WorldWideScience

Sample records for care demand case

  1. Managed care demands flexibility, creativity.

    Science.gov (United States)

    1996-05-01

    The definition of hospice care is changing as home care providers come under managed care regulations. Hospice care for AIDS patients is demanding, requiring extra time from home care providers. The managed care cost-cutting measures require creativitity and patience. The Visiting Nurses and Hospice of San Francisco (VNH) has held seminars to help providers adapt to managed care.

  2. Disaggregation of the demand for hospital care

    NARCIS (Netherlands)

    E.K.A. van Doorslaer (Eddy); R.C.J.A. van Vliet (René)

    1988-01-01

    textabstractIn this article we want to confront some of the results of the theoretical literature on aggregation with the empirical consequences of aggregation in the context of the analysis of demand for hospital care. There has been an evolution in the estimation of hospital demand functions from

  3. Intermittent Demand Forecasting in a Tertiary Pediatric Intensive Care Unit.

    Science.gov (United States)

    Cheng, Chen-Yang; Chiang, Kuo-Liang; Chen, Meng-Yin

    2016-10-01

    Forecasts of the demand for medical supplies both directly and indirectly affect the operating costs and the quality of the care provided by health care institutions. Specifically, overestimating demand induces an inventory surplus, whereas underestimating demand possibly compromises patient safety. Uncertainty in forecasting the consumption of medical supplies generates intermittent demand events. The intermittent demand patterns for medical supplies are generally classified as lumpy, erratic, smooth, and slow-moving demand. This study was conducted with the purpose of advancing a tertiary pediatric intensive care unit's efforts to achieve a high level of accuracy in its forecasting of the demand for medical supplies. On this point, several demand forecasting methods were compared in terms of the forecast accuracy of each. The results confirm that applying Croston's method combined with a single exponential smoothing method yields the most accurate results for forecasting lumpy, erratic, and slow-moving demand, whereas the Simple Moving Average (SMA) method is the most suitable for forecasting smooth demand. In addition, when the classification of demand consumption patterns were combined with the demand forecasting models, the forecasting errors were minimized, indicating that this classification framework can play a role in improving patient safety and reducing inventory management costs in health care institutions.

  4. Demand of elderly people for residential care: an exploratory study

    NARCIS (Netherlands)

    van Bilsen, P.; Hamers, J.; Groot, W.; Spreeuwenberg, C.

    2006-01-01

    Background: Because of the rapid aging population, the demand for residential care exceeds availability. This paper presents the results of a study that focuses on the demand of elderly people for residential care and determinants (elderly people's personal characteristics, needs and resources) that

  5. Improving long-term care provision: towards demand-based care by means of modularity

    Directory of Open Access Journals (Sweden)

    Meijboom Bert

    2010-09-01

    Full Text Available Abstract Background As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of demand for long-term care complicates the movement towards demand-based care provision. This paper aims to advance long-term care practice and, to that end, examines the application of modularity. This concept is recognized in a wide range of product and service settings for its ability to design demand-based products and processes. Methods Starting from the basic dimensions of modularity, we use qualitative research to explore the use and application of modularity principles in the current working practices and processes of four organizations in the field of long-term care for the elderly. In-depth semi-structured interviews were conducted with 38 key informants and triangulated with document research and observation. Data was analyzed thematically by means of coding and subsequent exploration of patterns. Data analysis was facilitated by qualitative analysis software. Results Our data suggest that a modular setup of supply is employed in the arrangement of care and service supply and assists providers of long-term care in providing their clients with choice options and variation. In addition, modularization of the needs assessment and package specification process allows the case organizations to manage client involvement but still provide customized packages of care and services. Conclusion The adequate setup of an organization's supply and its specification phase activities are indispensible for long-term care providers who aim to do better in terms of quality and efficiency. Moreover, long-term care providers could benefit from joint provision of care and services by means of modular working teams. Based upon our findings, we are able to

  6. Demand of elderly people for residential care: an exploratory study

    Directory of Open Access Journals (Sweden)

    Groot W

    2006-03-01

    Full Text Available Abstract Background Because of the rapid aging population, the demand for residential care exceeds availability. This paper presents the results of a study that focuses on the demand of elderly people for residential care and determinants (elderly people's personal characteristics, needs and resources that are associated with this demand. Furthermore, the accuracy of the waiting list as a reflection of this demand has been examined. Methods 67 elderly people waiting for admission into a home for the elderly, are subjected to semi-structured interviews. The data are analyzed by using multivariate statistics. Results Elderly people who indicate that they would refuse an offer of admission into a home for the elderly feel healthier (p = 0.02, have greater self-care agency (p = 0.02 and perceive less necessity of admission (p Conclusion The results contribute to the understanding of waiting lists and the demand for residential care. It became apparent that not everybody who asks for admission into a home for the elderly, really needed it. The importance of elderly people's resources like social networks and the ability to manage everyday activities in relation to the demand for care became clear. These findings are important because they indicate that resources also play a role in predicting elderly people's demand and as a result can guide the development and the (redesign of adequate health care services.

  7. Overweight and Obesity and the Demand for Primary Physician Care

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Greve, Jane

    The standard economic model for the demand for health care predicts that unhealthy behaviour such as being overweight or obese should increase the demand for medical care, particularly as clinical studies link obesity to a number of serious diseases. In this paper, we investigate whether overweight......-60 years drawn from the National Health Interview (NHI) survey 2000 and merged to Danish register data, we compare differences in the impact of being overweight and obese relative to being normal weight on the demand for primary physician care. Estimated bodyweight effects vary across latent classes...... and show that being obese or overweight does not increase the demand for primary physician care among infrequent users but does so among frequent users....

  8. The Many Faces of Supplier Induced Demand in Health Care

    Directory of Open Access Journals (Sweden)

    J Ahmed

    2009-06-01

    Full Text Available "nHealth economists look towards health care sector as a market whereby there is a distinct demand and supply phenomenon exists. Dearth of regulation of the doctors' practices lead to inappropriate and unjustifiable demand for health care among the patients. In developing and under-developed countries, this adverse practice may push a poor family into a vicious circle of poverty and illness, especially where out of pocket expenditure on health is too high. Unnecessary prescriptions, pro­longed treatments and unjustified user fee grossly deprive the patient's family financially. In developed countries, the flourishing health care technology and sophisticated laboratory diagnostics could incur significant expenditure which is sometimes even not covered under the insurance. State is the custodian of health care in any country; therefore, vigilant regulation of the health care providers may curb the supplier induced demand through strict laws and policies.

  9. Oral literacy demand of health care communication: challenges and solutions.

    Science.gov (United States)

    Roter, Debra L

    2011-01-01

    Literacy deficits are widespread; one-quarter of the U.S. population has below basic literacy skills and the health consequences of literacy deficits are well-known and significant. While the need to simplify written health education print material is widely recognized, there has been little attempt to describe or reduce the literacy demand of health care dialogue. Patients with limited literacy complain they are not given information about their problems in ways they can understand, leaving them uninformed, frustrated, and distrustful. The purpose of this article is to review a conceptual approach to describing oral literacy demand in health care dialogue, to review several key studies that support the predictive validity of the conceptual framework in regard to patient satisfaction and recall of information, and to propose several practical ways to diminish literacy demand and facilitate more effective health care exchanges with patients.

  10. Impact of Universal Health Care Coverage on patient demand for health care services in Thailand.

    Science.gov (United States)

    Panpiemras, Jirawat; Puttitanun, Thitima; Samphantharak, Krislert; Thampanishvong, Kannika

    2011-12-01

    Fully implemented in Thailand in 2002, the Universal Health Care Coverage (UC) Program aimed to provide cheap access to health care services, for 30 baht (less than 1 U.S. dollar) per visit, to all uninsured Thais. In this paper, we studied the impact of the UC in Thailand on the demand for health care services using hospital level data. We found that the UC program was successful in increasing outpatient demand for health care, particularly the demand from the elderly and the poor. However, outpatient demand for health care dramatically increased during the first year of the program and faded away quickly in subsequent years. In contrast to outpatient demand, the number of inpatient visits and the number of days for which the inpatients were admitted at hospitals declined after the UC program was launched. In this paper, we offer our explanation of these phenomena, highlight problems associated with the UC program, and provide policy recommendations to improve the program.

  11. Demand for orthodontic treatment among 9-18 year-olds seeking dental care in Dar-es-Salaam, Tanzania.

    NARCIS (Netherlands)

    Mugonzibwa, E.A.; Kuijpers-Jagtman, A.M.; Hof, M.A. van 't; Kikwilu, E.

    2004-01-01

    OBJECTIVE: To investigate the demand for orthodontic treatment among 9-18 olds seeking dental care in Dar-es-Salaam, Tanzania. DESIGN: Case-control, interview and clinical study. SETTINGS: Children seeking dental care. MAIN OUTCOME MEASURES: Demand for orthodontic treatment. RESULTS: Most of the chi

  12. Supply and demand for long-term care services from the perspective of leaders of health care institutions1

    Science.gov (United States)

    Samoliński, Bolesław

    2015-01-01

    Introduction Poland's transition into the stage of intensive population aging imposes changes in demand for different forms of care (including long-term). The proportion of dependent persons (requiring care) in the population continues to increase. The number of people aged 80 and above (in 2013 – 1.48 million) will double by 2050 and reach 3.54 million. The research objective was to gain knowledge on the supply and demand of different institutionalized forms of care services from the healthcare system perspective. Material and methods A computer-assisted personal interview (CAPI) survey was carried out on a Poland-wide quota sample of health care and nursing centres operating within the healthcare system. The respondent group consisted of 96 directors of health care facilities. Results In the opinion of more than a half of surveyed directors, supply of health care and nursing centres in their region is insufficient in terms of the needs of both patients and elderly people. In the context of patients, the deficit is observed primarily in health care and treatment centres, long-term nursing care and health care institutions, whereas for the elderly people the main concern is availability of nursing care, day care or social aid centres. More than half of surveyed institutions admit patients requiring care on an ongoing basis; however, in the case of health care and treatment centres more than a year-long waiting time proved to be a frequent phenomenon. In the opinion of the surveyed directors, the key factors influencing the number of available places and waiting time are insufficient financing and personnel deficit. Conclusions Introduction of multiple changes to the operation of the care system in Poland is necessary in order to improve its availability, effectiveness and quality. Achievement of this objective requires implementation of a cohesive and integrated system dedicated to monitoring and diagnosing both the supply and demand for different forms of care

  13. Health care on demand: four telehealth priorities for 2016.

    Science.gov (United States)

    Grube, Mark E; Kaufman, Kenneth; Clarin, Dan; O'Riordan, Jason

    2016-01-01

    Consumers who are accustomed to on-demand, virtual services are looking for more convenient ways to access health care. Giving patients the opportunity to connect with physicians remotely can promote higher patient satisfaction and engagement. Telehealth options may have a high start-up cost, but that cost is likely well-justified by the potential to enhance quality, outcomes, and customer attraction and satisfaction/retention over the long-term.

  14. Elderly demand for family-based care and support: evidence from a social intervention strategy.

    Science.gov (United States)

    Aboagye, Emmanuel; Agyemang, Otuo Serebour; Tjerbo, Trond

    2013-12-06

    This paper examines the influence of the national health insurance scheme on elderly demand for family-based care and support. It contributes to the growing concern on the rapid increase in the elderly population globally using micro-level social theory to examine the influence the health insurance has on elderly demand for family support. A qualitative case study approach is applied to construct a comprehensive and thick description of how the national health insurance scheme influences the elderly in their demand for family support.Through focused interviews and direct observation of six selected cases, in-depth information on primary carers, living arrangement and the interaction between the health insurance as structure and elders as agents are analyzed. The study highlights that the interaction between the elderly and the national health insurance scheme has produced a new stratum of relationship between the elderly and their primary carers. Consequently, this has created equilibrium between the elderly demand for support and support made available by their primary carers. As the demand of the elderly for support is declining, supply of support by family members for the elderly is also on the decline.

  15. Gaps in need, demand, and effective demand for dental care utilization among residents of Krishna district, Andhra Pradesh, India

    Science.gov (United States)

    Pradeep, Y.; Chakravarty, Kalyan K.; Simhadri, Kavya; Ghenam, Alexis; Naidu, Guntipalli M.; Vundavalli, Sudhakar

    2016-01-01

    Aims: To identify the relation between need, demand, and effective demand for dental services in Andhra Pradesh, India. Materials and Methods: This is a cross-sectional study performed among populations residing in the rural and urban areas of Krishna district, Andhra Pradesh, India. Data were collected from 3102 individuals who were selected through multiphase random sampling. Data regarding self-perceived dental need, dental service utilization, and barriers for utilization were collected through s pretested questionnaire followed by type-III clinical examination to assess the normative need of the individuals. Chi-square test was used to compare independent and dependent variables, and further comparison was done with multivariate logistic regression analysis for significant variables. Results: Less than half (40%) of the participants perceived a need for dental care. Among the people who perceived need for care, only 21.4% utilized dental care and 78.6% of them had unmet dental needs. The two main reasons for not seeking dental care was lack of money, i.e., unaffordable dental treatment (48%) and having the perception that they do not have any dental problem (19.4%). Conclusions: There is an enormous difference between normative need, demand, and actual utilization rates in dental care, and hindrances for effective demand need to be addressed to improve dental care delivery system. PMID:27652242

  16. Demands and Job Resources in the Child Care Workforce: Swiss Lead Teacher and Assistant Teacher Assessments

    Science.gov (United States)

    Bloechliger, Olivia R.; Bauer, Georg F.

    2016-01-01

    Center-based child care has been struggling with poor health and high turnover rates of child care staff and their adverse impact on care quality for decades. Yet little is known about personal and structural antecedents of job resources and job demands that are valid predictors of health and turnover in the child care workforce. Research…

  17. A person-centred segmentation study in elderly care: towards efficient demand-driven care.

    Science.gov (United States)

    Eissens van der Laan, M R; van Offenbeek, M A G; Broekhuis, H; Slaets, J P J

    2014-07-01

    Providing patients with more person-centred care without increasing costs is a key challenge in healthcare. A relevant but often ignored hindrance to delivering person-centred care is that the current segmentation of the population and the associated organization of healthcare supply are based on diseases. A person-centred segmentation, i.e., based on persons' own experienced difficulties in fulfilling needs, is an elementary but often overlooked first step in developing efficient demand-driven care. This paper describes a person-centred segmentation study of elderly, a large and increasing target group confronted with heterogeneous and often interrelated difficulties in their functioning. In twenty-five diverse healthcare and welfare organizations as well as elderly associations in the Netherlands, data were collected on the difficulties in biopsychosocial functioning experienced by 2019 older adults. Data were collected between March 2010 and January 2011 and sampling took place based on their (temporarily) living conditions. Factor Mixture Model was conducted to categorize the respondents into segments with relatively similar experienced difficulties concerning their functioning. First, the analyses show that older adults can be empirically categorized into five meaningful segments: feeling vital; difficulties with psychosocial coping; physical and mobility complaints; difficulties experienced in multiple domains; and feeling extremely frail. The categorization seems robust as it was replicated in two population-based samples in the Netherlands. The segmentation's usefulness is discussed and illustrated through an evaluation of the alignment between a segment's unfulfilled biopsychosocial needs and current healthcare utilization. The set of person-centred segmentation variables provides healthcare providers the option to perform a more comprehensive first triage step than only a disease-based one. The outcomes of this first step could guide a focused and

  18. Demand management: another marketing tool or a way to quality care?

    Science.gov (United States)

    Mohler, M J; Harris, J M

    1998-05-01

    Demand management tools are population-based strategies used to control costs and improve utilization of services by assisting health consumers in maintaining their health and seeking appropriate health care. These tools are increasingly used by health care delivery systems and, in the US, by fiscal intermediaries, such as insurance companies. If these tools are not properly applied, there is a clear possibility that their use may lead a reduction of health care services with no improvement in clinical, humanistic, or economic outcomes. Demand management effectiveness has not been rigorously examined by the medical industry or academia. Before adopting or purchasing demand management technologies, health care systems should examine them carefully to determine how the tools were developed and who they were intended to serve. Once implemented, careful tracking of population outcomes is as necessary with these technologies as with any other technologies that can affect health care.

  19. Overweight and Obesity Among Wage-Earners and the Demand for Primary Physician Care

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Greve, Jane

    The standard economic model for the demand for health care predicts that unhealthy behaviour such as being  overweight or obese should increase the demand for medical care, particularly as clinical studies link obesity to a number of serious diseases. In this paper, we investigate whether...... overweight or obese individuals demand more medical care than their normal weight individuals by estimating a finite mixture model which splits the population into frequent and non-frequent users of primary physician (GP) services according to the individual's latent health status. Based on a sample of wage......-earners aged 25-60 years drawn from the National Health Interview (NHI) survey 2000 and merged to Danish register data, we compare differences in the impact of being overweight or obese relative to being normal weight on the demand for primary physician care. Estimated bodyweight effects vary across latent...

  20. "Doctor my eyes": A natural experiment on the demand for eye care services.

    Science.gov (United States)

    Dickey, H; Ikenwilo, D; Norwood, P; Watson, V; Zangelidis, A

    2016-02-01

    Preventive health care is promoted by many organisations from the World Health Organisation (WHO) to regional and national governments. The degree of cost-sharing between individuals and the health care service affects preventive service use. For instance, out-of-pocket fees that are paid by individuals for curative services reduce preventive care demand. We examine the impact of subsidised preventive care on demand. We motivate our analysis with a theoretical model of inter-temporal substitution in which individuals decide whether to have a health examination in period one and consequently whether to be treated if required in period two. We derive four testable hypotheses. We test these using the subsidised eye care policy introduced in Scotland in 2006. This provides a natural experiment that allows us to identify the effect of the policy on the demand for eye examinations. We also explore socio-economic differences in the response to the policy. The analysis is based on a sample from the British Household Panel Survey of 52,613 observations of people, aged between 16 and 59 years, living in England and Scotland for the period 2001-2008. Using the difference-in-difference methodology, we find that on average the policy did not affect demand for eye examinations. We find that demand for eye examinations only increased among high income households, and consequently, inequalities in eye-care services demand have widened in Scotland since the introduction of the policy.

  1. Demands on obstetrical care in the urban environment: postpartal survey.

    Science.gov (United States)

    Ahner, R; Stokreiter, C; Bikas, D; Kubista, E; Husslein, P

    1999-12-01

    In recent years, obstetrical management reflecting the individual needs of parturient women and newborn children has acquired an increasing significance. Today, the majority of obstetrical departments provide alternatives to traditional methods of delivery. The purpose of this study was to analyze the current obstetric situation as perceived by the women concerned. During the lying-in period spent in the care of the obstetrical department, 386 women were interviewed as to their birth experience. The questionnaire employed used a predominantly structured format. The present study examined a total of six of Vienna's municipal hospitals. The majority of women interviewed were satisfied with the standard of care provided by obstetricians and midwives. However, certain administrative and organizational aspects were subject to criticism, for example, shift changes among the medical staff as well as the presence of an excessive number of people during delivery were felt to detract from the intimate character of giving birth. In general, the standards of care provided by urban obstetrical departments as well as the experience of giving birth itself confirmed women's expectations. However, certain areas remain where improvements seem both desirable and feasible without requiring undue effort. Women who gave a positive assessment of their personal experience of delivery also tended to carry away a favorable impression of their stay in hospital as a whole.

  2. Residential water demand with endogenous pricing: The Canadian Case

    Science.gov (United States)

    Reynaud, Arnaud; Renzetti, Steven; Villeneuve, Michel

    2005-11-01

    In this paper, we show that the rate structure endogeneity may result in a misspecification of the residential water demand function. We propose to solve this endogeneity problem by estimating a probabilistic model describing how water rates are chosen by local communities. This model is estimated on a sample of Canadian local communities. We first show that the pricing structure choice reflects efficiency considerations, equity concerns, and, in some cases, a strategy of price discrimination across consumers by Canadian communities. Hence estimating the residential water demand without taking into account the pricing structures' endogeneity leads to a biased estimation of price and income elasticities. We also demonstrate that the pricing structure per se plays a significant role in influencing price responsiveness of Canadian residential consumers.

  3. Electric Power Demand Forecasting: A Case Study of Lucknow City

    Directory of Open Access Journals (Sweden)

    A.K. Bhardwaj and R.C. Bansal

    2011-03-01

    Full Text Available The study of forecasting identifies the urgent need for special attention in evolving effective energy policies to alleviate an energy famine in the near future. Since power demand is increasing day by day in entire world and it is also one of the fundamental infrastructure input for the development, its prospects and availability sets significant constraints on the socio-economic growth of every person as well as every country. A care full long-term power plan is imperative for the development of power sector. This need assumes more importance in the state of Uttar Pradesh where the demand for electrical energy is growing at a rapid pace. This study analyses the requirement of electricity with respect to the future population for the major forms of energy in the Lucknow city in Uttar Pradesh state of India. A model consisting of significant key energy indicators have been used for the estimation. Model wherever required refined in the second stage to remove the effect of auto-correlation. The accuracy of the model has been checked using standard statistical techniques and validated against the past data by testing for ‘expost’ forecast accuracy.

  4. Smokers' attitudes and behaviors related to consumer demand for cessation counseling in the medical care setting.

    Science.gov (United States)

    Weber, Deanne; Wolff, Lisa S; Orleans, Tracy; Mockenhaupt, Robin E; Massett, Holly A; Vose, Kathryn Kahler

    2007-05-01

    This study describes a new segmentation strategy exploring smokers' interest levels in counseling in the medical care setting in order to understand how public health communications can be designed to increase consumer demand for cessation services within this population. A subsample of 431 smokers from a large, nationally representative mail survey was analyzed and categorized into three cessation-demand groups: Low demand (LD), medium demand (MD), and high demand (HD). HD smokers were most likely to be heavy smokers, to make quitting a high priority, and to have self-efficacy in quitting. MD and LD smokers were less likely than HD smokers to have been told to quit smoking by a health care provider in the past or to believe that counseling is effective. The first step in the regression analysis revealed that age, cigarettes smoked per month, whether smokers were currently trying to quit, and whether they were ever told to quit smoking by their health care provider accounted for 21% of the variance in smokers' interest in smoking cessation counseling, F(4, 234) = 16.49, pconsumer demand for cessation counseling.

  5. Burnout and connectedness in the job demands-resources model: studying palliative care volunteers and their families.

    Science.gov (United States)

    Huynh, Jasmine-Yan; Winefield, Anthony H; Xanthopoulou, Despoina; Metzer, Jacques C

    2012-09-01

    This study examined the role of burnout and connectedness in the job demands-resources (JD-R) model among palliative care volunteers. It was hypothesized that (a) exhaustion mediates the relationship between demands and depression, and between demands and retention; (b) cynicism mediates the relationship between resources and retention; and (c) connectedness mediates the relationship between resources and retention. Hypotheses were tested in 2 separate analyses: structural equation modeling (SEM) and path analyses. The first was based on volunteer self-reports (N = 204), while the second analysis concerned matched data from volunteers and their family members (N = 99). While strong support was found for cynicism and connectedness as mediators in both types of analyses, this was not altogether the case for exhaustion. Implications of these findings for the JD-R model and volunteer organizations are discussed.

  6. Health care utilization patterns in developing countries: role of the technology environment in "deriving" the demand for health care.

    Science.gov (United States)

    Wouters, A V

    1992-01-01

    Health care services, in combination with several intermediate (proximate) determinants of health such as environmental sanitation and nutrition, directly influence health status. In the economics literature, this is referred to as the health production technology. Although many studies recognize that demand for health care depends on the health production technology, otherwise known as a "derived" demand, this review indicates that few of them have so far been able to fully incorporate this technology in estimating significant determinants of health care use. Understanding the technology environment could help explain why substantial portions of the population do not gain access to care even when financial factors do not appear to be a barrier. Also, low utilization of health services may simply reflect the low productivity of these services when other complementary factors such as nutrition or clean water and sanitation are lacking. Finally, since health-producing technology is often a multistep (multivisit) process, health care demand studies generally offer an incomplete picture of health care utilization patterns because they focus on a single event such as the first visit of an illness episode. Researchers should obtain more complete information on the interaction between all health production inputs, their availability and access to them. Multidisciplinary methodologies are likely to be useful.

  7. Future demand for dental care in Norway; a macro-economic perspective.

    Science.gov (United States)

    Grytten, J; Lund, E

    1999-10-01

    The future demand for dental care in Norway is discussed on the basis of economic theory. During the next 30 years gross national income will increase substantially due to a marked increase in national income from the sale of oil and gas. On the basis of the model we predict that this increase in income will lead to an increase in demand for dental services in the short run, say for the next 10-15 years. To a large extent this increase in demand is supported by evidence from dental epidemiology. In particular, an increasing proportion of elderly dentate people will demand more services. This picture is different in the long run, say from the year 2010-15 and onwards. Evidence from dental epidemiology indicates that at that stage there will be a fairly high proportion of disease-free individuals in the population who will demand less dental care. Such a trend is also supported by economic theory as long as disease-free individuals consume less dental care irrespective of their income.

  8. ANALYSIS ON AGRICULTRUAL INFORMATION DEMAND --Case of Jilin Province

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hui-min; JIANG Hui-ming

    2005-01-01

    With the rapid development of agricultural informalization in the world, the demand of agricultural information has been a focus in the international agriculture and information fields. Based on the investigation, this paper presented the four characteristics of the demand of agricultural information in China, including regionality, seasonality, great potential demand and variation in kind and level. The factors influencing the demand of agricultural information were analyzed by the Optimized Less Square (OLS) method. The result shows that, of all factors influcing agricultural information demand, the most important one is economy, the second is facility of information pass,and knowledge and education of user, credit of agricultural information service system and production situation follow. Taking Jilin Province as an example, this article also elaborated the agricultural information demand status, and deduced the regression model of agricultural information demand and verified it by the survey in rural Jilin.

  9. Improving long-term care provision: towards demand-based care by means of modularity

    NARCIS (Netherlands)

    C. de Blok; K. Luijkx; B. Meijboom; J. Schols

    2010-01-01

    Background: As in most fields of health care, societal and political changes encourage suppliers of long-term care to put their clients at the center of care and service provision and become more responsive towards client needs and requirements. However, the diverse, multiple and dynamic nature of d

  10. Stimulating the demand for dental care: An application of Ajzen and Fishbein's theory of reasoned action.

    NARCIS (Netherlands)

    Hoogstraten, J.; de Haan, W.; ter Horst, G.

    1985-01-01

    Applied I. Ajzen and M. Fishbein's (1980) attitude-behavior model to the problem of stimulating the demand for dental care with 329 members (aged 21-50 yrs) of health insurance companies who had not received regular dental treatment and/or certificate of dental fitness for at least 2 1/2 yrs. Applyi

  11. [Increase in the demand for eye-care services in the Netherlands 2010-2020

    NARCIS (Netherlands)

    Keunen, J.E.E.; Verezen, C.A.; Imhof, S.M.; Rens, G.H. van; Asselbergs, M.B.; Limburg, J.J.

    2011-01-01

    OBJECTIVE: The demand for eye-care services in the Netherlands is increasing. This article indicates the causes and attempts to provide an estimate of the increase between 2010 and 2020 and to indicate what will be the consequences. DESIGN: Descriptive study. METHOD: In the absence of data on the nu

  12. Negotiating user preferences, discrimination, and demand for migrant labour in long-term care.

    Science.gov (United States)

    Shutes, Isabel; Walsh, Kieran

    2012-01-01

    The restructuring of long-term care for older people has been marked both by the role of the market and by the role of migrant labor. This article develops the analysis of these processes at the microlevel of the provision of care. It draws on data collected as part of a cross-national comparative study on the employment of migrant care workers in residential care homes and home care services for older people in England and Ireland. The article examines, first, the ways in which divisions of race, ethnicity, and citizenship shape the preferences of service providers/employers and some service users as regards who provides care. Second, it examines how the institutional context of quasi-markets in long-term care shapes the negotiation of demand for migrant labor, the racialized preferences of individual users, alongside the rights of care workers to non-discrimination. It is argued that market-oriented policies for personalization, as well as for cost containment, raise implications for divisions of race, ethnicity, and citizenship in the provision of long-term care. At the same time, those divisions point to the limits of framing care in terms of the preferences of the individual as opposed to the social relations in which care is embedded.

  13. Analyzing demand-side efficiency in global health: an application to maternal care in Vietnam.

    Science.gov (United States)

    Radin, Elizabeth; Ariana, Proochista; Broekel, Tom; Tran, Toan Khanh

    2016-11-01

    This article investigates demand-side efficiency in global health-or the efficiency with which health system users convert public health resources into health outcomes. We introduce and explain the concept of demand-side efficiency as well as quantitative methods to empirically estimate it. Using a robust nonparametric form of technical efficiency analysis, we estimate demand side efficiency and its social determinants. We pilot these methods looking at how efficiently pregnant women in Northern Vietnam convert public health resources into appropriate maternal care as defined by national policy. We find that women who live in non-mountainous geographies, who are formally employed, who are pregnant with a boy and who are ethnic minorities are all more likely to be efficient at achieving appropriate care. We find no significant association between wealth or education and efficiency. Our results suggest that, in the Vietnamese context, women who are the most likely to achieve appropriate maternal care, are not necessarily the most likely to do so efficiently. Women who live in non-mountainous geographies and who are formally employed are both more likely to achieve appropriate care and to do so efficiently. Yet ethnic minority women, who do not systematically achieve better care, are more likely to be efficient or to achieve better care when compared with those with the same endowment of public health resources. On the methodological level, the pilot highlights that this approach can provide useful information for policy by identifying which groups of people are more and less likely to be efficient. By understanding which groups are more likely to be efficient-and in turn how and why-it may be possible to devise policies to promote the drivers of, or conversely address the constraints to, optimizing demand-side efficiency.

  14. Demand Constraints and New Demands: Regulations, Markets and Institutions Efficiency (A Case Study for Cape Verde

    Directory of Open Access Journals (Sweden)

    Bernardo Reynolds Pacheco de Carvalho

    2014-08-01

    Full Text Available Economic efficiency is a key issue in economic research and for policy design, and certainly for food security challenges. In the food system dynamics the understanding of changes and trends is crucial to improve our capacity to deal with the objectives of sustainable development and quality of life. Food system efficiency evaluation is necessary with regard to production and consumption efficiencies as well as market and governance dilemmas. Regulations and institutional efficiency are crucial aspects that are frequently forgotten, and efforts should be made to improve the capacity to deal with those methodological needs. In many situations, in the real world, data and measurements are difficult or even impossible to get in numeric or quantitative terms. Frequently, a qualitative evaluation is the only way to proceed, but measurements and numeric references are still important, mainly when changes over time are central to the research. The actual paper follows a structural food system model (WFSE – World Food Security Equation and a general equilibrium approach (ICI model – induced changes and innovation model to show in a country case study (Cape Verde the important role of markets and institutions as compared to regulation practices directed to improve economic efficiency subject to demand behavior. Cape Verde is a very challenging country with regard to the food security status (where natural resources are very poor for agricultural production but with great success in global and macro terms in the last 10 years. The main problems nowadays are clearly at local level. The present research tries to highlight the global achievements and explore local assessment efforts on food consumption conditions. A specific region is studied, in the island of Santo Antão, one of the most important production regions. Three different production systems were compared mainly with regard to their respective influence on consumption habits, incomes and

  15. A person-centred segmentation study in elderly care : Towards efficient demand-driven care

    NARCIS (Netherlands)

    Eissens-van der Laan, Monique; van Offenbeek, Marjolein; Broekhuis, Manda; Slaets, Joris

    2014-01-01

    Providing patients with more person-centred care without increasing costs is a key challenge in healthcare. A relevant but often ignored hindrance to delivering person-centred care is that the current segmentation of the population and the associated organization of healthcare supply are based on di

  16. Consumer Demand on Halal Cosmetics and Personal Care Products in Indonesia

    Directory of Open Access Journals (Sweden)

    Muniaty Aisyah

    2016-12-01

    Full Text Available This research aims to analyze the influential factors involved in Moslem consumers’ decision to purchase halal cosmetics and personal care products in Indonesia by using the Theory of Planned Behavior. 100 questionnaires were analyzed using Structural Equation Modeling, collected from respondents of female consumers who purchased Wardah cosmetics and personal care products in South Jakarta and South Tangerang. The findings show that attitude, subjective norm, perceived behavioral control and purchase intention are positively related to the consumers’ decision to purchase halal cosmetics and personal care products. By addressing the consumers’ traits that can predict halal cosmetics and personal care products necessity, marketers could generate proper marketing strategies to validate consumers’ demand which in turn will stimulate the growth of halal products industry in Indonesia.DOI: 10.15408/aiq.v9i1.1867

  17. [Job Demands-Resources, exhaustion and work engagement in a long-term care institution].

    Science.gov (United States)

    Conway, P M; Neri, L; Campanini, P; Francioli, L; Camerino, D; Punzi, S; Fichera, G P; Costa, G

    2012-01-01

    In this study, we aimed at testing the main hypotheses of the Job Demands-Resources model (JD-R) in a sample of employees (n = 205, mainly healthcare workers) of a long-term care institution located in Northern Italy. Hierarchical linear regression analyses show that almost all job demands considered were significantly associated with higher general psycho-physical exhaustion (beta ranging from 0.14 to 0.29), whereas more unfavourable scores in all job resources were associated with lower work engagement (from -0.27 to -0.51). However, also significant cross-over associations were observed, mainly between job resources and exhaustion, with effect sizes comparable with those found for the relationships between job demands and exhaustion. Hence, our study only partially supports the JD-R model. Implications of results for work-related stress management are finally discussed.

  18. Population ageing and its implications on aggregate health care demand: empirical evidence from 22 OECD countries.

    Science.gov (United States)

    Palangkaraya, Alfons; Yong, Jongsay

    2009-12-01

    Recent evidence indicates that the relationship between age and health care expenditure is not as straightforward as it appears. In fact, micro-level studies find that time to death, rather than ageing, is possibly the main driver of the escalating health care costs in developed countries. Unfortunately, the evidence at the macro level is less clear and often depends on the specification of the empirical model used. We use an aggregate demand framework to assess whether health expenditure is more likely to be driven by ageing per se or proximity to death. Using panel data from 22 OECD countries from the first half of the 1990s, we find population ageing to be negatively correlated with health expenditure once proximity to death is accounted for. This suggests that the effects of ageing on health expenditure growth might be overstated while the effects of the high costs of medical care at the end of life are potentially underestimated. With respect to the latter, our finding highlights the importance of long-term and hospice care management. An expanded long-term care program may not only improve patient welfare, but also reduce costs of care by reducing the duration of hospital care for terminally ill patients. If expensive medical treatment for patients near the end of life can be controlled for, health expenditure growth resulting from population ageing is unlikely to present a most serious problem.

  19. System dynamics modeling on health care : supply and demand of dementia care

    NARCIS (Netherlands)

    Rouwette, E.A.J.A.

    2006-01-01

    This presentation will address the use of system dynamics models to analyze complex problems in health care. System dynamics has been used on health related issues since at least the 1960s and in the Netherlands since the 1980s. In this approach a group of experts and stakeholders participates in de

  20. Synthesizing Econometric Evidence: The Case of Demand Elasticity Estimates.

    Science.gov (United States)

    DeCicca, Philip; Kenkel, Don

    2015-06-01

    Econometric estimates of the responsiveness of health-related consumer demand to higher prices are often key ingredients for risk policy analysis. We review the potential advantages and challenges of synthesizing econometric evidence on the price-responsiveness of consumer demand. We draw on examples of research on consumer demand for health-related goods, especially cigarettes. We argue that the overarching goal of research synthesis in this context is to provide policy-relevant evidence for broad-brush conclusions. We propose three main criteria to select among research synthesis methods. We discuss how in principle and in current practice synthesis of research on the price-elasticity of smoking meets our proposed criteria. Our analysis of current practice also contributes to academic research on the specific policy question of the effectiveness of higher cigarette prices to reduce smoking. Although we point out challenges and limitations, we believe more work on research synthesis in this area will be productive and important.

  1. Demand characterization and looking for a children’s emergency care: opinion of parents and legal guardians

    Directory of Open Access Journals (Sweden)

    Bruna Antoniassi Silva

    2015-03-01

    Full Text Available Health services are organized hierarchically in order to obtain better resolution and universal access. However, in practice, this has not occurred due to the limitation of services in primary care, and the gateway has been hospitals, through the ready attendance, emergency rooms or clinics because many believe it is the fastest and most effective form of care. Therefore, the objective of this study was to identify the reasons for parents/guardians to choose the ready attendance service for the assistance of their children. It is a descriptive and cross-sectional study with a quantitative approach. The sample consisted of 380 parents/guardians, the collection site was a children's health care center in Londrina, from June to August 2013. After analyzing the data, it was observed that 73.9% of the population resorted directly to the ready attendance service. From the small portion that searched for other hospitals, only 12.6% were sent to the ready attendance service. The main complaint was fever with 25.7% and cases of seizures appeared in last place with 0.4%. The present study revealed a great demand of the population studied by ready attendance services instead of primary care, with complaints often solvable in primary care, which confirms the deficiency in priority principles by the Unified Health System such as accessibility and response capacity of primary health services.

  2. Factors and models associated with the amount of hospital care services as demanded by hospitalized patients: a systematic review.

    NARCIS (Netherlands)

    Oostveen, C.J. van; Ubbink, D.T.; Huis in het Veld, J.G.; Bakker, P.J.; Vermeulen, H.

    2014-01-01

    Background: Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care

  3. Creating demand for cataract services: a Cambodian case study

    Directory of Open Access Journals (Sweden)

    Seng Sophal

    2006-12-01

    Full Text Available Following decades of civil disturbance in Cambodia, by the early 1990s there were few doctors remaining in the country, and little in the way of eye care services.With NGO support, training centres were established to train medical graduates and nurses as ‘basic eye doctors’ and ‘basic eye nurses’. These workers were then placed in provincial eye units to serve the eye care needs of those provinces. However, it soon became clear that, despite evidence that blindness, including cataract blindness, was prevalent, patients were not attending these provincial eye units. Attention was therefore given to finding out more about the barriers preventing patients benefiting from these services.

  4. Operational resilience of reservoirs to climate change, agricultural demand, and tourism: A case study from Sardinia.

    Science.gov (United States)

    Mereu, Simone; Sušnik, Janez; Trabucco, Antonio; Daccache, Andre; Vamvakeridou-Lyroudia, Lydia; Renoldi, Stefano; Virdis, Andrea; Savić, Dragan; Assimacopoulos, Dionysis

    2016-02-01

    Many (semi-) arid locations globally, and particularly islands, rely heavily on reservoirs for water supply. Some reservoirs are particularly vulnerable to climate and development changes (e.g. population change, tourist growth, hydropower demands). Irregularities and uncertainties in the fluvial regime associated with climate change and the continuous increase in water demand by different sectors will add new challenges to the management and to the resilience of these reservoirs. The resilience of vulnerable reservoirs must be studied in detail to prepare for and mitigate potential impacts of these changes. In this paper, a reservoir balance model is developed and presented for the Pedra e' Othoni reservoir in Sardinia, Italy, to assess resilience to climate and development changes. The model was first calibrated and validated, then forced with extensive ensemble climate data for representative concentration pathways (RCPs) 4.5 and 8.5, agricultural data, and with four socio-economic development scenarios. Future projections show a reduction in annual reservoir inflow and an increase in demand, mainly in the agricultural sector. Under no scenario is reservoir resilience significantly affected, the reservoir always achieves refill. However, this occurs at the partial expenses of hydropower production with implications for the production of renewable energy. There is also the possibility of conflict between the agricultural sector and hydropower sector for diminishing water supply. Pedra e' Othoni reservoir shows good resilience to future change mostly because of the disproportionately large basin feeding it. However this is not the case of other Sardinian reservoirs and hence a detailed resilience assessment of all reservoirs is needed, where development plans should carefully account for the trade-offs and potential conflicts among sectors. For Sardinia, the option of physical connection between reservoirs is available, as are alternative water supply measures

  5. Demands, constructions and challenges experienced by occupational therapists in primary health care

    Directory of Open Access Journals (Sweden)

    Fernanda dos Reis

    2014-05-01

    Full Text Available Objective: To understand the demands, constructions and challenges experienced by occupational therapists in primary health care in Fortaleza city, Ceará, Brazil. Methods: This is a qualitative study conducted with 13 occupational therapists of the Support Centers for Family Health. It used the focus group method in March 2011 at the headquarters of the Regional Council of Physiotherapy and Occupational Therapy – 6th Region. After the thematic analysis of the material, with theoritical contributions of occupational therapy and collective health, the following categories emerged: construction of work processes; demand and assisted population; contributions and challenges of the occupational therapists. Results: It could be observed that occupational therapists encouraged teams to perform joint actions through health promotion activities for priority groups and created room for planning the construction of comprehensive care between healthcare teams and users, highlighting the challenges of the territory as a space for interdisciplinary achievements, where the problem resolution requires sensitivity and recognition by the professional categories in field. Conclusion: It is understood that diversities and specificities inherent to the territory relate to the needs, and the community daily routine, in addition to the field stresses, counters the team work logic, implying fragility in the actions of supporters. doi:10.5020/18061230.2013.p356

  6. Influence of the demand information quality on planning process accuracy in supply chain. Case studies

    Directory of Open Access Journals (Sweden)

    Natalia Szozda

    2013-06-01

    Full Text Available Background: Identification and analysis of factors that affect the accuracy of demand planning process across the supply chain is one of the most important problems which influence the effectiveness of its material and information flows. Material and methods: On the basis of demand planning process investigation authors define the main elements affecting the right supply chain performance level and investigate the possible connections between demand information quality and demand planning process accuracy. Later, an overview of some recent developments in the analyzed research area is provided. Results: Based on the literature review, there is described the defined factors impact on the accuracy of demand plan in each echelon for case companies. There are considered three cases. The examples illustrate supply chains of different manufacturing companies. The focus is placed on demand planning across the supply chains. The issue of determining the accuracy of future sales plans in each echelon of supply chains and factors affecting it are raised. Taking into account the case companies demand planning process analyses, there are defined possible quality measures, that are possible to be used when forecasting the customer demand. Conclusions: One of the most important and difficult planning area in the companies is becoming planning demand. Errors in planning are reflected not just in the business resource planning but also in the entire supply chain. Presented cases show that many factors affect the proper demand planning process in the supply chain, like e.g.  information technologies, lead-time, or number of supplied materials. As it can be seen from the case studies, the model of collecting information from the market plays an important role in the demand planning process.

  7. Economic Analysis of Urban Fuelwood Demand - The case of Harare in Zimbabwe

    NARCIS (Netherlands)

    Chambwera, M.

    2004-01-01

    This study carries out an economic analysis of the demand for fuelwood in urban areas using Harare, the capital city of Zimbabwe, as a case study. The demand for fuelwood in urban areas is one of the causes of several environmental and health problems in Africa, where the up to 90% of energy require

  8. Forecasting demand for single-period products : A case study in the apparel industry

    NARCIS (Netherlands)

    Mostard, Julien; Teunter, Ruud; de Koster, Rene

    2011-01-01

    The problem considered is that of forecasting demand for single-period products before the period starts. We study this problem for the case of a mail order apparel company that needs to order its products pre-season. The lack of historical demand data implies that other sources of data are needed.

  9. High Job Demands and Low Job Control Increase Nurses' Professional Leaving Intentions: The Role of Care Setting and Profit Orientation.

    Science.gov (United States)

    Wendsche, Johannes; Hacker, Winfried; Wegge, Jürgen; Rudolf, Matthias

    2016-10-01

    We investigated how two types of care setting (home care and nursing home) and type of ownership (for-profit vs. public/non-profit) of geriatric care services interacted in influencing registered nurses' intention to give up their profession. In prior research, employment in for-profit-organizations, high job demands, and low job control were important antecedents of nurses' intent to leave. However, the impact of care setting on these associations was inconclusive. Therefore, we tested a mediated moderation model predicting that adverse work characteristics would drive professional leaving intentions, particularly in for-profit services and in nursing homes. A representative German sample of 304 registered nurses working in 78 different teams participated in our cross-sectional study. As predicted, lower job control and higher job demands were associated with higher professional leaving intentions, and nurses reported higher job demands in public/non-profit care than in for-profit care, and in nursing homes compared to home care. Overall, RNs in nursing homes and home care reported similar intent to leave, but in for-profit settings only, nurses working in nursing homes reported higher professional leaving intentions than did nurses in home care, which was linked to lower job control in the for-profit nursing home setting, supporting mediated moderation. Taken together, our results indicate that the interplay of care setting and type of ownership is important when explaining nurses' intentions to give up their profession. © 2016 Wiley Periodicals, Inc.

  10. The Role of Demand Factors in Utilization of Professional Care during Childbirth: Perspectives from Yemen

    Science.gov (United States)

    Kempe, Annica; Noor-Aldin Alwazer, Fatoom; Theorell, Töres

    2011-01-01

    Background. Utilization of professional care during childbirth by women in low-income countries is important for the progress towards MDG 5. In Yemen, home births have decreased minimally during the past decades. Objective. The study investigates the influence of socio-demographic, birth outcome and demand factors on women's future preference of a home or institutional childbirth. Method. We interviewed 220 women with childbirth experience in urban/rural Yemen. We performed bivariate chi-square tests and multiple logistic regression analysis. A multistage sampling process was used. Results. The issues of own choice, birth support and birth complications were the most important for women's preference of future location of childbirth. Women who had previously been able to follow their own individual choice regarding birth attendance and/or location of childbirth were six times more likely to plan a future childbirth in the same location and women who received birth support four times more likely. Birth complications were associated with a 2.5-fold decrease in likelihood. Conclusions. To offer women with institutional childbirth access to birth support is crucial in attracting women to professional care during childbirth. Yemeni women's low utilization of modern delivery care should be seen in the context of women's low autonomy and status. PMID:21941663

  11. China's medical savings accounts: an analysis of the price elasticity of demand for health care.

    Science.gov (United States)

    Yu, Hao

    2016-09-20

    Although medical savings accounts (MSAs) have drawn intensive attention across the world for their potential in cost control, there is limited evidence of their impact on the demand for health care. This paper is intended to fill that gap. First, we built up a dynamic model of a consumer's problem of utility maximization in the presence of a nonlinear price schedule embedded in an MSA. Second, the model was implemented using data from a 2-year MSA pilot program in China. The estimated price elasticity under MSAs was between -0.42 and -0.58, i.e., higher than that reported in the literature. The relatively high price elasticity suggests that MSAs as an insurance feature may help control costs. However, the long-term effect of MSAs on health costs is subject to further analysis.

  12. [Abdominal pregnancy care. Case report].

    Science.gov (United States)

    Morales Hernández, Sara; Díaz Velázquez, Mary Flor; Puello Tamara, Edgardo; Morales Hernández, Jorge; Basavilvazo Rodríguez, Maria Antonia; Cruz Cruz, Polita del Rocío; Hernández Valencia, Marcelino

    2008-10-01

    Abdominal pregnancies are the implantation of gestation in some of the abdominal structures. This kind of pregnancies represents sevenfold maternal death risk than tubarian ectopic pregnancies, and 90-fold death risk than normal ones. Previous cases have erroneously reported as abscess in Douglas punch, and frequently result in obitus or postnatal deaths. We report a case of a patient with 27 years old, and diagnosis of 25.2 weeks of pregnancy, prior placenta and anhidramnios, referred due to difficult in uterine contour delimitation, easy palpation of fetal parts, cephalic pole in left hypochondrious and presence of mass in hypogastria, no delimitations, pain with mobilization, no transvaginal bleed and fetal movements. Interruption of pregnancy is decided by virtue of severe oligohidramnios, retardation in fetal intrabdominal growth, and recurrent maternal abdominal pain. Surgical intervention was carried out for resolution of the obstetrical event, in which was found ectopic abdominal pregnancy with bed placental in right uterine horn that corresponded to a pregnancy of 30 weeks of gestation. Abdominal pregnancy is still a challenge for obstetrics due to its diagnosis and treatment. Early diagnosis is oriented to prevent an intrabdominal hemorrhage that is the main maternal cause of mortality.

  13. Coming to grips with challenging behaviour: a cluster randomised controlled trial on the effects of a new care programme for challenging behaviour on burnout, job satisfaction and job demands of care staff on dementia special care units

    NARCIS (Netherlands)

    Zwijsen, S.A.; Gerritsen, D.L.; Eefsting, J.A.; Smalbrugge, M.; Hertogh, C.M.; Pot, A.M.

    2015-01-01

    BACKGROUND: Caring for people with dementia in dementia special care units is a demanding job. Challenging behaviour is one of the factors influencing the job satisfaction and burnout of care staff. A care programme for the challenging behaviour of nursing home residents with dementia might, next to

  14. Clinical demand in an emergency care unit according to the Manchester triage system

    Directory of Open Access Journals (Sweden)

    Aline Santos Diniz

    2014-06-01

    Full Text Available The general objective of the present study is to identify the clinical demand of patients cared for by nursing professionals according to the risk classification of an Emergency Care Unit, following the Manchester triage system. It is a quantitative descriptive study whose sample was composed of 364 patient records. The data was analyzed via the Statistical Package for the Social Sciences, using descriptive, bivariate statistics and Spearman’s correlation. The patient’s main complaints were: “Adult indisposition,” “Problems with the limbs,” “Abdominal pain,” and “Headaches.” There was inverse correlation between age and risk classification (rs = -0.14 p=0,005, and time of admittance and risk classification (rs = -1.02, p=0.046. We conclude that the patients classified according to risk presented urgent and non-urgent complaints. The higher the patient’s age and the later in the day they were admitted, the more severe their clinical condition.   doi: 10.5216/ree.v16i2.21700.

  15. [Clinical case: Complicated grief in primary care. Care plan].

    Science.gov (United States)

    Ruymán Brito-Brito, Pedro; Rodríguez-Ramos, Mercedes; Pérez-García-Talavera, Carlos

    2009-01-01

    This is the case of a 61-year-old patient woman that visits her nurse in Primary Health Care to get the control of blood pressure and glycemia. In the last two years has suffered the loss of her husband and of two brothers beside having lived through other vital stressful events that have taken her to a situation of complicated grief. The care plan is realized using the M. Gordon assessment system and standardized languages NANDA, NOC and NIC. The principal aims were the improvement of the depression level and the improvement in the affliction resolution. As suggested interventions were proposed to facilitate the grief and the derivation to a mental health unit. A follow-up of the patient was realized in nursing consultation at Primary health care to weekly intervals, in the beginning, and monthly, later. The evaluation of the care plan reflects an improvement in the criteria of Prigerson's complicated grief; an increase of the recreative activities; the retreat of the mourning that still she was guarding; as well as an improvement in the control of the blood pressure numbers. The attention of nurses before a case of complicated grief turns out to be complex. Nevertheless the suitable accomplishment of certain interventions orientated to facilitating the grief, with a follow-up in consultation, shows the efficiency. The difficulty in the boarding of the psychosocial problems meets increased at the moment of are necessary the nursing diagnostics adapted for every individual case. The work in group between nurses could improves the consensus.

  16. Demand forecast: a case study at a meat agribusiness in west Santa Catarina

    Directory of Open Access Journals (Sweden)

    Cleunice Zanella

    2016-03-01

    Full Text Available Based on demand forecasts, companies plan production, financial and personnel scenarios, both in the long and short term. The forecasts are essential, especially for companies working with a push production system, for which there is no sale of collateral. They should therefore plan their production and financial systems with the aim of meeting the demand forecast of their products or services. Thus, this study was conducted at a meat agribusiness located in Chapecó, in the state of Santa Catarina, in order to analyze the demand forecasting methods used by the company. It is a case study with a qualitative approach. Data collection was conducted through semi-structured interviews with the operations manager, commercial manager and analysts who respond to the demand forecasts made. The main results highlight the use of both quantitative and qualitative methods, as well as indicating the importance of demand forecasts for the planning of the company

  17. Nurse case managers: patient care implications at a Pakistani university.

    Science.gov (United States)

    Walani, Laila

    The role of the nurse in hospital is varied and some are choosing to incorporate more managerial and administrative skills into their clinical role. One such role is that of the nurse case manager (NCM). This particular role concentrates on involving the family and the patient in his or her own care, facilitation of the care plan, and open discussions between the patient, medics and nursing staff. NCMs in the author's hospital have made a remarkable contribution to patient care. It is a challenging and exceedingly demanding role in both developing and developed countries, but one that is increasingly important. The NCMs are involved in coordination, facilitation of core process and mobilization of resources, not only in hospital but at the patient's home. In this short introductory article the role of NCM is highlighted and the author discusses how this diverse role is concerned with patient care. NCMs work with multidisciplinary teams to enhance the patient's care process. Their attention is also given to cost reduction and clinical pathway management.

  18. Effect of Pressure dependent demand on pipe network analysis: A case study

    Directory of Open Access Journals (Sweden)

    MINAKSHI SHRIVASTAVA

    2014-01-01

    Full Text Available Water distribution network is most important part of world’s infrastructure. In the present work, analysis for proposed site of school of planning and architecture, Bhopal is done by using demand based analysis and the design is further analyzed for pressure dependent demand. Detailed study of variation of threshold pressure with power function is carried out .Complete site is divided into two zones having two separate water tank for supply and the analysis is done by varying threshold pressure and power function in case of pressure dependent demand by using commercial pipe network analysis software.

  19. [Domestic violence against women and health care demands. Results of a female emergency department patient survey].

    Science.gov (United States)

    Brzank, P; Hellbernd, H; Maschewsky-Schneider, U; Kallischnigg, G

    2005-03-01

    Domestic violence (DV) is a serious risk for women's health. So far, little attention has been paid to this area in research and medical care in Germany. Acknowledging this deficit, the S.I.G.N.A.L.-Intervention Project has started to develop a program to improve the medical care for victimized women. For the first time in Germany, data on the health care needs of victimized women have been collected within the S.I.G.N.A.L.-Evaluation Research Project. This article presents the results of a female patient survey (n=806) on DV conducted in the emergency department (ED) of a university hospital in Berlin. The results demonstrate that 36.6% of women reported at least one episode of DV after the age of 16. A total of 4.6% were victims of DV over the past year, and 1.5% of women came to the ED for treatment of injuries caused by violence. A total of 57% of the victims of at least one episode of DV in their lifetime after the age of 16 described a negative impact on their health. The most frequently reported sequelae were head injuries, haematomas and fractures, gastrointestinal disorders, headache/migraine and heart disease. The psychological symptoms were anxiety, depression and suicide/self-mutilation attempts. Some 52% of the victims who reported health consequences had received medical care. In case of DV occurring, 67% of all women said that they would discuss it with their physicians. Approximately 80% of all respondents favoured a routine inquiry for DV as part of the medical history protocol of the ED.

  20. Medicaid Crowd-Out of Private Long-Term Care Insurance Demand : Evidence from the Health and Retirement Survey

    NARCIS (Netherlands)

    Brown, J.R.; Coe, N.B.; Finkelstein, A.

    2006-01-01

    This paper provides empirical evidence of Medicaid crowd out of demand for private long-term care insurance. Using data on the near- and young-elderly in the Health and Retirement Survey, our central estimate suggests that a $10,000 decrease in the level of assets an individual can keep while qualif

  1. CUSTOMER CARE AS AN ESSENTIAL ELEMENT IN THE TELECOMMUNICATION INDUSTRY : Case Airtel Ghana.

    OpenAIRE

    Gambo, Ramatu Bashiru

    2016-01-01

    Today, an evolution of mobile internet has led to a dramatic demand of mobile network services within the telecommunication industry. This has compelled telecommunication companies not to only consider price as a major competing tool in intense competing markets but also, focus on customer care as a means of excelling in those markets. The purpose of this study is to investigate customer care activities practiced by Airtel Ghana, the case company and their impact on the company’s service deli...

  2. Demand-driven land evaluation; with case studies in Santa Catarina-Brazil

    NARCIS (Netherlands)

    Bacic, I.L.Z.

    2003-01-01

    The main objective of this thesis is to improve use and usefulness of information for rural land use decisions based on an operational demand-driven approach for land evaluation with case studies in Santa Catarina State, Brazil. To achieve this objective, the following research questions were formul

  3. A Qualitative Case Study of Expert Special Educators Effectively Negotiating Their Job Demands

    Science.gov (United States)

    Ortogero, Shawna P.

    2013-01-01

    This qualitative case study explored how three expert secondary special education teachers in Hawaii constructed their perceived roles and successfully negotiated their job demands. There is a strong connection between role problems and special education teachers leaving the profession. The special education teacher shortage has a direct impact on…

  4. Mass Housing and Changings in Housing Demand, Case of Diyarbakir, Turkey

    OpenAIRE

    2005-01-01

    The aim of this study is to analyze changings in housing demand, especially in term of house size in Diyarbakýr case, in Turkey. Though Housing in Turkey is in a free market system, there is a Mass Housing Administration (TOKÝ) has been doing mass houses for, relatively, middle class income people. Diyarbakýr, one of the cities that TOKÝ has done two thousand houses, has taken too much migration, so that the demand in housing form and structure has different alterations. This process should b...

  5. Comparative analysis of the expected demands for nursing care services among older people from urban, rural, and institutional environments

    Directory of Open Access Journals (Sweden)

    Borowiak E

    2015-02-01

    Full Text Available Ewa Borowiak,1,2,* Joanna Kostka,3,* Tomasz Kostka1 1Department of Geriatrics, Medical University of Lodz, Poland; 2Institute of Nursing, Medical University of Lodz, Poland; 3Department of Physical Medicine, Medical University of Lodz, Poland *These authors contributed equally to this work Background: Demand for nursing and social services may vary depending on the socio-demographic variables, health status, receipt of formal and informal care provided, and place of residence. Objectives: To conduct a comparative analysis of the expectations of older people from urban, rural, and institutional environments concerning nursing care with respect to the care provided and elements of a comprehensive geriatric assessment. Material and methods: The study comprised 2,627 individuals above the age of 65 years living in urban (n=935 and rural (n=812 areas as well as nursing homes (n=880. Results: Family care was most often expected both in urban (56.6% and rural (54.7% environments, followed by care provided simultaneously by a family and nurse (urban – 18.8%; rural – 26.1% and realized only by a nurse (urban – 24.6%; rural – 19.2%. Not surprisingly, nursing home residents most commonly expected nursing care (57.5% but 33.1% preferred care provided by family or friends and neighbors. In the whole cohort of people living in the home environment (n=1,718, those living with family demonstrated willingness to use primarily care implemented by the family (62.0%, while respondents living alone more often expected nursing services (30.3%. In the logistic regression model, among the respondents living in the city, only the form of care already received determined the expectations for nursing care. Among the respondents living in the county, the presence of musculoskeletal disorders, better nutritional status, and current care provided by family decreased expectations for nursing care. Higher cognitive functioning, symptoms of depression, and living alone

  6. Research on the Demands of Long-term Care Service for the Elderly and Its Inlfuencing Factors:A Case of Shannxi Province%老年人长期照护服务的需求意愿分析及对策建议--基于陕西省的调查

    Institute of Scientific and Technical Information of China (English)

    翟绍果; 郭锦龙

    2013-01-01

    In order to understand the demands of long-term care service for the elderly and its inlfuencing factors, random sampling is used in the questionnaire survey on urban and rural elderly in Shaanxi Province. The result shows that the demands of the elderly appear as diversiifed due to the difference of gender, physical health, spiritual life, and the current way of pension. The main factors inlfuencing needs of the elderly are gender, the ability to take care of themselves, spiritual life, current pension ways, whether the current service comprehensive, whether they satisifed with the current service. Therefore, in order to effectively meet the needs of long-term care service for the elderly, we must make efforts to increase the income of the elderly, formulate and improve relevant laws and policies, mobilize all social sectors to participate actively, and shape the healthy and active aging view.%为了解老年人长期照护服务的需求意愿及其影响因素,本文采用随机抽样方法对陕西省城乡老年人作了问卷调查。研究发现,老年人的需求意愿因性别、身体健康状况、精神生活、当前养老方式等的不同而呈现出多样化特征;影响老年人需求的因素依次是性别、生活能否自理、精神生活、当前养老方式、当前长期照护服务是否全面、对当前长期照护服务是否满意等。为有效满足老年人的长期照护服务需求,须努力增加老年人收入,制定并完善相关法律政策,调动社会各方力量积极参与,塑造全新的健康老龄观和积极老龄观。

  7. Factors and models associated with the amount of hospital care services as demanded by hospitalized patients: a systematic review.

    Directory of Open Access Journals (Sweden)

    Catharina J van Oostveen

    Full Text Available BACKGROUND: Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care and inherent costs. The aim of this study was to ascertain which patient-related characteristics or models can predict the need for medical and nursing care in general hospital settings. METHODS: We systematically searched MEDLINE, Embase, Business Source Premier and CINAHL. Pre-defined eligibility criteria were used to detect studies that explored patient characteristics and health status parameters associated to the use of hospital care services for hospitalized patients. Two reviewers independently assessed study relevance, quality with the STROBE instrument, and performed data analysis. RESULTS: From 2,168 potentially relevant articles, 17 met our eligibility criteria. These showed a large variety of factors associated with the use of hospital care services; models were found in only three studies. Age, gender, medical and nursing diagnoses, severity of illness, patient acuity, comorbidity, and complications were the characteristics found the most. Patient acuity and medical and nursing diagnoses were the most influencing characteristics. Models including medical or nursing diagnoses and patient acuity explain the variance in the use of hospital care services for at least 56.2%, and up to 78.7% when organizational factors were added. CONCLUSIONS: A larger variety of factors were found to be associated with the use of hospital care services. Models that explain the extent to which hospital care services are used should contain patient characteristics, including patient acuity, medical or nursing diagnoses, and organizational and staffing characteristics, e.g., hospital size, organization of care, and the size and skill mix of staff. This would

  8. Optimal demand reponse to water pricing policies under limited water supply in irrigation: a case study

    Science.gov (United States)

    Grießbach, Ulkrike; Stange, Peter; Schuetze, Niels

    2015-04-01

    Due to climate change, extreme weather conditions such as droughts may have an increasing impact on irrigated agriculture. To cope with the higher demand of water, a new decision support framework is developed which focuses on an integrated management of both irrigation water supply and demand. For modeling the regional water demand, local stochastic water demand functions are used which are derived from optimized agronomic response on farms scale. These functions take into account different soil types, crops, stochastically generated climate scenarios considering different economic conditions, e.g., variable and fixed costs. This generic approach enables the consideration of both multiple crops at farm scale as well as of the aggregated response to water pricing at a regional scale for full and deficit irrigation systems. Within the SAPHIR (SAxonian Platform for High Performance IRrigation) project a prototype of a decision support system is developed and applied for a case study in Saxony which helps to evaluate combined water supply and demand management policies on a regional level.

  9. A methodological proposal to research patients’ demands and pre-test probabilities using paper forms in primary care settings

    Directory of Open Access Journals (Sweden)

    Gustavo Diniz Ferreira Gusso

    2013-04-01

    Full Text Available Objective: The purpose of this study is to present a methodology for assessing patients’ demands and calculating pre-test probabilities using paper forms in Primary Care. Method: Most developing countries do not use Electronic Health Records (EHR in primary care settings. This makes it difficult to access information regarding what occurs within the health center working process. Basically, there are two methodologies to assess patients’ demands and problems or diagnosis stated by doctors. The first is based on single attendance at each appointment, while the second is based on episodes of care; the latter deals with each problem in a longitudinal manner. The methodology developed in this article followed the approach of confronting the ‘reason for the appointment’ and ‘the problem registered’ by doctors. Paper forms were developed taking this concept as central. All appointments were classified by the International Classification of Primary Care (ICPC. Discussion: Even in paper form, confrontation between ‘reason for the appointment’ and ‘problem registered’ is useful for measuring the pre-test probabilities of each problem-based appointment. This approach can be easily reproduced in any health center and enables a better understanding of population profile. Prevalence of many illnesses and diseases are not known in each reality, and studies conducted in other settings, such as secondary and tertiary care, are not adequate for primary health care. Conclusion: This study offers adequate technology for primary health care workers that have potential to transform each health center into a research-led practice, contributing directly to patient care.

  10. The care of my child with cancer: a new instrument to measure caregiving demand in parents of children with cancer.

    Science.gov (United States)

    Wells, Diane Keegan; James, Kelly; Stewart, Janet L; Moore, Ida M; Kelly, Katherine Patterson; Moore, Barbara; Bond, Dana; Diamond, Joy; Hall, Brenda; Mahan, Rosemary; Roll, Lona; Speckhart, Beth

    2002-06-01

    The growing societal trend toward delivering more and more illness-related care in the home, driven both by family preferences and by mandates from third-party reimbursers, places additional responsibilities for increasingly complex caregiving on parents of children with serious illness. This article reports on the development and initial field test of The Care of My Child with Cancer, a caregiving demand instrument specific to the childhood cancer population. The instrument demonstrated strong internal consistency and test-retest reliability, and exploratory factor analysis provided initial evidence for the instrument's construct validity. The instrument will now be applied in a collaborative program of nursing research to further investigate caregiving demand and ultimately to develop nursing interventions to maximize medical and quality of life outcomes for children with cancer and their families.

  11. Learning the meaning of care: a case study in a geriatric home in Upper Egypt.

    Science.gov (United States)

    Boggatz, Thomas; Dassen, Theo

    2006-04-01

    Geriatric care is a new phenomenon in Egypt. This study investigates how Egyptian caregivers experience their work and how they conceive its meaning. A qualitative case study in a geriatric home in Upper Egypt was conducted using structured interviews with 10 staff members and content analysis according to Mayring. Performing care required learning to overcome initial experiences of fear, disgust, and sexual taboo. Care was perceived as a laborious repetition. Its ideal form was described as a reaction to a demand combined with kind patience and a family-like relationship. Christian and female values allowed coping with experienced problems and alleviated conflicts between traditional gender roles and care of male residents. Traditional values helped to adapt to the requirements of providing care. Sexual taboos may reduce willingness to provide care, but traditional values may encourage caregivers.

  12. Innovations In Diabetes Care Around the World: Case Studies Of Care Transformation Through Accountable Care Reforms.

    Science.gov (United States)

    Thoumi, Andrea; Udayakumar, Krishna; Drobnick, Elizabeth; Taylor, Andrea; McClellan, Mark

    2015-09-01

    The rising prevalence, health burden, and cost of chronic diseases such as diabetes have accelerated global interest in innovative care models that use approaches such as community-based care and information technology to improve or transform disease prevention, diagnosis, and treatment. Although evidence on the effectiveness of innovative care models is emerging, scaling up or extending these models beyond their original setting has been difficult. We developed a framework to highlight policy barriers-institutional, regulatory, and financial-to the diffusion of transformative innovations in diabetes care. The framework builds on accountable care principles that support higher-value care, or better patient-level outcomes at lower cost. We applied this framework to three case studies from the United States, Mexico, and India to describe how innovators and policy leaders have addressed barriers, with a focus on important financing barriers to provider and consumer payment. The lessons have implications for policy reform to promote innovation through new funding approaches, institutional reforms, and performance measures with the goal of addressing the growing burdens of diabetes and other chronic diseases.

  13. Issue Salience and the Domestic Legitimacy Demands of European Integration. The Cases of Britain and Germany

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    Henrike Viehrig

    2008-04-01

    Full Text Available The salience of European issues to the general public is a major determinant of the domestic legitimacy demands that governments face when they devise their European policies. The higher the salience of these issues, the more restrictive will be the legitimacy demands that governments have to meet on the domestic level. Whereas the domestic legitimacy of European policy can rest on a permissive consensus among the public in cases of low issue salience, it requires the electorate’s explicit endorsement in cases of high issue salience. Polling data from Britain and Germany show that the salience of European issues is clearly higher in Britain than in Germany. We thus conclude that British governments face tougher domestic legitimacy demands when formulating their European policies than German governments. This may contribute to accounting for both countries’ different approaches to the integration process: Germany as a role model of a pro-integrationist member state and, in contrast, Britain as the eternal 'awkward partner'.

  14. Improving Demand-oriented Quality Care in Family Planning--A Review of Practice and Experience in Family Planning Programme of Qianjiang, Hubei

    Institute of Scientific and Technical Information of China (English)

    Jia-yuan LIAO; Meng-ye PENG; Er-sheng GAO

    2003-01-01

    @@ With the mainstreaming being the demand from the people at reproductive age, we systematically analyzed the ideas and ways to implement quality care (QC) in family planning (FP) in Qianjiang, including advocating the conception of quality care, carrying out health education and counseling, strengthening capacity building of service system and reforming measurement of the evaluation and other aspects. The demand-oriented QC in FP has met personalized and verified demands from people of reproductive age satisfactorily, and kept the fertility rate at a lower level while uplifting satisfaction of the public. The demand-oriented QC in FP in Qianjiang county proved to be a successful and great worth practice.

  15. Information Technology Framework for Pharmaceutical Supply Chain Demand Management: a Brazilian Case Study

    Directory of Open Access Journals (Sweden)

    Pedro Domingos Antoniolli

    2016-01-01

    Full Text Available The paper aims at proposing an information technology framework for demand management within a dyad on the supply chain pharmaceutical industry. The paper adopts the exploratory study as research method, involving a producer of generic drugs and its main distributor. Data was collected by semi - structured interviews. In pharmaceu tical supply chain, sharing information boosted by information technology translates into greater flexibility and reliability, lower costs, obtained through more reliable forecasting, and lower inventory requirements. There are few initiatives involving In formation Technology (IT applied to demand management in pharmaceutical supply chains available in the literature. It was found that the IT framework proposed in this research is adherent to the demand management of the focused pharmaceutical dyad. Other assumption was that, if partners processes integration exist, better supply chain performance is achieved. It was found that, by means of proposed tools and solutions, such as RFID and involved partners applications integration, this goal could be achieved . Because of the chosen research approach, results may be restricted to these specific dyadic processes. Further application of the proposed IT framework have to be tested. The paper identifies demand management strategic and operational processes that can reach a better performance by using the proposed IT framework. Based on the literature, were identified which IT requirements should be met to demand management processes optimization. Additionally, were applied questionnaires and interviews to the focuse d dyad personnel, to corroborate the data identified in the literature. Answers found in the case study link literature elements with those stated by respondents. Finally, based on this, was conceived an IT framework composed of three elements: 1. One spec ific for infrastructure, to enable data and systems interoperability among SC participants, considering a

  16. The old care paradigm is dead, long live the new sustainable care paradigm: how can GP commissioning consortia meet the demand challenges of 21st century healthcare?

    Science.gov (United States)

    Mackenzie, James

    2011-07-01

    There are many challenges facing the health system in the 21st century - the majority of which are related to managing demand for health services. To meet these challenges emerging GP commissioning consortia will need to take a new approach to commissioning health services - an approach that moves beyond the current acute-centred curative paradigm of care to a new sustainable paradigm of care that focuses on primary care, integrated services and upstream prevention to manage demand. A key part of this shift is the recognition that the health system does not operate in a vacuum and that strategic commissioning decisions must take account of wider determinants of health and well-being, and operate within the finite limits of the planet's natural resources. The sustainable development principle of balancing financial, social and environmental considerations is crucial in managing demand for health services and ensuring that the health system is resilient to risks of resource uncertainty and a changing climate. Building sustainability into the governance and contracting processes of GP commissioning consortia will help deliver efficiency savings, impact on system productivity, manage system risk and help manage demand through the health co-benefits of taking a whole systems approach to commissioning decisions. Commissioning services from providers committed to corporate social responsibility and sustainable business practices allows us to move beyond a health system that cures people reactively to one in which the health of individuals and populations is managed proactively through prevention and education. The opportunity to build sustainability principles into the culture of GP commissioning consortia upfront should be seized now to ensure the new model of commissioning endures and is fit for the future.

  17. Women's participation in rural credit programmes in Bangladesh and their demand for formal health care: is there a positive impact?

    Science.gov (United States)

    Nanda, P

    1999-08-01

    Within the overall aim of poverty alleviation, development efforts have included credit and self-employment programmes. In Bangladesh, the major beneficiaries of such group-based credit programmes are rural women who use the loans to initiate small informal income-generating activities. This paper explores the benefits of women's participation in credit programmes on their own health seeking. Using data from a sample of 1798 households from rural Bangladesh, conducted in 1991-1992 through repeated random sampling of 87 districts covered by Grameen Bank, Bangladesh Rural Advancement Committee (BRAC) and Bangladesh Rural Development Board (BRDB), this paper addresses the question: does women's participation in credit programmes significantly affect their use of formal health care? A non-unitary household preference model is suggested to test the hypothesis that women's empowerment through participation in these programmes results in greater control of resources for their own demand for formal health care. The analysis controls for endogeneity due to self-selection and other unobserved village level factors through the use of a weighted two stage instrumental variable approach with village level fixed effects. The findings indicate a positive impact of women's participation in credit programmes on their demand for formal health care. The policy simulations on the results of this study highlight the importance of credit programmes as a health intervention in addition to being a mechanism for women's economic empowerment.

  18. Demand and predictors for post-discharge medical counseling in home care patients: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Shih-Tan Ding

    Full Text Available RATIONALE: Post-discharge care is challenging due to the high rate of adverse events after discharge. However, details regarding post-discharge care requirements remain unclear. Post-discharge medical counseling (PDMC by telephone service was set-up to investigate its demand and predictors. METHODS: This prospective study was conducted from April 2011 to March 2012 in a tertiary referral center in northern Taiwan. Patients discharged for home care were recruited and educated via telephone hotline counseling when needed. The patient's characteristics and call-in details were recorded, and predictors of PDMC use and worsening by red-flag sign were analyzed. RESULTS: During the study period, 224 patients were enrolled. The PDMC was used 121 times by 65 patients in an average of 8.6 days after discharge. The red-flag sign was noted in 17 PDMC from 16 patients. Of the PDMC used, 50% (n = 60 were for symptom change and the rest were for post-discharge care problems and issues regarding other administrative services. Predictors of PDMC were underlying malignancy and lower Barthel index (BI. On the other hand, lower BI, higher adjusted Charlson co-morbidity index (CCI, and longer length of hospital stay were associated with PDMC and red-flag sign. CONCLUSIONS: Demand for PDMC may be as high as 29% in home care patients within 30 days after discharge. PDMC is needed more by patients with malignancy and lower BI. More focus should also be given to those with lower BI, higher CCI, and longer length of hospital stay, as they more frequently have red flag signs.

  19. Veterans Health Administration Office of Nursing Services exploration of positive patient care synergies fueled by consumer demand: care coordination, advanced clinic access, and patient self-management.

    Science.gov (United States)

    Wertenberger, Sydney; Yerardi, Ruth; Drake, Audrey C; Parlier, Renee

    2006-01-01

    The consumers who utilize the Veterans Health Administration healthcare system are older, and most are learning to live with chronic diseases. Their desires and needs have driven changes within the Veterans Health Administration. Through patient satisfaction initiatives and other feedback sources, consumers have made it clear that they do not want to wait for their care, they want a say in what care is provided to them, and they want to remain as independent as possible. Two interdisciplinary processes/models of healthcare are being implemented on the national level to address these issues: advanced clinic access and care coordination. These programs have a synergistic relationship and are integrated with patient self-management initiatives. Positive outcomes of these programs also meet the needs of our staff. As these new processes and programs are implemented nationwide, skills of both patients and nursing staff who provide their care need to be enhanced to meet the challenges of providing nursing care now and into the 21st century. Veterans Health Administration Office of Nursing Services Strategic Planning Work Group is defining and implementing processes/programs to ensure nurses have the knowledge, information, and skills to meet these patient care demands at all levels within the organization.

  20. Palliative care case management in primary care settings: A nationwide survey

    NARCIS (Netherlands)

    Plas, A.G. van der; Deliens, L.; Watering, M. van de; Jansen, W.J.; Vissers, K.C.P.; Onwuteaka-Philipsen, B.D.

    2013-01-01

    BACKGROUND: In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the

  1. Influences on Case-Managed Community Aged Care Practice.

    Science.gov (United States)

    You, Emily Chuanmei; Dunt, David; Doyle, Colleen

    2016-10-01

    Case management has been widely implemented in the community aged care setting. In this study, we aimed to explore influences on case-managed community aged care practice from the perspectives of community aged care case managers. We conducted 33 semistructured interviews with 47 participants. We drew these participants from a list of all case managers working in aged care organizations that provided publicly funded case management program(s)/packages in Victoria, Australia. We used a multilevel framework that included such broad categories of factors as structural, organizational, case manager, client, and practice factors to guide the data analysis. Through thematic analysis, we found that policy change, organizational culture and policies, case managers' professional backgrounds, clients with culturally and linguistically diverse backgrounds, and case management models stood out as key influences on case managers' practice. In the future, researchers can use the multilevel framework to undertake implementation research in similar health contexts.

  2. An Optimization of (Q,r Inventory Policy Based on Health Care Apparel Products with Compound Poisson Demands

    Directory of Open Access Journals (Sweden)

    An Pan

    2014-01-01

    Full Text Available Addressing the problems of a health care center which produces tailor-made clothes for specific people, the paper proposes a single product continuous review model and establishes an optimal policy for the center based on (Q,r control policy to minimize expected average cost on an order cycle. A generic mathematical model to compute cost on real-time inventory level is developed to generate optimal order quantity under stochastic stock variation. The customer demands are described as compound Poisson process. Comparisons on cost between optimization method and experience-based decision on Q are made through numerical studies conducted for the inventory system of the center.

  3. A case study of ethanol water demand during industrial phase in Brazil

    Science.gov (United States)

    Hernandes, T.; Scarpare, F. V.; Guarenghi, M.; Pereira, T.; Galdos, M. V.

    2012-12-01

    Thayse A. D. Hernandesb, Fábio V. Scarparea, Marjorie M. Guarenghib, Tássia P. Pereirab, Marcelo V. Galdosa a Laboratório Nacional de Ciência e Tecnologia do Bioetanol - CTBE/CNPEM, Caixa Postal 6170, 13083-970 Campinas, São Paulo, Brazil, E-mail: fabio.scarpare@bioetanol.org.br b Faculdade de Engenharia Mecânica, Unicamp, Cidade Universitária "Zeferino Vaz", CEP 13083-860, Campinas, SP, Brazil In São Paulo State, the water resources have being used by sugarcane industry responsibly, through high reuse rates that may reach 95% during industrial process. The average amount of catchment water stays around 2.0 m3 Mg 1 of industrial sugarcane stalk. However, in some modern mills which use higher technical level of closed water circuit, the standard goal for sugarcane industry, 1.0 m3 Mg 1 can be reached. In some regions where the uptake water for industrial segment is high as in São Paulo State, water use assessment is desired for sustainable ethanol production. Thus, two regions in São Paulo State with two plants each were taken as a case study aiming to assess ethanol water demand during the industrial phase. Araraquara was the first study region where the water demand was classified as in critical condition in 2010 according to the Water and Electrical Energy Department of São Paulo State (DAEE). The industrial activities were responsible for 50% of the water catchment. Araçatuba was the second study region where water demand was classified as being of concern (DAEE) due to high percentage of catchment water for industrial activities, around 90%. Data regarding the amount of millable cane processed, days of the plant operation, ratio of cane used for ethanol production in 2010/2011 season were used for direct water demand estimation considering different water catchment scenarios of 2.0, 1.0 and 0.7 (technological development prediction scenario) m3 Mg-1 of millable cane. For indirect water demand estimation, data regarding installed capacity of each

  4. Impoverishment of practice: analysis of effects of economic discourses in home care case management practice.

    Science.gov (United States)

    Ceci, Christine

    2006-03-01

    Home care is a health sector under increasing pressure. Demand is often said to be outstripping capacity, with constant change and retrenchment distinguishing features of the current context. This paper takes a reading of the current conditions of home care using data gathered during a field study of home care case management practices conducted in 2004. As economic discourses become increasingly influential in determining responses to client situations, case managers (and their managers) find themselves with limited capacity to exercise control over their practices. A growing gap between professionally influenced discourses--those presumably intended to guide practice--and organizational priorities creates a dissonance for case managers as the political-ethical dimensions of their practices are displaced by budget "realities." For front-line workers, such displacement cannot be sustained in their face-to-face encounters with clients, leading to a growing sense of frustration and powerlessness among these highly skilled practitioners.

  5. The impact of the increase in user fees on the demand for primary health care in the Parque Family Health Unit

    OpenAIRE

    Ramos, António; Rúbio, Catarina; Rodrigues, Diogo; Nunes, Gonçalo; Bettencourt, Joana; Ângelo, Samuel; Coelho, Sónia; Maria, Vasco

    2013-01-01

    Objectives: To assess the impact of the increase in user fees on the demand for primary health care in the Parque Family Health Unit, to compare consultation rates in the Parque FHU between January 1and May 31, 2011, and the same period in 2012, and to identify factors associated with patient demand for care in this unit. Design: Retrospective longitudinal, observational and analytical. Setting: Parque Family Health Unit, North Lisbon Health Centres Group (ACES Lisboa Norte) Population: Pa...

  6. Dental education and changing oral health care needs: disparities and demands.

    Science.gov (United States)

    Albino, Judith E N; Inglehart, Marita R; Tedesco, Lisa A

    2012-01-01

    The population of the United States has changed dramatically over recent decades and, with it, the oral health care needs of the nation. Most notably, the racial/ethnic composition of the population has shifted from a European American majority to what is now a much more diverse population, comprising a variety of racial/ethnic groups that, taken together, will become the majority by mid-century. The proportion of children from minority racial groups will represent more than half of all U.S. children by 2025. These groups are overrepresented among those living below the poverty level and have higher levels of oral disease and are less likely to have access to care than the European American segment of the U.S. population. Most of the population needing dental care in the future will be comprised of these now underserved groups, along with other groups who can be described in terms of the health and social challenges of aging, disabilities, or other special health care conditions. This article provides an overview of these various needs and what they will mean for the dental practitioners of tomorrow and suggests that dental education has not adapted to the changing population and its oral health needs as quickly as it should. As a result, we identify major gaps in current dental curricula and make some recommendations for change. Research has shown that dental education has a crucial influence on future providers' professional attitudes and behavior related to providing care for patients from underserved patient groups. Acknowledging the specific needs of patients and ensuring that future providers are optimally prepared to respond to these challenges must be a major goal of dental education in the twenty-first century. The Journal of Dental Education will continue to play a critical role in informing readers about innovative approaches and best practices that ensure this goal can be met.

  7. Traumatic Brain Injury Recovery Care: Demand Forecasting Staffing, and Treatment Planning

    Science.gov (United States)

    2013-03-21

    pathology, occupational therapy, psychologists, physical therapy, and rehab nurses . Treatment is based upon symptoms of the client. “We treat...pathology, occupational therapy, psychology, physical therapy, and rehab nursing . In Figure 25 there are five hypothetical treatments. Each treatment...Cochran, J. K., & Bharti, A. (2006). Stochastic bed balancing of an obstetrics hospital. Health Care Management Science , 9, 31-45. Cochran, J. K

  8. Exploring the Demands on Nurses Working in Health Care Facilities During a Large-Scale Natural Disaster

    Directory of Open Access Journals (Sweden)

    Gillian C. Scrymgeour

    2016-06-01

    Full Text Available Nurses are pivotal to an effective societal response to a range of critical events, including disasters. This presents nurses with many significant and complex challenges that require them to function effectively under highly challenging and stressful circumstances and often for prolonged periods of time. The exponential growth in the number of disasters means that knowledge of disaster preparedness and how this knowledge can be implemented to facilitate the development of resilient and adaptive nurses and health care organizations represents an important adjunct to nurse education, policy development, and research considerations. Although this topic has and continues to attract attention in the literature, a lack of systematic understanding of the contingencies makes it difficult to clearly differentiate what is known and what gaps remain in this literature. Providing a sound footing for future research can be facilitated by first systematically reviewing the relevant literature. Focused themes were identified and analyzed using an ecological and interactive systems framework. Ten of the 12 retained studies included evacuation, revealing that evacuation is more likely to occur in an aged care facility than a hospital. The unpredictability of an event also highlighted organizational, functional, and competency issues in regard to the complexity of decision making and overall preparedness. The integrative review also identified that the unique roles, competencies, and demands on nurses working in hospitals and residential health care facilities during a natural disaster appear invisible within the highly visible event.

  9. A Novel Hierarchical Model to Locate Health Care Facilities with Fuzzy Demand Solved by Harmony Search Algorithm

    Directory of Open Access Journals (Sweden)

    Mehdi Alinaghian

    2014-08-01

    Full Text Available In the field of health losses resulting from failure to establish the facilities in a suitable location and the required number, beyond the cost and quality of service will result in an increase in mortality and the spread of diseases. So the facility location models have special importance in this area. In this paper, a successively inclusive hierarchical model for location of health centers in term of the transfer of patients from a lower level to a higher level of health centers has been developed. Since determination the exact number of demand for health care in the future is difficult and in order to make the model close to the real conditions of demand uncertainty, a fuzzy programming model based on credibility theory is considered. To evaluate the proposed model, several numerical examples are solved in small size. In order to solve large scale problems, a meta-heuristic algorithm based on harmony search algorithm was developed in conjunction with the GAMS software which indicants the performance of the proposed algorithm.

  10. Balanced scorecard application in the health care industry: a case study.

    Science.gov (United States)

    Kocakülâh, Mehmet C; Austill, A David

    2007-01-01

    Balanced scorecards became a popular strategic performance measurement and management tool in the 1990s by Robert Kaplan and David Norton. Mainline companies accepted balanced scorecards quickly, but health care organizations were slow to adopt them for use. A number of problems face the health care industry, including cost structure, payor limitations and constraints, and performance and quality issues that require changes in how health care organizations, both profit and nonprofit, manage operations. This article discusses balanced scorecards generally from theoretical and technical views, and why they should be used by health care organizations. The authors argue that balanced scorecards are particularly applicable to hospitals, clinics, and other health care companies. Finally, the authors perform a case study of the development, implementation, and use of balance scorecards by a regional Midwestern health care system. The positive and negative aspects of the subject's balanced scorecard are discussed. Leaders in today's health care industry are under great pressure to meet their financial goals. The industry is faced with financial pressures from consumers, insurers, and governments. Inflation in the industry is much higher than it is within the overall economy. Employers can no longer bear the burden of rising group health insurance costs for its employees. Too many large companies have used bankruptcy law as a shield to reduce or shift some of their legal obligations to provide health insurance coverage to present or retired employees. Stakeholders of health care providers are demanding greater control over costs. As the segment of un- or underinsured within the United States becomes larger as a percentage of the population, voters are seriously beginning to demand some form of national health insurance, which will drastically change the health care industry.

  11. A Solution Approach from an Analytic Model to Heuristic Algorithm for Special Case of Vehicle Routing Problem with Stochastic Demands

    OpenAIRE

    Selçuk K. İşleyen; Ö. Faruk Baykoç

    2008-01-01

    We define a special case for the vehicle routing problem with stochastic demands (SC-VRPSD) where customer demands are normally distributed. We propose a new linear model for computing the expected length of a tour in SC-VRPSD. The proposed model is based on the integration of the “Traveling Salesman Problem” (TSP) and the Assignment Problem. For large-scale problems, we also use an Iterated Local Search (ILS) algorithm in order to reach an effective solution.

  12. The impact of climate change on the BRICS economies: The case of insurance demand.

    Science.gov (United States)

    Ranger, N.; Surminski, S.

    2012-04-01

    Session ERE5.1 Climate change impact on economical and industrial activities The impact of climate change on the BRICS economies: The case of insurance demand. Over the past decade, growth in the BRICS (Brazil, Russia, India, China and South Africa) economies has been a key driver of global economic growth. Current forecasts suggest that these markets will continue to be areas of significant growth for a large number of industries. We consider how climate change may influence these trends in the period to 2030, a time horizon that is long in terms of strategic planning in industry, but relatively short for climate change analysis, where the impacts are predicted to be most significant beyond around 2050. Based on current evidence, we expect climate change to affect the BRICS economies in four main ways: 1. The impact of physical climatic changes on the productivity of climate-sensitive economic activity, the local environment, human health and wellbeing, and damages from extreme weather. 2. Changing patterns of investment in climate risk management and adaptation 3. Changing patterns of investments in areas affected by greenhouse gas (GHG) mitigation policy, 4. The impacts of the above globally, including on international trade, growth, investment, policy, migration and commodity prices, and their impacts on the BRICS. We review the evidence on the impacts of climate change in the BRICS and then apply this to one particular industry sector: non-life insurance. We propose five potential pathways through which climate change could influence insurance demand: economic growth; willingness to pay for insurance; public policy and regulation; the insurability of natural catastrophe risks; and new opportunities associated with adaptation and greenhouse gas mitigation. We conclude that, with the exception of public policy and regulation, the influence of climate change on insurance demand to 2030 is likely to be small when compared with the expected growth due to rising

  13. Improving Diabetes Care in the Military Primary Care Clinic: Case Study Review

    Science.gov (United States)

    2016-03-23

    required application of innovative and creative strategies to improve self- management . The cases are representative of some common themes within the patient with type 2 diabetes in a military primary care clinic....enabled patients to engage in self- management . Moreover, this study seeks to better understand how applying the ADA Standards of Care in a military

  14. Linking Agricultural Trade, Land Demand and Environmental Externalities: Case of Oil Palm in South East Asia

    OpenAIRE

    Othman, Jamal

    2003-01-01

    Reduction of support measures affecting soybean oil in the major soybean producing countries, as a consequence of WTO rules, coupled with rising demand for palm oil in non-traditional palm oil importing countries may lead to pronounced increases in agricultural land demand for oil palm expansion in Malaysia and Indonesia – two main palm oil producing and exporting countries. However, it is expected that the effects on agricultural land demand and consequently impact upon the environment will ...

  15. A Framework for Sustainable Urban Water Management through Demand and Supply Forecasting: The Case of Istanbul

    Directory of Open Access Journals (Sweden)

    Murat Yalçıntaş

    2015-08-01

    Full Text Available The metropolitan city of Istanbul is becoming overcrowded and the demand for clean water is steeply rising in the city. The use of analytical approaches has become more and more critical for forecasting the water supply and demand balance in the long run. In this research, Istanbul’s water supply and demand data is collected for the period during 2006 and 2014. Then, using an autoregressive integrated moving average (ARIMA model, the time series water supply and demand forecasting model is constructed for the period between 2015 and 2018. Three important sustainability metrics such as water loss to supply ratio, water loss to demand ratio, and water loss to residential demand ratio are also presented. The findings show that residential water demand is responsible for nearly 80% of total water use and the consumption categories including commercial, industrial, agriculture, outdoor, and others have a lower share in total water demand. The results also show that there is a considerable water loss in the water distribution system which requires significant investments on the water supply networks. Furthermore, the forecasting results indicated that pipeline projects will be critical in the near future due to expected increases in the total water demand of Istanbul. The authors suggest that sustainable management of water can be achieved by reducing the residential water use through the use of water efficient technologies in households and reduction in water supply loss through investments on distribution infrastructure.

  16. Confronting evidence: individualised care and the case for shared decision-making.

    LENUS (Irish Health Repository)

    Ryan, P

    2014-11-01

    In many clinical scenarios there exists more than one clinically appropriate intervention strategy. When these involve subjective trade-offs between potential benefits and harms, patients\\' preferences should inform decision-making. Shared decision-making is a collaborative process, where clinician and patient reconcile the best available evidence with respect for patients\\' individualized care preferences. In practice, clinicians may be poorly equipped to participate in this process. Shared decision-making is applicable to many conditions including stable coronary artery disease, end-of-life care, and numerous small decisions in chronic disease management. There is evidence of more clinically appropriate care patterns, improved patient understanding and sense of empowerment. Many trials reported a 20% reduction in major surgery in favour of conservative treatment, although demand tends to increase for some interventions. The generalizability of international evidence to Ireland is unclear. Considering the potential benefits, there is a case for implementing and evaluating shared decision-making pilot projects in Ireland.

  17. Implications of the introduction of laboratory demand management at primary care clinics in South Africa on laboratory expenditure

    Directory of Open Access Journals (Sweden)

    Ozayr H. Mahomed

    2016-02-01

    Full Text Available Background: Diagnostic health laboratory services are regarded as an integral part of the national health infrastructure across all countries. Clinical laboratory tests contribute substantially to health system goals of increasing quality of care and improving patient outcomes.Objectives: This study aimed to analyse current laboratory expenditures at the primary healthcare (PHC level in South Africa as processed by the National Health Laboratory Service and to determine the potential cost savings of introducing laboratory demand management.Methods: A retrospective cross-sectional analysis of laboratory expenditures for the 2013/2014 financial year across 11 pilot National Health Insurance health districts was conducted. Laboratory expenditure tariff codes were cross-tabulated to the PHC essential laboratory tests list (ELL to determine inappropriate testing. Data were analysed using a Microsoft Access database and Excel software.Results: Approximately R35 million South African Rand (10% of the estimated R339 million in expenditures was for tests that were not listed within the ELL. Approximately 47% of expenditure was for laboratory tests that were indicated in the algorithmic management of patients on antiretroviral treatment. The other main cost drivers for non-ELL testing included full blood count and urea, as well as electrolyte profiles usually requested to support management of patients on antiretroviral treatment.Conclusions: Considerable annual savings of up to 10% in laboratory expenditure are possible at the PHC level by implementing laboratory demand management. In addition, to achieve these savings, a standardised PHC laboratory request form and some form of electronic gatekeeping system that must be supported by an educational component should be implemented.

  18. Demand assessment and price-elasticity estimation of quality-improved primary health care in Palestine: a contribution from the contingent valuation method.

    Science.gov (United States)

    Mataria, Awad; Luchini, Stéphane; Daoud, Yousef; Moatti, Jean-Paul

    2007-10-01

    This paper proposes a new methodology to assess demand and price-elasticity for health care, based on patients' stated willingness to pay (WTP) values for certain aspects of health care quality improvements. A conceptual analysis of how respondents consider contingent valuation (CV) questions allowed us to specify a probability density function of stated WTP values, and consequently, to model a demand function for quality-improved health care, using a parametric survival approach. The model was empirically estimated using a CV study intended to assess patients' values for improving the quality of primary health care (PHC) services in Palestine. A random sample of 499 individuals was interviewed following medical consultation in four PHC centers. Quality was assessed using a multi-attribute approach; and respondents valued seven specific quality improvements using a decomposed valuation scenario and a payment card elicitation technique. Our results suggest an inelastic demand at low user fees levels, and when the price-increase is accompanied with substantial quality-improvements. Nevertheless, demand becomes more and more elastic if user fees continue to rise. On the other hand, patients' reactions to price-increase turn out to depend on their level of income. Our results can be used to design successful health care financing strategies that include a consideration of patients' preferences and financial capacities.

  19. [Individualised care plan during extracorporeal membrane oxygenation. A clinical case].

    Science.gov (United States)

    Call Mañosa, S; Pujol Garcia, A; Chacón Jordan, E; Martí Hereu, L; Pérez Tejero, G; Gómez Simón, V; Estruga Asbert, A; Gallardo Herrera, L; Vaquer Araujo, S; de Haro López, C

    2016-01-01

    An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy.

  20. Uptake of meningococcal conjugate vaccine among adolescents in large managed care organizations, United States, 2005: Demand, supply and seasonality

    Directory of Open Access Journals (Sweden)

    Wortley Pascale M

    2009-11-01

    Full Text Available Abstract Background In February 2005, the US Advisory Committee on Immunization Practices recommended the new meningococcal conjugate vaccine (MCV4 for routine use among 11- to 12-year-olds (at the preadolescent health-care visit, 14- to 15-year-olds (before high-school entry, and groups at increased risk. Vaccine distribution started in March; however, in July, the manufacturer reported inability to meet demand and widespread MCV4 shortages were reported. Our objectives were to determine early uptake patterns among target (11-12 and 14-15 year olds and non-target (13- plus 16-year-olds age groups. A post hoc analysis was conducted to compare seasonal uptake patterns of MCV4 with polysaccharide meningococcal (MPSV4 and tetanus diphtheria (Td vaccines. Methods We analyzed data for adolescents 11-16 years from five managed care organizations participating in the Vaccine Safety Datalink (VSD. For MCV4, we estimated monthly and cumulative coverage during 2005 and calculated risk ratios. For MPSV4 and Td, we combined 2003 and 2004 data and compared their seasonal uptake patterns with MCV4. Results Coverage for MCV4 during 2005 among the 623,889 11-16 years olds was 10%. Coverage for 11-12 and 14-15 year olds was 12% and 11%, respectively, compared with 8% for 13- plus 16-year-olds (p Conclusion A surge in vaccine uptake between June and August was observed among adolescents for MCV4, MPSV4 and Td vaccines. The increase in summer-time vaccinations and vaccination of non-targeted adolescents coupled with supply limitations likely contributed to the reported shortages of MCV4 in 2005.

  1. Prevalence of nephropathy in the German diabetes population-Is early referral to nephrological care a realistic demand today?

    Science.gov (United States)

    Pommer, Wolfgang

    2008-10-01

    In Germany, diabetes mellitus in the general population has increased to ∼8 million people. The implication of this trend for future nephrological care is not well known, as data on this issue are rather limited. Results from different population-based studies suggest that microalbuminuria in diabetic patients is present in 20-30% of the cases. Findings from the diabetes disease management programme in the North-Rhine area revealed the prevalence of chronic kidney disease (CKD) stage II in half of the participants (CKD stage III was present in ∼20%). Only a small proportion of this cohort (∼1-2%) will reach end-stage renal failure, probably due to the excess mortality risks attributed to advanced kidney disease. Results from the QUASI-Niere registry, which reports on renal replacement therapy in Germany, indicate almost constant incidence and prevalence rates of diabetes in the last 5 years (30.6-34.2% and 23.6-27.1%, respectively). The high percentages of early stages of CKD in the diabetes population indicate a potentially high burden of future nephrological care, especially if patients are referred to nephrologists at an early stage. In reality, in nephrological care, bearing this burden is impossible without expanding the resources for this patient group.

  2. Emergency care outcomes of acute chemical poisoning cases in Rawalpindi

    Institute of Scientific and Technical Information of China (English)

    Ibrar Rafique; Umbreen Akhtar; Umar Farooq; Mussadiq Khan; Junaid Ahmad Bhatti

    2016-01-01

    Objective: To assess the emergency care outcomes of acute chemical poisoning cases in tertiary care settings in Rawalpindi, Pakistan. Methods: The data were extracted from an injury surveillance study conducted in the emergency departments (ED) of three tertiary care hospitals of Rawalpindi city from July 2007 to June 2008. The World Health Organization standard reporting questionnaire (one page) was used for recording information. Associations of patients' characteristics with ED care outcomes, i.e., admitted vs. discharged were assessed using logistic regression models. Results: Of 62 530 injury cases reported, chemical poisoning was identified in 434 (0.7%) cases. The most frequent patient characteristics were poisoning at home (61.9%), male gender (58.6%), involving self-harm (46.0%), and youth aged 20–29 years (43.3%). Over two-thirds of acute poisoning cases (69.0%) were admitted. Acute poisoning cases were more likely to be admitted if they were youth aged 10–19 years [odds ratio (OR)=4.41], when the poisoning occurred at home (OR=21.84), and was related to self-harm (OR=18.73) or assault (OR=7.56). Conclusions: Findings suggest that controlling access of poisonous substances in youth and at homes might reduce related ED care burden. Safety promotion agencies and emergency physicians can use these findings to develop safety messages.

  3. System Dynamics Approach to Urban Water Demand Forecasting A Case Study of Tianjin

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hongwei; ZHANG Xuehua; ZHANG Baoan

    2009-01-01

    A system dynamics approach to urban water demand forecasting was developed based on the analysis of urban water resources system.which was characterized by multi.feedback and nonlinear interactions among system elements.As an example,Tianjin water resources system dynamic model was set up to forecast water resources demand of the planning years.The practical verification showed that the relative error was lower than 1O%.Furthermore,through the comparison and analysis of the simulation results under different development modes presented in this paper.the forecasting results ofthe water resources demand ofTianiin was achieved based on sustainable utilization strategy of water resources.

  4. The (in)accuracy of travel demand forecasts in the case of no-build alternatives

    DEFF Research Database (Denmark)

    Nicolaisen, Morten Skou; Næss, Petter

    -build alternatives, in order to assess the impact of doing something rather than doing nothing. Previous research on the accuracy of demand forecasts has focused exclusively on the build alternatives, and revealed inaccuracies in the form of large imprecisions as well as systematic biases. However, little...... underestimation of travel demand observed in previous studies of build alternatives. These results indicate that the problem of systematic biases in travel demand forecasts for road projects have more problematic implications than previously assumed. The effect inflates rather than diminishes the problem...... of previously observed discrepancies between expected and observed travel demand, and the true magnitude of forecasting bias is thus greater than reported so far. The main implication for planning practice is that impact appraisals of road construction as a means of congestion relief appear overly beneficial...

  5. A stable demand for money despite financial crisis: The case of Venezuela.

    OpenAIRE

    Bjørnland, Hilde C.

    2003-01-01

    This paper investigates the demand for broad money in Venezuela, over a period of financial crisis and substantial exchange rate fluctuations. The analysis shows that there exist a long run relationship between real money, real income, inflation, the exchange rate and the domestic interest rate, that remains stable over major policy changes and large shocks. The long run properties emphasize that both inflation and exchange rate depreciations have negative effects on real money demand. The lo...

  6. A Solution Approach from an Analytic Model to Heuristic Algorithm for Special Case of Vehicle Routing Problem with Stochastic Demands

    Directory of Open Access Journals (Sweden)

    2009-03-01

    Full Text Available We define a special case for the vehicle routing problem with stochastic demands (SC-VRPSD where customer demands are normally distributed. We propose a new linear model for computing the expected length of a tour in SC-VRPSD. The proposed model is based on the integration of the “Traveling Salesman Problem” (TSP and the Assignment Problem. For large-scale problems, we also use an Iterated Local Search (ILS algorithm in order to reach an effective solution.

  7. Integrated Care in College Health: A Case Study

    Science.gov (United States)

    Tucker, Cary; Sloan, Sarah K.; Vance, Mary; Brownson, Chris

    2008-01-01

    This case study describes 1 international student's treatment experience with an integrated health program on a college campus. This program uses a multidisciplinary, mind-body approach, which incorporates individual counseling, primary care, psychiatric consultation, a mindfulness-based cognitive therapy class, and a meditation group.

  8. Transforming Cultures of Care: A Case Study in Organizational Change

    Science.gov (United States)

    Purvis, Karyn; Cross, David; Jones, Daren; Buff, Gary

    2012-01-01

    The authors report on a small organizational case study highlighting the dimensions of trauma-informed care, the processes of organizational change, and the growth of caregiver expertise. The article is framed by the notion of caregiving cultures, which refers to the beliefs, languages, and practices of caregivers and caregiving organizations.…

  9. Pathological Demand Avoidance in a population-based cohort of children with epilepsy: four case studies.

    Science.gov (United States)

    Reilly, Colin; Atkinson, Patricia; Menlove, Leanne; Gillberg, Christopher; O'Nions, Elizabeth; Happé, Francesca; Neville, Brian G R

    2014-12-01

    Childhood epilepsy is associated with a range of neurobehavioural comorbidities including Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), motor impairments and emotional problems. These difficulties frequently have a greater impact on quality of life than seizures. Pathological Demand Avoidance (PDA) is a term increasingly in use in the UK and Europe to describe behaviours associated with an extreme resistance to demands and requests and the need to be in control in social interactions. In a population-based group of 85 children with epilepsy, four (5%) were identified as displaying significant symptoms of PDA, were assessed using the Extreme Demand Avoidance Questionnaire (EDA-Q) and are described in detail. As well as significant symptoms of PDA, the four children met criteria for a range of neurobehavioural disorders; all four had cognitive impairment (IQDSM-IV-TR criteria for ADHD. Three, in addition, met criteria for ASD and Developmental Coordination Disorder (DCD) and two for Oppositional Defiant Disorder (ODD). All four experienced their first seizure before 5 years of age. School and parent reports indicated very significant functional impairment and management concerns, particularly with respect to complying with everyday demands. Symptoms of PDA should be considered when evaluating neurobehavioural comorbidity in childhood epilepsy.

  10. [Fiscal policy, affordability and cross effects in the demand for tobacco products: the case of Uruguay].

    Science.gov (United States)

    Carbajales, Alejandro Ramos; Curti, Dardo

    2010-01-01

    Uruguay, a country with a solid tobacco control policy since 2005 shows, contrary to expectations, an insignificant decrease in total tobacco products' sales in the last five years. The hypothesis is that on one side, changes in household income and the income elasticity of the demand for cigarettes were important countervailing factors in the demand of both products. The period 2005-2009 shows a large increase of 36% in household real income in Uruguay due to fast economic recovery after the 2002 crisis. The second factor is the interchangeability of roll your own and cigarettes and the impact on the demand of each product as a reaction to tax and price changes. The tax and price of roll your own tobacco remains substantially lower than that of cigarettes. This fact, and the increased substitution of roll your own for cigarettes seems to be the main reasons for the low impact of the policy of tobacco tax and price increases. This paper then consists of a revision of a 2004 study to estimate separate demands for both main tobacco products and obtain estimates for own price, cross price and income elasticities. Then, a simulation study was performed using the elasticities found and two scenarios of increases in household income: moderate (2.5% per year) and high (5% per year) confirming that countries where income is growing fast and with a potential for substitution towards cheaper products require substantial cigarette tax and price increases for a fiscal tobacco control policy to become effective.

  11. The emotional experience of patient care: a case for innovation in health care design.

    Science.gov (United States)

    Altringer, Beth

    2010-07-01

    This paper considers recent developments in health care facility design and in the psychology literature that support a case for increased design sensitivity to the emotional experience of patient care. The author discusses several examples of innovative patient-centred health care design interventions. These generally resulted in improvements in the patient and staff experience of care, at less cost than major infrastructural interventions. The paper relates these developments in practice with recent neuroscience research, illustrating that the design of the built environment influences patient emotional stress. In turn, patient emotional stress appears to influence patient satisfaction, and in some instances, patient outcomes. This paper highlights the need for further research in this area.

  12. [Management of onychocryptosis in primary care: A clinical case].

    Science.gov (United States)

    Zavala Aguilar, K; Gutiérrez Pineda, F; Bozalongo de Aragón, E

    2013-09-01

    Onychocryptosis (ingrown toenail) is a condition commonly seen in Primary Care clinics. It is uncomfortable and restrictive for patients and has a high incidence in males between second and third decades of life. It is of unknown origin, with a number of predisposing triggering factors being involved. Treatment depends on the stage of the ingrown nail and the procedures may range from conservative to minor surgery that can be performed by the Primary Care physician in the health centre. We report the case of a 25-year onychocryptosis that did not respond to conservative management, and was extracted with partial matricectomy of the nail.

  13. The business case for health-care quality improvement.

    Science.gov (United States)

    Swensen, Stephen J; Dilling, James A; Mc Carty, Patrick M; Bolton, Jeffrey W; Harper, Charles M

    2013-03-01

    The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance.

  14. The importance of flexibility in supply and demand in the Natural Gas Market - the Brazilian case

    Energy Technology Data Exchange (ETDEWEB)

    Uchoa Cavalcanti Almeida, Jose Ricardo

    2007-07-01

    In Brazil, there is a paradox: an apparent surplus and lack of natural gas at the same time, because the ballast gas for gas fired power plants tends to stay immobile for a long time, jeopardizing the development of a potential demand in the non-thermoelectric market. This is a situation in which opportunities for modulating the system may produce clear efficiency gains, with benefits for society. That modulation would occur according to the different stages of operational development of the power and natural gas systems. Due to the challenges faced, this article is presenting options in the commercial and operational models by structuring flexibility on the supply side and on the demand side of natural gas that would ensure optimization of investments in exploration and production of natural gas, as well as investments in LNG terminals, transportation and distribution gas pipelines and in the systems of end uses of natural gas. (auth)

  15. Does Trade Help to Explain Tourism Demand? The Case of Portugal

    Directory of Open Access Journals (Sweden)

    Nuno Carlos LEITÃO

    2010-03-01

    Full Text Available The tourism industry has expanded in recent years due to internal and external environmental forces. These forces, income, trade, consumer price, and geographical distance are interconnected. Accounting for imperfect competition and increasing returns to scale, the new trade theory offers the explanation of dynamic gains from international trade. A large number of studies attempt to test the hypothesis that there is a link between trade and tourism. Most of the studies show that trade and tourism are positively correlated. This paper specifies static and dynamic panel demand models for tourism in Portugal and estimates demand equations using tourist inflow data for the period 1995-2006. We find that bilateral trade, immigration, border, and geographical distance between Portugal and countries of origin are the main determinants of tourism to Portugal. The dynamic panel data approach indicates that trade, population, and income are more important determinants than relative price.

  16. Demand for Private Health Insurance Where Public Health Services are Free: The Case of Malawi

    Science.gov (United States)

    Makoka, Donald; Kaluwa, Ben; Kambewa, Patrick

    This study assesses the determinants of demand for private health insurance among formal sector employees in Malawi using a multinomial logit. We examine membership in the three different schemes of Medical Aid Society of Malawi`s (MASM), which was the only health insurance provider at the time of the study. The results indicate that formal sector employees prefer to receive medical treatment from private health facilities, but lack of access to information prevents many from becoming insured. Further, the probability of enrolling in any of MASM`s schemes increases with income and with age for the top and minimum schemes. More children and good health status reduce the probability of enrolling into the two lower schemes. Policies that improve access to information and income among the target group are likely to increase demand for MASM schemes.

  17. Negotiating a demand side bid: City of San Jose case study

    Energy Technology Data Exchange (ETDEWEB)

    1993-06-01

    This report emphasizes the transferability of the gathered information to other local municipal governments. The report provides: general background information on demand side bidding; advantages and disadvantages of participation; alternative and ``ideal`` scenarios for bidding; review of potential pitfalls and lessons learned; and a general framework of information based on this particular request for DSB proposals and the City of San Joe`s response experience.

  18. Evaluating rare earth element availability: a case with revolutionary demand from clean technologies.

    Science.gov (United States)

    Alonso, Elisa; Sherman, Andrew M; Wallington, Timothy J; Everson, Mark P; Field, Frank R; Roth, Richard; Kirchain, Randolph E

    2012-03-20

    The future availability of rare earth elements (REEs) is of concern due to monopolistic supply conditions, environmentally unsustainable mining practices, and rapid demand growth. We present an evaluation of potential future demand scenarios for REEs with a focus on the issue of comining. Many assumptions were made to simplify the analysis, but the scenarios identify some key variables that could affect future rare earth markets and market behavior. Increased use of wind energy and electric vehicles are key elements of a more sustainable future. However, since present technologies for electric vehicles and wind turbines rely heavily on dysprosium (Dy) and neodymium (Nd), in rare-earth magnets, future adoption of these technologies may result in large and disproportionate increases in the demand for these two elements. For this study, upper and lower bound usage projections for REE in these applications were developed to evaluate the state of future REE supply availability. In the absence of efficient reuse and recycling or the development of technologies which use lower amounts of Dy and Nd, following a path consistent with stabilization of atmospheric CO(2) at 450 ppm may lead to an increase of more than 700% and 2600% for Nd and Dy, respectively, over the next 25 years if the present REE needs in automotive and wind applications are representative of future needs.

  19. [Acute care nursing pathology: case report of odynophagia].

    Science.gov (United States)

    Hernández-Fabà, Eva; Sanfeliu-Julià, Cristina

    2010-01-01

    Since 2008, the Institut Catala de la Salut (ICS) introduced the nurses management plan for acute pathology, in primary care centres. In the implementation of this system of organization, the ICS introduced various diseases protocols with performance algorithms. To raise awareness of the the practice of acute pathology, we present a clinical case. An urgent consultation of a 30 year-old male, with fever, sore throat and cough, which was managed and resolved by a nurse. The aim of this new management plan is that nursing is the first health professional to take care of patient coming to primary care centre without a scheduled visit, to avoid saturating the general clinic or hospital emergencies. This new organisational system involves an increase in the responsibilities of nursing in the diagnosis and treatment of patients.

  20. Severe ovarian hyperstimulation syndrome: Intensive care management of two cases

    Directory of Open Access Journals (Sweden)

    Praveen Talawar

    2011-01-01

    Full Text Available Severe ovarian hyperstimulation syndrome (OHSS is characterized by increased capillary permeability and fluid retention in the third space. It is generally a complication of assisted reproduction therapy (ART with exogenous gonadotropins, but cases with natural onset of OHSS have been reported. The massive extravascular exudation can cause tense ascites, pleural and pericardial effusion, hypovolemic shock, oliguria, electrolyte imbalance (hyponatremia and hyperkalemia, and hemoconcentration, with a tendency for hypercoagulability and risk of life-threatening thromboembolic complications. The patient can rarely develop multi-organ failure (adult respiratory distress syndrome, renal failure and death. With increasing use of ART, this syndrome may be seen more frequently in the intensive care unit (ICU, requiring multidisciplinary care. We report the management of two cases of severe OHSS, which required admission to the ICU in our hospital.

  1. Solidarity by demand? Exit and voice in international medical travel - The case of Indonesia

    NARCIS (Netherlands)

    Ormond, M.E.

    2015-01-01

    Globally, more patients are intentionally travelling abroad as consumers for medical care. However, while scholars have begun to examine international medical travel's (IMT) impacts on the people and places that receive medical travellers, study of its impacts on medical travellers' home contexts ha

  2. A Successful Case Study of Small Business Energy Efficiency and Demand Response with Communicating Thermostats

    Energy Technology Data Exchange (ETDEWEB)

    Herter, Karen; Wayland, Seth; Rasin, Josh

    2009-08-12

    This report documents a field study of 78 small commercial customers in the Sacramento Municipal Utility District service territory who volunteered for an integrated energy-efficiency/demand-response (EE-DR) program in the summer of 2008. The original objective for the pilot was to provide a better understanding of demand response issues in the small commercial sector. Early findings justified a focus on offering small businesses (1) help with the energy efficiency of their buildings in exchange for occasional load shed, and (2) a portfolio of options to meet the needs of a diverse customer sector. To meet these expressed needs, the research pilot provided on-site energy efficiency advice and offered participants several program options, including the choice of either a dynamic rate or monthly payment for air-conditioning setpoint control. Overall results show that pilot participants had energy savings of 20%, and the potential for an additional 14% to 20% load drop during a 100 F demand response event. In addition to the efficiency-related bill savings, participants on the dynamic rate saved an estimated 5% on their energy costs compared to the standard rate. About 80% of participants said that the program met or surpassed their expectations, and three-quarters said they would probably or definitely participate again without the $120 participation incentive. These results provide evidence that energy efficiency programs, dynamic rates and load control programs can be used concurrently and effectively in the small business sector, and that communicating thermostats are a reliable tool for providing air-conditioning load shed and enhancing the ability of customers on dynamic rates to respond to intermittent price events.

  3. Taking Advantages of China's Increasing Demand for Recycled Resources : Case Company: Ni-Met Resources Inc.

    OpenAIRE

    Liang, Ye

    2010-01-01

    The purpose of this thesis is to review the feasibility and advise the management of Ni-Met on the location of a warehouse in China. Ni-Met is a global company involved in trading of resources and commodities - primary and secondary metals, minerals and plastics. A sizeable portion of its sales are into China. The objective of this thesis is to suggest the most suitable way for Ni-Met to take advantage of China’s huge demand for commodities and resources. Ni-Met wants to increase...

  4. Meeting the Demand for Accountability: Case Study of a Teacher Education Program in China

    Directory of Open Access Journals (Sweden)

    Tak Cheung CHAN

    2009-02-01

    Full Text Available To meet the demand for accountability, a teacher education program in a university located in South China has established processes at the college, the program, and the faculty levels to assure its program quality. Highlights of the processes are: involvement of stakeholders and the examination of program effectiveness. Although much has been done to help program candidates succeed, more effort is needed in the areas of program assessment and continuous improvement to assure program quality. An accountability implementation plan, a beginning teacher mentoring program, and a comparative study of beginning teacher performance were recommended to further enforce its strategies toward program accountability.

  5. A particle swarm approach to solve vehicle routing problem with uncertain demand: A drug distribution case study

    Directory of Open Access Journals (Sweden)

    Babak Farhang Moghadam

    2010-07-01

    Full Text Available During the past few years, there have tremendous efforts on improving the cost of logistics using varieties of Vehicle Routing Problem (VRP models. In fact, the recent rise on fuel prices has motivated many to reduce the cost of transportation associated with their business through an improved implementation of VRP systems. We study a specific form of VRP where demand is supposed to be uncertain with unknown distribution. A Particle Swarm Optimization (PSO is proposed to solve the VRP and the results are compared with other existing methods. The proposed approach is also used for real world case study of drug distribution and the preliminary results indicate that the method could reduce the unmet demand significantly.

  6. New methods for solving a vertex p-center problem with uncertain demand-weighted distance: A real case study

    Directory of Open Access Journals (Sweden)

    Javad Nematian

    2015-04-01

    Full Text Available Vertex and p-center problems are two well-known types of the center problem. In this paper, a p-center problem with uncertain demand-weighted distance will be introduced in which the demands are considered as fuzzy random variables (FRVs and the objective of the problem is to minimize the maximum distance between a node and its nearest facility. Then, by introducing new methods, the proposed problem is converted to deterministic integer programming (IP problems where these methods will be obtained through the implementation of the possibility theory and fuzzy random chance-constrained programming (FRCCP. Finally, the proposed methods are applied for locating bicycle stations in the city of Tabriz in Iran as a real case study. The computational results of our study show that these methods can be implemented for the center problem with uncertain frameworks.

  7. [Case management. The nursing business of care or cost].

    Science.gov (United States)

    Sandhu, B K; Duquette, A; Kérouac, S; Rouillier, L

    1992-01-01

    Less money spent on health services, cost-effectiveness, better productivity and more efficiency are some of the driving forces of contemporary "neo-liberalism" and political trends. How can nursing services and the profession's human values adapt in this difficult context? The authors describe the newest modality of patient care delivery system: nursing case management. They examine the factors and assumptions that led up to its development and point out the validity of asking some serious questions before embarking on the euphoria of case management.

  8. Reliability-Based Marginal Cost Pricing Problem Case with Both Demand Uncertainty and Travelers’ Perception Errors

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    Shaopeng Zhong

    2013-01-01

    Full Text Available Focusing on the first-best marginal cost pricing (MCP in a stochastic network with both travel demand uncertainty and stochastic perception errors within the travelers’ route choice decision processes, this paper develops a perceived risk-based stochastic network marginal cost pricing (PRSN-MCP model. Numerical examples based on an integrated method combining the moment analysis approach, the fitting distribution method, and the reliability measures are also provided to demonstrate the importance and properties of the proposed model. The main finding is that ignoring the effect of travel time reliability and travelers’ perception errors may significantly reduce the performance of the first-best MCP tolls, especially under high travelers’ confidence and network congestion levels. The analysis result could also enhance our understanding of (1 the effect of stochastic perception error (SPE on the perceived travel time distribution and the components of road toll; (2 the effect of road toll on the actual travel time distribution and its reliability measures; (3 the effect of road toll on the total network travel time distribution and its statistics; and (4 the effect of travel demand level and the value of reliability (VoR level on the components of road toll.

  9. Recreation Demands of Customers in Thermal Tourism Establishments: Case of Balikesir Province

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    Mehmet KAÇAR

    2014-08-01

    Full Text Available Evaluate recreation demand of customers who lodge in thermal hotels at Balıkesir province. Thermal tourism addresses to people who want to be healthier or aim to have sustainable health level. Parallel to the alternative tourism trend, in recent years there is an increase in number of tourists who visits to thermal facilities for daily trip or for a longer time period. In this study it is aimed to evaluate planning and developing spare time activities for customers who lodge in thermal facilities. The population of this research consist thermal hotel customers at Balikesir region from September to December in 20 13. Sample includes 400 customers who stay Asya Pamukcu Hotel Balikesir . In this research, “Customers‟ Recreational Demand Determination Survey” is applied which consists of questions related to spare time activities and questioner is developed by conside ring expert opinion and test re - test technique. The obtained data from survey is analyzed by SPSS 17 software. According to results, it is shown that, customers activities are insufficient related to spare times. Another result obtained from this researc h is that customers are willing to have recreational components in thermal facilities. Furthermore, it is shown that customers need information about thermal practices.

  10. Teaching Medical Students about Quality and Cost of Care at Case Western Reserve University.

    Science.gov (United States)

    Headrick, Linda A.; And Others

    1992-01-01

    At Case Western University (Ohio), medical students critically analyze the quality and cost of asthma care in the community by studying patients in primary care practices. Each writes a case report, listing all medical charges and comparing them with guidelines for asthma care. Several recommendations for improved care have emerged. (MSE)

  11. Contrasting Electricity Demand with Wind Power Supply: Case Study in Hungary

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    Imre M. Jánosi

    2009-09-01

    Full Text Available We compare the demand of a large electricity consumer with supply given by wind farms installed at two distant geographic locations. Obviously such situation is rather unrealistic, however our main goal is a quantitative characterization of the intermittency of wind electricity. The consumption pattern consists of marked daily and weekly cycles interrupted by periods of holidays. In contrast, wind electricity production has neither short-time nor seasonal periodicities. We show that wind power integration over a restricted area cannot provide a stable baseload supply, independently of the excess capacity. Further essential result is that the statistics are almost identical for a weekly periodic pattern of consumption and a constant load of the same average value. The length of both adequate supply and shortfall intervals exhibits a scale-free (power-law frequency distribution, possible consequences are shortly discussed.

  12. Money-in-the-Utility-Function: Model Simulations and Money Demand Estimation in the Case of the Republic of Macedonia

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    Ivanov Mile

    2015-03-01

    Full Text Available This paper aims to reassess and analyze the dynamic interactions between money, prices and economic activity in the case of the Republic of Macedonia. The first part of the paper simulates the property of the superneutrality of money, based on Sidrauski’s (1967 framework. The second part presents the money demand estimations on the monetary aggregate M2 for the period from 2002 to 2012, using the cointegration approach. Following Cziráky and Gillman (2006, we examine the validity of the Fisher equation in the case of Macedonia. The Fisher equation does not hold in the case of Macedonia, so the inflation rate must be included in the money demand specification. The estimated cointegration equation is in line with economic theory. The cointegration equation shows income elasticity less than unity (0,81, small and negative interest rate semi-elasticity (-0.17 and negative elasticity with respect to inflation. The short-run dynamics reveal that only 2,70% of the disequilibrium is corrected in a single quarter. The properties of stability imply that the M2 aggregate may serve as a proper policy indicator.

  13. Midwifery care: a perinatal mental health case scenario.

    Science.gov (United States)

    Marnes, Joanne; Hall, Pauline

    2013-12-01

    The establishment of the National Perinatal Depression Initiative (NPDI, 2008-2013) has brought a focus across Australia for the need to identify women at risk of perinatal mental health disorders, suggesting that routine screening by relevant health professionals may aid earlier detection, better care and improved outcomes. Midwives are frequently the primary point of contact in the perinatal period and thus ideally placed to identify, interpret and manage complex situations, including screening for perinatal mental health disorders. This paper offers strategies that could be implemented into daily midwifery practice in order to achieve the goals consistent with the National Perinatal Depression Initiative. A case study (Jen) and discussion, guided by recommendations from the Australian Nursing and Midwifery Competency standards and beyondblue Clinical Practice Guidelines, are used to demonstrate how midwifery care can be provided. In accordance with her legal obligations, the midwife should act within her scope of practice to undertake a series of psychosocial and medical assessments in order to best determine how midwifery care and support can be of benefit to Jen, her infant and her family. Suggestions described include administration of validated screening questionnaires, clinical interview, physical assessment, discussion with partner, awareness of the mother-infant interactions and questioning around baby's sleep and feeding. Based on evaluation of the information gained from a bio-psycho-social assessment, suggestions are made as to the midwifery care options that could be applied.

  14. [Nursing care in patients undergoing radiological surgery. A case report].

    Science.gov (United States)

    Armero-Barranco, David; Ruiz-Mateos, María; Alcaraz-Baños, Miguel; Bernal-Páez, Fernando Luis

    2007-01-01

    We report the case of a 73-year-old man with medical diagnoses of long-standing diabetes mellitus, chronic ischemia of the lower limbs and intermittent claudication, for which the patient had been treated with minimally invasive radiological surgery. On arrival at the radiology unit, the patient had nursing diagnoses of anxiety and fear. Intraoperatively, the client had nursing diagnoses of pain, urine retention and infection risk. At discharge, a collaboration problem was detected and hemorrhagic risk. The patient received individualized nursing care. Interventions were planned following the nursing intervention classification (NIC) and the expected results for these interventions followed the Nursing Outcomes Classification (NOC) taxonomy. The application of an appropriate nursing care plan contributes to making the patient's hospital stay easier, more comfortable and less traumatic.

  15. Multicriterial Hierarchy Methods Applied in Consumption Demand Analysis. The Case of Romania

    Directory of Open Access Journals (Sweden)

    Constantin Bob

    2008-03-01

    Full Text Available The basic information for computing the quantitative statistical indicators, that characterize the demand of industrial products and services are collected by the national statistics organizations, through a series of statistical surveys (most of them periodical and partial. The source for data we used in the present paper is an statistical investigation organized by the National Institute of Statistics, "Family budgets survey" that allows to collect information regarding the households composition, income, expenditure, consumption and other aspects of population living standard. In 2005, in Romania, a person spent monthly in average 391,2 RON, meaning about 115,1 Euros for purchasing the consumed food products and beverage, as well as non-foods products, services, investments and other taxes. 23% of this sum was spent for purchasing the consumed food products and beverages, 21.6% of the total sum was spent for purchasing non-food goods and 18,1%  for payment of different services. There is a discrepancy between the different development regions in Romania, regarding total households expenditure composition. For this reason, in the present paper we applied statistical methods for ranking the various development regions in Romania, using the share of householdsí expenditure on categories of products and services as ranking criteria.

  16. Effects and side-effects of integrating care: the case of mental health care in the Netherlands

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    Giel J.M. Hutschemaekers

    2007-08-01

    Full Text Available Purpose Description and analysis of the effects and side-effects of integrated mental health care in the Netherlands. Context of case Due to a number of large-scale mergers, Dutch mental health care has become an illustration of integration and coherence of care services. This process of integration, however, has not only brought a better organisation of care but apparently has also resulted in a number of serious side-effects. This has raised the question whether integration is still the best way of reorganising mental health care. Data sources Literature, data books, patients and professionals, the advice of the Dutch Commission for Mental Health Care, and policy papers. Case description Despite its organisational and patient-centred integration, the problems in the Dutch mental health care system have not diminished: long waiting lists, insufficient fine tuning of care, public order problems with chronic psychiatric patients, etc. These problems are related to a sharp rise in the number of mental health care registrations in contrast with a decrease of registered patients in first-level services. This indicates that care for people with mental health problems has become solely a task for the mental health care services (monopolisation. At the same time, integrated institutions have developed in the direction of specialised medical care (homogenisation. Monopolisation and homogenisation together have put the integrated institutions into an impossible divided position. Conclusions and discussion Integration of care within the institutions in the Netherlands has resulted in withdrawal of other care providers. These side-effects lead to a new discussion on the real nature and benefits of an integrated mental health care system. Integration requires also a broadly shared vision on good care for the various target groups. This would require a radicalisation of the distinction between care providers as well as a recognition of the different goals of

  17. Determining factors affecting tourism demand for Malaysia using ARDL modeling: A case of Europe countries

    Science.gov (United States)

    Borhan, Nurbaizura; Arsad, Zainudin

    2016-10-01

    Tourism industry is the second largest foreign exchange earner after manufacturing in Malaysia. With regards to the importance of tourism industry in Malaysia, any factors that influence tourism demand should be considered cautiously by the government and tourism authorities in order to attract more international tourists in the near future. The purpose of this study is to investigate the dynamic long-run and short-run relationship between the number of international tourist arrivals from six European countries and four selected economic variables. The economic variables used in this study are exchange rate, gross domestic product, relative price and substitute relative price. This study also examines the impact of the European Sovereign crisis on the number of arrivals from the selected European countries to Malaysia. The data covers the period from quarter 1 (Q1) of 1999 to quarter 3 (Q3) of 2014 and employs the autoregressive distributed lag (ARDL) bounds testing approach proposed by Pesaran et al. (2001). The results of unit root test show a mixture of integrated at level and order one, I(0) and I(1). The results show that there exist long-run cointegration between the number of international tourist arrivals and exchange rate, level of income, tourism price and substitute tourism price for all countries. Generally, the results show that level of income is in line with the economic theory and Thailand is a competing destination for the tourism industry in Malaysia. Surprisingly, relative price is found to have positive impact on the number of arrivals to Malaysia and this suggests that an increase in the price level in Malaysia is unexpectedly increase the number of international tourist arrivals to Malaysia. Therefore the Malaysian government and tourism authorities should continue the efforts to withstand the growth of the tourism industry.

  18. Industrial water demand management and cleaner production potential: a case of three industries in Bulawayo, Zimbabwe

    Science.gov (United States)

    Gumbo, Bekithemba; Mlilo, Sipho; Broome, Jeff; Lumbroso, Darren

    The combination of water demand management and cleaner production concepts have resulted in both economical and ecological benefits. The biggest challenge for developing countries is how to retrofit the industrial processes, which at times are based on obsolete technology, within financial, institutional and legal constraints. Processes in closed circuits can reduce water intake substantially and minimise resource input and the subsequent waste thereby reducing pollution of finite fresh water resources. Three industries were studied in Bulawayo, Zimbabwe to identify potential opportunities for reducing water intake and material usage and minimising waste. The industries comprised of a wire galvanising company, soft drink manufacturing and sugar refining industry. The results show that the wire galvanising industry could save up to 17% of water by recycling hot quench water through a cooling system. The industry can eliminate by substitution the use of toxic materials, namely lead and ammonium chloride and reduce the use of hydrochloric acid by half through using an induction heating chamber instead of lead during the annealing step. For the soft drink manufacturing industry water intake could be reduced by 5% through recycling filter-backwash water via the water treatment plant. Use of the pig system could save approximately 12 m 3/month of syrup and help reduce trade effluent fees by Z30/m 3 of “soft drink”. Use of a heat exchanger system in the sugar refining industry can reduce water intake by approximately 57 m 3/100 t “raw sugar” effluent volume by about 28 m 3/100 t “raw sugar”. The water charges would effectively be reduced by 52% and trade effluent fees by Z3384/100 t “raw sugar” (57%). Proper equipment selection, equipment modification and good house-keeping procedures could further help industries reduce water intake and minimise waste.

  19. Getting into hot water Problematizing hot water service demand: The case of Old Cairo

    Science.gov (United States)

    Culhane, Thomas Henry

    This dissertation analyzes hot water demand and service infrastructure in two neighboring but culturally distinct communities of the urban poor in the inner-city area of central Cairo. The communities are the Historic Islamic Cairo neighborhood of Darb Al Ahmar at the foot of Al-Azhar park, and the Zurayib neighborhood of Manshiyat Nasser where the Coptic Zabaleen Recyclers live. The study focuses on the demand side of the hot water issue and involves consideration of built-environment infrastructures providing piped water, electricity, bottled gas, sewage, and the support structures (wiring and plumbing) for consumer durables (appliances such as hot water heaters, stoves, refrigerators, air conditioners) as well as water pumps and water storage tanks. The study asks the questions "How do poor communities in Cairo value hot water" and "How do cost, infrastructure and cultural preferences affect which attributes of hot water service are most highly preferred?". To answer these questions household surveys based primarily on the World Bank LSMS modules were administered by professional survey teams from Darb Al Ahmar's Aga Khan Trust for Culture and the Zabaleen's local NGO "Spirit of Youth" in their adjacent conununities in and surrounding historic Cairo. In total 463 valid surveys were collected, (231 from Darb Al Ahmar, 232 from the Zabaleen). The surveys included a contingent valuation question to explore Willingness to Pay for improved hot water service; the surveys queried household assets as proxies for income. The dissertation's findings reveal that one quarter of the residents of Darb Al Ahmar and two-thirds of the residents of Manshiyet Nasser's Zabaleen lack conventional water heating service. Instead they employ various types of stoves and self-built contraptions to heat water, usually incurring considerable risk and opportunity costs. However the thesis explores the notion that this is rational "satisficing" behavior; despite the shortcomings of such self

  20. Operational effectiveness and quality assurance mechanisms with stochastic demand of blood supply: blood bank case study.

    Science.gov (United States)

    Smith, Alan D

    2011-01-01

    A general overview of various blood products operational effectiveness and related strategies that can be utilised by service providers (in particular, healthcare providers) is presented in the present study. In terms of the massive volumes of blood products, the North American blood centres collect more than eight million units of whole blood, which represents appropriately 50% of the US and Quebec, Canada?s volunteer donor blood supply. A case study of the quality inspection and inventory control concerns of the Central Blood Bank, located in the metropolitan area of Pittsburgh, PA, is presented. Initially, brief introduction to its general operating environment is followed by sections describing its general situation, quality-service initiatives, and followed by a fairly detailed discussion of the practical applications of lessons learned from the case study.

  1. Mental health problems in Pakistani society as a consequence of violence and trauma: a case for better integration of care

    Directory of Open Access Journals (Sweden)

    Muhammad Tahir Khalily

    2011-10-01

    Full Text Available Objectives: This paper discusses the increasing incidence of mental health problems in Pakistan, and specifically in the Swat valley, in relation to the growing insurgency and current violence in Pakistani society. The paper argues that the health care system's response in Pakistan is not adequate to meet the current challenges and that changes in policy are needed to build mental health care services as an important component of the basic health package at primary care level in the public sector. Method: This paper reviews the existing mental health situation in Pakistan with reference to the findings of a case study in the Swat valley in Khyber Pukhtoonkhwa Pakistan. The figures presented in the case study are used to support the need for an integrated national mental health policy. Conclusion: Mental health care needs to be incorporated as a core service in primary care and supported by specialist services. There is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands. A collaborative network between stakeholders in the public and private sector, as well as non-governmental organisations are required that promotes mental health care and advocates for changes in mental health policy.

  2. Mental health problems in Pakistani society as a consequence of violence and trauma: a case for better integration of care

    Directory of Open Access Journals (Sweden)

    Muhammad Tahir Khalily

    2011-10-01

    Full Text Available Objectives: This paper discusses the increasing incidence of mental health problems in Pakistan, and specifically in the Swat valley, in relation to the growing insurgency and current violence in Pakistani society. The paper argues that the health care system's response in Pakistan is not adequate to meet the current challenges and that changes in policy are needed to build mental health care services as an important component of the basic health package at primary care level in the public sector.Method: This paper reviews the existing mental health situation in Pakistan with reference to the findings of a case study in the Swat valley in Khyber Pukhtoonkhwa Pakistan. The figures presented in the case study are used to support the need for an integrated national mental health policy.Conclusion: Mental health care needs to be incorporated as a core service in primary care and supported by specialist services. There is a strong need to provide adequate training for general practitioners and postgraduate training for mental health professionals to meet the current demands. A collaborative network between stakeholders in the public and private sector, as well as non-governmental organisations are required that promotes mental health care and advocates for changes in mental health policy.

  3. Informal care givers’ experiences with support in primary palliative care when a case manager is involved: a descriptive study in the Netherlands.

    NARCIS (Netherlands)

    Plas, A.G.M. van der; Francke, A.L.; Deliens, L.; Jansen, W.J.J.; Vissers, K.C.; Onwuteaka-Philipsen, B.D.

    2016-01-01

    Introduction: Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal care givers. The case manager provides support in addition to the care provided by the home care nurse and gen

  4. Equity in health care financing: The case of Malaysia

    Science.gov (United States)

    Yu, Chai Ping; Whynes, David K; Sach, Tracey H

    2008-01-01

    Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes). Conclusion Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth

  5. Equity in health care financing: The case of Malaysia

    Directory of Open Access Journals (Sweden)

    Sach Tracey H

    2008-06-01

    Full Text Available Abstract Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO and a regressive finance source (indirect taxes. Conclusion Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers

  6. On-demand d-modafinil may be an effective treatment option for lifelong premature ejaculation: a case report.

    Science.gov (United States)

    Serefoglu, E C

    2016-02-01

    Premature ejaculation (PE) is considered to be the most common form of male sexual dysfunction. Given that acute oral administration of d-isomer of modafinil (d-modafinil) can extend the latency to ejaculation in rats without suppressing sexual behaviour, the effects of on-demand d-modafinil treatment were examined on a 30-year-old male patient with lifelong PE. The patient was instructed to take d-modafinil 100 mg 3 h prior to the sexual relation for four times and was invited for a control visit. The patient was re-evaluated 2 weeks later. He reported that his IELT increased to 15 min. He reported heartburn and insomnia when he used d-modafinil for the first time; however, these symptoms were transient and did not recur after the initial dose. Overall, he reported considerable improvement and noted that he feels much better with the treatment. Based on this limited data, on-demand d-modafinil seems to be an effective treatment for men with lifelong PE. The side effects were transient and mild in the reported case. Further randomised clinical trials are necessary to elucidate the therapeutic concept of this drug in patients with lifelong PE.

  7. Study on service demands towards Institute of Postpartum Care%孕产妇对月子机构的服务需求调查分析

    Institute of Scientific and Technical Information of China (English)

    黄舒蓉; 吴瑜瑜; 常羽丰; 邹芳亮; 蔡文智

    2016-01-01

    Objective To investigate the maternal attitude and demands for Institute of Postpartum Care in order to provide targeted services.Methods 285 women were a investigated about maternal attitude and demands towards Institute of Postpartum Care with self-designed questionnaire.Results 97.9% (279/285) women thought sitting the month (puerperal period) was very important,50.2% (143/285)women were interested in Institute of Postpartum Care.They thought the main three advantages were energy saving,medical expertise and technology and avoidance of family conflicts;The three major issues were high price,lack of monitoring mechanism and unfamiliar environment and less family company;33 items of services demands over four points accounted for 78.6%,the three modules with highest scores were cleaning services scored 4.64±0.47,newborn services scored 4.45±0.41,consultation service scored 4.41:±0.53.Conclusions Professional postnatal care services have been a trend and social need,and a large proportion of women have great interest and demand on Institute of Postpartum Care which should make full use of its concentrate resources,and provide specific services according to maternal demands for services.It is urgent to build unified service standards and evaluation indicators to improve service quality.%目的 了解孕产妇对产后月子机构的态度与服务需求,以便其为产妇提供针对性的服务项目.方法 采取自行设计的调查表,针对产后月子机构的态度以及服务内容需求对285名孕产妇进行调查.结果 97.9%(279/285)的孕产妇认为产后坐月子非常重要,50.2%(143/285)的孕产妇对月子机构感兴趣.孕产妇认为产后月子机构主要的3个优势分别为节约产妇与家人的精力、医学专业知识与技术及避免家庭矛盾;主要存在的3个问题为价钱偏高、没有监督机制以及环境陌生且与家人相处少;服务项目需求得分为4分以上的需求项为33

  8. Describing Long-Term Electricity Demand Scenarios in the Telecommunications Industry: A Case Study of Japan

    Directory of Open Access Journals (Sweden)

    Yusuke Kishita

    2016-01-01

    Full Text Available Due to the rapid expansion of information and communication technology (ICT usage, the telecommunications industry is faced with a challenge to promote green ICT toward achieving a low-carbon society. One critical obstacle in planning long-term strategies for green ICT is the uncertainty of various external factors, such as consumers’ lifestyle and technological advancement. To tackle this issue, this paper employs a scenario planning method to analyze electricity consumption in the telecommunications industry, where both changes in various external factors and energy-saving measures are assumed. We propose a model to estimate future electricity consumption of the telecommunications industry using a statistical approach. In a case study, we describe four scenarios that differ in the diffusion of ICT and the technological advancement of ICT equipment in order to analyze the electricity consumption in Japan’s telecommunications industry to 2030. The results reveal that the electricity consumption in 2030 becomes 0.7–1.6-times larger than the 2012 level (10.7 TWh/year. It is also shown that the most effective measures to reduce the electricity consumption include improving the energy efficiency of IP (Internet Protocol communication equipment and mobile communication equipment.

  9. Leadership models in health care - a case for servant leadership.

    Science.gov (United States)

    Trastek, Victor F; Hamilton, Neil W; Niles, Emily E

    2014-03-01

    Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients.

  10. Personnel and patient scheduling in the high demanded hospital services: a case study in the physiotherapy service.

    Science.gov (United States)

    Ogulata, S Noyan; Koyuncu, Melik; Karaskas, Esra

    2008-06-01

    High demand but limited staffs within some services of a hospital require a proper scheduling of staff and patients. In this study, a hierarchical mathematical model is proposed to generate weekly staff scheduling. Due to computational difficulty of this scheduling problem, the entire model is broken down into manageable three hierarchical stages: (1) selection of patients, (2) assignment of patients to the staff, (3) scheduling of patients throughout a day. The developed models were tested on the data collected in College of Medicine Research Hospital at Cukurova University using GAMS and MPL optimization packages. From the results of the case study, the presented hierarchical model provided a schedule that ensures to maximize the number of selected patients, to balance the workload of physiotherapist, and to minimize waiting time of patients in their treatment day.

  11. Pneumothoraces in a Neonatal Tertiary Care Unit: Case Series

    Directory of Open Access Journals (Sweden)

    Rehan Ali

    2013-01-01

    Full Text Available Objective: Neonatal pneumothoraces are associated with high mortality. Prompt recognition to minimize its complications is paramount for ultimate outcome of these babies.Methods: A retrospective case series study was carried out at Aga khan University Hospital, from January 2010 to December 2010 to determine the etiology and outcome of neonates with pneumothorax in a neonatal tertiary care unit.Results: Ten neonates diagnosed radiologically with pneumothoraces were included. M: F ratio was 1:2.3. Birth weight ranged from 1750-3600 grams with a mean of 2100 grams. The occurrence of pneumothoraces was 50% on the left side, 20% on right, and 30% were bilateral. Primary etiology included pneumonia and sepsis (30%, hyaline membrane disease (20%, meconium aspiration syndrome (20% and congenital diaphragmatic hernia (10%. Spontaneous pneumothoraces were present in 20% of cases. In our study, the incidence of neonatal pneumothoraces was 2.5/1000 births compared to 10-15/1000 in Denmark, 10-20/1000 in Turkey and 6.3/1000 from Vermont Oxford Group. Despite the small number of cases, one incidental finding was the occurrence of pneumothorax, which declined in elective cesarean section after 37 weeks gestation i.e., 1.3 of 1000 births. Mortality was 60% determined mainly by the primary etiology and other co-morbid conditions.Conclusion: The study showed a higher number of mortality cases (60%. Although, it was difficult to draw a conclusion from the limited number of cases, there may be a benefit on neonatal respiratory outcome to be obtained by better selection of mothers and by waiting until 37 weeks before performing elective cesarean section. Adequate clinician training in soft ventilation strategies will reduce the occurrence of pneumothoraces.

  12. [Malnutrition and intensive care: discussion on a difficult case].

    Science.gov (United States)

    Berger, Mette M; Revelly, Jean-Pierre; Cayeux, Marie-Christine; Gersbach, Philippe; Chioléro, René L

    2003-06-01

    Hospital malnutrition is an insidious problem which is responsible for many complications. Critically ill patients are frequently hypermetabolic with increased nutritional requirements, and are exposed to the risk of underfeeding. The case report presents the case of a patient which stayed 22 days in the intensive care unit (ICU), and whose nutritional support failed: he ultimately died of surgical and infectious complications. An optimal support includes a early metabolic support provided as glucose-insulin-potassium infusion and antioxidant micronutrients, with an enteral nutrition initiated on days 3 or 4. It is frequently difficult to reach energy targets with exclusive enteral nutrition: if the latter is not reached after 5-6 days of enteral feeding, combination with parenteral nutrition enables worsening of the energy deficit. Transition to oral feeding is another critical event which may expose the patient to underfeeding: prescription of oral supplements and/or maintenance of overnight enteral feeding providing 50-75% of energy requirements helps overcome this period. The case illustrates the importance of monitoring daily and cumulated energy balance.

  13. Development of an interactive model for planning the care workforce for Alberta: case study

    Directory of Open Access Journals (Sweden)

    Bloom Judy

    2012-08-01

    Full Text Available Abstract Introduction In common with other jurisdictions, Alberta faces challenges in ensuring a balance in health worker supply and demand. As the provider organization with province-wide responsibility, Alberta Health Services needed to develop a forecasting tool to inform its position on key workforce parameters, in the first instance focused on modeling the situation for Registered Nurses, Licensed Practical Nurses and health care aides. This case study describes the development of the model, highlighting the choices involved in model development. Case description A workforce planning model was developed to test the effect of different assumptions (for instance about vacancy rates or retirement and different policy choices (for example about the size of intakes into universities and colleges, different composition of the workforce. This case study describes the choices involved in designing the model. The workforce planning model was used as part of a consultation process and to develop six scenarios (based on different policy choices. Discussion and evaluation The model outputs highlighted the problems with continuation of current workforce strategies and the impact of key policy choices on workforce parameters. Conclusions Models which allow for transparency of the underlying assumptions, and the ability to assess the sensitivity of assumptions and the impact of policy choices are required for effective workforce planning.

  14. Unexplained neuropsychiatric symptoms in intensive care: A Fahr Syndrome case.

    Science.gov (United States)

    Calili, Duygu Kayar; Mutlu, Nevzat Mehmet; Mutlu Titiz, Ayse Pinar; Akcaboy, Zeynep Nur; Aydin, Eda Macit; Turan, Isil Ozkocak

    2016-08-01

    Fahr Syndrome is a rare disease where calcium and other minerals are stored bilaterally and symmetrically in the basal ganglia, cerebellar dentate nucleus and white matter. Fahr Syndrome is associated with various metabolic disorders, mainly parathyroid disorders. The presented case discusses a 64-year old male patient admitted to the intensive care unit of our hospital diagnosed with aspiration pneumonia and urosepsis. The cranial tomography examination to explain his nonspecific neurological symptoms showed bilateral calcifications in the temporal, parietal, frontal, occipital lobes, basal ganglia, cerebellar hemisphere and medulla oblongata posteriorly. His biochemical test results also indicated parathormone-calcium metabolic abnormalities. Fahr Syndrome must be considered for a definitive diagnosis in patients with nonspecific neuropsychiatric symptoms and accompanying calcium metabolism disorders in order to control serious morbidity and complications because of neurological damage.

  15. Designing a Care Pathway Model – A Case Study of the Outpatient Total Hip Arthroplasty Care Pathway

    Directory of Open Access Journals (Sweden)

    Robin I. Oosterholt

    2017-03-01

    Full Text Available Introduction: Although the clinical attributes of total hip arthroplasty (THA care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. Theory: The outpatient THA care pathway enables patients to be discharged on the day of surgery, short- ening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. Methods: An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi- structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. Results: The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1 and mobilisation & discharge (4. The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. Conclusion: The design addressed existing problems and is an optimisation of the case hospital’s pathway. The network of actors consists of the patient (1, radiologist (1, anaesthetist (1, nurse specialist (1, pharmacist (1, orthopaedic surgeon (1,4, physiotherapist (1,4, nurse (4, doctor (4 and patient applica- tion (1,4. The critical value exchanges include patient preparation (mental and practical, patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.

  16. Energy Demand

    NARCIS (Netherlands)

    Stehfest, E. et al.

    2014-01-01

    Key policy issues – How will energy demand evolve particularly in emerging and medium- and low- income economies? – What is the mix of end-use energy carriers to meet future energy demand? – How can energy efficiency contribute to reducing the growth rate of energy demand and mitigate pressures on t

  17. Role of Occupational Therapy in Case Management and Care Coordination for Clients With Complex Conditions.

    Science.gov (United States)

    Robinson, Monica; Fisher, Thomas F; Broussard, Kim

    2016-01-01

    Specific aspects of the profession of occupational therapy support a distinct value for its practitioners participating fully in the development of case management and care coordination systems. The expectation in the 21st century is that the U.S. health care system must be transformed from one that promotes volume of service to one that promotes value of care. Case management and care coordination will be critical components of that transformation. Occupational therapy's principles, education, practice, approach, and perspective offer much to benefit this increased attention to case management and care coordination. Occupational therapy practitioners should promote themselves and their profession as these system changes develop.

  18. Life Cycle Assessment Projection of Photovoltaic Cells: A Case Study on Energy Demand of Quantum Wire Based Photovoltaic Technology Research

    Science.gov (United States)

    Mukherjee, Shilpi

    With increasing clean-energy demand, photovoltaic (PV) technologies have gained attention as potential long-term alternative to fossil fuel energy. However, PV research and manufacture still utilize fossil fuel-powered grid electricity. With continuous enhancement of solar conversion efficiency, it is imperative to assess whether overall life cycle efficiency is also being enhanced. Many new-material PV technologies are still in their research phase, and life cycle analyses of these technologies have not yet been performed. For best results, grid dependency must be minimized for PV research, and this can be accomplished by an analytical instrument called Life Cycle Assessment (LCA). LCA is the study of environmental impacts of a product throughout its life cycle. While there are some non-recoverable costs of research, energy is precious, and the PV research community should be aware of its energy consumption. LCA can help identify options for energy conservation through process optimization. A case study was conducted on the energy demand of a test-bed emerging PV technology using life cycle assessment methodology. The test-bed system chosen for this study was a new-material PV cell. The objective was to quantify the total energy demand for the research phase of the test-bed solar cell's life cycle. The objective was accomplished by collecting primary data on energy consumption for each process in the development of this solar cell. It was found that 937 kWh of energy was consumed for performing research on a single sample of the solar cell. For comparison, this energy consumption is 83% of Arkansas's average monthly residential electricity consumption. Life cycle inventory analysis showed that heating, ventilation, and air conditioning consumed the bulk of the energy of research. It is to be noted that the processes studied as part of the solar cell test-bed system are representative of a research process only. Life cycle thinking can identify energy hot-spots and

  19. The performance of integrated health care networks in continuity of care: a qualitative multiple case study of COPD patients

    Directory of Open Access Journals (Sweden)

    Sina Waibel

    2015-07-01

    Full Text Available Background: Integrated health care networks (IHN are promoted in numerous countries as a response to fragmented care delivery by providing a coordinated continuum of services to a defined population. However, evidence on their effectiveness and outcome is scarce, particularly considering continuity across levels of care; that is the patient's experience of connected and coherent care received from professionals of the different care levels over time. The objective was to analyse the chronic obstructive pulmonary disease (COPD patients’ perceptions of continuity of clinical management and information across care levels and continuity of relation in IHN of the public health care system of Catalonia.Methods: A qualitative multiple case study was conducted, where the cases are COPD patients. A theoretical sample was selected in two stages: (1 study contexts: IHN and (2 study cases consisting of COPD patients. Data were collected by means of individual, semi-structured interviews to the patients, their general practitioners and pulmonologists and review of records. A thematic content analysis segmented by IHN and cases with a triangulation of sources and analysists was carried out.Results: COPD patients of all networks perceived that continuity of clinical management was existent due to clear distribution of roles for COPD care across levels, rapid access to care during exacerbations and referrals to secondary care when needed; nevertheless, patients of some networks highlighted too long waiting times to non-urgent secondary care. Physicians generally agreed with patients, however, also indicated unclear distribution of roles, some inadequate referrals and long waiting times to primary care in some networks. Concerning continuity of information, patients across networks considered that their clinical information was transferred across levels via computer and that physicians also used informal communication mechanisms (e-mail, telephone; whereas

  20. Opportunities for Automated Demand Response in Wastewater Treatment Facilities in California - Southeast Water Pollution Control Plant Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, Daniel [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Goli, Sasank [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Faulkner, David [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); McKane, Aimee [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2012-12-20

    This report details a study into the demand response potential of a large wastewater treatment facility in San Francisco. Previous research had identified wastewater treatment facilities as good candidates for demand response and automated demand response, and this study was conducted to investigate facility attributes that are conducive to demand response or which hinder its implementation. One years' worth of operational data were collected from the facility's control system, submetered process equipment, utility electricity demand records, and governmental weather stations. These data were analyzed to determine factors which affected facility power demand and demand response capabilities The average baseline demand at the Southeast facility was approximately 4 MW. During the rainy season (October-March) the facility treated 40% more wastewater than the dry season, but demand only increased by 4%. Submetering of the facility's lift pumps and centrifuges predicted load shifts capabilities of 154 kW and 86 kW, respectively, with large lift pump shifts in the rainy season. Analysis of demand data during maintenance events confirmed the magnitude of these possible load shifts, and indicated other areas of the facility with demand response potential. Load sheds were seen to be possible by shutting down a portion of the facility's aeration trains (average shed of 132 kW). Load shifts were seen to be possible by shifting operation of centrifuges, the gravity belt thickener, lift pumps, and external pump stations These load shifts were made possible by the storage capabilities of the facility and of the city's sewer system. Large load reductions (an average of 2,065 kW) were seen from operating the cogeneration unit, but normal practice is continuous operation, precluding its use for demand response. The study also identified potential demand response opportunities that warrant further study: modulating variable-demand aeration loads, shifting

  1. Self-care project for faculty and staff of future health care professionals: Case report.

    Science.gov (United States)

    MacRae, Nancy; Strout, Kelley

    2015-01-01

    Self-care among health care providers is an important component of their ability to provide quality health care to patients. Health care institutions have programs in place for students that emphasize health and wellness, but few programs are available for faculty and staff. To address this gap and facilitate modeling health and wellness strategies for students, a New England institution that educates health care practitioners began a pilot self-care project for faculty and staff. Both quantitative and qualitative data were collected. The template used for this project could be used as a stepping-stone for future wellness self-care program in higher education for faculty, staff, and students.

  2. Decentralisation of long-term care in the Netherlands: the case of day care at green care farms for people with dementia

    NARCIS (Netherlands)

    Nowak, S.J.M.; Molema, C.M.; Baan, C.A.; Oosting, S.J.; Vaandrager, L.; Hop, P.; Bruin, de R.

    2015-01-01

    Responsibility for health and social care services is being delegated from central to local authorities in an increasing number of countries. In the Netherlands, the planned transfer of responsibility for day care for people with dementia from the central government to municipalities is a case in po

  3. Medical care epidemiology and unwarranted variation: the Israeli case.

    Science.gov (United States)

    Goodman, David C; Goodman, Andrew A

    2017-01-01

    In an article in this Journal, Mendlovic and colleagues report on regional variation in medical care across Israeli regions. This study joins a growing literature demonstrating generally high variation in the provision of health care services within developed countries. This commentary summarizes the status of medical care epidemiology and its studies of unwarranted variation in health care, and provides a conceptual framework to guide future studies. Recommendations are offered for advancing studies in Israel that could guide policy development and clinical improvement.

  4. Designing a green gas supply to meet a regional seasonal demand: A case study: 23 juni 2014

    OpenAIRE

    Bekkering, J.; Hengeveld, E.J.; Gemert, W.J.T. van; Broekhuis, A.A.

    2014-01-01

    One of the issues concerning the replacement of natural gas by green gas is the seasonal pattern of the gas demand. When constant production is assumed, this may limit the injected quantity of green gas into a gas grid to the level of the minimum gas demand in summer. A procedure was proposed to increase the gas demand coverage in a geographical region, i.e. the extent to which natural gas demand can be replaced by green gas. This was done by modeling flexibility into farm-scale green gas sup...

  5. How effective are programs at managing transition from hospital to home? A case study of the Australian transition care program

    Directory of Open Access Journals (Sweden)

    Gray Leonard C

    2012-03-01

    Full Text Available Abstract Background An increasing demand for acute care services due in part to rising proportions of older people and increasing rates of chronic diseases has led to new models of post-acute care for older people that offer coordinated discharge, ongoing support and often a focus on functional restoration. Overall, review of the literature suggests there is considerable uncertainty around the effectiveness and resource implications of the various model configurations and delivery approaches. In this paper, we review the current evidence on the efficacy of such programs, using the Australian Transition Care Program as a case study. Discussion The Australian Transition Care Program was established at the interface of the acute and aged care sectors with particular emphasis on transitions between acute and community care. The program is intended to enable a significant proportion of care recipients to return home, rather than prematurely enter residential aged care, optimize their functional capacity, and reduce inappropriate extended lengths of hospital stay for older people. Broadly, the model is configured and targeted in accordance with programs reported in the international literature to be effective. Early evaluations suggest good acceptance of the program by hospitals, patients and staff. Ultimately, however, the program's place in the array of post-acute services should be determined by its demonstrated efficacy relative to other services which cater for similar patient groups. Summary Currently there is a lack of robust evaluation to provide convincing evidence of efficacy, either from a patient outcome or cost reduction perspective. As the program expands and matures, there will be opportunity to scrutinise the systematic effects, with lessons for both Australian and international policy makers and clinical leaders.

  6. Case management to improve major depression in primary health care : a systematic review

    NARCIS (Netherlands)

    Gensichen, J; Beyer, M; Muth, C; Gerlach, FM; Von Korff, M; Ormel, J

    2006-01-01

    Background. Deficits in the care of depression lead to poor medication adherence, which increases the risk of an unfavourable outcome for this care. This review evaluates effects on symptoms and medication adherence of case management in primary health care. Method. A systematic literature search wa

  7. Designing a green gas supply to meet a regional seasonal demand: A case study : 23 juni 2014

    NARCIS (Netherlands)

    Bekkering, J.; Hengeveld, E.J.; Gemert, W.J.T. van; Broekhuis, A.A.

    2014-01-01

    One of the issues concerning the replacement of natural gas by green gas is the seasonal pattern of the gas demand. When constant production is assumed, this may limit the injected quantity of green gas into a gas grid to the level of the minimum gas demand in summer. A procedure was proposed to inc

  8. Choice of an Optimal Management Strategy of Transport Demand Using Multi-Criteria Analysis: City of Zagreb Case Study

    Directory of Open Access Journals (Sweden)

    Ljupko Šimunović

    2013-03-01

    Full Text Available After initial enthusiasm by motor vehicles, society is lately increasingly noticing their shortcomings. Traffic problems caused by excessive use of cars, still represent a very serious and widespread problem, particularly in cities. Public opinion expresses dissatisfaction with the quality of the environment and traffic conditions. As the most important demand, the demand for human health stands out in the first place, and, consequently, the demand for sustainable transport development. The fact that the EU is involved in solving traffic problems by means of various directives and scientific research projects, points out the seriousness of the problem. Two solutions which are mainly used for solving traffic problems in cities are the construction or extension of existing transport infrastructure and traffic demand management (TDM. Traffic demand management is a new paradigm, which aims at reducing or transforming of traffic demand through reduction of unnecessary drives by cars and improvement of more efficient, healthier and, above all, cleaner forms of public and non-motorized transport. There is a whole range of methods for traffic demand management, such as Park & Ride system, carpooling, carsharing, priority for the vehicles with specified number of passenger – HOV, teleworking, congestion charging, charging for use of road infrastructure, bicycling infrastructure improvement, etc. The topic of the work focuses on the choice of optimal traffic demand management strategies in the city of Zagreb using multi-criteria analysis.

  9. Equity in health care financing: The case of Malaysia

    OpenAIRE

    Sach Tracey H; Whynes David K; Yu Chai

    2008-01-01

    Abstract Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implication...

  10. “Souls of the ancestor that knock us out” and other tales. A qualitative study to identify demand-side factors influencing malaria case management in Cambodia

    Directory of Open Access Journals (Sweden)

    O’Connell Kathryn A

    2012-10-01

    Full Text Available Abstract Background Appropriate case management of suspected malaria in Cambodia is critical given anti-malarial drug resistance in the region. Improving diagnosis and the use of recommended malarial treatments is a challenge in Cambodia where self-treatment and usage of drug cocktails is widespread, a notable difference from malaria treatment seeking in other countries. This qualitative study adds to the limited evidence base on Cambodian practices, aiming to understand the demand-side factors influencing treatment-seeking behaviour, including the types of home treatments, perceptions of cocktail medicines and reasons for diagnostic testing. The findings may help guide intervention design. Methods The study used in-depth interviews (IDIs (N = 16 and focus group discussions (FGDs (N = 12 with Cambodian adults from malaria-endemic areas who had experienced malaria fever in the previous two weeks. Data were analysed using NVivo software. Results Findings suggest that Cambodians initially treat suspected malaria at home with home remedies and traditional medicines. When seeking treatment outside the home, respondents frequently reported receiving a cocktail of medicines from trusted providers. Cocktails are perceived as less expensive and more effective than full-course, pre-packaged medicines. Barriers to diagnostic testing include a belief in the ability to self-diagnose based on symptoms, cost and reliance on providers to recommend a test. Factors that facilitate testing include recommendation by trusted providers and a belief that anti-malarial treatment for illnesses other than malaria can be harmful. Conclusions Treatment-seeking behaviour for malaria in Cambodia is complex, driven by cultural norms, practicalities and episode-related factors. Effective malaria treatment programmes will benefit from interventions and communication materials that leverage these demand-side factors, promoting prompt visits to facilities for suspected

  11. Improvement in hearing after chiropractic care: a case series

    Directory of Open Access Journals (Sweden)

    Di Duro Joseph O

    2006-01-01

    Full Text Available Abstract Background The first chiropractic adjustment given in 1895 was reported to have cured deafness. This study examined the effects of a single, initial chiropractic visit on the central nervous system by documenting clinical changes of audiometry in patients after chiropractic care. Case presentation Fifteen patients are presented (9 male, 6 female with a mean age of 54.3 (range 34–71. A Welch Allyn AudioScope 3 was used to screen frequencies of 1000, 2000, 4000 and 500 Hz respectively at three standard decibel levels 20 decibels (dB, 25 dB and 40 dB, respectively, before and immediately after the first chiropractic intervention. Several criteria were used to determine hearing impairment. Ventry & Weinstein criteria of missing one or more tones in either ear at 40 dB and Speech-frequency criteria of missing one or more tones in either ear at 25 dB. All patients were classified as hearing impaired though greater on the right. At 40 dB using the Ventry & Weinstein criteria, 6 had hearing restored, 7 improved and 2 had no change. At 25 dB using the Speech-frequency criteria, none were restored, 11 improved, 4 had no change and 3 missed a tone. Conclusion A percentage of patients presenting to the chiropractor have a mild to moderate hearing loss, most notably in the right ear. The clinical progress documented in this report suggests that manipulation delivered to the neuromusculoskeletal system may create central plastic changes in the auditory system.

  12. The multidisciplinary team in palliative care: A case reflection

    Directory of Open Access Journals (Sweden)

    Liza Bowen

    2014-01-01

    Full Text Available This essay is a reflection on the multidisciplinary team in palliative care, from the perspective of a final year MBBS student from the UK spending one month with an Indian pain and palliative care team at Institute Rotary Cancer Hospital (IRCH, AIIMS, New Delhi.

  13. 民族高校女职工围绝经期症状及保健需求调查分析%Investigation and Analysis of Perimenopausal Symptoms and Health Care Demand of the Nationalities University Women

    Institute of Scientific and Technical Information of China (English)

    余学红

    2016-01-01

    目的::了解民族高校妇女的围绝经期症状及保健需求情况,为围绝经期妇女保健工作提供科学依据.方法:采用问卷调查的方法,对民族高校647例40~60岁妇女进行调查.结果:调查对象围绝经期相关症状发生率为77.13%,其主要症状依次为:记忆力下降(65.84%)、情绪波动(64.30%)、失眠(63.83%)、潮热(58.73%)、月经紊乱(54.40%)等.各年龄组围绝经期症状发生率比较,差异有统计学意义(p<0.05),且随着年龄增大,其发生率逐渐增高.围绝经期妇女保健需求主要为定期全面体检和预防骨质疏松;希望得到围绝经期健康咨询与指导的妇女占53.48%.结论:民族高校妇女围绝经期相关症状发生率高,对围绝经期保健知识及服务需求迫切.相关卫生服务部门应高度重视,实施干预模式,加强对民族高校围绝经期妇女的健康管理,积极开展全科医疗卫生保健服务,以提高围绝经期妇女的生活质量.%Objective:To understand the situation of perimenopausal symptoms and health care demand in nationalities university women, to community perimenopause women's health care and provide scientific basis for. Methods: Using the method of questionnaire survey was conducted on the 647 cases of 40 ~60 years old women in university . Results:The survey of menopausal symptoms, occurrence rate is 77. 13%, the incidence of main symptoms were:the decline of memory (65. 84%), mood swings (64. 30%), insomnia (63. 83%), fever (58. 73%), menstrual disorder (54. 40%). Each age group of perimenopausal symptoms occur rate compares difference to have statistical sense (p< 0. 05), increases with age, the incidence rate increase. Perimenopausal health care demand mainly for the regular physical examination and prevention of osteoporosis, hope to get the perimenopausal health counseling and guidance of perimenopausal women accounted for 53. 48%. Conclusion: the perimenopausal symptoms of

  14. Climate change and its role in forecasting energy demand in buildings: A case study of Douala City, Cameroon

    Indian Academy of Sciences (India)

    Modeste Kameni Nematchoua; Gh R Roshan; René Tchinda; T Nasrabadi; Paola Ricciardi

    2015-02-01

    The foremost role of a building is to assure the comfort of its occupants. The thermal comfort of a building depends on the outdoor climate and requires a demand in energy for heating and cooling. In this paper, demand of energy (heating/cooling) in the buildings is discussed in Douala, Cameroon. Daily data of the last 40 years coming from five weather stations of Cameroon have been studied. Some forecasts have been carried out with 14 GCM models, associated to three future climate scenarios B1, A2, and A1B. However, only INCM3 of General Circulation Model (GCM) and A2 scenario was used. Energy demand in buildings is valued by HDD (heating degree day) and CDD (cooling degree day) indices. Obtained results show that the temperature evolves more quickly in dry season than in rainy season in Douala. Climate rise indicates an increasing demand of energy in the buildings for cooling. Global Douala heating shows a definite effect on outdoor comfort. From 2045 to 2075, the demand of energy for cooling will be superior to 50%. The total demand in energy for heating in the buildings is estimated to be 67.882 kcal from 1970 to 2000 and will be around 67.774 kcal from 2013 to 2043.

  15. 临终患者家属安宁疗护知识需求调查%Investigation on the Demand of Dying Patients' Families on Hospice Care Knowledge

    Institute of Scientific and Technical Information of China (English)

    张宇平; 诸海燕; 马红丽

    2016-01-01

    Objective To learn the demand of dying patients' families in general hospital so as to improve the effectiveness and pertinence of education measures.Method Self-designed survey was adopted in the investigation. The questionnaire included general information of patients' families, their demand of hospice care knowledge and its proper forms and methods. Patients' families should fill the questionnaire. However, when they are incompetent, training nurses could fill the questionnaire by means of questions and answers.Results Through this investigation, we found that there was a clear correlation between the awareness of patients' families on hospice care and education level and age. The awareness of patients' families on hospice care knowledge had been significantly improved after intervention.Conclusion Strengthen the education of hospice care knowledge to dying patients' families and meet their demand of relevant knowledge. Various means should be carried out to popularize hospice care knowledge and death education should be promoted so that people could have a rational attitude towards death and accept hospice care.

  16. Demand forecasting

    OpenAIRE

    Gregor, Belčec

    2011-01-01

    Companies operate in an increasingly challenging environment that requires them to continuously improve all areas of the business process. Demand forecasting is one area in manufacturing companies where we can hope to gain great advantages. Improvements in forecasting can result in cost savings throughout the supply chain, improve the reliability of information and the quality of the service for our customers. In the company Danfoss Trata, d. o. o. we did not have a system for demand forecast...

  17. Coordinating Mental Health Care Across Primary Care and Schools: ADHD as a Case Example

    OpenAIRE

    Power, Thomas J.; Blum, Nathan J.; Guevara, James P; Jones, Heather A.; Leslie, Laurel K.

    2013-01-01

    Although primary care practices and schools are major venues for the delivery of mental health services to children, these systems are disconnected, contributing to fragmentation in service delivery. This paper describes barriers to collaboration across the primary care and school systems, including administrative and fiscal pressures, conceptual and linguistic differences between healthcare and educational professionals, role restrictions among professionals, and privacy laws. Strategies for...

  18. An interdisciplinary-interuniversity health care team management decision-making case study course.

    Science.gov (United States)

    DeSalvo, R J; Arlinghaus, E J; Rowe, K W

    1985-01-01

    An elective case study course involving graduate students from various health profession disciplines from two universities was developed in order to provide a forum for health care teams to discuss the philosophical and functional impact of situations and their alternative solutions. The case studies stressed various aspects of the decision-making process and were nonclinical/technical but health care administratively oriented in nature. Course evaluations manifest that participants from each discipline improved their problem-solving and leadership abilities, and created a cross-fertilization of knowledge and understanding of the various health care disciplines and their perspectives that each brings to the health care system.

  19. 老年人对社区护理需求的调查与分析%A survey and analysis of the demand of community care for elderly

    Institute of Scientific and Technical Information of China (English)

    李玲玲

    2015-01-01

    Objective To investigate the quality of life of the elderly community, and analyze the demand for community care of the elderly. Methods 200 new two community elderly were randomly selected, the quality of life condition by the method of questionnalre investigation and comprehensive quality of life questionnalre survey of the elderly in community were researched, influence of quality of elderly life and their needs for community nursing were explored through the analysis. Results The quality of life of the elderly in an overall score was (61.71±9.90) points; factors that affect their quality of life was the number of major illness, the economic situation of the elderly age, economic status and their level of education and were engaged the occupation. Survey results showed the need of community care share was 89.06%. In addition, by analyzing the quality of life of older people and their care needed of the community the results showed a negative correlation between the relations, especially the body function and social function of the performance of the quality of life of the elderly was the most significant. Conclusion The low overall quality of life in the community of the elderly, thus the demand for community care of the elderly on a strong, community health services should be based on-site service as well as the prevention of chronic diseases in elderly missionary infectious disease prevention, education and care,nurses, etc. as the core of community care through community care to improve the quality of life of older persons.%目的:调查社区老年人的生活质量,分析老年人对社区护理的需求。方法随机选取新二社区的200名老年人,采用问卷调查和生活质量综合评定量表的方法调查社区老年人的生活质量状况,通过分析调查情况探讨影响老年人生活质量的情况和他们对于社区护理的需求。结果调查统计结果显示社区老年人的生活质量总得分为(61.71±9.90)

  20. Distribution network design under demand uncertainty using genetic algorithm and Monte Carlo simulation approach: a case study in pharmaceutical industry

    Science.gov (United States)

    Izadi, Arman; Kimiagari, Ali Mohammad

    2014-05-01

    Distribution network design as a strategic decision has long-term effect on tactical and operational supply chain management. In this research, the location-allocation problem is studied under demand uncertainty. The purposes of this study were to specify the optimal number and location of distribution centers and to determine the allocation of customer demands to distribution centers. The main feature of this research is solving the model with unknown demand function which is suitable with the real-world problems. To consider the uncertainty, a set of possible scenarios for customer demands is created based on the Monte Carlo simulation. The coefficient of variation of costs is mentioned as a measure of risk and the most stable structure for firm's distribution network is defined based on the concept of robust optimization. The best structure is identified using genetic algorithms and 14 % reduction in total supply chain costs is the outcome. Moreover, it imposes the least cost variation created by fluctuation in customer demands (such as epidemic diseases outbreak in some areas of the country) to the logistical system. It is noteworthy that this research is done in one of the largest pharmaceutical distribution firms in Iran.

  1. A Case Report for a Complex Denture Case on a Special Care Patient with Osteogenesis Imperfecta.

    Science.gov (United States)

    Sawyer, Colin; Drysdale, David

    2015-05-01

    This case report presents a patient with Dentogenesis Imperfecta (DI) associated with Osteogenesis Imperfecta (OI) and its subsequent dental manifestations. The patient in this report (see Figure 1) has spent his life living with his disability type III OI (also known as brittle bone disease) and its degenerative affects. The patient is independent and enjoys his social life but felt his existing dentures were having an adverse effect on the quality of his life. The patient attended Dorset County Hospitals Special Care Dentistry and on clinical examination it was noted the patient was partially dentate with a class III malocclusion and brownish discoloration of the remaining teeth caused by enamel hypoplasia. Treatment for this patient would entail making a maxillary complete denture and a mandibular partial chrome denture, normally quite simple tasks but due to the DI and its dental manifestations, the treatment would be complicated. This case demonstrates how a complex case treated by a collaborative dental team using their different skills and knowledge can lead to a successful and rewarding treatment for both patient and team.

  2. Developing the DESCARTE Model: The Design of Case Study Research in Health Care.

    Science.gov (United States)

    Carolan, Clare M; Forbat, Liz; Smith, Annetta

    2016-04-01

    Case study is a long-established research tradition which predates the recent surge in mixed-methods research. Although a myriad of nuanced definitions of case study exist, seminal case study authors agree that the use of multiple data sources typify this research approach. The expansive case study literature demonstrates a lack of clarity and guidance in designing and reporting this approach to research. Informed by two reviews of the current health care literature, we posit that methodological description in case studies principally focuses on description of case study typology, which impedes the construction of methodologically clear and rigorous case studies. We draw from the case study and mixed-methods literature to develop the DESCARTE model as an innovative approach to the design, conduct, and reporting of case studies in health care. We examine how case study fits within the overall enterprise of qualitatively driven mixed-methods research, and the potential strengths of the model are considered.

  3. Experiences of Emotion Management in Medical Care (Case Study: Toronto

    Directory of Open Access Journals (Sweden)

    Masoud Kianpour

    2013-02-01

    pastoral and spiritual care for patients, their relatives, and other medical personnel. Approximately 50 chaplains work in different Toronto hospitals, of whom 21 individuals were selected using purpose f ul sampling : a non-random method o f sampling in which the researcher selects “in f ormation-rich” cases f or in-depth interview. The author tried to collect data as records of action-in-process from a variety of people. Because the in-depth responses obtained by qualitative studies cannot be easily categorized, analysis must rely less on counting and correlating and more on interpretation, summary and integration. Therefore, more than anything else, the findings of this study are supported by quotations and case descriptions. The method of data analysis is qualitative description, with a phenomenological inclination: that is, the goal is to describe emotion management experiences as they are lived and felt by chaplains.     Discussion of Results & Conclusions   Chaplains who participated in this study are between the ages of 33 and 65. The average age is approximately 52. Also, 11 chaplains work part-time and 10 chaplains work full-time. 18 of the 21 chaplains in the sample are women. Recruiting more than 3 male chaplains was not possible due to the fact that hospital chaplaincy is a job predominantly occupied by women. In terms of ethnicity, the majority of the respondents are white, with European and Anglo-Saxon backgrounds. However, the sample also includes two Asian chaplains (with Chinese and Indian backgrounds and one from the Caribbean Islands. Moreover, the sample includes chaplains from five different religions and faith traditions. The majority of the chaplains are Christian, including five chaplains belonging to the Anglican Church, three to the Roman Catholic Church, two to the United Church of Canada, and one to the Baptist Church. The remaining four Christian chaplains did not specify their Church. Several of the chaplains are church ministers. Also

  4. Nutritional self-care in two older Norwegian males - A case study

    OpenAIRE

    2013-01-01

    Introduction: How to support nutritional self-care among older vulnerable individuals living in their own homes can be considered important knowledge for health care professionals. Aim: The aim of this case study was to evaluate the effects of a nutritional intervention by comparing self-reported perceived health, sense of coherence, self-care ability and nutritional risk in two older home-dwelling individuals before, during and after the intervention and also to describe experiences of nutri...

  5. Bacterial transmission from lens storage cases to contact lenses - Effects of lens care solutions and silver impregnation of cases

    NARCIS (Netherlands)

    Vermeltfoort, Pit B. J.; Hooymans, Johanna M. M.; Busscher, Henk J.; van der Mei, Henny C.

    2008-01-01

    The killing efficacies of multipurpose lens care solutions on planktonic and biofilm bacteria grown in polypropylene contact lens storage cases with and without silver impregnation and effects on bacterial transmission from storage cases to silicone hydrogel contact lenses were investigated. For tra

  6. Quantifying and reducing uncertainty in land use change model projections : Case studies on the implications of increasing bioenergy demands

    NARCIS (Netherlands)

    Verstegen, J.A.

    2016-01-01

    Land use change is a central issue in the sustainability debate, because of its impacts on e.g. climate change, water availability and quality, soil quality and erosion, and biodiversity. Continuing population growth, shifting diets towards higher meat consumption and increasing bioenergy demands ca

  7. Connection, regulation, and care plan innovation: a case study of four nursing homes.

    Science.gov (United States)

    Colón-Emeric, Cathleen S; Lekan-Rutledge, Deborah; Utley-Smith, Queen; Ammarell, Natalie; Bailey, Donald; Piven, Mary L; Corazzini, Kirsten; Anderson, Ruth A

    2006-01-01

    We describe how connections among nursing home staff impact the care planning process using a complexity science framework. We completed six-month case studies of four nursing homes. Field observations (n = 274), shadowing encounters (n = 69), and in-depth interviews (n = 122) of 390 staff at all levels were conducted. Qualitative analysis produced a conceptual/thematic description and complexity science concepts were used to produce conceptual insights. We observed that greater levels of staff connection were associated with higher care plan specificity and innovation. Connection of the frontline nursing staff was crucial for (1) implementation of the formal care plan and (2) spontaneous informal care planning responsive to changing resident needs. Although regulations could theoretically improve cognitive diversity and information flow in care planning, we observed instances of regulatory oversight resulting in less specific care plans and abandonment of an effective care planning process. Interventions which improve staff connectedness may improve resident outcomes.

  8. Neuroleptic Malignant Syndrome Requiring Neurological Intensive Care Unit Follow-up: Review with Nine Cases

    Directory of Open Access Journals (Sweden)

    Nazlı Gamze Bülbül

    2014-12-01

    Full Text Available Neuroleptic malignant syndrome (NMS is a rare but life-threatening clinical manifestation induced by neuroleptic medication. Although NMS is regarded as a psychiatric diagnosis, its treatment requires a systematic approach and thus intensive care follow-up. In this paper, we report nine cases with NMS followed up in our Neurology Intensive Care Unit over the last three years.

  9. Pursuing an Ethic of Care: A Case Study of One Female Superintendent

    Science.gov (United States)

    Rico, Rachelle G.

    2009-01-01

    This instrumental case study explores how the Ethic of Care is experienced within one Midwestern school system as an alternative approach to traditional school system hierarchical infrastructures. Through the qualitative tradition of portraiture (Lawrence-Lightfoot & Davis, 1997), this study documents the caring leadership actions, behaviors and…

  10. Evaluation of moral case deliberation at the Dutch Health Care Inspectorate: A pilot study

    NARCIS (Netherlands)

    W. Seekles (Wike); G.A. Widdershoven (Guy); P.B.M. Robben (Paul); G. Van Dalfsen (Gonny); B. Molewijk (Bert)

    2016-01-01

    textabstractBackground: Moral case deliberation (MCD) as a form of clinical ethics support is usually implemented in health care institutions and educational programs. While there is no previous research on the use of clinical ethics support on the level of health care regulation, employees of regul

  11. Reliability Demands in FTTH Access Networks

    DEFF Research Database (Denmark)

    Pedersen, Jens Myrup; Knudsen, Thomas Phillip; Madsen, Ole Brun

    2005-01-01

    In this paper reliability and bandwidth demands of existing, new and expected classes of applications running over Fiber To The Home (FTTH) networks to private users and small enterprises are analysed and discussed. Certain applications such as home security and telemedicine are likely to require...... high levels of reliability in the sense that the demands for network availability are high; even short times without connectivity are unacceptable. To satisfy these demands, physical redundancy in the networks is needed. It seems to be the case that - at least in the short term - most reliability......-critical applications do not require much bandwidth. This implies that redundancy do not need to be by fiber, but can be ensured by e.g. coax, copper or wireless solutions. However, implementing these solutions need careful planning to ensure the physical redundancy. In the long term, it is more likely that physical...

  12. Reliability Demands in FTTH Access Networks

    DEFF Research Database (Denmark)

    Pedersen, Jens Myrup; Knudsen, Thomas Phillip; Madsen, Ole Brun

    2004-01-01

    In this paper reliability and bandwidth demands of existing, new and expected classes of applications running over Fiber To The Home (FTTH) networks to private users and small enterprises are analyzed and discussed. Certain applications such as home security and telemedicine are likely to require...... high levels of reliability in the sense that the demands for network availability are high; even short times without connectivity are unacceptable. To satisfy these demands, physical redundancy in the networks is needed. It seems to be the case that - at least in the short term - most reliability......-critical applications do not require much bandwidth. This implies that redundancy do not need to be by fiber, but can be ensured by e.g. coax, copper or wireless solutions. However, implementing these solutions need careful planning to ensure the physical redundancy. In the long term, it is more likely that physical...

  13. Demanding Satisfaction

    Science.gov (United States)

    Oguntoyinbo, Lekan

    2010-01-01

    It was the kind of crisis most universities dread. In November 2006, a group of minority student leaders at Indiana University-Purdue University Indianapolis (IUPUI) threatened to sue the university if administrators did not heed demands that included providing more funding for multicultural student groups. This article discusses how this threat…

  14. Usefulness of a Regional Health Care Information System in primary care: a case study.

    Science.gov (United States)

    Maass, Marianne C; Asikainen, Paula; Mäenpää, Tiina; Wanne, Olli; Suominen, Tarja

    2008-08-01

    The goal of this paper is to describe some benefits and possible cost consequences of computer based access to specialised health care information. A before-after activity analysis regarding 20 diabetic patients' clinical appointments was performed in a Health Centre in Satakunta region in Finland. Cost data, an interview, time-and-motion studies, and flow charts based on modelling were applied. Access to up-to-date diagnostic information reduced redundant clinical re-appointments, repeated tests, and mail orders for missing data. Timely access to diagnostic information brought about several benefits regarding workflow, patient care, and disease management. These benefits resulted in theoretical net cost savings. The study results indicated that Regional Information Systems may be useful tools to support performance and improve efficiency. However, further studies are required in order to verify how the monetary savings would impact the performance of Health Care Units.

  15. 35 cases ventilator-associated pneumonia of prevention and care measures

    Institute of Scientific and Technical Information of China (English)

    杨文斌

    2014-01-01

    Objects: To discuss 35 cases ventilator-associated pneumonia of prevention and care measures. Method: It col ected 35 cases patients of ventilator-associated pneumonia from January 2007 to January 2010 in our hospital, It selects U.S. production of 7200 and 760 ventilator, began to control ventilation (ACMV). Results:The group of 35 patients with VAP, 30 cases were improved and offline successful after treatment, including machine 2 times on three cases of myasthenia gravis, successful weaning 2. Conclusion: The development of rational treatment and care measures can improve the survival rate of patients, shorter mechanical ventilation and length of stay, thus reducing the financial burden on patients.

  16. Do-it-yourself managed care. Case study I: Randall's Medical Network. Case study II: Hershey's Managed Care Plan.

    Science.gov (United States)

    1993-01-01

    Employers, who pay for much of the healthcare in this country, are not waiting for government to restructure the healthcare system. In this cover story, PROFILES examines how two firms formed their own managed care networks to control healthcare cost and quality, and what hospitals did to become players. By understanding the employer' point of view, hospital marketers can better anticipate their needs and develop a marketing strategy to form closer relationships with employers, provide quality care at a lower cost, and increase their market share.

  17. Technological progress and long-term energy demand - a survey of recent approaches and a Danish case

    DEFF Research Database (Denmark)

    Klinge Jacobsen, Henrik

    2001-01-01

    technologies are covered. Technological progress is an important issue for modelling long-term energy demand and is often characterised as the main contributor to the di!erent energy demand forecasts from di!erent models. New economic theoretical developments in the "elds of endogenous growth and industrial...... organisation have important implications for the attempts to endogenise technological innovation and di!usion of new energy technologies. A range of analytical and empirical models with di!erent descriptions of technological progress is surveyed in the paper. To analyse the importance of the technology...... important for long-term projections. A limitation of the vintage modelling approach applied in the long term explains some of the di!erences in projections among the two types of models. The applied vintage model of electric appliances does not adequately describe the category of new energy...

  18. Price Elasticity of Demand and Capacity-Restraint Transit Fare Strategy: A Case Study of Bangkok Mass Transit System

    Directory of Open Access Journals (Sweden)

    Ackchai Sirikijpanichkul

    2015-01-01

    Full Text Available Traffic congestion is a chronic problem of Bangkok. Similar to other metropolises, the city perpetually seeks for alternatives to road travel. Mass rapid transit seems to be the only way out that is expected to mitigate traffic congestion in the city. However, without common fare system, travelers need to pay an initial entrance fee every time they enter each transit system. This excess cost tapers the demand and affects the efficient use of the system. This research investigates the influence of fare price on transit use which is measured by price elasticity of demand and proposes the optimum fare price if the common fare is used. The analysis is based on the findings from the stated preference survey techniques. Finally, the conclusion on fare level that encourage more patronage, maintain service quality and operator revenue is addressed.

  19. Intrathecal analgesia and palliative care: A case study

    Directory of Open Access Journals (Sweden)

    Naveen S Salins

    2010-01-01

    Full Text Available Intrathecal analgesia is an interventional form of pain relief with definite advantages and multiple complications. Administration of intrathecal analgesia needs a good resource setting and expertise. Early complications of intrathecal analgesia can be very distressing and managing these complications will need a high degree of knowledge, technical expertise and level of experience. Pain control alone cannot be the marker of quality in palliative care. A holistic approach may need to be employed that is more person and family oriented.

  20. Product structure metrics as an indicator of demand-supply chain efficiency : case study in the cellular network industry

    OpenAIRE

    Kaski, Timo

    2002-01-01

    Product structure affects demand-supply chain performance, this is almost self-evident. But how to develop better product structures? Which design alternative is the best among several options? Markets define the number of product variants needed. Therefore, limiting product variations is not a feasible solution. This research made an effort to develop a method to guide product structure development and to quantify comparison of alternative design implementations. The study aimed at reducing ...

  1. Opportunities for Automated Demand Response in California Agricultural Irrigation

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, Daniel [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Aghajanzadeh, Arian [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); McKane, Aimee [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2015-08-01

    Pumping water for agricultural irrigation represents a significant share of California’s annual electricity use and peak demand. It also represents a large source of potential flexibility, as farms possess a form of storage in their wetted soil. By carefully modifying their irrigation schedules, growers can participate in demand response without adverse effects on their crops. This report describes the potential for participation in demand response and automated demand response by agricultural irrigators in California, as well as barriers to widespread participation. The report first describes the magnitude, timing, location, purpose, and manner of energy use in California. Typical on-­farm controls are discussed, as well as common impediments to participation in demand response and automated demand response programs. Case studies of demand response programs in California and across the country are reviewed, and their results along with overall California demand estimates are used to estimate statewide demand response potential. Finally, recommendations are made for future research that can enhance the understanding of demand response potential in this industry.

  2. A system dynamics model for simulating the logistics demand dynamics of metropolitans: A case study of Beijing, China

    Directory of Open Access Journals (Sweden)

    Ying Qiu

    2015-05-01

    Full Text Available Purpose: We attempted to propose an approach to simulate the dynamics of Beijing’s logistics demand, which can do some help to find out the dynamics path of the needed storage and shipment, put forward with logistics policies and enhance logistics service. Design/methodology/approach: We present a paper with system dynamics (SD methodology, which was run by the software of Vensim®. Findings: With SD model, causal loop diagram and stock and flow diagram are constructed, as well as some experiments and policy analysis. The research findings revealed that the increase of average shipping capacity for a vehicle will bring a decrease in congestion and CO2 emission directly and the decrease of the average fuel use for a vehicle can help with the reduction of CO2 emission directly. Both the two parameters are the indirect causes of logistics demand dynamics in Beijing. Originality/value: Researches of this paper are aiming at handling logistics demand dynamics of Beijing, problems belonging to the area of complex systems, with SD model, where, to the best of our knowledge, no significant research has been done.

  3. Opportunities for Open Automated Demand Response in Wastewater Treatment Facilities in California - Phase II Report. San Luis Rey Wastewater Treatment Plant Case Study

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, Lisa; Lekov, Alex; McKane, Aimee; Piette, Mary Ann

    2010-08-20

    This case study enhances the understanding of open automated demand response opportunities in municipal wastewater treatment facilities. The report summarizes the findings of a 100 day submetering project at the San Luis Rey Wastewater Treatment Plant, a municipal wastewater treatment facility in Oceanside, California. The report reveals that key energy-intensive equipment such as pumps and centrifuges can be targeted for large load reductions. Demand response tests on the effluent pumps resulted a 300 kW load reduction and tests on centrifuges resulted in a 40 kW load reduction. Although tests on the facility?s blowers resulted in peak period load reductions of 78 kW sharp, short-lived increases in the turbidity of the wastewater effluent were experienced within 24 hours of the test. The results of these tests, which were conducted on blowers without variable speed drive capability, would not be acceptable and warrant further study. This study finds that wastewater treatment facilities have significant open automated demand response potential. However, limiting factors to implementing demand response are the reaction of effluent turbidity to reduced aeration load, along with the cogeneration capabilities of municipal facilities, including existing power purchase agreements and utility receptiveness to purchasing electricity from cogeneration facilities.

  4. Implications of case managers' perceptions and attitude on safety of home-delivered care.

    Science.gov (United States)

    Jones, Sarahjane

    2015-12-01

    Perceptions on safety in community care have been relatively unexplored. A project that sought to understand the multiple perspectives on safety in the NHS case-management programme was carried out in relation to the structure, process, and outcome of care. This article presents a component of the nursing perspective that highlights an important element in the structure of nursing care that could potentially impede the nurses' ability to be fully effective and safe. A single case study of the case-management programme was undertaken. Three primary care organisations from three strategic health authorities participated, and three focus groups were conducted (one within each organisation). In total, 17 case management nurses participated. Data were audiotaped and transcribed verbatim and subjected to framework analysis. Nursing staff attitudes were identified as a structure of care that influence safety outcomes, particularly their perceptions of the care setting and the implications it has on their role and patient behaviour. Greater understanding of the expected role of the community nurse is necessary, and relevant training is required for nurses to be successful in empowering patients to perform more safely. In addition, efforts need to be made to improve patients' trust in the health-care system to prevent harm and promote more effective utilisation of resources.

  5. [Community resources prescription for self-care improvement in chronic illnesses. Clinical case management in Primary Health Care].

    Science.gov (United States)

    Pérez-Vico-Díaz de Rada, Lucía; González-Suárez, Miriam; Duarte-Clíments, Gonzalo; Brito-Brito, Pedro Ruymán

    2014-01-01

    A case is presented of a 52 year-old male seen in a Primary Care nursing clinic for a type 2 diabetes mellitus metabolic control. The frequency of the visits increased due to perceived difficulties caused by changing the medical treatment. A focused interview was conducted under functional health patterns framework. The patient was unable to write or read, had not worked for the last 25 years, and expressed a lack of control over his self-care. An action plan was prepared, prioritizing Ineffective Health Maintenance, Powerlessness, and Impaired Social Interaction NANDA-I nursing diagnoses. The goals were set at improving knowledge and control over his disease and participating in leisure activities. To achieve these, the social health resources in the area were contacted, and agreed that the patient could attend activities that could improve his self-care and his quality of life. An improvement in his diabetes control was observed in the following evaluations, with an increase in his level of knowledge and self-care. The Primary Health care nurse should consider available community resources by using a comprehensive approach to chronic diseases for their therapeutic benefit and management, especially in those patients with adverse sociocultural conditions.

  6. Evidence-informed case rates: paying for safer, more reliable care.

    Science.gov (United States)

    De Brantes, François; Rastogi, Amita

    2008-06-01

    There is widespread dissatisfaction with the current modes of paying for health care. Created by Prometheus Payment, evidence-informed case rates (ECRs) are designed to create fair payments for all providers delivering care to a patient for a particular condition. ECRs would combine global fees with an allowance for complications and performance incentives.The authors model ECRs for two scenarios, acute myocardial infarction and diabetes. Their analysis shows that, under fee-for-service payments, a high proportion of the costs of care go toward potentially avoidable complications--some 30 percent of payments for acute myocardial infarctions and 60 percent of payment for diabetes care. They conclude that ECRs would hold the delivery system accountable for the technical risk it imputes on the total costs of care--for medical errors and potentially avoidable complications. Further, ECRs would create incentives for providers to deliver care that is safer, more reliable, and consistent with evidence-based guidelines.

  7. When constitutional justice has the last word on health care: the case of Chile.

    Science.gov (United States)

    Zúñiga Fajuri, Alejandra

    2014-01-01

    The Chilean health care system is in crisis. Since the recent ruling of the Constitutional Court that declared the risk rating (actuarial insurance) of private health insurers unconstitutional, all of the social actors related to health care have tried to agree on a legislative reform that would overcome the existing highly segmented and inequitable system, which is a legacy of Pinochet's dictatorship. Here we demonstrate how the social and political demands for legislative reform in the health care sector have been supported by the decisions of the courts. To achieve its goals of reducing equity gaps in health and ending the judicialization of health care (claims for protection represent almost 70% of total resources of the courts), the National Congress of Chile is trying to create a new national health insurance system that guarantees the right to a minimum level of health care. Part of this effort involves obtaining the constitutional approval of the courts. In Chile, justice has the final word on health care.

  8. Digital transformation in home care. A case study.

    Science.gov (United States)

    Bennis, Sandy; Costanzo, Diane; Flynn, Ann Marie; Reidy, Agatha; Tronni, Catherine

    2007-01-01

    Simply implementing software and technology does not assure that an organization's targeted clinical and financial goals will be realized. No longer is it possible to roll out a new system--by solely providing end user training and overlaying it on top of already inefficient workflows and outdated roles--and know with certainty that targets will be met. At Virtua Health's Home Care, based in south New Jersey, implementation of their electronic system initially followed this more traditional approach. Unable to completely attain their earlier identified return on investment, they enlisted the help of a new role within their health system, that of the nurse informaticist. Knowledgeable in complex clinical processes and not bound by the technology at hand, the informaticist analyzed physical workflow, digital workflow, roles and physical layout. Leveraging specific tools such as change acceleration, workouts and LEAN, the informaticist was able to redesign workflow and support new levels of functionality. This article provides a view from the "finish line", recounting how this role worked with home care to assimilate information delivery into more efficient processes and align resources to support the new workflow, ultimately achieving real tangible returns.

  9. Health, Quality of Care and Quality of Life: A Case of Frail Older Adults

    Science.gov (United States)

    Hsieh, Chang-Ming

    2009-01-01

    This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two…

  10. The Community Health Care Demands Status and Its Influencing Factors of Elderly in Xi anni ng Ci ty%咸宁市城区老年人社区护理需求及其影响因素分析

    Institute of Scientific and Technical Information of China (English)

    张志霞; 罗菊英; 汪娟; 叶艳胜; 孔令磷

    2016-01-01

    Objectives To investigate community health care demands status and its influencing factors of elderly in Xianning City and to provide scientific reference for better community nursing services.Methods A self-designed community health care demand questionnaire was used to analyze the current status of community health care de-mands for 294 elderly in Xianning city.Results The total score of community health care demands of the elderly in Xianning was 2.89 ± 0.82. The demand of health prevention was the highest ,while the demand of disease nursing was the lowest.Multiple linear regression analysis showed that demand of disease nursing(β′=0.131) ,health pre-vention(β′=0.152) ,and overall community health nursing(β′=0.178)for elderly with higher educational level were higher than elderly with lower educational level(P<0.05). The elderly who were married showed more demand of health prevention than the elderly who were unmarried ,divorced or widowed(β′=0.154 ,P<0.05). The demand of health promotion for the younger elderly(β′= -0.128)and elderly with higher economic level(β′= 0.163)were higher than the older elderly and elderly with low economic level(P<0.05).Conclusions The elderly showed higher demands of health promotion.Community health care services should be made according to the demands of the elderly.%目的:探讨咸宁市城区老年人社区护理需求及影响因素。方法采用自制社区护理需求问卷对咸宁市城区294名老年人进行问卷调查。结果咸宁市城区老年人的社区护理总需求得分为2.89±0.82分,疾病预防需求最高,疾病护理需求最低。多元线性回归分析显示,文化程度较高者疾病护理(β′=0.131)、疾病预防(β′=0.152)和社区护理总需求(β′=0.178)得分高于文化程度较低者(P<0.05);有配偶者疾病预防得分高于未婚/离异/丧偶者(β′=0.154,P<0.05);经济收入较高(β′=0.163

  11. Meeting energy demand in a developing economy without damaging the environment. A case study in Sabah, Malaysia, from technical, environmental and economic perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Siong Lee; Lim, Yun Seng [Department of Physical Science, Electrical and Electronic Engineering, Tunku Abdul Rahman University (Malaysia)

    2010-08-15

    The challenges faced by the developing countries are unique in that they need to meet the increasing energy demands for their economic growths at a competitive price without damaging the environments. In this paper, a case study on the electricity demand issue in Sabah, Malaysia, is presented to investigate potential solutions in addressing this current need for a typical developing economy from the technical, economical and environmental perspectives. Sabah, one of the 13 states in Malaysia, is currently experiencing a serious power shortage, especially at the east coast. A 300 MW coal plant is proposed by the electricity utility company. However, the proposal has been rejected in the past several years due to the negative environmental impacts of the plant. In this paper, a number of alternative solutions were evaluated and proposed with respect to the viability of technologies, financial return and minimum environmental impact in terms of GHG emission. (author)

  12. The Impact of the Medicare-Eligible Retiree Health Care Fund on Navy Military Treatment Facilities’ Demand-to-Capacity Solution

    Science.gov (United States)

    2012-03-01

    Dental Intern, Dental Fellow, Dental Resident, Veterinarian 2—Direct Care Professional Physician Assistant, Nurse Practitioner, Nurse Midwife...Specialty Care that includes Obstetrics/Gynecology, General Surgery, Orthopedics , Podiatry, Mental Health, Substance Abuse Rehabilitation Program (SARP...2) Specialty Care that includes Obstetrics/Gynecology, General Surgery, Orthopedics , Mental Health, a Substance Abuse Rehabilitation Program (SARP

  13. Does Energy Efficiency Reduce Emissions and Peak Demand? A Case Study of 50 Years of Space Heating in Melbourne

    Directory of Open Access Journals (Sweden)

    Graham Palmer

    2012-07-01

    Full Text Available This paper examines the relationship between space heating energy efficiency and two related but distinct measures; greenhouse mitigation, and peak demand. The historic role of Melbourne’s space heating provides an opportunity to assess whether improvements in energy efficiency lead to sustained reductions in energy consumption or whether rebound factors “take back” efficiency gains in the long run. Despite significant and sustained improvements in appliance efficiency, and the thermal efficiency of new building fabrics, the per-capita heating energy consumption has remained remarkably stable over the past 50 years. Space heating efficiency is bound up with notions of comfort, sufficiency and lifestyle, and the short-run gains from efficiency become incorporated into a new set of norms. It is this evolution of cultural norms that reconciles the contradiction between the short-run gains from efficiency measures, with the efficiency rebound that becomes evident over the long-term. The related, but distinct peak demand measure can be influenced by efficiency measures, but energy efficiency measures will not alter the requirement for large-scale conventional energy to provide affordable and reliable winter heating.

  14. Scenario analyses of road transport energy demand: a case study of ethanol as a diesel substitute in Thailand

    Energy Technology Data Exchange (ETDEWEB)

    Chollacoop, N. [National Metal and Materials Technology Center (MTEC), Bioenergy Laboratory, Pathumthani (Thailand); Saisirirat, P. [King Mongkut' s University of Technology Thonburi (KMUTT), Department of Mechanical Engineering, Bangkok (Thailand); Fukuda, T.; Fukuda, A. [Asian Transportation Research Society (ATRANS), Bangkok (Thailand); Fukuda, T.; Fukuda, A. [College of Science and Technology, Nihon University, Department of Transportation Engineering and Socio-Technology, Chiba (Japan)

    2011-07-01

    Ethanol is conventionally used as a blend with gasoline due to its similar properties, especially the octane number. However, ethanol has also been explored and used as a diesel substitute. While a low-blend of ethanol with diesel is possible with use of an emulsifier additive, a high-blend of ethanol with diesel may require major adjustment of compression-ignition (CI) diesel engines. Since dedicated CI engines are commercially available for a high-blend ethanol in diesel (ED95), a fuel mixture comprised of 95% ethanol and 5% additive, this technology offers an option for an oil-importing country like Thailand to reduce its fossil import by use of its own indigenous bio-ethanol fuel. Among many strong campaigns on ethanol utilization in the transportation sector under Thailand's Alternative Energy Strategic Plan (2008-2022), the Thai Ministry of Energy has, for the first time, conducted a demonstration project with ethanol (ED95) buses on the Thai road system. The current investigation thus aims to assess and quantify the impact of using this ED95 technology to reduce fossil diesel consumption by adjusting the commercially available energy demand model called the Long range Energy Alternatives Planning system (LEAP). For this purpose, first, the necessary statistical data in the Thai transportation sector were gathered and analyzed to construct the predicative energy demand model. Then, scenario analyses were conducted to assess the benefit of ED95 technology on the basis of energy efficiency and greenhouse gas emission reduction. (authors)

  15. Demand Uncertainty

    DEFF Research Database (Denmark)

    Nguyen, Daniel Xuyen

    This paper presents a model of trade that explains why firms wait to export and why many exporters fail. Firms face uncertain demands that are only realized after the firm enters the destination. The model retools the timing of uncertainty resolution found in productivity heterogeneity models...... the high rate of exit seen in the first years of exporting. Finally, when faced with multiple countries in which to export, some firms will choose to sequentially export in order to slowly learn more about its chances for success in untested markets....

  16. Psychosocial issues in palliative care: A review of five cases

    Directory of Open Access Journals (Sweden)

    Tonia C Onyeka

    2010-01-01

    Full Text Available Palliative care is not just vital in controlling symptoms of the patient′s disease condition, but also aims to extend the patient′s life, giving it a better quality. However, several times in the course of management, the psychosocial impact of cancer, HIV/AIDS, and other life-limiting disease conditions may not be noticed and dealt with during the admission period, thereby giving rise to a more complex situation than the disease condition itself. This article aims to review some psychosocial issues and measures that can be taken to address them. It highlights the various roles and the importance of the clinician, nurse, social worker, and other members of the multidisciplinary team in tackling these issues and will help healthcare professionals in this field achieve better practice in the future.

  17. Assessing ecological land use and water demand of river systems: a case study in Luanhe River, North China

    Directory of Open Access Journals (Sweden)

    D. H. Yan

    2012-08-01

    Full Text Available Economic and social development has greatly increased ecological water demand and modified land use of river systems worldwide, causing overall degradation of many of these systems. In this study, theoretical and technical frameworks for regionalization on the eco-environmental function of river systems are formulated and applied to the Luanhe River system. Based on its eco-environmental functions, this river can be regionalized into four types of first-class functional areas: ecological preservation areas, habitat restoration areas, ecological buffer areas and development and utilization areas. Considering the overall eco-environmental functions, we assessed the ecological land use of the Luanhe River system. The total area of basic ecological land use is 876.98 km2; the restrictive ecological land use is 1745.52 km2; ecological land use of the river system returned from farmland is 284.25 km2; and that returned from construction land is 17.35 km2. The average minimum ecological flow of mainstreams in upper and middle reaches of the Luanhe River is 4.896 m3 s−1 based on the habitat method. And the recommended minimum and suitable annual ecological water demand of channels in the lower reaches are 391 million m3 and 819.5 million m3, respectively. The evaporation and seepage consumption and vegetation consumption in riparian zones of the Luanhe River system are approximately 132.6 million m3 and 145.3 million m3 per year, respectively. Our results suggest that is crucial to regulate the instream ecological water use of the Luanhe River's mainstream starting from the Panjiakou-Daheiting Reservoir system. We recommend accelerating ecological land-use planning and strengthening the regulation of ecological water use on this river system focusing on important lower reaches under the condition of competitive water demand.

  18. Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes

    Directory of Open Access Journals (Sweden)

    Marc Carreras

    2016-08-01

    Full Text Available Background: The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care. Methods: A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain for the year 2012 (N = 92,498 individuals. A set of individual cost models as a function of sex, age and morbidity burden were adjusted and individual healthcare costs were calculated using a retrospective full-costing system. The individual morbidity burden was inferred using the Clinical Risk Groups (CRG patient classification system. Results: Depending on the characteristics of the data, and according to the algorithm criteria, the choice of model was a linear model on the log of costs or a generalized linear model with a log link. We checked for goodness of fit, accuracy, linear structure and heteroscedasticity for the models obtained. Conclusion: The proposed algorithm identified a set of suitable cost models for the distinct groups of services integrated care entails. The individual morbidity burden was found to be indispensable when allocating appropriate resources to targeted individuals.

  19. Current Situation of Information Demand of Farmers in Taihang Mountain Area: A Case Study of Pingshan County in Hebei Province

    Institute of Scientific and Technical Information of China (English)

    Lipeng; GUO; Haiyan; CAI

    2014-01-01

    Since the reform and opening-up,economy of mountain areas in China has realized considerable development.However,due to such factors as terrain,traffic,and individual differences,compared with plain and coastal areas,mountain areas still lag far behind.In recent years,informationization construction of China develops rapidly,but it nearly stagnates in mountain rural areas.Information has become an essential factor restricting economic development of rural areas.Based on the survey of current information demand of farmers carried out in Pingshan County in Hebei Province in 2010,this study came up with relevant recommendations,in order to speed up development of rural economic in mountain areas,narrow the regional gap,improve living condition of farmers in mountain areas,and increase income level of farmers in mountain areas.

  20. Implementation of nutrition care service development plan at Banning Memorial Hospital: a case study.

    Science.gov (United States)

    Ben Oumlil, A; Rao, C P

    1992-01-01

    Health care service markets in general and hospital care service markets in particular are characterized by many competitive developments. Hence, hospital marketing managers are forced to respond to these emerging competitive pressures. However, in formulating appropriate marketing management strategies, hospital managers need to have detailed knowledge about consumers and their behaviors in the marketplace. This paper focuses on the Nutrition Care division of the Department of Nutrition Service at a hospital and its venture into new service development. This case study is intended to emphasize the significance of acquiring adequate knowledge of customers in the health care services industry. It particularly emphasizes the critical role that this type of information concerning customer behavior plays in the development and implementation of an appropriate business expansion strategy. Furthermore, the aim of this case study is to help the reader to relate the acquired marketing information to the problem at hand, and make the appropriate marketing management decision.

  1. Scenario Analyses of Road Transport Energy Demand: A Case Study of Ethanol as a Diesel Substitute in Thailand

    Directory of Open Access Journals (Sweden)

    Atsushi Fukuda

    2011-01-01

    Full Text Available Ethanol is conventionally used as a blend with gasoline due to its similar properties, especially the octane number. However, ethanol has also been explored and used as a diesel substitute. While a low-blend of ethanol with diesel is possible with use of an emulsifier additive, a high-blend of ethanol with diesel may require major adjustment of compression-ignition (CI diesel engines. Since dedicated CI engines are commercially available for a high-blend ethanol in diesel (ED95, a fuel mixture comprised of 95% ethanol and 5% additive, this technology offers an option for an oil-importing country like Thailand to reduce its fossil import by use of its own indigenous bio-ethanol fuel. Among many strong campaigns on ethanol utilization in the transportation sector under Thailand’s Alternative Energy Strategic Plan (2008–2022, the Thai Ministry of Energy has, for the first time, conducted a demonstration project with ethanol (ED95 buses on the Thai road system. The current investigation thus aims to assess and quantify the impact of using this ED95 technology to reduce fossil diesel consumption by adjusting the commercially available energy demand model called the Long range Energy Alternatives Planning system (LEAP. For this purpose, first, the necessary statistical data in the Thai transportation sector were gathered and analyzed to construct the predicative energy demand model. Then, scenario analyses were conducted to assess the benefit of ED95 technology on the basis of energy efficiency and greenhouse gas emission reduction.

  2. Beyond the limits of clinical governance? The case of mental health in English primary care

    Directory of Open Access Journals (Sweden)

    Campbell Stephen

    2008-03-01

    Full Text Available Abstract Background Little research attention has been given to attempts to implement organisational initiatives to improve quality of care for mental health care, where there is a high level of indeterminacy and clinical judgements are often contestable. This paper explores recent efforts made at an organisational level in England to improve the quality of primary care for people with mental health problems through the new institutional processes of 'clinical governance'. Methods Framework analysis, based on the Normalisation Process Model (NPM, of attempts over a five year period to develop clinical governance for primary mental health services in Primary Care Trusts (PCTs. The data come from a longitudinal qualitative multiple case-study approach in a purposive sample of 12 PCTs, chosen to reflect a maximum variety of organisational contexts for mental health care provision. Results The constant change within the English NHS provided a difficult context in which to attempt to implement 'clinical governance' or, indeed, to reconstruct primary mental health care. In the absence of clear evidence or direct guidance about what 'primary mental health care' should be, and a lack of actors with the power or skills to set about realising it, the actors in 'clinical governance' had little shared knowledge or understanding of their role in improving the quality of mental health care. There was a lack of ownership of 'mental health' as an integral, normalised part of primary care. Conclusion Despite some achievements in regard to monitoring and standardisation of prescribing practice, mental health care in primary care seems to have so far largely eluded the gaze of 'clinical governance'. Clinical governance in English primary mental health care has not yet become normalised. We make some policy recommendations which we consider would assist in the process normalisation and suggest other contexts to which our findings might apply.

  3. Language Discordance and Patient- Centered Care in Occupational Therapy: A Case Study.

    Science.gov (United States)

    Martinez, Jenny; Leland, Natalie

    2015-04-01

    The accumulative burden of a growing non-English speaking minority population and health disparities in the United States demonstrate the urgency of examining occupational therapy practices and defining care that is timely, effective, safe, and patient-centered. In this context, we investigate an occupational therapy episode of care from the perspectives of patient, caregiver, and primary occupational therapy care provider. Treatment sessions were observed and one-on-one semistructured interviews were conducted with the participants. Several themes describing areas of concern in communication and care delivery emerged, including expectations for care, the therapy relationship, professional identity, and pragmatic constraints. The use of untrained interpreters compromised treatment effectiveness and safety. This case highlights potential areas of concern in therapy when working with a diverse patient population. Abundant opportunities exist for occupational therapy to situate itself as an equitable, responsive, valuable, and essential service.

  4. August 2016 critical care case of the month

    Directory of Open Access Journals (Sweden)

    Deangelis JL

    2016-08-01

    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: The patient is a previously healthy, albeit anxious, 15-year-old girl seen by her primary care physician. She has had several months of general malaise and ongoing fatigue and an increased frequency in night terrors over the past few weeks. Her family attributes this to stress of school and her new job. She was noted to have lost 3 kg in the previous nine weeks. PMH, SH, and FH: Her PMH was unremarkable. She is a student and denies smoking, drinking or drug abuse. Her family history is noncontributory. Physical Examination: Vital signs: BP 100/60 mm Hg, P 90 beats/min and regular, R 16 breaths/min, T 100.8 ºF, BMI 15; Diffuse, non-tender lymphadenopathy through the submandibular and upper anterior cervical chains; Lungs: clear; Heart: regular rhythm without murmur: Abdomen: slightly rounded and firm. Which of the following are diagnostic considerations at this time? 1. Anorexia nervosa 2. ...

  5. Saving More Teeth—A Case for Personalized Care

    Directory of Open Access Journals (Sweden)

    Alexandre R. Vieira

    2015-02-01

    Full Text Available Background: Certain risk factors such as tobacco use, diabetes, genetic variations on the IL1 gene, and other inflammatory conditions are hypothesized to predict tooth loss in patients treated in a large medical center. Tooth loss trends are hypothesized to be greater in patients with more risk factors. Methods: DNA samples for 881 individuals were taken from the Dental Registry and DNA Repository at University of Pittsburgh School of Dental Medicine. Clinical data for all 4137 subjects in the registry were also available. SNP genotyping was performed on the samples for IL1α (rs1800587 and IL1β (rs1143634. IL1 positive status was determined as having one or more of the recessive alleles for either SNP. Tooth loss status was determined based on dental records and data gathered for age, sex, ethnicity, and self-reported medical history. Various statistical analyses were performed on the data including genetic association analysis by the PLINK software, chi-square, Mann-Whitney U, and ANOVA tests to determine significance. Results: Tooth loss averages increased with age by all risk factors (smoking, diabetes, hypertension, and interleukin genotypes; p = 4.07E-13 and by number of risk factors (p = 0.006. Increased tooth loss is associated with age and number of risk factors including diabetes, tobacco use, IL1+, and cardiovascular disease. Conclusion: These trends suggest that older patients and those with more risk factors should seek further preventive care to reduce future tooth loss.

  6. Factores asociados a la demanda de servicios para la atención del parto en México Factors associated with the demand for delivery care in Mexico

    Directory of Open Access Journals (Sweden)

    Miguel Ángel González-Block

    2010-10-01

    Full Text Available Objetivo. Analizar los factores asociados a la utilización de la institución de atención del parto en México para documentar el proceso de integración funcional de instituciones de salud. Material y métodos. Se utilizó información de mujeres con último parto entre 2000 y 2005 en la Encuesta Nacional de Salud y Nutrición 2006. Se aplicó la prueba de ji cuadrada para probar diferencias entre institución utilizada y aseguramiento. Se usó regresión logística para identificar factores que favorecieron la demanda de instituciones diferentes a las de afiliación de la mujer. Resultados. El 62.6% de mujeres con seguridad social utilizó instituciones de afiliación y 13.4% instituciones públicas. Entre no aseguradas 43.3% utilizó instituciones públicas y 19% seguridad social; 64.3% de afiliadas al Seguro Popular se atendieron en instituciones públicas. Variables de acceso, nivel socioeconómico y condiciones de vida influyeron en la demanda referida. Conclusiones. El traslape para atención de partos institucionales documenta la existencia de integración funcional de facto entre instituciones de salud mexicanas.Objective. Analyze the factors associated with the utilization of delivery care institutions in Mexico in order to document the functional integration of health institutions. Materials and Methods. Based on the 2006 National Health and Nutrition Survey, information from women whose last birth was between 2000 and 2005 was used. Chi square was used to test differences between institutions used and health insurance type. A logistic regression was carried out to identify factors associated with the demand for institutions with which women were not affiliated. Results. Women with social security used in 62% of the cases the institution of their affiliation and 13.4% used public institutions. For uninsured women, 43.3% used public institutions and 19.0% social security institutions; 64.3% of the Seguro Popular affiliates were

  7. Sustaining food self-sufficiency of a nation: The case of Sri Lankan rice production and related water and fertilizer demands.

    Science.gov (United States)

    Davis, Kyle Frankel; Gephart, Jessica A; Gunda, Thushara

    2016-04-01

    Rising human demand and climatic variability have created greater uncertainty regarding global food trade and its effects on the food security of nations. To reduce reliance on imported food, many countries have focused on increasing their domestic food production in recent years. With clear goals for the complete self-sufficiency of rice production, Sri Lanka provides an ideal case study for examining the projected growth in domestic rice supply, how this compares to future national demand, and what the associated impacts from water and fertilizer demands may be. Using national rice statistics and estimates of intensification, this study finds that improvements in rice production can feed 25.3 million Sri Lankans (compared to a projected population of 23.8 million people) by 2050. However, to achieve this growth, consumptive water use and nitrogen fertilizer application may need to increase by as much as 69 and 23 %, respectively. This assessment demonstrates that targets for maintaining self-sufficiency should better incorporate avenues for improving resource use efficiency.

  8. Connecting teens to caring adults in a school-based health center: a case study.

    Science.gov (United States)

    Blacksin, Beth A; Kelly, Patricia J

    2015-01-01

    The traditional medical care system is generally unable to provide the broad health and wellness services needed by many adolescents, especially those from low-income and racial/ethnic minority communities. Using a theoretical framework adapted from Bronfenbrenner's ecological model of multiple influencers, this case study examined how a school-based health center was able to provide a network of connections for adolescents to caring adults within the school and the local community. Contributors to this network were the creation of a student-centered community with access to adolescent-friendly services, providers acting as connectors, and care of the whole adolescent.

  9. A Randomized Controlled Trial of Hospital-based Case Management in Cancer Care

    DEFF Research Database (Denmark)

    Wulff, Christian N; Vedsted, Peter; Søndergaard, Jens

    2012-01-01

    BACKGROUND: Case management (CM) models based on experienced nurses are increasingly used to improve coordination and continuity of care for patients with complex health care needs. Anyway, little is known about the effects of hospital-based CM in cancer care.Aim.To analyse the effects of hospital......-based CM on (i) GPs' evaluation of information from the hospital and collaboration with the hospital staff and (ii) patients' contacts with GPs during daytime and out of hours. DESIGN: A randomized controlled trial allocated 280 colorectal cancer patients 1:1 to either a control group or CM intervention...

  10. Case studies from three states: breaking down silos between health care and criminal justice.

    Science.gov (United States)

    Bechelli, Matthew J; Caudy, Michael; Gardner, Tracie M; Huber, Alice; Mancuso, David; Samuels, Paul; Shah, Tanya; Venters, Homer D

    2014-03-01

    The jail-involved population-people with a history of arrest in the previous year-has high rates of illness, which leads to high costs for society. A significant percentage of jail-involved people are estimated to become newly eligible for coverage through the Affordable Care Act's expansion of Medicaid, including coverage of substance abuse treatment and mental health care. In this article we explore the need to break down the current policy silos between health care and criminal justice, to benefit both sectors and reduce unnecessary costs resulting from lack of coordination. To draw attention to the hidden costs of the current system, we review three case studies, from Washington State, Los Angeles County in California, and New York City. Each case study addresses different aspects of care needed by or provided to the jail-involved population, including mental health and substance abuse, emergency care, and coordination of care transitions. Ultimately, bending the cost curve for health care and criminal justice will require greater integration of the two systems.

  11. Streptococcus salivarius meningitis after dental care: case report

    Directory of Open Access Journals (Sweden)

    Maira Zoppelletto

    2012-12-01

    Full Text Available Introduction. Streptococcus salivarius is a common commensal of the oral mucosa, associated with infections in different sites. Meningitis due to this species are described in a few occasions . In this study refer to a case recently diagnosed in our hospital for treatment of a subsequent dental caries. Case report. A man of 35 years, presents to the emergency room with fever, headache, confusion, marked nuchal rigor.Anamnesis is the treatment of dental caries on the previous day.The blood count showed 24.7x109 / L with WBC 22.9x109 / L (92.9% neutrophils. The lumbar puncture CSF noted cloudy with 15.0 x 109 / L WBC, glicorrachia 5 g / L, protidorrachia 6.5 g / L. Microscopic examination showed numerous granulocytes and prevalence of Gram-positive cocci.The pneumococcal antigen was negative.The blood cultures before starting antibiotic therapy, were negative. CSF was isolated from the culture of a Streptococcus salivarius. To antibiotic therapy started in the ED, after lumbar puncture is associated with the Ampicillin Ceftriaxone and continued for 15 days to improve the patient’s general condition, then resigned in the 17 th day. Materials and methods. From CSF inoculated in blood agar plates and chocolate agar alpha hemolytic colonies were isolated, catalysis negative, optochin resistant. The biochemical identification performed with Phoenix (BD and confirmed by PCR Pan bacterial (16S rDNA bacterial strain identified as Streptococcus salivarius.The antibiogram performed with Phoenix (BD according to the CLSI guidelines indicated sensitivity to penicillin, vancomycin, cefotaxime, cefepime, and chloramphenicol. Conclusions. Meningitis by Streptococcus salivarius was found in a few cases, mainly related to the transmission of health personnel from the oral cavity during lumbar punctures performed without the use of surgical masks. The following bacterial meningitis in dental treatment having a low incidence and often fatal course be suspected by

  12. Demand and influencing factors analysis of home care for discharged patients%太原市出院患者居家护理需求及影响因素分析

    Institute of Scientific and Technical Information of China (English)

    石贞仙; 田艳妮

    2015-01-01

    目的:探讨出院患者的居家护理需求及其影响因素。方法采用自设问卷对太原市3所三级甲等综合医院的450例有不同居家护理需求的出院患者进行调查;采用均数±标准差( x± s)、百分比(%)进行统计学描述,采用t检验、方差分析、多元线性回归进行统计学分析。结果出院患者护理需求均分为(2.47±0.96)分,需求强度健康指导、康复护理、心理护理、临床护理、生活护理分别为(2.85±1.25),(2.75±1.64),(2.58±1.68),(2.46±1.17),(1.85±1.03)分;多元线性回归分析显示,患病种类和收入水平是居家护理需求的正性影响因素;ADL得分和婚姻状况是居家护理需求的负性影响因素。结论居家护理是未来护理的发展方向,应以需求为导向,从多角度出发,制定针对性的对策,开展适合国情的居家护理,满足多元化需求。%Objective To explore the demand and influencing factors analysis of home care for discharged patients. Methods The self-designed questionnaire was used to investigated 450 patients discharged from three level three class A hospitals in Taiyuan; we utilized (x± s), (%) to statistically describe, and applied t test, variance analysis and multiple linear regression for statistically analysis. Results The average demand score of nursing care was (2. 47 ± 0. 96) in discharged patients, while the score of demand degree of health guidance, rehabilitation nursing, psychological nursing, clinical nursing and life care were ( 2. 85 ± 1. 25), (2. 75 ± 1. 64), (2. 58 ± 1. 68), (2. 46 ± 1. 17) and (1. 85 ± 1. 03) respectively; multi liner regression analysis represented that the type of patients and income were the positive influencing factors for the demand of home care;the score of ADL and marriage status were the negative influencing factors for home care demand. Conclusions Home care is one direction of nursing development in future, so it should guide by

  13. A Case of Congenital Tuberculosis in a Tertiary Care Hospital

    Directory of Open Access Journals (Sweden)

    Ishrat Jahan

    2011-07-01

    Full Text Available Congenital tuberculosis is an unusual and severe clinical presentation of Mycobacterium tuberculosis (MTB infection. It is usually difficult to diagnose and treat. We report a tenweek-old male infant who had presented with fever, difficulty in breathing, abdominal distension, convulsion, low weight gain since one month of his age. The diagnosis was made by demonstration of MTB bacilli in the gastric aspirate of baby and chest radiography. Treatment with the four drug regimen including streptomycin was initiated, but the baby died on the third day of ATT. This case gives an account of difficulties in diagnosis and therapeutic management of congenital tuberculosis and alerts for development of protocols that foresee these difficulties.

  14. Component-Based Modelling for Scalable Smart City Systems Interoperability: A Case Study on Integrating Energy Demand Response Systems.

    Science.gov (United States)

    Palomar, Esther; Chen, Xiaohong; Liu, Zhiming; Maharjan, Sabita; Bowen, Jonathan

    2016-10-28

    Smart city systems embrace major challenges associated with climate change, energy efficiency, mobility and future services by embedding the virtual space into a complex cyber-physical system. Those systems are constantly evolving and scaling up, involving a wide range of integration among users, devices, utilities, public services and also policies. Modelling such complex dynamic systems' architectures has always been essential for the development and application of techniques/tools to support design and deployment of integration of new components, as well as for the analysis, verification, simulation and testing to ensure trustworthiness. This article reports on the definition and implementation of a scalable component-based architecture that supports a cooperative energy demand response (DR) system coordinating energy usage between neighbouring households. The proposed architecture, called refinement of Cyber-Physical Component Systems (rCPCS), which extends the refinement calculus for component and object system (rCOS) modelling method, is implemented using Eclipse Extensible Coordination Tools (ECT), i.e., Reo coordination language. With rCPCS implementation in Reo, we specify the communication, synchronisation and co-operation amongst the heterogeneous components of the system assuring, by design scalability and the interoperability, correctness of component cooperation.

  15. Component-Based Modelling for Scalable Smart City Systems Interoperability: A Case Study on Integrating Energy Demand Response Systems

    Science.gov (United States)

    Palomar, Esther; Chen, Xiaohong; Liu, Zhiming; Maharjan, Sabita; Bowen, Jonathan

    2016-01-01

    Smart city systems embrace major challenges associated with climate change, energy efficiency, mobility and future services by embedding the virtual space into a complex cyber-physical system. Those systems are constantly evolving and scaling up, involving a wide range of integration among users, devices, utilities, public services and also policies. Modelling such complex dynamic systems’ architectures has always been essential for the development and application of techniques/tools to support design and deployment of integration of new components, as well as for the analysis, verification, simulation and testing to ensure trustworthiness. This article reports on the definition and implementation of a scalable component-based architecture that supports a cooperative energy demand response (DR) system coordinating energy usage between neighbouring households. The proposed architecture, called refinement of Cyber-Physical Component Systems (rCPCS), which extends the refinement calculus for component and object system (rCOS) modelling method, is implemented using Eclipse Extensible Coordination Tools (ECT), i.e., Reo coordination language. With rCPCS implementation in Reo, we specify the communication, synchronisation and co-operation amongst the heterogeneous components of the system assuring, by design scalability and the interoperability, correctness of component cooperation. PMID:27801829

  16. Component-Based Modelling for Scalable Smart City Systems Interoperability: A Case Study on Integrating Energy Demand Response Systems

    Directory of Open Access Journals (Sweden)

    Esther Palomar

    2016-10-01

    Full Text Available Smart city systems embrace major challenges associated with climate change, energy efficiency, mobility and future services by embedding the virtual space into a complex cyber-physical system. Those systems are constantly evolving and scaling up, involving a wide range of integration among users, devices, utilities, public services and also policies. Modelling such complex dynamic systems’ architectures has always been essential for the development and application of techniques/tools to support design and deployment of integration of new components, as well as for the analysis, verification, simulation and testing to ensure trustworthiness. This article reports on the definition and implementation of a scalable component-based architecture that supports a cooperative energy demand response (DR system coordinating energy usage between neighbouring households. The proposed architecture, called refinement of Cyber-Physical Component Systems (rCPCS, which extends the refinement calculus for component and object system (rCOS modelling method, is implemented using Eclipse Extensible Coordination Tools (ECT, i.e., Reo coordination language. With rCPCS implementation in Reo, we specify the communication, synchronisation and co-operation amongst the heterogeneous components of the system assuring, by design scalability and the interoperability, correctness of component cooperation.

  17. On the Inclusion of Energy-Shifting Demand Response in Production Cost Models: Methodology and a Case Study

    Energy Technology Data Exchange (ETDEWEB)

    O' Connell, Niamh [Technical Univ. of Denmark, Lyngby (Denmark); Hale, Elaine [National Renewable Energy Lab. (NREL), Golden, CO (United States); Doebber, Ian [National Renewable Energy Lab. (NREL), Golden, CO (United States); Jorgenson, Jennie [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-07-20

    In the context of future power system requirements for additional flexibility, demand response (DR) is an attractive potential resource. Its proponents widely laud its prospective benefits, which include enabling higher penetrations of variable renewable generation at lower cost than alternative storage technologies, and improving economic efficiency. In practice, DR from the commercial and residential sectors is largely an emerging, not a mature, resource, and its actual costs and benefits need to be studied to determine promising combinations of physical DR resource, enabling controls and communications, power system characteristics, regulatory environments, market structures, and business models. The work described in this report focuses on the enablement of such analysis from the production cost modeling perspective. In particular, we contribute a bottom-up methodology for modeling load-shifting DR in production cost models. The resulting model is sufficiently detailed to reflect the physical characteristics and constraints of the underlying flexible load, and includes the possibility of capturing diurnal and seasonal variations in the resource. Nonetheless, the model is of low complexity and thus suitable for inclusion in conventional unit commitment and market clearing algorithms. The ability to simulate DR as an operational resource on a power system over a year facilitates an assessment of its time-varying value to the power system.

  18. How the Trivialization of the Demands of High-Tech Care in the Home is Turning Family Members Into Para-Medical Personnel

    Science.gov (United States)

    Guberman, Nancy; Gagnon, Eric; Cote, Denyse; Gilbert, Claude; Thivierge, Nicole; Tremblay, Marielle

    2005-01-01

    This study analyzes the transfer of specialized professional activities from health care workers to patients and their family members in the context of the shift to ambulatory care for acute and chronic illnesses requiring hospitalization. Based on 119 semidirective interviews with patients released from hospital after early discharge and/or with…

  19. Family solidarity and informal care: the case of care for people with dementia.

    Science.gov (United States)

    ter Meulen, Ruud; Wright, Katharine

    2012-09-01

    According to Bayertz the core meaning of solidarity is the perception of mutual obligations between the members of a community. This definition leaves open the various ways solidarity is perceived by individuals in different communities and how it manifests itself in a particular community. This paper explores solidarity as manifested in the context of families in respect of caregiving for a family member who has become dependent because of disease or illness. Though family caregiving is based on the same perception of mutual obligation as the solidarity that supports welfare arrangements in society, the manifestation of solidarity in families is different. Solidarity that underpins welfare arrangements is based on a perception of mutual obligation towards an anonymous dependent other and is enforced by the government. Solidarity in families is directed towards a concrete other and is based on free choice, albeit often accompanied by a strong sense of personal duty. In this paper we try to distinguish between solidarity as a sociological concept and as a moral concept. An important moral element of solidarity, as expressed in families, is the need for recognition of family caregivers, not only of their concrete practical efforts, but also of their own identity as caregivers and as individuals. We illustrate this argument by referring to examples in the Nuffield Council on Bioethics report Dementia: ethical issues, about the experiences of family caregivers in dementia care and the importance for them of recognition of their role.

  20. Enabling Precision Medicine With Digital Case Classification at the Point-of-Care

    Directory of Open Access Journals (Sweden)

    Patrick Obermeier

    2016-02-01

    Full Text Available Infectious and inflammatory diseases of the central nervous system are difficult to identify early. Case definitions for aseptic meningitis, encephalitis, myelitis, and acute disseminated encephalomyelitis (ADEM are available, but rarely put to use. The VACC-Tool (Vienna Vaccine Safety Initiative Automated Case Classification-Tool is a mobile application enabling immediate case ascertainment based on consensus criteria at the point-of-care. The VACC-Tool was validated in a quality management program in collaboration with the Robert-Koch-Institute. Results were compared to ICD-10 coding and retrospective analysis of electronic health records using the same case criteria. Of 68,921 patients attending the emergency room in 10/2010–06/2013, 11,575 were hospitalized, with 521 eligible patients (mean age: 7.6 years entering the quality management program. Using the VACC-Tool at the point-of-care, 180/521 cases were classified successfully and 194/521 ruled out with certainty. Of the 180 confirmed cases, 116 had been missed by ICD-10 coding, 38 misclassified. By retrospective application of the same case criteria, 33 cases were missed. Encephalitis and ADEM cases were most likely missed or misclassified. The VACC-Tool enables physicians to ask the right questions at the right time, thereby classifying cases consistently and accurately, facilitating translational research. Future applications will alert physicians when additional diagnostic procedures are required.

  1. Meeting Rural Demand: A Case for Combining Community-Based Distribution and Social Marketing of Injectable Contraceptives in Tigray, Ethiopia

    Science.gov (United States)

    Prata, Ndola; Weidert, Karen; Fraser, Ashley; Gessessew, Amanuel

    2013-01-01

    Background In Sub-Saharan Africa, policy changes have begun to pave the way for community distribution of injectable contraceptives but sustaining such efforts remains challenging. Combining social marketing with community-based distribution provides an opportunity to recover some program costs and compensate workers with proceeds from contraceptive sales. This paper proposes a model for increasing access to injectable contraceptives in rural settings by using community-based distributers as social marketing agents and incorporating financing systems to improve sustainability. Methods This intervention was implemented in three districts of the Central Zone of Tigray, Ethiopia and program data has been collected from November 2011 through October 2012. A total of 137 Community Based Reproductive Health Agents (CBRHAs) were trained to provide injectable contraceptives and were provided with a loan of 25 injectable contraceptives from a drug revolving fund, created with project funds. The price of a single dose credited to a CBRHA was 3 birr ($0.17) and they provide injections to women for 5 birr ($0.29), determined with willingness-to-pay data. Social marketing was used to create awareness and generate demand. Both quantitative and qualitative methods were used to examine important feasibility aspects of the intervention. Results Forty-four percent of CBRHAs were providing family planning methods at the time of the training and 96% believed providing injectable contraceptives would improve their services. By October 2012, 137 CBRHAs had successfully completed training and provided 2541 injections. Of total injections, 47% were provided to new users of injectable contraceptives. Approximately 31% of injections were given for free to the poorest women, including adolescents. Conclusions Insights gained from the first year of implementation of the model provide a framework for further expansion in Tigray, Ethiopia. Our experience highlights how program planners can

  2. Meeting rural demand: a case for combining community-based distribution and social marketing of injectable contraceptives in Tigray, Ethiopia.

    Directory of Open Access Journals (Sweden)

    Ndola Prata

    Full Text Available BACKGROUND: In Sub-Saharan Africa, policy changes have begun to pave the way for community distribution of injectable contraceptives but sustaining such efforts remains challenging. Combining social marketing with community-based distribution provides an opportunity to recover some program costs and compensate workers with proceeds from contraceptive sales. This paper proposes a model for increasing access to injectable contraceptives in rural settings by using community-based distributers as social marketing agents and incorporating financing systems to improve sustainability. METHODS: This intervention was implemented in three districts of the Central Zone of Tigray, Ethiopia and program data has been collected from November 2011 through October 2012. A total of 137 Community Based Reproductive Health Agents (CBRHAs were trained to provide injectable contraceptives and were provided with a loan of 25 injectable contraceptives from a drug revolving fund, created with project funds. The price of a single dose credited to a CBRHA was 3 birr ($0.17 and they provide injections to women for 5 birr ($0.29, determined with willingness-to-pay data. Social marketing was used to create awareness and generate demand. Both quantitative and qualitative methods were used to examine important feasibility aspects of the intervention. RESULTS: Forty-four percent of CBRHAs were providing family planning methods at the time of the training and 96% believed providing injectable contraceptives would improve their services. By October 2012, 137 CBRHAs had successfully completed training and provided 2541 injections. Of total injections, 47% were provided to new users of injectable contraceptives. Approximately 31% of injections were given for free to the poorest women, including adolescents. CONCLUSIONS: Insights gained from the first year of implementation of the model provide a framework for further expansion in Tigray, Ethiopia. Our experience highlights how

  3. "Here's my dilemma". Moral case deliberation as a platform for discussing everyday ethics in elderly care.

    Science.gov (United States)

    van der Dam, S; Abma, T A; Kardol, M J M; Widdershoven, G A M

    2012-09-01

    Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: 'resident's behavior', 'divergent perspectives on good care' and 'organizational context'. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical 'blind spots'.

  4. On the Inclusion of Energy-Shifting Demand Response in Production Cost Models: Methodology and a Case Study

    DEFF Research Database (Denmark)

    O'Connell, Niamh; Hale, Elaine; Doebber, Ian

    a case study of aggregated supermarket refrigeration systems providing balancing energy reserves in real-time markets at different levels of variable generation (VG). This DR resource is implemented in a test power system that represents a subset of the U.S Western Interconnection centered on Colorado......% to 55% VG. This is attributable to the inability of DR to provide energy storage on horizons longer than 24 hours. Overall, this work is a study in methodology. The case study is included primarily to show that the model is working properly and that this line of research is worthwhile. The reported...... penetration (increasing). Future work includes extending this method and developing new methods to be able to model physically realistic DR resources at scale. Some important aspects not studied here include capturing all possible value streams for a single resource (capacity, energy, and ancillary service...

  5. A day in the life: a case series of acute care palliative medicine--the Cleveland model.

    Science.gov (United States)

    Lagman, Ruth; Walsh, Declan; Heintz, Jessica; Legrand, Susan B; Davis, Mellar P

    2008-01-01

    Palliative care in advanced disease is complex. Knowledge and experience of symptom control and management of multiple complications are essential. An interdisciplinary team is also required to meet the medical and psychosocial needs in life-limiting illness. Acute care palliative medicine is a new concept in the spectrum of palliative care services. Acute care palliative medicine, integrated into a tertiary academic medical center, provides expert medical management and specialized care as part of the spectrum of acute medical care services to this challenging patient population. The authors describe a case series to provide a snapshot of a typical day in an acute care inpatient palliative medicine unit. The cases illustrate the sophisticated medical care involved for each individual and the important skill sets of the palliative medicine specialist required to provide high-quality acute medical care for the very ill.

  6. The construction of a decision tool to analyse local demand and local supply for GP care using a synthetic estimation model.

    NARCIS (Netherlands)

    Graaf-Ruizendaal, W.A. de; Bakker, D.H. de

    2013-01-01

    Background: This study addresses the growing academic and policy interest in the appropriate provision of local healthcare services to the healthcare needs of local populations to increase health status and decrease healthcare costs. However, for most local areas information on the demand for primar

  7. Demand-side management energy saving potential in commercial and governmental/institutional sectors and its impact on power planning : a case study of central grid of Oman

    Energy Technology Data Exchange (ETDEWEB)

    Malik, A.S.; Al-Khrousi, A.R.; Al-Hindi, M.; Al-Mahrouqi, Y. [Sultan Qaboos Univ., Al-Khod (Oman). College of Engineering

    2006-07-01

    The results of Demand-Side Management (DSM) energy saving potential in commercial, government and institutional sectors of Oman were presented along with an evaluation of its impact on generation capacity and energy savings. DSM was defined as electricity demand management by methods such as peak clipping, valley filling, load shifting, and strategic conservation. Peak clipping reduces electricity demand during on-peak periods of the day, thus lowering the peak demand that utilities must meet. In contrast, valley filling increases the electrical load during off-peak periods. Load shifting refers to the movement of loads from peak periods to off-peak periods without any shift in energy use. Strategic load growth aims to increase the load in the future, while strategic conservation aims to decrease the load in the future without any shift in demand to another time. The purpose of DSM is to influence the amount or timing of customers' energy use. It has a positive environmental outlook and provides the best solution between load growth and increasing constraints on new and existing generation, transmission and distribution capacity. Resource options for DSM include energy efficiency options, such as energy efficient appliances, lighting, high efficiency heating, ventilating and air conditioning. Other options include load management and tariffs such as time-of-use incentives. The goal of electricity planning is to meet the load forecast with high reliability at a minimum cost. DSM economic energy savings potential is worked out from both the customer point of view and the electric utility's point of view. The study showed that the use of DSM in commercial and government sectors is economically justified from the customer point of view. DSM programs in the government and commercial sectors reduced the energy consumption to 21 and 38 per cent respectively. The discounted payback period of investment in efficient lighting and air-conditioning was between 4

  8. The Role of Private Sector in Meeting Health Care Demand(PartⅠ)%私人部门在满足医疗需求方面的作用(上)

    Institute of Scientific and Technical Information of China (English)

    郑宗美; 莱因哈特; 王宇

    2015-01-01

    本文就私人部门在满足医疗需求方面的作用进行分析,认为如果私人部门能够得到有效监管,并按照社会道德认同的方式进行运转,一国医疗体系就能够受益于私人部门。本部分探讨了医疗体系的基本功能及其目标,介绍了绝对平均主义、两阶层医疗体系和多阶层医疗体系三种分配医疗服务的观点,指出当前用货币价值衡量医疗产出价值是次优选择;而衡量医疗服务分配效率也存在争议。%This paper analyzes the role of private sector in meeting health care demand and believes that national health care system will be able to benefit from the private sector if the private sector can be effectively regulated and op-erates according to the social moral. In this part,the basic function and target of health care system are discussed,the views of three kinds of health care allocation (the absolute equalitarianism, two-class health care system and multi-class health care system) are introduced and it is suboptimal choice to value health care output by currency is pointed;What’s more,controversies are still existing in how to value the health care allocation efficiency.

  9. Two Case Reports of Neuroinvasive West Nile Virus Infection in the Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Edgardo M. Flores Anticona

    2012-01-01

    Full Text Available We describe the clinical course of two cases of neuroinvasive West Nile Virus (WNV infection in the critical care unit. The first case is a 70-year-old man who presented during summer with mental status changes. Cerebrospinal fluid (CSF analysis revealed pleocytosis with lymphocyte predominance. WNV serology was positive in the CSF. His condition worsened with development of left-sided weakness and deterioration of mental status requiring intensive care. The patient gradually improved and was discharged with residual left-sided weakness and near-complete improvement in his mental status. The second case is an 81-year-old man who presented with mental status changes, fever, lower extremity weakness, and difficulty in walking. CSF analysis showed pleocytosis with neutrophil predominance. WNV serology was also positive in CSF. During the hospital stay his mentation worsened, eventually requiring intubation for airway protection and critical care support. The patient gradually improved and was discharged with residual upper and lower extremity paresis. Neuroinvasive WNV infection can lead to significant morbidity, especially in the elderly. These cases should be suspected in patients with antecedent outdoor activities during summer. It is important for critical care providers to be aware of and maintain a high clinical suspicion of this disease process.

  10. Generic project definitions for improvement of health care delivery: A case-base approach

    NARCIS (Netherlands)

    Niemeijer, G.C.; Does, R.J.M.M.; de Mast, J.; Trip, A.; van den Heuvel, J.

    2011-01-01

    Background: The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. Methods: This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning a

  11. Case Management as a Significant Component of Usual Care Psychotherapy for Youth with Disruptive Behavior Problems

    Science.gov (United States)

    Zoffness, Rachel; Garland, Ann; Brookman-Frazee, Lauren; Roesch, Scott

    2009-01-01

    Youth with disruptive behavior problems (DBPs) represent the majority of youth served in usual care (UC) psychotherapy, and are at high risk for maladaptive outcomes. Little is known about UC psychotherapeutic strategies utilized with this population. Researchers and clinicians suggest that case management (CM) is a major activity occurring in…

  12. Medication Abortion within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

    Science.gov (United States)

    Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily

    2012-01-01

    Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants:…

  13. Reenacted Case Scenarios for Undergraduate Healthcare Students to Illustrate Person-Centered Care in Dementia

    Science.gov (United States)

    Bradley, Sandra L.; De Bellis, Anita; Guerin, Pauline; Walters, Bonnie; Wotherspoon, Alison; Cecchin, Maggie; Paterson, Jan

    2010-01-01

    Healthcare practitioners have suggested that interpreting person-centered care for people who have dementia to undergraduate students requires guidance in practical application. This article describes the production of a written and digital interdisciplinary educational resource for tertiary students. It uses real-life case scenarios provided by…

  14. Developing power markets - Development of market place for meeting the demand - Case India, in transition from regulated to competitive structure

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, Pranay; Sarkar, Prabhajit Kumar

    2010-09-15

    Power Market players of developing countries with supply deficit are exposed to a unique combination of price risk and quantity risk which is not the case with developed nations that have taken path of liberalization to open up their power markets. India has one of the largest generation capacities in the world, yet till recently the Indian Power sector was highly regulated. However, the last decade has witnessed many initiatives so as to make the sector market oriented. This paper provides opportunity for developing countries to learn from Indian experience of introducing competition in the power sector.

  15. Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation

    Directory of Open Access Journals (Sweden)

    Martin Roland

    2012-07-01

    Full Text Available Introduction: In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model.Methods: Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation.Results: Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes.Conclusion: Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve

  16. Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation

    Directory of Open Access Journals (Sweden)

    Martin Roland

    2012-07-01

    Full Text Available Introduction: In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model. Methods: Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation. Results: Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes. Conclusion: Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve

  17. Tracking the evolution of hospice palliative care in Canada: A comparative case study analysis of seven provinces

    Directory of Open Access Journals (Sweden)

    Richards Judy-Lynn

    2010-06-01

    of the established system of care were taken, often out of necessity. Three kinds of circumventions were identified from the data: (1 interventions to shift the system (e.g., the role of advocacy; (2 service innovations (e.g., educational initiatives; and (3 new alternative structures (e.g., the establishment of independent hospice organizations. Overall, the evolution of HPC across the case study provinces has been markedly slow, but steady and continuous. Conclusions HPC in Canada remains at the margins of the health care system. Its integration into the primary health care system may ensure dedicated and ongoing funding, enhanced access, quality and service responsiveness. Though demographics are expected to influence HPC demand in Canada, our study confirms that concerned citizens, advocacy organizations and local champions will continue to be the agents of change that make the necessary and lasting impacts on HPC in Canada.

  18. Upper gastrointestinal symptoms, psychosocial co-morbidity and health care seeking in general practice: population based case control study

    Science.gov (United States)

    Bröker, Linda E; Hurenkamp, Gerard JB; ter Riet, Gerben; Schellevis, François G; Grundmeijer, Hans G; van Weert, Henk C

    2009-01-01

    Background The pathophysiology of upper gastrointestinal (GI) symptoms is still poorly understood. Psychological symptoms were found to be more common in patients with functional gastrointestinal complaints, but it is debated whether they are primarily linked to GI symptoms or rather represent motivations for health-care seeking. Purpose of our study was to compare co-morbidity, in particular psychological and social problems, between patients with and without upper GI symptoms. In addition, we investigated whether the prevalence of psychological and social problems is part of a broader pattern of illness related health care use. Methods Population based case control study based on the second Dutch National Survey of general practice (conducted in 2001). Cases (adults visiting their primary care physician (PCP) with upper GI symptoms) and controls (individuals not having any of these complaints), matched for gender, age, PCP-practice and ethnicity were compared. Main outcome measures were contact frequency, prevalence of somatic as well as psychosocial diagnoses, prescription rate of (psycho)pharmacological agents, and referral rates. Data were analyzed using odds ratios, the Chi square test as well as multivariable logistic regression analysis. Results Data from 13,389 patients with upper GI symptoms and 13,389 control patients were analyzed. Patients with upper GI symptoms visited their PCP twice as frequently as controls (8.6 vs 4.4 times/year). Patients with upper GI symptoms presented not only more psychological and social problems, but also more other health problems to their PCP (odds ratios (ORs) ranging from 1.37 to 3.45). Patients with upper GI symptoms more frequently used drugs of any ATC-class (ORs ranging from 1.39 to 2.90), including psychotropic agents. The observed differences were less pronounced when we adjusted for non-attending control patients. In multivariate regression analysis, contact frequency and not psychological or social co

  19. Upper gastrointestinal symptoms, psychosocial co-morbidity and health care seeking in general practice: population based case control study

    Directory of Open Access Journals (Sweden)

    Schellevis François G

    2009-09-01

    Full Text Available Abstract Background The pathophysiology of upper gastrointestinal (GI symptoms is still poorly understood. Psychological symptoms were found to be more common in patients with functional gastrointestinal complaints, but it is debated whether they are primarily linked to GI symptoms or rather represent motivations for health-care seeking. Purpose of our study was to compare co-morbidity, in particular psychological and social problems, between patients with and without upper GI symptoms. In addition, we investigated whether the prevalence of psychological and social problems is part of a broader pattern of illness related health care use. Methods Population based case control study based on the second Dutch National Survey of general practice (conducted in 2001. Cases (adults visiting their primary care physician (PCP with upper GI symptoms and controls (individuals not having any of these complaints, matched for gender, age, PCP-practice and ethnicity were compared. Main outcome measures were contact frequency, prevalence of somatic as well as psychosocial diagnoses, prescription rate of (psychopharmacological agents, and referral rates. Data were analyzed using odds ratios, the Chi square test as well as multivariable logistic regression analysis. Results Data from 13,389 patients with upper GI symptoms and 13,389 control patients were analyzed. Patients with upper GI symptoms visited their PCP twice as frequently as controls (8.6 vs 4.4 times/year. Patients with upper GI symptoms presented not only more psychological and social problems, but also more other health problems to their PCP (odds ratios (ORs ranging from 1.37 to 3.45. Patients with upper GI symptoms more frequently used drugs of any ATC-class (ORs ranging from 1.39 to 2.90, including psychotropic agents. The observed differences were less pronounced when we adjusted for non-attending control patients. In multivariate regression analysis, contact frequency and not psychological or

  20. An Investigation of Health Status and Demands of Long-Term Care among Urban Community Senior Citizens%城市社区老年人健康状况与长期护理需求调查研究

    Institute of Scientific and Technical Information of China (English)

    王海彦; 刘苹; 韩广营; 金婧

    2012-01-01

    目的 了解城市社区老年人的健康状况,分析长期护理需求情况及影响因素.方法 多阶段分层抽样,用自行设计的问卷调查1 000 名社区老年人.结果 老年人慢性病患病种数多,心脑血管系统疾病居首位;老年人日间护理中心与护理院分别居长期护理需求首位;影响老年人长期护理需求的影响因素有服药情况、情绪低落程度、医疗费用来源等.结论 社区老年人长期护理需求较高,应以需求为导向,培养长期护理人才,促进社区护理发展.%Objective To understand the health status and to analyse the influencing factors of LTC demands among urban community senior citizens. Method Self- designed questionnaire was used to investigate 1 000 senior citizens aged over 60 years in the urban community by multi- stage stratified sampling. Results Senior citizens had various chronic diseases and cardiovascular system disease was the first. In terms of the demand for LTC, elderly day care center and nursing home were predominant. The main influencing factors of LTC demand were the situation of take medicine, depression and the source of medical payment. Conclusions There are high demands of LTC among urban community senior citizens Also, it is necessary to educate general nurses qualified in long- term care for the senior citizens to promote the community development.

  1. [Basic health care in developing countries--realization of a desirable dream of the government--demands and tasks of German physicians].

    Science.gov (United States)

    Windorfer, A; Schulz, W

    1986-02-01

    In most newly independent African countries, medical care imitates the Western model, with large urban hospitals containing much of the health care personnel and equipment. A decline in the availability of funds for training and facilities, and the appearance of new diseases provoked by industrialization led to the decline of both the quality and the quantity of medical care, especially in rural areas. In the 1970s, a number of African nations developed a network of ambulatory health facilities and village health workers, thus instituting a Primary Health Care System (PHC-System). Due to logistical and supervisory problems, however, these networks often disintegrated after foreign professionals and administrators departed. They are, nevertheless, prerequisites for the gradual improvement of the health care of rural populations in developing countries. Two basic requirements for their establishment and development are a relatively large personnel and financial investment, and the continuous counselling and supervision of trained nonprofessionals. The tasks which these health workers learn and eventually perform over a 1-2 year period include preventive medicine, counselling patients, providing medicines, reporting to responsible clinics, family planning, child care, and the treatment of a variety of diseases. Preventive measures in the framework of PHC Systems encompass 2 principle areas of hygiene, i.e., provision of clean drinking water and proper disposal of human and other wastes; and innoculations. Providing family planning information is a principle duty of the village health workers. To satisfy minimal rural health care and prevention requirements, regional medical centers serving an area of radius 100 to 150 km are needed to train the village health workers, provide basic medicines, and supply medicine and professional medical supervision to the ambulatory centers.

  2. Apnea-hypopnea index use among intensive care patients: a case series

    Science.gov (United States)

    2014-01-01

    Introduction ApneaLink™ (RESMED-Munich, Germany) is a simple and inexpensive device that determines the apnea-hypopnea index. The sensitivity and specificity of the apnea-hypopnea index are 100 and 87.5%, respectively. Our hypothesis can be used to create a treatment plan using the apnea-hypopnea index for intensive care unit patients. Case presentation This treatment plan has been created by determining the apnea-hypopnea index of eight Caucasian patients with a variety of diagnoses. Case 1 is that of a 70-year-old man diagnosed with rectum cancer and scheduled for elective surgery. Case 2 is that of a 65-year-old man diagnosed with rectum cancer and scheduled for elective surgery. Case 3 is that of a 78-year-old woman diagnosed with chronic obstructive pulmonary disease-pneumonia. Case 4 is that of a 26-year-old man diagnosed with head trauma. Case 5 is that of an 80-year-old man diagnosed with cerebrovascular disease. Case 6 is that of a 79-year-old man diagnosed with cerebrovascular disease. Case 7 is that of an 8-year-old girl diagnosed with ventricular septal defect-epidural hemorragia. Case 8 is that of a 42-year-old man diagnosed with subarachnoid hemorrage. Conclusions The apnea-hypopnea index can be informative regarding prognosis and outcomes, and helps to take precautions and develop new treatment strategies among critical patients in intensive care. The integration of developments in sleep medicine to intensive care unit practices means that we can be more informed about critical patients. PMID:24906620

  3. Meeting increased demand.

    Science.gov (United States)

    Blair, Andrew

    2004-07-01

    of people affected by arthritis will increase by nearly 50%. A huge increase in numbers affected with musculoskeletal conditions will require significant increases in health care resources, including hospital beds and facilities, orthopaedic surgeons and other health care professionals. New Zealand has been slow to acknowledge and plan for the increased demand for health services which is looming. Growing New Zealand's economy will help, but alone will not be enough. It is more than just finding the financial resources to better meet the demand. The enormous demands on the availability of treatment resources including hospital facilities and trained health care professionals must be addressed. There are major workforce issues to be faced. The change in population distribution between young and old will have an impact and it will be necessary to ensure that there are sufficient numbers of properly trained health care professionals available at all levels. It is hoped that improvements in preventative care programmes and new technologies and treatment techniques may reduce the rate of demand. As the health of our population is improved through targeted programmes dealing with obesity, diabetes, smoking and accident prevention, it may be possible to reallocate or change the focus of resources within the health and hospital sectors. Many countries are developing national strategies for their aging population. Clearly the New Zealand Government needs to move swiftly to develop a plan to manage the increased burden that is developing as a result of the aging population. That plan must create an environment which facilitates, encourages and supports greater private investment in healthcare facilities and healthcare delivery. Incentives must be created to motivate individuals to take greater responsibility for their healthcare needs and the funding of it. The development of a long term strategy to meet the challenges of the aging population is a priority.

  4. Brain lesions in eclampsia: A series of 39 cases admitted in an Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Y Brouh

    2016-01-01

    Full Text Available The aim of this study was to identify the encephalic lesions in the eclampsia occurrences. Within a period of 18 months, computed tomography (CT of the brain was performed in all patients admitted in intensive care for eclampsia. These CTs were analyzed and intracerebral lesions were identified. Thirty-nine patients were included. We noted 10 cases of ischemic stroke, 9 cases of cerebral edema, and 3 cases of hemorrhagic stroke and subarachnoid hemorrhage. The CT scan came back to normal in 20 eclamptic patients. Overall, delays in obstetric and intensive care and time of completion of the CT were long. CT has allowed highlighting in patients with eclampsia varied intracerebral lesions. The early performance of the CT is therefore essential for a better support of patients.

  5. Integrating Web-Based Applications into Aged Care: Two Case Studies and Discussion.

    Science.gov (United States)

    Rehm, Imogen C; Musić, Selma; Carlsson, Anthony; Scanlan, Faye; Silver, Mark; Bhar, Sunil S

    2016-09-01

    In anticipation of the growing need for adequate mental health care for older adults in residential aged care facilities, psychologists are challenged to overcome several barriers that impede the uptake and delivery of their services in such settings. Information and communication technologies (ICT) have strong potential to overcome some of these barriers by supporting the delivery of evidence-based psychosocial treatments for common psychogeriatric issues. This paper presents two case studies that illustrate when and how psychologists can use various ICT applications (e.g., tablet devices, web-based applications) integrated with cognitive behavioural and reminiscence-based therapies. Both case studies demonstrate that ICT can effectively support the therapeutic alliance, enhance therapeutic engagement, and individualize treatment delivery to accommodate the needs of elderly patients. It is hoped that these case studies will encourage clinicians to consider using ICT to augment therapy with their elderly patients.

  6. Pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka, India

    Directory of Open Access Journals (Sweden)

    Ramesha K

    2009-01-01

    Full Text Available Background and Objective: Acute poisoning is a medical emergency. It is important to know the nature, severity and outcome of acute poisoning cases in order to take up appropriate planning, prevention and management techniques. This study aimed to assess the pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka. Materials and Methods: This is a retrospective hospital record-based study conducted in a tertiary care hospital attached to a medical institution in Karnataka. The study included 136 cases and data regarding age, sex, time elapsed after intake; circumstances of poisoning, name of the poisonous substance, chemical type, duration of hospitalization, severity and outcome were collected in the prestructured proforma. Results: Incidence was more common among males (75.4% compared to females (24.3. Most cases of acute poisoning presented among 20- to 29-year age group (31.2% followed by 12- to 19-year age group (30.2%. A majority of poisoning cases (36.0% were due to organophosphorus compound (OPC. Total mortality was found to be 15.4%. Mortality rate due to corrosives was significantly high compared with OPC poisoning (χ2 = 4.12, P = 0.04. Of the 56 patients of OPC and carbamate poisoning, 13 patients (23.2% had respiratory arrest and required respiratory support. Time lapse had a significant role on the mortality in cases of acute poisoning (χ2 = 10.9, P = 0.01. Conclusion: Poisoning is more common in young males. The overall mortality is substantially high, mainly contributed by self-poisoning with insecticides and corrosives. Early care in a tertiary care center may help to reduce mortality in India.

  7. Courts and health care rationing: the case of the Brazilian Federal Supreme Court.

    Science.gov (United States)

    Wang, Daniel W L

    2013-01-01

    The recognition that access to health care is a constitutional right in Brazil has resulted in a situation in which citizens denied treatments by the public health care system have brought lawsuits against health authorities, claiming that their right to health was violated. This litigation forces the courts to decide between a patient-centred and a population-centred approach to public health - a choice that forces the courts to assess health care rationing decisions. This article analyses the judgments of the Brazilian Federal Supreme Court in right to health cases, arguing that the Court's recent decisions have been contrary to their long-standing stance against rationing. In 2009, the Court organized a public hearing to discuss this topic with civil society and established criteria to determine when rationing would be legal. However, I argue that these criteria for health care rationing do not adequately address the most difficult health care distribution dilemmas. They force the health care system to keep their rationing criteria implicit and make population-centred concerns secondary to individual-centred ones.

  8. Intensive care unit admission of obstetric cases: a single centre experience with contemporary update.

    Science.gov (United States)

    Ng, Vivian K S; Lo, T K; Tsang, H H; Lau, W L; Leung, W C

    2014-02-01

    OBJECTIVES. To review the characteristics of a series of obstetric patients admitted to the intensive care unit in a regional hospital in 2006-2010, to compare them with those of a similar series reported from the same hospital in 1989-1995 and a series reported from another regional hospital in 1998-2007. DESIGN. Retrospective case series. SETTING. A regional hospital in Hong Kong. PATIENTS. Obstetric patients admitted to the Intensive Care Unit of Kwong Wah Hospital from 1 January 2006 to 31 December 2010. RESULTS. From 2006 to 2010, there were 67 such patients admitted to the intensive care unit (0.23% of total maternities and 2.34% of total intensive care unit admission), which was a higher incidence than reported in two other local studies. As in the latter studies, the majority were admitted postpartum (n=65, 97%), with postpartum haemorrhage (n=39, 58%) being the commonest cause followed by pre-eclampsia/eclampsia (n=17, 25%). In the current study, significantly more patients had had elective caesarean sections for placenta praevia but fewer had had a hysterectomy. The duration of intensive care unit stay was shorter (mean, 1.8 days) with fewer invasive procedures performed than in the two previous studies, but maternal and neonatal mortality was similar (3% and 6%, respectively). CONCLUSION. Postpartum haemorrhage and pregnancy-induced hypertension were still the most common reasons for intensive care unit admission. There was an increasing trend of intensive care unit admissions following elective caesarean section for placenta praevia and for early aggressive intervention of pre-eclampsia. Maternal mortality remained low but had not decreased. The intensive care unit admission rate by itself might not be a helpful indicator of obstetric performance.

  9. [An outbreak of scabies in a tertiary-care hospital from a crusted scabies case].

    Science.gov (United States)

    Elgueta N, Andrea; Parada E, Yolanda; Guzmán G, Wilma; Molina C, Paula; González A, Patricia

    2007-08-01

    In February 2005 we performed an epidemiological study of an outbreak of scabies in a tertiary-care hospital which started from a crusted scabies case. We detected 10 secondary cases, 8 in healthcare workers and 2 in hospitalized patients. The attack rate was 4.1%. In contrast to previously described outbreaks, the crusted scabies case was recognized at admission. The outbreak causes were: lacking adherence to contact precautions, long stay of the primary case in the hospital ward and delay of specific treatment. The main control measures were: alerting the hospital services about the outbreak, performing epidemiologic surveillance, coordinating with the Hospital Direction and the Occupational Health Department, education of healthcare workers in control measures, implementation of isolation measures and treatment of cases and contacts with 5% permethrin topical lotion.

  10. Two Case Studies Using Mock-Ups for Planning Adult and Neonatal Intensive Care Facilities

    Directory of Open Access Journals (Sweden)

    Sue Hignett

    2010-01-01

    Full Text Available This paper describes two case studies using a 5-step protocol to determine functional space requirements for cardiac and neonatal intensive care clinical activities. Functional space experiments were conducted to determine the spatial requirements (defined as the minimumsized rectangle to encompass the Link Analysis. The data were collected with multi-directional filming and analysed frame-by-frame to plot the movements between the nurses and other components in the space. The average clinical functional space for the adult critical care unit was 22.83m2 (excluding family and hygiene space and in-room storage. The average functional clinical space for neonatal intensive care unit was 13.5m2 (excluding circulation and storage. The use of the 5-step protocol is reviewed, with limitations in case study 1 addressed in case study 2. The findings from both case studies have been incorporated into government guidance and achieved knowledge transfer by being implemented in building design.

  11. Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care

    Directory of Open Access Journals (Sweden)

    Kronogård Maria

    2009-09-01

    Full Text Available Abstract Background Adequate resource allocation is an important factor to ensure equity in health care. Previous reimbursement models have been based on age, gender and socioeconomic factors. An explanatory model based on individual need of primary health care (PHC has not yet been used in Sweden to allocate resources. The aim of this study was to examine to what extent the ACG case-mix system could explain concurrent costs in Swedish PHC. Methods Diagnoses were obtained from electronic PHC records of inhabitants in Blekinge County (approx. 150,000 listed with public PHC (approx. 120,000 for three consecutive years, 2004-2006. The inhabitants were then classified into six different resource utilization bands (RUB using the ACG case-mix system. The mean costs for primary health care were calculated for each RUB and year. Using linear regression models and log-cost as dependent variable the adjusted R2 was calculated in the unadjusted model (gender and in consecutive models where age, listing with specific PHC and RUB were added. In an additional model the ACG groups were added. Results Gender, age and listing with specific PHC explained 14.48-14.88% of the variance in individual costs for PHC. By also adding information on level of co-morbidity, as measured by the ACG case-mix system, to specific PHC the adjusted R2 increased to 60.89-63.41%. Conclusion The ACG case-mix system explains patient costs in primary care to a high degree. Age and gender are important explanatory factors, but most of the variance in concurrent patient costs was explained by the ACG case-mix system.

  12. Nutritional self-care in two older Norwegian males: a case study

    Directory of Open Access Journals (Sweden)

    Tomstad ST

    2013-05-01

    Full Text Available Solveig T Tomstad,1,2 Ulrika Söderhamn,2 Geir Arild Espnes,1,3 Olle Söderhamn21Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology, Trondheim, 2Centre for Caring Research-Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, 3Research Centre for Health Promotion and Resources, Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology, Trondheim, NorwayBackground: Knowledge about how to support nutritional self-care in the vulnerable elderly living in their own homes is an important area for health care professionals. The aim of this case study was to evaluate the effects of nutritional intervention by comparing perceived health, sense of coherence, self-care ability, and nutritional risk in two older home-dwelling individuals before, during, and after intervention and to describe their experiences of nutritional self-care before and after intervention.Methods: A study circle was established to support nutritional self-care in two older home-dwelling individuals (≥65 years of age, who participated in three meetings arranged by health professionals over a period of six months. The effects of this study circle were evaluated using the Nutritional Form For the Elderly, the Self-care Ability Scale for the Elderly (SASE, the Appraisal of Self-care Agency scale, the Sense of Coherence (SOC scale, and responses to a number of health-related questions. Qualitative interviews were performed before and after intervention to interpret the changes that occurred during intervention.Results: A reduced risk of undernutrition was found for both participants. A higher total score on the SASE was obtained for one participant, along with a slightly stronger preference for self-care to maintain sufficient food intake, was evident. For the other

  13. The Business Case for Palliative Care: Translating Research Into Program Development in the U.S.

    Science.gov (United States)

    Cassel, J Brian; Kerr, Kathleen M; Kalman, Noah S; Smith, Thomas J

    2015-12-01

    Specialist palliative care (PC) often embraces a "less is more" philosophy that runs counter to the revenue-centric nature of most health care financing in the U.S. A special business case is needed in which the financial benefits for organizations such as hospitals and payers are aligned with the demonstrable clinical benefits for patients. Based on published studies and our work with PC programs over the past 15 years, we identified 10 principles that together form a business model for specialist PC. These principles are relatively well established for inpatient PC but are only now emerging for community-based PC. Three developments that are key for the latter are the increasing penalties from payers for overutilization of hospital stays, the variety of alternative payment models such as accountable care organizations, which foster a population health management perspective, and payer-provider partnerships that allow for greater access to and funding of community-based PC.

  14. Advertising product improvement opportunities using segmentation in Video-on-Demand services : A case study of MTG’s opportunities in the shift from television to streaming video

    OpenAIRE

    Kohlberg, Marcus; Westman, Lars-Peter

    2014-01-01

    More and more people choose to watch television online through online video-on- demand services. For media corporations, such as the Modern Times Group (MTG), this means that video-on-demand will become an increasingly important source of revenue. Because video-on-demand is an online service, advertising products offered therein are in competition with other online advertising products. Currently, MTG’s video-on-demand advertising products are the same as on regular television, meaning they h...

  15. Open source clinical portals: a model for healthcare information systems to support care processes and feed clinical research. An Italian case of design, development, reuse, and exploitation.

    Science.gov (United States)

    Locatelli, Paolo; Baj, Emanuele; Restifo, Nicola; Origgi, Gianni; Bragagia, Silvia

    2011-01-01

    Open source is a still unexploited chance for healthcare organizations and technology providers to answer to a growing demand for innovation and to join economical benefits with a new way of managing hospital information systems. This chapter will present the case of the web enterprise clinical portal developed in Italy by Niguarda Hospital in Milan with the support of Fondazione Politecnico di Milano, to enable a paperless environment for clinical and administrative activities in the ward. This represents also one rare case of open source technology and reuse in the healthcare sector, as the system's porting is now taking place at Besta Neurological Institute in Milan. This institute is customizing the portal to feed researchers with structured clinical data collected in its portal's patient records, so that they can be analyzed, e.g., through business intelligence tools. Both organizational and clinical advantages are investigated, from process monitoring, to semantic data structuring, to recognition of common patterns in care processes.

  16. What Factors Influence States' Capacity to Report Children's Health Care Quality Measures? A Multiple-Case Study.

    Science.gov (United States)

    Christensen, Anna L; Petersen, Dana M; Burton, Rachel A; Forsberg, Vanessa C; Devers, Kelly J

    2017-01-01

    Objectives The objective of this study was to describe factors that influence the ability of state Medicaid agencies to report the Centers for Medicare & Medicaid Services' (CMS) core set of children's health care quality measures (Child Core Set). Methods We conducted a multiple-case study of four high-performing states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program: Illinois, Maine, Pennsylvania, and Oregon. Cases were purposively selected for their diverse measurement approaches and used data from 2010 to 2015, including 154 interviews, semiannual grant progress reports, and annual public reports on Child Core Set measures. We followed Yin's multiple-case study methodology to describe how and why each state increased the number of measures reported to CMS. Results All four states increased the number of Child Core Set measures reported to CMS during the grant period. Each took a different approach to reporting, depending on the available technical, organizational, and behavioral inputs in the state. Reporting capacity was influenced by a state's Medicaid data availability, ability to link to other state data systems, past experience with quality measurement, staff time and technical expertise, and demand for the measures. These factors were enhanced by CHIPRA Quality Demonstration grant funding and other federal capacity building activities, as hypothesized in our conceptual framework. These and other states have made progress reporting the Child Core Set since 2010. Conclusion With financial support and investment in state data systems and organizational factors, states can overcome challenges to reporting most of the Child Core Set measures.

  17. Challenges and opportunities in building a sustainable rural primary care workforce in alignment with the Affordable Care Act: the WWAMI program as a case study.

    Science.gov (United States)

    Allen, Suzanne M; Ballweg, Ruth A; Cosgrove, Ellen M; Engle, Kellie A; Robinson, Lawrence R; Rosenblatt, Roger A; Skillman, Susan M; Wenrich, Marjorie D

    2013-12-01

    The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.

  18. Analysis of health care status and demands of children of birth defects%出生缺陷患儿保健状况及保健需求分析

    Institute of Scientific and Technical Information of China (English)

    张颖; 丁辉

    2011-01-01

    [Objective]To acknowledge the health care status and demands of children born with birth defects.[Methods]Between July 2007 and September 2008, 453 live born cases of birth defects were diagnosed and registered by the Beijing Birth Defects Monitoring network-a hospital based birth defects registry system.Their parents were called to assess their survival status from birth up to the age of 6~8 months.[Results]The proportions of 315 live born infants with birth defects inhabited in Beijing, Expanded Program of Immunization, and physical examination were 94.00%,93.40% respectively.The proportions of having been to the hospital once at least, not having been to the hospital, not acknowledging the fact of infants' birth defects were 70.70%, 27.10%, and 2.20% respectively.[Conclusions]The medical services were not enough for the demands of children born with birth defects.To establish registry system of children born with birth defects, to accomplish the net of diagnosis, therapy and transport of children born with birth defect will provide more services to the children born with birth defects.%[目的]了解出生缺陷患儿保健状况及其家长对相关儿童保健的需求.[方法]对2007年7月-2008年9月分娩且家长均居住在北京市海淀区的453例活产出生缺陷患儿,分娩6~8个月时通过电话调查方式询问出生缺陷患儿家长.[结果]315例在北京市生活的儿童接受计划免疫接种率94.00%、体检率93.40%;70.70%"到医院复诊过至少1次",27.10%"未到医院复查",2.20%"家长否认孩子有出生缺陷".[结论]目前的医疗保健机构不能满足出生缺陷患儿医疗保健需求;建立有效的出生缺陷患儿信息登记系统对于患儿信息的长期随访至关重要;完善出生缺陷患儿诊断、治疗、转诊网络,为患儿提供更好的后续服务.

  19. Pertussis as health care workers infectious disease – The clinical case with a commentary

    Directory of Open Access Journals (Sweden)

    Ernest Kuchar

    2013-10-01

    Full Text Available We discuss the changing epidemiological situation of pertussis observed in recent years, with a focus on the shift of cases from young children to older age groups, teenagers and adults. Whooping cough may affect healthcare workers who belong to a high-risk group and cause hospital infections. We present a case report of pertussis in a nurse and the recommended prophylactic measures in healthcare workers. The current definition and diagnosis of pertussis is also discussed. The clinical course of pertussis can be significantly alleviated and highly non-specific, with no typical coughing and vomiting in people vaccinated against whooping cough a few years earlier. Pertussis should be considered in the differential diagnosis of cough lasting more than fourteen days. Improvement of the epidemiological situation requires, besides immunization of infants, regular and universal booster immunization for adolescents and adults. Vaccinations for health care workers of neonatal and pediatric wards are recommended in the National Program of Immunization for 2013. It seems that booster vaccination of health care workers with a triple vaccine against diphtheria, tetanus and acellular pertussis (dTpa of the reduced quantity of antigens, particularly of health workers caring for infants, children and the elderly, may be the most effective way to reduce the risk of pertussis transmission in the health care environment. Med Pr 2013;64(5:731–739

  20. Modernisation as a professionalising strategy: the case of critical care in England.

    Science.gov (United States)

    Green, Judith; Durand, Mary Alison; Hutchings, Andrew; Black, Nick

    2011-09-01

    There has been broad agreement about how to characterise the processes of 'modernisation' of the public sector in welfare societies, but rather less consensus on the impact of this modernisation on professionals. This paper takes critical care in England as a case study to explore how professionals in one setting account for the changes associated with modernisation. In contrast to reports from other arenas, critical care professionals were positive about the processes and outcomes of 'modernisation' in general, and there was a surprising lack of nostalgia in their accounts of organisational changes. However, joking comments suggested considerable scepticism about the initiatives explicitly associated with the national organisation that was charged with 'modernising' critical care, the Modernisation Agency. We suggest that the relative optimism of staff is in part explained by historical and political contingencies which meant that critical care, as a relatively new clinical specialty, benefited in tangible ways from modernisation. Further, all staff groups were able to attribute gains, rather than losses, in autonomy and authority to the modernisation of critical care. Their accounts suggest that modernisation can be a professionalising strategy, with responses to change being neither resistant nor compliant, but sceptically strategic.

  1. Feminist health care in a hostile environment: a case study of the Womancare Health Center.

    Science.gov (United States)

    Hyde, Cheryl A

    2008-01-01

    This article presents a case study of the Womancare Health Center in order to illustrate the development of and challenges to the feminist health movement in the United States. Specific attention is placed on the legislative, fiscal, and direct actions by the New Right against this organization. Analysis focuses on the means through which Womancare survived. The repercussions of constant intimidation and harassment for women's health programs and for health care policy overall are discussed.

  2. Servant leadership: a case study of a Canadian health care innovator

    OpenAIRE

    2012-01-01

    Tim H VanderpylSchool of Global Leadership, Regent University, Virginia Beach, VA, USAAbstract: Both servant leadership and innovation are easier to theorize than to actually implement in practice. This article presents a case study of a Canadian health care executive who led a remarkable turnaround of St Michael's Health Centre, a floundering and almost bankrupt nursing home. In less than 7 years, Kevin Cowan turned around the finances and changed numerous broken relationships into s...

  3. Demand generation and social mobilisation for integrated community case management (iCCM and child health: Lessons learned from successful programmes in Niger and Mozambique

    Directory of Open Access Journals (Sweden)

    Alyssa B Sharkey

    2014-11-01

    Full Text Available We present the approaches used in and outcomes resulting from integrated community case management (iCCM programmes in Niger and Mozambique with a strong focus on demand generation and social mobilisation. We use a case study approach to describe the programme and contextual elements of the Niger and Mozambique programmes. Awareness and utilisation of iCCM services and key family practices increased following the implementation of the Niger and Mozambique iCCM and child survival programmes, as did care–seeking within 24 hours and care–seeking from appropriate, trained providers in Mozambique. These approaches incorporated interpersonal communication activities and community empowerment/participation for collective change, partnerships and networks among key stakeholder groups within communities, media campaigns and advocacy efforts with local and national leaders. iCCM programmes that train and equip community health workers and successfully engage and empower community members to adopt new behaviours, have appropriate expectations and to trust community health workers’ ability to assess and treat illnesses can lead to improved care–seeking and utilisation, and community ownership for iCCM.

  4. Identifying patients suitable for palliative care - a descriptive analysis of enquiries using a Case Management Process Model approach

    Directory of Open Access Journals (Sweden)

    Kuhn Ulrike

    2012-11-01

    Full Text Available Abstract Background In Germany, case management in a palliative care unit was first implemented in 2005 at the Department of Palliative Medicine at the University Hospital Cologne. One of the purposes of this case management is to deal with enquiries from patients and their relatives as well as medical professionals. Using the Case Management Process Model of the Case Management Society of America as a reference, this study analysed (a how this case management was used by different enquiring groups and (b how patients were identified for case management and for palliative care services. The first thousand enquiries were analysed considering patient variables, properties of the enquiring persons and the content of the consultations. Results Most enquiries to the case management were made by telephone. The majority of requests regarded patients with oncological disease (84.3 %. The largest enquiring group was composed of patients and relatives (40.8 %, followed by internal professionals of the hospital (36.1 %. Most of the enquiring persons asked for a patient’s admission to the palliative care ward (46.4 %. The second most frequent request was for consultation and advice (30.9 %, followed by requests for the palliative home care service (13.3 %. Frequent reasons for actual admissions were the need for the treatment of pain, the presence of symptoms and the need for nursing care. More than half of the enquiries concerning admission to the palliative care ward were followed by an admission. Conclusions Case management has been made public among the relevant target groups. Case management as described by the Case Management Process Model helps to identify patients likely to benefit from case management and palliative care services. In addition, with the help of case management palliative patients may be allocated to particular health care services.

  5. The Impact of Direct Provision Accommodation for Asylum Seekers on Organisation and Delivery of Local Primary Care and Social Care Services: A Case Study

    LENUS (Irish Health Repository)

    Pieper, Hans-Olaf

    2011-05-15

    Abstract Background Many western countries have policies of dispersal and direct provision accommodation (state-funded accommodation in an institutional centre) for asylum seekers. Most research focuses on its effect on the asylum seeking population. Little is known about the impact of direct provision accommodation on organisation and delivery of local primary care and social care services in the community. The aim of this research is to explore this issue. Methods In 2005 a direct provision accommodation centre was opened in a rural area in Ireland. A retrospective qualitative case study was designed comprising in-depth interviews with 37 relevant stakeholders. Thematic analysis following the principles of framework analysis was applied. Results There was lack of advance notification to primary care and social care professionals and the community about the new accommodation centre. This caused anxiety and stress among relevant stakeholders. There was insufficient time to plan and prepare appropriate primary care and social care for the residents, causing a significant strain on service delivery. There was lack of clarity about how primary care and social care needs of the incoming residents were to be addressed. Interdisciplinary support systems developed informally between healthcare professionals. This ensured that residents of the accommodation centre were appropriately cared for. Conclusions Direct provision accommodation impacts on the organisation and delivery of local primary care and social care services. There needs to be sufficient advance notification and inter-agency, inter-professional dialogue to manage this. Primary care and social care professionals working with asylum seekers should have access to training to enhance their skills for working in cross-cultural consultations.

  6. 我国失能老人的长期照料需求与供给分析%Long - term Care of Chinese Disabled Elderly Demand and Supply Analysis

    Institute of Scientific and Technical Information of China (English)

    苏群; 彭斌霞

    2014-01-01

    The data used in this study is from China Health and Retirement Longitudinal Survey(CHRALS)in 2011. Through analyzing the demand and supply of long - term care of disabled elder,this article shows the current life situation of disabled elderly and puts up with policies to solve the contradiction between supply and demand. The result shows that 13. 02 percent elder those activity of daily living are damaged,and must rely on others to provide care for life. As the growth of the age,the likelihood of disability increased. The rural people have more demand of long - term care than the urban. Womenˊs care needs are more 2. 33 percent than menˊs. Most disabled elderly rely mainly on family - based care;institutional care resources are scarce,structural imbalanced;and community care is at an early stage of development. Based on disabled elderly own special characteristics and economic and social environment,our country should continue to encourage and support family caregivers,while vigorously explore the development of appropriate community care services.%本文利用2011年“中国健康与养老追踪调查(CHRALS)”的数据,通过对我国失能老人的照料需求与供给的分析,揭示出我国失能老人的生活现状并针对供需之间的矛盾提出解决的对策。研究结果表明我国有13.02℅的老年人由于日常生活活动能力受损,表现为失能状态,需要他人提供日常生活照料;随着年龄的增长,失能的可能性加大;农村照料需求高于城镇,女性的照料需求比男性高出2.33℅。大多数失能老人主要依靠家庭照料为主;机构照料资源匮乏,结构失调;社区照料更是处于起步发展阶段。基于失能老人自身特征及我国特殊的经济社会环境,应建立以家庭照料为基础,社区照料和机构照料相融合的长期照料服务体系。

  7. Case and Relation (CARE based Page Rank Algorithm for Semantic Web Search Engines

    Directory of Open Access Journals (Sweden)

    N. Preethi

    2012-05-01

    Full Text Available Web information retrieval deals with a technique of finding relevant web pages for any given query from a collection of documents. Search engines have become the most helpful tool for obtaining useful information from the Internet. The next-generation Web architecture, represented by the Semantic Web, provides the layered architecture possibly allowing data to be reused across application. The proposed architecture use a hybrid methodology named Case and Relation (CARE based Page Rank algorithm which uses past problem solving experience maintained in the case base to form a best matching relations and then use them for generating graphs and spanning forests to assign a relevant score to the pages.

  8. Prevalence of multidrug resistance among retreatment pulmonary tuberculosis cases in a tertiary care hospital, Hyderabad, India

    Directory of Open Access Journals (Sweden)

    Subhakar Kandi

    2013-01-01

    Full Text Available Background: India is one of the high tuberculosis (TB burden countries in the world. India ranks second in harboring multi drug resistant (MDR-TB cases. About 50,000 of MDR cases are recorded in retreatment pulmonary TB cases. This study was conducted in a tertiary care facility (Government General and Chest Hospital in Hyderabad, India. Objectives: Toassess: Proportion of the TB patients having MDR-TB at the initiation of retreatment regimen; the prevalence of isoniazid (INH resistance in this geographical area. Materials and Methods: An analytical, observational, prospective cohort study of patients attending the out-patient department from December 2010 to March 2011. Results: Sputum samples from 100 patients were subjected to acid fast bacilli (AFB culture and drug sensitivity testing. Of these, 28 (28% were MDR-TB, 42 (42% were non-MDR-TB and 39% being INH resistance. Conclusions: In conclusion, one third of the retreatment pulmonary TB cases attending a tertiary care institute for TB will be MDR-TB at the initiation of treatment and there is a need to include ethambutol in the continuation phase of new TB case treatment in view of high INH resistance.

  9. Case management used to optimize cancer care pathways: A systematic review

    Directory of Open Access Journals (Sweden)

    Søndergaard Jens

    2008-11-01

    Full Text Available Abstract Background Reports of inadequate cancer patient care have given rise to various interventions to support cancer care pathways which, overall, seem poorly studied. Case management (CM is one method that may support a cost-effective, high-quality patient-centred treatment and care. The purpose of this article was to summarise intervention characteristics, outcomes of interest, results, and validity components of the published randomized controlled trials (RCTs examining CM as a method for optimizing cancer care pathways. Methods PubMed, Embase, Web of Science, CINAHL and The Cochrane Central Register of Controlled Trials were systematically searched for RCTs published all years up to August 2008. Identified papers were included if they passed the following standards. Inclusion criteria: 1 The intervention should meet the criteria for CM which includes multidisciplinary collaboration, care co-ordination, and it should include in-person meetings between patient and the case manager aimed at supporting, informing and educating the patient. 2 The intervention should focus on cancer patient care. 3 The intervention should aim to improve subjective or objective quality outcomes, and effects should be reported in the paper. Exclusion criteria: Studies centred on cancer screening or palliative cancer care. Data extraction was conducted in order to obtain a descriptive overview of intervention characteristics, outcomes of interest and findings. Elements of CONSORT guidelines and checklists were used to assess aspects of study validity. Results The searches identified 654 unique papers, of which 25 were retrieved for scrutiny. Seven papers were finally included. Intervention characteristics, outcomes studied, findings and methodological aspects were all very diverse. Conclusion Due to the scarcity of papers included (seven, significant heterogeneity in target group, intervention setting, outcomes measured and methodologies applied, no conclusions

  10. [Medical care for asylum seekers and refugees at the University Medical Center Hamburg-Eppendorf--A case series].

    Science.gov (United States)

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

    2016-01-01

    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.

  11. Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups : A case study

    NARCIS (Netherlands)

    Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, H.J.M.

    2015-01-01

    Background Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Du

  12. Understanding 'caring' through biopolitics: the case of nurses under the Nazi regime.

    Science.gov (United States)

    Foth, Thomas

    2013-10-01

    These days, discussions of what might be the 'essence' or the 'core' of nursing and nursing practice sooner or later end in a discussion about the concept of care. Most of the 'newer' nursing theories use this concept as a theoretical core concept. Even though these theoretical approaches use the concept of care with very different philosophical foundations and theoretical consistency, they concur in defining care as the essence of nursing and thereby glorify goodness as the decisive characteristic of nursing. These theoretical approaches neglect the fact that nursing is above all a profession with a societal task and is characterized by an asymmetrical power relation between nurses and their patients. Based on the results of a research project that analysed the role nurses played in the killing of psychiatric patients in Germany during the Nazi regime, I demonstrate that an approach based on the concept of care is not able to explain how nurses were able to commit crimes of such atrocity. These crimes were bound to an emotional investment that sustained the production of 'life unworthy of living'. In the case of nurses under the Nazi regime, certainly a kind of sadism was at issue that can only be explained if we recognize that the social bond is characterized by a certain tension; 'goodness' that caring theories assign to the social bond always coexists with the capacity for destruction. Using the Foucauldian theoretical framework of biopower and biopolitics enables one to analyse violence and power as integral parts of nurses' practice. Seen from this perspective, the killing of patients was part of a biopolitical programme and not a relapse into barbarism. The concept of care obscures the political agenda of nursing and does not provide a critical and political framework to analysing nursing practice.

  13. 我国居家养老服务保障供求关系研究%The Analysis of China’s supply and demand of home care services

    Institute of Scientific and Technical Information of China (English)

    李兵水; 肖伊雪; 姜晨卉

    2011-01-01

    In China,faced with the silver-haired wave,the supply of the home care services is relatively weak.The home care services market can not meet the growing demand for aged care services and the contradiction has become increasingly conspicuous.This paper re%面对我国银发浪潮的挑战,居家养老服务的供给却相对乏力,居家养老服务市场与日益增长的养老服务需求不相适应,矛盾日益突出。文章对居家养老服务供求失衡进行研究,从供求总量失衡以及结构失衡两方面展开论述,分析失衡现象背后的原因,设计出居家养老服务供求均衡机制以实现居家养老服务的供求均衡。

  14. The effect of a celebrity health disclosure on demand for health care: trends in BRCA testing and subsequent health services use.

    Science.gov (United States)

    Roberts, Megan C; Dusetzina, Stacie B

    2017-03-15

    In May 2013, an internationally renowned celebrity-Angelina Jolie-disclosed her receipt of BRCA1/BRCA2 (BRCA) testing and subsequent double mastectomy in a highly publicized editorial. Publicity surrounding celebrity health services use increases awareness of important health issues and demand for health services. We aimed to describe BRCA testing trends before and after Jolie's disclosure, breast cancer-related services use following testing, and test reimbursement trends. MarketScan Commercial Claims data were used to compare trends in BRCA testing before and after Jolie's health disclosure using an interrupted time series model among women aged 18-64. We used modified Poisson regression to estimate risks for health services use (surgical consult, mastectomy, mammography, magnetic resonance imaging, genetic counseling) following BRCA testing. BRCA testing rates increased from 12.5 to 19.0 tests/100,000 women between January 2013 and October 2014. Immediately following Jolie's disclosure, testing increased by approximately 37% (p BRCA testing increased, use of post-testing follow-up services declined after Jolie's disclosure. Mean insurance reimbursement and patient out-of-pocket spending on the test decreased by 3 and 36%, respectively. While genetic testing uptake increased following Jolie's disclosure, subsequent health services use associated with BRCA mutations declined, suggesting that celebrity disclosures may be associated with potential genetic testing overuse.

  15. A rare case of sigmoid volvulus complicating pregnancy in a Tertiary care centre: a case report

    Directory of Open Access Journals (Sweden)

    Rajarajeswari Ramalingam

    2016-04-01

    Full Text Available Intestinal obstruction complicating pregnancy is an extremely rare complication during pregnancy. Volvulus of the sigmoid colon is the most common cause of intestinal obstruction complicating pregnancy accounting for upto 44% of the aetiology. We report a case of sigmoid volvulus complicating pregnancy in a woman with 34 weeks amenorrhoea which was diagnosed early in spite of its late presentation and successfully managed with resection and primary anastamosis. Sigmoid volvulus complicating pregnancy carries a high maternal mortality and morbidity, fetal mortality and needs a high index of suspicion and early surgical intervention. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 1273-1275

  16. Care for Amish and Mennonite children with cystic fibrosis: a case series

    Directory of Open Access Journals (Sweden)

    Anbar Ran D

    2009-01-01

    Full Text Available Abstract Background Published articles have described a lack of willingness to allow preventative measures, as well as other types of modern therapies, as an obstacle to providing medical care for Amish and Mennonite populations. Methods We present data regarding the 12 Amish and Mennonite patients at the SUNY Upstate Medical University Pediatric Cystic Fibrosis Center and three representative case reports. Results Families of patients from these communities receiving care at our Center have accepted preventive therapy, acute medical interventions including home intravenous antibiotic administration, and some immunizations for their children with cystic fibrosis, which have improved the health of our patients. Some have even participated in clinical research trials. Health care education for both the child and family is warranted and extensive. Significant Cystic Fibrosis Center personnel time and fundraising are needed in order to address medical bills incurred by uninsured Amish and Mennonite patients. Conclusion Amish and Mennonite families seeking care for cystic fibrosis may choose to utilize modern medical therapies for their children, with resultant significant improvement in outcome.

  17. The Evaluation of Nursing Care Satisfaction and Patient Learning Needs in day Case Surgery.

    Science.gov (United States)

    Goktas, Sonay B; Yildiz, Tülin; Nargiz, Sibel Kosucu

    2015-12-01

    Patients in surgical service units have higher expectations for treatment and care. The aims of this study were to determine nursing care satisfaction and information requirements at the time of discharge of patients from a day surgery unit and to assess the effects of demographics. The study was conducted on 291 patients undergoing day case surgery. Patient perception scale for nursing care (PPSN) and the patient learning needs scale (PLNS) were used and total and sub-dimension points averages were calculated and then compared with demographic data using the Kruskal-Wallis test. The results were evaluated at the p patients, 58.8 % (n = 171) were females and the average age was 49.5 ± 15.3 years. PPSN and PLNS total point averages were 68.16 ± 10.17 and 178.53 ± 27.59, respectively. A significant difference was determined in PPSN total point average with regard to previous hospitalisations; the PPSN total point average was higher for patients with prior hospitalisations (p patient satisfaction and patient information requirements could change according to demographic features of the patients at a day case surgery unit. In this respect, healthcare providers should offer healthcare services by evaluating the personal characteristics of patients because this is important for their satisfaction.

  18. Servant leadership: a case study of a Canadian health care innovator

    Directory of Open Access Journals (Sweden)

    Vanderpyl TH

    2012-02-01

    Full Text Available Tim H VanderpylSchool of Global Leadership, Regent University, Virginia Beach, VA, USAAbstract: Both servant leadership and innovation are easier to theorize than to actually implement in practice. This article presents a case study of a Canadian health care executive who led a remarkable turnaround of St Michael's Health Centre, a floundering and almost bankrupt nursing home. In less than 7 years, Kevin Cowan turned around the finances and changed numerous broken relationships into strategic alliances. Under his leadership, St Michael's Health Centre went from being one of the most underperforming health care organizations in Canada, to one of the most innovative. This article describes some of Cowan's strategies and argues that a servant leadership approach has a direct impact on an organization's ability to innovate. As far as the author is aware, this is the first published article on this specific change effort, which presents a unique perspective on the topics of servant leadership and innovation.Keywords: servant leadership, innovation, Canada, health care, case study

  19. Alignment between chronic disease policy and practice: case study at a primary care facility.

    Directory of Open Access Journals (Sweden)

    Claire A Draper

    Full Text Available Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009 to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy.One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10, focus groups (n = 8 and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy formed the basis of the guide questions used in focus groups and interviews.The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care.Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible

  20. Using information technology for an improved pharmaceutical care delivery in developing countries. Study case: Benin.

    Science.gov (United States)

    Edoh, Thierry Oscar; Teege, Gunnar

    2011-10-01

    One of the problems in health care in developing countries is the bad accessibility of medicine in pharmacies for patients. Since this is mainly due to a lack of organization and information, it should be possible to improve the situation by introducing information and communication technology. However, for several reasons, standard solutions are not applicable here. In this paper, we describe a case study in Benin, a West African developing country. We identify the problem and the existing obstacles for applying standard ECommerce solutions. We develop an adapted system approach and describe a practical test which has shown that the approach has the potential of actually improving the pharmaceutical care delivery. Finally, we consider the security aspects of the system and propose an organizational solution for some specific security problems.

  1. The Case for Improved Interprofessional Care: Fatal Analgesic Overdose Secondary to Acute Dental Pain during Pregnancy

    Directory of Open Access Journals (Sweden)

    Sarah K. Y. Lee

    2016-01-01

    Full Text Available Prenatal oral health extends beyond the oral cavity, impacting the general well-being of the pregnant patient and her fetus. This case report follows a 19-year-old pregnant female presenting with acute liver failure secondary to acetaminophen overdose for management of dental pain following extensive dental procedures. Through the course of her illness, the patient suffered adverse outcomes including fetal demise, acute kidney injury, spontaneous bacterial peritonitis, and septic shock before eventual death from multiple organ failure. In managing the pregnant patient, healthcare providers, including physicians and dentists, must recognize and optimize the interconnected relationships shared by the health disciplines. An interdisciplinary approach of collaborative and coordinated care, the timing, sequence, and treatment for the pregnant patient can be improved and thereby maximize overall quality of health. Continued efforts toward integrating oral health into general healthcare education through interprofessional education and practice are necessary to enhance the quality of care that will benefit all patients.

  2. The Case for Improved Interprofessional Care: Fatal Analgesic Overdose Secondary to Acute Dental Pain during Pregnancy

    Science.gov (United States)

    Chuang, Alice; Munz, Stephanie M.; Dabiri, Darya

    2016-01-01

    Prenatal oral health extends beyond the oral cavity, impacting the general well-being of the pregnant patient and her fetus. This case report follows a 19-year-old pregnant female presenting with acute liver failure secondary to acetaminophen overdose for management of dental pain following extensive dental procedures. Through the course of her illness, the patient suffered adverse outcomes including fetal demise, acute kidney injury, spontaneous bacterial peritonitis, and septic shock before eventual death from multiple organ failure. In managing the pregnant patient, healthcare providers, including physicians and dentists, must recognize and optimize the interconnected relationships shared by the health disciplines. An interdisciplinary approach of collaborative and coordinated care, the timing, sequence, and treatment for the pregnant patient can be improved and thereby maximize overall quality of health. Continued efforts toward integrating oral health into general healthcare education through interprofessional education and practice are necessary to enhance the quality of care that will benefit all patients. PMID:27847654

  3. "Collaboration technology": a case study of innovation in order set and clinical care standardization.

    Science.gov (United States)

    Yount, Brian; McNamara, Timothy

    2008-11-06

    Effective standardization of clinical processes, which is a growing priority for healthcare provider organizations and networks, requires effective teamwork among clinicians and staff from multidisciplinary backgrounds--often from geographically dispersed facilities--to reach consensus on care practices. Yet, most healthcare provider organizations have no precedence or tools for managing large-scale, sustained, collaborative activities. This presentation explores the human and social implications of technology. It specifically addresses healthcare collaboration and describes how innovative collaboration management technologies can be used in the healthcare industry to accelerate care standardization, order set standardization and other initiatives necessary for successful computerized provider order entry and electronic health record deployments. These topics are explored through presentation of a survey of healthcare executives and a case study of an advanced collaboration application that was adapted and deployed in a partnership between a large healthcare provider organization and a commercial developer of document management and collaboration management technologies.

  4. Treatment of 31 Cases of Infant Respiratory Tract Infection by Health-care Tuina plus Medicated Bath

    Institute of Scientific and Technical Information of China (English)

    LI Jie; WU Xue-fei

    2003-01-01

    Thirty-one cases of infant respiratory tract infection were treated by no-pain health-care Tuina plus medicated bath. Since the therapeutic effects were satisfactory, so parents and infants are willing to accept.

  5. Reporting new cases of anaemia in primary care settings in Crete, Greece: a rural practice study

    Directory of Open Access Journals (Sweden)

    Lionis Christos

    2012-04-01

    Full Text Available Abstract Background Early diagnosis of anaemia represents an important task within primary care settings. This study reports on the frequency of new cases of anaemia among patients attending rural primary care settings in Crete (Greece and to offer an estimate of iron deficiency anaemia (IDA frequency in this study group. Methods All patients attending the rural primary health care units of twelve general practitioners (GPs on the island of Crete for ten consecutive working days were eligible to participate in this study. Hemoglobin (Hb levels were measured by portable analyzers. Laboratory tests to confirm new cases of anaemia were performed at the University General Hospital of Heraklion. Results One hundred and thirteen out of 541 recruited patients had a low value of Hb according to the initial measurement obtained by the use of the portable analyzer. Forty five (45.5% of the 99 subjects who underwent laboratory testing had confirmed anaemia. The mean value of the Hb levels in the group with confirmed anaemia, as detected by the portable analyzer was 11.1 g/dl (95% Confidence Interval (CI from 10.9 to 11.4 and the respective mean value of the Hb levels obtained from the full blood count was 11.4 g/dl (95% CI from 11.2 to 11.7 (P = 0.01. Sixteen out of those 45 patients with anaemia (35.6% had IDA, with ferritin levels lower than 30 ng/ml. Conclusion Keeping in mind that this paper does not deal with specificity or sensitivity figures, it is suggested that in rural and remote settings anaemia is still invisible and point of care testing may have a place to identify it.

  6. Pattern of seizure cases in tertiary care hospitals in Karnataka state of India

    Directory of Open Access Journals (Sweden)

    Nitin Joseph

    2013-01-01

    Full Text Available Background: The prevalence and incidence of epilepsy is higher in developing countries than in developed countries. Understanding pattern and risk factors of seizure cases will help in suggesting appropriate preventive measures. Objectives: This study was carried out to assess the pattern of seizure, its management and compliance with treatment. Materials and Methods: Data from medical records of seizure cases in three tertiary care hospitals of Mangalore city in south India admitted from January 2006 to December 2011 were collected and analyzed. Results: Nearly half (44.4% of the 196 cases belonged to productive age group (15-45 years and 2/3 rd (60.7% were males. Majority (>80% cases were unskilled workers and of low socio-economic status groups. Family history of seizures was present in 8.4% cases. Mean age of onset of seizure was found to be 19.9 years. Proportion of generalized tonic clonic seizure cases was 78.1%. Secondary seizures were seen in 66 (33.7% cases with the most common cause being trauma to the head (24.2%. Refractory seizures were present in 2.7% cases. Monotherapy was the most commonly followed treatment regimen and phenytoin was the most popular anti-epileptic drug (AED used. Non-compliance with AEDs was seen in 18.1% cases and was more among patients on polytherapy (P = 0.032. Conclusion: Seizure manifestations and treatment compliance vary widely in the studied population. In depth analysis of each seizure type will give more information about the factors associated with it.

  7. Investigation on Demands of Medical and Health Care Personnel from Vocational Colleges in Guangxi%广西高职高专医疗卫生人才需求调查

    Institute of Scientific and Technical Information of China (English)

    冯艺萍

    2012-01-01

    设计统一用人单位招聘意向调查表,对广西区内102家医药类用人单位进行问卷调查。结果显示.99.02%的用人单位招聘需求呈持续增长的态势。招聘的专业类型受医院级别及规模的影响。各类型用人单位薪酬无显著性差异(P〉0.05),具有良好综合素质的毕业生受到用人单位的青睐。%Aim:To get the idea of employing units' demand status on the vocational medical and health care personnel under the new medical system in Guangxi, so as to provide reference for the personnel cultivation. Methods Carried out questionnaire survey on 102 regional recruitment units with uniform questionnaire of employment intent. Result.. The employing demand tendency of 99.02 % employing units is continuously increasing, the demand for the major types are related with the ranks and scales of the hospital, and no significant difference in the salary, and the graduates with good comprehensive quality are favored by recruit units. Conclusion: To cultivate highly talent, pragmatic individuals who are not afraid to get down to work and stay at it until the job is done well, vocational colleges still have more to do in renewing the education ideas and making adjustment in course content and teaching mode.

  8. Approaches to integrated housing, health and social care services: case studies from North Tyneside Council and Northumbria Healthcare

    OpenAIRE

    Cook, Glenda; Aitken, Dominic; Hodgson, Philip; Marston, Roy; Binks, Eleanor; Peach, Robert; McMillan, Christine; Herman, Linda; Burke, Wendy; Park, Karen; Conway, Shirley; Graham, Helen; Blood, Gail; Cossar, Paula; McKinnon, Debora

    2016-01-01

    The Care Act 2014 places a duty on local authorities to integrate services, including housing, where this could improve wellbeing by preventing, reducing and/or delaying care needs (LGA 2015). Despite calls for greater collaborative working between housing and health professionals, there are limited examples of live projects taking an integrated approach to service delivery.\\ud \\ud This case study report presents three case studies of innovative approaches to integrated working across housing...

  9. Malignant Catatonia Warrants Early Psychiatric-Critical Care Collaborative Management: Two Cases and Literature Review

    Science.gov (United States)

    Tan, Josh; Krzeminski, Sylvia; Hazeghazam, Maryam; Bandlamuri, Meghana; Carlson, Richard W.

    2017-01-01

    Malignant catatonia (MC) is a life-threatening manifestation which can occur in the setting of an underlying neuropsychiatric syndrome or general medical illness and shares clinical and pathophysiological features and medical comorbidities with the Neuroleptic Malignant Syndrome (NMS). The subsequent diagnosis and definitive therapy of MC are typically delayed, which increases morbidity and mortality. We present two cases of MC and review recent literature of MC and NMS, illustrating factors which delay diagnosis and management. When clinical features suggest MC or NMS, we propose early critical care consultation and stabilization with collaborative psychiatric management. PMID:28250995

  10. Malignant Catatonia Warrants Early Psychiatric-Critical Care Collaborative Management: Two Cases and Literature Review

    Directory of Open Access Journals (Sweden)

    Julia Park

    2017-01-01

    Full Text Available Malignant catatonia (MC is a life-threatening manifestation which can occur in the setting of an underlying neuropsychiatric syndrome or general medical illness and shares clinical and pathophysiological features and medical comorbidities with the Neuroleptic Malignant Syndrome (NMS. The subsequent diagnosis and definitive therapy of MC are typically delayed, which increases morbidity and mortality. We present two cases of MC and review recent literature of MC and NMS, illustrating factors which delay diagnosis and management. When clinical features suggest MC or NMS, we propose early critical care consultation and stabilization with collaborative psychiatric management.

  11. Malignant Catatonia Warrants Early Psychiatric-Critical Care Collaborative Management: Two Cases and Literature Review.

    Science.gov (United States)

    Park, Julia; Tan, Josh; Krzeminski, Sylvia; Hazeghazam, Maryam; Bandlamuri, Meghana; Carlson, Richard W

    2017-01-01

    Malignant catatonia (MC) is a life-threatening manifestation which can occur in the setting of an underlying neuropsychiatric syndrome or general medical illness and shares clinical and pathophysiological features and medical comorbidities with the Neuroleptic Malignant Syndrome (NMS). The subsequent diagnosis and definitive therapy of MC are typically delayed, which increases morbidity and mortality. We present two cases of MC and review recent literature of MC and NMS, illustrating factors which delay diagnosis and management. When clinical features suggest MC or NMS, we propose early critical care consultation and stabilization with collaborative psychiatric management.

  12. Economic valuation of informal care in Asia: a case study of care for disabled stroke survivors in Thailand.

    Science.gov (United States)

    Riewpaiboon, Arthorn; Riewpaiboon, Wachara; Ponsoongnern, Kanyarat; Van den Berg, Bernard

    2009-08-01

    This study values informal care for disabled stroke survivors in Thailand. It applies the conventional recommended opportunity cost method to value informal care in monetary terms. Data were collected by means of face-to-face interviews conducted during 2006. The sample consisted of 101 disabled persons who had suffered a stroke at least six months prior to the interview, and who had a functional status score of less than 95 as measured by the Barthel Index. Average monthly time spent on informal care was 94.6 hours, and the major source of opportunity cost was forgone unpaid work (43.5%). The average monthly monetary value of informal care was 4642.6 baht, based on 2006 prices. This study shows that providing informal care involves a substantial opportunity cost, implying a hidden value to Thai society.

  13. Turning Risks into Opportunities in Contract Management: A Case Study in the Health Care Industry

    Directory of Open Access Journals (Sweden)

    Elizabeth McVicker

    2011-01-01

    Full Text Available Problem statement: This case study presented students with a situation based in the healthcare industry, highlighting the importance of contract review, clear communications and interestbased negotiations in order to avoid the costly consequences that could be associated with contract related disputes. The case allowed students to understand how clearly written contracts play a deciding role in the success of business partnerships. Students practiced negotiation skills while discussing the performance clauses of the contract and considering effective amendments to that contract with the purpose of extending a business relationship. Approach: The author interviewed a project manager working for a preferred implementation vendor which had a contract with a large hospital provider in Colorado and California. The purpose of the interview and the case study focused on contract law, contract management, enterprise risk management and negotiation skills. The case study is based on class room use with practical, real-life contract management scenarios. Results: The team projects submitted for this case study in case management highlighted the receptivity of students in understanding the benefit of preserving business relationships, avoiding litigation and carefully wording the specifics of complex contracts. The students excelled in practicing interest-based bargaining skills and writing contract amendments that reflected the specifics of the complex contract problem presented. Conclusion/Recommendations: Case studies focused on real business situations resonate well with upper division students in business law classes; the complexities of the situations and of the contract language did not deter students from brainstorming solutions to the problems presented and in writing amendments to the contract such that the business relationship was preserved. The results of the students’ work on this case study problem were presented to the

  14. Implementation of mental health service has an impact on retention in HIV care: a nested case-control study in a japanese HIV care facility.

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    Shinjiro Tominari

    Full Text Available BACKGROUND: Poor retention in the care of patients with human immunodeficiency virus (HIV is associated with adverse patient outcomes such as antiretroviral therapy failure and death. Therefore, appropriate case management is required for better patient retention; however, which intervention in case management is important has not been fully investigated. Meanwhile, in Japan, each local government is required to organize mental health services for patients with HIV so that a case manager at an HIV care facility can utilize them, but little is known about the association between implementation of the services and loss to follow-up. Therefore, we investigated that by a nested case-control study. METHODS: The target population consisted of all patients with HIV who visited Osaka National Hospital, the largest HIV care facility in western Japan, between 2000 and 2010. Loss to follow-up was defined as not returning for follow-up care more than 1 year after the last visit. Independent variables included patient demographics, characteristics of the disease and treatment, and whether the patients have received mental health services. For each case, three controls were randomly selected and matched. RESULTS: Of the 1620 eligible patients, 88 loss to follow-up cases were identified and 264 controls were matched. Multivariate-adjusted conditional logistic regression revealed that loss to follow-up was less frequent among patients who had received mental health services implemented by their case managers (adjusted odds ratio [95% confidence interval] 0.35 [0.16-0.76]. Loss to follow-up also occurred more frequently in patients who did not receive antiretroviral therapy (adjusted odds ratio [95% confidence interval], 7.51 [3.34-16.9], who were under 30 years old (2.74 [1.36-5.50], or who were without jobs (3.38 [1.58-7.23]. CONCLUSION: Mental health service implementation by case managers has a significant impact on patient retention.

  15. Comparing Dutch Case management care models for people with dementia and their caregivers: The design of the COMPAS study

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    MacNeil Vroomen Janet

    2012-05-01

    Full Text Available Abstract Background Dementia care in the Netherlands is shifting from fragmented, ad hoc care to more coordinated and personalised care. Case management contributes to this shift. The linkage model and a combination of intensive case management and joint agency care models were selected based on their emerging prominence in the Netherlands. It is unclear if these different forms of case management are more effective than usual care in improving or preserving the functioning and well-being at the patient and caregiver level and at the societal cost. The objective of this article is to describe the design of a study comparing these two case management care models against usual care. Clinical and cost outcomes are investigated while care processes and the facilitators and barriers for implementation of these models are considered. Design Mixed methods include a prospective, observational, controlled, cohort study among persons with dementia and their primary informal caregiver in regions of the Netherlands with and without case management including a qualitative process evaluation. Inclusion criteria for the cohort study are: community-dwelling individuals with a dementia diagnosis who are not terminally-ill or anticipate admission to a nursing home within 6 months and with an informal caregiver who speaks fluent Dutch. Person with dementia-informal caregiver dyads are followed for two years. The primary outcome measure is the Neuropsychiatric Inventory for the people with dementia and the General Health Questionnaire for their caregivers. Secondary outcomes include: quality of life and needs assessment in both persons with dementia and caregivers, activity of daily living, competence of care, and number of crises. Costs are measured from a societal perspective using cost diaries. Process indicators measure the quality of care from the participant’s perspective. The qualitative study uses purposive sampling methods to ensure a wide variation of

  16. Informal care for people with chronic psychotic symptoms: four case studies in a San community in South Africa.

    Science.gov (United States)

    den Hertog, Thijs N; Gilmoor, Andrew R

    2017-03-01

    Despite the internationally recognised importance of informal care, especially in settings with limited services, few studies focus on the informal care for people with mental health problems in low- and middle-income countries. Making informal care visible is important for understanding the challenges and identifying the needs to be addressed. This ethnographic case study explored the dynamics of informal care for people with chronic psychotic symptoms in a group of San living in poor socioeconomic circumstances in a township near Kimberley, Northern Cape, South Africa. Data were collected in 2013 and 2014 and included semi-structured interviews, informal conversations and observations. Using local terminology, four individuals with chronic psychotic symptoms were identified and selected during the research process. A total of 33 semi-structured interviews took place with their caregivers. Data were analysed using descriptive, interpretive and pattern coding to identify core themes and interrelations across the four cases. Results indicate that informal care is characterised by shared and fragmented care structures. Care was shared among family members from various households and unrelated community members. This allowed for an adaptive process that responded to local dynamics and the care recipients' needs. However, informal care was fragmented as it was generally uncoordinated, which increased the recipients' vulnerability as caregivers could redirect care-giving responsibility and withdraw care. Specific challenges for providing care were related to poverty and care resistance. To improve the living conditions of people suffering from psychosis-related mental health problems, community-based mental healthcare should broaden its scope and incorporate local strengths and challenges.

  17. Identifying the Unique Aspects of Adolescent and Young Adult Palliative Care: A Case Study to Propel Programmatic Changes in Pediatric Hospitals.

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    Humphrey, Lisa; Dell, Mary Lynn

    2015-09-01

    Using a case study, in this article we seek to highlight how the distinct developmental needs of adolescent and young adult patients facing a life-threatening condition require a different approach to patient care by pediatric health care workers. The case underscores pitfalls in using a pediatric construct of care in areas of pain management, social stressors, and advanced care planning, and suggests programs to implement for improvement, including partnership with psychiatry, substance abuse, and palliative care specialists.

  18. Robinow Syndrome: a Rare Case Report from a Tertiary Care Hospital in Eastern India

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    Shruti Saraswat

    2016-10-01

    Full Text Available Background Robinow syndrome is a rare congenital disorder with phenotypically heterogeneous abnormalities. Two modes of inheritances are known for this syndrome namely autosomal recessive and autosomal dominant. Case Report We describe here an eighteen-month-old child who had mesomelic short stature, abnormal facial features, clinodactyly, micropenis and vertebral changes which were further supported radiologically. The case was the first of his kind, which came to our hospital. The diagnosis was challenging and ascertained only after confirmation with multiple specialties and various interdepartmental discussions. Conclusion The syndrome is rare and hence is less known among health care workers. Also, the prenatal testing which is available for the entity needs to be explained to the suspected mothers.

  19. [Management and Nursing care for a patient with Lynch syndrome: A case report].

    Science.gov (United States)

    Pacheco-Pérez, Luis Arturo; Guevara Valtier, Milton Carlos

    2016-01-01

    Colorectal cancer is one of the leading causes of death from cancer worldwide. Main interventions to reduce the impact are aimed to enhance prevention and early detection. Results of several studies show that tests such as the fecal occult blood test and colonoscopy are effective for early diagnosis. There are hereditary syndromes such as Lynch Syndrome that can lead to certain types of cancers, including bowel neoplasms, therefore early detection needs to be included as part of the treatment. In these cases, family genetic testing is recommended if the bowel cancer is diagnosed before 50 years old. A care plan including the NANDA (North American Nursing Diagnosis Association), NOC (Nursing Outcomes Classification) and NIC (Nursing Interventions Classification) was developed for a patient with suspected Lynch Syndrome. Nurses should be qualified to identify potential cases of cancer associated with this syndrome, and thus, reduce the likelihood that family members develop the disease, through genetic counseling and education of environmental risk factors.

  20. Demands of immigration among Chinese immigrant nurses.

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    Ma, Amy X; Griffin, Mary T Quinn; Capitulo, Katie L; Fitzpatrick, Joyce J

    2010-10-01

    The purpose of this study was to identify the demands of immigration among Chinese nurses that have immigrated to the USA. The relationship between the demands of immigration and length of stay in the USA was investigated also. A descriptive correlational study design was used. A convenience sample of 128 nurses was recruited. A self-administered survey was conducted using the demands of immigration scale developed by Aroian, along with a demographic questionnaire. The results showed Chinese immigrant nurses have high demands of immigration. There were significant negative relationships between the demands of immigration and length of stay in the USA. Immigration demands decreased as length of stay increased but remained high even for those who had been in the USA for > 5 years. This information is vital to health-care agencies designing and implementing adaptation programmes targeting these demands to facilitate Chinese nurses' adaptation process.

  1. Dwellers' health care consciousness and community nursing demand in suburb of Jiujiang city%郊区居民保健意识及社区护理需求调查

    Institute of Scientific and Technical Information of China (English)

    廖晓春

    2009-01-01

    目的 调查江西省九江市市郊农村居民健康保健意识、社区护理需求等.方法 采用问卷调查法,于2008年3-5月抽取九江市市郊2个村的农村家庭进行问卷调查.结果 农村居民健康知识缺乏,居民迫切需要的社区护理项目有5项,分别为一般常见病的简单处理241人,占87.2%;社区紧急救护251人,占86.6%;社区的健康教育250人,占86.2%;老年慢性病护理253人,占83.1%;上门基础护理232人,占80.0%.结论 农村居民保健意识有待提高,社区护理需求大,应结合地区特点,尽快加强农村社区护理服务.%Objective To study the dwellers' health care consciousness and community nursing demand in suburb of Jiujiang city. Methods Dwellers from two different villages were interviewed at their home with questionnaires during March to May of 2008. Results The dwellers were deficient in health care consciousness. There were five most urgent needs of community nursing programs: simple handling of the common diseases(87.2%), first aid in community(86. 6%); community health education (86. 2%), chronic illness nursing for old people (83. 1%) and basic nursing at home (80. 0%). Conclusion The dwellers' health care consciousness ought to be improved. Dwellers' demand of community nursing is enormous. Suburb community nursing ought to be strengthened according to district's characteristic.

  2. 失能老年人的生活状况和社区照护服务需求研究%Study on Current Life Situation and Community Care Service Demand of Disabled Elders

    Institute of Scientific and Technical Information of China (English)

    姜向群; 刘妮娜; 魏蒙

    2014-01-01

    This paper uses the datum of survey on the basic situation and service demand for the elderly in Xicheng District in Beijing from Gerontology Institute of Renmin University, and analyzes their current life situation and care service demand. The reality reveals that there has been a low degree of utilization of community service facilities for disabled elders. Besides, community service items have been in shortage and had low supply rate. Accordingly, this study recognized that the advancement of social services for disabled elders can be conducted from two aspects: the short-term goals and long-term planning. On one hand, short-term goals include following items: providing corresponding services subsidies for disabled elders, transferring the core of community servicesfrom "entertainment" to "health maintenance" and properly handling the relationship among home-based care, institution care and family support for disabled elders, etc. On the other hand, the long-term planning covers establishment of system and mechanism of social services for disabled elders, furthermore, promotion of the market development of social services for disabled elders etc.%利用中国人民大学老年学研究所2013年对北京市西城区老年人基本情况和服务需求的调查数据,就失能老年人的生活状况和照护服务需求进行分析。失能老年人对社区养老服务设施的利用率低,社区照护服务项目及有效供给不足。可以从短期目标与长期规划两个方面着手推进失能老年人的社会服务发展。短期目标包括给予失能老年人相应服务补贴,社区服务重心由“娱乐型”向“医养型”转变,妥善处理失能老年人居家养老、机构养老与家庭养老的关系等;长期目标包括建立失能老年人社会服务机制、推进失能老年人社会服务市场化发展等。

  3. Rapid spread of complex change: a case study in inpatient palliative care

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    Filipski Marta I

    2009-12-01

    Full Text Available Abstract Background Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC. Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report here results from a qualitative evaluation of the IPC initiative after a year of implementation; our purpose was to understand factors supporting or impeding the rapid and consistent spread of a complex program. Methods Quality improvement study using a case study design and qualitative analysis of in-depth semi-structured interviews with 36 national, regional, and local leaders. Results Compelling evidence of impacts on patient satisfaction and quality of care generated 'pull' among adopters, expressed as a remarkably high degree of conviction about the value of the model. Broad leadership agreement gave rise to sponsorship and support that permeated the organization. A robust social network promoted knowledge exchange and built on an existing network with a strong interest in palliative care. Resource constraints, pre-existing programs of a different model, and ambiguous accountability for implementation impeded spread. Conclusions A complex, hospital-based, interdisciplinary intervention in a large health care organization spread rapidly due to a synergy between organizational 'push' strategies and grassroots-level pull. The combination of push and pull may be especially important when the organizational context or the practice to be spread is complex.

  4. Palliative and Supportive Care in Acrometastasis to the Hand: Case Series

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    Narendra Kumar

    2011-01-01

    Full Text Available Acrometastasis to the hand is an unusual presentation which might mimic an infectious, inflammatory, or a metabolic pathology. We herein describe a case series of three patients of acrometastasis to the hand. We encountered three cases of acrometastasis to the hand attending the departmental clinics from 2007 to 2010. The median age at presentation was noted to be 55 years. All were males. The primaries included squamous cell carcinoma of the skin, larynx, and esophagus. In two patients, acrometastasis was detected at presentation and in one it was detected 2 years postcompletion of radical therapy. Two patients were offered palliative radiation to acrometastasis, and best supportive care was given to one. Palliation achieved after radiation was noted to be modest to good. The brief report highlights the importance of the clinical awareness of metastatic dissemination to unusual sites in the face of increasing cancer survivorship. Acrometastasis portends a poor prognosis with limited survival, and optimal integration of the best supportive care is mandatory. A short course of hypofractionated palliative radiation therapy results in modest to good palliation.

  5. Availability of antidotes and key emergency drugs in tertiary care hospitals of Punjab and assessment of the knowledge of health care professionals in the management of poisoning cases.

    Science.gov (United States)

    Arslan, Naheed; Khiljee, Sonia; Bakhsh, Allah; Ashraf, Muhammad; Maqsood, Iram

    2016-03-01

    This study was conducted to evaluate the availability of antidotes/key emergency drugs in tertiary care hospitals of the Punjab province, and to assess the knowledge of health care professionals in the stocking and administration of antidotes in the proper management of poisoning cases. Seventeen (n=17) tertiary care hospitals of Punjab Pakistan were selected. Two performas (A and B) were designed for 26 antidotes/key emergency drugs and given to the hospital pharmacists and physicians respectively. It was observed that Activated Charcoal, being the universal antidote was found only in 6 hospitals (41%). Digoxin Immune Fab, Edentate Calcium disodium and Glucagon were not available in emergency department of any hospital and even not included in the formulary of any hospital. About 80% pharmacists were aware of the method of preparation of Activated Charcoal and 85% physicians were familiar with its route of administration. Data showed that tertiary care hospitals of Punjab do not stock antidotes according to national drug policy. Moreover the study strongly suggests the development of health care centers and professional by organizing antidote awareness programs, continuous education and record keeping of poisonous cases and availability of emergency drugs around the clock.

  6. What is the role of a case manager in community aged care? A qualitative study in Australia.

    Science.gov (United States)

    You, Emily Chuanmei; Dunt, David; Doyle, Colleen

    2016-07-01

    This study aimed to explore the perceptions of case managers about their roles in providing community aged care in Australia. Purposeful sampling was used and 33 qualitative semi-structured interviews with 47 participants were conducted. Participants were drawn from a list of all case managers working in aged care organisations that provided publicly funded case-managed community aged care programmes in the State of Victoria, Australia. Participant selection criteria included age, gender, job titles, professional backgrounds, practice locations, organisational attributes and organisational size. Data collection was implemented between September 2012 and March 2013. Thematic analysis was performed. Participants believed that case managers performed diverse roles based on clients' needs. They also articulated 16 important roles of case managers, including advisors, advocates, carers, communicators, co-ordinators, educators, empowering clients, engaging clients and families, liaising with people, managing budgets, navigators, negotiators, networking with people, facilitators, problem solvers and supporters. However, they were concerned about brokers, mediators and counsellors in terms of the terminology or case managers' willingness to perform these roles. Moreover, they perceived that neither gatekeepers nor direct service provision was case managers' role. The findings of this study suggest that case managers working in community aged care sectors may be more effective if they practised the 16 roles aforementioned. With the value of helping rather than obstructing clients to access services, they may not act as gatekeepers. In addition, they may not provide services directly as opposed to their peers working in medical care settings. The findings will also assist organisations to design job descriptions specifying case managers' roles and associated job responsibilities. Clear job descriptions will further benefit the organisations in staff recruitment, orientation

  7. In the Belly of the Beast: A Case Study of Social Work in a Managed Care Organization

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    Lisa S. Patchner

    2002-05-01

    Full Text Available The employment of social workers within managed care organizations is a new phenomenon. As such, this case study utilized an exploratory-descriptive design that assessed social workers as case managers within a Medicaid HMO. The semi-structured interviews, focus groups, and participant observation suggested that the use of case management services, delivered primarily by social workers,was effective in addressing the bio-psychosocial needs of Medicaid consumers within a provider-driven HMO. Study findings recommend specific knowledge and skills that social workers need in order to prepare for practice within managed care environments.

  8. Animating the Ethical Demand

    DEFF Research Database (Denmark)

    Vistisen, Peter; Jensen, Thessa; Poulsen, Søren Bolvig

    2015-01-01

    This paper addresses the challenge of attaining ethical user stances during the design process of products and services and proposes animation-based sketching as a design method, which supports elaborating and examining different ethical stances towards the user. The discussion is qualified...... dispositions, as well as create an incentive for ethical conduct in development and innovation processes. The ethical fulcrum evolves around Løgstrup’s Ethical Demand and his notion of spontaneous life manifestations. From this, three ethical stances are developed; apathy, sympathy and empathy. By exploring...... both apathetic and sympathetic views, the ethical reflections are more nuanced as a result of actually seeing the user experience simulated through different user dispositions. Exploring the three ethical stances by visualising real use cases with the technologies simulated as already being implemented...

  9. Simulation of Electricity Demand Function in Agricultural Sector: An Application of Genetic Algorithm (Case Study: Electricity-Fed Wells of Iran

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    Hossein Sadeghi

    2014-11-01

    Full Text Available Due to several problems arisen from consumption of gas oil, it is necessary to electricity substitute fossil fuels in agriculture wells in Iran. Problems such as lack of opportune and adequate supply of fuel, air and soil pollution, noise pollution and huge costs of installation, operation and maintenance imply the necessity of replacing gas oil systems by electricity-consuming ones in agriculture sector of Iran.However, it is essential to study on the demand of electricity, nowadays, substituting other energy sources.As water wells are the main electricity consumersin agriculture sector, the estimation of energy demand function would be beneficial for policy makers to achieve their goals. The present paper investigates on energy demand function in agriculture sector of Iran.Genetic algorithm techniques are appliedto estimate electricity demand in agricultural sector in three forms: linear, quadratic and exponential equations. Based on the conventional criteria, the exponential model is selected as the best model for estimation. Furthermore, electricity demand of agricultural sector is forecasted under three scenarios for years next three years.

  10. An econometric analysis of electricity demand response to price changes at the intra-day horizon: The case of manufacturing industry in West Denmark

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    Niels Framroze Møller

    2015-06-01

    Full Text Available The use of renewable energy implies a more variable supply of power. Market efficiency may improve if demand can absorb some of this variability by being more flexible, e.g. by responding quickly to changes in the market price of power. To learn about this, in particular, whether demand responds already within the same day, we suggest an econometric model for hourly consumption- and price time series. This allows for multi-level seasonality and that information about day-ahead prices does not arrive every hour but every 24th hour (as a vector of 24 prices. We confront the model with data from the manufacturing industry of West Denmark (2007-2011. The results clearly suggest a lack of response. The policy implication is that relying exclusively on hourly price response by consumers for integrating volatile renewable electricity production is questionable. Either hourly price variation has to increase considerably or demand response technologies be installed.

  11. [Breast feeding and child care: a case study of 2 rural areas of Mexico].

    Science.gov (United States)

    Pérez-Gil-Romo, S E; Rueda-Arróniz, F; Díez-Urdanivia-Coria, S

    1993-01-01

    The present research is included in the fields of public health, social sciences and gender studies. Its objective is to provide insight into the nursing behaviour of two groups of mothers, their domestic and extra-domestic child care arrangements and their attitudes towards breast-feeding. Thirty-five mothers were selected in Malinalco, Mexico, and 35 in the Sierra de Juárez, Oaxaca. Each mother had at least two children and one of them under three years of age. The study was exploratory in its initial phase, subsequently cross-sectional, comparative and prospective. It constitutes a foundation for longitudinal case studies. A pre-coded questionnaire, including the following issues, was administered: family composition; maternal schooling; maternal employment; nursing behaviour with the last child; child care and attitudes towards breast-feeding. The main information regarding 33 mothers in Malinalco and 31 in Oaxaca revealed that in both areas mothers decided how to feed their children during the first days; during the first month, 55 per cent of mothers in Malinalco breast-fed their child, while approximately 90 per cent did so in Oaxaca. The majority of women worked outside home and resorted to extra-domestic arrangements for child care. No relation was found between the feeding method chosen with the last child and maternal employment. About 90 per cent of women in both areas were "happy" to have been born females and breast-feeding was considered a "must". Seventy five per cent of mothers would not allow other women to breast feed their child, even though they were aware that maternal milk is the best.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Survival of the project: a case study of ICT innovation in health care.

    Science.gov (United States)

    Andreassen, Hege K; Kjekshus, Lars Erik; Tjora, Aksel

    2015-05-01

    From twenty years of information and communication technology (ICT) projects in the health sector, we have learned one thing: most projects remain projects. The problem of pilotism in e-health and telemedicine is a growing concern, both in medical literature and among policy makers, who now ask for large-scale implementation of ICT in routine health service delivery. In this article, we turn the question of failing projects upside down. Instead of investigating the obstacles to implementing ICT and realising permanent changes in health care routines, we ask what makes the temporary ICT project survive, despite an apparent lack of success. Our empirical material is based on Norwegian telemedicine. Through a case study, we take an in-depth look into the history of one particular telemedical initiative and highlight how ICT projects matter on a managerial level. Our analysis reveals how management tasks were delegated to the ICT project, which thus contributed to four processes of organisational control: allocating resources, generating and managing enthusiasm, system correction and aligning local practice and national policies. We argue that the innovation project in itself can be considered an innovation that has become normalised in health care, not in clinical, but in management work. In everyday management, the ICT project appears to be a convenient tool suited to ease the tensions between state regulatory practices and claims of professional autonomy that arise in the wake of new public management reforms. Separating project management and funding from routine practice handles the conceptualised heterogeneity between innovation and routine within contemporary health care delivery. Whilst this separation eases the execution of both normal routines and innovative projects, it also delays expected diffusion of technology.

  13. Evaluation of Suicide and Intoxication Cases Admitted to our Newly Opened Intensive Care Unit

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    Nalan Muhammedoğlu

    2014-09-01

    Full Text Available Aim: The aim of this study was to evaluate the suicide and intoxication cases between April 2011 and April 2013. Methods: We retrospectively analyzed hospital records of patients who were admitted to our intensive care unit due to suicide and intoxication. The age, sex, intoxication causes, laboratory analyses, treatment refusal rates, and the prognosis were evaluated. Results: A total of 308 patients (105 males, 203 females were admitted to the intensive care unit. The mean age of the patients was 27.45±10.26 years (males: 28.70±9.86 years, females: 26.80±10.43 years. There were only 4 patients over 65 years of age. 275 patients had drug intoxication (antidepressant drug, pain killer, antibiotic, etc. and 33 patients had other causes of intoxication. When analyzing the prognosis; a total of 234 patients were discharged after initial treatment and 57 patients were discharged due to treatment refusal. 15 patients were referred for inpatient psychiatric treatment, 1 patient to the Alcohol and Drug Addiction Treatment Center (AMATEM and 1 patient was referred to İstanbul University Medical Faculty due to acute hepatic failure. Conclusion: The patients admitted to our intensive care unit due to suicide and intoxications were mainly females (65.9% and individuals of young age (median age: 27.45 years. Female patients had used antidepressants for suicide attempts and males had used antiflu-acetaminophen combinations. No mortality was observed. (The Me­di­cal Bul­le­tin of Ha­se­ki 2014; 52:153-7

  14. Learning by doing. Training health care professionals to become facilitator of moral case deliberation.

    Science.gov (United States)

    Stolper, Margreet; Molewijk, Bert; Widdershoven, Guy

    2015-03-01

    Moral case deliberation (MCD) is a dialogue among health care professionals about moral issues in practice. A trained facilitator moderates the dialogue, using a conversation method. Often, the facilitator is an ethicist. However, because of the growing interest in MCD and the need to connect MCD to practice, healthcare professionals should also become facilitators themselves. In order to transfer the facilitating expertise to health care professionals, a training program has been developed. This program enables professionals in health care institutions to acquire expertise in dealing with moral questions independent of the expertise of an (external) ethicist. Over the past 10 years, we developed a training program with a specific mix of theory and practice, aiming to foster the right attitude, skills and knowledge of the trainee. The content and the didactics of the training developed in line with the philosophy of MCD: pragmatic hermeneutics, dialogical ethics and Socratic epistemology. Central principles are: 'learning by doing', 'reflection instead of ready made knowledge', and 'dialogue on dialogue'. This paper describes the theoretical background and the didactic content of the current training. Furthermore, we present didactic tools which we developed for stimulating active learning. We also go into lessons we learned in developing the training. Next, we provide some preliminary data from evaluation research of the training program by participants. The discussion highlights crucial aspects of educating professionals to become facilitators of MCD. The paper ends with concluding remarks and a plea for more evaluative evidence of the effectiveness and meaning of this training program for doing MCD in institutions.

  15. Doença de alzheimer e demandas de cuidados: o que os enfermeiros sabem? Mal de Alzheimer y demandas de cuidados: ¿Cuánto saben los enfermeros? Alzheimer diseases and care demands: what do nurses know?

    Directory of Open Access Journals (Sweden)

    Silvana Poltroniere

    2011-06-01

    is to unveil nurses' knowledge of Alzheimer's Diseases (AD and the demands of care for patients and their families. It is a descriptive and exploratory study with a qualitative approach. Data were collected through semistructured interviews. Data saturation occurred after interviewing eleven nurses in two private hospitals. Six categories emerged from the content analysis: AD characterization, risk factors, ways to diagnose, complications, treatment medication, patient and family care. It was observed that nurses have partial knowledge regarding AD, focusing their care action only on the clinical changes of the cause of admission. They recognize signs and symptoms but show themselves only as supporting assistants when they should act more autonomously while dealing with care demands and family support.

  16. A Case of Biotinidase Deficiency in an Adult with Respiratory Failure in the Intensive Care Unit

    Science.gov (United States)

    Demirtürk, Zerrin; Şentürk, Evren; Köse, Abbas; Özcan, Perihan Ergin; Telci, Lütfi

    2016-01-01

    Background: Biotinidase deficiency (BD) is a rare, inherited autosomal recessive disorder that is treatable within childhood. We present a patient with pneumonia and respiratory acidosis who was not diagnosed with any systemic disorders; the patient was finally diagnosed as BD. Case Report: A thirty-year-old woman was admitted to the emergency department with respiratory failure that had persisted for a few days and progressively weakening over the previous six months. Then, the patient was admitted to the intensive care unit with marked respiratory acidosis, respiratory failure and alterations in consciousness. At the follow-up, the patient was not diagnosed with a systematic disorder. Rather, the patient’s historical clinical findings suggested a metabolic disorder. Finally, the patient was diagnosed with biotinidase deficiency. Conclusion: Even though biotinidase deficiency is not frequently seen in the intensive care unit, metabolic syndromes such as biotinidase deficiency should be considered. Patients should be evaluated holistically with attention to medical history, family history and clinical findings. PMID:27761288

  17. Lessons for health care reform from the less developed world: the case of the Philippines.

    Science.gov (United States)

    Obermann, Konrad; Jowett, Matthew R; Taleon, Juanito D; Mercado, Melinda C

    2008-11-01

    International technical and financial cooperation for health-sector reform is usually a one-way street: concepts, tools and experiences are transferred from more to less developed countries. Seldom, if ever, are experiences from less developed countries used to inform discussions on reforms in the developed world. There is, however, a case to be made for considering experiences in less developed countries. We report from the Philippines, a country with high population growth, slow economic development, a still immature democracy and alleged large-scale corruption, which has embarked on a long-term path of health care and health financing reforms. Based on qualitative health-related action research between 2002 and 2005, we have identified three crucial factors for achieving progress on reforms in a challenging political environment: (1) strive for local solutions, (2) make use of available technology and (3) work on the margins towards pragmatic solutions whilst having your ethical goals in mind. Some reflection on these factors might stimulate and inform the debate on how health care reforms could be pursued in developed countries.

  18. All patient refined-diagnostic related group and case mix index in acute care palliative medicine.

    Science.gov (United States)

    Lagman, Ruth L; Walsh, Declan; Davis, Mellar P; Young, Brett

    2007-03-01

    The All Patient Refined-Diagnostic Related Group (APR-DRG) is a modification of the traditional DRG that adds four classes of illness severity and four classes of mortality risk. The APR-DRG is a more accurate assessment of the complexity of care. When individuals with advanced illness are admitted to an acute inpatient palliative medicine unit, there may be a perception that they receive less intense acute care. Most of these patients, however, are multisymptomatic, have several comorbidities, and are older. For all patients admitted to the unit, a guide was followed by staff physicians to document clinical information that included the site(s) of malignancy, site(s) of metastases, disease complications, disease-related symptoms, and comorbidities. We then prospectively compared DRGs, APR-DRGs, and case mix index (CMI) from January 1-June 30, 2003, and February 1-July 31,2004, before and after the use of the guide. The overall mean severity of illness (ASOI) increased by 25% (P < 0.05). The mean CMI increased by 12% (P < 0.05). The average length of stay over the same period increased slightly from 8.97 to 9.56 days. Systematic documentation of clinical findings using a specific tool for patients admitted to an acute inpatient palliative medicine unit based on APR-DRG classifications captured a higher severity of illness and may better reflect resource utilization.

  19. [Caring for a pre-schoolchild using the health assets model: a case report].

    Science.gov (United States)

    Ramos-Morcillo, Antonio Jesús; Fernández-Salazar, Serafín

    2012-01-01

    The health assets model is a field of work that has protective effects on children associated with the protection, safety, and to their well being. This assets model is complementary, to the deficit model, which is often absent. From this point of view, we present the case of a 4 year old who was healthy and for whom a series of activities were designed with parents as primary implementers and directed primarily to the maintenance of health and child welfare. To do this, a care plan for parents caring for the learning child was developed based NANDA nursing taxonomy, and the NOC and NIC classifications in order to achieve the desired outcomes and carry out the appropriate nursing interventions. From the methodological point of view, possessing a common language and a nursing diagnostic taxonomy are keys to the development of our profession, but to work from a salutogenic perspective based on the NANDA International diagnoses, we believe that this does not fit properly. There is a lack of development in this area and would be interesting to develop it.

  20. An Analysis of Gap in TQM Indicators in Health Care Institutions (Case: Isfahan Khorshid Hospital

    Directory of Open Access Journals (Sweden)

    M Sadr-Bafghi

    2009-01-01

    Full Text Available Introduction: Many organizations, especially, service organizations, relative to their goals and mission, have a special view towards quality phenomena and its management and are turning to approaches such as TQM to help manage their business. This study examined the TQM indicators gap in Isfahan Khorshid hospital. As fuzzy set theory is better than the logical theory for estimating the linguistic factors, this paper tries to apply fuzzy approach to quality management in hospitals and analyzes the gap between personnel expectations and perception. Methods: This paper analyzes medical total quality management in a case (Internal Section of Khorshid Hospital, based on gap analysis model and fuzzy logic. A questionnaire was therefore applied to measure expectations and perceptions of hospital personnel. Results: This study results show that on the whole, there is a significant difference between TQM expectations and perceptions among K`horshid hospital personnel. Conclusions: Spurred by impressive results in other industries, this compelling and logical approach has begun to penetrate the thinking of health care accrediting agencies, business coalitions, private foundations and leading health care organizations. However, before making a commitment to TQM, hospital decision makers should thoroughly understand what it is they are committing to, and solve the main barriers such as the conflict between hospital management philosophies and TQM philosophies.

  1. Restructuring patient flow logistics around patient care needs: implications and practicalities from three critical cases.

    Science.gov (United States)

    Villa, Stefano; Barbieri, Marta; Lega, Federico

    2009-06-01

    To make hospitals more patient-centered it is necessary to intervene on patient flow logistics. The study analyzes three innovative redesign projects implemented at three Italian hospitals. The three hospitals have reorganized patient flow logistics around patient care needs using, as proxies, the expected length of stay and the level of nursing assistance. In order to do this, they have extensively revised their logistical configuration changing: (1) the organization of wards, (2) the hospital's physical lay-out, (3) the capacity planning system, and (4) the organizational roles supporting the patient flow management. The study describes the changes implemented as well as the results achieved and draws some general lessons that provide useful hints for those other hospitals involved in such type of redesign projects. The paper ends by discussing some policy implications. In fact, the results achieved in the three cases investigated provide interesting material for further discussion on clinical, operational, and economic issues.

  2. Appendicitis Diagnosed by Emergency Physician Performed Point-of-care Transvaginal Ultrasound: Case Series

    Directory of Open Access Journals (Sweden)

    Robert Bramante

    2013-09-01

    Full Text Available Lower abdominal pain in females of reproductive age continues to be a diagnostic dilemma for the emergency physician (EP. Point-of-care ultrasound (US allows for rapid, accurate, and safe evaluation of abdominal and pelvic pain in both the pregnant and non-pregnant patient. We present 3 cases of females presenting with right lower quadrant and adnexal tenderness where transvaginal ultrasonography revealed acute appendicitis. The discussion focuses on the use of EP-performed transvaginal US in gynecologic and intra-abdominal pathology and discusses the use of a staged approach to evaluation using US and computed tomography, as indicated. [West J Emerg Med. 2013;14(5:415-418.

  3. [Application of an OPT model in a paediatric nursing clinical case in primary health care].

    Science.gov (United States)

    Rifà Ros, Rosa; Pérez Pérez, Isabel

    2011-01-01

    This article describes the assessment and nursing diagnostic hypothesis generation on a 10 years old child with a parietal contusion who attended the health care centre with his mother. The health centre is located in a rural area in Catalonia, and a paediatric nurse was placed in charge of the child. In the assessment and the subsequent information analysis, the nurse identified an unhealthy situation for the correct development of the child. The situation required the mother's intervention and a change in her habits and behaviours. For the approach of the case study, the OPT model (Outcome Present-state Testing) by Pesut and Herdman was used. The assessment was made by using Marjory Gordon's Functional Health Patterns assessment, and the NANDA-I nursing diagnoses taxonomy, NOC Outcomes taxonomy and NIC Interventions taxonomy was used for the diagnoses and planning.

  4. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center.

    Science.gov (United States)

    Garg, Sunil Kumar

    2015-04-01

    Bodybuilding is the use of progressive resistance exercise to control and develop one's musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

  5. Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Garg

    2015-01-01

    Full Text Available Bodybuilding is the use of progressive resistance exercise to control and develop one′s musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.

  6. Case-finding of dementia in general practice and effects of subsequent collaborative care; design of a cluster RCT

    Directory of Open Access Journals (Sweden)

    van den Dungen Pim

    2012-08-01

    Full Text Available Abstract Background In the primary care setting, dementia is often diagnosed relatively late in the disease process. Case finding and proactive collaborative care may have beneficial effects on both patient and informal caregiver by clarifying the cause of cognitive decline and changed behaviour and by enabling support, care planning and access to services. We aim to improve the recognition and diagnosis of individuals with dementia in general practice. In addition to this diagnostic aim, the effects of case finding and subsequent care on the mental health of individuals with dementia and the mental health of their informal carers are explored. Methods and design Design: cluster randomised controlled trial with process evaluation. Participants: 162 individuals ≥ 65 years, in 15 primary care practices, in whom GPs suspect cognitive impairment, but without a dementia diagnosis. Intervention; case finding and collaborative care: 2 trained practice nurses (PNs invite all patients with suspected cognitive impairment for a brief functional and cognitive screening. If the cognitive tests are supportive of cognitive impairment, individuals are referred to their GP for further evaluation. If dementia is diagnosed, a comprehensive geriatric assessment takes place to identify other relevant geriatric problems that need to be addressed. Furthermore, the team of GP and PN provide information and support. Control: GPs provide care and diagnosis as usual. Main study parameters: after 12 months both groups are compared on: 1 incident dementia (and MCI diagnoses and 2 patient and caregiver quality of life (QoL-AD; EQ5D and mental health (MH5; GHQ 12 and caregiver competence to care (SSCQ. The process evaluation concerns facilitating and impeding factors to the implementation of this intervention. These factors are assessed on the care provider level, the care recipient level and on the organisational level. Discussion This study will provide insight

  7. Profile of Cancer Cases at a Tertiary Care Level Teaching Hospital in Rural Western Maharashtra, India

    Directory of Open Access Journals (Sweden)

    Jayant D Deshpande , Kailash K Singh , Deepak B Phalke

    2012-01-01

    Full Text Available Background: Cancer is one of the major public health problems worldwide. Prevalence and pattern of cancer is known to vary from region to region. Epidemiological information on cancer including the pattern is an important basis for determining the priorities for cancer control in any population group. Objective: Present work is an attempt to study magnitude, profile and some epidemiological aspects in relation to cancer cases at a tertiary care level teaching hospital in rural area. Method: All records were studied and analyzed. A total of 1106 patients were treated during the period studied. A proforma was used to collect data such as age, sex, place of residence, type of cancers and treatment given. The data collected were entered into MS-Excel sheets and analysis was carried out. The information obtained was tabulated analyzed using the software GraphPad Instat demo version. Results: A total of 1106 cancer patients were treated during the January 2010 to December 2010. Among these, 626(56.60 were females and 480(43.39 were females. In males, the common cancers were oral cavity cancers, lung cancers and GIT cancers. The most common cancers among females were the cervical carcinomas, which constituted 32.10% of the total number of cancers cases followed by cancers of breast. Almost 2/3rd of cases occurred in the age group of 41 to 70 years. Maximum frequency was observed in 51–60 year age group in both sexes. Maximum numbers (74.59% of the cases were from rural area. The main methods of cancer treatment were surgery, chemotherapy and radiotherapy, used alone or in combination. Conclusion: Tobacco and alcohol related cancers predominated in males. In females, cervical cancer predominated over breast cancer. Human behavior is a major determinant in the successful control of cancer. Understanding cancer magnitude, risk and trends will be of help in cancer control.

  8. The Q(s,S) control policy for the joint replenishment problem extended to the case of correlation among item-demands

    DEFF Research Database (Denmark)

    Larsen, Christian

    2009-01-01

    We develop an algorithm to compute an optimal Q(s,S) policy for the joint replenishment problem when demands follow a compound correlated Poisson process. It is a non-trivial generalization of the work by Nielsen and Larsen [2005. An analytical study of the Q(s,S) policy applied to the joint...

  9. The Q(s,S) control policy for the joint replenishment problem extended to the case of correlation among item-demands

    DEFF Research Database (Denmark)

    Larsen, Christian

      We develop an algorithm to compute an optimal Q(s,S) policy for the joint replenishment problem when demands follow a compound correlated Poisson process. It is a non-trivial generalization of the work by Nielsen and Larsen (2005). We make some numerical analyses on two-item problems where we...

  10. Piped water consumption in Ghana: A case study of temporal and spatial patterns of clean water demand relative to alternative water sources in rural small towns.

    Science.gov (United States)

    Kulinkina, Alexandra V; Kosinski, Karen C; Liss, Alexander; Adjei, Michael N; Ayamgah, Gilbert A; Webb, Patrick; Gute, David M; Plummer, Jeanine D; Naumova, Elena N

    2016-07-15

    Continuous access to adequate quantities of safe water is essential for human health and socioeconomic development. Piped water systems (PWSs) are an increasingly common type of water supply in rural African small towns. We assessed temporal and spatial patterns in water consumption from public standpipes of four PWSs in Ghana in order to assess clean water demand relative to other available water sources. Low water consumption was evident in all study towns, which manifested temporally and spatially. Temporal variability in water consumption that is negatively correlated with rainfall is an indicator of rainwater preference when it is available. Furthermore, our findings show that standpipes in close proximity to alternative water sources such as streams and hand-dug wells suffer further reductions in water consumption. Qualitative data suggest that consumer demand in the study towns appears to be driven more by water quantity, accessibility, and perceived aesthetic water quality, as compared to microbiological water quality or price. In settings with chronic under-utilization of improved water sources, increasing water demand through household connections, improving water quality with respect to taste and appropriateness for laundry, and educating residents about health benefits of using piped water should be prioritized. Continued consumer demand and sufficient revenue generation are important attributes of a water service that ensure its function over time. Our findings suggest that analyzing water consumption of existing metered PWSs in combination with qualitative approaches may enable more efficient planning of community-based water supplies and support sustainable development.

  11. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    NARCIS (Netherlands)

    Plas, A.G.M. van der; Onwuteaka-Philipsen, B.D.; Vissers, K.C.; Deliens, L.; Jansen, W.J.J.; Francke, A.L.

    2016-01-01

    Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case managemen

  12. Ethical issues related to managed care: an in-depth discussion of an occupational therapy case study.

    Science.gov (United States)

    Lohman, H; Brown, K

    1997-01-01

    What are the ethical responsibilities of occupational therapists when managed care plans override their clinical judgment and deny reimbursement for needed assessment or therapy? Using an example from a true case, this article presents an analysis of the ethical problems experienced in managed care when explicit business goals are in conflict with the humanistic commitments of our field. Strategies for ethical action are recommended, including: good communication with the case manager, effective advocacy for the patient, consultation with ethics resources, and advocacy at the policy-making level. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworth.com].

  13. Demandas de atendimento psiquiátrico em um hospital universitário Demandas de lo atendimiento psiquiátrico en un hospital universitario Demands of psychiatric care in a university hospital

    Directory of Open Access Journals (Sweden)

    Naiara Gajo Silva

    2011-09-01

    la necesidad de la interconsulta de enfermería psiquiátrica en este hospital.This is a cross-sectional study that aimed to describe the psychiatric demand in a university hospital in the city of Cuiabá, state of Mato Grosso, Brazil, and to know the current situation of the service to this demand. The data were collected from the inpatient medical records in a university hospital, from June to August, 2009, in a total of 551 records. Despite being considered by the literature as unprepared, nursing is the professional category that most identifies the psychiatric demand in this hospital. The treatment plan to this demand was restricted to medication, nine evaluations of psychology and thirteen consultation-liaison psychiatric service, without a significant involvement of nursing. The approach of emotional and/or mental aspects results in the improvement in the quality of nursing care, and there is a need for the nurses to qualify for that. To make it happen, we propose a reflection on the need for the consultation-liaison psychiatric service in this hospital.

  14. Hidden Owners, Hidden Profits, and Poor Nursing Home Care: A Case Study.

    Science.gov (United States)

    Harrington, Charlene; Ross, Leslie; Kang, Taewoon

    2015-01-01

    The study examined the ownership transparency, financial accountability, and quality indicators of a regional for-profit nursing home chain in California, using a case study methodology to analyze data on the chain's ownership and management structure, financial data, staffing levels, deficiencies and complaints, and litigation. Secondary data were obtained from regulatory and cost reports and litigation cases. Qualitative descriptions of ownership and management were presented and quantitative analyses were conducted by comparing financial and quality indicators with other California for-profit chains, for-profit non-chains, and nonprofit nursing home groups in 2011. The chain's complex, interlocking individual and corporate owners and property companies obscured its ownership structure and financial arrangements. Nursing and support services expenditures were lower than nonprofits and administrative costs were higher than for-profit non-chains. The chain's nurse staffing was lower than expected staffing levels; its deficiencies and citations were higher than in nonprofits; and a number of lawsuits resulted in bankruptcy. Profits were hidden in the chain's management fees, lease agreements, interest payments to owners, and purchases from related-party companies. Greater ownership transparency and financial accountability requirements are needed to ensure regulatory oversight and quality of care.

  15. Cytopathology of neoplastic meningitis: A series of 66 cases from a tertiary care center

    Directory of Open Access Journals (Sweden)

    Gurdeep Singh

    2013-01-01

    Full Text Available Background: Neoplastic meningitis (NM is a condition characterized by leptomeningeal involvement by metastatic carcinoma. Detection of exfoliated malignant cells in cerebrospinal fluid (CSF due to meningeal metastasis is frequently associated with diverse neurologic presentations. Materials and Methods: In this retrospective study of all cases of NM diagnosed in CSF samples over a 20-year period at a tertiary care referral center, the cytomorphologic features were reviewed. Results: Sixty six cases of NM were identified of which 36 already had an established diagnosis of malignancy while in 30 patients, there was no previously known tumor. The most common known primary in the former group was breast followed by ovary. Single cell pattern, cellular cannibalism, moderate cytoplasm and rounded nuclei were seen in breast and lung tumors. Papillary architecture and cytoplasmic vacuolation were seen in the ovarian primaries. Melanin pigment was seen in malignant melanoma. Conclusion: CSF cytology is an important tool for diagnosis of NM. Cytomorphologic features helped in diagnosis and for prediction of the primary site. Correct identification of this condition is important as it has therapeutic and prognostic implications.

  16. [Pharmaceutical care of serious bleeding induced by tramadol-warfarin interaction: a case report].

    Science.gov (United States)

    Dong, Shu-jie; Zhang, Ting; Li, Yan; Zhai, Suo-di

    2014-10-18

    Warfarin is a high-alert medication, which may result in bleeding if used improperly. In our case, one elderly female with atrial fibrillation had taken warfarin for more than half a year, and her international normalized ratio (INR) was maintained within the therapeutic range. The patient began to take tramadol to alleviate her shoulder pain. Three days later she presented hematuresis and had ecchymosis in her right upper arm, and in the meantime her INR rose to 10.04. Clinical pharmacists analyzed the cause for bleeding by searching relevant literature, and finally discovered the interaction between warfarin and tramadol. On the basis of that, the clinical pharmacists provided pharmaceutical care, offered specific medication education, as well as assisted the physicians to establish the medication plan for warfarin reuse. Eventually, her INR declined to reference ranges, and her hematuresis and ecchymosis were alleviated significantly. This successful case reveals that clinical pharmacy services contribute to better treatment outcomes. Clinical pharmacists can play an active role in anticoagulation management in healthcare team.

  17. The effect of social health insurance on prenatal care: the case of Ghana.

    Science.gov (United States)

    Abrokwah, Stephen O; Moser, Christine M; Norton, Edward C

    2014-12-01

    Many developing countries have introduced social health insurance programs to help address two of the United Nations' millennium development goals-reducing infant mortality and improving maternal health outcomes. By making modern health care more accessible and affordable, policymakers hope that more women will seek prenatal care and thereby improve health outcomes. This paper studies how Ghana's social health insurance program affects prenatal care use and out-of-pocket expenditures, using the two-part model to model prenatal care expenditures. We test whether Ghana's social health insurance improved prenatal care use, reduced out-of-pocket expenditures, and increased the number of prenatal care visits. District-level differences in the timing of implementation provide exogenous variation in access to health insurance, and therefore strong identification. Those with access to social health insurance have a higher probability of receiving care, a higher number of prenatal care visits, and lower out-of-pocket expenditures conditional on spending on care.

  18. Development and measurement properties of the self assessment version of the INTERMED for the elderly to assess case complexity

    NARCIS (Netherlands)

    Peters, Lilian L.; Boter, Han; Slaets, Joris P. J.; Buskens, Erik

    2013-01-01

    Objectives: The INFERMED for the Elderly Self Assessment (IM-E-SA) was developed to support health care professionals in providing demand driven elderly care. It assesses case complexity and health care needs as perceived by older adults themselves. By applying this instrument tailored care can be p

  19. Using institutional theory to analyse hospital responses to external demands for finance and quality in five European countries

    OpenAIRE

    Robert, Glenn Brian; Anderson, Janet

    2015-01-01

    Objectives: Given the impact of the global economic crisis, delivering better health care with limited finance grows more challenging. Through the lens of institutional theory, this paper explores pressures experienced by hospital leaders to improve quality and constrain spending, focusing on how they respond to these often competing demands. Methods: An in-depth, multilevel analysis of health care quality policies and practices in five European countries including longitudinal case studies i...

  20. A Study in Child Care (Case Study from Volume II-A): "A Rolls-Royce of Day Care." Day Care Programs Reprint Series.

    Science.gov (United States)

    O'Farrell, Brigid

    The Amalgamated Day Care Center is an independent trust established through a collective bargaining agreement between the Amalgamated Clothing Workers of America, AFL-CIO, and the employers of the garment industry. The free center, open from 6:00 a.m. to 6:00 p.m., is located near the Chicago garment industries to minimize transportation problems…

  1. THE STUDY OF INFLUENCE ON SUPPLY AND DEMAND OF WOOD AND CARBON STOCK CHANGING WOODEN HOUSE LIFE - CASE STUDY FOR WAKAYAMA PREFECTURE USING GEOGRAPHICAL INFORMATION -

    Science.gov (United States)

    Arikawa, Miho; Taenaka, Sayuri; Tanikawa, Hiroki

    The study evaluated the influence of supply and demand of residential wood on the amounts of carbon fixation and CO2 absorption by forests. The residential wood occupies most of all wood demand. The result of the analysis revealed that both the amounts of carbon fixation in the forest and the residence decreased. Moreover, it was clarified that the wood utilization for long-lived houses made the amounts of carbon fixation in the forests and residences the maximum. On the other hand, the amounts of CO2 absorption by the man-made forest would decrease in the future. However, the study showed the possibility of the increase in CO2 absorption admitted in the Kyoto Protocol.

  2. Perceptions of Nursing Care for Cardiovascular Cases, Knowledge on the Telehealth and Telecardiology in Indonesia

    Directory of Open Access Journals (Sweden)

    Rr. Tutik Sri Hariyati

    2012-02-01

    Full Text Available Background: Nowadays, the life-style displacement promotes the increasing of degenerative disease, such as cardiovascular disease, which since 1995, has been stated as the main cause of fatality in Indonesia. Telehealth was defined as the use of the telecommunication technology to support the health information and increase the health service. Telehealth in developed countries can improve the behavior of healthy living. Telehealth in Indonesia is expected to increase healthy lifestyles that can reduce the risk of cardiovascular disease and other degenerative diseases.Objectives: This study aimed to explore perceptions of related experience in the nursing care of cardiovascular cases, experience in the use of telehealth and hopes in telehealth implementation in Indonesia.Study Design: This study used a qualitative study with focus group discussions approach. Participants in this study are 64 nurses. The selection of participants was carried out using purposive sampling. The data of this research, which were in the form of transcript and field report from each group discussion of the FGD, was analyzed using the phenomenology method developed by Collaizi.Results: The theme of nursing care was divided into 4 sub-themes that were: assessment, diagnosis, planning, implementation and evaluation. The subtheme of definition and hopes to telehealth was stated, “As far as I know, the heart hospital has used online system, so that if we want to do referral, the patient can consultation directly, but t I don’t know about the system. With Telehealth, nurses could observe the sign and symptoms from patient’s home.Conclusion: The results of qualitative studies show that telehealth In Indonesia was limited. Expectations for the development of telehealth/telecardiology is to further facilitate consultation, communication and education can support the patient or a nurse

  3. VESICOVAGINAL FISTULA: OUR EXPERIENCE OF 47 CASES IN A TERTIARY CARE HOSPITAL OF WEST BENGAL

    Directory of Open Access Journals (Sweden)

    Biswajit

    2016-06-01

    Full Text Available Vesicovaginal Fistula (VVF, an abnormal communication between the urinary bladder and vagina, is one of the most distressing and embarrassing health problem for the ladies. The present observational study was planned to inquire into the demographic and aetiologic pattern of vesicovaginal fistula and the long-term success rate of its surgical management following different techniques of repair in a tertiary care centre of West Bengal, India. MATERIAL AND METHODS A total of 47 patients with vesicovaginal fistula presented at our hospital over a span of nine years, were observed during their course of treatment. The patients were evaluated with clinical history, physical examination, routine laboratory investigations, intravenous urogram and cystoscopy. Then the patients had undergone operation by vaginal or abdominal route. Patients were discharged from the hospital with per urethral catheter. On 21st post-operative day, routine cystogram was done in every patient before catheter removal to exclude the failure of the operation. RESULT Of the observed 47 patients, 66% were tracked back to their obstetric causes and 34% patients could be linked up to gynaecological aetiology like a complication of hysterectomy or after brachytherapy for carcinoma of cervix. In 23.4% of patients, the repair of fistula was done by vaginal route, whereas in 76.6% cases by abdominal approach. Overall success rate of surgical repair was 87.3%, which is comparable to the success rate mentioned in literature. CONCLUSION In spite of a decline in the incidence of vesicovaginal fistula in the western world, it is still highly prevalent in the developing countries. Prolonged obstructive labour was found as the most common aetiology of this devastating condition in our region. Timely intervention with meticulous surgical technique is essential for an acceptable success rate in fistula repair surgery. However, improved obstetric care, institutional delivery, high literacy rate

  4. Supply and demand analysis for flood insurance by using logistic regression model: case study at Citarum watershed in South Bandung, West Java, Indonesia

    Science.gov (United States)

    Sidi, P.; Mamat, M.; Sukono; Supian, S.

    2017-01-01

    Floods have always occurred in the Citarum river basin. The adverse effects caused by floods can cover all their property, including the destruction of houses. The impact due to damage to residential buildings is usually not small. Indeed, each of flooding, the government and several social organizations providing funds to repair the building. But the donations are given very limited, so it cannot cover the entire cost of repair was necessary. The presence of insurance products for property damage caused by the floods is considered very important. However, if its presence is also considered necessary by the public or not? In this paper, the factors that affect the supply and demand of insurance product for damaged building due to floods are analyzed. The method used in this analysis is the ordinal logistic regression. Based on the analysis that the factors that affect the supply and demand of insurance product for damaged building due to floods, it is included: age, economic circumstances, family situations, insurance motivations, and lifestyle. Simultaneously that the factors affecting supply and demand of insurance product for damaged building due to floods mounted to 65.7%.

  5. Innovation and Demand

    DEFF Research Database (Denmark)

    Andersen, Esben Sloth

    2007-01-01

    the demand-side of markets in the simplest possible way. This strategy has allowed a gradual increase in the sophistication of supply-side aspects of economic evolution, but the one-sided focus on supply is facing diminishing returns. Therefore, demand-side aspects of economic evolution have in recent years...... received increased attention. The present paper argues that the new emphasis on demand-side factors is quite crucial for a deepened understanding of economic evolution. The major reasons are the following: First, demand represents the core force of selection that gives direction to the evolutionary process....... Second, firms' innovative activities relate, directly or indirectly, to the structure of expected and actual demand. Third, the demand side represents the most obvious way of turning to the much-needed analysis of macro-evolutionary change of the economic system....

  6. To what extent do primary care practice nurses act as case managers life style counselling regarding weight management?

    NARCIS (Netherlands)

    Dillen, van S.; Hiddink, G.J.

    2014-01-01

    Background - In this review study, we are the first to explore whether the practice nurse (PN) can act as case manager lifestyle counselling regarding weight management in primary care. Methods - Multiple electronic databases (MEDLINE, PsycINFO) were searched to identify relevant literature after 19

  7. How can collaboration be strengthened between public health and primary care? : A Dutch multiple case study in seven neighbourhoods

    NARCIS (Netherlands)

    Storm, Ilse; van Gestel, Anke; van de Goor, Ien; van Oers, Hans

    2015-01-01

    BACKGROUND: Although public health and primary care share the goal of promoting the health and wellbeing of the public, the two health sectors find it difficult to develop mutually integrated plans and to collaborate with each other. The aim of this multiple case study was to compare seven neighbour

  8. Problems Associated with Coordination and Role Definitions in Health Care Teams: A Hospice Program Evaluation and Intervention Case Study.

    Science.gov (United States)

    Berteotti, Carol R.; And Others

    Using an evaluation of a hospital-based hospice as a case study, this paper analyzes problematic issues surrounding health care teams (HCTs) in light of findings revealed in the literature concerning HCT structures and processes. The factors of coordination and role definitions in HCTs and their manifestations in a particular hospice HCT in terms…

  9. Fewer intensive care unit refusals and a higher capacity utilization by using a cyclic surgical case schedule

    NARCIS (Netherlands)

    Houdenhoven, van Mark; Oostrum, van Jeroen M.; Wullink, Gerhard; Hans, Erwin; Hurink, Johann L.; Bakker, Jan; Kazemier, Geert

    2008-01-01

    Purpose: Mounting health care costs force hospital managers to maximize utilization of scarce resources and simultaneously improve access to hospital services. This article assesses the benefits of a cyclic case scheduling approach that exploits a master surgical schedule (MSS). An MSS maximizes ope

  10. Fashioning the Reciprocal Norms of Elder Care: A Case of Immigrants in the United States and Their Parents in Taiwan

    Science.gov (United States)

    Sun, Ken C.

    2012-01-01

    In this study, the author uses the changing practice of geriatric care within transnational Taiwanese families as a case to examine the processes through which a family ideology "travels," varies, and operates across worlds. Specifically, the author argues that family members across generations reconstruct "rules of reciprocity" to facilitate the…

  11. PERFECT DEMAND ILLUSION

    Directory of Open Access Journals (Sweden)

    Alexander Yu. Sulimov

    2015-01-01

    Full Text Available The article is devoted to technique «Perfect demand illusion», which allows to strengthen the competitive advantageof retailers. Also in the paper spells out the golden rules of visual merchandising.The definition of the method «Demand illusion», formulated the conditions of its functioning, and is determined by the mainhypothesis of the existence of this method.Furthermore, given the definition of the «Perfect demand illusion», and describes its additional conditions. Also spells out the advantages of the «Perfect demandillusion», before the «Demand illusion».

  12. Pluralist social constraints on the development of a health care system: the case of Israel.

    Science.gov (United States)

    Palley, H A; Yishai, Y; Ever-Hadani, P

    1983-01-01

    The effectiveness of Israel's health care system is hindered by pluralism, in terms both of its many separate health service institutions and of the particularism of those institutions. Although the health care system provides modern health care to a widely insured population, it does so inefficiently and at unnecessary expense. The lack of vertical and horizontal integration of the health care system has led to problems of fragmentation, duplication, and lack of coordination of services. Because of its limited resources, Israel must work to surmount this pluralism and achieve integrated planning if it is to succeed in providing the efficient and cost-effective care its population needs.

  13. A case study of employee voice and organizational performance in the context of residential aged care

    OpenAIRE

    Azam Bazooband; Abdolvahab Baghbanian; Ghazal Torkfar

    2016-01-01

    As the population of old people is on the great increase in countries, the necessity of aged-care centers is not deniable. Likewise the other health care services, the quality of services provided by care givers for old people in residential aged care centers is a significant and vital factor. The main objective of this paper is to conduct a descriptive research of correlation type on the impact of employee voice on organizational performance in four non-for-profit aged care centers, in Sh...

  14. 私人部门在满足医疗需求方面的作用(下)%The Role of Private Sector in Meeting Health Care Demand(PartⅡ)

    Institute of Scientific and Technical Information of China (English)

    郑宗美; 莱因哈特; 王宇(译)

    2015-01-01

    本文就私人部门在满足医疗需求方面的作用进行分析,认为如果私人部门能够得到有效监管,并按照社会道德认同的方式进行运转,一国医疗体系就能够受益于私人部门。本部分探讨了私人部门的效率及私人医疗市场的作用。尽管私人部门效率普遍被认为高于公共部门,但私人企业追求低成本、高价格,而且有可能要求患者接受过度医疗。医疗服务并不满足市场运行的基本条件;如果社会成员之间的医疗服务分配由市场主导,分配结果可能与社会期望实现的目标不一致。建立社会医保体系是一种行之有效的医疗服务再分配方法。%This paper analyzes the role of private sector in meeting health care demand and believes that national health care system will be able to benefit from the private sector if the private sector can be effectively regulated and op-erates according to the social moral. This part discusses the efficiency of private sector and the role of private medical market. Although the efficiency of private sector is generally considered to be higher than the public sector,the pursuit of low cost and high prices may cover overtreatment. Medical service does not meet the basic condition of market opera-tion;if the distribution of medical services among social members is dominated by the market, the results may not be consistent with the goal of social expectations. The establishment of social health insurance system is a kind of effective method for medical service redistribution.

  15. Urogenital fistulae: A prospective study of 50 cases at a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Mathur Rajkumar

    2010-01-01

    % illiterate and 69% were short Statured. Vesico vaginal fistulae (VVF was seen in 64% cases of which 50% were due to obstructed labor, 19% cases post LSCS and 31% cases post total abdominal hysterectomy (TAH. 68% of urogenital fistulae were between 1 to 3 cms. We obtained a 75% cure rate in UVF, 87.5% cure rate in RVF while a 93.75% cure rate was observed in patients with VVF. 76% of all patients were cured while 8% had a recurrence, probably due to the large size of fistula. Conclusion : Genital fistula is preventable, yet it remains a significant cause of morbidity among females of reproductive age group. Despite facilities available, certain conditions like physical, social, economic, illiteracy, and a very casual attitude towards maternal health and children birth practices limit utilization of services for women. It is important that the modern health care providers should be aware of these aspects, so that they can recognize services that are appropriate and acceptable to the people. Thus, one must agree that in cases of urogenital fistulae, "prevention is better than cure".

  16. 医改中规避供方诱导需求的补偿方式研究%The Compensation Way in Health Care Reform for Evading Supplier Induced Demand

    Institute of Scientific and Technical Information of China (English)

    蒋涌; 王智

    2014-01-01

    In the current medical insurance system, supplier induced demand is regarded as the major inducement for the increase of hos-pitalization costs and is the most serious ethical risk in the medical field. As ethical risks in the medical field are caused by information asymmetry between supply and requisitioning parties, health economics put forward that rational compensation design is necessary. Health care reform departments shall pay close attention on the ethical risks in the current medical insurance system. The design of compensation approach shall be the focus of policy making with the analysis of utility models. In conclusion, payment by capitation is a better way than payment by items in evading the ethical risks.%在现行的医疗保障制度中,供方诱导需求被认为是导致医疗费用上涨的重要诱因,同时也是我国医疗领域最严重的道德风险问题。医疗领域的道德风险根源于供需双方的信息不对称,因此卫生经济学认为合理的补偿方式设计是必要的。我国现行医疗保障制度中的医疗供方的道德风险问题应该引起医改部门的重视,通过效用模型分析,政府对医疗供方的补偿方式的设计应该成为政策制定的重点。结论显示,用按固定人头付费相对于现行的按项目付费制能够更有效的规避道德风险。

  17. The evaluation of cases with pneumothorax in the neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Müsemma Karabel

    2013-09-01

    Full Text Available Objectives: Early diagnosis and treatment is essentialin reducing mortality in newborns with pneumothorax. Inthis study, newborns with a diagnosis of pneumothorax inneonatal intensive care unit of our hospital were evaluatedand aimed to increase the awareness of physicians.Methods: 12 cases with pneumothorax were evaluatedretrospectively. The gender, birth weight, gestational age,mode of delivery, the presence of underlying disease,pneumothorax localization, implementation of the surfactantand mechanical ventilation and existence or absenceof mortality were recorded.Results: During the study, pneumothorax was detected12 patients. Male/female ratio was 1.4. Eight of the patientshad born with cesarean delivery, the mean birthweight of cases was 2623±912 g and, 66.7% of caseswere term babies. Pneumothorax was observed in thefirst week of life in all patients and it occurred spontaneouslyin 4 patients. The frequency of bilateral pneumothoraxwas 41.7%. For the treatment, closed tube drainagewas performed in 9 patients. The overall mortality ratewas 66.7%. Half of the patients who died had congenitalanomalies such as diaphragmatic eventration (n=1,hydrocephalus (n=1, encephalocel (n=1, non-immunehydrops fetalis (n=1.Conclusion: Additional congenital anomalies, such asPDAs and persistent pulmonary hypertension were foundto be effective on mortality in neonates with pneumothorax.Although, it is a life-threatening condition, the emergencytreatment is life saving. Therefore, in patients withrisk factors, keeping pneumothorax in mind is also thefirst step of the treatment. J Clin Exp Invest 2013; 4 (3:289-292Key words: Newborn, respiratuar distress, pneumothorax,treatment, outcome

  18. A retrospective study of 296 cases of intra uterine fetal deaths at a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Neetu Singh

    2013-04-01

    Full Text Available Background: To identify the risk factors and to streamline preventive and management protocols for IUD. Methods: This was a retrospective study from January 2011 to December 2012 which was conducted at G.S.V.M. Medical College, Kanpur. IUD was defined as fetal death beyond 20 weeks of gestation and/or birth weight > 500g. Maternal and fetal records were analysed. Mode of delivery and associated complications were studied. Results: Total number of deliveries were 7310.Incidence of IUD at our centre was 40 per 1000. 55.73% were antepartum and 11.06% were intra partum. In 33.44% cases, no causes were identified. Among the identifiable causes, very severe anemia (16.55% and hypertensive disorders (10.81% were most common followed by placental causes (12.16%.Congenital malformations were responsible for 9.45% cases .Induction was done in 151 patients,111 patients had spontaneous onset of labour and caesarean section was done in 34 patients. The most devastating complication of IUD was DIC found in 14 patients (3.71%. Conclusions: The present study is an effort to compile a profile of maternal, fetal and placental causes culminating to IUD at our centre. This emphasizes the importance of proper antenatal care and identification of risk factors and its treatment. Institutional deliveries should be promoted to prevent intrapartum fetal deaths .A substantial number of IUD are still labeled as unexplained, hence cannot be prevented. Decrease in the incidence of IUD would significantly reduce the perinatal mortality. [Int J Reprod Contracept Obstet Gynecol 2013; 2(2.000: 141-146

  19. Facility Delivery, Postnatal Care and Neonatal Deaths in India: Nationally-Representative Case-Control Studies.

    Directory of Open Access Journals (Sweden)

    Shaza A Fadel

    Full Text Available Clinical studies demonstrate the efficacy of interventions to reduce neonatal deaths, but there are fewer studies of their real-life effectiveness. In India, women often seek facility delivery after complications arise, rather than to avoid complications. Our objective was to quantify the association of facility delivery and postnatal checkups with neonatal mortality while examining the "reverse causality" in which the mothers deliver at a health facility due to adverse perinatal events.We conducted nationally representative case-control studies of about 300,000 live births and 4,000 neonatal deaths to examine the effect of, place of delivery and postnatal checkup on neonatal mortality. We compared neonatal deaths to all live births and to a subset of live births reporting excessive bleeding or obstructed labour that were more comparable to cases in seeking care.In the larger study of 2004-8 births, facility delivery without postnatal checkup was associated with an increased odds of neonatal death (Odds ratio = 2.5; 99% CI 2.2-2.9, especially for early versus late neonatal deaths. However, use of more comparable controls showed marked attenuation (Odds ratio = 0.5; 0.4-0.5. Facility delivery with postnatal checkup was associated with reduced odds of neonatal death. Excess risks were attenuated in the earlier study of 2001-4 births.The combined effect of facility deliveries with postnatal checks ups is substantially higher than just facility delivery alone. Evaluation of the real-life effectiveness of interventions to reduce child and maternal deaths need to consider reverse causality. If these associations are causal, facility delivery with postnatal check up could avoid about 1/3 of all neonatal deaths in India (~100,000/year.

  20. Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Report

    Directory of Open Access Journals (Sweden)

    Mehmet Akif Yazar

    2016-04-01

    Full Text Available SUMMARY Invasive pulmonary aspergillosis (IPA is an infection rarely seen in intensive care units (ICU. We aimed to discuss the case of IPA found in a patient followed up in our ICU due to chronic obstructive pulmonary disease (COPD. A 58-year old patient diagnosed with COPD has been admitted to our ICU due to respiratory failure. There were not any other diseases except from COPD. In his radiological imaging there were diffuse bilateral infiltrates in the chest X-ray and diffuse infiltration in the thorax tomography. Aspergillus spp was isolated in the bronchoalveolar lavage sample from patient and caspofungin was added to the treatment. On the 12th day of the treatment, it was observed that the results of the control radiological imaging became normal and there was no isolation in the control cultures. In recent years, fungal infections have been determined at an increasing rate in the patients who are not immunosuppressed and hospitalized in ICU. In the IPA cases, it has been shown that such underlying causes as diabetes, malnutrition, use of steroid, uremia, cirrhosis and COPD may create risk. Our patient did not have other disease except from COPD and there was a story of prolonged using of steroid. Steroids are quite frequently used in the ICUs. In the patients with chronic pulmonary diseases, even if it is low dose and short-term, the treatment of steroid is accepted as a risk factor in terms of IPA. Since signs and symptoms are atypical in this group of patients, it is rather difficult to diagnose IPA in the short term. The isolation of aspergillus in our patient’s tracheal aspirate taken earlier enabled us to start the treatment early. Although there are not comprehensive studies, it should be kept in mind that İPA may develop in the patients who is using long-term steroid, is admitted to the ICUs due to COPD exacerbations without any other disease.

  1. Scaling up paediatric HIV care with an integrated, family-centred approach: an observational case study from Uganda.

    Science.gov (United States)

    Luyirika, Emmanuel; Towle, Megan S; Achan, Joyce; Muhangi, Justus; Senyimba, Catherine; Lule, Frank; Muhe, Lulu

    2013-01-01

    Family-centred HIV care models have emerged as an approach to better target children and their caregivers for HIV testing and care, and further provide integrated health services for the family unit's range of care needs. While there is significant international interest in family-centred approaches, there is a dearth of research on operational experiences in implementation and scale-up. Our retrospective case study examined best practices and enabling factors during scale-up of family-centred care in ten health facilities and ten community clinics supported by a non-governmental organization, Mildmay, in Central Uganda. Methods included key informant interviews with programme management and families, and a desk review of hospital management information systems (HMIS) uptake data. In the 84 months following the scale-up of the family-centred approach in HIV care, Mildmay experienced a 50-fold increase of family units registered in HIV care, a 40-fold increase of children enrolled in HIV care, and nearly universal coverage of paediatric cotrimoxazole prophylaxis. The Mildmay experience emphasizes the importance of streamlining care to maximize paediatric capture. This includes integrated service provision, incentivizing care-seeking as a family, creating child-friendly service environments, and minimizing missed paediatric testing opportunities by institutionalizing early infant diagnosis and provider-initiated testing and counselling. Task-shifting towards nurse-led clinics with community outreach support enabled rapid scale-up, as did an active management structure that allowed for real-time review and corrective action. The Mildmay experience suggests that family-centred approaches are operationally feasible, produce strong coverage outcomes, and can be well-managed during rapid scale-up.

  2. Opposite Drug Prescription and Cost Trajectories following Integrative and Conventional Care for Pain – A Case-Control Study

    Science.gov (United States)

    Sundberg, Tobias; Petzold, Max; Kohls, Niko; Falkenberg, Torkel

    2014-01-01

    Objectives Pharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden. Methods In this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives). Results After index care visits, conventional care pain patients (n = 1050) compared to IC patients (n = 213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p = 0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p = 0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p = 0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups. Conclusions Drug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC. PMID:24827981

  3. Integration of the leprosy programme into primary health care: a case study of perceptions of primary health care workers.

    Science.gov (United States)

    Raju, M S; Dongre, V V

    2003-01-01

    Integration of the vertical leprosy programme into the existing horizontal health programme poses various administrative and operational challenges to programmers. In order to understand the preparedness of the PHC workers for integration of leprosy into primary health care services, 71 PHC workers were interviewed using a structured interview schedule. The results showed that about 42% of the staff have heard of the concept of integration earlier and 90% of the PHC staff are willing to treat leprosy patients in the primary health care centre, but only 72% were in favour of integration. The reasons for favouring integration were (1) wider coverage with MDT, (2) frequent field visits by the worker, (3) better rapport with the community, (4) timely treatment and (5) cost-effectiveness. About 28% of the staff members did not favour integration for the reasons that the leprosy programme would suffer, targets cannot be met, supervision would be difficult, knowledge of the staff was inadequate and importance cannot be given to leprosy as family planning is always a priority in PHC centres. About 43% of the staff felt that the performance of the leprosy programme would be better after integration. With regard to workload, 60% of the sample felt that there would be increase in the workload in the field, record maintenance and supervision. The difficulties foreseen by the workers were grouped into 6 categories, viz., administrative, managerial, technical, personnel, social and miscellaneous. It is worth noting that 91% of the staff that included all categories said they were not afraid of leprosy, but needed training in leprosy work. About 50% of the staff expected increase in salaries and promotions if integration took place.

  4. Punica granatum L. Hydrogel for Wound Care Treatment: From Case Study to Phytomedicine Standardization

    Directory of Open Access Journals (Sweden)

    Aline Fleck

    2016-08-01

    Full Text Available The pharmacological activities of many Punica granatum L. components suggest a wide range of clinical applications for the prevention and treatment of diseases where chronic inflammation is believed to play an essential etiologic role. The current work reports a case study analyzing the effect produced by a magistral formulation of ethanolic extracts of Punica granatum peels on a non-healing chronic ulcer. The complete closure of the chronic ulcer that was initially not responsive to standard medical care was observed. A 2% (w/w P. granatum peels ethanolic extract hydrogel-based formulation (PGHF was standardized and subjected to physicochemical studies to establish the quality control parameters using, among others, assessment criteria such as optimum appearance, pH range, viscosity and hydrogel disintegration. The stability and quantitative chromatographic data was assessed in storage for six months under two temperature regimes. An efficient HPLC-DAD method was established distinguishing the biomarkers punicalin and punicalagin simultaneously in a single 8 min run. PGHF presented suitable sensorial and physicochemical performance, showing that punicalagin was not significantly affected by storage (p > 0.05. Formulations containing extracts with not less than 0.49% (w/w total punicalagin might find good use in wound healing therapy.

  5. Evaluation of point-of-care testing of C-reactive protein in forensic autopsy cases.

    Science.gov (United States)

    Soejima, Mikiko; Koda, Yoshiro

    2014-04-01

    We assessed the technical performance and robustness of the point-of-care test for C-reactive protein (CRP) NycoCard CRP for use in forensic autopsy cases. The results of 17 of 39 cadaver blood samples that had CRP in the range effectively measured by the NycoCard (5-120mg/l) correlated well (r=0.99) with those of quantitative latex agglutination immunoassay (turbidimetry), and the out-of-range NycoCard results were fully consistent with those obtained by turbidimetry. For the ten sera whose CRP >120mg/l according to NycoCard, a significant correlation (r=0.98) was observed between values multiplied by the dilution ratio and those of turbidimetry. No significant differences were observed after a freeze-thaw procedure. In addition, CRP results using recombinant human CRP spiked with hemoglobin up to 80g/l were not significantly different from the unspiked results in PBS. The test allows reliable and cost-effective on-site measurement of CRP from a small volume of serum (5μl) with simple equipment. This semi-quantification method of CRP should be useful for diagnosis during autopsy.

  6. Medication review and transitions of care: a case report of a decade-old medication error.

    Science.gov (United States)

    Comer, Rachel; Lizer, Mitsi

    2015-03-01

    A 69-year-old Caucasian male with a 25-year history of paranoid schizophrenia was brought to the emergency department because of violence toward the staff in his nursing facility. He was diagnosed with a urinary tract infection and was admitted to the behavioral health unit for medication stabilization. History included a five-year state psychiatric hospital admission and nursing facility placement. Because of poor cognitive function, the patient was unable to corroborate medication history, so the pharmacy student on rotation performed an in-depth chart review. The review revealed a transcription error in 2003 deleting amantadine 100 mg twice daily and adding amiodarone 100 mg twice daily. Subsequent hospitalization resulted in another transcription error increasing the amiodarone to 200 mg twice daily. All electrocardiograms conducted were negative for atrial fibrillation. Once detected, the consulted cardiologist discontinued the amiodarone, and the primary care provider was notified via letter and discharge papers. An admission four months later revealed that the nursing facility restarted the amiodarone. Amiodarone was discontinued and the facility was again notified. This case reviews how a 10-year-old medication error went undetected in the electronic medical records through numerous medication reconciliations, but was uncovered when a single comprehensive medication review was conducted.

  7. Marfan Syndrome: new diagnostic criteria, same anesthesia care? Case report and review

    Directory of Open Access Journals (Sweden)

    Maria Rita Araújo

    Full Text Available Abstract Background: Marfan's Syndrome (MFS is a disorder of connective tissue, mainly involving the cardiovascular, musculoskeletal, and ocular systems. The most severe problems include aortic root dilatation and dissection. Anesthetic management is vital for the improvement on perioperative morbidity. Case report: 61-year-old male with MFS, presenting mainly with pectus carinatum, scoliosis, ectopia lens, previous spontaneous pneumothorax and aortal aneurysm and dissection submitted to thoracoabdominal aortic prosthesis placement. Underwent routine laparoscopic cholecystectomy due to lithiasis. Important findings on preoperative examination were thoracolumbar kyphoscoliosis, metallic murmur on cardiac exam. Chest radiograph revealed Cobb angle of 70°. Echocardiogram showed evidence of aortic mechanical prosthesis with no deficits. Discussion: Preoperative evaluation should focus on cardiopulmonary abnormalities. The anesthesiologist should be prepared for a potentially difficult intubation. Proper positioning and limb support prior to induction is crucial in order to avoid joint injuries. Consider antibiotic prophylaxis for subacute bacterial endocarditis. The patient should be carefully positioned to avoid joint injuries. Intraoperatively cardiovascular monitoring is mandatory: avoid maneuvers that can lead to tachycardia or hypertension, control airway pressure to prevent pneumothorax and maintain an adequate volemia to decrease chances of prolapse, especially if considering laparoscopic surgery. No single intraoperative anesthetic agent or technique has demonstrated superiority. Adequate postoperative pain management is vitally important to avoid the detrimental effects of hypertension and tachycardia.

  8. Punica granatum L. Hydrogel for Wound Care Treatment: From Case Study to Phytomedicine Standardization.

    Science.gov (United States)

    Fleck, Aline; Cabral, Patrik F G; Vieira, Felipe F M; Pinheiro, Deo A; Pereira, Carlos R; Santos, Wilson C; Machado, Thelma B

    2016-08-22

    The pharmacological activities of many Punica granatum L. components suggest a wide range of clinical applications for the prevention and treatment of diseases where chronic inflammation is believed to play an essential etiologic role. The current work reports a case study analyzing the effect produced by a magistral formulation of ethanolic extracts of Punica granatum peels on a non-healing chronic ulcer. The complete closure of the chronic ulcer that was initially not responsive to standard medical care was observed. A 2% (w/w) P. granatum peels ethanolic extract hydrogel-based formulation (PGHF) was standardized and subjected to physicochemical studies to establish the quality control parameters using, among others, assessment criteria such as optimum appearance, pH range, viscosity and hydrogel disintegration. The stability and quantitative chromatographic data was assessed in storage for six months under two temperature regimes. An efficient HPLC-DAD method was established distinguishing the biomarkers punicalin and punicalagin simultaneously in a single 8 min run. PGHF presented suitable sensorial and physicochemical performance, showing that punicalagin was not significantly affected by storage (p > 0.05). Formulations containing extracts with not less than 0.49% (w/w) total punicalagin might find good use in wound healing therapy.

  9. An analysis on the predictive demand for health care workforce in health care facilities in the city of Karamay in Xinj iang%新疆克拉玛依市医疗机构卫生人员需求预测分析

    Institute of Scientific and Technical Information of China (English)

    白思敏; 欧阳静; 张建华; 许强; 杨良佩; 叶庆; 朱朝刚

    2014-01-01

    目的:探讨新疆克拉玛依市2006-2010年医疗机构提供医疗卫生服务以及社会发展情况,测算2011-2015年医疗机构的卫生技术人员数量和机构,为合理配置与规划医疗机构的发展提供有效的依据。方法根据2006-2010的卫生服务需求数据,利用等维灰数递补动态模型预测2011-2015年的卫生服务需求数据,再利用卫生服务需求法计算2011-2015年的医生数,最后利用相应的指标推算其他人员的数据量。结果根据卫生服务需求法测算2011年克市医疗卫生机构总人数应为3508名,其中医生926名、护士1111名,2015年为3663名,其中医生967名、护士1160名;截止2010年底卫生人员是2987名,与2011年测算的卫生人员总数相差521名,卫生技术人员2010年数量与2015年测算的卫生技术人员相差643名。结论克市医疗机构卫生人员总量不足,卫生人员结构不合理,工勤人员比例偏高,其他卫生技术人员比例偏低;2011-2015年克市卫生技术人才引进工作压力大。%Objective The number and structure of health care workforce in health care facilities over 2011 to 2015 in Karamay were predicted to provide the information of the rational allocation and scientific plan-ning for health care facilities′development,by analyzing the condition of health services provided by health care facilities and social development from 2006 to 2010 in Karamay.Methods Based on health services de-mand data during 2006 to 2010,a dimension gray recurrence dynamic model was developed to predict the health services demand from 2011 to 2015 in Karamay.Subsequently the calculation method of health serv-ices demand was used to estimate the number of physicians.Finally the corresponding indices were applied to obtain the number of the other workers.Results The estimated total number of health care workforce by 2011 was 3508,and among whom physicians and nurses were 926 and 1 111,respectively

  10. Determining the Role of Inefficiency on Elasticity of Output Supply and Input Demand: A Case Study of Irrigated Wheat in 27 provinces of Iran

    Directory of Open Access Journals (Sweden)

    Alireza Garshasbi

    2014-01-01

    Full Text Available This article appraises the impressions of technical and price or allocative inefficiency on elasticity of the supply of wheat and demand of its inputs in 27 provinces of Iran. To this purpose, first the technical, price and economic efficiency has been calculated utilizing the stochastic frontier functions of production and cost. The influencing factors of efficiency including: the degree of scale economies, the share of technology in manufacturing process, the share of governmental supports, the cost of production processes and the experience have been estimated via a panel data approach. At the end, rejecting the hypothesis of perfect efficiency of farmers in production, the functions of output supply and input demand have been assessed in two scenarios (concerning efficiency and inefficiency using a profit function and the impact of general (economic inefficiency on relative and crossover elasticities of output and input are evaluated. The results show that the average of technical, price and economic efficiency of irrigated wheat respectively equal to 69, 63 and 45 percent. The estimated parameters have been affected, concerning the inefficiency. Although relative elasticities of output and inputs are appeared with expected signs, entering the inefficiency, elasticity of irrigated wheat is generally increased.

  11. Severe imported malaria in an intensive care unit: a review of 59 cases

    Directory of Open Access Journals (Sweden)

    Santos Lurdes C

    2012-03-01

    Full Text Available Abstract Background In view of the close relationship of Portugal with African countries, particularly former Portuguese colonies, the diagnosis of malaria is not a rare thing. When a traveller returns ill from endemic areas, malaria should be the number one suspect. World Health Organization treatment guidelines recommend that adults with severe malaria should be admitted to an intensive care unit (ICU. Methods Severe cases of malaria in patients admitted to an ICU were reviewed retrospectively (1990-2011 and identification of variables associated with in-ICU mortality performed. Malaria prediction score (MPS, malaria score for adults (MSA, simplified acute physiology score (SAPSII and a score based on WHO's malaria severe criteria were applied. Statistical analysis was performed using StataV12. Results Fifty nine patients were included in the study, all but three were adults; 47 (79,6% were male; parasitaemia on admission, quantified in 48/59 (81.3% patients, was equal or greater than 2% in 47 of them (97.9%; the most common complications were thrombocytopaenia in 54 (91.5% patients, associated with disseminated intravascular coagulation (DIC in seven (11.8%, renal failure in 31 (52.5% patients, 18 of which (30.5% oliguric, shock in 29 (49.1% patients, liver dysfunction in 27 (45.7% patients, acidaemia in 23 (38.9% patients, cerebral dysfunction in 22 (37.2% patients, 11 of whom with unrousable coma, pulmonary oedema/ARDS in 22 (37.2% patients, hypoglycaemia in 18 (30.5% patients; 29 (49.1% patients presented five or more dysfunctions. The case fatality rate was 15.2%. Comparing the four scores, the SAPS II and the WHO score were the most sensitive to death prediction. In the univariate analysis, death was associated with the SAPS II score, cerebral malaria, acute renal and respiratory failure, DIC, spontaneous bleeding, acidosis and hypoglycaemia. Age, partial immunity to malaria, delay in malaria diagnosis and the level of parasitaemia were

  12. Causality in demand

    DEFF Research Database (Denmark)

    Nielsen, Max; Jensen, Frank; Setälä, Jari;

    2011-01-01

    This article focuses on causality in demand. A methodology where causality is imposed and tested within an empirical co-integrated demand model, not prespecified, is suggested. The methodology allows different causality of different products within the same demand system. The methodology is applied...... to fish demand. On the German market for farmed trout and substitutes, it is found that supply sources, i.e. aquaculture and fishery, are not the only determinant of causality. Storing, tightness of management and aggregation level of integrated markets might also be important. The methodological...... implication is that more explicit focus on causality in demand analyses provides improved information. The results suggest that frozen trout forms part of a large European whitefish market, where prices of fresh trout are formed on a relatively separate market. Redfish is a substitute on both markets...

  13. Intensive medical student involvement in short-term surgical trips provides safe and effective patient care: a case review

    Directory of Open Access Journals (Sweden)

    Macleod Jana B

    2011-09-01

    Full Text Available Abstract Background The hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. We report on a student-faculty collaboration that has successfully operated an annual, short-term surgical intervention in Haiti for the last three years. Medical students were responsible for logistics and were overseen by faculty members for patient care. Substantial planning with local partners ensured that trip activities supplemented existing surgical services. A case review was performed hypothesizing that such trips could provide effective surgical care while also providing a suitable educational experience. Findings Over three week-long trips, 64 cases were performed without any reported complications, and no immediate perioperative morbidity or mortality. A plurality of cases were complex urological procedures that required surgical skills that were locally unavailable (43%. Surgical productivity was twice that of comparable peer institutions in the region. Student roles in patient care were greatly expanded in comparison to those at U.S. academic medical centers and appropriate supervision was maintained. Discussion This demonstration project suggests that a properly designed surgical trip model can effectively balance the surgical needs of the community with an opportunity to expose young trainees to a clinical and cross-cultural experience rarely provided at this early stage of medical education. Few formalized programs currently exist although the experience above suggests the rewarding potential for broad-based adoption.

  14. "Because somebody cared about me. That's how it changed things": homeless, chronically ill patients' perspectives on case management.

    Directory of Open Access Journals (Sweden)

    Elizabeth Davis

    Full Text Available BACKGROUND: Case management programs for chronically ill, homeless people improve health and resource utilization by linking patients with case managers focused on improving management of medical and psychosocial problems. Little is known about participants' perspectives on case management interventions. METHODS: This qualitative study used in-depth, one-on-one interviews to understand the impact of a case management program from the perspective of participants. A standardized interview guide with open-ended questions explored experiences with the case management program and feelings about readiness to leave the program. RESULTS: FOUR RECURRENT THEMES EMERGED: (1 Participants described profound social isolation prior to case management program enrollment; (2 Participants perceived that caring personal relationships with case managers were key to the program; (3 Participants valued assistance with navigating medical and social systems; and (4 Participants perceived that their health improved through both the interpersonal and the practical aspects of case management. CONCLUSIONS: Chronically ill, homeless people enrolled in a case management program perceived that social support from case managers resulted in improved health. Programs for this population should consider explicitly including comprehensive social support interventions. Further research on case management should explore the impact of different types of social support on outcomes for homeless chronically ill patients.

  15. Currency substitution, portfolio diversification, and money demand

    OpenAIRE

    Freitas, Miguel Lebre de; Veiga, Francisco José

    2006-01-01

    We extend the Thomas (1985) dynamic optimising model of money demand and currency substitution to the case in which the individual has restricted or no access to foreign currency denominated bonds. In this case Currency Substitution decisions and Asset Substitution decisions are not separable. The results obtained suggest that the significance of an expected exchange rate depreciation term in the demand for domestic money provides a valid test for the presence of currency subst...

  16. Creative solutions for severe dementia with BPSD: a case of art therapy used in an inpatient and residential care setting.

    Science.gov (United States)

    Peisah, C; Lawrence, G; Reutens, S

    2011-08-01

    Behavioral and psychological symptoms of dementia (BPSD) are common, distressing and compromise care. Their diverse etiology necessitates targeted, individualized treatment. We present a case of an 82-year-old with severe dementia and BPSD, and with limited response to a range of pharmacological and non-pharmacological treatments. Individualized art therapy was developed in an inpatient setting using felt material cut into shapes and coloring with stencils and pre-drawn line drawings utilizing preserved skills of coloring, while supporting frontal-executive and language deficits. The activity was replicable and carried over to the residential care setting and supported by family and professional carers.

  17. Developing Occupational Health Care Services For Better Customer Satisfaction : a case-study- Lohja Occupational Health

    OpenAIRE

    Pulliainen, Petra

    2015-01-01

    The renewal of Good Occupational Health Practice in Finland brings new challenges and triggers self-examination among occupational health care providers. Successful renewal of occupational health care practices emphasizes activity, commitment and trustworthiness from occupational health care providers but also from the customer companies. For this co-operation to work effectively, communication in a common language increases its’ importance furthermore. Since purchasing occupational health ca...

  18. The Nordic maintenance care program – case management of chiropractic patients with low back pain: A survey of Swedish chiropractors

    Directory of Open Access Journals (Sweden)

    Jørgensen Kristian

    2008-06-01

    Full Text Available Abstract Background Chiropractic treatment for low back pain (LBP can often be divided into two phases: Initial treatment of the problem to attempt to remove pain and bring it back into its pre-clinical or maximum improvement status, and "maintenance care", during which it is attempted to maintain this status. Although the use of chiropractic maintenance care has been described and discussed in the literature, there is no information as to its precise indications. The objective of this study is to investigate if there is agreement among Swedish chiropractors on the overall patient management for various types of LBP-scenarios, with a special emphasis on maintenance care. Method The design was a mailed questionnaire survey. Members of the Swedish Chiropractors' Association, who were participants in previous practice-based research, were sent a closed-end questionnaire consisting of nine case scenarios and six clinical management alternatives and the possibility to create one's own alternative, resulting in a "nine-by-seven" table. The research team defined its own pre hoc choice of "clinically logical" answers based on the team's clinical experience. The frequency of findings was compared to the suggestions of the research team. Results Replies were received from 59 (60% of the 99 persons who were invited to take part in the study. A pattern of self-reported clinical management strategies emerged, largely corresponding to the "clinically logical" answers suggested by the research team. In general, patients of concern would be referred out for a second opinion, cases with early recovery and without a history of previous low back pain would be quickly closed, and cases with quick recovery and a history of recurring events would be considered for maintenance care. However, also other management patterns were noted, in particular in the direction of maintenance care. Conclusion To a reasonable extent, Swedish chiropractors participating in this

  19. THE DEMAND DISRUPTION MANAGEMENT PROBLEM FOR A SUPPLY CHAIN SYSTEM WITH NONLINEAR DEMAND FUNCTIONS

    Institute of Scientific and Technical Information of China (English)

    Minghui XU; Xiangtong QI; Gang YU; Hanqin ZHANG; Chengxiu GAO

    2003-01-01

    This paper addresses the problem of handling the uncertainty of demand in aone-supplier-one-retailer supply chain system. Demand variation often makes the real productiondifferent from what is originally planned, causing a deviation cost from the production plan. Assumethe market demand is sensitive to the retail price in a nonlinear form, we show how to effectivelyhandle the demand uncertainty in a supply chain, both for the case of centralized-decision-makingsystem and the case of decentralized-decision-making system with perfect coordination.

  20. Diabetes Case Management in Primary Care: The New Brunswick Experience and Expanding the Practice of the Certified Diabetes Educator Nurse into Primary Care.

    Science.gov (United States)

    Jones, Shelley L

    2015-08-01

    The role of the outreach diabetes case manager in New Brunswick, Canada, was first developed in the Moncton Area of Horizon Health Network in response to a physician-identified gap between patients' diagnoses of diabetes and their attendance at the local diabetes education centre. This model of collaborative interprofessional practice increases support for primary care providers and people living with diabetes in that they are being provided the services of certified diabetes educators who can address knowledge gaps with respect to evidence-based guidelines and best practice, promote advancement of diabetes and chronic-disease management therapies and support adherence to treatment plans and self-management practices. This report chronicles a review of the implementation, expansion and evaluation of the outreach diabetes case manager model in the province of New Brunswick, Canada, along with the rationale for development of the role for registered nurses in other jurisdictions.

  1. A GIS-based methodology for highlighting fuelwood supply/demand imbalances at the local level: A case study for Central Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Ghilardi, Adrian; Guerrero, Gabriela; Masera, Omar [CIECO, Center for Ecosystems Research, Universidad Nacional Autonoma de Mexico, Antigua carretera a Patzcuaro 8701, 58 190 Morelia (Mexico)

    2009-06-15

    When fuelwood is harvested at a rate exceeding natural growth and inefficient conversion technologies are used, negative environmental and socio-economic impacts, such as fuelwood shortages, natural forests degradation and net GHG emissions arise. In this study, we argue that analyzing fuelwood supply/demand spatial patterns require multi-scale approaches to effectively bridge the gap between national results with local situations. The proposed methodology is expected to help 1) focusing resources and actions on local critical situations, starting from national wide analyses and 2) estimating, within statistically robust confidence bounds, the proportion of non-renewable harvested fuelwood. Starting from a previous work, we selected a county-based fuelwood hot spot in the Central Highlands of Mexico, identified from a national wide assessment, and developed a grid-based model in order to identify single localities that face concomitant conditions of high fuelwood consumption and insufficient fuelwood resources. By means of a multi-criteria analysis (MCA), twenty localities, out of a total of 90, were identified as critical in terms of six indicators related to fuelwood use and availability of fuelwood resources. Fuelwood supply/demand balances varied among localities from -16.2 {+-} 2.5 Gg y{sup -1} to 4.4 {+-} 2.6 Gg y{sup -1}, while fractions of non-renewable fuelwood varied from 0 to 96%. These results support the idea that balances and non-renewable fuelwood fractions (mandatory inputs for Clean Development Mechanism (CDM) cookstoves projects) must be calculated on a locality by locality basis if gross under or over-estimations want to be avoided in the final carbon accounting. (author)

  2. Movement Demands and Running Intensities of Semi-Professional Rugby League Players during A 9’s Tournament: A Case Study

    Directory of Open Access Journals (Sweden)

    Paul Inglis, Stephen P. Bird

    2017-03-01

    Full Text Available The objective of the study was to describe the movement demands and running intensities of semi-professional rugby league players during a rugby league 9’s (RL9’s tournament. Six semi-professional rugby league players competed in a RL9’s tournament over a two-day period comprising of six games. Movement demands and running intensities were recorded using Global Positioning System (GPS devices providing data on distance and speeds. Data is presented as mean (95% Confidence Intervals with changes (≥ 75% likely to exceed the smallest worthwhile change (0.2 considered practically important. Outside backs performed significantly (p 2.0 decreases in performance variables were observed over the two days. The biggest magnitude of change over the two days was seen with very large decreases in relative HSR (- 2.10 and sprint (- 2.14 distance. Between playing groups, the outside backs had the biggest decrease in running intensity with a very large (- 2.32 significant (p < 0.05 decrease in VHSR on day 2 (3.3 m·min-1 [2.5 – 4.1] compared to day 1 (4.9 m·min-1 [4.4 – 5.4]. Running intensities are decreased during an intensified RL9’s tournament in semi-professional rugby league players. The observed decreases in running performances between playing groups are in agreement with previous research and may support the use of individualized player monitoring and recovery management during a RL9’s tournament-style competition.

  3. Integration of health and social care: a case of learning and knowledge management.

    Science.gov (United States)

    Williams, Paul M

    2012-09-01

    This paper considers integration of health and social care as an exercise in learning and knowledge management (KM). Integration assembles diverse actors and organisations in a collective effort to design and deliver new service models underpinned by multidisciplinary working and generic practice. Learning and KM are integral to this process. A critical review of the literature is undertaken to identify theoretical insights and models in this field, albeit grounded mainly in a private sector context. The findings from a research study involving two integrated services are then used to explore the role of, and approach to, learning and KM. This case study research was qualitative in nature and involved an interrogation of relevant documentary material, together with 25 in-depth interviews with a cross-section of strategic managers and professionals undertaken between March and May 2011. The evidence emerging indicated no planned strategies for learning and KM, but rather, interventions and mechanisms at different levels to support integration processes. These included formal activities, particularly around training and appraisal, but also informal ones within communities of practice and networking. Although structural enablers such as a co-location of facilities and joint appointments were important, the value of trust and inter-personal relationships was highlighted especially for tacit knowledge exchange. The infrastructure for learning and KM was constructed around a collaborative culture characterised by a coherent strategic framework; clarity of purpose based on new models of service; a collaborative leadership approach that was facilitative and distributed; and, a focus on team working to exploit the potential of multidisciplinary practice, generic working and integrated management. The discussion and conclusion use Nonaka's knowledge conversation model to reflect on the research findings, to comment on the absence of an explicit approach to learning and KM

  4. The Distribution of Health Services in Iran Health Care System: A Case Study at East Azerbaijan

    Directory of Open Access Journals (Sweden)

    Hassan Almaspoor-khangah

    2016-10-01

    Full Text Available Background: It is necessary that various aspects of health information and statistics are identified and measured since health problems are getting more complex day by day. Objective: This study is aimed to investigate the distribution of health services in the health care system in Iran and the case of study is East Azerbaijan province. Methods: This research was a retrospective, descriptive, cross-sectional study. The statistical population included all health service providers in East Azerbaijan Province in the public, private, charity, military, social security, and NGO sectors. In this study, the data from all functional health sectors, including hospitals, health centers, and clinical, rehabilitation centers and all clinics and private offices were studied during 2014. The data relevant to performance were collected according to a pre-determined format (researcher- built checklist which was approved by five professionals and experts Health Services Management (content validity. Results: The study findings showed that the public sector by 45.28% accounted for the highest share of provided services and the private sector, social security, military institutions, charities and NGOs institutions by 25.47%, 18.92%, 4.37%, 3.3%, and 2.66% next rank in providing health services in East Azerbaijan province have been allocated. Conclusion: The results show that most of the health services in East Azerbaijan Province belongs to the public sector and the private sector has managed to develop its services in some parts surpassed the public sector. According to the study findings, Policies should be aimed to create balance and harmony in the provision of services among all service providers.

  5. Quality of Care in Creches for Disadvantaged Children: A Brazilian Case Study.

    Science.gov (United States)

    Ferreira, M. C. Rossetti; And Others

    A study was conducted to critically assess the developmental conditions of 187 children (ages 1 month to 6 years) in eight creches (day nurseries) located in and around Ribeirao Preto, Brazil. Data were collected through informal interviews of day care staff and from 20 hours of direct observations of day care units. Findings indicated inadequate…

  6. Towards healthcare business intelligence in long-term care: an explorative case study in the Netherlands.

    NARCIS (Netherlands)

    Spruit, M.; Vroon, R.; Batenburg, R.

    2014-01-01

    This research contributes to the domain of long-term care by exploring knowledge discovery techniques based on a large dataset and guided by representative information needs to better manage both quality of care and financial spendings, as a next step towards more mature healthcare business intellig

  7. Towards healthcare business intelligence in long-term care: an explorative case study in the Netherlands

    NARCIS (Netherlands)

    Spruit, M.R.; Vroon, R.; Batenburg, R.S.

    2014-01-01

    This research contributes to the domain of long-term care by exploring knowledge discovery techniques based on a large dataset and guided by representative information needs to better manage both quality of care and financial spendings, as a next step towards more mature healthcare business intellig

  8. Health Care Utilization among Migrant Latino Farmworkers: The Case of Skin Disease

    Science.gov (United States)

    Feldman, Steven R.; Vallejos, Quirina M.; Quandt, Sara A.; Fleischer, Alan B., Jr.; Schulz, Mark R.; Verma, Amit; Arcury, Thomas A.

    2009-01-01

    Context: Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources. Purpose: Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers. Methods: Three hundred and four migrant…

  9. What Works In Chronic Care Management : The Case Of Heart Failure

    NARCIS (Netherlands)

    Sochalski, Julie; Jaarsma, Tiny; Krumholz, Harlan M.; Laramee, Ann; McMurray, John J. V.; Naylor, Mary D.; Rich, Michael W.; Riegel, Barbara; Stewart, Simon

    2009-01-01

    The evidence base of what works in chronic care management programs is underdeveloped. To fill the gap, we pooled and reanalyzed data from ten randomized clinical trials of heart failure care management programs to discern how program delivery methods contribute to patient outcomes. We found that pa

  10. The Where is Norovirus Control Lost (WINCL) Study: an enhanced surveillance project to identify norovirus index cases in care settings in the UK and Ireland

    Science.gov (United States)

    Wilson, Jennie; Haig, Caroline E; McCowan, Colin; Leanord, Alistair; Loveday, Heather

    2015-01-01

    Background: Norovirus outbreaks have a significant impact on all care settings; little is known about the index cases from whom these outbreaks initiate. Aim: To identify and categorise norovirus outbreak index cases in care settings. Methods: A mixed-methods, multi-centre, prospective, enhanced surveillance study identified and categorised index cases in acute and non-acute care settings. Results: From 54 participating centres, 537 outbreaks were reported (November 2013 to April 2014): 383 (71.3%) in acute care facilities (ACF); 115 (21.4%) in residential or care homes (RCH) and 39 (7.3%) in other care settings (OCS). Index cases were identified in 424 (79%) outbreaks. Of the 245 index cases who were asymptomatic on admission and not transferred within/into the care setting, 123 (50%) had been an inpatient/resident for 4 days. Four themes emerged: missing the diagnosis, care service under pressure, delay in outbreak control measures and patient/resident location and proximity. Conclusion: The true index case is commonly not identified as the cause of a norovirus outbreak with at least 50% of index cases being misclassified. Unrecognised norovirus cross-transmission occurs frequently suggesting that either Standard Infection Control Precautions (SICPs) are being insufficiently well applied, and or SICPs are themselves are insufficient to prevent outbreaks.

  11. Palliative care in the home: a case study of secondary histiocytic sarcoma in a 3-year-old child

    Directory of Open Access Journals (Sweden)

    Zuzana Karabová

    2013-12-01

    Full Text Available This article describes the medical, psychological, and social challenges encountered during home-based, family-centred palliative care of a 3-year-old female with secondary histiocytic sarcoma diagnosed during treatment for T-cell acute lymphoblastic leukaemia. Histiocytic sarcoma is an exceedingly rare cancer in adults, but even less frequent and highly aggressive when presenting as a secondary cancer in children. Comprehensive, multidisciplinary paediatric hospice care services are not widely available across Slovakia,thus limiting the number of patients and families offered such highly specialized end-of-life care. This case study illustrates the primary benefits for the child and family of such a program as well as the impact on the medical and nursing professionals working in the fi eld of paediatric haematology-oncology.

  12. Reducing Disparities through Culturally Competent Health Care: An Analysis of the Business Case

    Science.gov (United States)

    Brach, Cindy; Fraser, Irene

    2016-01-01

    Finding ways to deliver high-quality health care to an increasingly diverse population is a major challenge for the American health care system. The persistence of racial and ethnic disparities in health care access, quality, and outcomes has prompted considerable interest in increasing the cultural competence of health care, both as an end in its own right and as a potential means to reduce disparities. This article reviews the potential role of cultural competence in reducing racial and ethnic health disparities, the strength of health care organizations’ current incentives to adopt cultural competence techniques, and the limitations inherent in these incentives that will need to be overcome if cultural competence techniques are to become widely adopted. PMID:12938253

  13. Household fuel demand analysis

    Energy Technology Data Exchange (ETDEWEB)

    Cohn, S.; Hirst, E.; Jackson, J.

    1976-01-01

    This study develops econometric models of residential demands for electricity, natural gas, and petroleum products. Fuel demands per household are estimated as functions of fuel prices, per capita income, heating degree days, and mean July temperature. Cross-sectional models are developed using a large data base containing observations for each state and year from 1951 through 1974. Long-run own-price elasticities for all three fuels are greater than unity with natural gas showing the greatest sensitivity to own-price changes. Cross-price elasticities are all less than unity except for the elasticity of demand for oil with respect to the price of gas (which is even larger than the own-price elasticity of demand for oil). The models show considerable stabiity with respect to own-price elasticities but much instability with respect to the cross-price and income elasticities.

  14. Intelligent energy demand forecasting

    CERN Document Server

    Hong, Wei-Chiang

    2013-01-01

    This book offers approaches and methods to calculate optimal electric energy allocation, using evolutionary algorithms and intelligent analytical tools to improve the accuracy of demand forecasting. Focuses on improving the drawbacks of existing algorithms.

  15. Domestic Demand Will Work

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    China can invigorate its economy by expanding domestic demand and boosting consumption chinese bankers are preparing to set up finance companies that provide consumer loans in major cities like Beijing and Shanghai.

  16. Impact of Energy Demands

    Science.gov (United States)

    Cambel, Ali B.

    1970-01-01

    The types of pollutants associated with the process of power production are identified. A nine-point proposal is presented on the ways the increase in power demands might be achieved with the minimum threat to the environment. (PR)

  17. Maternal care in rural China: a case study from Anhui province

    Directory of Open Access Journals (Sweden)

    Li Xiaohong

    2008-03-01

    Full Text Available Abstract Background Studies on prenatal care in China have focused on the timing and frequency of prenatal care and relatively little information can be found on how maternal care has been organized and funded or on the actual content of the visits, especially in the less developed rural areas. This study explored maternal care in a rural county from Anhui province in terms of care organization, provision and utilization. Methods A total of 699 mothers of infants under one year of age were interviewed with structured questionnaires; the county health bureau officials and managers of township hospitals (n = 10 and county level hospitals (n = 2 were interviewed; the process of the maternal care services was observed by the researchers. In addition, statistics from the local government were used. Results The county level hospitals were well staffed and equipped and served as a referral centre for women with a high-risk pregnancy. Township hospitals had, on average, 1.7 midwives serving an average population of 15,000 people. Only 10–20% of the current costs in county level hospitals and township hospitals were funded by the local government, and women paid for delivery care. There was no systematic organized prenatal care and referrals were not mandatory. About half of the women had their first prenatal visit before the 13th gestational week, 36% had fewer than 5 prenatal visits, and about 9% had no prenatal visits. A major reason for not having prenatal care visits was that women considered it unnecessary. Most women (87% gave birth in public health facilities, and the rest in a private clinic or at home. A total of 8% of births were delivered by caesarean section. Very few women had any postnatal visits. About half of the women received the recommended number of prenatal blood pressure and haemoglobin measurements. Conclusion Delivery care was better provided than both prenatal and postnatal care in the study area. Reliance on user fees gave

  18. Movement Demands and Running Intensities of Semi-Professional Rugby League Players during A 9’s Tournament: A Case Study

    Science.gov (United States)

    Inglis, Paul; Bird, Stephen P.

    2017-01-01

    The objective of the study was to describe the movement demands and running intensities of semi-professional rugby league players during a rugby league 9’s (RL9’s) tournament. Six semi-professional rugby league players competed in a RL9’s tournament over a two-day period comprising of six games. Movement demands and running intensities were recorded using Global Positioning System (GPS) devices providing data on distance and speeds. Data is presented as mean (95% Confidence Intervals) with changes (≥ 75%) likely to exceed the smallest worthwhile change (0.2) considered practically important. Outside backs performed significantly (p Outside backs also performed significantly (p 2.0) decreases in performance variables were observed over the two days. The biggest magnitude of change over the two days was seen with very large decreases in relative HSR (- 2.10) and sprint (- 2.14) distance. Between playing groups, the outside backs had the biggest decrease in running intensity with a very large (- 2.32) significant (p < 0.05) decrease in VHSR on day 2 (3.3 m·min-1 [2.5 – 4.1]) compared to day 1 (4.9 m·min-1 [4.4 – 5.4]). Running intensities are decreased during an intensified RL9’s tournament in semi-professional rugby league players. The observed decreases in running performances between playing groups are in agreement with previous research and may support the use of individualized player monitoring and recovery management during a RL9’s tournament-style competition. Key points Running intensities are decreased during an intensified rugby league 9’s tournament in semi-professional rugby league players. Forwards and backs performed significantly less high-intensity sprint efforts on day two than day one of the tournament. Appropriate planning and implementation of recovery strategies between games may reduce the potential effects of residual fatigue. PMID:28344447

  19. Nonmaternal Care's Association With Mother's Parenting Sensitivity: A Case of Self-Selection Bias?

    Science.gov (United States)

    Nomaguchi, Kei M; Demaris, Alfred

    2013-06-01

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

  20. Citizenship and people living with dementia: A case for the ethics of care.

    Science.gov (United States)

    Brannelly, Tula

    2016-05-01

    The ethics of care is an emerging field of interest in many disciplines, including care for people with dementia. The ethics of care as proposed by Joan Tronto is a political argument for care together with a set of principles, the integrity of care, to guide and critique practice. This two-pronged approach enables on one hand, a political, complex and situated examination of inequality, and on the other hand the integrity of care provides a set of principles to guide inclusive citizenship practices. This approach has the significant advantage of recognition of the fight that people with dementia face to achieve rights and citizenship as an issue of social justice. In this paper, three challenges to citizenship are discussed in relation to people with dementia using an ethics of care lens: (a) citizenship as a relationship between the individual and the state; (b) citizenship as a practice and (c) citizenship as identity and belonging. I propose that citizenship can be achieved by promoting inclusion in defining and creating policy, research and practice.

  1. Social support in type II diabetes care: a case of too little, too late

    Directory of Open Access Journals (Sweden)

    Sadasivan S

    2012-11-01

    Full Text Available Amudha Kadirvelu, Sivalal Sadasivan, Shu Hui NgSchool of Medicine and Health Sciences, Monash University Sunway Campus, Selangor, MalaysiaAbstract: Coping with type II diabetic patients is increasingly posing large financial burdens, sorely felt especially by growing economies. Self-management has been found to be an effective approach towards maintaining good control in diabetics. However, although efforts at implementing self-management have had initial success, there has been a lack of sustainability. This review examines the different components impinging on self-care among type II diabetic patients. These include the critical role of social support, the need for support from health care providers, the value of support from family and friends, the influence of sex and cultural factors in self-care behavior, the benefits of peer support, and the role of literacy in diabetes self-care. Despite the mounting evidence for the effectiveness of social support in diabetes care, and the various stakeholders including this in their clinical guidelines, there has only been a lukewarm response from policy-makers towards ensuring its implementation. Hence, more effort is required from health care providers in moving away from just understanding the effects of new drugs and subsequently putting their patients on these drugs, and going back to the basics of communicating with the patients, understanding their woes, and helping to motivate/empower their patients. This paper analyzes the various components of social support, their influence on diabetes self-care, and how health care providers can help in this process.Keywords: type II diabetes mellitus, social support, self-management/self-care

  2. To what extent do primary care practice nurses act as case managers life style counselling regarding weight management?

    OpenAIRE

    Dillen, van, J.; Hiddink, G.J.

    2014-01-01

    Background - In this review study, we are the first to explore whether the practice nurse (PN) can act as case manager lifestyle counselling regarding weight management in primary care. Methods - Multiple electronic databases (MEDLINE, PsycINFO) were searched to identify relevant literature after 1995. Forty-five studies fulfilled the inclusion criteria. In addition, all studies were judged on ten quality criteria by two independent reviewers. Results - Especially in the last three years, man...

  3. Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series

    Directory of Open Access Journals (Sweden)

    Fligou Fotini

    2010-03-01

    Full Text Available Abstract Introduction Tetanus rarely occurs in developed countries, but it can result in fatal complications including respiratory failure due to generalized muscle spasms. Magnesium infusion has been used to treat spasticity in tetanus, and its effectiveness is supported by several case reports and a recent randomized controlled trial. Case presentations Three Caucasian Greek men aged 30, 50 and 77 years old were diagnosed with tetanus and admitted to a general 12-bed intensive care unit in 2006 and 2007 for respiratory failure due to generalized spasticity. Intensive care unit treatment included antibiotics, hydration, enteral nutrition, early tracheostomy and mechanical ventilation. Intravenous magnesium therapy controlled spasticity without the need for additional muscle relaxants. Their medications were continued for up to 26 days, and adjusted as needed to control spasticity. Plasma magnesium levels, which were measured twice a day, remained in the 3 to 4.5 mmol/L range. We did not observe hemodynamic instability, arrhythmias or other complications related to magnesium therapy in these patients. All patients improved, came off mechanical ventilation, and were discharged from the intensive care unit in a stable condition. Conclusion In comparison with previous reports, our case series contributes the following meaningful additional information: intravenous magnesium therapy was used on patients already requiring mechanical ventilation and remained effective for up to 26 days (significantly longer than in previous reports without significant toxicity in two patients. The overall outcome was good in all our patients. However, the optimal dose, optimal duration and maximum safe duration of intravenous magnesium therapy are unknown. Therefore, until more data on the safety and efficacy of magnesium therapy are available, its use should be limited to carefully selected tetanus cases.

  4. Obstetric hemorrhage in a case of hypertrophic obstructive cardiomyopathy with automatic implantable cardioverter defibrillator: Anaesthesia and intensive care management.

    Science.gov (United States)

    Mishra, Sandeep Kumar; Bhat, Ravindra R; Kavitha, Jayaram; Kundra, Pankaj; Parida, Satyen

    2016-01-01

    The physiological changes occurring during pregnancy and labor may reveal or exacerbate the symptoms of hypertrophic obstructive cardiomyopathy (HOCM). The addition of obstetric hemorrhage to this presents a unique challenge to the anesthesiologists and intensivists managing these patients in the operation theatres and the Intensive Care Units. Here we present a case of HOCM with automatic implantable cardioverter defibrillator in situ and postpartum hemorrhagic shock.

  5. The Management of Pemphigus Vulgaris in a Burn Intensive Care Unit: A Case Report and Treatment Review

    Science.gov (United States)

    2014-10-01

    e357 The diagnosis of pemphigus encompasses a group of potentially fatal, autoimmune blistering diseases of the skin and mucous membranes...047X/2014 DOI: 10.1097/BCR.0000000000000049 Pemphigus vulgaris is a rare, potentially fatal, autoimmune blistering disease of the skin and mucous...Drive, Suite 1, Lackland AFB, Texas 78236. The Management of Pemphigus Vulgaris in a Burn Intensive Care Unit: A Case Report and Treatment Review

  6. and lsquo;WhatsApp' as an adjunct to home based pin tract care: a case report

    Directory of Open Access Journals (Sweden)

    Ganesh Singh Dharmshaktu

    2014-08-01

    Full Text Available Mobile based technology can be a cheap and handy adjunct to a home based programme for managing pin tract care in chronic orthopaedic cases. The text message and image based mobile platforms may serve as an evaluation tool relieving patient of agony of long and painful commutes on simple health issues like wound dressings. A case report depicting versatility of the idea with regard to its efficacy in clinical scenario is presented here. [Int J Res Med Sci 2014; 2(4.000: 1746-1747

  7. Case Control Analyses of Acute Endophthalmitis after Cataract Surgery in South India Associated with Technique, Patient Care, and Socioeconomic Status

    Directory of Open Access Journals (Sweden)

    Taraprasad Das

    2012-01-01

    Full Text Available Purpose. We investigated acute endophthalmitis incidence following cataract surgery vis-a-vis the current technological and postoperative care changes in higher and lower socioeconomic categories of patients in South India. Methods. In a retrospective case control study, we analyzed 62 cases of acute endophthalmitis and 5 controls for each endophthalmitis case from 46,095 cataract surgeries done between years 1993 and 1998. The time period covered the transition of surgical technique and after care. In addition, we analyzed systemic diseases, surgeon factor, habitat, and socioeconomic status. Results. Clinical and culture positive endophthalmitis incidence were 0.13% and 0.07%, respectively. Differential incidence of 0.10% and 0.17% for in- and ambulatory care surgeries, respectively, was close to statistical significance (=0.054. Lower economy category ambulatory patients had higher risk of infection. Conclusion. Ambulatory cataract surgery carried additional risk for post-operative infection in lower socioeconomic group. Improved health education could ensure greater safety.

  8. Conservative care of De Quervain’s tenosynovitis/ tendinopathy in a warehouse worker and recreational cyclist: a case report

    Science.gov (United States)

    Howell, Emily R.

    2012-01-01

    Objective This case study was conducted to evaluate the conservative management of a patient presenting with right sided wrist and thumb pain diagnosed as De Quervain’s tenosynovitis/tendinopathy. Clinical features A 49-year-old female warehouse worker and recreational cyclist with right-sided De Quervain’s tenosynovitis/tendinopathy that began after a long-distance cycling trip. Intervention and outcome Treatment included ultrasound, soft tissue and myofascial release therapy, tool assisted fascial stripping or “guasha”, acupuncture, mobilizations and kinesiology taping. Home advice included icing, rest, wrist bracing, elevation and eccentric rehabilitation exercises. The positive outcome was a complete resolution of the patient’s complaint. Summary This case demonstrates how De Quervain’s disease is a challenging condition to treat with conservative methods and can be aggravated with new exacerbating factors as treatment continues. In this case, the addition of the active care (including eccentric exercises and self-care) helped to reinforce the passive care given in the office and accelerate the recovery. PMID:22675225

  9. HIV Stigma as a Barrier to Retention in HIV Care at a General Hospital in Lima, Peru: a Case-Control Study

    OpenAIRE

    Valenzuela, Carla; Ugarte-Gil, Cesar; Paz, Jorge; Echevarria, Juan; Gotuzzo, Eduardo; Vermund, Sten H.; Kipp, Aaron M.

    2015-01-01

    HIV stigma as a barrier to retention in HIV care has not been well-studied outside the United States. We conducted a case-control study in Lima, Peru to examine this issue. Cases were out-of-care for ≥12 months (n=66) and controls were recruited from patients in active care presenting for a clinic visit (n=110). A previously validated HIV stigma scale with four domains was used. Associations between being out-of-care and each stigma domain were assessed using multivariable logistic regression...

  10. Simulation analysis by a model projecting world energy supply and demand over the very long term. A case study on China

    Energy Technology Data Exchange (ETDEWEB)

    Matsui, Ken-ichi [Ryukoku Univ., Kyoto (Japan); Ito, Hiroyoshi; Yamada, Akira

    1995-09-01

    In May 1994, China announced a plan to construct nuclear power plants with total output of 300 to 350 million kW by the year 2050, nine times that of the current nuclear power plants in Japan. In this study, simulations were made to see the effect of nuclear power plants on emission of carbon dioxide gas by using conventionally expected capability of nuclear power generation in China as BAU (Business As Usual) cases, namely 0.5 million kW in 2000, 11 million kW in 2030, 16 million kW in 2050 and 32 million kW in 2100, as well as using expanded cases of nuclear power, namely 160 million kW in 2030, 320 million kW in 2050 and 370 million kW in 2100. The current study estimated that the emission of carbon dioxide gas in China would be reduced by approximately 450 million tons in 2050 and 460 million tons in 2100 in the expanded cases of nuclear power in comparison with the BAU cases. (author)

  11. Percutaneous dilatational tracheostomy without fiber optic bronchoscopy-Evaluation of 80 intensive care units cases

    NARCIS (Netherlands)

    J.A. Calvache (Jose Andrés); R.A. Molina García (Rodrigo); A.L. Trochez (Adolfo); J. Benitez (Javier); L.A. Flga (Lucía Arroyo)

    2013-01-01

    textabstractBackground: The development of percutaneous dilatational tracheostomy techniques (PDT) has facilitated the procedure in Intensive Care Units (ICU). Objective: To describe the early intra and post-operative complications in ICU patients requiring percutaneous dilatational tracheostomy usi

  12. Primary health care and equity: the case of lesbian, gay, bisexual, trans and intersex Australians.

    Science.gov (United States)

    Rosenstreich, Gabi; Comfort, Jude; Martin, Paul

    2011-01-01

    The current period of health reform in Australia offers an opportunity for positive actions to be taken to address the significant challenges that lesbian, gay, bisexual, trans, intersex and other sexuality, sex and gender diverse (LGBTI) people face in the health system. This paper provides analysis of why this group should be considered a priority health group using a social determinants of health framework, which has, to date, largely been ignored within primary health care policy reform in Australia. Several key areas of the primary health care reform package are considered in relation to LGBTI health and well-being. Practical suggestions are provided as to how the primary health care sector could contribute to reducing the health inequities affecting LGBTI people. It is argued that care needs to be taken to ensure the reform process does not further marginalise this group.

  13. Health care institution labor law: case law developments, 1974-78.

    Science.gov (United States)

    Shepard, I M

    1978-01-01

    This Article examines the key National Labor Relations Board and federal court interpretations of the much-heralded 1974 Health Care Institution Amendments to the National Labor Relations Act. It analyzes NLRB decisions that have resulted in a proliferation of separate employee bargaining units at health care facilities, and that have applied the strike notice provisions of the NLRA to labor disputes involving building trade employees engaged in construction at operating health care facilities. In addition, the Article examines the Board's decision to decline jurisdiction over employee unions representing interns and residents, and summarizes both the special NLRB rules designed to apply to union solicitation of employees at health care facilities and the conflicting circuit court decisions that have modified the Board's specialized solicitation rules.

  14. Is multiculturalism bad for health care? The case for re-virgination.

    Science.gov (United States)

    de Lora, Pablo

    2015-04-01

    Hymenoplasty is a surgical procedure requested by women who are expected to remain virgins until marriage. In this article, I assess the ethical and legal challenges raised by this request, both for the individual physician and for the health care system. I argue that performing hymenoplasty is not always an unethical practice and that, under certain conditions, it should be provided by the health care system.

  15. Case Study: Transitional Care For a Patient with Benign Prostatic Hyperplasia and Recurrent Urinary Tract Infections

    OpenAIRE

    Bradway, Christine; Bixby, M. Brian; Hirschman, Karen B.; McCauley, Kathleen; Naylor, Mary D

    2013-01-01

    Chronic urologic conditions, including benign prostatic hyperplasia, recurrent urinary tract infections, and urinary incontinence, are common in older adults. This article highlights the urologic and transitional care needs of an elderly, cognitively impaired male during and after an acute hospitalization. Collaboration between the patient, his family, the advanced practice nurse, primary care providers, and outpatient urology office are described. The importance of mutual goal setting and a ...

  16. Implementing a continuum of care model for older people - results from a Swedish case study

    Directory of Open Access Journals (Sweden)

    Anna Duner

    2011-11-01

    Full Text Available Introduction: There is a need for integrated care and smooth collaboration between care-providing organisations and professions to create a continuum of care for frail older people. However, collaboration between organisations and professions is often problematic. The aim of this study was to examine the process of implementing a new continuum of care model in a complex organisational context, and illuminate some of the challenges involved. The introduced model strived to connect three organisations responsible for delivering health and social care to older people: the regional hospital, primary health care and municipal eldercare.Methods: The actions of the actors involved in the process of implementing the model were understood to be shaped by the actors' understanding, commitment and ability. This article is based on 44 qualitative interviews performed on four occasions with 26 key actors at three organisational levels within these three organisations.Results and conclusions: The results point to the importance of paying regard to the different cultures of the organisations when implementing a new model. The role of upper management emerged as very important. Furthermore, to be accepted, the model has to be experienced as effectively dealing with real problems in the everyday practice of the actors in the organisations, from the bottom to the top.

  17. The politics of presidential medical care. The case of John F. Kennedy.

    Science.gov (United States)

    McDermott, Rose

    2014-01-01

    Political concerns often compromise the delivery of high quality medical care in ways that can be both problematic and dangerous for political leaders. President John F. Kennedy's medical care offers a particularly rich exposition of the many ways in which these dynamics can play out and how additional factors can complicate matters, such as when the patient is himself duplicitous, when family members try to intervene in care, and when public exposure risks political future. This article examines the politics and management of Kennedy's medical conditions by the various physicians involved in his care and explores how these considerations may have compromised not only the quality of his care but, in turn, exerted an influence on his behavior. This happened not only through the downstream effect of his treatment on his thoughts and behavior but also through the tremendous allocation of time and attention that his care required--attention a healthier man would have been able to direct toward problems of greater national concern.

  18. 基于患者需求的院内慢性肾脏病一体化护理转诊模式探讨%Investigation of the integrated care model based on patients′demand in in-charge patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    许莹; 曹立云; 田君叶; 于重燕; 李利平; 管艳萌

    2015-01-01

    目的:根据慢性肾脏病( CKD)患者的特点和需求,探讨建立医院内CKD患者一体化护理模式,给患者提供持续完整的护理服务。方法成立CKD一体化护理小组,对2013年1—5月住院CKD患者的知识来源和疾病管理方式进行问卷调查,建立院内CKD护理转诊流程。结果150例患者对肾脏病护理知识了解情况中按患者得分情况依次为对自身疾病认识程度(4.41±1.11)分,对肾脏病知识了解程度(3.21±0.84)分,对疾病知识关注程度(2.75±1.30)分,疾病自我护理技术的掌握程度(1.39±0.83)分。分别有88.67%和60.00%的患者认为疾病信息来源于医护人员,但仍有大量患者从媒体、亲朋好友等处获得了不同的对疾病的认识。105例(70.00%)的患者希望定期门诊随访和教育得到疾病护理支持,位居第1位。经小组讨论初步建立院内一体化护理转诊模式,即针对目标患者进行转诊前护理和教育,配合转诊交接单一对一交接,转诊后护理和教育的模式。有81名护士参与流程运行并提出了改进建议。结论 CKD患者需要医护人员提供长期、连续、完整及个体化的护理和健康教育。建立院内CKD一体化护理转诊可能是解决这一问题的恰当方式。%Objective To investigate effect of the integrated care model based on patients′demand in in-charge patients with chronic kidney disease ( CKD) .Methods Established CKD integrated care team , and a questionnaire survey about knowledge and disease management was conducted in hospitalized CKD patients from January to May, 2013, and established the CKD care referral model in hospital .Results A total of 150 cases of hospitalized patients with CKD received a questionnaire .The scores of patients′awareness of CKD was (4.41 ± 1.11), and the knowledge about kidney disease was (3.21 ±0.84), and the degree of concern for knowledge of

  19. Griggs percutaneous tracheostomy without bronchoscopic guidance is a safe method: A case series of 300 patients in a tertiary care Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Saroj Kumar Pattnaik

    2014-01-01

    Full Text Available Introduction: Percutaneous tracheostomy (PCT is being increasingly done by intensivists for critical care unit patients requiring either prolonged ventilation and/or for airway protection. [1] Bronchoscopic guidance considered a gold standard, [2],[3] is not always possible due to logistic reasons and ventilation issues. We share our experience of Griggs PCT technique without bronchoscopic guidance with simple modifications to ensure safe execution of the procedure. Objective: The purpose of this study was to evaluate the safety issues and complications of PCT without bronchoscopic guidance in a multi-disciplinary tertiary Intensive Care Unit (ICU. Materials and Methods: A retrospective review of consecutive PCTs performed in our ICU between August 2010 and December 2013 by Griggs guide wire dilating forceps technique without bronchoscopic guidance is being presented. It is done by withdrawing endotracheal tube with inflated cuff while monitoring expired tidal volume on ventilator and ensuring the free mobility of guide wire during each step of the procedure, thereby ensuring a safe placement of the tracheostomy tube (TT in trachea. Results: Analysis of 300 PCTs showed 26 patients (8.6% had complications including 2 (0.6% patients deteriorated neurologically and 2 (0.6% deaths observed within 24 h following procedure. The median operating time was 3.5 min (range, 2.5-8 min. There were no TT placement problems in any case. Conclusion: Percutaneous tracheostomy can be safely performed without bronchoscopic guidance by adhering to simple steps as described.

  20. Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy.

    Directory of Open Access Journals (Sweden)

    Joilda Silva Nery

    2014-11-01

    Full Text Available Social determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP and primary health care (Family Health Program-FHP programs on new case detection rate of leprosy.We conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004-2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI  =0.74-0.83 and significantly increased in municipalities with FHP coverage in the medium (72-95% (Risk Ratio 1.05; 95% CI  =1.02-1.09 and higher coverage tertiles (>95% (Risk Ratio 1.12; 95% CI  =1.08-1.17.At the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.

  1. A retrospective study of paradigm and outcome of acute poisoning cases in a tertiary care teaching hospital in Southern India

    Directory of Open Access Journals (Sweden)

    Arulmurugan C.

    2015-10-01

    Results: Incidence was high among males (60.36% compared to females (39.64%. Most of the cases of acute poisoning were in the age group 10 to 30 years (60.95% followed by 30 to 50 years age group (30.77%. A majority of poisoning cases (27.2% were due to organophosphorus (OPC insecticide. Total mortality was found to be 5.32%. Mortality rate due to Paraquat, Abrus Pretorius seeds was significantly high compared with OPC because there is no specific antidote. Time lapse had a very significant role in the mortality in cases of poisoning. Conclusions: Poisoning is common with young males. The mortality is high, in cases of self-poisoning with parquet and abrus seeds. Despite the highest consumption rate, no mortality was observed with organophosphorus because of early medical intervention and specific antidote. Early medical care in a tertiary care hospital will help to reduce significant mortality in India. [Int J Res Med Sci 2015; 3(10.000: 2654-2657

  2. The elderly and a remote home care: The case of Slovenia

    Directory of Open Access Journals (Sweden)

    Kerbler Boštjan

    2013-01-01

    Full Text Available Due to increasing ageing, western countries are facing an increase in financial needs to provide suitable healthcare, social care and housing for the elderly. One of society’s responses to these issues is the idea of moving elder-care activities to their living environments. This can be achieved with the help of information and communication technologies (ICT by which home care could be provided remotely. However, the findings of various authors suggest that elderly people have mostly negative attitudes towards a remote home care. In order to determine the views of the elderly towards this service in Slovenia, a survey was conducted, the results of which are discussed in this article. Contrary to our assumption, it turned out that elderly people have positive attitudes towards remote home care. This was attributed to effectively informing respondents and increasing their understanding of the operation and usability of the service. Raising the awareness of potential users is therefore crucial for its acceptance in a society.

  3. A case study of employee voice and organizational performance in the context of residential aged care

    Directory of Open Access Journals (Sweden)

    Azam Bazooband

    2016-06-01

    Full Text Available As the population of old people is on the great increase in countries, the necessity of aged-care centers is not deniable. Likewise the other health care services, the quality of services provided by care givers for old people in residential aged care centers is a significant and vital factor. The main objective of this paper is to conduct a descriptive research of correlation type on the impact of employee voice on organizational performance in four non-for-profit aged care centers, in Shiraz, Iran. Sample size was estimated 156 based on Morgan table. Data collection tool was employee voice standard questionnaire with 12 items at three dimensions and organizational performance questionnaire with 22 items at seven dimensions. Collected data was analyzed by SPSS statistical software version 22 and the correlation coefficient test (p = <0.05. The significance level was set at P < 0.05 and P < 0.001. Findings showed that there are positive and significant correlations between self-efficacy, encouragement and safety with organizational performance. Also there are positive and significant correlations between organizational performance dimensions including (reliability, attitude, job quality, innovation, co-operation, job quantity, personal learning and employee voice. Indeed, results showed that, when encouragement taken in to consideration employees may perceive a positive voice climate in an organization, and as a result, the other components of voice climate (safety and self-efficacy would be developed and the organizational performance will be increased.

  4. Education on Demand

    DEFF Research Database (Denmark)

    Boysen, Lis; Hende, Merete

    2015-01-01

    Dette notat beskriver nogle af resultaterne fra programmet "Education on Demand' i projektet Det erhvervsrettede Uddannelseslaboratorium. Programmet har haft fokus på udfordringer og forandringsbehov i uddannelsesinstitutioner og -systemet. Herunder har det beskæftiget sig særligt med de to temat......Dette notat beskriver nogle af resultaterne fra programmet "Education on Demand' i projektet Det erhvervsrettede Uddannelseslaboratorium. Programmet har haft fokus på udfordringer og forandringsbehov i uddannelsesinstitutioner og -systemet. Herunder har det beskæftiget sig særligt med de...

  5. Demand Modelling in Telecommunications

    Directory of Open Access Journals (Sweden)

    M. Chvalina

    2009-01-01

    Full Text Available This article analyses the existing possibilities for using Standard Statistical Methods and Artificial Intelligence Methods for a short-term forecast and simulation of demand in the field of telecommunications. The most widespread methods are based on Time Series Analysis. Nowadays, approaches based on Artificial Intelligence Methods, including Neural Networks, are booming. Separate approaches will be used in the study of Demand Modelling in Telecommunications, and the results of these models will be compared with actual guaranteed values. Then we will examine the quality of Neural Network models. 

  6. Travel Demand Modeling

    Energy Technology Data Exchange (ETDEWEB)

    Southworth, Frank [ORNL; Garrow, Dr. Laurie [Georgia Institute of Technology

    2011-01-01

    This chapter describes the principal types of both passenger and freight demand models in use today, providing a brief history of model development supported by references to a number of popular texts on the subject, and directing the reader to papers covering some of the more recent technical developments in the area. Over the past half century a variety of methods have been used to estimate and forecast travel demands, drawing concepts from economic/utility maximization theory, transportation system optimization and spatial interaction theory, using and often combining solution techniques as varied as Box-Jenkins methods, non-linear multivariate regression, non-linear mathematical programming, and agent-based microsimulation.

  7. Factors influencing decision-making by social care and health sector professionals in cases of elder financial abuse.

    Science.gov (United States)

    Davies, Miranda L; Gilhooly, Mary L M; Gilhooly, Kenneth J; Harries, Priscilla A; Cairns, Deborah

    2013-01-01

    This study aimed to identify the factors that have the greatest influence on UK social care and health sector professionals' certainty that an older person is being financially abused, their likelihood of intervention, and the type of action most likely to be taken. A factorial survey approach, applying a fractional factorial design, was used. Health and social care professionals (n = 152) viewed a single sample of 50 elder financial abuse case vignettes; the vignettes contained seven pieces of information (factors). Following multiple regression analysis, incremental F tests were used to compare the impact of each factor on judgements. Factors that had a significant influence on judgements of certainty that financial abuse was occurring included the older person's mental capacity and the nature of the financial problem suspected. Mental capacity accounted for more than twice the variance in likelihood of action than the type of financial problem. Participants from social care were more likely to act and chose more actions compared to health sector participants. The results are discussed in relation to a bystander intervention model. The impact of the older person's mental capacity on decision-making suggests the need for training to ensure action is also taken in cases where older people have full mental capacity and are being abused. Training also needs to highlight the more subtle types of financial abuse, the types that appear not to lead to certainty or action.

  8. MANAGEMENT AND ASSESSMENT OF PROGNOSIS OF INFRATENTORIAL HAEMORRHAGE CASES OF STROKE IN A TERTIARY CARE HOSPITAL, CHENNAI

    Directory of Open Access Journals (Sweden)

    Venkata Ramanaiah

    2015-05-01

    Full Text Available BACKGROUND : It is estimated that every year , 15 million people suffer from stroke in the world out of which six million die and another five million are permanently disabled. There are limited studies on the infratentorial haemorrhage cases of stroke especially in India. In this context , this present study was conducted to find o ut management and prognosis assessment of infratentorial haemorrhage cases admitted in a tertiary care hospital in Chennai , India. METHODS : This is a prospective observational study conducted on the stroke cases admitted to the neurology department of Sri Ramachandra Medical College Hospital ( SRMC , Chennai during August 2010 to February 2013. The prognosis of the patients was assessed through National Institutions of Health Stroke scale and Modified Rankin Prognostic Score. RESULTS : A total of 1 , 809 cases of stroke were admitted during this period out of which 43 were i nfratentorial haemorrhage cases ( 2.4% . It was found that 88.3% undergone treatment for reduction of cerebral edema , 83.7% for prevention of seizures , 81.4% for reduction of systemic hyperte nsion , 79.0% were given antibiotic therapy while 39.5% required ventilatory support. Majority of the patients were in the first category of Modified Rankin Prognosis score ( 37.2% while as per National Institutions of Health Stroke Scale scoring , it was fo und that a majority of the patents were in moderate category of stroke ( 60.5% . The case fatality rate was found to be 25.6%. The case fatality rate was found to be insignificantly higher in cerebellar haemorrhage cases ( 23.8% compa red to pontine hemorrhage cases ( 19.1% . CONCLUSIONS : The proportion of infratentorial type of haemorrhage is comparatively less common type than supratentorial type and ischaemic type of cerebral stroke. The case fatality rate was found to be 25.6% which was similar to other studies. There is a need for further studies on infratentorial haemorrhage.

  9. The role of the media in agenda setting: the case of long-term care rebalancing.

    Science.gov (United States)

    Miller, Edward Alan; Nadash, Pamela; Goldstein, Rachel

    2015-01-01

    This study investigates the role of print media in state policy agendas in four states-Connecticut, Minnesota, Oregon, and Utah-in rebalancing long-term care away from institutions toward home- and community-based (HCBS) services. Ordinary least squares regression is used to model states' policy agendas, as measured by the proportion of Medicaid long-term care spending on HCBS expenditures and number of rebalancing bills proposed, from 1999 to 2008. Results reveal a relationship between states' rebalancing agendas and the extent of media coverage, and state economic, political, and programmatic characteristics. Findings suggest that media coverage reflects broader shifts in state-level attitudes toward rebalancing.

  10. Assessment of new public management in health care: the French case.

    Science.gov (United States)

    Simonet, Daniel

    2014-10-06

    The French health care system embraced New Public Management (NPM) selectively, and crafted their own version of NPM using Diagnostic-Related-Group accounting to re-centralize the health care system. Other organizational changes include the adoption of quasi-markets, public private partnerships, and pay-for-performance schemes for General Practitioners. There is little evidence that these improved the performance of the system. Misrepresentation has remained high. With the 2009 Hospital, Patients, Health and Territories Act physician participation in hospital governance receded. Decision-making powers and health units were re-concentrated to instill greater national coherence into the health system.

  11. 我国三城市未婚女青年人工流产后服务需求调查%Post- abortion care service demands among unmarried young women in three cities in China: A cross -sectional survey

    Institute of Scientific and Technical Information of China (English)

    任姗姗; 庞成; 何电; 周猷; 吉宁; 程怡民

    2012-01-01

    Objective: To explore unmet demands for post - abortion care (PAC) among unmarried young women with induced abortion. Methods; A total of 27 hospitals in Beijing, Shanghai and Zhengzhou were selected by a random sampling as study sites. A cross - sectional survey was conducted among all women younger than 25 years old and seeking for first - trimester pregnancy termination services. Results: About 39.3% of respondents had their sexual debut younger than 20 years old. A-bout 4.1% of respondents experienced an unwanted sex and 22.0% had sex with more than one male partner. Multiple induced abortions occurred in 31.3% of them. And 65.4% of current unintended pregnancies resulted from no use of contraceptives. Among 785 young women who used condoms, only 9.0% used in each sex intercouse. Emergency contraceptive was u-tilized by only 25.3% of them. The rates of seeking for counseling services and inquiring information about contraception from health professionals initiatively were 54.7% and 19.1% respectively, while only 17.9% and 0.9% acquired medical staffs' responses to contraceptives and free delivery services of contraceptives. Age, early sexual debut, number of sexual partners, premarital cohabitation, and educational background were statistically associated with occurrence of multiple induced abortions. Respondents'age, early sexual debut, educational background, and initiative in counseling about contraception issues were influencing factors of the knowledge score of contraceptives. Conclusion; There are enormous unmet demands for PAC services among unmarried young women in China.%目的:了解未婚青少年人工流产后计划生育服务需求.方法:在北京、上海、郑州3城市共随机选取27家医院,对2005年7~9月在所选医院寻求早孕人工流产服务的全部<25岁未婚女青年进行问卷调查.结果:39.3%的调查对象在20岁前发生首次性行为,4.1%经历过非意愿性行为,31.3%有重复人工流产史,65.4%

  12. 49 CFR 1018.20 - Written demand for payment.

    Science.gov (United States)

    2010-10-01

    ... the circumstances of the particular case, the second and third demands may: (1) Offer or seek to... 49 Transportation 8 2010-10-01 2010-10-01 false Written demand for payment. 1018.20 Section 1018... Collection of Claims § 1018.20 Written demand for payment. (a) The Board shall make appropriate...

  13. Oil supply and demand

    Energy Technology Data Exchange (ETDEWEB)

    Rech, O

    2004-07-01

    World oil demand, driven by economic development in China, posted the highest growth rate in 20 years. In a context of geopolitical uncertainty, prices are soaring, encouraged by low inventory and the low availability of residual production capacity. Will 2004 bring a change in the oil market paradigm? (author)

  14. DEMAND AND PRICES

    Directory of Open Access Journals (Sweden)

    VĂDUVA MARIA

    2014-08-01

    Full Text Available Studying the consumer’s behavior by the ordinal approach of utility with the help of indifference curves allows us to deduce the two “movement laws of demand” in this chapter: the demand for a “normal” good is decreasing function of its price and an increasing function of income. We will use the elasticity concept to measure the intensity of the relation that is established between the demand, on the one hand, and prices or income, on the other hand: elasticity – price, direct and crossed, and elasticity – income. We can classify the goods in many categories, depending on the values that this elasticity takes. The demand elasticity can be determined depending on price and income. It reflects the proportion in which the demand for different products changes with the modification of the consumers’ income, the other factors remaining constant. The elasticity compared to the income is a demonstration of legality from the consumer’s sphere, which determines a certain hierarchy of the needs of each population category in a certain level of income. The movement of prices orients both the options and decisions of producers, namely the most useful productions and the most efficient investments, as well as the consumers’ options and decisions on the most advantageous buying of goods and services that they need. The prices appear as a “signal system” coordinating and making coherence the economic agents’ decisions – producers, consumers and population.

  15. Vehicle Routing Problem with Demand and Travel Time Uncertainty in Case of Emergency%应急情况下需求和旅行时间不确定的车辆路径问题研究

    Institute of Scientific and Technical Information of China (English)

    周桂姣; 卢山; 雷全胜

    2016-01-01

    Considering the emergency cases,we need to meet the demand as much as possible in the shortest time so as to save more lives and property at the price of freight.In this paper,the objective of model is to minimize the delay time and mini-mize unmet demand.First we introduce a deadline for the arriving goods.Then the maximum,average and resource reservation strategy were used to solve the vehicle routing problem with demand and travel time uncertainty.Finally,the model is solved with the help of CPLEX and numerical experiments proved the advantage of robust optimization method under the uncertain environ-ment.%考虑到应急情况下,需要在最短的时间下满足尽可能多需求,从而挽救更多的生命和财产甚至不惜以运费为代价,所以文中的模型以最小化延迟时间和最小化未满足需求为目标研究需求和旅行时间都不确定的车辆路径问题。首先,引入了一个允许最晚到货时间;然后,应用最大化策略、平均策略和资源保留策略三种鲁棒策略;最后,借助CPLEX对模型进行求解,并进行数值实验证明鲁棒优化方法在不确定环境下的优势。

  16. Esophageal perforation caused by fish vertebra ingestion in a seven-month-old infant demanded surgical intervention:A case report

    Institute of Scientific and Technical Information of China (English)

    Ming-Yu Chang; Ming-Ling Chang; Chang-Teng Wu

    2006-01-01

    A seven-month-old infant was admitted to our hospital with a 1-wk history of shortness of breath, dysphagia,and fever. Diagnosis of esophageal perforation following fish vertebra ingestion was made by history review,pneumomediastinum and an irregular hyperdense lesion noted in initial chest radiogram. Neck computed tomography (CT) confirmed that the foreign body located at the cricopharyngeal level and a small esophageal tracheal fistula was shown by esophagogram. The initial response to treatment of fish bone removal guided by panendoscopy and antibiotics administration was poor since pneumothorax plus empyema developed. Fortunately,the patient's condition finally improved after decortication, mediastinotomy and perforated esophagus repair.To our knowledge, this is the first case report of esophageal perforation due to fish bone ingestion in infancy.In addition to particular caution that has to be taken when feeding the innocent, young victim, it may indicate the importance of surgical intervention for complicated esophageal perforation in infancy.

  17. Water and Energy Savings using Demand Hot Water Recirculating Systems in Residential Homes: A Case Study of Five Homes in Palo Alto, California

    Energy Technology Data Exchange (ETDEWEB)

    Ally, M.R.

    2002-11-14

    This report summarizes a preliminary study aimed at estimating the potential of saving potable water, (and the electrical energy used to heat it), that is presently lost directly to the drain while occupants wait for hot water to arrive at the faucet (point of use). Data were collected from five single-family homes in Palo Alto, California. Despite the small sample size in this study, the results make a compelling case for retrofitting homes with hot water recirculation systems to eliminate unnecessary wastage of water at the point of use. Technical as well as behavioral and attitudinal changes towards water conservation are necessary for a fulfilling and successful conservation effort. This report focuses on the technical issues, but behavioral issues are also noted, which may be factored into future studies involving local and state governments and utility companies.

  18. "Finding a way out": Case histories of mental health care-seeking and recovery among long-term internally displaced persons in Georgia.

    Science.gov (United States)

    Singh, Namrita S; Jakhaia, Nino; Amonashvili, Nino; Winch, Peter J

    2016-04-01

    Trajectories of illness and recovery are ongoing and incomplete processes cocreated by individuals, their informal support networks, formal care-givers and treatment contexts, and broader social systems. This analysis presents two case histories of care-seeking for, and recovery from, mental illness and psychosocial problems in the context of protracted internal displacement. These case histories present individuals with experiences of schizophrenia and depression drawn from a sample of adult long-term internally displaced persons (IDPs) in Georgia, a country in the South Caucasus. Dimensions of care-seeking were compiled into a matrix for analysis. Interviews were open coded, and codes were linked with matrix dimensions to construct each case history. Findings illustrated that individuals moved cyclically among self-care, household support, lay care, and formal services domains to understand and manage their problems. Living with mental illness and within displacement are experiences that intersect at various points, including in the recognition and perceived causes of illness, stressors such as discrimination and isolation, the affordability and availability of services, and the capacity of social networks to provide informal care. Interventions are needed to support informal care-givers and build lay referral networks, as well as to identify intervention points within care-seeking processes. Interventions that target the mental health needs of displaced persons have the potential to contribute to the development of an innovative community mental health care system in Georgia.

  19. Do Australian Fire Brigades Owe a Common Law Duty of Care? A Review of Three Recent Cases

    Directory of Open Access Journals (Sweden)

    Michael Eburn

    2013-12-01

    Full Text Available The law regarding the fire service’s liability for alleged negligence in the way they plan for or respond to a fire is reasonably untested. This paper reports on three cases that were decided in 2012 by the Supreme Courts of New South Wales, Tasmania and the Australian Capital Territory. It is argued that the weight of authority is that the fire brigades are established to provide fire services for the common good, not for individual benefit, and the financial burden of unfortunate operational decisions should be borne by insurers or by the uninsured. Even so, two Supreme Courts have arrived at different conclusions with respect to the question of whether or not the NSW Rural Fire Service owes a common law duty of care to those at risk from bushfire. It is therefore argued that the issue of duty of care would benefit from a determination by the High Court of Australia.

  20. A Case Study of a Male School Principal's Leadership Practices: An Exploration of Emotion & the Ethic of Care

    Science.gov (United States)

    Myers, Edward L.

    2013-01-01

    This qualitative single-site case study examined the philosophy, decisions, and behaviors of a particular male school principal who subscribed to a form of care-based leadership practice. A Pennsylvania high school principal with a distinct leadership philosophy centered on the ethic of care was chosen to participate in this study. The purpose of…

  1. Integration of footprints information systems in palliative care: the case of Medical Center of Central Georgia.

    Science.gov (United States)

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

    2012-06-01

    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..

  2. Traditional Healing and Western Health Care: A Case Against Formal Integration.

    Science.gov (United States)

    Bates, V. Edward

    Based on selected reading of the literature on medical anthropology and the sociology of modern and traditional system integration in other societies (developing and developed), this paper argues that state heteronomy is patently contraindicated, yet inevitable, should the funding and power structure behind Western health care systems be formally…

  3. Psychosocial care to affected citizens and communities in case of CBRN incidents: a systematic review.

    NARCIS (Netherlands)

    Gouweloos, J.; Dückers, M.; Brake, H. te; Kleber, R.; Dorgendijk, A.

    2014-01-01

    Disasters are associated with a substantial psychosocial burden for affected individuals (including first responders) and communities. Knowledge about how to address these risks and problems is valuable for societies worldwide. Decades of research into post-disaster psychosocial care has resulted in

  4. Psychosocial care to affected citizens and communities in case of CBRN incidents: A systematic review.

    NARCIS (Netherlands)

    Gouweloos, Juul; Dückers, M.; Te Brake, Hans; Kleber, Rolf; Drogendijk, A.N.

    2014-01-01

    Disasters are associated with a substantial psychosocial burden for affected individuals (including first responders) and communities. Knowledge about how to address these risks and problems is valuable for societies worldwide. Decades of research into post-disaster psychosocial care has resulted in

  5. Hippi Care Hospital: Towards Proactive Business Processes in Emergency Room Services. Teaching Case

    Science.gov (United States)

    Tan, Kar Way; Shankararaman, Venky

    2014-01-01

    It was 2:35 am on a Saturday morning. Wiki Lim, process specialist from the Process Innovation Centre (PIC) of Hippi Care Hospital (HCH), desperately doodling on her notepad for ideas to improve service delivery at HCH's Emergency Department (ED). HCH has committed to the public that its ED would meet the service quality criterion of serving 90%…

  6. Gender Policies Meet VET Practices--The Case of Health and Social Care in Norway

    Science.gov (United States)

    Høst, Håkon; Seland, Idunn; Skålholt, Asgeir

    2015-01-01

    Could the labour market gender balance be improved by introducing new types of apprenticeship-trained workers? This article investigates what happened in the wake of the Norwegian VET programme for health and social care, a new approach introduced via the 1994 educational reform. By upgrading this traditionally female-dominated area of education,…

  7. The Effects of Advertising Strategies on Consumer Trust: A Case of Skin Care Products in Taiwan

    Directory of Open Access Journals (Sweden)

    Velly Anatasia

    2016-09-01

    Full Text Available The main aim of this study was to develop advertising strategies in order to increase consumer trust. Four advertising elements, celebrity endorsement, branding, product attribute, and third party certification, were investigated in this study. Data were collected to answer two research questions: (1 To investigate the advertising strategies of skin care products leading to consumer trust, (2 To know the effects of advertising strategies in skin care products on consumer trust. A 5-point Likert scale survey was distributed to the female population in Taipei area. Via online and personal approaches, 266 questionnaires were returned. Targeting on 18-30 years old female skin care product users who stay in Taipei area more than six months, 240 qualified questionnaires were analyzed. The four independent variables are found having a significant relationship with trust in skin care advertising, in which branding has the greatest influence on increasing consumer trust. The control variable which is financial status is not found having statistically significant effect on consumer trust. To conclude, this study is dedicated to the communities in order to optimize their marketing strategies.

  8. Participation in mental health care by ethnic minority users: Case studies from the Netherlands and Brazil

    NARCIS (Netherlands)

    Soares de Freitas, C.S.

    2011-01-01

    This thesis examines participation in mental health care by users from socially disadvantaged ethnic minority groups in the Netherlands and in Brazil. Despite considerable evidence that minority users are under-represented in health participatory spaces in these and other countries around the world,

  9. E-health business model dynamics in long term care: case studies in the Dutch market

    NARCIS (Netherlands)

    Udo, Roderick; Roelfsema, Hein; Kort, Helianthe

    2012-01-01

    Full text via link One of the most important drivers of change in the health care sector is the desire of elderly people to age in place. The growing use of internet applications and communication technology together with innovations in buildings have created new commercial opportunities to cater th

  10. Making health care more sustainable: the case of the English NHS.

    Science.gov (United States)

    Pencheon, David

    2015-10-01

    The NHS is the most revered organisation in Britain: 'the proudest achievement of our modern society'. It is certainly the largest, although since its inception in 1948 it has operated in a government-funded environment of restricted resources. Nevertheless, it has also benefitted from a generally effective model of intervention centred on a hospital care system integrating specialist and emergency care and a primary care system which functions as both a source of treatment and a gatekeeper to specialist care. New circumstances, including environmentally-generated risk and a shifting disease reality, challenges the adequacy of this model. This paper argues that these new circumstances, some of which have seen a legislative response by government, mean that the NHS has to apply sustainable development thinking programmatically throughout its management and operations. It is also argued that the organisation needs to refocus towards prevention particularly in order to stem the rising tide of non-communicable disease. This paper sets out the thinking and actions of the Sustainable Development Unit, which has the task of developing and implanting sustainability concepts in the NHS. It is argued that the cause of sustainable development calls for a mix of cultural and technological shifts, new incentives and a rolling programme of innovative change. Some examples of success are presented.

  11. Training, supervision and quality of care in selected integrated community case management (iCCM programmes: A scoping review of programmatic evidence

    Directory of Open Access Journals (Sweden)

    Xavier Bosch–Capblanch

    2014-11-01

    Full Text Available To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM programmes and to draw lessons learned from existing evaluations of those programmes

  12. Toxicoepidemiology of acute poisoning cases in a secondary care hospital in rural South India: A five-year analysis

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    T H Indu

    2015-01-01

    Full Text Available Objective: To ascertain the trend of poisoning cases admitted to the Government District Headquarters Hospital, a secondary care center in Udhagamandalam, Nilgiris District, Tamil Nadu, India, over a five-year period. Materials and Methods: The number of cases that presented to the hospital annually (incidence, mortality, and case fatality rates, socio-demographic pattern, and the nature of the poison were noted. Results: A total of 1860 poisoning cases (80 deaths were reported during the period from October 2008 to September 2013. The incidence of poisoning was found to increase every year. The average incidence was 1.60 per 1000 population, while the average case fatality rate and mortality rates were 40.51 and 0.07, respectively. A total of 1148 (62% were males. The majority of cases were seen in the 21-30 age group (41.24%. The poisonings were largely deliberate self-harm (n = 1,755; 94.35%, followed by accidental (n = 85; 4.57%. Agrochemicals were the main choice of poisoning agents and among these, organophosphates were the major cause. Conclusion: The data generated can help policy makers take decisions on the sale and availability of pesticides in this region.

  13. Pulmonary interstitial emphysema presenting in a woman on the intensive care unit: case report and review of literature

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    Jovaisa Tomas

    2011-06-01

    Full Text Available Abstract Introduction Pulmonary interstitial emphysema is a life-threatening form of ventilator-induced lung injury. We present one of the few reported adult cases of pulmonary interstitial emphysema in a woman with respiratory failure admitted to our intensive care unit. Case presentation An 87-year-old Caucasian woman with a diagnosis of community-acquired pneumonia was admitted to our intensive care unit requiring invasive ventilation. The combination of a poor oxygenation index and bilateral alveolar/interstitial infiltrates on a chest radiograph fulfilled the criteria for adult respiratory distress syndrome; the cause was thought to be a combination of the direct pneumonic pulmonary injury and extrapulmonary severe sepsis. By day seven, the fraction of inspired oxygen, peak airway and positive end expiratory pressures weaned sufficiently to allow an uncomplicated percutaneous tracheostomy. On day 10, problems with ventilation necessitated recruitment maneuvers with a Mapleson C circuit, after which dramatic surgical emphysema was noted. An upper airway bronchoscopy showed no obvious tracheal wall injury, and computed tomography of her chest showed extensive surgical emphysema, perivascular emphysema and peribronchial emphysema, which were consistent with a diagnosis of pulmonary interstitial emphysema. Over the following days, despite protective ventilatory strategies and intercostal tube thoracostomy, lung compliance along with oxygenation deteriorated and our patient died on day 14. Conclusion The development of pulmonary interstitial emphysema is a rare but real risk when caring for patients with worsening lung compliance on the intensive care unit. Improved awareness of the condition, early protective ventilation strategies and timely treatment of any of the lethal complications will hopefully result in improved survival from the condition in adults.

  14. Strategies for improving patient recruitment to focus groups in primary care: a case study reflective paper using an analytical framework

    Directory of Open Access Journals (Sweden)

    Tilling Michelle

    2009-09-01

    Full Text Available Abstract Background Recruiting to primary care studies is complex. With the current drive to increase numbers of patients involved in primary care studies, we need to know more about successful recruitment approaches. There is limited evidence on recruitment to focus group studies, particularly when no natural grouping exists and where participants do not regularly meet. The aim of this paper is to reflect on recruitment to a focus group study comparing the methods used with existing evidence using a resource for research recruitment, PROSPeR (Planning Recruitment Options: Strategies for Primary Care. Methods The focus group formed part of modelling a complex intervention in primary care in the Resources for Effective Sleep Treatment (REST study. Despite a considered approach at the design stage, there were a number of difficulties with recruitment. The recruitment strategy and subsequent revisions are detailed. Results The researchers' modifications to recruitment, justifications and evidence from the literature in support of them are presented. Contrary evidence is used to analyse why some aspects were unsuccessful and evidence is used to suggest improvements. Recruitment to focus group studies should be considered in two distinct phases; getting potential participants to contact the researcher, and converting those contacts into attendance. The difficulty of recruitment in primary care is underemphasised in the literature especially where people do not regularly come together, typified by this case study of patients with sleep problems. Conclusion We recommend training GPs and nurses to recruit patients during consultations. Multiple recruitment methods should be employed from the outset and the need to build topic related non-financial incentives into the group meeting should be considered. Recruitment should be monitored regularly with barriers addressed iteratively as a study progresses.

  15. Promoting employee acceptance of a consumer bill of rights in a complex medical care organization: a case study.

    Science.gov (United States)

    Mullen, P D; Leifer, B H

    1982-01-01

    To develop strong health education programs, health educators working in complex medical care organizations must often secure professional cooperation across disciplines, coordination of services, and orientation of policies, procedures, and personnel toward patient preferences and needs. Frequently, they undertake these tasks against the tide, within a problematic organizational structure. The present case study illustrates the difficulties posed by introducing change in medical care organizations in the context of an education program to acquaint employees of a large HMO with a consumer bill of rights mandated by the consumer Board of Trustees. The underlying assumption was that in a bureaucratic institution, an employee-centered and modest system reform strategy would be effective in bringing about client-centered outcomes-in this case, increased recognition of client rights. The case analysis and results of a post-intervention, cross-sectional survey suggest that in units where a threshold level of participation was reached, there were improvements in knowledge about the Bill and employee attitudes. The program was less successful with hospital nurses whose feelings about physicians were not taken into account fully, and with physicians whose relative lack of integration into the policy and managerial domains made them harder to reach.

  16. Evidence-based health care policy in reimbursement decisions: lessons from a series of six equivocal case-studies.

    Directory of Open Access Journals (Sweden)

    Pieter Van Herck

    Full Text Available CONTEXT: Health care technological evolution through new drugs, implants and other interventions is a key driver of healthcare spending. Policy makers are currently challenged to strengthen the evidence for and cost-effectiveness of reimbursement decisions, while not reducing the capacity for real innovations. This article examines six cases of reimbursement decision making at the national health insurance authority in Belgium, with outcomes that were contested from an evidence-based perspective in scientific or public media. METHODS: In depth interviews with key stakeholders based on the adapted framework of Davies allowed us to identify the relative impact of clinical and health economic evidence; experience, expertise & judgment; financial impact & resources; values, ideology & political beliefs; habit & tradition; lobbyists & pressure groups; pragmatics & contingencies; media attention; and adoption from other payers & countries. FINDINGS: Evidence was not the sole criterion on which reimbursement decisions were based. Across six equivocal cases numerous other criteria were perceived to influence reimbursement policy. These included other considerations that stakeholders deemed crucial in this area, such as taking into account the cost to the patient, and managing crisis scenarios. However, negative impacts were also reported, in the form of bypassing regular procedures unnecessarily, dominance of an opinion leader, using information selectively, and influential conflicts of interest. CONCLUSIONS: 'Evidence' and 'negotiation' are both essential inputs of reimbursement policy. Yet, purposely selected equivocal cases in Belgium provide a rich source to learn from and to improve the interaction between both. We formulated policy recommendations to reconcile the impact of all factors identified. A more systematic approach to reimburse new care may be one of many instruments to resolve the budgetary crisis in health care in other countries as

  17. Integrating care for older people with complex needs: key insights and lessons from a seven-country cross-case analysis

    Directory of Open Access Journals (Sweden)

    Walter P Wodchis

    2015-09-01

    Full Text Available Background: To address the challenges of caring for a growing number of older people with a mix of both health problems and functional impairment, programmes in different countries have different approaches to integrating health and social service supports. Objective: The goal of this analysis is to identify important lessons for policy makers and service providers to enable better design, implementation and spread of successful integrated care models. Methods: This paper provides a structured cross-case synthesis of seven integrated care programmes in Australia, Canada, the Netherlands, New Zealand, Sweden, the UK and the USA. Key findings: All seven programmes involved bottom-up innovation driven by local needs and included: (1 a single point of entry, (2 holistic care assessments, (3 comprehensive care planning, (4 care co-ordination and (5 a well-connected provider network. The process of achieving successful integration involves collaboration and, although the specific types of collaboration varied considerably across the seven case studies, all involved a care coordinator or case manager. Most programmes were not systematically evaluated but the two with formal external evaluations showed benefit and have been expanded. Conclusions: Case managers or care coordinators who support patient-centred collaborative care are key to successful integration in all our cases as are policies that provide funds and support for local initiatives that allow for bottom-up innovation. However, more robust and systematic evaluation of these initiatives is needed to clarify the ‘business case’ for integrated health and social care and to ensure successful generalization of local successes.

  18. Fidelity and moderating factors in complex interventions: a case study of a continuum of care program for frail elderly people in health and social care

    Directory of Open Access Journals (Sweden)

    Hasson Henna

    2012-03-01

    Full Text Available Abstract Background Prior studies measuring fidelity of complex interventions have mainly evaluated adherence, and not taken factors affecting adherence into consideration. A need for studies that clarify the concept of fidelity and the function of factors moderating fidelity has been emphasized. The aim of the study was to systematically evaluate implementation fidelity and possible factors influencing fidelity of a complex care continuum intervention for frail elderly people. Methods The intervention was a systematization of the collaboration between a nurse with geriatric expertise situated at the emergency department, the hospital ward staff, and a multi-professional team with a case manager in the municipal care services for older people. Implementation was evaluated between September 2008 and May 2010 with observations of work practices, stakeholder interviews, and document analysis according to a modified version of The Conceptual Framework for Implementation Fidelity. Results A total of 16 of the 18 intervention components were to a great extent delivered as planned, while some new components were added to the model. No changes in the frequency or duration of the 18 components were observed, but the dose of the added components varied over time. Changes in fidelity were caused in a complex, interrelated fashion by all the moderating factors in the framework, i.e., context, staff and participant responsiveness, facilitation, recruitment, and complexity. Discussion The Conceptual Framework for Implementation Fidelity was empirically useful and included comprehensive measures of factors affecting fidelity. Future studies should focus on developing the framework with regard to how to investigate relationships between the moderating factors and fidelity over time. Trial registration ClinicalTrials.gov, NCT01260493.

  19. Severe Vertex Epidural Hematoma in a Child: A Case Report of a Management without Expert Neurosurgical Care

    Directory of Open Access Journals (Sweden)

    Christophe Brévart

    2011-01-01

    Full Text Available Vertex epidural hematomas (VEDHs are an uncommon situation and difficulties may be encountered in their diagnosis and management. This is more complicated when the surgical management has to be performed by general surgeons, not specialized in neurosurgery, in a remote location. It was in this context that we were brought to care in charge a 2-year-old boy who required a neurosurgical emergency rescue for a severe VEDH in Djibouti. Through the description of this case, we want to emphasize the value of developing a network of teleconsultation for the benefit of remote and isolated locations and learning basic techniques of emergency neurosurgery.

  20. Evaluation of a policy to strengthen case management and quality of diabetes care in general practice in Denmark

    DEFF Research Database (Denmark)

    Rudkjøbing, Andreas; Vrangbaek, Karsten; Birk, Hans Okkels;

    2015-01-01

    OBJECTIVES: To evaluate the utilization of a policy for strengthening general practitioner's case management and quality of care of diabetes patients in Denmark incentivized by a novel payment mode. We also want to elucidate any geographical variation or variation on the basis of practice features...... of the GP were are able to determine differences in use of the policy in relation to the practice-specific information. RESULTS: At the end of the study period (2007-2012) approximately 30% of practices have enrolled extending services to approximately 10% of the diabetes population. There is regional...

  1. Evaluation of service quality by using fuzzy MCDM: A case study in Iranian health-care centers

    Directory of Open Access Journals (Sweden)

    Leili Afkham

    2012-01-01

    Full Text Available Service quality plays an important role in health care systems since hospitals are responsible for people's lives. This study presents an effective approach for evaluating and comparing service qualities of four hospitals. Service quality consists of different attributes and many of them are intangible and difficult to measure. Therefore, we propose a fuzzy method to resolve the ambiguity of the concepts, which are associated with human judgments. SERVQUAL model is used to evaluate the respondents' judgments of service quality and multi attribute decision making approach is implemented for the comparison among hospitals. The paper use analytical hierarchy process (AHP for obtaining criteria weight and TOPSIS for ranking the cases.

  2. Improving on-time performance in health care organizations: a case study.

    Science.gov (United States)

    Lapierre, S D; Batson, C; McCaskey, S

    1999-01-01

    In this paper, we propose a strategy to build a measurement system that helps improve on-time performance in health care organizations. We analyze the measurement system for monitoring the performance of daily start times of first surgeries in a U.S. hospital. Although surgeons appear to be the main cause of delay, efforts to improve their on-time performance alone are not sufficient to improve on-time performance for first surgeries. Therefore, working on the main source of delay to improve performance, as the Pareto principle suggests, does not always work in the health care context. Rather, we found that ameliorating the hospital's overall on-time performance achieves the desired result of improving surgeons' performance through a snowball effect (a self-reinforcing effect) and, consequently, the on-time performance for first surgeries also improves.

  3. Health care decisions by Sukuma 'peasant intellectuals': a case of radical empiricism?

    Science.gov (United States)

    Stroeken, Koen

    2012-04-01

    Health care decisions in Sukuma-speaking rural communities in Tanzania reproduce a practical epistemology that could be described as radically empiricist, rather than just pluralist; their point of reference is the deeper 'relation' between events, which collective traditions articulate and subjects may experience, but which escapes the atomistic perception privileged by biomedicine. This analysis relies on a diverse portfolio of ethnographic data, including the use and structure of medicinal recipes, the choices of mental health care according to experienced 'effectiveness', and lay discussions on the correct aetiology and treatment of reproductive disorder. Combining two dimensions for a given medical epistemology, the (empirical/ habitual) basis of its transmission and the (open/closed) relation with other epistemologies, four types are proposed: monism, dualism, pluralism, and radical empiricism. The concept of peasant intellectuals, it is argued, needs to be rethought in contexts of medicinal initiation.

  4. Marketing environment dynamics and implications for pricing strategies: the case of home health care.

    Science.gov (United States)

    Ponsford, B J; Barlow, D

    1999-01-01

    This research reviews the factors affecting the pricing or rate schedules of home health care agencies. A large number of factors affect costs and thus rate structures. The major factors include reimbursement structures with accompanying discount structures, administrative burdens, and risks. Channel issues include bargaining power, competition, and size. Staffing issues affect pricing and product through the provider level, productivity, and quality outcomes. Physician and patient issues include quality concerns and choices. These factors are discussed in light of overall marketing strategy and the interaction of pricing with other marketing controllables such as product, place/distribution, and promotion. Economic and accounting principles are also reviewed with consideration to understanding direct and indirect costs in order to enable negotiators to effectively price health care services.

  5. Evaluating Nurses Acceptance of Hospital Information Systems: A Case Study of a Tertiary Care Hospital.

    Science.gov (United States)

    Khalifa, Mohamed

    2016-01-01

    This study aims at evaluating hospital information systems (HIS) acceptance factors among nurses, in order to provide suggestions for successful HIS implementation. The study used mainly quantitative survey methods to collect data directly from nurses through a questionnaire. The availability of computers in the hospital was one of the most influential factors, with a special emphasis on the unavailability of laptop computers and computers on wheels to facilitate immediate data entry and retrieval when nurses are at the point of care. Nurses believed that HIS might frequently slow down the process of care delivery and increase the time spent by patients inside the hospital especially during slow performance and responsiveness phases. Recommendations were classified into three main areas; improving system performance and availability of computers in the hospital, increasing organizational support in the form of providing training and protected time for nurses' to learn and enhancing users' feedback by listening to their complaints and considering their suggestions.

  6. The universe of ANA testing: a case for point-of-care ANA testing.

    Science.gov (United States)

    Konstantinov, Konstantin N; Rubin, Robert L

    2017-12-01

    Testing for total antinuclear antibodies (ANA) is a critical tool for diagnosis and management of autoimmune diseases at both the primary care and subspecialty settings. Repurposing of ANA from a test for lupus to a test for any autoimmune condition has driven the increase in ANA requests. Changes in ANA referral patterns include early or subclinical autoimmune disease detection in patients with low pre-test probability and use of negative ANA results to rule out underlying autoimmune disease. A positive result can lead to further diagnostic considerations. Currently, ANA tests are performed in centralized laboratories; an alternative would be ANA testing at the clinical point-of-care (POC). By virtue of its near real-time data collection capability, low cost, and ease of use, we believe the POC ANA has the potential to enable a new paradigm shift in autoimmune serology testing.

  7. 空巢老人需求缺失的调查分析--以浙江为例%Investigation and Analysis of Demand Shortage of Empty-nest Elderly People:A Case Study of Zhejiang

    Institute of Scientific and Technical Information of China (English)

    吴瑛

    2015-01-01

    The number of empty-nest elderly people is increasing continuously , thus the society gives much attention to them. As a prerequisite to provide effective support , the recognition of empty-nest elderly requirements becomes a key. Taking Zhejiang empty-nest elderly as investigation object with the method of random sampling questionnaire, the conclusion was that their demands focus on children worry, body care, psychological comfort and economic distress, which influence the empty-nest elderly people’s life and become the difficult desire to achieve. Therefore , care and support both from the body and mind are necessary to help them to achieve senses of security , belonging, existence, value and achievement.%空巢老人数量持续增加,社会各界给予极大关注。作为提供有效支持的前提,识别空巢老人需求成为一个关键。文章以浙江空巢老人作为调查对象,通过随机抽样和发放问卷,进行需求分析。调查发现:牵挂子女、身体照料、心理慰藉、经济困扰,从不同程度上影响着空巢老人的生活,成为其渴望的诉求。因此,需要从身心角度给予关心和支持,以助空巢老人实现安全感、归属感、存在感、价值感和成就感。

  8. Demand surge following earthquakes

    Science.gov (United States)

    Olsen, Anna H.

    2012-01-01

    Demand surge is understood to be a socio-economic phenomenon where repair costs for the same damage are higher after large- versus small-scale natural disasters. It has reportedly increased monetary losses by 20 to 50%. In previous work, a model for the increased costs of reconstruction labor and materials was developed for hurricanes in the Southeast United States. The model showed that labor cost increases, rather than the material component, drove the total repair cost increases, and this finding could be extended to earthquakes. A study of past large-scale disasters suggested that there may be additional explanations for demand surge. Two such explanations specific to earthquakes are the exclusion of insurance coverage for earthquake damage and possible concurrent causation of damage from an earthquake followed by fire or tsunami. Additional research into these aspects might provide a better explanation for increased monetary losses after large- vs. small-scale earthquakes.

  9. APACHE II: preliminary report on 100 intensive care unit cases in University Hospital, Kuala Lumpur.

    Science.gov (United States)

    Teoh, G S; Mah, K K; abd Majid, S; Streram; Yee, M K

    1991-03-01

    A good overall assessment of the severity of illnesses of patients admitted to a general intensive care unit (ICU) is not without problems. The APACHE (acute physiology and chronic health evaluation) prognostic scoring system enables us to stratify acutely ill patients and compare efficiency of ICU therapy in different hospitals. This preliminary study carried out on 100 consecutive admissions to the ICU in University Hospital, Kuala Lumpur showed the spectrum of ICU admissions and the direct relationship between APACHE II score and mortality.

  10. Migration and Tourism Demand

    Directory of Open Access Journals (Sweden)

    Nuno Carlos LEITÃO

    2012-02-01

    Full Text Available This study considers the relationship between immigration and Portuguese tourism demand for the period 1995-2008, using a dynamic panel data approach. The findings indicate that Portuguese tourism increased significantly during the period in accordance with the values expected for a developed country. The regression results show that income, shock of immigration, population, and geographical distance between Portugal and countries of origin are the main determinants of Portuguese tourism.

  11. Market Expects Demand Increase

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    In the recent releasing Textile Industry Invigorating Plan,"givingattention to both domestlc and overseas markets"is put into a keyposition.Under a series policies,such as increasing the tax rebaterate for textile and garment exports,and granting loan for SME,thefurther development of this industry is expectative.Otherwise,weshould know that it costs time for demand driving.This need ourpatients.The only questionis how much time we have to wait.

  12. Demand scenarios, worldwide

    Energy Technology Data Exchange (ETDEWEB)

    Schaefer, A. [Massachusetts Inst. of Technology, Center for Technology, Policy and Industrial Development and the MIT Joint Program on the Science and Policy of Global Change, Cambridge, MA (United States)

    1996-11-01

    Existing methods are inadequate for developing aggregate (regional and global) and long-term (several decades) passenger transport demand scenarios, since they are mainly based on simple extensions of current patterns rather than causal relationships that account for the competition among transport modes (aircraft, automobiles, buses and trains) to provide transport services. The demand scenario presented in this paper is based on two empirically proven invariances of human behavior. First, transport accounts for 10 to 15 percent of household total expenditures for those owning an automobile, and around 5 percent for non-motorized households on average (travel money budget). Second, the mean time spent traveling is approximately one hour per capita per day (travel time budget). These two budgets constraints determine the dynamics of the scenario: rising income increases per capita expenditure on travel which, in turn, increase demand for mobility. Limited travel time constraints travelers to shift to faster transport systems. The scenario is initiated with the first integrated historical data set on traffic volume in 11 world regions and the globe from 1960 to 1990 for all major modes of motorized transport. World average per capita traffic volume, which was 1,800 kilometers in 1960 and 4,2090 in 1990, is estimated to rise to 7,900 kilometers in 2020 - given a modest average increase in Gross World Product of 1.9% per year. Higher economic growth rates in Asian regions result in an increase in regional per capita traffic volume up to a factor of 5.3 from 1990 levels. Modal splits continue shifting to more flexible and faster modes of transport. At one point, passenger cars can no longer satisfy the increasing demand for speed (i.e. rising mobility within a fixed time budget). In North America it is estimated that the absolute traffic volume of automobiles will gradually decline starting in the 2010s. (author) 13 figs., 6 tabs., 35 refs.

  13. The ethics of attribution: the case of health care outcome indicators.

    Science.gov (United States)

    Russell, E

    1998-11-01

    The ethical basis of clinical outcomes measurement is a desire to improve care in a way which will increase both clinical effectiveness and value for money-beneficence as well as competence. To date in the U.K., any debate about producing comparative indicators of clinical outcomes has been concerned mainly with the unfairness to individual doctors or clinical teams of judging their performance on this basis. There has been less interest in the prime purpose of such production, which is to increase the accountability and effectiveness of the NHS as a publicly funded service. Rather than working to improve clinical effectiveness and outcomes within clinical services, health authorities which wish to improve outcomes for their populations have been encouraged simply to shift the contract to another provider of care. The key issue on which the ethics of either action rests is the extent to which the attribution of outcome to intervention is valid and reliable and, therefore, that judgements about performance are just and thus ethical. The consequence of unjust judgements may be to increase the inequalities that medical care resource allocation should attempt to reduce.

  14. Are lessons from the education sector applicable to health care reforms? The case of Uganda.

    Science.gov (United States)

    Okuonzi, S A; Birungi, H

    2000-01-01

    The decision by donors to use external aid for poverty alleviation in very low-income countries and the redefinition of development to include human aspects of society have renewed interest in education and health services. The debate about accountability, priorities and value-for-money of social services has intensified. Uganda's universal primary education programme (UPE) has within 2 years of inception achieved 90% enrollment. The programme has been acclaimed as successful. But the health sector that has been implementing primary health care and reforms for two decades is viewed as having failed in its objectives. The paper argues that the education sector has advantages over the health sector in that its programme is simple in concept, and was internally designed involving few actors. The sector received strong political support, already has an extensive infrastructure, receives much more funding and has a straightforward objective. Nevertheless, the health sector has made some achievements in AIDS control, in the prevention and control of epidemics, and in behavioural change. But these achievements will not be noticed if only access and health-status are used to assess the health sector. However, UPE demonstrates that a universal basic health care is possible, given the same level of resources and political commitment. The lesson for the health sector is to implement a priority universal health care programme based on national values and to assess its performance using the objectives of the UPE.

  15. The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study

    Science.gov (United States)

    Fischler, Ilan; Stuckey, Melanie I; Klassen, Philip E; Chen, John

    2017-01-01

    Background Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. Objective The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. Methods The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Results Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. Conclusions EMR implementation

  16. Risk factors of diabetic foot Charcot arthropathy: a case-control study at a Malaysian tertiary care centre

    Science.gov (United States)

    Fauzi, Aishah Ahmad; Chung, Tze Yang; Latif, Lydia Abdul

    2016-01-01

    INTRODUCTION This study aimed to determine the risk factors of diabetic Charcot arthropathy of the foot among diabetic patients with and without foot problems. METHODS This was a case-control study involving diabetic patients attending the Diabetic Foot Care and Wound Management Clinic at University Malaya Medical Centre, Kuala Lumpur, Malaysia, from June 2010 to June 2011. Data on sociodemographic profiles, foot factors and diabetes characteristics was collected and analysed. RESULTS A total of 48 diabetic patients with Charcot arthropathy of the foot were identified. Data from these 48 patients was compared with those of 52 diabetic patients without foot problems. Up to 83.3% of patients with diabetic Charcot arthropathy presented with unilateral Charcot foot, most commonly located at the midfoot (45.8%). Patients with a history of foot problems, including foot ulcer, amputation, surgery or a combination of problems, had the highest (26-time) likelihood of developing Charcot arthropathy (odds ratio 26.4; 95% confidence interval 6.4–109.6). Other significant risk factors included age below 60 years, more than ten years’ duration of diabetes mellitus and the presence of nephropathy. CONCLUSION A history of prior diabetic foot problems is the greatest risk factor for developing diabetic Charcot arthropathy, compared with other risk factors such as diabetes characteristics and sociodemographic profiles. Preventive management of diabetic foot problems in the primary care setting and multidisciplinary care are of paramount importance, especially among chronic diabetic patients. PMID:27075668

  17. Safety cases for medical devices and health information technology: involving health-care organisations in the assurance of safety.

    Science.gov (United States)

    Sujan, Mark A; Koornneef, Floor; Chozos, Nick; Pozzi, Simone; Kelly, Tim

    2013-09-01

    In the United Kingdom, there are more than 9000 reports of adverse events involving medical devices annually. The regulatory processes in Europe and in the United States have been challenged as to their ability to protect patients effectively from unreasonable risk and harm. Two of the major shortcomings of current practice include the lack of transparency in the safety certification process and the lack of involvement of service providers. We reviewed recent international standardisation activities in this area, and we reviewed regulatory practices in other safety-critical industries. The review showed that the use of safety cases is an accepted practice in UK safety-critical industries, but at present, there is little awareness of this concept in health care. Safety cases have the potential to provide greater transparency and confidence in safety certification and to act as a communication tool between manufacturers, service providers, regulators and patients.

  18. Assessing health care needs and clinical outcome with Urological case complexity : A study using INTERMED

    NARCIS (Netherlands)

    Herms, AMRD; Pinggera, GM; De Jonge, P; Strasser, H; Sollner, W

    2003-01-01

    Urinary tract symptoms and, particularly, urinary incontinence are often chronic and complex conditions that cause diagnosis, treatment, and management problems. In many cases, psychosocial factors contribute to the development of a chronic condition. The authors investigated whether INTERMED, an in

  19. Reflections on the care delivered in a suspected case of infanticide.

    Science.gov (United States)

    Scherer, Edson Arthur; Scherer, Zeyne Alves Pires

    2007-01-01

    This study resulted from the experience of supervising a suspected infanticide case hospitalized at a psychiatric ward. We aimed to find support in scientific literature about infanticide, point out an interdisciplinary health team's affliction and uncertainties when faced with this kind of case and suggest strategies for dealing with these feelings and their possible consequences in dealing with this case. Professionals involved in this case observed their discomfort about the situation and difficulties caused by feelings of guilt about the child's death, whether intentional or not. Specialists suggests that the relation between psychiatry and the law should be facilitated by "demedicalizing" the crime, including socioeconomic factors, comorbidities, domestic violence, cultural norms etc. The team must try and learn from these mothers, overcoming their anger or repulsion with compassion and courage to understand infanticide.

  20. Spontaneous diabetic myonecrosis: report of four cases from a tertiary care institute

    OpenAIRE

    Mukherjee, Soham; Aggarwal, Anuradha; Rastogi, Ashu; Bhansali, Anil; Prakash, Mahesh; Vaiphei, Kim; Dutta, Pinaki

    2015-01-01

    Summary Spontaneous diabetic muscle infarction (DMI) is a rare and under diagnosed complication of diabetes mellitus. Clinically it presents with acute to subacute onset swelling, pain and tenderness of muscle(s) without systemic manifestations. MRI is helpful in diagnosis, exclusion of other causes and for localization of affected muscle for biopsy in atypical cases. Muscles of the thighs are commonly affected in diabetic myonecrosis (DMN). Here we present the summary of four cases seen in t...