center remains tracker: A novel application for tracking decedents and improving the autopsy workflow

    Directory of Open Access Journals (Sweden)

    Matthew A Smith


    Full Text Available All hospitals deal with patient deaths. Multiple departments and personnel must be coordinated to ensure that decedents are safely managed. Prior to 2004, at the University of Pittsburgh Medical Center (UPMC, when a patient passed away, the process of alerting involved personnel, transporting the decedent, and tracking the completion of clinical documents was cumbersome and inefficient. In order to address these concerns, UPMC Remains Tracker, a web-based application, was developed to improve the efficiency and simplify the logistics related to the management of patient deaths. The UPMC Information Services division developed UPMC Remains Tracker, an application that tracks decedents′ locations, documentation status, and autopsy status within UPMC hospitals. We assessed qualitative improvement in decedent remains tracking, decedent paperwork management, and staff satisfaction and compliance. UPMC Remains Tracker improved the process of tracking decedents′ locations, identifying involved personnel, monitoring autopsy requests, and determining the availability for funeral home transportation. Resident satisfaction with UPMC Remains Tracker was generally positive and scored as "Improved efficiency" and makes identifying and tracking decedents "Much easier". Additionally, the nursing staff reacted favorably to the application. A retrospective review of the use of the application in the management of 100 decedents demonstrated a 93% compliance rate. Among the cases requiring an autopsy, there was a 90% compliance rate. The process of tracking decedents, their paperwork, involved staff, and decedent autopsy status is often inefficient. This assessment suggests that incorporating new technologies such as UPMC Remains Tracker into the management of hospital deaths provides accurate tracking of remains, streamlines the administrative tasks associated with deaths, and increases nursing and resident satisfaction and compliance.

  14. Clinical characteristics and prognostic factors of splenic abscess: A review of 67 cases in a single medical center of Taiwan

    Institute of Scientific and Technical Information of China (English)

    Kuo-Chin Chang; Chuan-Mo Lee; Tsung-Hui Hu; Seng-Kee Chuah; Chi-Sin Changchien; Tung-Lung Tsai; Sheng-Nan Lu; Yi-Chun Chiu; Yaw-Sen Chen; Chih-Chi Wang; Jui-Wei Lin


    AIM: To analyze 67 cases of splenic abscess in a medical center of Taiwan during a period of 19 years.METHODS: From January 1986 to December 2004, a total of 67 patients with splenic abscess were enrolled for the retrospective study. The clinical characteristics,underlying diseases, organism spectra, therapeutic methods, APACHE Ⅱ scores, and mortality rates were analyzed.RESULTS: There were 41 males and 26 females with the mean age of 54.1± 14.1 years. Multiple splenic abscesses (MSA) account for 28.4% and solitary splenic abscess in 71.6% of the patients. Twenty-six of sixtyseven patients (35.8%) had extrasplenic abscesses, with leading site of liver (34.6%). Microbiological cultures were positive in 58 patients (86.6%), with 71.8% in blood culture and 93.5% in abscess culture. Gram negative bacillus (GNB) infection predominated (55.2%),with leading pathogen ofKlebsiella pneumoniae (22.4%),followed by gram positive coccus (GPC) infection (31%).Splenectomy was performed in 26 patients (38.8%),percutaneous drainage or aspiration in 21 (31.3%),and antibiotic therapy alone in 20 patients (29.9%).Eventually, 12 of 67 patients expired (17.9 %). By statistics, spleen infected with GNB was likely to develop multiple abscesses compared with infection with GPC(P=0.036). Patients with GNB infection (P= 0.009) andmultiple abscesses (P= 0.011) experienced a higher mortality rate than patients with GPC infection and solitary abscess. The mean APACHE Ⅱ score of 12 expired patients (16.3 ±3.2) was significantly higher than that of the 55 survivals (7.2 ± 3.8) (P< 0.001).CONCLUSION: MSA, GNB infection, and high APACHEⅡ scores are poor prognostic factors. Early surgical intervention should be encouraged when these risk factors are present.

  15. The Role of Wrist Magnetic Resonance Arthrography in Diagnosing Triangular Fibrocartilage Complex Tears; Experience at King Hussein Medical Center, Jordan

    Directory of Open Access Journals (Sweden)

    Asem A. Al-Hiari


    Full Text Available Objectives: The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC and to compare the results of the magnetic resonance arthrography (MRA with the gold standard arthroscopic findings. Methods:The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. Results: After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93% and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactorypain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39, and specificity was 80% (16/20. The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34. Conclusion: These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.

  16. East Asia Rolls On

    Institute of Scientific and Technical Information of China (English)


    The economic recovery in East Asia remains unchanged on its upward trajectory despite the earthquake and devastating tsunami in Japan on March 11.Growth in East Asia slowed after a sharp rebound from the global financial crisis but is improving nonetheless.The World Bank’s East Asia and Pacific Economic Update issued on March 21 projects real GDP growth in East Asia will be smaller than that of 2010 in the following two years.Besides future East Asian economic trends,the report also discusses the impact of the Japanese catastrophe.Edited excerpts follow:

  17. Kazakhstan: A Key Economic Driving Force of Central Asia

    Institute of Scientific and Technical Information of China (English)


    @@ Located strategically in the center of Eurasia, the Republic of Kazakhstan has been the largest country in terms of its territory, and also one of the most important economy and dynamic transport hub with abundant resources in Central Asia.

  18. Marketing Development Information in South Asia. (United States)

    Geethananda, Hemamalee


    Discusses adapting traditional marketing strategies for the nonprofit sector, including libraries and information centers, and describes experiences of the Development Information Network for South Asia in Sri Lanka. Topics addressed include librarians' value systems, including free access to information; the need for information marketing;…

  19. Assistance Focus: Asia/Pacific Region

    Energy Technology Data Exchange (ETDEWEB)


    The Clean Energy Solutions Center, an initiative of the Clean Energy Ministerial, helps countries throughout the world create policies and programs that advance the deployment of clean energy technologies. Through the Solutions Center's no-cost 'Ask an Expert' service, a team of international experts has delivered assistance to countries in all regions of the world. High-impact examples from the Asia/Pacific region are featured here.

  20. Commercialization as a recommended approach to hospital restructuring: Case study of Łańcut Medical Center


    Wiktor Patena; Bartłomiej Kaszyk


    Our society is on the brink of health care system reorganization and implementation of new medical technology. Hospitals have to be a core component of the medical revolution so they have to be prepared for the upcoming leap in their development. If Poland wants to be a pioneer in providing new medical solutions, the current ineffective system has to be changed. The necessary action should be taken to deal with the financial problems Polish hospitals have faced for over 20 years. The current ...

  1. Stateside Care of Marines and Sailors Injured in Iraq at the National Naval Medical Center in Bethesda, Maryland (United States)


    licensed medical providers; other branches of the armed services refer to them as medics. A respiratory therapist must be nearby to manage intubated ...patient, the scenario is similar: the primary RN receives a report from the Air Force medical personnel and performs a quick visual assessment of the...The occu- pants not only suffer blast injuries but also major impact injuries because of the sequences of events. Added to that scenario, the service

  2. Administration of over-the-counter medication to children at home--a survey of parents from community health centers. (United States)

    Anderson, Colleen; Rolfe, Paula; Brennan-Hunter, Andrea


    Parents (n = 135) were surveyed in relation to administering antipyretic/analgesic medications to their children (2 months-6 years) at home. Parents usually chose acetaminophen, calculated dosages based on weight but did not always know the child's weight, administered medications with a dropper, and reported having a sick child was moderately stressful. Many children were medicated for pain and/or fever during the week prior to immunization and many weighed more than the age/weight recommended dosages on the label. Community health nurses can facilitate safe administration of medications by integrating knowledge of parents' pain and fever management practices into discussions and anticipatory planning during clinic visits.

  3. Radiation Therapy Improves Survival Outcome in Pancreatic Adenocarcinoma: Comparison of a 15-Year Institutional Experience at the University of Nebraska Medical Center with SEER Data


    Baine, Michael J.; Chi Lin


    Objectives. We examined the role of radiation therapy (RT) in pancreatic adenocarcinoma (PA) treatment through a 15-year retrospective analysis of patients treated at University of Nebraska Medical Center (UNMC) as well as those from the SEER database. Methods. A total of 561 patients diagnosed with PA at UNMC between 1995 and 2011 and 60,587 patients diagnosed between 1995 and 2009 from the SEER were included. Examined prognostic factors for overall survival (OS) were age, gender, race, stag...

  4. A Study of Meeting the Emotional Needs of Dying Patients and their Families at Walter Reed Army Medical Center, Washington, DC (United States)


    for the creation of a special thanatology team called "The Care Team". This interdisciplinary team consisting of volunteer physicians, nurses, social...the status quo, (2) establish a fully operational hospice, or (3) establish a thanatology team that is specifically designed to help dying patients... Thanatology Team To some the status quo is not acceptable, yet at the same time establishing a fully operational hospice at Walter Reed Army Medical Center

  5. Stereotactic Body Radiotherapy for Medically Inoperable Lung Cancer: Prospective, Single-Center Study of 108 Consecutive Patients

    Energy Technology Data Exchange (ETDEWEB)

    Taremi, Mojgan, E-mail: [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University Health Network, Toronto, ON (Canada); Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Hope, Andrew [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University Health Network, Toronto, ON (Canada); Dahele, Max [Department of Radiation Oncology, Stronach Regional Cancer Center, Newmarket, ON (Canada); Pearson, Shannon [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Fung, Sharon [Department of Biostatistics, Princess Margaret Hospital, Toronto, ON (Canada); Purdie, Thomas [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Brade, Anthony [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University Health Network, Toronto, ON (Canada); Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Cho, John; Sun, Alexander; Bissonnette, Jean-Pierre; Bezjak, Andrea [Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON (Canada); Department of Radiation Oncology, University Health Network, Toronto, ON (Canada)


    Purpose: To present the results of stereotactic body radiotherapy (SBRT) for medically inoperable patients with Stage I non-small-cell lung cancer (NSCLC) and contrast outcomes in patients with and without a pathologic diagnosis. Methods and Materials: Between December 2004 and October 2008, 108 patients (114 tumors) underwent treatment according to the prospective research ethics board-approved SBRT protocols at our cancer center. Of the 108 patients, 88 (81.5%) had undergone pretreatment whole-body [18F]-fluorodeoxyglucose positron emission tomography/computed tomography. A pathologic diagnosis was unavailable for 33 (28.9%) of the 114 lesions. The SBRT schedules included 48 Gy in 4 fractions or 54-60 Gy in 3 fractions for peripheral lesions and 50-60 Gy in 8-10 fractions for central lesions. Toxicity and radiologic response were assessed at the 3-6-month follow-up visits using conventional criteria. Results: The mean tumor diameter was 2.4-cm (range, 0.9-5.7). The median follow-up was 19.1 months (range, 1-55.7). The estimated local control rate at 1 and 4 years was 92% (95% confidence interval [CI], 86-97%) and 89% (95% CI, 81-96%). The cause-specific survival rate at 1 and 4 years was 92% (95% CI, 87-98%) and 77% (95% CI, 64-89%), respectively. No statistically significant difference was found in the local, regional, and distant control between patients with and without pathologically confirmed NSCLC. The most common acute toxicity was Grade 1 or 2 fatigue (53 of 108 patients). No toxicities of Grade 4 or greater were identified. Conclusions: Lung SBRT for early-stage NSCLC resulted in excellent local control and cause-specific survival with minimal toxicity. The disease-specific outcomes were comparable for patients with and without a pathologic diagnosis. SBRT can be considered an option for selected patients with proven or presumed early-stage NSCLC.

  6. Electronic health record training in undergraduate medical education: bridging theory to practice with curricula for empowering patient- and relationship-centered care in the computerized setting. (United States)

    Wald, Hedy S; George, Paul; Reis, Shmuel P; Taylor, Julie Scott


    While electronic health record (EHR) use is becoming state-of-the-art, deliberate teaching of health care information technology (HCIT) competencies is not keeping pace with burgeoning use. Medical students require training to become skilled users of HCIT, but formal pedagogy within undergraduate medical education (UME) is sparse. How can medical educators best meet the needs of learners while integrating EHRs into medical education and practice? How can they help learners preserve and foster effective communication skills within the computerized setting? In general, how can UME curricula be devised for skilled use of EHRs to enhance rather than hinder provision of effective, humanistic health care?Within this Perspective, the authors build on recent publications that "set the stage" for next steps: EHR curricula innovation and implementation as concrete embodiments of theoretical underpinnings. They elaborate on previous calls for maximizing benefits and minimizing risks of EHR use with sufficient focus on physician-patient communication skills and for developing core competencies within medical education. The authors describe bridging theory into practice with systematic longitudinal curriculum development for EHR training in UME at their institution, informed by Kern and colleagues' curriculum development framework, narrative medicine, and reflective practice. They consider this innovation within a broader perspective-the overarching goal of empowering undergraduate medical students' patient- and relationship-centered skills while effectively demonstrating HCIT-related skills.


    Directory of Open Access Journals (Sweden)

    N. P. Savina


    Full Text Available Abstract:The Operative Information Support Service for Scientific Research of the Medical Radiological Research Center named after A. F. Tsyb — Branch of the FSBI «National Medical Research Radiological Center” of the RF Health Ministry presented a report on providing off-budget support for scientific activities over the period from 1993 to 2014 using domestic and foreign information resources. The dynamics of employee activities in institutional sectors with aim to receive financial support for fundamental and applied scientific research on a competitive and non-competitive basis was given. The analysis of the obtained data indicated that a multi-channeling in off-budget funding was formed. It also showed to some extent a situation at the open market of grants in the field of medical radiology, radiobiology, and radiation epidemiology among leading investors in intellectual products.

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


    ...- centered care, recreation therapy and mental health programs and staff. The area will have limited public... commenters wanted to see the development of more outdoor sports facilities for veterans, such as a fitness... coordination with VA patient-centered care, recreation therapy and mental health programs and staff. An...

  9. Neurology in Asia. (United States)

    Tan, Chong-Tin


    Asia is important as it accounts for more than half of the world population. The majority of Asian countries fall into the middle income category. As for cultural traditions, Asia is highly varied, with many languages spoken. The pattern of neurologic diseases in Asia is largely similar to the West, with some disease features being specific to Asia. Whereas Asia constitutes 60% of the world's population, it contains only 20% of the world's neurologists. This disparity is particularly evident in South and South East Asia. As for neurologic care, it is highly variable depending on whether it is an urban or rural setting, the level of economic development, and the system of health care financing. To help remedy the shortage of neurologists, most counties with larger populations have established training programs in neurology. These programs are diverse, with many areas of concern. There are regional organizations serving as a vehicle for networking in neurology and various subspecialties, as well as an official journal (Neurology Asia). The Asian Epilepsy Academy, with its emphasis on workshops in various locations, EEG certification examination, and fellowships, may provide a template of effective regional networking for improving neurology care in the region.

  10. Zika virus in Asia. (United States)

    Duong, Veasna; Dussart, Philippe; Buchy, Philippe


    Zika virus (ZIKV) is an emerging mosquito-borne virus that was first isolated from a sentinel rhesus monkey in the Zika Forest in Uganda in 1947. In Asia, the virus was isolated in Malaysia from Aedes aegypti mosquitoes in 1966, and the first human infections were reported in 1977 in Central Java, Indonesia. In this review, all reported cases of ZIKV infection in Asia as of September 1, 2016 are summarized and some of the hypotheses that could currently explain the apparently low incidence of Zika cases in Asia are explored.

  11. Zika virus in Asia

    Directory of Open Access Journals (Sweden)

    Veasna Duong


    Full Text Available Zika virus (ZIKV is an emerging mosquito-borne virus that was first isolated from a sentinel rhesus monkey in the Zika Forest in Uganda in 1947. In Asia, the virus was isolated in Malaysia from Aedes aegypti mosquitoes in 1966, and the first human infections were reported in 1977 in Central Java, Indonesia. In this review, all reported cases of ZIKV infection in Asia as of September 1, 2016 are summarized and some of the hypotheses that could currently explain the apparently low incidence of Zika cases in Asia are explored.

  12. Asia's Economic Voices

    Institute of Scientific and Technical Information of China (English)


    @@ After several months of unease,economies across Asia are breathing a sigh of relief as recovery hopes become realities.But even with noticeable improvements being made,Asian nations still face the challenge of moving away from a dependence on exports and maintaining growth momentum.These issues were hot topics at this year's Boao Forum for Asia,with Asia's green recovery as its theme.More than2,000 economists and businesspeople from home and abroad attended the forum held in Boao of south China's Hainan Province from April9 to 11.

  13. Quantitative Analysis of Contributing Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center (United States)


    physicians, Doctors of Medicine (M.D.) or Doctors of Osteopathy (D.O.); physician assistants; or clinical nurse practitioners. Physicians, physician...treatment methods including spinal manipulation and the whole body concept and confer the Doctor of Osteopathy (D.O.) degree. After completion of...medical school, both Doctors of Medicine and Doctors of Osteopathy are licensed by their state boards and may become board certified in any medical

  14. Aim to International Shipping Center

    Institute of Scientific and Technical Information of China (English)

    Hu Wenxiu


    @@ Since 1990s,various countries in the world have been focusing on the construction of the key ports,leading to a fiercer competition between ports.For example,in East Asia,South Korea and Japan are rivaling for the international shipping center in Northeast Asia.Taking Busan Port and Gwangyang Port as the central ports,South Korea is boosting the ports expansion plans,to construct a"logistic center in Northeast Asia".Meanwhile.Japan is projecting the optimizmg and integration of port resources,to regain the international shipping center in Asia.The central government of China made plans for constructing Shanghai Shipping Center as early in 1996.and after 13 years'construction,now Shanghai Port has the largest cargo throughput and the second largest container throughput in the world.

  15. Unification of South Asia (United States)


    Asia: for example, Jainism, Buddhism, Sikhism and Christians. The Hindus are the descendants of the Aryans, nomadic people of Central Asia who... traditions . There are hundred thousands of people from Bangladesh who have, illegally, crossed over to India, over the years in pursuit of a better economic...festival of Urns. Such tradition is believed common even at the few Muslim ’dargahs’ at Priol Ponda and Cuncolim." "Prof Robert S. Newman, a

  16. Nuclear South Asia (United States)


    nuclear equation in South Asia, the geopolitical and geoeconomic realities will keep China out of the South Asian nuclear picture. As Pakistan...remain unipolar for quite some time with the United States as the global superpower. There is predominance of geoeconomics as against drag China into the nuclear equation in South Asia, the geopolitical and geoeconomic realities will likely keep China out of the South Asian

  17. Commercializing medical technology. (United States)

    Scanlon, Kevin J; Lieberman, Mark A


    As medicine moves into the 21st century, life saving therapies will move from inception into medical products faster if there is a better synergy between science and business. Medicine appears to have 50-year innovative cycles of education and scientific discoveries. In the 1880's, the chemical industry in Germany was faced with the dilemma of modernization to exploit the new scientific discoveries. The solution was the spawning of novel technical colleges for training in these new chemical industries. The impact of those new employees and their groundbreaking compounds had a profound influence on medicine and medical education in Germany between 1880 and 1930. Germany dominated international science during this period and was a training center for scientists worldwide. This model of synergy between education and business was envied and admired in Europe, Asia and America. British science soon after evolved to dominate the field of science during the prewar and post World War (1930's-1970's) because the German scientists fled Hitler's government. These expatriated scientists had a profound influence on the teaching and training of British scientists, which lead to advances in medicine such as antibiotics. After the Second World War, the US government wisely funded the development of the medical infrastructure that we see today. British and German scientists in medicine moved to America because of this bountiful funding for their research. These expatriated scientists helped drive these medical advances into commercialized products by the 1980's. America has been the center of medical education and advances of biotechnology but will it continue? International scientists trained in America have started to return to Europe and Asia. These American-trained scientists and their governments are very aware of the commercial potential of biotechnology. Those governments are now more prepared to play an active role this new science. Germany, Ireland, Britain, Singapore

  18. Health challenges in Kazakhstan and Central Asia. (United States)

    Adambekov, Shalkar; Kaiyrlykyzy, Aiym; Igissinov, Nurbek; Linkov, Faina


    The Central Asian region, which encompasses Kazakhstan, Uzbekistan, Tajikistan, Turkmenistan and Kyrgyzstan, is an interesting geographic region with a rich history dating back to the Silk Road, Mongol conquests and expansion of the Russian Empire. However, from a public health viewpoint, the Central Asian region is under-investigated, and many public health challenges exist, as countries of Central Asia inherited the centralised medical systems practiced in the Soviet Union, and are currently undergoing rapid transitions. A large number of low and middle-income countries around the world, including countries of Central Asia, face a double burden of chronic and infectious disease. This essay focuses on the exploration of the most important public health challenges in the Central Asian region, including limited scientific productivity, the double burden of chronic and infectious disease, the need for healthcare reform and the reduction in care variation. Central Asia has a large number of medical schools, medical centres, and emerging research institutes that can be used to foster a change in medical and public health practice in the region.

  19. Building the Medical Imaging Resource Center Based on PACS to Improve the Teaching Medical Imaging%构建基于PACS的医学影像教学资源中心提升教学质量

    Institute of Scientific and Technical Information of China (English)

    王世威; 姜慧萍; 韩浙; 许茂盛


    [目的]构建基于图像存档与传输系统(picture archiving and communication system,PACS)的数字化医学影像教学资源中心,提升医学影像学教学质量。[方法]设计电子教案(electronic teaching file,ETF)生成模块,并把它整合在PACS系统报告工作站,配置电子教案服务器,建立电子教案数据库,并通过与PACS系统交互的接口模块,实现影像电子教案的制作,然后利用医院PACS系统中海量的数字化医学影像资料,建立数字化医学影像教学资源中心。[结果]通过整合在PACS系统报告工作站中的电子教案生成模块,选择典型病例、感兴趣病例,并经过简单的处理后自动快速地生成电子教案,成功构建数字化医学影像教学资源中心。[结论]基于PACS系统成功构建数字化医学影像教学资源中心,最大限度实现医学影像教学资源共享,将改变医学影像学教学模式,极大地提升医学影像学教学质量。%[Purpose] To build the digital Medical Imaging Resource Center based on the picture archiving and communication system(PACS) to improve the teaching medical imaging. [Methods] The generating module of the electronic teaching file(ETF) was developed and integrated into the report work-station of PACS. The ETF server was configurated. The ETF database was created. The ETF was created through the interface module with PACS, and then the medical imaging electronic teaching resources center was built. [Result] Using the generation module of the ETF integrated in report workstation of PACS, the ETF can be automatical y created quickly through simply processing after selecting typical cases or the cases of interest. The medical imaging electronic teaching resources center has been built successful y by using the great number of medical image data in the hospital PACS. [Conclusion]The medical imaging electronic teaching resources center can be built successful y based on PACS

  20. New Think Tanks and the Obama Administration's Asia- Pacific Policy Making: The Case of the Center for a New American Security%新思想库与奥巴马政府的亚洲政策决策——以新美国安全研究中心为例

    Institute of Scientific and Technical Information of China (English)



    In America's foreign policy decision making, think tanks play an extraordinary role in terms of new policy innovation, leadership development, providing platforms for policy debates and educating and guiding public opinion. The recently established Center for a New American Security has tremendous influence on the foreign policy of the Obama Administration. Its Asia policy research emphasizes a pragmatic approach, and focuses on resto- ring "participation" of America in Asia Affairs, while advocating for the enhancement and upgrading of American alliances in Asia. It has also pushed the United States to participate enthusiastically in the region's multi-lateral institutions. Its policy recommendations have a profound impact on contemporary American policy making with respect to Asia.%在美国对外政策决策体系中,思想库在政策理念创新、人才储备、打造政策辩论平台以及教育和引导公众等方面具有非凡的作用。新近兴起的新美国安全研究中心对奥巴马政府的对外政策影响巨大。该中心的亚洲政策研究强调务实的态度,注重美国对亚洲事务的重新“参与”,倡导强化和升级美国在亚洲的联盟关系,推动美国积极介入地区多边制度,其政策建议通过“旋转门制度”等对当前美国的亚洲政策决策产生了深刻影响。

  1. Improvements in self-efficacy for engaging in patient-centered communication following a course in peer-supervision and communication for medical students

    DEFF Research Database (Denmark)

    Lassesen, Berit; O Connor, Maja; Kjær, Louise Binow

    . Conclusion: The students’ motivation to learn the skills taught in the course emerged as a significant independent predictor of the desired learning outcome, supporting self-regulated learning theory stating that motivational factors are important predictors of learning outcome, suggesting the importance......ID: 170 Individual Paper Berit Lassesen1, Maja O’Connor2, Louise Binnow Kjær3, Anne-Mette Mørcke3, Robert Zachariae2, 1Aarhus Universitet, School of Business and Social Science, Denmark; 2Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital...... and Department of Psychology and Behavioral Science, Aarhus University, Aarhus, Denmark; 3Center for Medical Education, Aarhus University, Aarhus, Denmark.; Aim: The aim was to evaluate the outcome of a training course in peer-supervision and communication with the aim of improving medical...

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

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


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

  3. Invasive amebiasis and ameboma formation presenting as a rectal mass: An uncommon case of malignant masquerade at a western medical center

    Institute of Scientific and Technical Information of China (English)


    A 54-year-old man presented with rectal pain and bleeding secondary to ulcerated, necrotic rectal and cecal masses that resembled colorectal carcinoma upon colonoscopy. These masses were later determined to be benign amebomas caused by invasive Entamoeba histolytica, which regressed completely with medical therapy. In Western countries, the occurrence of invasive protozoan infection with formation of amebomas is very rare and can mistakenly masquerade as a neoplasm. Not surprisingly, there have been very few cases reported of this clinical entity within the United States. Moreover, we report a patient that had an extremely rare occurrence of two synchronous lesions, one involving the rectum and the other situated in the cecum. We review the current literature on the pathogenesis of invasive E. Histolytica infection and ameboma formation, as well as management of this rare disease entity at a western medical center.

  4. A Survey of Intravenous Remifentanil Use for Labor Analgesia at Academic Medical Centers in the United States. (United States)

    Aaronson, Jaime; Abramovitz, Sharon; Smiley, Richard; Tangel, Virginia; Landau, Ruth


    Remifentanil is most commonly offered when neuraxial labor analgesia is contraindicated. There is no consensus regarding the optimal administration, dosing strategy, or requirements for maternal monitoring, which may pose a patient safety issue. This exploratory survey evaluated the current practices regarding remifentanil use for labor analgesia at academic centers in the United States. Of 126 obstetric anesthesia directors surveyed, 84 (67%) responded. In 2014 to 2015, an estimated 36% (95% confidence interval: 25.7-46.3) of centers used remifentanil, most of which did so less than 5 times. Some serious maternal and neonatal respiratory complications occurred, emphasizing that clinical protocols and adequate monitoring are key to ensure maternal and neonatal safety.

  5. Effect of a Comprehensive Health Care Program by Korean Medicine Doctors on Medical Care Utilization for Common Infectious Diseases in Child-Care Centers

    Directory of Open Access Journals (Sweden)

    Minjung Park


    Full Text Available As the role of traditional medicine in community health improvement increases, a comprehensive health care program for infectious diseases management in child-care centers by Korean medicine doctors was developed. The purpose of this study is to evaluate the effects of the program intervention on infection-related medical care utilization among children. The study used a quasi-experimental design with nonequivalent control group, comparing pre- and post-intervention data of the same children. The program implemented interventions in terms of management, education, and medical examination for the teachers, parents, and children in 12-week period. The frequency of utilization, cost, and prescription days of drugs and antibiotics due to infectious diseases prior to the intervention were compared with those during the 3-month intervention, using health insurance claim data. A panel analysis was also conducted to support the findings. A significant reduction (12% in infection-related visit days of hospitals was observed with the intervention (incident rate ratio = 0.88, P=0.01. And medical cost, drug prescription days, and antibiotics prescription days were decreased, although not statistically significant. A further cost-effectiveness analysis in terms of social perspectives, considering the opportunity costs for guardians to take children to medical institutions, would be needed.

  6. Peritoneal dialysis in Asia. (United States)

    Cheng, I K


    The socioeconomic status of Asian countries is diverse, and government reimbursement policies for treatment of patients suffering from end-stage renal disease (ESRD) vary greatly from one country to another. Both of these factors have a major impact not only on the choice of treatment for ESRD but also on the utilization of peritoneal dialysis (PD) in this region. Based on the data collected from 11 representative Asian countries, several observations can be made. First, the treatment rates for ESRD in these countries correlated closely with their gross domestic product (GDP) per capita income. Second, the PD utilization rate appeared to have a biphasic relationship with the GDP per capita income and treatment rate, in that countries with the highest and the lowest treatment rates tended to have lower PD utilization rates, whereas countries with modest treatment rates tended to have higher PD utilization rates. The reason for low PD utilization in countries with the highest treatment rates differs from that in countries with low treatment rates. In the former, because of full government reimbursement, there is little physician incentive to introduce PD as an alternative form of ESRD treatment to in-center hemodialysis (HD), whereas in the latter, the complete lack of government reimbursement prevents the introduction of PD as a form of treatment. This pattern is likely to change in the future because, of the 11 countries surveyed, all except Thailand have recorded a growth rate which is higher for PD than HD over the last three years. The rate of utilization of different PD systems varies greatly among different Asian countries. Automated PD has yet to gain popularity in Asia. Conventional straight-line systems remain the dominant PD systems in use in Hong Kong, Korea, Thailand, and the Philippines, while in Malaysia and Singapore UV germicidal connection devices are most popular. However, in all these countries there has been a progressive shift over the last

  7. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center. (United States)

    Garg, Sunil Kumar


    Bodybuilding is the use of progressive resistance exercise to control and develop one's musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

  8. Adjusting to Random Demands of Patient Care: A Predictive Model for Nursing Staff Scheduling at Naval Medical Center San Diego (United States)


    West Model Adult ICU Model Holt-Winters’ Expo Smoothing Model Month Total Req. Acuity Adj. FTEs Leve l Tren d Seaso n Predicted FTE’s...Surgical Model Medical Total Req. FTE’s Based Holt-Winters’ Expo Smoothing Model Month Workload Acuity/FTE’ s Level Tren d Season Predicte d

  9. A Case Study of the Implementation of Radio Frequency Identification Asset Visibility Tracking at Walter Reed Army Medical Center (United States)


    Chapa , Director of Logistics at WAMC, the "biomedical maintenance efficiency jumped to 98-99 percent in performance of scheduled services, because you... Chapa , Director of Logistics at WAMC, recalls an instance where a particular pump was recalled due to a bad gasket. Using the RFID system, medical

  10. Non-doctor consultations and self-medication practices in patients seen at a tertiary dental center in Ibadan

    Directory of Open Access Journals (Sweden)

    Happy Adeyinka Adedapo


    Conclusion: Self-medication practices were quite high in this study, and these practices were also prevalent among the educated people. Drug control enforcement needs to be intensified and dental public health education needs to be given greater priority in the overall public health campaigns.

  11. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Garg


    Full Text Available Bodybuilding is the use of progressive resistance exercise to control and develop one′s musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

  12. Building and evaluating an informatics tool to facilitate analysis of a biomedical literature search service in an academic medical center library. (United States)

    Hinton, Elizabeth G; Oelschlegel, Sandra; Vaughn, Cynthia J; Lindsay, J Michael; Hurst, Sachiko M; Earl, Martha


    This study utilizes an informatics tool to analyze a robust literature search service in an academic medical center library. Structured interviews with librarians were conducted focusing on the benefits of such a tool, expectations for performance, and visual layout preferences. The resulting application utilizes Microsoft SQL Server and .Net Framework 3.5 technologies, allowing for the use of a web interface. Customer tables and MeSH terms are included. The National Library of Medicine MeSH database and entry terms for each heading are incorporated, resulting in functionality similar to searching the MeSH database through PubMed. Data reports will facilitate analysis of the search service.

  13. Community health worker integration into the health care team accomplishes the triple aim in a patient-centered medical home: a Bronx tale. (United States)

    Findley, Sally; Matos, Sergio; Hicks, April; Chang, Ji; Reich, Douglas


    Community health workers are ideally suited to the care coordination niche within the patient-centered medical home (PCMH) team, but there are few case studies detailing how to accomplish this integration. This qualitative study documents how community health workers (CHWs) were integrated into a PCMH in South Bronx, New York. Results show that integration was linked to clear definition of their care coordination role within the care team, meticulous recruitment, training and supervision by a senior CHW, shared leadership of the care management team, and documented value for money. By helping the team understand patients' backgrounds, constraints, and preferences, they helped everyone genuinely focus on the patient.

  14. Improving the quality of health services organization structure by reengineering: circular design and clinical case impact in an academic medical center. (United States)

    Lartin-Drake, J M; Curran, C; Gillis-Donovan, J; Kruger, N R; Ziegenfuss, J T; Ostrem, J; Zanotti, M


    Innovation to improve the quality of structure and process in health care organization is reported in this case example of change in an academic medical center. Interactive planning and the circular organization design concept were the driving principles and methods. This report presents the needs for and initial obstructions to change, planning and project design work, a description of the change process, and illustrative accomplishments to date--two cases, one of conscious sedation policy and one of nuisance pages. Evaluative criteria for judging the progress and lessons of the project regarding key design characteristics also are included.

  15. Determination of prevalence and causes of hyponatremia in patient's admitted in pediatric intensive care unit of the Children's Hospital Medical Center

    Directory of Open Access Journals (Sweden)

    Kadivar M


    Full Text Available Among the 708 patients who were admitted in the pediatric intensive care unit (PICU of the children's hospital medical center, there were 100 patients with hyponatermia (Na<130 mEq/L. 62% of these patients had hyponatermia at the beginning of admission and 38% during hospitalization in PICU. According to the classification of hyponatermia in comparison to body fluid, this study revealed 7% pseudohyponatermia, 40% euvolemic hyponatermia, 34% hypovolemic hyponatermia and 10% hypovolemic hyponatermia. In conclusion, the most perevalent causes of hyponatermia in this study were syndrome of inappropriate antidiuretic hormone secretion (SIADH (27%, water intoxication (22% and extrarenal losses (20%

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

    Energy Technology Data Exchange (ETDEWEB)

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


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

  17. Rationale and design of a patient-centered medical home intervention for patients with end-stage renal disease on hemodialysis. (United States)

    Porter, Anna C; Fitzgibbon, Marian L; Fischer, Michael J; Gallardo, Rani; Berbaum, Michael L; Lash, James P; Castillo, Sheila; Schiffer, Linda; Sharp, Lisa K; Tulley, John; Arruda, Jose A; Hynes, Denise M


    In the U.S., more than 400,000 individuals with end-stage renal disease (ESRD) require hemodialysis (HD) for renal replacement therapy. ESRD patients experience a high burden of morbidity, mortality, resource utilization, and poor quality of life (QOL). Under current care models, ESRD patients receive fragmented care from multiple providers at multiple locations. The Patient-Centered Medical Home (PCMH) is a team approach, providing coordinated care across the healthcare continuum. While this model has shown some early benefits for complex chronic diseases such as diabetes, it has not been applied to HD patients. This study is a non-randomized quasi-experimental intervention trial implementing a Patient-Centered Medical Home for Kidney Disease (PCMH-KD). The PCMH-KD extends the existing dialysis care team (comprised of a nephrologist, dialysis nurse, dialysis technician, social worker, and dietitian) by adding a general internist, pharmacist, nurse coordinator, and a community health worker, all of whom will see the patients together, and separately, as needed. The primary goal is to implement a comprehensive, multidisciplinary care team to improve care coordination, quality of life, and healthcare use for HD patients. Approximately 240 patients will be recruited from two sites; a non-profit university-affiliated dialysis center and an independent for-profit dialysis center. Outcomes include (i) patient-reported outcomes, including QOL and satisfaction; (ii) clinical outcomes, including blood pressure and diet; (iii) healthcare use, including emergency room visits and hospitalizations; and (iv) staff perceptions. Given the significant burden that patients with ESRD on HD experience, enhanced care coordination provides an opportunity to reduce this burden and improve QOL.

  18. Empowerment, motivation, and medical adherence (EMMA: the feasibility of a program for patient-centered consultations to support medication adherence and blood glucose control in adults with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Varming AR


    Full Text Available Annemarie Reinhardt Varming,1 Ulla Møller Hansen,1 Gudbjörg Andrésdóttir,2 Gitte Reventlov Husted,1 Ingrid Willaing1 1Patient Education Research, 2Complications Research, Steno Diabetes Center, Gentofte, Denmark Purpose: To explore the feasibility of a research-based program for patient-centered consultations to improve medical adherence and blood glucose control in patients with type 2 diabetes.  Patients and methods: The patient-centered empowerment, motivation, and medical adherence (EMMA consultation program consisted of three individual consultations and one phone call with a single health care professional (HCP. Nineteen patients with type 2 diabetes completed the feasibility study. Feasibility was assessed by a questionnaire-based interview with patients 2 months after the final consultation and interviews with HCPs. Patient participation was measured by 10-second event coding based on digital recordings and observations of the consultations.  Results: HCPs reported that EMMA supported patient-centered consultations by facilitating dialogue, reflection, and patient activity. Patients reported that they experienced valuable learning during the consultations, felt understood, and listened to and felt a trusting relationship with HCPs. Consultations became more person-specific, which helped patients and HCPs to discover inadequate diabetes self-management through shared decision-making. Compared with routine consultations, HCPs talked less and patients talked more. Seven of ten dialogue tools were used by all patients. It was difficult to complete the EMMA consultations within the scheduled time.  Conclusion: The EMMA program was feasible, usable, and acceptable to patients and HCPs. The use of tools elicited patients’ perspectives and facilitated patient participation and shared decision-making. Keywords: type 2 diabetes, adherence, participation, dialogue, health education, self-management

  19. A study on the Rate of Knowledge, Attitude and Practice of Medical Students towards Method of Medical Records Documentation at Mazandaran University of Medical Sciences Affiliated Therapeutic and Teaching Centers 2003

    Directory of Open Access Journals (Sweden)

    A. Balaghafari


    Full Text Available Background and Objectives: History, clinical findings, procedures undertaken, and patients response to treatment are written in clinical records, hence their contents are indicators of physicians’ evaluation. If clinical records are provided precisely, clear and systematized, they indicate the clinical thinking of the staff and facilitate patients diagnosis process. These records have an important role in coordinating professional staff involved in patient care. Since the physicians and medical students are involved more in medical records documentation than the other hospital staff, thus, a study on their knowledge, attitude and practice towards the principles of medical records documentation is undertaken.Materials and Methods: This is a descriptive study, which is done about the rate of knowledge, attitude and practice of 207 Medical students of Mazandaran University of Medical Sciences in university hospitals. Descriptive and inferential statistical analytic methods were used for the collected data. For comparison of the hospitals, regarding observing designed principals in the completion of medical files, according to the filled questionnaires the minimum and maximum score designated as 1-5 which is very poor to excellent. Then the mean score was calculated and considered for the comparison of hospitals. For the determination of the relationship between knowledge, attitude, and practice, β Kendall’s Tau Test was used.Results: The majority of the participants had low knowledge (77.8% about medical records documentation. Most of them did not have good attitude (54.1 about completion of medical records and significance and value of medical records documentation in treatment, education, and research.Conclusion: Results indicate that incompletion of medical records at the university affiliated hospitals are due to lack of awareness of the students towards the method of medical records documentation. In addition, not considering the

  20. Medications (for IBS)

    Medline Plus

    Full Text Available ... Anthony J. Lembo, MD, Instructor of Medicine, Harvard Medical School; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA. Last modified on February 23, ...

  1. Profile of patients receiving medical care at a reference, support, and treatment center for psoriasis patients at a university hospital* (United States)

    Cordeiro Júnior, Túlio Germano Machado; Andrade, Bruno D' Paula; Palitot, Esther Bastos; Piuvezam, Márcia Regina; Mascarenhas, Sandra Rodrigues


    Psoriasis is a chronic, inflammatory, immune-mediated disease affecting 1-3% of the population worldwide. This work seeks to draw a profile of patients with psoriasis, analyzing socioeconomic, anthropometric, and clinical aspects. For this, medical records from 81 individuals who received medical care in a university hospital in 2014 were consulted. It was observed that the patients were mostly dark-skinned black adult men, with a low education level and a low income, who were sedentary, former smokers, obese, with an increase in waist circumference, and who did not consume alcohol. Psoriasis vulgaris predominated, beginning mainly on the scalp, hands, and feet. In addition, many presented some type of associated comorbidity and had relatives with psoriasis. PMID:27828656

  2. A Model for Protective Behavior Against the Harmful Effects of Radiation for Radiological Technologists in Medical Radiological Technologists in Medical Centers

    Energy Technology Data Exchange (ETDEWEB)

    Han, Eun Ok [Daegu Health College, Daegu (Korea, Republic of); Moon, In Ok [Ewha Woman' s University, Seoul (Korea, Republic of)


    Protective behavior of radiological technologists against radiation exposure is important to achieve reduction of the patient doses without compromising medical achievements. This study attempts to provide a basic model for the sophisticated intervention strategy that increases the level of the protective behavior of the technologists. The model was applied to real situations in Korea to demonstrate its utility. The results of this study are summarized as follows: First, the protective environment showed the highest relationship in the factors considered, r=0.637 (p<0.01). Secondly, the important factors were protective environment in environment characteristics, expectation for the protective behavior 0.228 (p<0.001), self efficacy 0.142 (p<0.001), and attitude for the protective behavior 0.178 (p<0.001) in personal characteristics, and daily patient -0.112 (p<0.001) and number of the participation in the education session for the protective behavior 0.074 (p<0.05). Thirdly, the final protective behavior model by a path analysis method had direct influence on the attitude 0.171 (p<0.01) and environment 0.405 (p<0.01) for the protective behavior, self efficacy 0.122 (p<0.01), expectation for the protective behavior 0.16 (p<0.01), and self-efficacy in the specialty of projects 0.154 (p<0.01). The acceptance of the model determined by the absolute fit index (GFI), 0.969, and by the incremental fit index (CFI), 0.943, showed very significant levels. Value of 2/df that is a factor applied to verify the acceptance of the model was 37, which implies that the result can be accepted in the desirable range. In addition, the parsimonious fit index configured by AGFI (0.890) and TLI (0.852) was also considered as a scale that accepts the model in practical applications. In case of the establishment of some specific intervention strategies based on the protective behavior model against harmful radiation effects proposed in this study, the strategy will provide an effective way

  3. An Assessment of Health Literacy Rates in a Sample of Active-Duty Military Personnel at a Major Medical Center (United States)


    behaviors, for exam- ple, adherence to medical regiments, proper exercise, and diet. Social cognitive theory was developed by Albert Bandura and...and Health Education: Theory, Research and Practtce.3rd ed. San Francisco, CA. Jossey-Bass; 2002:214-245. 19. Bandura A. Social cognitive theory: an...SoclaLCognitlve_Theory_Overview. htm. Accessed April 2006. 21. Bandura A. Health promotion by social cogni- tive means. Health Educ Bebav. 2004;31(2):143- 164. 318

  4. Clinical and Paraclinical Findings of Cerebrovascular Accidents in Children Admitted to Pediatric Medical Center from 1993 till 2003


    M. Dehghani; H Montazer Lotfe Elahi; M Ashrafi


    Introduction: Stroke is a clinical diagnosis which brings up cerebrovascular diseases. Stroke includes any cerebrovascular accident which leads to local neural defect and lasts more than 24 hours. Stroke has severe and irreversible complications and high rates of recurrence after first episode, therefore we decided to study clinical and paraclinical findings of this disease for better diagnosis and prevention of it. Methods: We prepared a case series study to review medical files of the patie...

  5. Assistance Focus: Asia/Pacific Region (Brochure)

    Energy Technology Data Exchange (ETDEWEB)


    The Clean Energy Solutions Center Ask an Expert service connects governments seeking policy information and advice with one of more than 30 global policy experts who can provide reliable and unbiased quick-response advice and information. The service is available at no cost to government agency representatives from any country and the technical institutes assisting them. This publication presents summaries of assistance provided to governments in the Asia/Pacific region, including the benefits of that assistance.

  6. [Shared web-based data center for multi-institutional clinical trials: evaluation of UMIN-INDICE (university hospital medical information network-internet data and information center for medical research)in clinical trials of JIVROSG (Japan interventional radiology in oncology study group)]. (United States)

    Sone, Miyuki; Arai, Yasuaki; Kiuchi, Takahiro; Ishikawa, Hirono; Aoki, Noriaki; Inaba, Yoshitaka; Yoshioka, Tetsuya; Aramaki, Takeshi; Kobayashi, Takeshi; Matsuoka, Toshiyuki; Anai, Hiroshi; Tanigawa, Noboru; Osuga, Keigo; Takeuchi, Yoshito; Okusaka, Takushi; Kanazawa, Susumu; Matsui, Osamu; Endo, Keigo


    A patient registration system is mandatory for establishing the scientific credibility of the multi-center clinical trials. The Japan Interventional Radiology in Oncology Study Group (JIVROSG) was organized in 2002 to establish evidence supporting the procedures used in interventional radiology. The Internet Data and Information Center for Medical Research (INDICE), provided by the University Hospital Medical Information Network(UMIN), has been utilized for patient registration in the clinical trials of JIVROSG. In this study, the safety and efficacy of UMIN-INDICE were evaluated. From 2002 to 2010, 18 clinical trials, including one international trial, were conducted. A total of 736 patients were enrolled from 51 institutions. No significant trouble was encountered during this period. A questionnaire survey demonstrated that 90% of participating researchers could use this system without difficulties. UMIN-INDICE may contribute to promoting clinical trials as an infrastructure of multicenter studies.

  7. Community Essay: Implementation of the MediSend Program: a multidisciplinary medical surplus recovery initiative at an academic health science center

    Directory of Open Access Journals (Sweden)

    Biruh Workeneh


    Full Text Available As a second year medical student my focus was narrowly on navigating and absorbing the enormous amount of information that I needed to pass my courses—it was not one year at a time, rather it was one course at a time. This changed when I became a student leader and met phenomenal individuals, like my co-author, who introduced the idea of medical surplus recovery to me, as well as Martin Lazar, who founded MediSend/International. The world was not simply going to wait while I struggled to finish medical school, and if I wanted to make a difference I had to jump in. In the article below we describe the MediSend Program, a student-conceived, student-driven effort to collect medical, dental, and educational surplus at the University of Texas Health Science Center at Houston. The students that helped and continue to help craft the MediSend Program have realized that they are not only important constituents of higher education, but they play a vital role in shaping university priorities. In the process, the MediSend Program has provided an uncommon learning experience, one that incorporates the values of compassion and altruism with environmental preservation and equitable resource distribution. I am no longer a student and consider my participation in sustainable solutions a duty, a sensibility that was shaped during my tenure in medical school. Sustainability should be a universal guiding principle in healthcare education and practice, as well as other disciplines, because it is the key to human survival.

  8. Provider perceptions of the social work environment and the state of pediatric care in a downsized urban public academic medical center. (United States)

    Tataw, David Besong


    The author's purpose through this study was to document and analyze health provider perceptions of their social work environment and the state of pediatric care at Los Angeles County King/Drew Hospital and Medical Center in 2000, after the restructuring and downsizing of the hospital and its community clinics. The research results showed nurses and physicians reporting that both the quality of pediatric care and the provider social work environment were poor. Negative factors in the social work environment included: low employee morale, poorly staffed clinical teams, lack of professional autonomy, perceptions of low quality of care for pediatric patients, and interpersonal issues of poor communication and collaboration among providers. Providers also perceived a non-supportive work environment, sense of powerlessness, poor quality of work, lack of goal clarity from leadership, lack of fairness in leadership behavior, and an organizational leadership that is abandoning its core mission and values, thereby making it difficult for providers to carry out their professional functions. The author's findings in this study suggest a relationship between intra-role conflict, social employment environment and quality of care at King/Drew Medical Center in 2000. Lessons for practice are presented.

  9. Emergence of serine carbapenemases (KPC and SME) among clinical strains of Enterobacteriaceae isolated in the United States Medical Centers: report from the MYSTIC Program (1999-2005). (United States)

    Deshpande, Lalitagauri M; Rhomberg, Paul R; Sader, Helio S; Jones, Ronald N


    Among 8885 Enterobacteriaceae tested in the 1999 to 2005 period as part of the USA Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program, 51 strains with increased imipenem and meropenem MIC values (> or =2 microg/mL) were detected. bla(KPC) was identified from 28 Klebsiella pneumoniae from 3 medical centers in the New York City area (8 ribotypes), 2 Klebsiella oxytoca from Arkansas (same ribotype), 7 Citrobacter freundii (6 from New York [5 ribotypes] and 1 from Delaware), 4 Enterobacter spp. from New York (2 species, different ribotypes), 3 Escherichia coli (2 from New York and 1 from Ohio, same ribotype), and 1 Serratia marcescens (New York). Sequencing confirmed KPC-2 or -3 in all of the strains. S. marcescens strains harboring SME-1 (2 isolates, same ribotype) and SME-2 (1 isolate) were identified from medical centers in Illinois and Washington state, respectively. Our results indicate that bla(KPC-2/3) has emerged widely (New York City area, Arkansas, Delaware, and Ohio) among Enterobacteriaceae isolated in the MYSTIC Program participant sites (2000-2005) and continues to be isolated from multiple species, as a result of clonal expansion and horizontal gene transfer. The escalating occurrence (0.35%) of serine carbapenemases could compromise the role of carbapenems and other beta-lactams in USA clinical practice although observed in only a few locations to date.

  10. Investigating the Prevalence of Pervasive Developmental Disorders According to Sex in a Sample of Iranian Children Referred to Medical-Rehabilitation Centers and Psychiatrics Clinics

    Directory of Open Access Journals (Sweden)

    K. Khushabi


    Full Text Available Introduction & Objective: According to significance of pervasive developmental disorders (PDD in children and the increasing rate of its prevalence in referred patients to clinic in recent years and due to absence of any report about the rate of PPD in our country, this study was carried out. The aim of this study was to determine the prevalence of PPD in a sample of Iranian children who referred to medical and rehabilitation centers.Materials & Methods: 248 children who referred to three medical-rehabilitation centers were participated in the research. Accessible sampling with diagnosis of PDD based on DSM-IV criteria was chosen. The obtained data were analyzed using descriptive statistics methods such as percent and frequency distribution. Results: Autistics disorder was most prevalent among pervasive developmental disorders. In this research Autistic disorder (proportion 4/1 to 1, Asperger disorder (proportion 3 to 1 and childhood disintegrative disease were more prevalent in boys than girls. Ret disorders was observed only in girls and pervasive developmental disease (NOS was seen in both sexes. Conclusion: The results showed that pervasive developmental disorders are 4 times more prevalent in boys than girls and the findings of this research were consistent with those of previous studies.

  11. A study on organizational culture, structure and information technology as three KM enablers: A case study in five Iranian medical and healthcare research centers

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    Mahdi Iran-nejad-parizi


    Full Text Available This study investigates organizational structure, culture, and information technology as knowledge management (KM infrastructural capabilities, and compares their significance and status quo in five medical research centers in Tehran, Iran. Objectives of this research were pursued by employing two statistical methods, regression analysis and Friedman test. Included in the study were 135 people (researchers and support staff from five medical and healthcare research centers of Tehran. A survey questionnaire including 23 questions was utilized to examine organizational structure, culture and information technology indicators. And another 12 questions examined KM effectiveness. The Friedman test indicated that in terms of their status quo, the three studied KM enablers are at different conditions, with organizational culture having the best (mean rank=1.79 and IT the worst (mean rank=2.14 status. Moreover, it was revealed by regression analysis that organizational structure is believed to have the most significant impact (Beta= 0.397 on the effectiveness of knowledge management initiatives, while information technology gained the least perceived impact (Beta= 0.176.

  12. Kedrostis Medik. in Asia

    Directory of Open Access Journals (Sweden)

    W.J.J.O. De Wilde


    Full Text Available DE WILDE, W.J.J.O.  & DUYFJES, BRIGITTA E.E. 2004. Kedrostis Medik. in Asia. Reinwardtia 12(2:129 – 133. — Kedrostis (Cucurbitaceae occurs in Africa and Madagascar and comprises 4 (5 species in Asia. Of these 2 species are found in India and Sri Lanka and 2 (3 species in western Malesia. One Malesian species is for the first time included in Kedrostis here, Kedrostis bennettii (Miq. W.J. de Wilde & Duyfjes, and one species is described as new here, Kedrostis hirta W.J. de Wilde & Duyfjes. One more Malesian species is insufficiently known to be formally described.  Keywords: Kedrostis, Cucurbitaceae, SE Asia, taxonomy

  13. International nuclear cooperation in Asia

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Yong-Kyu


    Nuclear power project traditionally involve huge financial investment, highly sophisticated technology, and long lead time. Many countries, particularly developing ones, find it impossible to implement their nuclear power programs without technical cooperation and assistance from advanced countries. In this Asia and Pacific Region, seven countries have commercial nuclear power units in operation and/or under construction. Korea has six nuclear power units in operation, and three under construction. Active nuclear cooperation has been instrumental in implementing her abmitious nuclear power programs successfully. Nuclear cooperation is one of the widely recognized necessities, which is quite often talked about among the countries of the Asia and Pacific Region. But the differences in nuclear maturity and national interests among those in the region seem to be standing against it. Given the constraints, it is not easy to select appropriate areas for cooperation. There is no doubt, however, that they should include the nuclear policy, nuclear safety, radwaste management, radiological protection, and the management of nuclear units. In order to effectively promote nuclear cooperation in the Region, the scope of RCA activities must be expanded to include the nuclear power area. The Regional Nuclear Data Bank, the Regional Training Center and the Nuclear Emergency Response Center, for example, would be the effective tools for cooperation to meet the demands of the countries in the Region. In view of the technological gap between Japan and all others in the region, we cannot speak of a regional nuclear cooperation without heavily counting on Japan, the most advanced nuclear state in the region. For these reasons, Japan is expected to share an increasing portion of her nuclear technology with others.

  14. Epilepsy: Asia versus Africa. (United States)

    Bhalla, Devender; Tchalla, Achille Edem; Marin, Benoît; Ngoungou, Edgard Brice; Tan, Chong Tin; Preux, Pierre-Marie


    Is epilepsy truly an "African ailment"? We aimed to determine this, since international health agencies often refer to epilepsy as an African disease and the scientific literature has spoken the same tone. Various published materials, mainly reports, articles, were used to gather Asian and African evidence on various aspects of epilepsy and many of its risk and associated factors. Our results suggest that in no way can epilepsy be considered as an African ailment and such characterization is most likely based on popular beliefs rather than scientific evidence. In comparison to Africa, Asia has a 5.0% greater burden from all diseases, and is 17.0% more affected from neuropsychiatric disorders (that include epilepsy). Given that more countries in Asia are transitioning, there may be large demographic and lifestyle changes in the near future. However these changes are nowhere close to those expected in Africa. Moreover, 23 million Asians have epilepsy in comparison to 3.3 million Africans and 1.2 million sub-Saharan Africans. In comparison to Africa, Asia has more untreated patients, 55.0% more additional epilepsy cases every year, because of its larger population, with greater treatment cost and possibly higher premature mortality. Of several associated factors discussed herein, many have more importance for Asia than Africa. The current state of epilepsy in Asia is far less than ideal and there is an urgent need to recognize and accept the importance of epilepsy in Asia. In no way can epilepsy be considered as an African ailment. This is most likely based on popular beliefs rather than scientific evidence. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.

  15. The Relationship between Wife Abuse and Mental Health in Women Experiencing Domestic Violence referred to the Forensic Medical Center of Shiraz

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    Arezoo Shayan


    Full Text Available Background and Objectives: Neglecting women's health and the domestic violence prevailing against them can cause a variety of mental and even physical diseases that threaten the health of the family. Disruptions in the life pattern of women and mothers have adverse health effects for both the family and the entire society. The present study was conducted to investigate the relationship between wife abuse and mental health in female victims of domestic violence referred to the Forensic Medical Center of Shiraz. Materials and Methods: The present cross-sectional, descriptive, analytical study was conducted over three months in 2013 on 197 women with abusive husbands referred to the Forensic Medical Center of Shiraz. The study data collection tools included a demographic information questionnaire, the General Health Questionnaire (GHQ-28 and a standard violence against women questionnaire. Cronbach's alpha was measured to assess the data collection tools' reliability. Data were analyzed in SPSS-18. Results: The mean age of the study subjects was reported as 30.42±6.72. More than 50 percent of the women had been victim to domestic violence and suffered from disorders in all the aspects of general health (P<0.05. There was a positive relationship between domestic violence and all the aspects of general health. In other words, violence of any kind was a predictor of general health disorders (P<0.05. Domestic violence was found to have the greatest effect on the incidence of depression and anxiety. Conclusion: The present study revealed the psychological consequences of wife abuse and violence against women and confirmed the damaging effect of violence on women's mental health. In addition to imposing heavy costs on the society for providing healthcare and medications, mental health disorders in women are also a burden for the family life and the children's upbringing.

  16. Hospital outpatient perceptions of the physical environment of waiting areas: the role of patient characteristics on atmospherics in one academic medical center

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    Sun Pi-hung


    Full Text Available Abstract Background This study examines hospital outpatient perceptions of the physical environment of the outpatient waiting areas in one medical center. The relationship of patient characteristics and their perceptions and needs for the outpatient waiting areas are also examined. Method The examined medical center consists of five main buildings which house seventeen primary waiting areas for the outpatient clinics of nine medical specialties: 1 Internal Medicine; 2 Surgery; 3 Ophthalmology; 4 Obstetrics-Gynecology and Pediatrics; 5 Chinese Medicine; 6 Otolaryngology; 7 Orthopedics; 8 Family Medicine; and 9 Dermatology. A 15-item structured questionnaire was developed to rate patient satisfaction covering the four dimensions of the physical environments of the outpatient waiting areas: 1 visual environment; 2 hearing environment; 3 body contact environment; and 4 cleanliness. The survey was conducted between November 28, 2005 and December 8, 2005. A total of 680 outpatients responded. Descriptive, univariate, and multiple regression analyses were applied in this study. Results All of the 15 items were ranked as relatively high with a range from 3.362 to 4.010, with a neutral score of 3. Using a principal component analysis' summated scores of four constructed dimensions of patient satisfaction with the physical environments (i.e. visual environment, hearing environment, body contact environment, and cleanliness, multiple regression analyses revealed that patient satisfaction with the physical environment of outpatient waiting areas was associated with gender, age, visiting frequency, and visiting time. Conclusion Patients' socio-demographics and context backgrounds demonstrated to have effects on their satisfaction with the physical environment of outpatient waiting areas. In addition to noticing the overall rankings for less satisfactory items, what should receive further attention is the consideration of the patients' personal

  17. Commercialization as a recommended approach to hospital restructuring. Case study of Łańcut Medical Center

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    Wiktor Patena


    Full Text Available Our society is on the brink of health care system reorganization and implementation of new medical technology. Hospitals have to be a core component of the medical revolution so they have to be prepared for the upcoming leap in their development. If Poland wants to be a pioneer in providing new medical solutions, the current ineffective system has to be changed. The necessary action should be taken to deal with the financial problems Polish hospitals have faced for over 20 years. The current structure of hospitals - SPZOZ, is old-fashioned and cannot adapt to a turbulent social and economic environment. The hospitals should be commercialized and restructured. Being capitalized companies will give incentives and new tools to deal with financial problems. The article presents an example of the commercialized hospital in Łańcut. We make the observations that commercialization increases: a hospital’s profitability, its employment productivity, its capital investment spending and leverage. The case proves that the transformation of hospitals to capital companies proposed by the Ministry of Health may be an appropriate approach and it does work once a reasonable management board is in charge. However, the legal structure alteration should be treated as the first step in the overall restructuring process. The article highlights the problem of managers of Polish hospitals who do not only struggle with financial shortages, but barely know which business model they should follow after commercialization to successfully run the restructuring process. Having examined the LMC the authors are crafting a prelude to the overall research on already commercialized hospitals to find an appropriate business model.

  18. Lean Six Sigma in health care and the challenge of implementation of Six Sigma methodologies at a Veterans Affairs Medical Center. (United States)

    Pocha, Christine


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


    Institute of Scientific and Technical Information of China (English)

    Mark L Wahlqvist


    @@ Populations in Asia are experiencing significant gains in life expectancy,especially in North East Asia and amongst Orientals throughout the region,with Japan,HongKong,Singapore and Macau having amongst the world's best life expectancies.

  20. Comparison of continuing medical education (CME priorities of midwives employed at health facilities and treatment centers of Kashan and Aran & Bidgol - 2010

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    S Behrouzifar


    Full Text Available Introduction: In Continuing Medical Education (CME, paying attention to professional empowerment on the basis of community needs and learners’ institutional requirements is necessary. This study was conducted to determine continuing CME priorities of midwifery graduates employed in health and treatment centers of Kashan and Aran & Bidgol cities located in central Iran (2010. Methods: This cross-sectional study was conducted on 71 midwives. A questionnaire including 87 educational items in 6 subjects was designed. Every item was scored on a Likert scale ranging from zero to ten. Data were extracted, classified and analyzed by SPSS software using descriptive and inferential statistics. Results: Of the six subjects raised, gynecology (7.89±1.54 had the highest score and fundamentals of nursing (6.05±2.35 had the lowest score. Among different disease the topics of abnormal genital tract bleeding (9.32±1.3, diabetes mellitus during pregnancy (9.26±1.27, breast cancer (9±1.97, anemia (8.87±1.71, preventing the birth of premature infants (8.44±2.34 and infection control in special units (7.36±3.06, had the highest means, respectively. There was a statistically significant difference between two groups of midwives employed in health centers and treatment centers regarding the need for learning some subjects. Conclusion: The need for CME priorities varied according to functional domains. This is essential to be considered by decision makers.

  1. The residency program in social medicine of Montefiore Medical Center: 37 years of mission-driven, interdisciplinary training in primary care, population health, and social medicine. (United States)

    Strelnick, A H; Swiderski, Debbie; Fornari, Alice; Gorski, Victoria; Korin, Eliana; Ozuah, Philip; Townsend, Janet M; Selwyn, Peter A


    Founded in 1970 to train physicians to practice in community health centers and underserved areas, the Residency Program in Social Medicine (RPSM) of Montefiore Medical Center, Bronx, New York, has graduated 562 board-eligible family physicians, general internists, and pediatricians whose careers fulfill this mission. The RPSM was a model for federal funding for primary care residency programs and has received Title VII grants during most of its history. The RPSM has tailored its mission and structured its curriculum to promote a community and population orientation and to provide the requisite knowledge and skills for integrating social medicine into clinical practice. Six unique hallmarks of RPSM training are (1) mission-oriented resident recruitment/selection and self-management, (2) interdisciplinary collaborative training among primary care professionals, (3) community-health-center-based and community-oriented primary care education, (4) biopsychosocial and ecological family systems curriculum, (5) the social medicine core curriculum and projects, and (6) grant support through Title VII. These hallmark curricular, training, and funding elements, in which population health is deeply embedded, have been carefully evaluated, regularly revised, and empirically validated since the program's inception. Practice outcomes for RPSM graduates as leaders in and advocates for population health and the care of underserved communities are described and discussed in this case study.

  2. Medication Use Patterns, Treatment Satisfaction, and Inadequate Control of Osteoporosis Study in the Asia-Pacific Region (MUSIC OS-AP: Design of a multinational, prospective, observational study examining the impact of gastrointestinal events on osteoporosis management in postmenopausal women

    Directory of Open Access Journals (Sweden)

    Ankita Modi


    Conclusions: The results of MUSIC OS-AP will highlight the association of gastrointestinal events with patient-reported outcomes among postmenopausal women with osteoporosis and elucidate physicians' management of gastrointestinal events among this patient population in the Asia-Pacific region.

  3. State Institution "National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine" - research activities and scientific advance in 2013. (United States)

    Bazyka, D; Sushko, V; Chumak, A; Buzunov, V; Talko, V; Yanovych, L


    Research activities and scientific advance achieved in 2013 at the State Institution "National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine" (NRCRM) concerning medical problems of the Chornobyl disaster, radiation medicine, radiobiology, radiation hygiene and epidemiology in collaboration with the WHO network of medical preparedness and assistance in radiation accidents are outlined in the annual report. Key points include the research results of XRCC1 and XPD gene polymorphism in thyroid cancer patients, CD38 gene GG genotype as a risk factor for chronic lymphocytic leukemia, frequency of 185delAG and 5382insC mutations in BRCA1 gene in women with breast cancer, cognitive function and TERF1, TERF2, TERT gene expression both with telomere length in human under the low dose radiation exposure. The "source-scattering/shielding structures- man" models for calculation of partial dose values to the eye lens and new methods for radiation risk assessment were developed and adapted. Radiation risks of leukemia including chronic lymphocytic leukemia in the cohort of liquidators were published according to the "case-control" study results after 20 years of survey. Increase of non-tumor morbidity in liquidators during the 1988-2011 with the maximum level 12-21 years upon irradiation was found. Incidence in evacuees appeared being of two-peak pattern i.e. in the first years after the accident and 12 years later. Experimental studies have concerned the impact of radio-modifiers on cellular systems, reproductive function in the population, features of the child nutrition in radiation contamination area were studied. Report also shows the results of scientific and organizational, medical and preventive work, staff training, and implementation of innovations. The NRCRM Annual Report was approved at the Scientific Council meeting of NAMS on March 3, 2014.

  4. Literacy in South Asia. (United States)

    Srivastava, R. N.


    A study of the various facets and dimensions of literacy programs in South Asia indicates that literacy is viewed as a means of human resource development geared toward meaningful participation of all sectors in society, with individual programs varying according to the magnitude of illiteracy, national goals, linguistic setting, and regional…

  5. Looking to Asia

    Institute of Scientific and Technical Information of China (English)


    Beijing Review:You said foreign policy under the Barack Obama administration is a policy of confrontation and containment of China.So do you think the expanded U.S.presence in Asia is mainly targeting China? If so,what are the consequences in terms of diplomatic relations between the two countries?

  6. Social Capital in Asia

    DEFF Research Database (Denmark)

    Li, Peter Ping


    This article provides an overview of social capital in Asia. Social capital is trust and appears in two main forms: relational, based on societal norms, and systemic, based on societal institutions. The relational encourages personalistic transactions; and systemic trust, supports more formal...

  7. Multicultural Central Asia. (United States)

    Boyle, Eric D.

    This article addresses the multicultural aspect of Central Asia in response to the discussion on diversity in U.S. classrooms. Many areas of the world are more diverse than the U.S., and these areas experience successes and failures with many of the same issues the U.S. is currently struggling with. Comparing the U.S. diversity debate with similar…

  8. Vancomycin and Five Broad-spectrum Antibiotic Utilization Evaluation in an Educational Medical Center in One Year

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    SiminDokht Shoaei


    Full Text Available  Background: Antibiotics can be life saving if they are used correctly, and can have unwanted side effects specially resistance with incorrect use. Unfortunately in fear of no response, physicians use broad spectrum antibiotics meticulously. In this Drug Utilization Evaluation (DUE, improper use of Vancomycin and five broad-spectrum antibiotics are studied to find faults and solution for this problem. Methods:This descriptive cross-sectional study performed during the March of 2012 to March of 2013.DUE of Imipenem, Meropenem, Piperacillin-Tazobactam, Cefepime, Ciprofloxacin and Vancomycin was done in 6 wards of Imam Hossein Hospital in Tehran. Demographic, clinical, laboratory, imaging and treatment data were looked for in medical records of 686 patients. Evaluation was done by three infectious disease specialist based on reference text book of Mandell’s Principles and Practice of Infectious Diseases 2010 and IDSA Guidelines. Results:This study showed 38.5% of prescriptions were correct and the remained 61.5% were incorrect with different faults predominantly incorrect overuse in 51.1%.Ciprofloxacin was the most common incorrect used drug in 74.8% cases and Piperacillin-Tazobactam with 48.7% cases had the least common incorrect use. There was no fault in prescription of antibiotics observing age and sex (pregnancy, breast feeding factors. Conclusions:Our results reveal a significant high level of the inappropriate use of Antibiotics mostly as overuse and empirically without culture results. It is needed to establish continuing medical education (CME courses and a locally conformable guideline of antibiotic use based on antibiogram results.

  9. Application of health management in medical examination center%健康管理在体检中心的应用

    Institute of Scientific and Technical Information of China (English)



    目的:探讨健康管理在体检中心中的应用效果。方法:选取在体检中心体检者152例,随机平分为两组。对照组给予常规体检流程服务,研究组给予健康管理(中医体质辨识干预)服务,对相关结果进行比较分析。结果:研究组在对医院的满意度、健康生活方式、自身健康状况、自身疾病防治知识知晓率4个方面明显优于对照组(P<0.05)。结论:健康管理在体检中心的应用效果确切,可有效提高体检者的自我保健知识,提高受检者对于健康知识的了解和认识,提高其对医院的满意度和可信度。%Objective:To discuss the application effect of health management in medical examination center.Methods:152 cases took physical examination in the medical center were selected.They were randomly divided into the two groups.Patients in the control group were given routine physical examination process service,while patients in the study group were given health management(Traditional Chinese medicine constitution identification intervention)service.The relative results were compared and analyzed.Results:The study group on hospital satisfaction, healthy lifestyle, their own health, aware of knowledge about prevention and cure their diseases were significantly better than those of the control group (P<0.05).Conclusion:The application effect of health management in medical examination center is definite.It can effectively improve the self health care knowledge of physical examination of person who took physical examination,improve the understanding of the health knowledge of the subjects,improve the satisfaction and credibility for the hospital.


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    Full Text Available There had been a great dedication on the prevention of the acquired disease in the past. The well known are eugenetic advisory centers in which people could get information for a given inherited disease, later so called genetic advisory centers. Their work, besides is based on the principles of informing the patients for the difficulties, importance and prognoses of determined inherited disease. This activity, which is the highest achievement in the medical genetics, can be called genetic information, which is very important for regular treatment of every patient.The accurate etiological diagnosis is an essential precondition for giving the genetic information, assessment of the risk, the eventual treatment, as for the prenatal diagnosis e.i. prevention of congenital malformations.The genetic consulting is applicable in all possible phenotype manifestations of the breaking genes, regardless to the categorical custody of the examinees with retards in their development. In fact, that’s a summary of standards which are applicable in the basic prevention in disabilities in the psycho-physical development, whose reasons are genetically determined. Preventive activities are mostly used with mentally retarded as a result of the frequent intercession of the psychological disorders all together in different syndromes and diseases.The genetic consulting activities of the Center for Mental Health for children and adolescents in Skopje are based on the appliance of the following methodology: fortification of the risk for the appearance of inherited anomalies; explanation and assessment of the established risk in the concrete family situation, assurance of adequate assistance concerning the accurate and practical assessment of the risk and preparation of rational plan for subsequent treatment and decisions; consequent observation of the situations and evaluation of achieved results etc. In that way, the acting of medical-genetic advising center in the

  11. Happy crisis tests hospitals' PR plan. Septuplets' arrival swamps Iowa hospitals with national, international media. Blank Children's Hospital, Iowa Methodist Medical Center, Des Moines. (United States)


    The public relations staff believed the birth of healthy septuplets would become a human interest story for local media. But the staff was stunned at the outpouring of international and national media knocking at their front doors. The staff of both Iowa Methodist Medical Center and Blank Children's Hospital in Des Moines, Iowa, organized a communications plan for 14 official press conferences, constant updates to the media and a website to handle ongoing inquiries from the public. As a result, the story of the McCaughey septuplets was shown in more than 10,000 television stories around the world. The hospitals received more than 36,000 magazine and newspaper articles. The public relations staff not only fielded more than 2,000 phone calls in the days following the Nov. 19 birth, but more than 15 major networks parked their vehicles and satellite dishes in front of the hospital.

  12. A study on socio-demographic characteristics of alcoholics attending the de-addiction center at Burdwan medical college and hospital in West Bengal

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    Aditya Prasad Sarkar


    Full Text Available Prevalence of alcohol use in India is reported to be 21.4% and there is increasing alcohol intake among the young people. The present study was undertaken to study the socio-demographic characteristics of patients having alcohol-related disorders attending the de-addiction center at Burdwan Medical College in West Bengal and to find out some factors responsible for that. A clinic-based descriptive cross-sectional study was conducted among 187 patients with the help of pre-tested pre-designed schedule after obtaining informed consent. Data analysis was carried out with the help of Epi info software version 6. Majority of the patients were male, in productive age group and married. Age of initiation and amount of alcohol intake were significantly associated with positive family history of alcoholism. Children having family history of alcoholism should be counseled to prevent development of alcoholism.

  13. Medical Illustration (United States)

    ... Accredited programs prepare students for a career in academic or research health science centers, industry, or consulting. As members of the health career profession with strong communication skills, medical illustrators work closely with clients to interpret ...

  14. Extrahepatic manifestations of chronic hepatitis C virus infection:297 cases from a tertiary medical center in Beijing, China

    Institute of Scientific and Technical Information of China (English)

    Cheng Zhaojing; Zhou Baotong; Shi Xiaochun; Zhang Yao; Zhang Lifan; Chen Limeng; Liu Xiaoqing


    Background Chronic hepatitis C virus (HCV) infection can affect multiple organ systems and cause a variety of extrahepatic manifestations (EMs).We sought to assess the constituent ratio of EMs in Chinese patients with chronic HCV infection and identify the clinical and biological factors associated with EM.Methods The medical records of 297 patients with chronic HCV infection were analyzed and demographic and epidemiological information was collected.The diagnosis of chronic HCV infection was based on positive anti-HCV combined with a positive HCV-RNA or at least two times of elevated aminotransferases attributable to HCV infection.Patients with HBV and/or HIV coinfection,autoimmune hepatitis,and history of alcohol abuse were excluded.Results Sixty-two percent (184/297) of the patients had at least one EM,including fatigue (29.4%),type 2 diabetes mellitus (28.2%),renal involvement (12.5%),lymphadenopathy (9.6%),fever (9.4%),thyroid dysfunction (8.1%),and arthralgia (7.4%).Neuropathy,sicca syndrome,B-cell lymphoma,Raynaud's phenomenon,and lichen planus were rare.The mean age of patients with EM was older compared with those without EM.Conclusions EMs were common in Chinese patients with chronic HCV infection,particularly fatigue,type 2 diabetes,renal impairment,lymphadenophy,fever,and thyroid dysfunction.Older age was associated with EMs.

  15. Knowledge level of primary care physicians who works in Denizli city center and interns in Pamukkale University medical faculty about alzheimer disease

    Directory of Open Access Journals (Sweden)

    Ahmet Ergin


    Full Text Available AIM: Many communities in the world are rapidly ageing, with aging dementia seen in the elderly, incidence and prevalence of Alzheimer and #8217;s disease which is the most common cause of dementia is also increasing. Therefore, primary care physicians will need to play a more significant role on the diagnosis and management of Alzheimer diseases in near future. The aim of this study was to determine the level of awareness on Alzheimers disease among primary care physicians who works in Denizli city center and interns in the Medical Faculty in Pamukkale University. METHODS: This cross-sectional study was conducted on primary care physicians who works in Denizli city center and interns in the Medical Faculty in Pamukkale University. 93 (60.4% family physicians and 65 (89.0% interns, a total of 158 (69.6% people participated in the study. The University of Alabama Alzheimers Disease Knowledge Test which consists of 12 questions was used to determine Alzheimers disease knowledge score. Data are evaluated by descriptive statistics, and either Mann-Whitney U test or Kruskal-Wallis test was used to determine the statistical differences between numeric variables. RESULTS: The mean of Alzheimers disease knowledge score of family physicians and interns were 5.16+/-1.83 and 7.34+/-1.85, respectively (p <0.001. Interns who previously took any course on Alzheimers disease had a higher average score of 8.41+/-1.67 than that of those who did not take any course 5.07+/-1.95, (p=0.04. Previous course among family physicians did not make any difference (p=0.568. CONCLUSION: Alzheimers disease knowledge among primary care physicians and interns is insufficient. Authorities should take the necessary actions to improve this situatio [TAF Prev Med Bull 2015; 14(2.000: 131-136

  16. Assessment of mothers’ satisfaction with the care of maternal care in Specialized Educational-Medical Centers in obstetrics and gynecological disease in Northwest, Iran

    Directory of Open Access Journals (Sweden)

    Simin Taghavi


    Full Text Available Introduction: Patients satisfaction includes the assessment of healthcare which she/he received. This study aims at assessment of mothers’ satisfaction with the care of maternal care in Specialized Educational-Medical Centers in obstetrics and gynecological disease in Northwest, Iran. Methods: In an analytic-descriptive cross-sectional study, 1000 female patients who admitted in educational-medical centers of Northwest were studied during a 2 years period (2010-2012. They asked to fill a 34-item closed-answer questionnaire (ranking from very unsatisfied to very satisfied responses following their discharge. Validity of the questionnaire was improved by gynecologist’s experts comments, and reliability of the questionnaire were assessed by test-retest methods (α = 0.946. Results: The satisfaction score (satisfied or very satisfied responses were 61.2, 55.8, 61.8 and 59.5 percent for admitting process, primary care services, treatments and therapeutic interventions and overall, respectively. The satisfaction score for access to doctors was highest in the morning and lowest at the night shifts. The satisfaction score about the personnel’s behavior was lowest during the night shifts. The satisfaction score about the residents’ behavior was highest for the morning shifts. There was no significant difference between the three working shifts regarding psychological feelings, humanitarian respect, and issues like nutrition and private and public hygiene. There was a significant direct correlation between the mean score of satisfaction and patients’ age (Spearman’s rho = 0.117, P < 0.001. Conclusion: The satisfaction level of patients hospitalized in Northwest of Iran's Hospitals was intermediate. Planning new strategies in this regard with emphasis on the main limitations may improve the satisfaction rate in the future.

  17. [Approaches for suicide prevention in Osaka Psychiatric Medical Center: the importance of multi-disciplinary cooperation and partnerships with other organizations]. (United States)

    Iwata, Kazuhiko


    Suicide is a very common problem in psychiatric practice today. Therefore, almost all staff of psychiatric hospitals have encountered the suicide of one or more of their patients. Our hospital, Osaka Psychiatric Medical Center, is a public psychiatric hospital in Japan. We provide treatment and support for patients from the acute to chronic phases of psychiatric disorders, and patients range from children to the elderly. Because we accept many patients with severe mental illness from other hospitals, many of our staff are routinely confronted with patients' violence or suicidal attempts. If a patient commits suicide, the relevant staff immediately have a conference to implement measures for preventing a recurrence. At the same time, information about the incident is conveyed to the medical safety management office and made known to all staff in our hospital. This office was established in 2007. Currently, all information about incidents and accidents in our hospital (e.g., suicide, problems between patients, problems with hospital facilities) is aggregated in the office and distributed to all staff members through the hospital intranet. This system makes it possible for staff to consider countermeasures against similar incidents and accidents, even if not involved in the incident. Additionally, we make an effort to develop cooperative relationships with organizations including the police, public health centers, and the fire department. The social welfare council in Hirakata City, where our hospital is located, provides some services to prevent suicide (e.g., telephone counseling, meetings with bereaved family members). Our hospital cooperates with these services by providing lecturers. The partnerships with these organizations help regarding the mental crises of patients in our hospital and fulfill a role to prevent suicide. Multi-disciplinary cooperation and partnerships with community organizations are not special approaches to suicide prevention, but ordinary

  18. Cautious Peace: Strategy and Circumstance in Asia-Pacific Security. (United States)


    of the Major Powers: A Workshop Report, East-West Center/Center for Naval Analyses, 1993 146 Paul Krugman , "The Myth of Asia’s Miracle," Foreign...within the next 15 years." Honolulu Star Bulletin, March 18, 1994, cited in PACOM Economic Update, 1994, p. 7. 151 10 11 12 13 7 See, e.g., Paul ... Krugman , "The Myth of Asia’s Miracle," Foreign Affairs, November/December 1994, pp. 62-78. 8 This compared favorably to North America, which had an

  19. Center for Women Veterans (United States)

    ... Aid & Attendance & Housebound Caregivers Community Living Centers (CLC) Community Nursing Homes Domiciliaries (Please contact your local VA Medical Center) Homemaker & Home Health Aid Care Hospice and Palliative Care State Veterans ...

  20. Academic Medical Centers Forming Accountable Care Organizations and Partnering With Community Providers: The Experience of the Johns Hopkins Medicine Alliance for Patients. (United States)

    Berkowitz, Scott A; Ishii, Lisa; Schulz, John; Poffenroth, Matt


    Academic medical centers (AMCs)--which include teaching hospital(s) and additional care delivery entities--that form accountable care organizations (ACOs) must decide whether to partner with other provider entities, such as community practices. Indeed, 67% (33/49) of AMC ACOs through the Medicare Shared Savings Program through 2014 are believed to include an outside community practice. There are opportunities for both the AMC and the community partners in pursuing such relationships, including possible alignment around shared goals and adding ACO beneficiaries. To create the Johns Hopkins Medicine Alliance for Patients (JMAP), in January 2014, Johns Hopkins Medicine chose to partner with two community primary care groups and one cardiology practice to support clinical integration while adding approximately 60 providers and 5,000 Medicare beneficiaries. The principal initial interventions within JMAP included care coordination for high-risk beneficiaries and later, in 2014, generating dashboards of ACO quality measures to facilitate quality improvement and early efforts at incorporating clinical pathways and Choosing Wisely recommendations. Additional interventions began in 2015.The principal initial challenges JMAP faced were data integration, generation of quality measure reports among disparate electronic medical records, receiving and then analyzing claims data, and seeking to achieve provider engagement; all these affected timely deployment of the early interventions. JMAP also created three regional advisory councils as a forum promoting engagement of local leadership. Network strategies among AMCs, including adding community practices in a nonemployment model, will continue to require thoughtful strategic planning and a keen understanding of local context.

  1. Clinical Features and Laboratory Findings of Visceral Leishmaniasis in Children Referred To Children Medical Center Hospital, Tehran, Iran during 2004-2011.

    Directory of Open Access Journals (Sweden)

    Azam Tofighi Naeem


    Full Text Available Visceral leishmaniasis (VL is one of the most important parasitic diseases endemic in northwestern and southern areas of Iran. The aim of the present study was to review the records of children hospitalized with VL in order to characterize the clinical features of children as well as laboratory finding in Children Medical Center Hospital, Tehran, Iran.The medical records of all children with a final diagnosis of VL were reviewed from 2004 to 2011. Demographic, clinical information, laboratory finding and treatment were considered.A total number of 34 children with confirmed VL through 2004-2011 were included in the study. The most prevalent sign and symptoms were fever (97.1%, pallor and weakness (97.1%, appetite loss (61.8%, splenomegaly (97.1% and hepatomegaly (88.2%. The most frequent laboratory abnormalities were hematological including anemia (97.1%, thrombocytopenia (91.2% and leukopenia (67.6%. Direct agglutination test (DAT was performed in 23 cases and all of them showed anti-Leishmania antibodies with titers of ≥ 1: 3200. In addition, 90% of patients had positive rK39 results. Identification of Leishmania in the aspirates of the bone marrow was found in 83.3% of patients.Regional surveillance system in order to monitoring of leishmaniasis trends as well as detection of new emerging foci is recommended.

  2. Hepatitis B Virus Vaccination Coverage in Medical, Nursing, and Paramedical Students: A Cross-Sectional, Multi-Centered Study in Greece. (United States)

    Papagiannis, Dimitrios; Tsimtsiou, Zoi; Chatzichristodoulou, Ioanna; Adamopoulou, Maria; Kallistratos, Ilias; Pournaras, Spyros; Arvanitidou, Malamatenia; Rachiotis, George


    Students of health professions are at high risk of hepatitis B Virus (HBV) infection during their clinical training. The aim of this cross-sectional, multi-centered study was to investigate the HBV vaccination coverage in Greek medical, nursing, and paramedical students, to look into their attitudes towards the importance of vaccines and to reveal reasons associated with not being vaccinated. A self-completed, anonymous questionnaire was distributed to 2119 students of health professions in Greece, during the academic year 2013-2014. The HBV vaccination coverage of students was high (83%), being higher among medical students (88.1%, vs. 81.4% among nursing and 80.1% among paramedical students; p vaccinated during childhood. In addition, 30% of the unvaccinated students declared fear over HBV safety. Our results indicate that the healthcare students achieved higher reported immunization rates compared to the currently serving healthcare workers, but also to the students of the last decade. The fact that nursing and paramedical students have lower coverage figures underlines the importance of targeted interventions for the different subgroups of healthcare students in terms of educational programs and screening for HBV markers in order to increase HBV vaccination uptake.

  3. "Efficacy of interferon and Amantadin for treatment of hepatitis in major thalasemia at Children’s Medical Center, Tehran "

    Directory of Open Access Journals (Sweden)

    Fallahi GHI


    Full Text Available Background: Major thalassemia is relatively common in Iran and in looking of their need to recurrent transfusion; their high risk for acquisition of HCV is revealed. These patients also suffer form liver hemosiderosis that accelerate disease excursion to cirrhosis and hepatocellular carcinoma. In this study combined therapy with interferon and amantadin has been evaluated. Methods: This prospective clinical trail has been done on thalasemic patients that had been contaminated by HCV and had laboratory signs of hepatitis. During years of 81-82, 26 patients admitted at Children Mmedical Center with major thalassemia and HCV hepatitis. Inclusion criteria were positive HCV-RNA, high ALT and histologic evidence of hepatitis in liver biopsy and exclusion criteria were history of incomplete treatment any contraindication of IFN or amantadin-emergence of drugs adverse reactions, to intending of these criteria 10 case of them had situation for treatment and follow-up. Results: In 10 cases, treatment with IFN  - 2b in doses 3 mu for every square meter of body surface three times in week subcutaneously and cap. Amantadin in doses 100 mg po B.d for 6 months was done and after it, 8 cases were negative for HCV-RNA (8% and in 6 patients, ALT turned to normal (60% and in 2 other case ALT decrease to lower than 50% of pretreatment value. None of them showed drug adverse reactions and response to therapy was better in lower ages. No relation between response to therapy and liver hemosiderosis, inflammation and sexuality was found. Conclusion: Combined therapy with IFN and Amantadin is effective in HCV treatment and for lower recurrence, treatment period longer than 24 wk, such as 48 wk is recommended

  4. Asbestos in Asia. (United States)

    Leong, Su Lyn; Zainudin, Rizka; Kazan-Allen, Laurie; Robinson, Bruce W


    Asbestos is a global killer. Despite lessons learned in the developed world on the use of asbestos and its hazardous pulmonary consequences, its use continues to increase in Asia. Although some countries such as Japan, Korea and Singapore have curtailed the use of this mineral, there are numerous countries in Asia that continue to mine, import and use this fibre, particularly China, which is one of the largest consumers in the world. Numerous factors ranging from political and economic to the lack of understanding of asbestos and the management of asbestos-related lung disease are keys to this observed trend. Awareness of these factors combined with early intervention may prevent the predicted Asian 'tsunami' of asbestos diseases.

  5. From traditional to patient-centered learning: curriculum change as an intervention for changing institutional culture and promoting professionalism in undergraduate medical education. (United States)

    Christianson, Charles E; McBride, Rosanne B; Vari, Richard C; Olson, Linda; Wilson, H David


    The authors reframe a curriculum change from a traditional lecture-based to an integrated patient-centered approach as an intervention for changing the culture and hidden curriculum of an institution in ways that promote professionalism. Within this context, the authors articulate some of the inherent process and relational factors brought about by these curricular changes that are essential elements of this intervention process. In 1998 the University of North Dakota School of Medicine and Health Sciences (UNDSMHS) introduced a new preclinical patient-centered learning (PCL) curriculum for first- and second-year medical students. Case-based, small-group learning forms the critical foundation of the PCL process, and an integrated basic and clinical science didactic component supports this process. At the student level, the case-based PCL process generates innovative opportunities for professionalism education from the explicitly articulated formal content that arises naturally from the cases, but more importantly from the implicit values inherent to the PCL small-group process itself--humanism, accountability, pursuit of excellence, and altruism. Further, the organizational changes necessary for the transformation to the PCL curriculum required process changes at student, faculty, and administrative levels that have resulted in a cultural shift toward relationship centeredness within the institution. The authors describe the evolution and structure of the PCL curriculum at UNDSMHS and how this curricular transformation has served as an intervention that promotes professionalism and institutional culture change through (1) processes at the student level that present new opportunities for professionalism education, and (2) processes at student, faculty, administrative, and institutional levels that have created an institutional culture that supports, models, and promotes relationship-centered professional values.

  6. When the library is located in prime real estate: a case study on the loss of space from the Duke University Medical Center Library and Archives. (United States)

    Thibodeau, Patricia L


    The Duke University Medical Center Library and Archives is located in the heart of the Duke Medicine campus, surrounded by Duke Hospital, ambulatory clinics, and numerous research facilities. Its location is considered prime real estate, given its adjacency to patient care, research, and educational activities. In 2005, the Duke University Library Space Planning Committee had recommended creating a learning center in the library that would support a variety of educational activities. However, the health system needed to convert the library's top floor into office space to make way for expansion of the hospital and cancer center. The library had only five months to plan the storage and consolidation of its journal and book collections, while working with the facilities design office and architect on the replacement of key user spaces on the top floor. Library staff worked together to develop plans for storing, weeding, and consolidating the collections and provided input into renovation plans for users spaces on its mezzanine level. The library lost 15,238 square feet (29%) of its net assignable square footage and a total of 16,897 (30%) gross square feet. This included 50% of the total space allotted to collections and over 15% of user spaces. The top-floor space now houses offices for Duke Medicine oncology faculty and staff. By storing a large portion of its collection off-site, the library was able to remove more stacks on the remaining stack level and convert them to user spaces, a long-term goal for the library. Additional space on the mezzanine level had to be converted to replace lost study and conference room spaces. While this project did not match the recommended space plans for the library, it underscored the need for the library to think creatively about the future of its facility and to work toward a more cohesive master plan.

  7. Southeast Asia Report. (United States)


    Industry Export Targets for 1984-1985 Outlined (KOMPAS, 15 Dec 83) 17 - a - [III - ASIA - 107] Transmigrants in South Aceh Threatened by Food Shortages...Agriculture, Hospitals 47 Thai Illegal Aliens Returned 48 MALAYSIA Rithauddeen To Seek Re-Election (NEW STRAITS TIMES, 24 Jan 84) 49 MCA Elections...Reserve units telling them of the plan to get the numbers down through " wastage and controlled recruiting." With the Budget allocation for the Army

  8. Asia at the Helm

    Institute of Scientific and Technical Information of China (English)


    @@ As the global economy transforms from a developed country centric to a more developing-focused model in the post-crisis world,Asia is emerging as a new economic powerhouse.Its policy choices are important for the continent's own sake,and also for the global economy as a whole.Dominique Strauss-Kahn,Managing Director of the IMF,noted this shift in a recent speech in Shanghai.Edited excerpts follow:

  9. Asia at the Helm

    Institute of Scientific and Technical Information of China (English)


    As the global economy transforms from a developed countrycentric to a more developing-focused model in the post-crisis world,Asia is emerging as a new economic powerhouse.Its policy choices are important for the continent’s own sake, and also for the global economy as a whole.Dominique Strauss-Kahn,Managing Director of the IMF,noted this shift in a recent speech in Shanghai.Edited excerpts follow

  10. Growing East Asia

    Institute of Scientific and Technical Information of China (English)


    @@ It was a busy exchanging period of East Asia in recent days. From October 28 to 31, 2007 the fourth China-ASEAN Expo (CAEXPO) and the fourth China-ASEAN Business and Investment Summit (CABIS) were held concurrently in Nanning, capital city of Guangxi Province in China. In the Expo,China witnessed a turnout of over 33,000 trade visitors and over 180 investment cooperation projects with ASEAN.

  11. [Tuberculosis in Asia]. (United States)


    populations. These factors pose particular problems for implementing DOTS in various ways. Socio-cultural and environmental factors are particularly important in Nepal, and several measures have been developed to overcome these difficulties. One is active community participation through the DOTS committee. The committee consists of a group of motivated people, including social workers, political leaders, health services providers, journalists, teachers, students, representatives of local organizations, medical schools and colleges, industries, private practitioners, and TB patients. One DOTS committee is formed in every treatment center. A key role of the DOTS committee is to identify local problems and their solutions. It increases public awareness about TB and DOTS; supports people with TB in the community by providing treatment observers and tracing late patients; and encourages cooperation among health institutions, health workers, NGOs, and political leaders. The case finding rate is now 69%, and nearly 95% of diagnosed TB cases are being treated under DOTS. The treatment success rate of new smear-positive cases is nearly 90%. Thus, DOTS increases the case finding and treatment success. 3. Cambodia: HIV/TB and the health sector reform: Tan Eang Mao (National Center for Tuberculosis and Leprosy Control, Cambodia) Cambodia is one of the 23 high burden countries of tuberculosis in the world. Moreover, HIV/AIDS has been spreading rapidly since 1990s, which is worsening the tuberculosis epidemics. To cope with the burden, Cambodia has started implementation of DOTS in 1994 and has expanded it to most of public hospitals across the country by 1998. NTP of Cambodia is now enjoying high cure rate of more than 90%. However, due to the constraints such as weak infrastructure and the poverty, it is proved that many of TB sufferers do not have access to the TB services, resulting in still low case detection rate. It is for this reason that the NTP has decided to expand DOTS to

  12. Medical Identity

    DEFF Research Database (Denmark)

    Musaeus, Peter


    Purpose: To examine philosophical stances underpinning medical identity and assess the conceptual relationship between physician, medical practice and culture. Argument: Medical identity is about the ideals and moral positions that physicians take when justifying themselves. Medical identity...... hedonistic versus sentimentalist approaches to medical identity. The sociocultural philosophical analysis of medical identity can shed light on what it means conceptually for a physician to harbor beliefs associated with him/her being taken to be an autonomous professional. It is important because it touches...... on the meaning of being a compassionate, good and skilled physician, making its relevance to person-centered medicine self-evident. Conclusion: Medical identity should be analyzed with reference to literature, philosophy and medical practice in order for the physician to exercise a reflective position...

  13. Dialogic Showcases Innovative Asian CT Solutions at Voice Asia '98

    Institute of Scientific and Technical Information of China (English)


    Dialogic Corporation showcases Computer Telephony (CT) solutions from some of Asia's leading CT developers at this Voice Asia'98 show. These vendors display the latest Asian solutions for IP Telephony,Speech Recognition, Telephone Company Enhanced Services Platform. Call Center and Unified Messaging, Open Switch and CT Servers.

  14. An assessment of technology-based service encounters & network security on the e-health care systems of medical centers in Taiwan

    Directory of Open Access Journals (Sweden)

    Chang Ching


    Full Text Available Abstract Background Enhancing service efficiency and quality has always been one of the most important factors to heighten competitiveness in the health care service industry. Thus, how to utilize information technology to reduce work load for staff and expeditiously improve work efficiency and healthcare service quality is presently the top priority for every healthcare institution. In this fast changing modern society, e-health care systems are currently the best possible way to achieve enhanced service efficiency and quality under the restraint of healthcare cost control. The electronic medical record system and the online appointment system are the core features in employing e-health care systems in the technology-based service encounters. Methods This study implemented the Service Encounters Evaluation Model, the European Customer Satisfaction Index, the Attribute Model and the Overall Affect Model for model inference. A total of 700 copies of questionnaires from two authoritative southern Taiwan medical centers providing the electronic medical record system and the online appointment system service were distributed, among which 590 valid copies were retrieved with a response rate of 84.3%. We then used SPSS 11.0 and the Linear Structural Relationship Model (LISREL 8.54 to analyze and evaluate the data. Results The findings are as follows: (1 Technology-based service encounters have a positive impact on service quality, but not patient satisfaction; (2 After experiencing technology-based service encounters, the cognition of the service quality has a positive effect on patient satisfaction; and (3 Network security contributes a positive moderating effect on service quality and patient satisfaction. Conclusion It revealed that the impact of electronic workflow (online appointment system service on service quality was greater than electronic facilities (electronic medical record systems in technology-based service encounters. Convenience and

  15. 77 FR 11136 - Proposed Collection; Comment Request; a Multi-Center International Hospital-Based Case-Control... (United States)


    ... International Hospital-Based Case-Control Study of Lymphoma in Asia (AsiaLymph) (NCI) SUMMARY: In compliance... the Office of Management and Budget (OMB) for review and approval. Proposed Collection: Title: A Multi-Center International Hospital- Based Case-Control Study of Lymphoma in Asia (AsiaLymph) (NCI). Type...

  16. JPRS Report, East Asia, Southeast Asia. (United States)


    and at Wat Nikhomsamakkhichai in Nikhom Subdistrict, Muang District, Lopburi Province. Meditation masters provide systematic instruction... Meditation masters have also been invited to come providing training at the Army Aviation Center. As a result of this mental development training...established a Saturday Buddhist school. It accepts children from Grade 6 through Grade 9. There are five classrooms . The school teaches Buddhist

  17. Supply chain dynamics in Asia


    Banomyong, Ruth


    Supply chain management in Asia is a relatively novel topic but a key challenge for all Asian based manufacturers and traders when trying to integrate into the "global market". The purpose of the paper is to describe key supply chain issues faced in Asia. These issues are related to supply chain security that forces Asian firms to comply with numerous requirements as well as the importance of a properly managed supply chain in enhancing firms' competitiveness. The critical role played by Asia...

  18. Hospitals - MEDICAL_CARE_FACILITIES_MHMP_IN: Medical Care Facilities in Indiana, derived from Essential Facilities Data of the Multi-Hazard Mitigation Planning Data (The Polis Center, Point Shapefile) (United States)

    NSGIC GIS Inventory (aka Ramona) — MEDICAL_CARE_FACILITIES_MHMP_IN.SHP is a point shapefile that shows medical care facilities in Indiana. MEDICAL_CARE_FACILITIES_MHMP_IN.SHP was derived from the...

  19. Evolution of the clinical trial landscape in Asia Pacific

    Directory of Open Access Journals (Sweden)

    Yathindranath S


    Full Text Available Shourav Yathindranath,1 Amar Kureishi,2 Simranjit Singh,3 Spencer Yeow,3 Grace Geng,4 Karen Wai,1 Audrey Ho,1 Elvira Zenaida Lansang,1 Ken J Lee5 1Feasibility and Site Identification Asia, 2Drug Development Asia, 3Strategic Planning Asia, Quintiles East Asia Private Limited, Singapore; 4People’s Republic of China Site Services, Quintiles, Beijing, People’s Republic of China; 5Asia Site Services, Quintiles East Asia Private Limited, Singapore Introduction: Asia Pacific has and continues to be one of the fastest-growing pharmaceutical markets in the world. This growth has a carry-over effect of driving pharmaceutical research and development investment in the region. Coupled with this, there have been multiple initiatives conducted by governments and other research focused organizations and societies in the region to help support this growth in research. In this report, we discuss the latest developments in pharmaceutical research and development in Asia Pacific and how these various initiatives have made an impact. Methods: An extensive search of the major clinical trial registries, along with the literature and Internet review of the recent developments in clinical trials, was performed comparing two time periods – 2009–2010 and 2011–2012. Results: In overall numbers, the clinical trial industry in Asia Pacific has remained stable when comparing the two time periods, with stable volumes of clinical trial numbers and site numbers. However, on closer inspection, a dynamic change in geography, nature, and therapeutic areas of the trials being conducted is observed. Japan, South Korea, People’s Republic of China, and Taiwan continue to be major clinical trial destinations. Developing countries, such as Indonesia, Vietnam, and Philippines, have seen rising standards of living and medical care; this is starting to impact their contribution to trials. Also, there are an increasing number of local trials in Asia Pacific with a bigger role

  20. Comparison of optimal cardiovascular risk factor management in patients with Type 2 diabetes who attended urban medical health center with those attended a tertiary care center: Experiences from Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Sedighe Moradi


    Conclusions: Both centers have failure in target achievement in some risk factors; however, the inability of the primary care center in controlling hyperlipidemia in comparison with the tertiary center is a serious warning to provide training about managing dyslipidemia in these centers.

  1. [Projects to accelerate the practical use of innovative medical devices to collaborate with TWIns, Center for Advanced Biomedical Sciences, Waseda University and School of Engineering, The University of Tokyo]. (United States)

    Niimi, Shingo; Umezu, Mitsuo; Iseki, Hiroshi; Harada, Hiroshi Kasanuki Noboru; Mitsuishi, Mamoru; Kitamori, Takehiko; Tei, Yuichi; Nakaoka, Ryusuke; Haishima, Yuji


    Division of Medical Devices has been conducting the projects to accelerate the practical use of innovative medical devices to collaborate with TWIns, Center for Advanced Biomedical Sciences, Waseda University and School of Engineering, The University of Tokyo. The TWIns has been studying to aim at establishment of preclinical evaluation methods by "Engineering Based Medicine", and established Regulatory Science Institute for Medical Devices. School of Engineering, The University of Tokyo has been studying to aim at establishment of assessment methodology for innovative minimally invasive therapeutic devices, materials, and nanobio diagnostic devices. This report reviews the exchanges of personnel, the implement systems and the research progress of these projects.

  2. Peking University Center of Medical Genetics (PUCMG): a comprehensive medical genetics program in China%中国医学遗传综合项目基地--北京大学医学遗传中心

    Institute of Scientific and Technical Information of China (English)

    Nanbert ZHONG


    @@ Medical genetics, as an important component in the advanced medical practice, has touched in variant aspects of clinical aspects. Globally, in both developed and developing countries, medical genetics is playing more and more important roles in dealing with the public healthcare. Being a medical specialty performing diagnosis and intervention for genetic disorders, the medical genetics has bridged the clinical practice and basic medical sciences. It is derived, but different, from human genetics. The difference of which is that the medical genetics provides clinical service for medical professionals and patients; however, the human genetics focuses on investigation of genetic principles.

  3. Gondwana to Asia: Preface (United States)

    Kwon, Sanghoon; Kim, Sung Won; Santosh, M.


    The Korean Peninsula, China, Japan, India, Sri Lanka, and Timor, among other regions, preserve important clues for the tectonic evolution of present-day Asia derived from the break-up of Mesozoic supercontinent Pangea. Evidence for the formation, evolution, and destruction of Earth's first coherent supercontinent Columbia during Paleoproterozoic, followed by the Neoproterozoic Rodinia and late Neoproterozoic-Cambrian Gondwana supercontinents are also recorded in many of these regions. The debates surrounding some of these aspects and the state-of-the-art knowledge from these terranes were the focal themes of discussion during the "2013 Annual Convention of the International Association for Gondwana Research (IAGR) and the 10th Gondwana to Asia International Conference" held at the Korea Institute of Geoscience and Mineral Resources (KIGAM), Korea during September 30th to October 2nd 2013. The conference was attended by more than 200 delegates representing 11 countries. The discussion continued at the "International conference on Continental Dynamics" held in Xian, China during April 2014. This special issue of Journal of Asian Earth Sciences, assembling 24 research papers is an outcome of the deliberations under various sessions of the above conferences. In assembling this special issue, we attempt to provide evidence-driven discussions on the construction and destruction of Precambrian and Paleozoic supercontinents preserved in present-day Asian continents. We also address a variety of themes including magmatic, metamorphic and metallogenic processes, as well as issues related to natural environment. We hope that the papers assembled in this special issue offer new insights into some of the key issues surrounding the geological, geophysical and geodynamic milieu in Asia, and a better understanding of analogous processes in other parts of the world.

  4. Family physicians' ability to perform population management is associated with adoption of other aspects of the patient-centered medical home. (United States)

    Ottmar, Jessica; Blackburn, Brenna; Phillips, Robert L; Peterson, Lars E; Jaén, Carlos Roberto


    The patient-centered medical home (PCMH) model is considered a promising approach to improving population health, but how elements of these advanced practice models relate to population health capability is unknown. To measure associations between family physicians' performance of population management with PCMH components, a cross-sectional survey was conducted with physicians accessing the American Board of Family Medicine Web site in 2011. Bivariate analysis and logistic regression tested associations between physician and practice demographics and specific PCMH features. The primary outcome was performance of population management. The final sample included 3855 physicians, 37.3% of whom reported performing population management. Demographic characteristics significantly associated with greater use of population management were female sex and graduation from an international medical school. PCMH components that remained associated with population management after adjustment were access to clinical case managers (odds ratio [OR]=2.01, 95% confidence interval [95% CI]: 1.69, 2.39), behavioral health collaboration (OR=1.49, 95% CI: 1.26, 1.77), having an electronic health record that supports meaningful use (OR=1.47, 95% CI: 1.25, 1.74), recent participation in a quality improvement project (OR=2.47, 95% CI: 2.12, 2.89), and routine measurement of patient difficulty securing an appointment (OR=2.87, 95% CI: 2.45, 3.37). Performance of population management was associated with several PCMH elements and resources not present in traditional primary care offices. Attention to these elements likely will enhance delivery of population management services in primary care.

  5. Workplace interpersonal conflicts among the healthcare workers: Retrospective exploration from the institutional incident reporting system of a university-affiliated medical center (United States)

    Huang, Szu-Fen; Liang, Huey-Wen; Chen, Li-Chin; Lin, Chia-Kuei; Huang, Hsiao-Fang; Hsieh, Ming-Yuan; Sun, Jui-Sheng


    Objective There have been concerns about the workplace interpersonal conflict (WIC) among healthcare workers. As healthcare organizations have applied the incident reporting system (IRS) widely for safety-related incidents, we proposed that this system might provide a channel to explore the WICs. Methods We retrospectively reviewed the reports to the IRS from July 2010 to June 2013 in a medical center. We identified the WICs and typed these conflicts according to the two foci (task content/process and interpersonal relationship) and the three properties (disagreement, interference, and negative emotion), and analyzed relevant data. Results Of the 147 incidents with WIC, the most common related processes were patient transfer (20%), laboratory tests (17%), surgery (16%) and medical imaging (16%). All of the 147 incidents with WIC focused on task content or task process, but 41 (27.9%) also focused on the interpersonal relationship. We found disagreement, interference, and negative emotion in 91.2%, 88.4%, and 55.8% of the cases, respectively. Nurses (57%) were most often the reporting workers, while the most common encounter was the nurse-doctor interaction (33%), and the majority (67%) of the conflicts were experienced concurrently with the incidents. There was a significant difference in the distribution of worker job types between cases focused on the interpersonal relationship and those without (p = 0.0064). The doctors were more frequently as the reporter when the conflicts focused on the interpersonal relationship (34.1%) than not on it (17.0%). The distributions of worker job types were similar between those with and without negative emotion (p = 0.125). Conclusions The institutional IRS is a useful place to report the workplace interpersonal conflicts actively. The healthcare systems need to improve the channels to communicate, manage and resolve these conflicts. PMID:28166260

  6. The effects of huko point massage with ice on intensity of pain due of Phlebotomy in children with thalassemia in Kerman Samen Alhojaj Medical Center, Iran

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    Rostami M


    Full Text Available Background and Objective: Venous catheter is one of the most painful medical procedures and frequently practiced in the children's thalassemia ward. Children with thalassemia experience moderate to severe pain during phlebotomy. The present study aimed to investigate the effect of huko point massage with ice on intensity of pain due of Phlebotomy In children with thalassemia. The relationship between anxiety and pain in children was also studied. Materials and Method: A randomized, clinical trial was conducted on 86 children of 6-12 years of age undergoing transfusion and referred to the thalassemia ward of Kerman Samen Alhojaj Medical Center in 2014. The children were selected using convenience sampling and assigned to the interventional and control groups using randomized block design. In the interventional group, 5 minutes before performing phlebotomy, huko point massage with ice was performed. In the control group, no intervention was performed. Data were collected using a demographic questionnaire and the Face, Legs, Activity, Cry, Consolability Scale (FLACC scale. Data were analyzed using Spearman's correlation and Mann-Whitney test by SPSS software version 22. Results: The mean pain score in the interventional group was 0.65 ± 0.75 and in the control group was 3.81 ± 1.84. A significant difference was observed between the pain severity of the two groups (P = 0.001. Conclusion: Huko point massage with ice can reduce intensity of pain due of phlebotomy in children with thalassemia. Accordingly, the application of huko point massage with ice is recommended as a non-pharmacological method of pain relief during phlebotomy in children with thalassemia.

  7. Underground laboratories in Asia

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Shin Ted, E-mail: [College of Physical Science and Technology, Sichuan University, Chengdu 610064 China (China); Yue, Qian, E-mail: [Key Laboratory of Particle and Radiation Imaging (Ministry of Education) and Department of Engineering Physics, Tsinghua University, Beijing 100084 China (China)


    Deep underground laboratories in Asia have been making huge progress recently because underground sites provide unique opportunities to explore the rare-event phenomena for the study of dark matter searches, neutrino physics and nuclear astrophysics as well as the multi-disciplinary researches based on the low radioactive environments. The status and perspectives of Kamioda underground observatories in Japan, the existing Y2L and the planned CUP in Korea, India-based Neutrino Observatory (INO) in India and China JinPing Underground Laboratory (CJPL) in China will be surveyed.

  8. Mortality in Asia. (United States)


    Although the general trend in mortality between 1950 and 1975 in South and East Asia has been downward, there is considerable country-to-country variation in the rate of decline. In countries where combined economic, social, and political circumstances resulted in controlling the disease spectrum (e.g., China, Malaysia, Sri Lanka), mortality levels declined to those seen in low-mortality countries. In most of the large countries of the region however, mortality declined at a slower rate, even slowing down considerably in the 1970's while the death rates remained high (e.g., India, Bangladesh, Thailand, Philippines); this slowing down of mortality level is attributed essentially to the poverty-stricken masses of society which were not able to take advantage of social, technological, and health-promoting behavioral changes conducive to mortality decline. Infant mortality levels, although declining since 1950, followed the same dismal pattern of the general mortality level. The rate varies from less than 10/1000 live births (Japan) to more than 140/1000 (Bangladesh, Laos, Nepal). Generally, rural areas exhibited higher infant mortality than urban areas. The level of child mortality declines with increases in the mother's educational level in Bangladesh, India, Indonesia, Sri Lanka, and Thailand. The largest decline in child mortality occurs when at least 1 parent has secondary education. The premature retardation of mortality decline is caused by several factors: economic development, nutrition and food supply, provision and adequacy of health services, and demographic trends. The outlook for the year 2000 for most of Asia's countries will depend heavily on significant population increases. In most countries, particularly in South Asia, population is expected to increase by 75%, much of it in rural areas and among poorer socioeconomic groups. In view of this, Asia's health planners and policymakers will have to develop health policies which will strike a balance

  9. Teaching Modern Southeast Asia

    Directory of Open Access Journals (Sweden)

    Thomas Williamson


    Full Text Available Teaching about Southeast Asia to undergraduates at an American liberal arts college presents several challenges. At my institution, it is the only course on the region in the curriculum; thus no preparation, and no follow-up. I have therefore struggled with the approach that I should take–pulled between a wish for students to gain an empirical understanding of Southeast Asian life, and a desire to have them learn the concepts and theories of critical inquiry. Obviously I am still learning how to successfully accomplish such an ambitious undertaking.

  10. 2005 Training Course on SHP for Asia-Pacific Region

    Institute of Scientific and Technical Information of China (English)


    “2005 Training Course on Small Hydropower for Asia-Pacific Countries” is specifically for developing countries under the list of aid to foreign countries by the Chines egovernment. Entrusted by the Ministry of Commerce, Hangzhou Regional Center for Small Hydro Power (HRC) will undertake the mission.

  11. First Class Service, First Class Enjoyment-- Guangzhou Asia International Hotel

    Institute of Scientific and Technical Information of China (English)


    @@ Situated in Guangzhou,Guangdong Asia International Hotel is the newest five star luxurious high intelligence exhibition business hotel. It is located the golden business center and the main road of Guangzhou-Huangshi East Road. It is only fifteen minutes' drive from Guangzhou train station, forty minutes'drive to Guangzhou New Baiyun International Airport.

  12. The Cultural and Ecological "Worlds" of Central Asia (United States)

    Quigley, Cassie; Allspaw, Kathleen


    With a grant through Indiana University's Inner Asian & Uralic National Resource Center, the authors developed an online, five-week unit that discusses the cultural and ecological "worlds" of central Asia, specifically the countries of Kazakhstan, Uzbekistan, Kyrgyzstan, Tajikistan, and Turkmenistan. There are two main ideas…

  13. Racial Differences in Processes of Care at End of Life in VA Medical Centers: Planned Secondary Analysis of Data from the BEACON Trial (United States)

    Williams, Beverly R.; Dionne-Odom, J. Nicholas; Redden, David T.; Noh, Hyunjin; Goode, Patricia S.; Kvale, Elizabeth; Bakitas, Marie; Bailey, F. Amos


    Abstract Background: Racial differences exist for a number of health conditions, services, and outcomes, including end-of-life (EOL) care. Objective: The aim of the study was to examine differences in processes of care in the last 7 days of life between African American and white inpatients. Methods: Secondary analysis was conducted of data collected in the Best Practices for End-of-Life Care for Our Nation's Veterans (BEACON) trial (conducted 2005–2011). Subjects were 4891 inpatient decedents in six Veterans Administration Medical Centers. Data were abstracted from decedents' medical records. Multi-variable analyses were conducted to examine the relationship between race and each of 18 EOL processes of care controlling for patient characteristics, study site, year of death, and whether the observation was pre- or post-intervention. Results: The sample consisted of 1690 African American patients (34.6%) and 3201 white patients (65.4%). African Americans were less likely to have: do not resuscitate (DNR) orders (odds ratio [OR]: 0.67; p = 0.004), advance directives (OR: 0.71; p = 0.023), active opioid orders (OR: 0.64, p = 0.0008), opioid medications administered (OR: 0.61, p = 0.004), benzodiazepine orders (OR: 0.68, p < 0.0001), benzodiazepines administered (OR: 0.61, p < 0.0001), antipsychotics administered (OR: 0.73, p = 0.004), and steroids administered (OR: 0.76, p = 0.020). Racial differences were not found for other processes of care, including palliative care consultation, pastoral care, antipsychotic and steroid orders, and location of death. Conclusions: Racial differences exist in some but not all aspects of EOL care. Further study is needed to understand the extent to which racial differences reflect different patient needs and preferences and whether interventions are needed to reduce disparities in patient/family education or access to quality EOL care. PMID:26840851

  14. Improving Student Persistence at the Genesis Center (United States)

    Fritz, Nancy; Alsabek, Barbara Piccirilli


    The Genesis Center is a community-based adult education center located in Providence, Rhode Island. Founded in 1982 to assist immigrants and refugees from Southeast Asia in their transition to life in the United States, the Genesis Center now provides adult education, job training, and child care services to people who have immigrated from all…

  15. Distribution and dynamics of mangrove forests of South Asia..

    Digital Repository Service at National Institute of Oceanography (India)

    Giri, C.; Long, J.; Abbas, S.; ManiMurali, R.; Qamer, F.M.; Pengra, B.; Thau, D.

    version: J. Environ. Manage., vol.48; 2015; 101-111 Distribution and dynamics of mangrove forests of South Asia Chandra Giri USGS Earth Resources Observation and Science (EROS) Center, Sioux Falls, SD, 57198, USA, Email: Jordan Long..., ARTS, contractor to USGS Earth Resources Observation and Science (EROS) Center, Sioux Falls, SD, 57198, USA. Sawaid Abbas, World Wide Fund for Nature (WWF) – Pakistan, The Hong Kong Polytechnic University, Hong Kong R.Mani Murali, CSIR - National...

  16. Successful Asia-Pacific Die Casting Industry Exhibition'2005

    Institute of Scientific and Technical Information of China (English)


    @@ Upon the expectation of practitioners in the die casting industry, the Asia-Pacific Die Casting Industry Exhibition'2005, sponsored by Chinese Mechanical Engineering Society (CMES) and China Productivity Promotion Center of Machinery Industry, organized by Foundry Institution of Chinese Mechanical Engineering Society (FICMES) and Productivity Promotion Center of Foundry Industry of China, was successfully held in INTEX Shanghai, China on August 13-17,2005.

  17. Dissemination and Molecular Epidemiology of KPC-Producing Klebsiella pneumoniae Collected in Puerto Rico Medical Center Hospitals during a 1-Year Period

    Directory of Open Access Journals (Sweden)

    Iraida E. Robledo


    Full Text Available During a 2003-2004 PCR-based surveillance study conducted in 6 Puerto Rico Medical Center hospitals, 27/92 multi-beta-lactam-resistant Klebsiella pneumoniae strains were identified as carbapenemase (KPC positive in 4 hospitals. The objectives of this study were to identify the KPC variants, their genetic relatedness, and any other beta-lactamases present. Susceptibility testing, pulsed field gel electrophoresis (PFGE, isoelectric focusing, PCR, and DNA sequencing were performed. KPC variants -2, -3, -4, and -6 were identified. Additional beta-lactamases detected were TEM, DHA, OXA-9 and -30. Antimicrobial susceptibility to carbapenems varied depending on the KPC variant. Five PFGE genetically related groups were identified in 15 isolates and 12 unrelated types. PFGE profiles suggested that both clonal and horizontal transfer are contributing to the dissemination of these isolates among the various hospitals. Comparison of the 2003 and a 2009 surveillance studies showed a significant increase in the KPC-positive K. pneumoniae isolates in the latter.

  18. Hazard-evaluation and technical-assistance report HETA 90-122-l2073, technical assistance to San Francisco General Hospital and Medical Center, San Francisco, California

    Energy Technology Data Exchange (ETDEWEB)

    Moss, C.E.; Seitz, T.


    In response to a request from the Director of the Environmental Health and Safety Department of the San Francisco General Hospital and Medical Center, located in San Francisco, California, an evaluation was undertaken of possible hazardous working conditions at that site. Concern existed about exposures to hazards while operating the germicidal lamp at the facility. Germicidal lamps were used to disinfect the air in tuberculosis and aerosolized pentamidine clinics. The workers wore no protective eye wear. All rooms used a 30 watt germicidal lamp. Lower wattage bulbs in the smaller rooms would have reduced occupational ultraviolet (UV) exposure. Reflectance levels of UV radiation were quite high and varied. Worker exposure to germicidal lamp UV levels was dependent on many factors, some of the most important ones being the position of the bulb in the room, age of the bulb, obstruction of the UV radiation by objects near the bulb, and the height of the worker. While there are no consensus guidelines available on ventilation systems designed for areas where germicidal lamps are used, the provision of good room air distribution and mixing is recommended to prevent stagnant air conditions or short circuiting of supply air within the room. Bulb changers need to be aware of the need for protective clothing and gloves for protection from both the UV radiation levels as well as possible glass breakage.

  19. Facilities of Downey Medical Center in Los Angeles%美国洛杉矶唐尼医学中心设施简介

    Institute of Scientific and Technical Information of China (English)



    介绍了该医学中心建筑设计理念与设施系统,该院地处美国西海岸,遵循加利福尼亚州建筑设施系统规范,不同于美国医院建设主流观点与做法,采用了全新风、变风量、非集中式空调等系统形式,以及蒸发冷却等多项节能措施,其设计方案、建设实践以及节能措施荣获美国供热制冷空调工程师学会2011年度最佳技术奖,值得我国参考与借鉴.%Presents the architectural design concept and facilities systems in the medical center, which followed California Mechanical Code, differing from mainstream values and practices of the American hospital construction, adopting the measures of total fresh air, variable air volume, non-centralized air-conditioning system, as well as the evaporative cooling system suitable to its local climate of the West Coast. The hospital building design, practices and energy-saving measures won ASHRAE's Best 2011 Technology Awards, being worthy of a salutary lesson.

  20. Radiation Therapy Improves Survival Outcome in Pancreatic Adenocarcinoma: Comparison of a 15-Year Institutional Experience at the University of Nebraska Medical Center with SEER Data

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    Michael J. Baine


    Full Text Available Objectives. We examined the role of radiation therapy (RT in pancreatic adenocarcinoma (PA treatment through a 15-year retrospective analysis of patients treated at University of Nebraska Medical Center (UNMC as well as those from the SEER database. Methods. A total of 561 patients diagnosed with PA at UNMC between 1995 and 2011 and 60,587 patients diagnosed between 1995 and 2009 from the SEER were included. Examined prognostic factors for overall survival (OS were age, gender, race, stage, year of diagnosis, and treatment with surgery, chemotherapy (CT, or RT. Time to death was plotted by Kaplan-Meier method. A Cox proportional hazards model was used to evaluate prognostic factors for OS. Results. The median OS was 7.3 and 5 months for patients from UNMC and the SEER database, respectively. A Cox model of patients from UNMC showed that RT was associated with improved OS (HR 0.77, P=0.018 after adjusting for factors including age, race, gender, stage, year of diagnosis, having surgery, or having CT. Cox analysis of patients from the SEER showed similar results (HR 0.65, P<0.0001. Conclusions. RT confers an independent survival advantage in patients being treated for PA which is apparent both at UNMC and through SEER data.

  1. Relationship Between Sleep Disorder and Pregnancy Depression in Primigravidae Referring to Health– Treatment Centers of Ahvaz Jundishapur University of Medical Sciences in 2010

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    ٍE Parsaie Rad


    Full Text Available Introduction: Sleep is an organized behavior which is repeated every day as a vital necessity, and based on biological rhythm. Sleep disorders are common problems in pregnancy that it seems to have emotional and psychological consequences in pregnant women. This study investigated the relationship between sleep disorders and depression during pregnancy among primigravidae. Methods: This cross-sectional, analytical study was conducted on 70 primigravidae with gestational age between 36 and 40 weeks, singleton without known disease. Subjects were selected by multi-stage sampling method in Health– Treatment centers of Ahvaz Jundishapour University of Medical Sciences. After filling demographic, Winefield & Tiggemann multidimensional support scale, ENRICH marital satisfaction scale and ISI questionnaires, subjects were classified into two groups: with and without sleep disorders. Then they were evaluated for depression by Beck questionnaire. Using SPSS(ver. 17, data was analyzed by T-test for quantitative variables, and chi square and Fisher test for qualitative variables, and Mann-Whitney test for ordinal variables. Results: Findings showed that the severity of sleep disorders is related to depression in pregnancy(p=0.01. There was a statistically significant relationship between difficulty falling asleep, sleep continuation, early awakening, and disruption of daily activities with depression during pregnancy(p= 0.03, 0.008, 0.03, and 0.001, respectively. Conclusion: With regard to the results, education about healthy sleep and suitable consultation during pregnancy is recommended in order to prevent mental complications and to achieve a safe pregnancy

  2. The Frequency of blaVIM, blaIMP, blaKPC and blaNDM Carbapenemase Genes in Clinical Isolates of Klebsiella Pneumoniae in Kermanshah Medical Centers

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    A Zare


    Full Text Available Background: Carbapenemase genes have been spread among strains of Klebsiella pneumoniae that make them resistant to carbapenems. Hence, the present study aimed to study the prevalence of carbapenmase genes within K. pneumoniae isolates in Kermanshah medical centers. Methods: Sixty isolates of K. pneumoniae were collected and identified using API kit. Then, antibiotic susceptibility of isolates was determined using a disk diffusion method. The carbapenems-resistant isolates were screened for carbapenemases production using the Modified Hodge Test (MHT. The carbapenemase genes of blaVIM, blaIMP, KPC and blaNDM were detected by PCR test . Results: Out of 60 isolates, 4 isolates were resistant to carbapenem antibiotics, but only one isolate was demonstrated to be positive for carbapenemases by MHT phenotypic testing. The gene of blaVIM was detected in three isolates by PCR, though other genes were not found in the isolates. Within the isolates, 6.67% and 100% were resistant to carbapenem and ampicillin, respectively. Conclusion: The study findings revealed that dissemination rate of carbapenemase genes was not reported to be high among isolates of K. pneumoniae in Kermanshah. Only blaVIM gene was probably more frequent than other tested genes. Since most isolates examined in this study were susceptible to carbapenem antibiotics, these antibiotics are still regarded as effective drugs against infections caused by K. pneumoniae.

  3. Correlation between carbapenem consumption and resistance to carbapenems among Enterobacteriaceae isolates collected from patients with intra-abdominal infections at five medical centers in Taiwan, 2006-2010. (United States)

    Ho, Cheng-Mao; Ho, Mao-Wang; Liu, Yung-Ching; Toh, Han-Siong; Lee, Yu-Lin; Liu, Yuag-Meng; Huang, Chi-Chang; Lu, Po-Liang; Liu, Chun-Eng; Chen, Yen-Hsu; Ko, Wen-Chien; Tang, Hung-Jen; Yu, Kwok-Woon; Chen, Yao-Shen; Chuang, Yin-Ching; Wang, Jen-Hsien; Hsueh, Po-Ren


    We investigated the trend in resistance to carbapenems among isolates of Enterobacteriaceae that had been collected from patients with intra-abdominal infections at five medical centers in Taiwan from 2006 to 2010 and evaluated the correlation between resistance to carbapenems and consumption of said agents as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART). During the study period, the usage of ertapenem and that of total carbapenems (ertapenem, imipenem, and meropenem) increased significantly from 6.13 to 13.38 defined daily doses per 1000 patient-days for ertapenem and from 20.43 to 34.25 defined daily doses per 1000 patient-days for total carbapenems. The most common species were Escherichia coli (n = 1095), Klebsiella spp. (n = 663), and Enterobacter spp. (n = 202). The susceptibility of all isolates to ertapenem and to imipenem varied during the study period. For ertapenem, the rates of nonsusceptibility ranged from 3.5% to 10.3% and those for imipenem ranged from 3.5% to 10.7%. Although the use of carbapenems increased during the study period, there was no marked increase in resistance to carbapenems. Continuous monitoring of resistance trends is necessary so that antimicrobial prescription policies can be adjusted and infection control intervention programs can be implemented.

  4. Air quality monitoring of the post-operative recovery room and locations surrounding operating theaters in a medical center in Taiwan.

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    Chin-Sheng Tang

    Full Text Available To prevent surgical site infection (SSI, the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH, and carbon dioxide (CO2, suspended particulate matter (PM, and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18% and traumatic surgery room (8%. The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers.

  5. Air quality monitoring of the post-operative recovery room and locations surrounding operating theaters in a medical center in Taiwan. (United States)

    Tang, Chin-Sheng; Wan, Gwo-Hwa


    To prevent surgical site infection (SSI), the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH), and carbon dioxide (CO2), suspended particulate matter (PM), and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18%) and traumatic surgery room (8%). The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers.

  6. Integrating community health workers into a patient-centered medical home to support disease self-management among Vietnamese Americans: lessons learned. (United States)

    Wennerstrom, Ashley; Bui, Tap; Harden-Barrios, Jewel; Price-Haywood, Eboni G


    There is evidence that patient-centered medical homes (PCMHs) and community health workers (CHWs) improve chronic disease management. There are few models for integrating CHWs into PCMHs in order to enhance disease self-management support among diverse populations. In this article, we describe how a community-based nonprofit agency, a PCMH, and academic partners collaborated to develop and implement the Patient Resource and Education Program (PREP). We employed CHWs as PCMH care team members to provide health education and support to Vietnamese American patients with uncontrolled diabetes and/or hypertension. We began by conducting focus groups to assess patient knowledge, desire for support, and availability of community resources. Based on findings, we developed PREP with CHW guidance on cultural tailoring of educational materials and methods. CHWs received training in core competencies related to self-management support principles and conducted the 4-month intervention for PCMH patients. Throughout the program, we conducted process evaluation through structured team meetings and patient satisfaction surveys. We describe successes and challenges associated with PREP delivery including patient recruitment, structuring/documenting visits, and establishing effective care team integration, work flow, and communication. Strategies for mitigating these issues are presented, and we make recommendations for other PCMHs seeking to integrate CHWs into care teams.

  7. Stroke in Asia: a global disaster. (United States)

    Kim, Jong S


    Although stroke is a world-wide problem, the burden of stroke is particularly serious in Asia; its mortality is higher than in Europe or North America. The situation in Asia is dichotomized. Stroke mortality and case fatality has been declining in northern-eastern countries such as Korea, Japan, Taiwan, and urbanized areas of China. This is attributed to both the risk factor control and stroke care improvement. However, declining stroke incidence is rarely observed, which is in part due to rapidly aging population. As a result, there is an increase in the number of stroke survivors who require long-term, costly care. The extremely low birth rate and relatively insecure social health system markedly increases the caregiver burden. The problem in southern Asian countries, such as India, Pakistan, Bangladesh, and Indonesia is more fundamental. With the improving control of infectious diseases, life expectancy is prolonged. However, risk factors such as hypertension, diabetes, obesity and cigarette smoking become prevalent, and are poorly controlled. Stroke neurologists, organized stroke centers, and diagnostic tools are insufficient, which has resulted in high stroke fatality and mortality. Throughout Asia, the most urgent priority should be the primary stroke prevention through promoting a healthy lifestyle, e.g. low salt intake, regular physical exercise, stopping smoking, government sectors should take a stronger initiative to accomplish this. The rapidly aging populations and stroke burden will shrink the economy and destabilize the society, not only in Asia but also globally unless appropriate efforts are promptly initiated, this may result in a global disaster.

  8. Commercial Crew Medical Ops (United States)

    Heinbaugh, Randall; Cole, Richard


    Provide commercial partners with: center insight into NASA spaceflight medical experience center; information relative to both nominal and emergency care of the astronaut crew at landing site center; a basis for developing and sharing expertise in space medical factors associated with returning crew.

  9. Comparison of Optimal Cardiovascular Risk Factor Management in Patients with Type 2 Diabetes Who Attended Urban Medical Health Center with those Attended a Tertiary Care Center: Experiences from Tehran, Iran (United States)

    Moradi, Sedighe; Haji Ghanbari, Mohammad Javad; Ebrahimi, Hedyeh


    Background: Diabetes is a leading cause of cardiovascular disease (CVD). Moreover, CVD accounts for primary cause of death among diabetic patients. Physicians, especially in the primary care setting, have effective role in the management of cardiovascular risk factors. Therefore, we aimed to compare the prevalence of modifiable cardiovascular risk factors in Type 2 diabetic patients attending to an urban health center as a primary care center with Institute of Endocrinology and Metabolism Diabetes Clinic (IEMDC) as a tertiary center. Methods: This cross-sectional study was performed on 200 adult diabetic patients attending urban health center (Abouzar Health Center) and 201 diabetic patients in a tertiary center. The patients’ cardiovascular risk factors including lipid profile, systolic and diastolic blood pressure (BP), and smoking history were recorded. The number of patients who did not achieve the target according to the American Diabetes Association guidelines was determined and compared. Results: The patients in urban health center were older than those who attending IEMDC (P = 0.004). The duration of diabetes was longer among urban center patients (P glycosylated hemoglobin level, high-density lipoprotein level, and systolic BP. Conclusions: Both centers have failure in target achievement in some risk factors; however, the inability of the primary care center in controlling hyperlipidemia in comparison with the tertiary center is a serious warning to provide training about managing dyslipidemia in these centers. PMID:27761215

  10. Huntington Disease in Asia

    Directory of Open Access Journals (Sweden)

    Miao Xu


    Conclusions: The lower epidemiology in Asians can be partly explained by the less cytosine-adenine-guanine repeats, different haplotypes, and CCG polymorphisms. For the physicians, atypical clinical profiles such as the initial symptom of ataxia, movement abnormalities of Parkinsonism, dystonia, or tics need to be paid more attention to and suggest gene testing if necessary. Moreover, some pathogenesis studies may help progress some new advanced treatments. The clinicians in Asian especially in China should promote the usage of genetic testing and put more effects in rehabilitation, palliative care, and offer comfort of patients and their families. The unified HD rating scale also needs to be popularized in Asia to assist in evaluating the progression of HD.

  11. Huntington Disease in Asia

    Institute of Scientific and Technical Information of China (English)

    Miao Xu; Zhi-Ying Wu


    Objective:The objective was to review the major differences of Huntington disease (HD) in Asian population from those in the Caucasian population.Data Sources:Data cited in this review were obtained from PubMed database and China National Knowledge Infrastructure (CNKI) from 1994 to 2014.All the papers were written in English or Chinese languages,with the terms of Asia/Asian,HD,genotype,epidemiology,phenotype,and treatment used for the literature search.Study Selection:From the PubMed database,we included the articles and reviews which contained the HD patients' data from Asian countries.From the CNKI,we excluded the papers which were not original research.Due to the language's restrictions,those data published in other languages were not included.Results:In total,50 papers were cited in this review,authors of which were from the mainland of China,Japan,India,Thailand,Taiwan (China),Korea,and western countries.Conclusions:The lower epidemiology in Asians can be partly explained by the less cytosine-adenine-guanine repeats,different haplotypes,and CCG polymorphisms.For the physicians,atypical clinical profiles such as the initial symptom of ataxia,movement abnormalities of Parkinsonism,dystonia,or tics need to be paid more attention to and suggest gene testing if necessary.Moreover,some pathogenesis studies may help progress some new advanced treatments.The clinicians in Asian especially in China should promote the usage of genetic testing and put more effects in rehabilitation,palliative care,and offer comfort of patients and their families.The unified HD rating scale also needs to be popularized in Asia to assist in evaluating the progression of HD.

  12. International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China

    Directory of Open Access Journals (Sweden)

    Chengquan Zhao


    Full Text Available Background: Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC and KingMed Diagnostics partnered to establish an international telepathology consultation service. Materials and Methods: This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014. Results: A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4% submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%, followed by bone/soft tissue (21.0% and gynecologic/breast (20.2% subspecialties. Average turnaround time (TAT per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7% where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered in 50.8% of cases. Conclusion: These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and

  13. International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China (United States)

    Zhao, Chengquan; Wu, Tao; Ding, Xiangdong; Parwani, Anil V.; Chen, Hualin; McHugh, Jeffrey; Piccoli, Anthony; Xie, Qinling; Lauro, Gonzalo Romero; Feng, Xiaodong; Hartman, Douglas J.; Seethala, Raja R.; Wu, Shangwei; Yousem, Samuel; Liang, Yaoming; Pantanowitz, Liron


    Background: Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC) and KingMed Diagnostics partnered to establish an international telepathology consultation service. Materials and Methods: This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014. Results: A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4%) submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%), followed by bone/soft tissue (21.0%) and gynecologic/breast (20.2%) subspecialties. Average turnaround time (TAT) per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7%) where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered) in 50.8% of cases. Conclusion: These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and dedicated

  14. Analysis of parasitic diseases diagnosed by tissue biopsy specimens at KyungHee Medical Center (1984-2005) in Seoul, Korea. (United States)

    Choi, Won-Hyung; Chu, Jong-Phil; Jiang, Meihua; Lee, Yun-Sik; Kim, Bum-Shik; Kim, Deog-Gon; Park, Yong-Koo


    We analyzed parasitic diseases diagnosed by tissue biopsy specimens at KyungHee Medical Center (KMC) from 1984 to 2005. The total number of parasite infection cases was 150 (0.07%) out of the total 211,859 biopsy specimens submitted for histopathological examinations. They consisted of 62 cysticercosis, 23 sparganosis, 16 paragonimiasis, 15 amebiasis, 11 anisakiasis, 11 clonorchiasis, 3 ascariasis, 2 scabies, 2 enterobiasis, 2 trichuriasis, 1 leishmaniasis, 1 taeniasis, and 1 thelaziasis. Out of 62 cysticercosis cases, 55 were detected in subcutaneous tissues or the central nerve system. Eighteen out of 23 sparganosis cases were involved in muscular and subcutaneous tissues. In most anisakiasis cases, the involved organ was the stomach. The lung and the pleura were the most common site of paragonimiasis. The incidence of parasitic diseases during the first 5 years (1984-1988) was the highest of all observed periods. After 1989, similar incidences were shown throughout the period. Whereas cysticercosis was diagnosed in 34 cases during 1984-1988, no case has been diagnosed since 2000. In the case of sparganosis, the chronological incidence was almost uniform throughout the period 1984-2005. Paragonimiasis showed a similar tendency to cysticercosis. In gender and age distribution of parasitic diseases, men showed higher incidence rates than females, and the age groups of the 40s or older indicated higher infection frequencies than other age groups. Therefore, these results are a significant report to appear the tendency of human parasitic disease diagnosed by tissue biopsy in association with parasitosis at KMC in Seoul.

  15. Replacement of HA-MRSA by CA-MRSA infections at an academic medical center in the midwestern United States, 2004-5 to 2008.

    Directory of Open Access Journals (Sweden)

    Michael Z David

    Full Text Available We noted anecdotally that infections designated as health care-associated (HA- MRSA by epidemiologic criteria seemed to be decreasing in incidence at the University of Chicago Medical Center (UCMC after 2004. We compared MRSA patients seen at any site of clinical care at UCMC and the isolates that caused their infections in 2004-5 (n = 545 with those in 2008 (n = 135. The percent of patients with MRSA infections cultured > 2 days after hospital admission decreased from 19.5% in 2004-5 to 7.4% in 2008 (p = 0.001. The percent in 2004-5 compared with 2008 who had a hospitalization (49.1% to 26.7%, p = 0.001 or surgery (43.0% to 14.1%, p<0.001 in the previous year decreased. In 2008 a greater percent of patients was seen in the emergency department (23.1% vs. 39.3% and a smaller percent both in intensive care units (15.6% vs. 6.7% and in other inpatient units (40.7% vs. 32.6% (p<0.001. The percent of patients with CA-MRSA infections by the CDC epidemiologic criteria increased from 36.5% in 2004-5 to 62.2% in 2008 (p<0.001. The percent of MRSA isolates sharing genetic characteristics of USA100 decreased from 27.9% (152/545 to 12.6% (17/135, while the percent with CA-MRSA (USA300 characteristics increased from 53.2% (290/545 to 66.7% (90/135. The percent of infections that were invasive did not change significantly. Our data suggest that HA-MRSA infections, both by epidemiologic and microbiologic criteria, relative to CA-MRSA, decreased between 2004-5 and 2008 at UCMC.

  16. What Ethical Issues Really Arise in Practice at an Academic Medical Center? A Quantitative and Qualitative Analysis of Clinical Ethics Consultations from 2008 to 2013. (United States)

    Wasson, Katherine; Anderson, Emily; Hagstrom, Erika; McCarthy, Michael; Parsi, Kayhan; Kuczewski, Mark


    As the field of clinical ethics consultation sets standards and moves forward with the Quality Attestation process, questions should be raised about what ethical issues really do arise in practice. There is limited data on the type and number of ethics consultations conducted across different settings. At Loyola University Medical Center, we conducted a retrospective review of our ethics consultations from 2008 through 2013. One hundred fifty-six cases met the eligibility criteria. We analyzed demographic data on these patients and conducted a content analysis of the ethics consultation write-ups coding both the frequency of ethical issues and most significant, or key, ethical issue per case. Patients for whom ethics consultation was requested were typically male (55.8 %), white (57.1 %), between 50 and 69 years old (38.5 %), of non-Hispanic origin (85.9 %), and of Roman Catholic faith (43.6 %). Nearly half (47.4 %) were in the intensive care unit and 44.2 % died in the hospital. The most frequent broad ethical categories were decision-making (93.6 %), goals of care/treatment (80.8 %), and end-of-life (73.1 %). More specifically, capacity (57.1 %), patient's wishes/autonomy (54.5 %), and surrogate decision maker (51.3 %) were the most frequent particular ethical issues. The most common key ethical issues were withdrawing/withholding treatment (12.8 %), patient wishes/autonomy (12.2 %), and capacity (11.5 %). Our findings provide additional data to inform the training of clinical ethics consultants regarding the ethical issues that arise in practice. A wider research agenda should be formed to collect and compare data across institutions to improve education and training in our field.

  17. Identification of Class-1 Integron and Various Β-Lactamase Classes among Clinical Isolates of Pseudomonas aeruginosa at Children's Medical Center Hospital

    Directory of Open Access Journals (Sweden)

    Hossein Fazeli


    Full Text Available Background: Pseudomonas aeruginosa is one of the most important oppor- tunistic pathogens responsible for various types of infections. Children suffer significant morbidity and mortality due to nosocomial infections. The aim of this study was to investigate the presence of Class-1 integron, blaBEL, blaPER, blaKPC, blaVIM, blaIMP and blaOXA-group-1  genes among P. aeruginosa isolates at Children's Medical Center Hospital in Iran and to determine phenotypic evi- dence of ESBL and MBL production.Methods: Antibiotic susceptibility tests were analyzed for 72 P. aeruginosa clinical isolates. Isolates were identified by using biochemical tests and con- firmed by PCR assay for oprL gene. ESBL and MBL producer isolates were identified  by phenotypic  tests (double disc synergy tests. Detection of β- lactamase genes and class-1 integron were performed by PCR method. Results: All of the isolates were susceptible to ceftazidime / clavulanate, me- ropenem, imipenem and ciprofloxacin. About 83.3% and 16.7% of isolates were  resistant  to  ceftazidime  and  amikacin  respectively.  Approximately,83.3% of isolates were considered as potential ESBL producers. None of the clinical isolates showed above β-lactamase genes. It seems that, the reason is the absence of class-1 integron in all of isolates. About 16.7% of strains were identified  as multidrug  resistant.  Fortunately,  all of the isolates were sus- ceptible to meropenem and imipenem which are effective against ESBL pro- ducing strains.Conclusion:  The absences of class-1 integron decreases the probability of acquired β-lactamase especially MBL. Thus, absolute susceptibility to carba- penems and ciprofloxacin among P. aeruginosa isolates in pediatric hospital has important implications for empirical antimicrobial therapy. It seems that these properties help to decrease mortality of nosocomial infections within children.

  18. Ciguatera Fish Poisoning in East Asia and Southeast Asia


    Thomas Y. K. Chan


    In the coastal countries of East Asia and Southeast Asia, ciguatera should be common because of the extensive tropical and subtropical coral reefs along the coasts and in the neighboring seas with ciguatoxic fishes. An extensive search of journal databases, the Internet and the government websites was performed to identify all reports of ciguatera from the regions. Based on the official data and large published case series, the incidence of ciguatera was higher in the coastal cities (Hong Kon...

  19. New epidemiology of Staphylococcus aureus infection in Asia. (United States)

    Chen, C-J; Huang, Y-C


    Not only is Asia the most populous region in the world, but inappropriate therapy, including self-medication with over-the-counter antimicrobial agents, is a common response to infectious diseases. The high antibiotic selective pressure among the overcrowded inhabitants creates an environment that is suitable for the rapid development and efficient spread of numerous multidrug-resistant pathogens. Indeed, Asia is among the regions with the highest prevalence rates of healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) and community-associated methicillin-resistant S. aureus (CA-MRSA) in the world. Most hospitals in Asia are endemic for multidrug-resistant methicillin-resistant S. aureus (MRSA), with an estimated proportion from 28% (in Hong Kong and Indonesia) to >70% (in Korea) among all clinical S. aureus isolates in the early 2010s. Isolates with reduced susceptibility or a high level of resistance to glycopeptides have also been increasingly identified in the past few years. In contrast, the proportion of MRSA among community-associated S. aureus infections in Asian countries varies markedly, from 35%. Two pandemic HA-MRSA clones, namely multilocus sequence type (ST) 239 and ST5, are disseminated internationally in Asia, whereas the molecular epidemiology of CA-MRSA in Asia is characterized by clonal heterogeneity, similar to that in Europe. In this review, the epidemiology of S. aureus in both healthcare facilities and communities in Asia is addressed, with an emphasis on the prevalence, clonal structure and antibiotic resistant profiles of the MRSA strains. The novel MRSA strains from livestock animals have been considered to constitute a public health threat in western countries. The emerging livestock-associated MRSA strains in Asia are also included in this review.

  20. Polymyositis: Medical Management (United States)

    ... email share facebook twitter google plus linkedin Medical Management Polymyositis (PM) is a highly treatable disease. Some ... PM) Signs and Symptoms Diagnosis Causes/Inheritance Medical Management Research Find your MDA Care Center Current Clinical ...

  1. Regional Disease Vector Ecology Profile East Asia (United States)


    outbreaks were recorded in Peru, and an isolated case occurred in Algeria . Body lice are common human parasites in mountainous temperate areas of East...up to 160 m, although they generally inhabit much shallower water. Sea snakes feed on fish, crustaceans , or other marine life. Hydrophiids are so...Laveran, Algiers, Algeria 18 Industrial and Pharmaceutical Corporation, Rangoon, Burma 19 Rogoff Medical Research Institute, Beillinson Medical Center

  2. Cyptotrama (Physalacriaceae, Agaricales) from Asia. (United States)

    Qin, Jiao; Yang, Zhu-Liang


    Cyptotrama was divided into several sections, of which sect. Xerulina was often treated as a separate genus by some mycologists. In this study, collections of Cyptotrama from East Asia, Southeast Asia, and South Asia were studied. For comparison, materials from North America and New Zealand were analysed. Our multi-gene phylogenetic analyses indicated that Cyptotrama is monophyletic and Xerulina should be treated as a section within the genus Cyptotrama. Different scenarios of morphological character evolution in Cyptotrama are discovered. A total of seven species of Cyptotrama can be recognized from Asia, three of which, Cyptotrama angustispora, C. glabra, and C. shennongjia, are new to science. Meanwhile, three taxa previously placed in Xerulina or Marasmius were proved to be members of Cyptotrama, and the new combinations, namely Cyptotrama trogioides, C. megaspora, and C. myochroa, are accordingly proposed. A key for the diagnosis of worldwide Cyptotrama species is provided.

  3. Current Research in Southeast Asia. (United States)

    Beh, Yolanda


    Briefly describes 22 reports on language-related research relevant to Southeast Asia, detailing study aims, methodology, researchers, and sponsors for studies conducted in Brunei Darussalam, Indonesia, Malaysia, Philippines, Singapore, and Thailand. (CB)

  4. ITMA Asia + CITME 2008 Unveil

    Institute of Scientific and Technical Information of China (English)


    The first edition of ITMA Asia + CITME, combining two previously independently produced Asian textile machinery exhibitions, will open its doors to the global textile industry July 27~31 at the Shanghai New International Expo Centre(SNIEC),

  5. Economic Development in Southeast Asia

    Directory of Open Access Journals (Sweden)

    David Dapice


    Full Text Available Most of the original ASEAN nations in Southeast Asia came out of the Asian Crisis facing slower growth (4%–6% a year and modest structural change compared to previous decades. [...

  6. Catfish culture in Southeast Asia


    Adan, R. I. Y.


    Catfish rank fifth in the world in terms of fresh and brackishwater fish culture. In Asia and the Pacific, the Clariidae family dominates production, representing nearly 80% of the total catfish production. Among the most cultured species are Clarias batrachus, C. macrocephalus, C. gariepinus. The domestic market generally absorbs catfish produce in Asia, although high-producing countries like Thailand and Vietnam engage in export. There are two basic markets for catfish: live fish and proces...

  7. Enhancing mHealth Technology in the Patient-Centered Medical Home Environment to Activate Patients With Type 2 Diabetes: A Multisite Feasibility Study Protocol (United States)

    Shi, Lu; Williams, Joel E; Dye, Cheryl J; Chen, Liwei; Crawford, Paul; Shry, Eric A; Griffin, Sarah F; Jones, Karyn O; Sherrill, Windsor W; Truong, Khoa; Little, Jeanette R; Edwards, Karen W; Hing, Marie; Moss, Jennie B


    Background The potential of mHealth technologies in the care of patients with diabetes and other chronic conditions has captured the attention of clinicians and researchers. Efforts to date have incorporated a variety of tools and techniques, including Web-based portals, short message service (SMS) text messaging, remote collection of biometric data, electronic coaching, electronic-based health education, secure email communication between visits, and electronic collection of lifestyle and quality-of-life surveys. Each of these tools, used alone or in combination, have demonstrated varying degrees of effectiveness. Some of the more promising results have been demonstrated using regular collection of biometric devices, SMS text messaging, secure email communication with clinical teams, and regular reporting of quality-of-life variables. In this study, we seek to incorporate several of the most promising mHealth capabilities in a patient-centered medical home (PCMH) workflow. Objective We aim to address underlying technology needs and gaps related to the use of mHealth technology and the activation of patients living with type 2 diabetes. Stated differently, we enable supporting technologies while seeking to influence patient activation and self-care activities. Methods This is a multisite phased study, conducted within the US Military Health System, that includes a user-centered design phase and a PCMH-based feasibility trial. In phase 1, we will assess both patient and provider preferences regarding the enhancement of the enabling technology capabilities for type 2 diabetes chronic care management. Phase 2 research will be a single-blinded 12-month feasibility study that incorporates randomization principles. Phase 2 research will seek to improve patient activation and self-care activities through the use of the Mobile Health Care Environment with tailored behavioral messaging. The primary outcome measure is the Patient Activation Measure scores. Secondary outcome

  8. Effective detection of the 2009 H1N1 influenza pandemic in U.S. Veterans Affairs medical centers using a national electronic biosurveillance system.

    Directory of Open Access Journals (Sweden)

    Patricia Schirmer

    Full Text Available BACKGROUND: The 2008-09 influenza season was the time in which the Department of Veterans Affairs (VA utilized an electronic biosurveillance system for tracking and monitoring of influenza trends. The system, known as ESSENCE or Electronic Surveillance System for the Early Notification of Community-based Epidemics, was monitored for the influenza season as well as for a rise in influenza cases at the start of the H1N1 2009 influenza pandemic. We also describe trends noted in influenza-like illness (ILI outpatient encounter data in VA medical centers during the 2008-09 influenza season, before and after the recognition of pandemic H1N1 2009 influenza virus. METHODOLOGY/PRINCIPAL FINDINGS: We determined prevalence of ILI coded visits using VA's ESSENCE for 2008-09 seasonal influenza (Sept. 28, 2008-April 25, 2009 corresponding to CDC 2008-2009 flu season weeks 40-16 and the early period of pandemic H1N1 2009 (April 26, 2009-July 31, 2009 corresponding to CDC 2008-2009 flu season weeks 17-30. Differences in diagnostic ICD-9-CM code frequencies were analyzed using Chi-square and odds ratios. There were 649,574 ILI encounters captured representing 633,893 patients. The prevalence of VA ILI visits mirrored the CDC's Outpatient ILI Surveillance Network (ILINet data with peaks in late December, early February, and late April/early May, mirroring the ILINet data; however, the peaks seen in the VA were smaller. Of 31 ILI codes, 6 decreased and 11 increased significantly during the early period of pandemic H1N1 2009. The ILI codes that significantly increased were more likely to be symptom codes. Although influenza with respiratory manifestation (487.1 was the most common code used among 150 confirmed pandemic H1N1 2009 cases, overall it significantly decreased since the start of the pandemic. CONCLUSIONS/SIGNIFICANCE: VA ESSENCE effectively detected and tracked changing ILI trends during pandemic H1N1 2009 and represents an important temporal alerting

  9. Prehospital road traffic injuries among the elderly in Beijing, China:data from the Beijing Emergency Medical Center, 2004-2010

    Institute of Scientific and Technical Information of China (English)

    AN Shuai; ZHANG Jin-jun; ZHANG Pei-xun; YIN Xiao-feng; KOU Yu-hui; WANG Yan-hua; WANG Zhen-wei


    Background Road traffic injuries (RTIs) are a worldwide issue associated with increasing development and motorization.However,statistical studies do not include any analyses of Beijing's geriatric population.Using data from the Beijing Emergency Medical Center,we present the main characteristics of traffic injuries involving the elderly in Beijing.We also provide objective information for those concerned with the safety of traffic systems and the prevention of traffic injuries.Methods In a longitudinal,retrospective study,data were collected on 1706 victims aged 65 years and older who sustained traffic injuries in Beijing between 2004 and 2010.Personal information,time of injury event,emergency care response time,road user type,striking vehicle type,injury site,and severity of injury were analyzed using x2 tests and Logistic regression analysis.Results The annual rate of traffic injuries was 21.80 per 100 000 elderly people in Beijing,and the morbidity rate decreased from 2004 to 2010 (P <0.001).The mean age was (72.92±5.67) years,and 911 (53.40%) of the victims were male.The majority of victims sustained head and lower limb injuries and were classified as being of medium severity.Traffic collisions occurred most frequently in the daytime excluding rush hours; these collisions included being hit by a car (85.64%) and pedestrian victim injuries (79.19%).Our statistical analysis found three factors for injury severity:abdominal injuries (P <0.001),number of injury sites (P=0.027),and head injuries (P=0.034).The decline in traffic injuries is due to a decrease in victims aged 65-74 years and pedestrians; the severity of RTIs also decreased.Conclusions This study highlights the declining trend in traffic injuries among older adults in Beijing.However,traffic injuries remain a serious public health problem for the elderly and effective measures are required to reduce their incidence.

  10. Epidemiology and risk factors for isolation of Escherichia coli producing CTX-M-type extended-spectrum β-lactamase in a large U.S. Medical Center. (United States)

    Hayakawa, Kayoko; Gattu, Sureka; Marchaim, Dror; Bhargava, Ashish; Palla, Mohan; Alshabani, Khaled; Gudur, Uma Mahesh; Pulluru, Harish; Bathina, Pradeep; Sundaragiri, Pranathi Rao; Sarkar, Moumita; Kakarlapudi, Hari; Ramasamy, Balaji; Nanjireddy, Priyanka; Mohin, Shah; Dasagi, Meenakshi; Datla, Satya; Kuchipudi, Vamsi; Reddy, Swetha; Shahani, Shobha; Upputuri, Vijaya; Marrey, Satya; Gannamani, Vedavyas; Madhanagopal, Nandhini; Annangi, Srinadh; Sudha, Busani; Muppavarapu, Kalyan Srinivas; Moshos, Judy A; Lephart, Paul R; Pogue, Jason M; Bush, Karen; Kaye, Keith S


    A case-case-control study was conducted to identify independent risk factors for recovery of Escherichia coli strains producing CTX-M-type extended-spectrum β-lactamases (CTX-M E. coli) within a large Southeastern Michigan medical center. Unique cases with isolation of ESBL-producing E. coli from February 2010 through July 2011 were analyzed by PCR for blaCTX-M, blaTEM, and blaSHV genes. Patients with CTX-M E. coli were compared to patients with E. coli strains not producing CTX-M-type ESBLs (non-CTX-M E. coli) and uninfected controls. Of 575 patients with ESBL-producing E. coli, 491 (85.4%) isolates contained a CTX-M ESBL gene. A total of 319 (84.6%) patients with CTX-M E. coli (282 [74.8%] CTX-M-15 type) were compared to 58 (15.4%) non-CTX-M E. coli patients and to uninfected controls. Independent risk factors for CTX-M E. coli isolation compared to non-CTX-M E. coli included male gender, impaired consciousness, H2 blocker use, immunosuppression, and exposure to penicillins and/or trimethoprim-sulfamethoxazole. Compared to uninfected controls, independent risk factors for isolation of CTX-M E. coli included presence of a urinary catheter, previous urinary tract infection, exposure to oxyimino-cephalosporins, dependent functional status, non-home residence, and multiple comorbid conditions. Within 48 h of admission, community-acquired CTX-M E. coli (n = 51 [16%]) and non-CTX-M E coli (n = 11 [19%]) strains were isolated from patients with no recent health care contacts. CTX-M E. coli strains were more resistant to multiple antibiotics than non-CTX-M E. coli strains. CTX-M-encoding genes, especially bla(CTX-M-15) type, represented the most common ESBL determinants from ESBL-producing E. coli, the majority of which were present upon admission. Septic patients with risk factors for isolation of CTX-M E. coli should be empirically treated with appropriate agents. Regional infection control efforts and judicious antibiotic use are needed to control the spread of these

  11. 2nd Asia-Pacific Conference on Complex Systems Design & Management

    CERN Document Server

    Fong, Saik; Krob, Daniel; Lui, Pao; Tan, Yang


    This book contains all refereed papers that were accepted to the second edition of the Asia-Pacific conference on « Complex Systems Design & Management Asia» (CSD&M Asia 2016) that took place in Singapore from February 24 to February 26, 2016 (Website: These proceedings cover the most recent trends in the emerging field of Complex Systems, both from an academic and a professional perspective. A special focus is put on Smart Nations: Designing and Sustaining. The CSD&M Asia 2016 conference is organized under the guidance of the Singapore division of the Center of Excellence on Systems Architecture, Management, Economy and Strategy (CESAMES) – Legal address: C.E.S.A.M.E.S. Singapore – 16 Raffles Quay – #38-03 Hong Leong Building – Singapore 048581 (website : – email:

  12. Southeast Asia Report (United States)


    the holding centers m Thailand. With the declining rate of acceptance of displaced persons mLsurf fordism ’ d U beC°meS ±neVltable that Thaila"d *as...dismissing from the ranks of the district, bureau, section, and specialized cadres those who are conservative , backward, lack dynamism, do not have

  13. USU Patient Simulation Center (United States)

    Federal Laboratory Consortium — he National Capital Area (NCA) Medical Simulation Center is a state-of-the-art training facility located near the main USU campus. It uses simulated patients (i.e.,...

  14. Study on the Hybrid Redundant Regional Electronic Medical Record Data Center Model%混合冗余式区域电子病历数据中心模型研究

    Institute of Scientific and Technical Information of China (English)

    朱远燕; 高春蓉


    The regional electronic medical record data center is the data resource and information base which can realize the medical business synergy function in the region. It will promote openness and sharing of medical information, and alleviate the imbalance of health resources, high medical costs and other problems. This paper mainly introduces the architecture of hybrid redundant data center model and its application implementation in the specific project.%区域电子病历数据中心是实现区域内医疗业务协同功能的数据资源和信息基础,将推动医疗信息的开放与共享,缓解医疗资源的不平衡、医疗成本高等问题。主要阐述混合冗余式数据中心模型架构及其在具体项目中的应用实现。

  15. Commercial Power of Asia

    Directory of Open Access Journals (Sweden)

    Iulia Monica Oehler-Sincai


    Full Text Available The present paper, based on a detailed analysis of the main statistical foreign trade indicators of the emerging economies of the Eastern and South-Eastern Asia, outlines a series of characteristics of the foreign trade flows of the analysed economies from the ’50 up to the present. The accent is set on the period 1995-2006, which emphasizes two moments of crisis of the Asian trade: 1997-1998 and 2001. At the level of the analysed economies, it can be remarked a tendency of continuous growth of the share of the intra-regional trade flows in the total trade flows, mainly due to their participation in regional trade agreements, to the strenghtening of the regional production networks, to the role of China as engine of economic growth in the whole region and even at global level. On product category, the manufactures have the greatest share in the merchandise exports of the Asian emerging economies (especially office and telecom equipment, integrated circuits, automotive products, textiles and clothing, etc.. While China surpassed the share of the Asian tigers of the first generation in the world trade in 2001 and that of Japan in 2004, the scenario presented in this paper indicates the surpass in 2007 of the share of Germany (second place in the world trade in 2005, the surpass of the share of the Asian tigers of the first generation in 2009, and the surpass of the share of the group of the 8 Asian tigers and that of the USA as well in 2012. In the following decades, China might become the strongest world economy at the global level, but only if the sustainable development and the eradication of the social inequities will become de facto priorities of the Chinese officials. The actual negative externalities (costs of the Chinese economic growth, transferred on the environment and the society, will be object to another analyse.

  16. Disconnected in a connected world: knowledge and understanding of Web 2.0 tools at the University of Pennsylvania Medical Center. (United States)

    Karpinski, Joanna Lynn


    This article outlines five Web 2.0 resources and looks at the use of these tools among medical and nursing professionals and students at the Hospital, Medical School, and Nursing School of the University of Pennsylvania. Questionnaires showed that a majority of the individuals surveyed were unfamiliar with Web 2.0 resources. Additional respondents recognized the tools but did not use them in a medical or nursing context, with a minimal number using any tools to expand their medical or nursing knowledge. A lack of time to set up and use the resources, difficulty of set-up and use, skepticism about the quality of user-generated medical content, and a lack of perceived need for Web 2.0 resources contributed substantially to non-use. The University of Pennsylvania Biomedical Library is responding by increasing the availability of basic, quick, and easy-to-use instructional materials for selected Web 2.0 resources.

  17. Tobacco use, exposure to second-hand smoke, and cessation training among the third-year medical and dental students in selected Member States of South-East Asia region: A trend analysis on data from the Global Health Professions Student Survey, 2005-2011

    Directory of Open Access Journals (Sweden)

    D N Sinha


    2006 and 2009 and 2011, while proportions of dental students reported that schools with a smoking ban policy have increased significantly in Bangladesh and Myanmar. Ever receiving cessation training increased significantly among medical students in Sri Lanka only, whereas, among dental students, it increased in India, Nepal, and Thailand. Conclusion: Trends of tobacco use and exposure to SHS among medical and dental students in most countries of the South-East Asia Region had changed only relatively between the two rounds of GHPSS (2005-2006 and 2009-2011. No significant improvement was observed in the trend in schools with a policy banning smoking in school buildings and clinics. Almost all countries in the SEA Region that participated in GHPSS showed no significant change in ever having received formal training on tobacco cessation among medical and dental students.

  18. Southeast Asia Report (United States)


    independents faction of Senator John Button and the premier; Mr Cain; in right-wing dominated NSW [New South Wales] it has made no inroads; in Tasmania it has...industrial crops and export crops such as peanuts, soybeans, tobacco, sesame, ginger , peppers, garlic, etc. Of special interest, the export shrimp movement...Right after the revolution, the public health service focused efforts on the urgent task of training medical personnel and Red Cross members in short

  19. Southeast Asia Report (United States)


    midwives and other health personnel are being trained according to speci- fic programmes and in- creasing numbers are being appointed. Hospitals...10,072 doctors, 2409 to 13,594 nurses, midwives and lady health visitors, from none to 369 State service, indigenous medical prac- titioners. Health...aircraft production, for light and medium class, is able to compete abroad in view of relatively cheap manpower and production costs. - e

  20. Southeast Asia Report (United States)


    more than two-thirds were no longer alive. At the same time, a medical secondary school and a midwifery school were set up and more and more new...of villages in the nation, have public health and midwifery stations. Although they are built of bamboo, they are large and spacious and have two to...Iraq, Laos, Madagascar, Mozambique, Nicaragua, Japan, Syria, the Federal Republic of Germany, Sweden , and Tanzania, and the permanent delegation of