Vickery, Erin L; Seidler, Elizabeth M; Jones, Todd E; Veledar, Emir; Chen, Suephy C
There is an increasing demand for a limited number of pigmented lesion clinic (PLC) visits at dermatology centers. To determine the proportion of visits to PLCs that are more frequent ("additional screening") than the recommended ("standard") follow-up schedule and to determine if certain patient characteristics correlate with the demand for these visits. A retrospective medical chart review of all PLC visits at an academic dermatology center from October 2010 to January 2012. A total of 609 patients associated with 1756 visits were identified. Of these, 25 patients associated with 26 visits were excluded owing to lack of melanoma diagnosis or risk factors, leaving 584 patients and 1730 visits. Diagnoses of these patients included in situ and invasive melanoma, dysplastic nevi, Spitz nevi, atypical nevus syndrome, family history of melanoma only, and other risk factors. The mean (SD) age was 48 (16) years, and 235 (40.2%) of the patients were male. The proportion of additional screening visits compared with standard visits. Standard visits were defined as occurring at the following frequencies: annually for mildly dysplastic nevi, Spitz nevi, or solely family history of melanoma; biannually for the first year, then annually thereafter for moderately dysplastic nevi or atypical nevus syndrome; biannually for up to 3 years, then annually thereafter for severely dysplastic nevi or melanomas in situ; every 3 months for 2 years, biannually for the following 2 years, then annually thereafter for invasive melanoma. A total of 1400 visits (80.9%) were standard, 257 (14.9%) were for additional screening, and 73 (4.2%) were "problem focused." Thirty percent of patients had at least 1 additional screening visit. The distribution of diagnoses among standard vs additional screening visits differed significantly, with "family history only" and "other risk factors" taking up a larger percentage of standard visits (15.1%) than the percentage of additional screening visits (8
van Bilsen, P.; Hamers, J.; Groot, W.; Spreeuwenberg, C.
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
de Meza, D
With rare exceptions the provision of actuarially fair health insurance tends to substantially increase the demand for medical care by redistributing income from the healthy to the sick. This suggests that previous studies which attribute all the extra demand for medical care to moral hazard effects may overestimate the efficiency costs of health insurance.
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
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 elaborate on how to further
Awoyemi, Bosede O; Novignon, Jacob
While induced abortion is considered to be illegal and socially unacceptable in Nigeria, it is still practiced by many women in the country. Poor family planning and unsafe abortion practices have daunting effects on maternal health. For instance, Nigeria is on the verge of not meeting the Millennium development goals on maternal health due to high maternal mortality ratio, estimated to be about 630 maternal deaths per 100,000 live births. Recent evidences have shown that a major factor in this trend is the high incidence of abortion in the country. The objective of this paper is, therefore, to investigate the factors determining the demand for abortion and post-abortion care in Ibadan city of Nigeria. The study employed data from a hospital-based/exploratory survey carried out between March to September 2010. Closed ended questionnaires were administered to a sample of 384 women of reproductive age from three hospitals within the Ibadan metropolis in South West Nigeria. However, only 308 valid responses were received and analysed. A probit model was fitted to determine the socioeconomic factors that influence demand for abortion and post-abortion care. The results showed that 62% of respondents demanded for abortion while 52.3% of those that demanded for abortion received post-abortion care. The findings again showed that income was a significant determinant of abortion and post-abortion care demand. Women with higher income were more likely to demand abortion and post-abortion care. Married women were found to be less likely to demand for abortion and post-abortion care. Older women were significantly less likely to demand for abortion and post-abortion care. Mothers' education was only statistically significant in determining abortion demand but not post-abortion care demand. The findings suggest that while abortion is illegal in Nigeria, some women in the Ibadan city do abort unwanted pregnancies. The consequence of this in the absence of proper post
Background While induced abortion is considered to be illegal and socially unacceptable in Nigeria, it is still practiced by many women in the country. Poor family planning and unsafe abortion practices have daunting effects on maternal health. For instance, Nigeria is on the verge of not meeting the Millennium development goals on maternal health due to high maternal mortality ratio, estimated to be about 630 maternal deaths per 100,000 live births. Recent evidences have shown that a major factor in this trend is the high incidence of abortion in the country. The objective of this paper is, therefore, to investigate the factors determining the demand for abortion and post-abortion care in Ibadan city of Nigeria. Methods The study employed data from a hospital-based/exploratory survey carried out between March to September 2010. Closed ended questionnaires were administered to a sample of 384 women of reproductive age from three hospitals within the Ibadan metropolis in South West Nigeria. However, only 308 valid responses were received and analysed. A probit model was fitted to determine the socioeconomic factors that influence demand for abortion and post-abortion care. Results The results showed that 62% of respondents demanded for abortion while 52.3% of those that demanded for abortion received post-abortion care. The findings again showed that income was a significant determinant of abortion and post-abortion care demand. Women with higher income were more likely to demand abortion and post-abortion care. Married women were found to be less likely to demand for abortion and post-abortion care. Older women were significantly less likely to demand for abortion and post-abortion care. Mothers’ education was only statistically significant in determining abortion demand but not post-abortion care demand. Conclusion The findings suggest that while abortion is illegal in Nigeria, some women in the Ibadan city do abort unwanted pregnancies. The consequence of this
Montezelli, Juliana Helena; Peres, Aida Maris; Bernardino, Elizabeth
To characterize the registered nurse's management activities in an emergency department. Qualitative research, implemented from February to April 2009 by a semi-structured interview with eight nurses from an emergency department at a university hospital in Curitiba, PR. Brazil. The data was submitted to content analyses. Two categories emerged: Management focused on meeting the institutional demands that emphasizes the Registered Nurses' bureaucratic activities required by the hospital; and Management focused on meeting the nursing care demands that prioritizes the care as the main management activity. The study reached its objective and joined the literature findings that the division between care and management does not match with the registered nurse's performance at an emergency department.
Datta Gupta, Nabanita; Greve, Jane
-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...
Vrhovec, Jure; Tajnikar, Maks
The aim of this paper is to explore the consequences of demographic ageing on healthcare demand in Slovenia for primary care, secondary care, hospital day-care treatments, and hospitalisations. In the paper, we develop a model for making projections of the total number of treatments using the age-group projection method with the scenario approach. The model allows the number of treatments to be observed with respect to medical services, age groups and main disease groups. The results are presented for the cross-section years 2015, 2025 and 2035. The smallest increase in the number of treatments occurs in primary care, a larger one for secondary care, and the largest for hospital day-care services and hospitalisations (up to 29.9%). The structure of demand will also change. Demand for healthcare services for children and infants will decrease while demand for diseases associated with older age groups will increase, particularly for diseases of the circulatory system, eye and adnexa, and diseases of the blood and blood-forming organs. The results presented in this paper can help improve understanding of similar processes in other countries for total healthcare demand and for changes in the structure of demand. The results show that the healthcare system in Slovenia will face a major additional burden in the next 20 years. Copyright Â© 2016 Elsevier Ireland Ltd. All rights reserved.
Grube, Mark E; Kaufman, Kenneth; Clarin, Dan; O'Riordan, Jason
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.
Green, Janette P; McNamee, Jennifer P; Kobel, Conrad; Seraji, Md Habibur R; Lawrence, Suanne J
Objective The aim of the present study was to develop a robust model that uses the concept of 'rehabilitation-sensitive' Diagnosis Related Groups (DRGs) in predicting demand for rehabilitation and geriatric evaluation and management (GEM) care following acute in-patient episodes provided in Australian hospitals. Methods The model was developed using statistical analyses of national datasets, informed by a panel of expert clinicians and jurisdictional advice. Logistic regression analysis was undertaken using acute in-patient data, published national hospital statistics and data from the Australasian Rehabilitation Outcomes Centre. Results The predictive model comprises tables of probabilities that patients will require rehabilitation or GEM care after an acute episode, with columns defined by age group and rows defined by grouped Australian Refined (AR)-DRGs. Conclusions The existing concept of rehabilitation-sensitive DRGs was revised and extended. When applied to national data, the model provided a conservative estimate of 83% of the activity actually provided. An example demonstrates the application of the model for service planning. What is known about the topic? Health service planning is core business for jurisdictions and local areas. With populations ageing and an acknowledgement of the underservicing of subacute care, it is timely to find improved methods of estimating demand for this type of care. Traditionally, age-sex standardised utilisation rates for individual DRGs have been applied to Australian Bureau of Statistics (ABS) population projections to predict the future need for subacute services. Improved predictions became possible when some AR-DRGs were designated 'rehabilitation-sensitive'. This improved methodology has been used in several Australian jurisdictions. What does this paper add? This paper presents a new tool, or model, to predict demand for rehabilitation and GEM services based on in-patient acute activity. In this model, the
Lako, Christiaan J; Rosenau, Pauline
In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the new Dutch health care system, the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by actively employing available quality and outcome information. They were, rather, referred by their general practitioner. Hospital choice is highly related to the importance a patient attaches to his or her physician's opinion about a hospital. Some patients indicated that their hospital choice was affected by the reputation of the hospital, by the distance they lived from the hospital, etc. but physician's advice was, by far, the most important factor. Policy consequences are important; the assumptions underlying the demand-driven model of patient health provider choice are inadequate to explain the pattern of observed responses. An alternative, more adequate model is required, one that takes into account the patient's confidence in physician referral and advice.
Ellis, Randall P; Martins, Bruno; Zhu, Wenjia
We estimate within-year price elasticities of demand for detailed health care services using an instrumental variable strategy, in which individual monthly cost shares are instrumented by employer-year-plan-month average cost shares. A specification using backward myopic prices gives more plausible and stable results than using forward myopic prices. Using 171 million person-months spanning 73 employers from 2008 to 2014, we estimate that the overall demand elasticity by backward myopic consumers is -0.44, with higher elasticities of demand for pharmaceuticals (-0.44), specialists visits (-0.32), MRIs (-0.29) and mental health/substance abuse (-0.26), and lower elasticities for prevention visits (-0.02) and emergency rooms (-0.04). Demand response is lower for children, in larger firms, among hourly waged employees, and for sicker people. Overall the method appears promising for estimating elasticities for highly disaggregated services although the approach does not work well on services that are very expensive or persistent. Copyright © 2017 Elsevier B.V. All rights reserved.
Domenighetti, G; Casabianca, A
The health care market is a very particular one that is mainly characterized by the absence of information and transparency at every level, particularly between the physician-supplier and the patient-consumer. On this market it is up to the physician to evaluate and define the patient's needs and to decide which are the most effective goods for the patient. The determinants of medical prescription are not only related to the health status of the patient, but also to the payment system (fee for services, salary), to physician density, professional uncertainty, the role and status of the physician in his profession, the legal framework which rules the medical profession, and also the information level of the patient. Agency relationship and professional uncertainty are the most relevant determinants of supplier-induced demand. Professional uncertainty inherent in the practice of a stochastic art such as medicine will "always" give an ethical justification for supplier-induced demand or for the pursuit of "maximal" and/or "defensive" care when market competition is perceived by the physician as a threat to his/her income or employment. Time is ripe for consumers and physicians empowerment in the aim to promote better self-management of health and more thoughtful access to care (for consumers) and more evidences based medicine for physicians.
Kurt Nielsen; Tseganesh Wubale Tamirat
We suggest a market design for rapid demand response in electricity markets. The solution consists of remotely controlled switches, meters, forecasting models as well as a flexible auction market to set prices and select endusers job by job. The auction market motivates truth-telling and makes it simple to involve the endusers in advance and to activate demand response immediately. The collective solution is analyzed and economic simulations are conducted for the case of Kenya. Kenya has been...
Wagner, Todd H; Jimison, Holly B
Consumer health information, once the domain of books and booklets, has become increasingly digitized and available on the Internet. This study assessed the effect of using computerized health information on consumers' demand for medical care. The dependent variable was self-reported number of visits to the doctor in the past year. The key independent variable was the use of computerized health information, which was treated as endogenous. We tested the effect of using computerized health information on physician visits using ordinary least squares, instrumental variables, fixed effects, and fixed-effects instrumental variables models. The instrumental variables included exposure to the Healthwise Communities Project, a community-wide health information intervention; computer ownership; and Internet access. Random households in three cities were mailed questionnaires before and after the Healthwise Communities Project. In total, 5909 surveys were collected for a response rate of 54%. In both the bivariate and the multivariate analyses, the use of computerized health information was not associated with self-reported entry into care or number of visits. The instrumental variables models also found no differences, with the exception that the probability of entering care was significantly greater with the two-stage conditional logit model (P information is intuitively appealing, we found little evidence of an association between using a computer for health information and self-reported medical visits in the past year. This study used overall self-reported utilizations as the dependent variable, and more research is needed to determine whether health information affects the health production function in other important ways, such as the location of care, the timing of getting care, or the intensity of treatment.
Many scholars claim that recent changes to Chinese society since economic reform have challenged longstanding forms of informal social care, such as filial piety. For instance there is a societal tension at work in contemporary Chinese society today. On the one hand decreasing co-residence in multi-generational households caused by rural-urban migration, population ageing, the fall in fertility and 'One-Child Policy', and women's increasing participation in the labour market, emphasises an individualised, wage earning centred society. On the other hand, the Chinese government has sought to enforce a form of institutionalised filial piety through policies that legally require younger generations fulfil the full responsibility of care as there is no institutionalised equivalent of the welfare state to provide e.g. home help or personal care to the elderly whose relatives live and work at some distance. This places many younger generations in the contradiction of having to comply with neo-liberal labour market demands while also fulfilling state enforced filial piety. This research is to look at how Chinese migrant worker experience perceived filial responsibilities in relation to End-of-Life care for parents diagnosed with cancer in the current Chinese context. My PhD, based on interviews with migrant peasant workers caught in this dilemma by the demands of having a terminally ill parent, examines how Chinese migrant peasant workers negotiate and conduct their filial practices. The preliminary analysis of the interviews suggests that 'Filial Piety' is getting reconstructed in multifaceted ways as they negotiate the care dilemmas they face. The way they engage with the concept of filial piety enables and constrains how they can think about and practically organise their parents' care. The result would shed a light on evaluation of and suggestions for governmental policy-makings, such as the newly implemented Parent-Visiting law in China, in terms of better reinforcing
Chan, Kim Geok; Lim, Khatijah Abdullah; Ling, How Kee
This paper examines the experiences of mothers caring for a child with Down syndrome in the Malaysian (Sarawak) context. Qualitative interviews were conducted with 26 biological mothers of children with Down syndrome aged 18 years and below. They were accessed through selected child health clinics, community-based rehabilitation centres and schools using purposive sampling within two regions in Sarawak, one of the two Borneo States of Malaysia. Major themes emerging within the context of care demands were children's health, developmental delays, daily needs and behaviour issues. The insights obtained into the care demands experienced by mothers of children with Down syndrome have several implications for practice by care professionals. © 2014 Wiley Publishing Asia Pty Ltd.
Heister, Thomas; Hagist, Christian; Kaier, Klaus
The emergence and spread of antimicrobial resistance (AMR) is still an unresolved problem worldwide. In intensive care units (ICUs), first-line antibiotic therapy is highly standardized and widely empiric while treatment failure because of AMR often has severe consequences. Simultaneously, there is a limited number of reserve antibiotics, whose prices and/or side effects are substantially higher than first-line therapy. This paper explores the implications of resistance-induced substitution effects in ICUs. The extent of such substitution effects is shown in a dynamic fixed effect regression analysis using a panel of 66 German ICUs with monthly antibiotic use and resistance data between 2001 and 2012. Our findings support the hypothesis that demand for reserve antibiotics substantially increases when resistance towards first-line agents rises. For some analyses the lagged effect of resistance is also significant, supporting the conjecture that part of the substitution effect is caused by physicians changing antibiotic choices in empiric treatment by adapting their resistance expectation to new information on resistance prevalence. The available information about resistance rates allows physicians to efficiently balance the trade-off between exacerbating resistance and ensuring treatment success. However, resistance-induced substitution effects are not free of charge. These effects should be considered an indirect burden of AMR. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
van Oostveen, Catharina J.; Gouma, Dirk J.; Bakker, Piet J.; Ubbink, Dirk T.
The actual amount of care hospitalised patients need is unclear. A model to quantify the demand for hospital care services among various clinical specialties would avail healthcare professionals and managers to anticipate the demand and costs for clinical care. Three medical specialties in a Dutch
Hagy, Alison P.
An implicit price for child care staff-to-child ratio was used to study demand for child care quality. Direct purchase-of-service contracts or vouchers, which subsidize only providers meeting state regulations, effectively lower implicit price and have little influence on the demand for quality. (Author/SK)
Bloechliger, Olivia R.; Bauer, Georg F.
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…
Sterke, Carolyn Shanty; Panneman, Martien J; Erasmus, Vicki; Polinder, Suzanne; van Beeck, Ed F
To estimate the increased care demand and medical costs caused by falls in nursing homes. There is compelling evidence that falls in nursing homes are preventable. However, proper implementation of evidence-based guidelines to prevent falls is often hindered by insufficient management support, staff time and funding. A three-round Delphi study. A panel of 41 experts, all working in nursing homes in the Netherlands, received three online questionnaires to estimate the extra hours of care needed during the first year after the fall. This was estimated for ten falls categories with different levels of injury severity, in three scenarios, that is a best-case, a typical-case and a worst-case scenario. We calculated the costs of falls by multiplying the mean amount of extra hours that the participants spent on the care for a resident after a fall with their hourly wages. In case of a noninjurious fall, the extra time spent on the faller is on average almost 5 hr, expressed in euros that add to € 193. The extra staff time and costs of falls increased with increasing severity of injury. In the case of a fracture of the lower limb, the extra staff time increased to 132 hr, expressed in euros that is € 4,604. In the worst-case scenario of a fracture of the lower limb, the extra staff time increased to 284 hr, expressed in euros that is € 10,170. Falls in nursing homes result in a great deal of extra staff time spent on care, with extra costs varying between € 193 for a noninjurious fall and € 10,170 for serious falls. This study could aid decision-making on investing in appropriate implementation of falls prevention interventions in nursing homes. © 2018 John Wiley & Sons Ltd.
Okido, Aline Cristiane Cavicchioli; Cunha, Suelen Teles da; Neves, Eliane Tatsch; Dupas, Giselle; Lima, Regina Aparecida Garcia de
to understand the experience of mothers of technology-dependent children as regards pharmaceutical care. this was a qualitative, descriptive-exploratory study developed based on open interviews using a structured characterization tool, and applied during home visits to 12 mothers caring for technology-dependent children. The data was submitted to inductive content analysis. this study is split into two themes: (i) maternal overload during pharmaceutical care, demonstrating the need to administer drugs continuously and the repercussions of this exhaustive care on the caregivers; (ii) the ease or difficulty of access to the medicines required, showing informal strategies and support networks. pharmaceutical care is a daily challenge expressed in maternal overload and difficulty accessing the drugs, made worse by failures in the care network and coordinated care.
Henry, E W
The framework of the Base Case and the High Case for 1990 for Ireland, related to the demand modules of the medium-term European Communities (EC) Energy Model, is described. The modules are: Multi-national Macre-economic Module (EURECA); National Input-Output Model (EXPLOR); and National Energy Demand Model (EDM). The final results of the EXPLOR and EDM are described; one set related to the Base Case and the other related to the High Case. The forecast or projection is termed Base Case because oil prices are assumed to increase with general price inflation, at the same rate. The other forecast is termed High Case because oil prices are assumed to increase at 5% per year more rapidly than general price inflation. The EXPLOR-EDM methodology is described. The lack of data on energy price elasticities for Ireland is noted. A comparison of the Base Case with the High Case is made. (MCW)
Cao, Shanshan; Gentili, Monica; Griffin, Paul M; Griffin, Susan O; Harati, Pravara; Johnson, Ben; Serban, Nicoleta; Tomar, Scott
Demand for dental care is expected to outpace supply through 2025. The objectives of this study were to determine the extent of pediatric dental care shortages in Georgia and to develop a general method for estimation that can be applied to other states. We estimated supply and demand for pediatric preventive dental care for the 159 counties in Georgia in 2015. We compared pediatric preventive dental care shortage areas (where demand exceeded twice the supply) designated by our methods with dental health professional shortage areas designated by the Health Resources & Services Administration. We estimated caries risk from a multivariate analysis of National Health and Nutrition Examination Survey data and national census data. We estimated county-level demand based on the time needed to perform preventive dental care services and the proportion of time that dentists spend on pediatric preventive dental care services from the Medical Expenditure Panel Survey. Pediatric preventive dental care supply exceeded demand in Georgia in 75 counties: the average annual county-level pediatric preventive dental care demand was 16 866 hours, and the supply was 32 969 hours. We identified 41 counties as pediatric dental care shortage areas, 14 of which had not been designated by the Health Resources & Services Administration. Age- and service-specific information on dental care shortage areas could result in more efficient provider staffing and geographic targeting.
Weng, Shuo-Chun; Chen, Yu-Chi; Chen, Ching-Yu; Cheng, Yuan-Yang; Tang, Yih-Jing; Yang, Shu-Hui; Lin, Jwu-Rong
The effect of health depreciation in older people on medical care demand is not well understood. We tried to assess the medical care demand with length of hospitalization and their impact on profits as a result of health depreciation. All participants who underwent comprehensive geriatric assessment were from a prospective cohort study at a tertiary hospital. A total of 1191 cases between September 2008 to October 2012 were investigated. Three sets of qualitative response models were constructed to estimate the impact of older adults' health depreciation on multidisciplinary geriatric care services. Furthermore, we analyzed the factors affecting the composite end-point of rehospitalization within 14 days, re-admission to the emergency department within 3 days and patient death. Greater health depreciation in elderly patients was positively correlated with greater medical care demand. Three major components were defined as health depreciation: elderly adaptation function, geriatric syndromes and multiple chronic diseases. On admission, the better the basic living functions, the shorter the length of hospitalization (coefficient = -0.35, P age and length of hospitalization. However, factors that correlated with relatively good outcome were functional improvement after medical care services and level of disease education. An optimal allocation system for selection of cases into multidisciplinary geriatric care is required because of limited resources. Outcomes will improve with health promotion and preventive care services. Geriatr Gerontol Int 2017; 17: 645-652. © 2016 Japan Geriatrics Society.
Van Eeden, K.; Moeke, D.; Bekker, R.
Nursing homes face ever-tightening healthcare budgets and are searching for ways to increase the efficiency of their healthcare processes without losing sight of the needs of their residents. Optimizing the allocation of care workers plays a key role in this search as care workers are responsible
In this paper, the dynamic determinants of money demand function and the long-run and short-run relationships between money demand, income and nominal interest rates are examined in Turkey for the time period 1980-2012. In particular we estimate a dynamic specification of a log money demand function based on Keynesian liquidity preference theory to ascertain the relevant elasticity of money demand. The empirical results of the study show that in Turkey inflation, exchange rate and money deman...
This thesis deals with unknown demand and control parameters in inventory control. Inventory control involves decisions on what to order when and in what quantity. These decisions are based on information about the demand. Models are constructed using complete demand information; these models ensure
Mohler, M J; Harris, J M
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.
van Oostveen, Catharina J; Gouma, Dirk J; Bakker, Piet J; Ubbink, Dirk T
The actual amount of care hospitalised patients need is unclear. A model to quantify the demand for hospital care services among various clinical specialties would avail healthcare professionals and managers to anticipate the demand and costs for clinical care. Three medical specialties in a Dutch university hospital participated in this prospective time and motion study. To include a representative sample of patients admitted to clinical wards, the most common admission diagnoses were selected from the most recent update of the national medical registry (LMR) of ICD-10 admission diagnoses. The investigators recorded the time spent by physicians and nurses on patient care. Also the costs involved in medical and nursing care, (surgical) interventions, and diagnostic procedures as an estimate of the demand for hospital care services per hospitalised patient were calculated and cumulated. Linear regression analysis was applied to determine significant factors including patient and healthcare outcome characteristics. Fifty patients on the Surgery (19), Pediatrics (17), and Obstetrics & Gynecology (14) wards were monitored during their hospitalization. Characteristics significantly associated with the demand for healthcare were: polypharmacy during hospitalization, complication severity level, and whether a surgical intervention was performed. A set of predictors of the demand for hospital care services was found applicable to different clinical specialties. These factors can all be identified during hospitalization and be used as a managerial tool to monitor the patients' demand for hospital care services and to detect trends in time.
Smits, M.T.; Roos, E.; Pries-Heje, J.; Chiasson, M.; Wareham, J.; Busquets, X.; Valor, J.
Governments and other policy makers use long-term planning models to support workforce planning decisions for regulating care markets and to ensure accurate balancing between care supply and demand. Our aim is to understand long-term effects of workforce planning decisions on care markets, in order
Arredondo, Armando; Ramos, René; Zúñiga, Alexis
Financing protection for both, users and providers of health care services is one of the main objectives of National Program of Health in Mexico, 2001-2006. In fact one of the elements of the present health care reform initiatives is need for the efficient allocation of financial resources, using resource allocation schemes by specific health care demands that combine both the economic, clinical and the epidemiological perspectives. The evaluation of such schemes has been approached in several ways; however, in the case of mental health services, there is dearth of studies that use economic assessment methods. Moreover, such studies are of limited scope, often a response to unmated health needs, disregarding the economic implication for health services production and financing and ensuing medical care market imbalances. This paper presents the results of an evaluative research work aimed to assess the average cost of depression and schizophrenia case management, the financial resources required to meet the health care demands by type of institution, period 1996-2000, in Mexico by type of health care provider. The case management average cost for schizophrenia was $211.00 US, and that for depression was $221.00 US. The demand of services for both conditions in each type of institution showed that the greatest relative demands (96% of the national total for depression and 94% of the national total for schizophrenia) occur in three institutions: IMSS, SSA and ISSSTE. The greatest demand of the health services for the two study condition corresponded to those insured by the IMSS, followed by those uninsured who use the SSA services, and those insured by the ISSSTE. The case management costs for mental conditions are in the middle range between hypertension and diabetes in the upper end, pneumonia and diarrhea in the lower end. The case managment costs of health care demands for the selected tracer conditions differ considerably among institutions for insure populations
objective of this paper is to examine factors influencing outpatient care demand in ..... Endogeneity of health insurance arises because the decision to purchase health ... insurance plan, or by purchasing privately a generous coverage. Existing ...
Bakker, A.B.; Demerouti, E.; Taris, A.W. (Toon); Schaufeli, W.B.; Schreurs, Paul J.G.
The job demands-resources (JD-R) model was tested in a study among 3,092 employees working in 1 of 4 different home care organizations. The central assumption in the model is that burnout develops when certain job demands are high and when job resources are limited because such negative working
Bernardo Reynolds Pacheco de Carvalho
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
This paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument. The instrument is viewed as a textbook "cost shifting" instrument that impacts plan offerings, but is unobserved by consumers. The paper finds a price elasticity of demand of around -0.20, matching the elasticity found in the RAND Health Insurance Experiment. The paper also studies within-market variation in demand for prescription drugs and other medical care services and obtains comparable price elasticity estimates. Published by Elsevier B.V.
Universal Precautions dictate sterilization for all invasive equipment that break the blood barrier; however, current methods of sterilization, such as steam and ethylene oxide gas (ETO), are not compatible with many of the delicate, heat-sensitive surgical instruments used in modern health care. In addition, traditional sterilization methods are often too time consuming for practical use in the operating room. Clearly, new sterilization processes need to be developed. In this article, the criteria modern sterilization processes must meet and how some manufacturers plan to meet this challenge are discussed. In addition, the pros and cons of using peracetic acid (the newest sterilization process currently available) are examined.
Kubicek, Bettina; Korunka, Christian; Ulferts, Heike
This paper introduces the concept of acceleration-related demands in the care of older adults. It examines these new demands and their relation to cognitive, emotional, and physical job demands and to employee well-being. Various changes in the healthcare systems of Western societies pose new demands for healthcare professionals' careers and jobs. In particular today's societal changes give rise to acceleration-related demands, which manifest themselves in work intensification and in increasing requirements to handle new technical equipment and to update one's job-related knowledge. It is, therefore, of interest to investigate the effects of these new demands on the well-being of employees. Survey. Between March-June 2010 the survey was conducted among healthcare professionals involved in care of older adults in Austria. A total of 1498 employees provided data on cognitive, emotional, and physical job demands and on acceleration-related demands. The outcome variables were the core dimensions of burnout (emotional exhaustion and depersonalization) and engagement (vigour and dedication). Hierarchical regression analyses show that acceleration-related demands explain additional variance for exhaustion, depersonalization, vigour, and dedication when controlling for cognitive, emotional, and physical demands. Furthermore, acceleration-related demands associated with increasing requirements to update one's knowledge are related to positive outcomes (vigour and dedication). Acceleration-related demands associated with an increasing work pace are related to negative outcomes such as emotional exhaustion. Results illustrate that new demands resulting from social acceleration generate potential challenges for on-the-job learning and potential risks to employees' health and well-being. © 2012 Blackwell Publishing Ltd.
Kumar, Smita; Cavallaro, Liz
Researchers are emotionally and psychologically affected by emotionally demanding research that demands a tremendous amount of mental, emotional, or physical energy and potentially affects or depletes the researcher's well-being. Little attention has been given to preparing doctoral students and novice researchers engaged in such studies. Four possible types of emotionally demanding research experiences are presented: sensitive issues, personal trauma previously experienced, experience of traumatic life events during research, and unexpected events that arise during research in what was previously not identified as a sensitive issue. The need for self-care is highly relevant to each type, despite their different impacts on researcher well-being. This conceptual article furthers conversation in the field about how researchers and educators can address the need for self-care to prepare novice researchers and proposes a conceptual framework for researcher self-care in emotionally demanding research, with an aim for future empirical study.
PNC collects and analyzes information about uranium market trend, world uranium supply and demand, and world uranium resources potential in order to establish the strategy of uranium exploration. This paper outlines the results obtained to forecast uranium supply and demand. Our forecast indicates that 8,500 tU, accounting for one-sixth of the demand in the year 2001, must be met by uranium produced by mines to be newly developed. After 2019, demand cannot be met by the 123 mines currently in operation or expected to have gone into production by this year. The projected shortage must therefore be covered by uranium to be newly discovered. To preclude this occurrence, uranium exploration will have to be steadily continued in order to ensure future new uranium resources, to alleviate anxiety about future supply, and to prevent sharp price hikes. (author)
John M Drake
Full Text Available In 2014, a major epidemic of human Ebola virus disease emerged in West Africa, where human-to-human transmission has now been sustained for greater than 12 months. In the summer of 2014, there was great uncertainty about the answers to several key policy questions concerning the path to containment. What is the relative importance of nosocomial transmission compared with community-acquired infection? How much must hospital capacity increase to provide care for the anticipated patient burden? To which interventions will Ebola transmission be most responsive? What must be done to achieve containment? In recent years, epidemic models have been used to guide public health interventions. But, model-based policy relies on high quality causal understanding of transmission, including the availability of appropriate dynamic transmission models and reliable reporting about the sequence of case incidence for model fitting, which were lacking for this epidemic. To investigate the range of potential transmission scenarios, we developed a multi-type branching process model that incorporates key heterogeneities and time-varying parameters to reflect changing human behavior and deliberate interventions in Liberia. Ensembles of this model were evaluated at a set of parameters that were both epidemiologically plausible and capable of reproducing the observed trajectory. Results of this model suggested that epidemic outcome would depend on both hospital capacity and individual behavior. Simulations suggested that if hospital capacity was not increased, then transmission might outpace the rate of isolation and the ability to provide care for the ill, infectious, and dying. Similarly, the model suggested that containment would require individuals to adopt behaviors that increase the rates of case identification and isolation and secure burial of the deceased. As of mid-October, it was unclear that this epidemic would be contained even by 99% hospitalization at the
van Klaveren, C.; Maassen van den Brink, H.; van Praag, B.
This study examines whether couples time their work hours and how this work timing influences child care demand and the time that spouses jointly spend on leisure, household chores, and child care. By using an innovative matching strategy, this study identifies the timing of work hours that cannot
Crowell, D M
The case manager's role in our complex health care system is demanding and draining without some self-reflective attention. The Wheel of Life is a key tool for individuals to assess how well they are leading a fully balanced life. The eight aspects of a balanced life--values, self-care, work, relationships, leisure, relaxation, exercise, and centering--are explained and discussed. A self-reflective activity is presented that encourages readers to assess their current life balance. This focused clarification of personal and professional life will facilitate a more fully balanced life with rewards for case managers as individuals, and for their family, clients, and the health care organization.
El-Kholy, Hosni; Faried, Ragy
The electric energy consumption rate in Egypt has an average increase of 7% per year through the last three decades. In order to satisfy the ever increasing energy demand, several actions were, and have to be taken. These actions have to be carried out in parallel. The one having the greatest effect is the measures carried out for energy conservation and loss reduction. Diversifying the energy source such as utilization of Renewable Energy technologies can contribute to satisfying the demand and extending the hydro-carbon reserves life. Regional integration of electrical networks will save expenditures used to build additional power plants.
Huynh, Jasmine-Yan; Winefield, Anthony H; Xanthopoulou, Despoina; Metzer, Jacques C
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.
Motlagh, Soraya Nouraei; Gorji, Hassan Abolghasem; Mahdavi, Ghadir; Ghaderi, Hossein
Introduction: In the majority of developing countries, the volume of medical insurance services, provided by social insurance organizations is inadequate. Thus, supplementary medical insurance is proposed as a means to address inadequacy of medical insurance. Accordingly, in this article, we attempted to provide the context for expansion of this important branch of insurance through identification of essential factors affecting demand for supplementary medical insurance. Method: In this study, two methods were used to identify essential factors affecting choice of supplementary medical insurance including Classification and Regression Trees (CART) and Bayesian logit. To this end, Excel® software was used to refine data and R® software for estimation. The present study was conducted during 2012, covering all provinces in Iran. Sample size included 18,541 urban households, selected by Statistical Center of Iran using 3-stage cluster sampling approach. In this study, all data required were collected from the Statistical Center of Iran. Results: In 2012, an overall 8.04% of the Iranian population benefited from supplementary medical insurance. Demand for supplementary insurance is a concave function of age of the household head, and peaks in middle-age when savings and income are highest. The present study results showed greater likelihood of demand for supplementary medical insurance in households with better economic status, higher educated heads, female heads, and smaller households with greater expected medical expenses, and household income is the most important factor affecting demand for supplementary medical insurance. Conclusion: Since demand for supplementary medical insurance is hugely influenced by households’ economic status, policy-makers in the health sector should devise measures to improve households’ economic or financial access to supplementary insurance services, by identifying households in the lower economic deciles, and increasing their
Jena, Anupam B; DePasse, Jacqueline W; Prasad, Vinay
The regulation of duty hours of physicians in training remains among the most hotly debated subjects in medical education. Although recent duty hour reforms have been chiefly motivated by concerns about resident well-being and medical errors attributable to resident fatigue, the debate surrounding duty hour reform has infrequently involved discussion of one of the most important secular changes in hospital care that has affected nearly all developed countries over the last 3 decades: the declining demand for hospital care. For example, in 1980, we show that resident physicians in US teaching hospitals provided, on average, 1,302 inpatient days of care per resident physician compared to 593 inpatient days in 2011, a decline of 54%. This decline in the demand for hospital care by residents provides an under-recognized economic rationale for reducing residency duty hours, a rationale based solely on supply and demand considerations. Work hour reductions and growing requirements for outpatient training can be seen as an appropriate response to the shrinking demand for hospital care across the health-care sector.
Pérez-Ciordia, Ignacio; Catalán Fabo, Francisca; Zalacain Nicolay, Fernando; Barriendo Antoñanzas, Maite; Solaegui Diaz de Guereñu, Ramón; Guillén Grima, Francisco
The demand placed on both hospital as well as extrahospital emergency care units currently continues to increase at a growing rate. This study has a twofold objective: the quantification and study of the personal characteristics of the users who are demanding emergency care and assessing whether televised soccer games have any bearing on the utilization of emergency care services. A longitudinal descriptive study (9,723 users demanding care) and study of cases and controls (1,284 users demanding care) according to whether or not a soccer game was being televised by means of a logistic regression model. The associations were quantified by means of the odds ratio (OR). Those dealt with by telephone or in infirmaries were not included in the study. A total 10.6% of the demand involved home visits, 4.8% of this total having been sent to hospital. A total 13.3% of the demand corresponds to individuals visiting from other healthcare districts, a total of 65 being overusers of emergency care (8 or more visits). The month of August (32.3%). Sundays (44.56%) and the 12:00 p.m.-2:00 p.m. timeframe (8.38%) are the times when the greatest demand for care occurs, the differences being statistically significant. Televised soccer games were associated to a 19.8% (p emergency care units has been found to exist, a major part of the demand being concentrated at highly specific points in time. A major degree of care is provided to those visiting from outside their own healthcare districts. Television soccer game broadcasts is associated with the greater utilization of the emergency care services.
Bjoerndal, Mette; Lund, Arne-Christian; Rud, Linda
The liberalization of the Nordic electricity markets started with the deregulation of the Norwegian market, and the later inclusion of Sweden, Denmark and Finland in The Nord Pool area has provided a truly international marketplace, where prices are quoted for all the Nordic countries except Iceland. The structure of the Norwegian supply side was a favorable starting point for the liberalization process with many independent (hydropower) producers and, following the Energy Act of 1991, the vertical separation of competitive production on the one hand and regulated transmission / distribution one the other hand (implemented as a requirement of separation of financial accounts). Moreover, since the mid 1990s (unregulated) retail competition has provided market based price-signals to customers, even to individual households. In this paper we will focus on the potential benefits of demand flexibility in order to enhance the performance of the electricity market in attaining optimal operation and development of the electricity system. These benefits will depend on the price elasticity of the demand. However, whether it is possible to act on price changes also depends on the information provided to and from the customers. Especially for short run flexibility, this may require two way communication devises for larger customer groups, which raises questions like who is to pay for the investments needed, and who will benefit from them. Demand response also depends on the marginal signals resulting from the different contracts offered to the customers. Today this includes ''variable'' price, spot price (based on Nord Pool Elspot) and fixed price contracts. Customer flexibility depends on the possibility of substitution for instance to other fuels / alternative energy provisions. Finally, flexibility will differ between customer classes, for instance households, industry, power intensive industry etc. In this paper we investigate demand response and customer flexibility in
DeCicca, Philip; Kenkel, Don
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. © 2015 Society for Risk Analysis.
Asadoorian, Malcolm O.; Eckaus, Richard S.; Schlosser, C. Adam
This paper is an empirical investigation of the effects of climate on the use of electricity by consumers and producers in urban and rural areas within China. It takes advantage of an unusual combination of temporal and regional data sets in order to estimate temperature, as well as price and income elasticities of electricity demand. The estimated positive temperature/electric power feedback implies a continually increasing use of energy to produce electric power which, in China, is primarily based on coal. In the absence of countervailing measures, this will contribute to increased emissions, increased atmospheric concentrations of greenhouse gases, and increases in greenhouse warming
Despite the increasing interest in clinical ethics, ethics consultation as a professional service is still rare in Europe. In this paper I refer to examples in the United States. In Germany, university hospitals and medical faculties are still hesitant about establishing yet another "committee". One of the reasons for this hesitation lies in the ignorance that exists here about how to provide medical ethics services; another reason is that medical ethics itself is not yet institutionalised at many German universities. The most important obstacle, however, may be that medical ethics has not yet demonstrated its relevance to the needs of those caring for patients. The Centre for Ethics and Law, Freiburg, has therefore taken a different approach from that offered elsewhere: clinical ethics consultation is offered on demand, the consultation being available to clinician(s) in different forms. This paper describes our experiences with this approach; practical issues are illustrated by a case study.
Paskaleva, I.; Kouteva, M.; Vaccari, F.; Panza, G.F.
The results of the study on the seismic site response in a part of the metropolitan Sofia are discussed. The neo-deterministic seismic hazard assessment procedure has been used to compute realistic synthetic waveforms considering four earthquake scenarios, with magnitudes M = 3.7, M = 6.3 and M = 7.0. Source and site specific ground motion time histories are computed along three investigated cross sections, making use of the hybrid approach, combining the modal summation technique and the finite differences scheme. Displacement and acceleration response spectra are considered. These results are validated against the design elastic displacement response spectra and displacement demand, recommended in Eurocode 8. The elastic response design spectrum from the standard pseudo-acceleration, versus natural period, Tn, format is converted to the Sa - Sd format. The elastic displacement response spectra and displacement demand are discussed with respect to the earthquake magnitude, the seismic source-to-site distance, seismic source mechanism, and the local geological site conditions. (author)
Lillrank, Paul; Groop, P Johan; Malmström, Tomi J
The structure of organizations that provide services should reflect the possibilities of and constraints on production that arise from the market segments they serve. Organizational segmentation in health care is based on urgency and severity as well as disease type, bodily function, principal method, or population subgroup. The result is conflicting priorities, goals, and performance metrics. A managerial perspective is needed to identify activities with similar requirements for integration, coordination, and control. The arguments in this article apply new reasoning to the previous literature. The method used in this article to classify health care provision distinguishes different types of health problems that share generic constraints of production. The analysis leads to seven different demand-supply combinations, each with its own operational logic. These are labeled demand and supply-based operating modes (DSO modes), and constitute the managerial building blocks of health care organizations. The modes are Prevention, Emergency, One visit, Project, Elective, Cure, and Care. As analytical categories the DSO modes can be used to understand current problems. Several operating modes in one unit create managerial problems of conflicting priorities, goals, and performance metrics. The DSO modes are constructed as managerially homogeneous categories or care platforms responding to general types of demand, and supply constraints. The DSO modes bring methods of industrial management to bear on efforts to improve health care. © 2010 Milbank Memorial Fund. Published by Wiley Periodicals Inc.
Hoogstraten, J.; de Haan, W.; ter Horst, G.
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.
van Offenbeek, M.A.G.; Kiewiet, D.J.; Oosterhuis, M.
Background: In the Netherlands the medical education system is in the process of being transformed to establish a more demand-oriented health care system. This transformation may entail the occupational restructuring of the medical profession. Meanwhile, on the supply side, the career intentions of
Datta Gupta, Nabanita; Greve, Jane
-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...
Montgomery Anthony; Panagopoulou Efharis; Costa Patricia
Health care professionals deal on a daily basis with several job demands – emotional, cognitive, organizational and physical. They must also ensure high quality care to their patients. The aim of this study is to analyse the impact of job demands on quality of care and to investigate team (backup behaviors) and individual (positivity ratio) processes that help to shield that impact. Data was collected from 2,890 doctors and nurses in 9 European countries by means of questionnaires. Job demand...
Osman Orkan Özer
Full Text Available ABSTRACT The objective of this study was to calculate the price, cross, and Morishima Technical Substitution elasticities for the costs of manpower, supply of mulberry leaves, transportation, heating, and material, all of which play pivotal roles for producers in sericulture. A survey was conducted by face-to-face interviews with 207 farmers within the scope of the study. At the analysis phase of the study, the share equity translog cost model was used. The response of the producers to the production input prices were calculated as inelastic. The strictest demand for an input belongs to mulberry leaves (-0.051 and the highest elasticity for transportation costs (-0.314. Sericulture dependents on workforce and mulberry leaves and this activity in Turkey is a labor-dense type of production.
Rapanos, V.T.; Polemis, M.L.
The purpose of this paper is to analyze the effects that energy taxes may have on reducing environmental pollution in Greece. We study the demand for residential energy for the period 1965-1998, and on the basis of these estimates we make forecasts for CO 2 emissions in the coming years. Furthermore we develop alternative scenarios for tax changes, and study their effects on CO 2 emissions. According to our findings the harmonization of the Greek energy taxes to the average European Union levels implies an increase of total CO 2 emissions by 6% annually. If taxes are raised, however, to the highest European Union levels, the CO 2 emissions are restricted significantly. These empirical findings may indicate that environmental taxation cannot be the unique instrument for combating pollution. (author)
Rapanos, Vassilis T.; Polemis, Michael L.
The purpose of this paper is to analyze the effects that energy taxes may have on reducing environmental pollution in Greece. We study the demand for residential energy for the period 1965-1998, and on the basis of these estimates we make forecasts for CO 2 emissions in the coming years. Furthermore we develop alternative scenarios for tax changes, and study their effects on CO 2 emissions. According to our findings the harmonization of the Greek energy taxes to the average European Union levels implies an increase of total CO 2 emissions by 6% annually. If taxes are raised, however, to the highest European Union levels, the CO 2 emissions are restricted significantly. These empirical findings may indicate that environmental taxation cannot be the unique instrument for combating pollution
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.
Alfieri, Emanuela; Ferrini, Anna Chiara; Gianfrancesco, Francesca; Lise, Gianluca; Messana, Giovanni; Tirelli, Lorenzo; Lorenzo, Ana; Sarli, Leopoldo
Since the recent introduction of the Case/Care Manager's professional figure, it is quite difficult to identify properly his/her own particular features, which could be mainly be found revising mainly in American studies. Therefore, the present study intended to identify the Case/Care Manager's skills and professional profile in an Intensive Care Unit experience, taking into consideration the staff's activities, perception and expectations towards the Case/Care Manager. In particular, it has been compared the experience of an Intensive Care Units where the Case/Care Manager's profile is operational to a different Unit where a Case/Care Manager is not yet in force. a Levati's model was used to map the Case/Care Manager's skills, involving each unit whole working staff, executives and caregivers through semi-structured interviews. It has been taken into consideration the Anaesthesia Unit and Emergency Unit of Cesena's healthcare organisation (AUSL of Romagna) and a Cardiology Intensive Care Unit of Piacenza's healthcare organisation, where the Case/Care Manager's profile has not been experimented yet. Firstly, it a data collection in each healthcare organization has been organised. Subsequently, semi-structured interviews to doctors, unit nurses, caregivers, nurses' coordinators and medical staff have been used to compare each healthcare system. The interviewees' described their expectations in relation to the Case/Care Manager working in a critical area. Then, every data collected during interviews has been organised to map a Case/Care Manager's essential professional profile to work in a critical area together with medical staff. Piacenza's O.U. critical area experience reported a major demand for patients' and patient's families' assistance. On the other hand, the very same aspects seem to have been better achieved in Cesena's O.U., where a Case/Care Manager's recent introduction has actually helped to overcome the void in organising systems. a Case/Care Manager
Full Text Available Objects: To study the demand of the aged community residents for college volunteers in home nursing care service and its influence factors. Methods: Questionnaires on the aged residents’ expectation and requirements for college volunteers in home nursing care was prepared on basis of studies of reference books, study materials and pre-investigation, and then the questionnaires was completed by means of convenient sampling of 200 aged residents. Results The demand and expectation of the elderly for college volunteers in health care and spiritual comfort was strong. The old people who have more children, living alone and often feel lonely are more likely to need college volunteers. Conclusions: Volunteers should be arranged reasonably according to the needs of the aged people, and priority should be given to those who have more children, living alone and often feel lonely.
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.
Mostard, Julien; Teunter, Ruud; de Koster, Rene
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.
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
Mereu, Simone; Sušnik, Janez; Trabucco, Antonio; Daccache, Andre; Vamvakeridou-Lyroudia, Lydia; Renoldi, Stefano; Virdis, Andrea; Savić, Dragan; Assimacopoulos, Dionysis
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
van Noort, Olivier; Schotanus, Fredo; van de Klundert, Joris; Telgen, Jan
In the Netherlands, home care services like district nursing and personal assistance are provided by private service provider organizations and covered by private health insurance companies which bear legal responsibility for purchasing these services. To improve value for money, their procurement increasingly replaces fee-for-service payments with population based budgets. Setting appropriate population budgets requires adaptation to the legitimate needs of the population, whereas historical costs are likely to be influenced by supply factors as well, not all of which are necessarily legitimate. Our purpose is to explain home care costs in terms of demand and supply factors. This allows for adjusting historical cost patterns when setting population based budgets. Using expenses claims of 60 Dutch municipalities, we analyze eight demand variables and five supply variables with a multiple regression model to explain variance in the number of clients per inhabitant, costs per client and costs per inhabitant. Our models explain 69% of variation in the number of clients per inhabitant, 28% of costs per client and 56% of costs per inhabitant using demand factors. Moreover, we find that supply factors explain an additional 17-23% of variation. Predictors of higher utilization are home care organizations that are integrated with intramural nursing homes, higher competition levels among home care organizations and the availability of complementary services. Copyright © 2017. Published by Elsevier B.V.
Conway, P M; Neri, L; Campanini, P; Francioli, L; Camerino, D; Punzi, S; Fichera, G P; Costa, G
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.
As the Asian country with the most aged population, Japan, has been modifying its social welfare system. In 2000, the Japanese social care vision turned towards meeting the elderly's care needs in their own homes with proper formal care services. This study aims to understand the quantitative properties of the macro supply and demand structure for facilities for the elderly who require support or long-term care throughout Japan and present them as index values. Additionally, this study compares the targets for establishing long-term care facilities set by Japan's Ministry of Health, Labor and Welfare for 2025. In 2014, approximately 90% of all the people who were certified as requiring support and long-term care and those receiving preventive long-term care or long-term care services, were 75 years or older. The target increases in the number of established facilities by 2025 (for the 75-years-or-older population) were calculated to be 3.3% for nursing homes; 2.71% for long-term-care health facilities; 1.7% for group living facilities; and, 1.84% for community-based multi-care facilities. It was revealed that the establishment targets for 2025 also increase over current projections with the expected increase of the absolute number of users of group living facilities and community-based multi-care facilities. On the other hand, the establishment target for nursing homes remains almost the same as the current projection, whereas that for long-term-care health facilities decreases. These changes of facility ratios reveal that the Japanese social care system is shifting to realize 'Ageing in Place'. When considering households' tendencies, the target ratios for established facilities are expected to be applied to the other countries in Asia.
As the Asian country with the most aged population, Japan, has been modifying its social welfare system. In 2000, the Japanese social care vision turned towards meeting the elderly’s care needs in their own homes with proper formal care services. This study aims to understand the quantitative properties of the macro supply and demand structure for facilities for the elderly who require support or long-term care throughout Japan and present them as index values. Additionally, this study compares the targets for establishing long-term care facilities set by Japan’s Ministry of Health, Labor and Welfare for 2025. In 2014, approximately 90% of all the people who were certified as requiring support and long-term care and those receiving preventive long-term care or long-term care services, were 75 years or older. The target increases in the number of established facilities by 2025 (for the 75-years-or-older population) were calculated to be 3.3% for nursing homes; 2.71% for long-term-care health facilities; 1.7% for group living facilities; and, 1.84% for community-based multi-care facilities. It was revealed that the establishment targets for 2025 also increase over current projections with the expected increase of the absolute number of users of group living facilities and community-based multi-care facilities. On the other hand, the establishment target for nursing homes remains almost the same as the current projection, whereas that for long-term-care health facilities decreases. These changes of facility ratios reveal that the Japanese social care system is shifting to realize ‘Ageing in Place’. When considering households’ tendencies, the target ratios for established facilities are expected to be applied to the other countries in Asia. PMID:29194405
Bambarén, Celso; Uyen, Angela; Rodriguez, Miguel
Introduction A model prepared by National Civil Defense (INDECI; Lima, Peru) estimated that an earthquake with an intensity of 8.0 Mw in front of the central coast of Peru would result in 51,019 deaths and 686,105 injured in districts of Metropolitan Lima and Callao. Using this information as a base, a study was designed to determine the characteristics of the demand for treatment in public hospitals and to estimate gaps in care in the hours immediately after such an event. A probabilistic model was designed that included the following variables: demand for hospital care; time of arrival at the hospitals; type of medical treatment; reason for hospital admission; and the need for specialized care like hemodialysis, blood transfusions, and surgical procedures. The values for these variables were obtained through a literature search of the databases of the MEDLINE medical bibliography, the Cochrane and SciELO libraries, and Google Scholar for information on earthquakes over the last 30 years of over magnitude 6.0 on the moment magnitude scale. If a high-magnitude earthquake were to occur in Lima, it was estimated that between 23,328 and 178,387 injured would go to hospitals, of which between 4,666 and 121,303 would require inpatient care, while between 18,662 and 57,084 could be treated as outpatients. It was estimated that there would be an average of 8,768 cases of crush syndrome and 54,217 cases of other health problems. Enough blood would be required for 8,761 wounded in the first 24 hours. Furthermore, it was expected that there would be a deficit of hospital beds and operating theaters due to the high demand. Sudden and violent disasters, such as earthquakes, represent significant challenges for health systems and services. This study shows the deficit of preparation and capacity to respond to a possible high-magnitude earthquake. The study also showed there are not enough resources to face mega-disasters, especially in large cities. Bambarén C , Uyen A
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
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
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
Jéssica Maria Arouca de Miranda
Full Text Available Background: To characterize the demands of health and quality of elderly peoplemonitored in the primary care of Rio Grande do Norte/Brazil. Methods and Findings: This is a descriptive, cross-sectional study of a quantitative approach with elderly patients monitored by the primary care. The sample was given for convenience, obtaining 120 participants. The research was conducted through an interview with theapplication of the following questionnaires: Mini Mental State Examination, Socio-demographic Data and Pain Characteristics, Short-Form-36, Mini Nutritional Assessment, the primary activities of daily living, the instrumental activities of daily living, Prism 7 and the Geriatric Depression Scale. Data analysis was performed using the SPSS statistical program, in which descriptive and association tests were used.The main demands were related to functionality, followed by nutritional and geriatric depression. The quality of life presented worse results in the domain of general health status and better scores in the emotional and mental health aspects. Regarding the dimensions, the physical health obtained aworse score. Conclusion: Based on the characterization of the health demands found, it is suggested to perform other studies with the same population, enabling to plan and implementing a multidimensional intervention and improving the quality of life of the elderly people. Keywords: Elderly; Quality of Life; Aging; Elderly Health; Nursing.
Giesen, Marie-Jeanne; Keizer, Ellen; van de Pol, Julia; Knoben, Joris; Wensing, Michel; Giesen, Paul
Objective To explore the potential impact of demand management strategies on patient decision-making in medically non-urgent and urgent scenarios during out-of-hours for children between the ages of 0 and 4 years. Design and methods We conducted a cross-sectional survey with paper-based case scenarios. A survey was sent to all 797 parents of children aged between 0 and 4 years from four Dutch general practitioner (GP) practices. Four demand management strategies (copayment, online advice, overview medical cost and GP appointment next morning) were incorporated in two medically non-urgent and two urgent case scenarios. Combining the case scenarios with the demand management strategies resulted in 16 cases (four scenarios each with four demand management strategies). Each parent randomly received a questionnaire with three different case scenarios with three different demand strategies and a baseline case scenario without a demand management strategy. Results The response rate was 47.4%. The strategy online advice led to more medically appropriate decision-making for both non-urgent case scenarios (OR 0.26; 95% CI 0.11 to 0.58) and urgent case scenarios (OR 0.16; 95% CI 0.08 to 0.32). Overview of medical cost (OR 0.59; 95% CI 0.38 to 0.92) and a GP appointment planned the next morning (OR 0.57; 95% CI 0.34 to 0.97) had some influence on patient decisions for urgent cases, but not for non-urgent cases. Copayment had no influence on patient decisions. Conclusion Online advice has the highest potential to reduce medically unnecessary use. Furthermore it enhanced safety of parents' decisions on seeking help for their young children during out-of-hours primary care. Valid online information on health symptoms for patients should be promoted. PMID:28487458
Oostveen, C.J. van; Ubbink, D.T.; Huis in het Veld, J.G.; Bakker, P.J.; Vermeulen, H.
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
van Oostveen, Catharina J.; Ubbink, Dirk T.; Huis In Het Veld, Judith G.; Bakker, Piet J.; Vermeulen, Hester
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
Brugués Brugués, Alba; Cubells Asensio, Irene; Flores Mateo, Gemma
To describe and analyse the implementaction of nurse demand managment (NDM) among health care providers in Catalonia from 2005 to 2014. Cross sectional survey. Participants All service providers in Catalonia (n=37). Main measurements Interviews with nurse manager of each health care provides about ht barriers and facilitators concerning NDM. Facilitators and barriers were classified into 3 types: (i)health professional (competence, attitudes, motivation for change and individual characteristics); (ii)social context (patients and companions), and (iii)system related factors (organization and structure, economic incentives). Of the 37 providers, 26 (70.3%) have implemented the Demand Management Nurse (NDM). The main barriers identified are the nurse prescriptin regulation, lack of knowledge and skills of nurses, and the lack of protocols at the start of implantation. Among the facilitators are the specific training of professionals, a higher ratio of nurses to doctors, consensus circuits with all professionals and linking the implementation of NDM to economic incentives. NDM is consolidated in Catalonia. However, the NDM should be included in the curricula of nursing degree and continuing education programs in primary care teams. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Bateman, P; Arnold, C; Brown, R; Foster, L V; Greening, S; Monaghan, N; Zoitopoulos, L
Routine dental care provided in special care dentistry is complicated by patient specific factors which increase the time taken and costs of treatment. The BDA have developed and conducted a field trial of a case mix tool to measure this complexity. For each episode of care the case mix tool assesses the following on a four point scale: 'ability to communicate', 'ability to cooperate', 'medical status', 'oral risk factors', 'access to oral care' and 'legal and ethical barriers to care'. The tool is reported to be easy to use and captures sufficient detail to discriminate between types of service and special care dentistry provided. It offers potential as a simple to use and clinically relevant source of performance management and commissioning data. This paper describes the model, demonstrates how it is currently being used, and considers future developments in its use.
Full Text Available During recent decades, many changes are happening in health sector and countries are trying to respond to the increasing health demands of people. Although hospitals have important role in health delivery system of any country, numerous factors have to be taken into account before establishing a new hospital in certain area. During recent decades, in many developing countries, new hospitals are built and equipped with sophisticated plant, without any scientific investigation. This means wastage of scarce resources. This paper aims to introduce need assessment methodology to establish hospitals and discuss the criteria to be met prior to their construction in the process of health care development.
Rocco, Philip; Haeder, Simon F
The implementation of the Affordable Care Act (ACA) has been a politically volatile process. The ACA's institutional design and delayed feedback effects created a window of opportunity for its partisan opponents to launch challenges at both the federal and state level. Yet as recent research suggests, postreform politics depends on more than policy feedback alone; rather, it is shaped by the partisan and interest-group environment. We argue that "intense policy demanders" played an important role in defining the policy alternatives that comprised congressional Republicans' efforts to repeal and replace the ACA. To test this argument, we drew on an original data set of bill introductions in the House of Representatives between 2011 and 2016. Our analysis suggests that business contributions and political ideology affected the likelihood that House Republicans would introduce measures repealing significant portions of the ACA. A secondary analysis shows that intense policy demanders also shaped the vote on House Republicans' initial ACA replacement plan. These findings highlight the role intense policy demanders can play in shaping the postreform political agenda. Copyright © 2018 by Duke University Press.
Vander Elst, Tinne; Cavents, Carolien; Daneels, Katrien; Johannik, Kristien; Baillien, Elfi; Van den Broeck, Anja; Godderis, Lode
A better knowledge of the job aspects that may predict home health care nurses' burnout and work engagement is important in view of stress prevention and health promotion. The Job Demands-Resources model predicts that job demands and resources relate to burnout and work engagement but has not previously been tested in the specific context of home health care nursing. The present study offers a comprehensive test of the Job-Demands Resources model in home health care nursing. We investigate the main and interaction effects of distinctive job demands (workload, emotional demands and aggression) and resources (autonomy, social support and learning opportunities) on burnout and work engagement. Analyses were conducted using cross-sectional data from 675 Belgian home health care nurses, who participated in a voluntary and anonymous survey. The results show that workload and emotional demands were positively associated with burnout, whereas aggression was unrelated to burnout. All job resources were associated with higher levels of work engagement and lower levels of burnout. In addition, social support buffered the positive relationship between workload and burnout. Home health care organizations should invest in dealing with workload and emotional demands and stimulating the job resources under study to reduce the risk of burnout and increase their nurses' work engagement. Copyright Â© 2016 Elsevier Inc. All rights reserved.
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
Gurtner, Caroline; Spirig, Rebecca; Staudacher, Diana; Huber, Evelyn
Patient-related complexity in nursing care - Collective case studies in the acute care hospital Abstract. Patient-related complexity of nursing is defined by the three characteristics "instability", "uncertainty", and "variability". Complexity increased in the past years, due to reduced hospital length of stay and a growing number of patients with chronic and multiple diseases. We investigated the phenomenon of patient-related complexity from the point of view of nurses and clinical nurse specialists in an acute care hospital. In the context of a collective case study design, nurses and clinical nurse specialists assessed the complexity of nursing situations with a questionnaire. Subsequently, we interviewed nurses and clinical nurse specialists about their evaluation of patient-related complexity. In a within-case-analysis we summarized data inductively to create case narratives. By means of a cross-case-analysis we compared the cases with regard to deductively derived characteristics. The four cases exemplarily showed that the degree of complexity depends on the controllability and predictability of clinical problems. Additionally, complexity increases or decreases, according to patients' individual resources. Complex patient situations demand professional expertise, experience, communicative competencies and the ability for reflection. Beginner nurses would benefit from support and advice by experienced nurses to develop these skills.
M. Oguz Sinemillioglu; Can Tuncay Akın; Havva Özyılmaz
The aim of this study is to analyze changings in housing demand, especially in term of house size in Diyarbakır case, in Turkey. Though Housing in Turkey is in a free market system, there is a Mass Housing Administration (TOKÃ ) has been doing mass houses for, relatively, middle class income people. Diyarbakır, one of the cities that TOKÃ 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 ...
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.
Full Text Available Water is the most essential component for sustaining lives of humans and other living creatures. Supplying potable water with adequate residual pressure is a fundamental responsibility of city administration, which they do during normal conditions. But sometimes, abnormal conditions are formed resulting pressure deficient conditions during the daily operations of water distribution networks. These are caused due to common occurrences such as pump failure, pipe bursts, and isolation of major pipes from the system for planned maintenance work and excessive firefighting demands. Total water stop conditions may arise, when the major source supplying water to the city fails in natural disaster such as floods, Tsunami, earthquake or manmade disaster such as terrorist attack. Unlike the pipe failure, longer time is required for restoring water in case of source failure condition. In such situations, the quantity of water is generally decreased and the water distribution systems (WDS may not be able to satisfy all consumers’ demands. In this context, the assumption that all demands are fully satisfied regardless of the pressure in the system becomes unreasonable. A realistic behavior of the network performance can only be attained by considering demands to be pressure dependent. This paper aims to describe how pressure dependent demand analysis is useful for the simulation of disaster scenario due to source failure of the Shirpur town. The simulation of failure scenario is carried out using WaterGEMs software. The paper also aims to prepare the action plans for the recovery of water supply in such crisis conditions.
Hadden, Kristie; Prince, Latrina Y; Barnes, C Lowry
In response to an assessment of organizational health literacy practices at a major academic health center, this case study evaluated the health literacy demands of patient-reported outcome measures commonly used in orthopedic surgery practices to identify areas for improvement. A mixed-methods approach was used to analyze the readability and patient feedback of orthopedic patient-reported outcome materials. Qualitative results were derived from focus group notes, observations, recordings, and consensus documents. Results were combined to formulate recommendations for quality improvement. Readability results indicated that narrative portions of sample patient outcome tools were written within or below the recommended eighth-grade reading level (= 5.9). However, document literacy results were higher than the recommended reading level (= 9.8). Focus group results revealed that participants had consensus on 8 of 12 plain language best practices, including use of bullet lists and jargon or technical words in both instruments. Although the typical readability of both instruments was not exceedingly high, appropriate readability formula and assessment methods gave a more comprehensive assessment of true readability. In addition, participant feedback revealed the need to reduce jargon and improve formatting to lessen the health literacy demands on patients. As clinicians turn more toward patient-reported measures to assess health care quality, it is important to consider the health literacy demands that are inherent in the instruments they are given in our health systems.
Aantjes, Carolien J; Simbaya, Joseph; Quinlan, Tim K C; Bunders, Joske F G
Aim We present the evolution of primary-level HIV and AIDS services, shifting from end of life to chronic care, and draw attention to the opportunities and threats for the future of Zambia's nascent chronic care system. Although African governments struggled to provide primary health care services in the context of a global economic crisis, civil society organisations (CSO) started mobilising settlement residents to respond to another crisis: the HIV and AIDS pandemic. These initiatives actively engaged patients, families and settlement residents to provide home-based care to HIV-infected patients. After 30 years, CHBC programmes continue to be appropriate in the context of changing health care needs in the population. The study took place in 2011 and 2012 and was part of a multi-country study. It used a mixed method approach involving semi-structured interviews, focus group discussions, structured interviews, service observations and a questionnaire survey. Findings Our research revealed long-standing presence of extensive mutual support amongst residents in many settlements, the invocation of cultural values that emphasise social relationships and organisation of people by CSO in care and support programmes. This laid the foundation for a locally conceived model of chronic care capable of addressing the new care demands arising from the country's changing burden of disease. However, this capacity has come under threat as the reduction in donor funding to community home-based care programmes and donor and government interventions, which have changed the nature of these programmes in the country. Zambia's health system risks losing valuable capacity for fulfilling its vision 'to bring health care as close to the family as possible' if government strategies do not acknowledge the need for transformational approaches to community participation and continuation of the brokering role by CSO in primary health care.
D Forrest; R Simmons
This paper uses an attendance demand model with panel data on over 4,000 games to examine economic problems of fixture congestion in English Football League schedules. We find that televised midweek Champions League matches involving English Premier League clubs have substantial adverse impacts on lower division Football League gate attendance. This suggests that affected clubs may have a case for compensation from the Premier League for loss of gate revenue from this source. Scheduling of ho...
Nursing job is generally related to intense pressure and high-level burnout because of its high demanding, challenging and stressful professional characteristic. Nursing staff in elderly home and long-term care facilities particularly experience higher level of physical job demands, more emotional exhaustion and lower level of job satisfaction than those in other units, thus bringing out higher burnout ratio among the nursing staffs. The main aim of this study was to reveal the causing factor...
de Jonge, Jan; Le Blanc, Pascale M; Peeters, Maria C W; Noordam, Hanneke
Research on emotional labour in health care work has not yet revealed under what conditions emotional job demands have an impact on employee health and well-being. There is a need for more theory to unveil the black box of emotional labour processes. To test the moderating role of matching (i.e. emotional) and non-matching (i.e. cognitive) job resources in the relation between emotional job demands and employee health/well-being (i.e. emotional exhaustion, employee creativity, and work motivation). A cross-sectional survey with anonymous questionnaires was conducted. A large organization for residential elderly care with eight locations in an urban area in the Netherlands. Questionnaires were distributed to 1259 health care workers, of which 826 people returned the questionnaire (66% response rate). In addition to descriptive statistics, multivariate multiple regression analysis (LISREL 8.54) with cross-validation was conducted. Findings showed that emotional job resources moderated the relation between emotional job demands and health/well-being outcomes. Firstly, emotional job resources were able to moderate the relation between emotional job demands and emotional exhaustion. Secondly, both emotional job resources and, to a lesser extent, cognitive job resources were able to moderate the relation between emotional job demands and positive well-being outcomes (i.e. employee creativity and work motivation). Finally, cross-validation showed that parameter estimates did not vary across subsamples. Job resources could compensate for resources lost through meeting the requirements of emotional job demands, thereby reducing stress-reactions and increasing well-being. Providing health care workers with more, preferably matching, job resources could make emotional job demands less stressful, and even stimulating and challenging. Future longitudinal studies should investigate the interplay of emotional job demands and (matching) job resources more profoundly.
Klie, T; Pfundstein, T
In times of demographic and social change, it is increasingly important to ensure the availability of care services to cover the growing demand. With the implementation of the German long-term insurance act in 1994, the responsibility of states and municipalities was maintained; however, given the long-term care legislation's market orientation and competition neutrality, the classic instruments for demand planning and supervision of infrastructure developments were lost. This leads to new challenges for states and municipalities: their conventional objective-oriented planning lacks professional and juridical legitimization. Calculations of requirements must relate to methodology and professional expertise. In order to exercise their influence on infrastructure development, instruments of demand planning other than subsidization are required. Using the example of Rheinland-Pfalz (Rhineland-Palatinate) and the newly implemented care structure planning, the concept of care monitoring is introduced, and instruments to influence infrastructure development are outlined.
Giesen, Marie-Jeanne; Keizer, Ellen; van de Pol, Julia; Knoben, Joris; Wensing, Michel; Giesen, Paul
To explore the potential impact of demand management strategies on patient decision-making in medically non-urgent and urgent scenarios during out-of-hours for children between the ages of 0 and 4 years. We conducted a cross-sectional survey with paper-based case scenarios. A survey was sent to all 797 parents of children aged between 0 and 4 years from four Dutch general practitioner (GP) practices. Four demand management strategies (copayment, online advice, overview medical cost and GP appointment next morning) were incorporated in two medically non-urgent and two urgent case scenarios. Combining the case scenarios with the demand management strategies resulted in 16 cases (four scenarios each with four demand management strategies). Each parent randomly received a questionnaire with three different case scenarios with three different demand strategies and a baseline case scenario without a demand management strategy. The response rate was 47.4%. The strategy online advice led to more medically appropriate decision-making for both non-urgent case scenarios (OR 0.26; CI 0.11 to 0.58) and urgent case scenarios (OR 0.16; CI 0.08 to 0.32). Overview of medical cost (OR 0.59; CI 0.38 to 0.92) and a GP appointment planned the next morning (OR 0.57; CI 0.34 to 0.97) had some influence on patient decisions for urgent cases, but not for non-urgent cases. Copayment had no influence on patient decisions. Online advice has the highest potential to reduce medically unnecessary use. Furthermore it enhanced safety of parents' decisions on seeking help for their young children during out-of-hours primary care. Valid online information on health symptoms for patients should be promoted. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Seyed Hossein Sajadifar
Full Text Available The present study tries to apply the “Partial Adjustment Model” and “Random Effect Model” techniques to the Stone-Greay’s linear expenditure system, in order to estimate the "Residential Seasonal Demand" for water in Arak city. Per capita water consumption of family residences is regressed on marginal price, per capita income, price of other goods, average temperature and average rainfall. Panel data approaches based on a sample of 152 observations from Arak city referred to 1993-2003. From the estimation of the Elasticity-price of the residential water demand, we want to know how a policy of responsive pricing can lead to more efficient household water consumption inArakcity. Results also indicated that summer price elasticity was twice the winter and price and income elasticity was less than 1 in all cases.
Historically, the Israeli health care system has been considered a high-performance system, providing universal, affordable, high-quality care to all residents. However, a decline in the ratio of physicians to population that reached a modern low in 2006, an approximate ten-percentage-point decline in the share of publicly financed health care between 1995 and 2009, and legislative mandates that favored private insurance have altered Israel's health care system for the worse. Many Israelis now purchase private health insurance to supplement the state-sponsored universal care coverage, and they end up spending more out of pocket even for services covered by the entitlement. Additionally, many publicly paid physicians moonlight at private facilities to earn more money. In this article I recommend that Israel increase public funding for health care and adopt reforms to address the rising demand for privately funded care and the problem of publicly paid physicians who moonlight at private facilities.
Pedro Domingos Antoniolli
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
Monge Galindo, L; López-Pisón, J; Samper Villagrasa, P; Peña Segura, J L
The purpose of this study is to determine the profile of the demand for paediatric neurology care in a Spanish tertiary hospital over the past 20 years. We studied epidemiological data, reasons for consultation, diagnoses and complementary tests from all patients examined by our Paediatric Neurology Unit in its 20 years of service (from May 1990 to March 2010). We also reviewed data from patients whose first visit took place within the last five years (2005-2010) and compared them to data obtained from a prior study carried out in this Unit from 1990 to 1995. To compare the first 5 years (group 1) with the last 5 years (group 2), we calculated confidence intervals, P<.05, for the frequency distribution (%) in each category. Main reasons for consultation and principal diagnoses for the 12726 patients evaluated in the 20-year period, as well as results from group 1 (2046 patients) and group 2 (4488 patients) corresponding to first and the last 5 years of activity respectively, are presented with their confidence intervals in a series of tables. Variations in the reasons for consultation, diagnoses and complementary tests over time reflect changes determined by medical, scientific and social progress, and organisational changes specific to each hospital. This explains the difficulty of comparing different patient series studied consecutively, which are even more pronounced between different hospitals. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.
Sharma, R K
THREE MODELS FOR FORECASTING HOME HEALTH CARE (HHC) NEEDS ARE ANALYZED: HSA/SP model (Health Systems Agency of Southwestern Pennsylvania); Florida model (Florida State Department of Health and Rehabilitative Services); and Rhode Island model (Rhode Island Department of Community Affairs). A utilization approach to forecasting is also presented.In the HSA/SP and Florida models, need for HHC is based on a certain proportion of (a) hospital admissions and (b) patients entering HHC from other sources. The major advantage of these models is that they are relatively easy to use and explain; their major weaknesses are an imprecise definition of need and an incomplete model specification.The Rhode Island approach defines need for HHC in terms of the health status of the population as measured by chronic activity limitations. The major strengths of this approach are its explicit assumptions and its emphasis on consumer needs. The major drawback is that it requires considerable local area data.The utilization approach is based on extrapolation from observed utilization experience of the target population. Its main limitation is that it is based on current market imperfections; its major advantage is that it exposes existing deficiencies in HHC.The author concludes that each approach should be tested empirically in order to refine it, and that need and demand approaches be used jointly in the planning process.
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
Zwijsen, S.A.; Gerritsen, D.L.; Eefsting, J.A.; Smalbrugge, M.; Hertogh, C.M.P.M.; Pot, A.M.
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
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
Zwijsen, S.A.; Gerritsen, D.L.; Eefsting, J.A.; Smalbrugge, M.; Hertogh, C.M.; Pot, A.M.
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
Huber, Carola A; Rosemann, Thomas; Zoller, Marco; Eichler, Klaus; Senn, Oliver
To investigate the demand for traditional out-of-hours general practitioner (GP) emergency care in Switzerland including GPs' satisfaction and reasons for encounter (RFE). During a 2-month period (2009), a questionnaire-based, cross-sectional study was performed in GPs participating in the mandatory out-of-hours service in the city of Zurich, Switzerland. The number and mode of patient contacts were assessed to investigate the demand for GP care in traditional out-of-hours services. GPs and patient characteristics, including RFE according to the International Classification of Primary Care, were noted. Descriptive statistics and non-parametric tests were conducted. Out of the 295 out-of-hours episodes during the study period, 148 (50%) duty periods were documented by a total of 93 GPs (75% men) with a mean (SD) age of 48.0 (6.2) years. The median (interquartile range) number of out-of-hours contacts was 5 (3-8) and the demand for home visits was significantly more common compared with practice and telephone consultations. A total of 112 different RFEs were responsible for the 382 documented patient contacts with fever accounting for the most common complaint (13.9%). Although 80% of GPs agreed to be satisfied overall with their profession as primary care provider, 57.6% among them were dissatisfied with the current out-of-hours service. Inappropriate payment and interference with their daily work in practice were most frequently reported. Our findings indicate that there is still strong patient demand for out-of-hours care with special need for home visits, suggesting that new organizational models such as integrating GPs into emergency care may not be an appropriate approach for all patients. Therefore, the ongoing reorganization of the out-of-hours-service in many health care systems has to be evaluated carefully in order not to miss important patient needs. © 2010 Blackwell Publishing Ltd.
Jonge, de J.; Blanc, Le P.M.; Peeters, M.C.W.; Noordam, H.
Background Research on emotional labour in health care work has not yet revealed under what conditions emotional job demands have an impact on employee health and well-being. There is a need for more theory to unveil the black box of emotional labour processes. Objectives To test the moderating role
Brown, J.R.; Coe, N.B.; Finkelstein, A.
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
Mabry, Linda; Parker, Kelsey N; Thompson, Sharon V; Bettencourt, Katrina M; Haque, Afsara; Luther Rhoten, Kristy; Wright, Rob R; Hess, Jennifer A; Olson, Ryan
The Community of Practice and Safety Support (COMPASS) program is a peer-led group intervention for home care workers. In a randomized controlled trial, COMPASS significantly improved workers' professional support networks and safety and health behaviors. However, quantitative findings failed to capture workers' complex emotional, physical, and social experiences with job demands, resource limitations, and the intervention itself. Therefore, we conducted qualitative follow-up interviews with a sample of participants (n = 28) in the program. Results provided examples of unique physical and psychological demands, revealed stressful resource limitations (e.g., safety equipment access), and elucidated COMPASS's role as a valuable resource.
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.
Zwijsen, S A; Gerritsen, D L; Eefsting, J A; Smalbrugge, M; Hertogh, C M P M; Pot, A M
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 diminishing the challenging behaviour of residents, improve job satisfaction and reduce the care staff's feelings of burnout. To determine the effects of a care programme for the challenging behaviour of nursing home residents with dementia on the burnout, job satisfaction and job demands of care staff. The care programme was implemented according to a stepped wedge design in which care units were randomly divided over five groups with different time points of starting with implementation. 17 Dutch dementia special care units. Care staff members of the 17 units. The care programme consists of an education package and of various structured assessment tools that guide professionals through the multidisciplinary detection, analysis, treatment and evaluation of treatment of challenging behaviour. Burnout, job satisfaction and job demands were measured before implementation, halfway through the implementation process and after all the care units had implemented the care programme. Burnout was measured with the Dutch version of the Maslach burnout inventory (UBOS-C, three subscales); job satisfaction and job demands were measured with subscales of the Leiden Quality of Work Questionnaire. Mixed model analyses were used to determine effects. Care staff could not be blinded for the intervention. Of the 1441 questionnaires, 645 were returned (response 45%, 318 control measurements, 327 intervention measurements) by 380 unique care staff members. Significant effects were found on job satisfaction (0.93, 95% CI 0.48-1.38). On the other outcomes, no significant changes in the scores were found. Positive effects of using the Grip on Challenging behaviour care programme were found on job
Chalil, D.; Barus, R.
Sustainable palm oil has been widely debated. Consuming countries insist certified sustainable produces palm oil, but in fact the absorption of the certified palm oil is still less than 60%. This raise questions about the sustainable palm oil demand. In this study, such a condition will be analysed in French-Indonesia supply chain case. Using monthly and quarterly data from 2010 to 2016 with Autoregressive Distributed Lag (ARDL) approach and Error Correction Model, demand influencing factors and price integration in each market of the supply chain is estimated. Two scenarios namely re-export and direct export models are considered in the Error Correction Model. The results show that France Gross Domestic Product, prices of France palm oil import from Indonesia, Malaysia, and Germany, and price of France groundnut import significantly influence the France palm oil import volume from Indonesia. Prices in each market along palm oil re-export France-Indonesia supply chain are co-integrated and converge towards long-run equilibrium, but not in the direct export supply chain. This leads to a conclusion that France market preferences in specific and EU market preferences in general need to be considered by Indonesian palm oil decision makers.
Viotti, Sara; Converso, Daniela
Background: The present study aims at investigating whether and how (1) job demands and job resources are associated with work-to-private-life interference (WLI) and (2) job resources moderate the relationship between job demands and WLI. Methods: Data were collected by a self-report questionnaire from three hospitals in Italy. The sample consisted of 889 health-care workers. Results: All job demands (i.e., quantitative demands, disproportionate patient expectations, and verbal aggressi...
I propose an application of the pure-consumption version of the Grossman model of health care demand, where utility depends on consumption and health status and health status on medical care and health technology. I derive the conditions under which an improvement in health care technology leads to an increase/decrease in health care consumption. In particular, I show how the direction of the effect depends on the relationship between the constant elasticity of substitution parameters of the utility and health production functions. I find that, under the constancy assumption, the ratio of the two elasticity of substitution parameters determines the direction of a technological change on health care demand. On the other hand, the technology share parameter in the health production function contributes to the size but not to the direction of the technological effect. I finally explore how the ratio of the elasticity of substitution parameters work in measurement and practice and discuss how future research may use the theoretical insight provided here. Copyright © 2014 John Wiley & Sons, Ltd.
Memarian, Babak; Mitropoulos, Panagiotis
Construction work involves significant physical, mental, and temporal task demands. Excessive task demands can have negative consequences for safety, errors and production. This exploratory study investigates the magnitude and sources of task demands on a concrete operation, and examines the effect of the production practices on the workers' task demands. The NASA Task Load Index was used to measure the perceived task demands of two work crews. The operation involved the construction of a cast-in-place concrete building under high schedule pressures. Interviews with each crew member were used to identify the main sources of the perceived demands. Extensive field observations and interviews with the supervisors and crews identified the production practices. The workers perceived different level of task demands depending on their role. The production practices influenced the task demands in two ways: (1) practices related to work organization, task design, resource management, and crew management mitigated the task demands; and (2) other practices related to work planning and crew management increased the crew's ability to cope with and adapt to high task demands. The findings identify production practices that regulate the workers' task demands. The effect of task demands on performance is mitigated by the ability to cope with high demands.
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 has been negligible and largely speculative. While proponents praise IMT's potential to make home health systems more responsive to the needs of market-savvy healthcare consumers, critics identify it as a way to further de-politicise the satisfaction of healthcare needs. This article draws from work on political consumerism, health advocacy and social movements to argue for a reframing of IMT not as a 'one-off' statement about or an event external to struggles over access, rights and recognition within medical travellers' home health systems but rather as one of a range of critical forms of on-going engagement embedded within these struggles. To do this, the limited extant empirical work addressing domestic impacts of IMT is reviewed and a case study of Indonesian medical travel to Malaysia is presented. The case study material draws from 85 interviews undertaken in 2007-08 and 2012 with Indonesian and Malaysian respondents involved in IMT as care recipients, formal and informal care-providers, intermediaries, promoters and policy-makers. Evidence from the review and case study suggests that IMT may effect political and social change within medical travellers' home contexts at micro and macro levels by altering the perspectives, habits, expectations and accountability of, and complicity among, medical travellers, their families, communities, formal and informal intermediaries, and medical providers both within and beyond the container of the nation-state. Impacts are conditioned by the ideological foundations underpinning home political and social systems, the status of a medical traveller's ailment or therapy, and the existence of organised support for recognition and
Weck, M. H J; van Hooff, J.; van Sark, W. G J H M
Demand response, defined as the shifting of electricity demand, is generally believed to have value both for the grid and for the market: by matching demand more closely to supply, consumers could profit from lower prices, while in a smart grid environment, more renewable electricity can be used and less grid capacity may be needed. However, the introduction of residential demand response programmes to support the development of smart grids that includes renewable generation is hampered by a ...
Natalia Szozda; Sylwia Werbińska-Wojciechowska
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 plannin...
Weck, M. H J; van Hooff, J.; van Sark, W. G J H M
Demand response, defined as the shifting of electricity demand, is generally believed to have value both for the grid and for the market: by matching demand more closely to supply, consumers could profit from lower prices, while in a smart grid environment, more renewable electricity can be used and
Perianayagam, Arokiasamy; Goli, Srinivas
India’s health care and health financing provision is characterized by too little Government spending on health, meager health insurance coverage, declining public health care use contrasted by highest levels of private out-of-pocket health spending in the world. To understand the interconnectedness of these disturbing outcomes, this paper envisions a theoretical framework of health insurance and health care revisits the existing health insurance schemes and assesses the health insurance cove...
Ranger, N.; Surminski, S.
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
Apajalahti, Eeva-Lotta; Lovio, Raimo; Heiskanen, Eva
Energy conservation is expected to contribute significantly to climate change mitigation and energy security. Traditionally, energy companies have had strong role in providing Demand Side Management (DSM) measures. However, after energy market liberalization in Europe, energy companies' DSM activities declined. In response, the EU issued Directive (2006/32/EC) on energy end-use efficiency and energy services (ESD) to motivate energy companies to promote energy efficiency and conservation, closely followed by Directive (2012/27/EU) on energy efficiency (EED), requiring the setting up energy efficiency obligation schemes. Despite strong political and economic motivation, energy companies struggle to develop energy efficiency services in liberalised energy markets due to conflicting institutional demands, which arise from contradicting policy requirements and customer relations. The main challenges in developing new innovative energy efficiency services, evidenced by an in-depth case study, were (1) the unbundling of energy company operations, which makes it difficult to develop services when the contribution of several business units is required and (2) the distrust among energy end-users, which renders the business logic of energy saving contract models self-contradictory. On the basis of the research, avenues out of these dilemmas are suggested. -- Highlights: •Energy companies struggle to become energy service provides •We explore the development of new energy saving business solutions •Dispersed organisational structure leaves energy saving business as isolated function •Strong consumer scepticism towards energy companies as providers of energy saving •More emphasis on the changing company-customer relationship is needed
Hannon, MJ; Foxon, TJ; Gale, WF
Product-Service Systems (PSSs) constitute a family of service-based business models designed to satisfy our societal needs in an economically and environmentally sustainable manner. To date however PSS application has remained niche due to a variety of critical barriers. This paper explores how ‘demand pull’ national government policies could support PSS activity by addressing these barriers and cultivating market demand. Lessons are drawn from a case study of how regulatory, economic incenti...
Rosenberg, Eva; Lind, Arne; Espegren, Kari Aamodt
Projections of energy demand are an important part of analyses of policies to promote conservation, efficiency, technology implementation and renewable energy production. The development of energy demand is a key driver of the future energy system. This paper presents long-term projections of the Norwegian energy demand as a two-step methodology of first using activities and intensities to calculate a demand of energy services, and secondly use this as input to the energy system model TIMES-Norway to optimize the Norwegian energy system. Long-term energy demand projections are uncertain and the purpose of this paper is to illustrate the impact of different projections on the energy system. The results of the analyses show that decreased energy demand results in a higher renewable fraction compared to an increased demand, and the renewable energy production increases with increased energy demand. The most profitable solution to cover increased demand is to increase the use of bio energy and to implement energy efficiency measures. To increase the wind power production, an increased renewable target or higher electricity export prices have to be fulfilled, in combination with more electricity export. - Highlights: • Projections to 2050 of Norwegian energy demand services, carriers and technologies. • Energy demand services calculated based on intensities and activities. • Energy carriers and technologies analysed by TIMES-Norway. • High renewable target results in more wind power production and electricity export. • Increased energy efficiency is important for a high renewable fraction
Barry, Colleen L; Epstein, Andrew J; Fiellin, David A; Fraenkel, Liana; Busch, Susan H
While there is broad recognition of the high societal costs of substance use disorders (SUD), treatment rates are low. We examined whether, in the United States, participants with substance or alcohol use disorder would report a greater willingness to enter SUD treatment located in a primary care setting (primary care) or more commonly found specialty care setting in the United States (usual care). Randomized survey-embedded experiment. US web-based research panel in which participants were randomized to read one-paragraph vignettes describing treatment in usual care (specialty drug or alcohol treatment center), primary care or collaborative care within a primary care setting. A total of 42 451 panelists aged 18+ were screened for substance or alcohol use disorder using validated diagnostic criteria. Participants included 344 with a substance use disorder and 634 with an alcohol use disorder not in treatment with no prior treatment history. Willingness to enter treatment across vignettes by condition. Among participants with a substance use disorder, 24.6% of those randomized to usual care reported being willing to enter drug treatment compared with 37.2% for primary care [12.6 percentage point difference; 95% confidence interval (CI) = 0.8, 24.4) and 34.0% for collaborative care (9.4 percentage point difference; 95% CI = -2.0, 20.8). Among participants with an alcohol use disorder, 17.6% of those randomized to usual care reported being willing to enter alcohol treatment compared with 20.3% for primary care (2.6 percentage point difference; 95% CI = -4.9, 10.1) and 20.8% for collaborative care (3.1 percentage point difference; 95% CI = -4.3, 10.6). The most common reason for not being willing to enter drug (63%) and alcohol (78%) treatment was the belief that treatment was not needed. In the United States, people diagnosed with substance or alcohol use disorders appear to be more willing to enter treatment in a primary care setting than in a specialty drug
Nigeria has experienced significant increase in economic growth in the last decade yet the health indicators are very poor particularly in the rural sector where ... In addition, improving education among women will enhance the demand for health inputs and improve the health of their children particularly for the poor and ...
Apps, Patricia F.; Kabátek, J.; Rees, Ray; van Soest, A.H.O.
This paper introduces a static structural model of hours of market labor supply, time spent on child care and other domestic work, and bought in child care for married or cohabiting mothers with pre-school age children. The father's behavior is taken as given. The main goal is to analyze the
Despite increases in availability of center based child care and preschool services in Turkey over the last decade, both the supply of services and utilization remain low. There are regional disparities in availability and the majority of children and households remain unserved in terms of child care and preschool services. This report has collected and assessed information on the supply a...
Elovainio, Marko; Heponiemi, Tarja; Kuusio, Hannamaria; Jokela, Markus; Aalto, Anna-Mari; Pekkarinen, Laura; Noro, Anja; Finne-Soveri, Harriet; Kivimäki, Mika; Sinervo, Timo
The association between psychosocial work environment and employee wellbeing has repeatedly been shown. However, as environmental evaluations have typically been self-reported, the observed associations may be attributable to reporting bias. Applying instrumental-variable regression, we used staffing level (the ratio of staff to residents) as an unconfounded instrument for self-reported job demands and job strain to predict various indicators of wellbeing (perceived stress, psychological distress and sleeping problems) among 1525 registered nurses, practical nurses and nursing assistants working in elderly care wards. In ordinary regression, higher self-reported job demands and job strain were associated with increased risk of perceived stress, psychological distress and sleeping problems. The effect estimates for the associations of these psychosocial factors with perceived stress and psychological distress were greater, but less precisely estimated, in an instrumental-variables analysis which took into account only the variation in self-reported job demands and job strain that was explained by staffing level. No association between psychosocial factors and sleeping problems was observed with the instrumental-variable analysis. These results support a causal interpretation of high self-reported job demands and job strain being risk factors for employee wellbeing. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Elbadawi, Ibrahim A
An empirical analysis of the demand for international reserves in the Sudan is presented, based on the error-correction model. This model is parametrically rich enough to allow the division of the effects into long-run influences, short-term adjustments, and proportional equilibrium impacts. Beside addressing conventional issues in reserve demand literature, the model explicitly incorporates the impact on reserve demand of remittances transferred by Sudanese nationals working abroad and the i...
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 ...
Mutambara, J; Dube, I; Matangi, E; Majeke, F
This study was done to find out about animal health service providers and factors that determined demand for community based veterinary service delivery in smallholder sector of Zimbabwe. Focus group discussions and a questionnaire was used to collect data on veterinary services providers and socio-economic factors related to animal health from a sample (N=333) smallholder livestock farmers from Gutu district of Masvingo province in Zimbabwe. Analytical techniques used were descriptive statistics, K-mean cluster analysis and Tobit regression model. Results showed that the majority of farmers (45%) obtained services from both Community Based Animal Health Workers (CBAHWs) and Department of Veterinary Service (DVS), 25% DVS only, 20% used CBAHWs while 10% did not seek any services. Further analysis showed that distance to CBAHW, distance to AHMC and employment status were significantly related to demand for CBAHWs with coefficients of -1.5, 0.7 and -10.3, respectively. The study thus concluded that CBAHW is an alternative animal health service delivery approach already practiced in smallholder farming sectors of Zimbabwe. Socio-economic factors significantly influenced the demand for CBAHW services. Given limited resources by state sponsored veterinary services, it is recommended that the CBAHWs approach should be encouraged as supplementary service provider especially in areas further DVS. These community organizations can be empowered by the state to deliver more improved services based on hygiene and modern science at a relatively low cost to farmers. Copyright © 2013 Elsevier B.V. All rights reserved.
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.
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.
Petridou, E; Gatsoulis, N; Dessypris, N; Skalkidis, Y; Voros, D; Papadimitriou, Y; Trichopoulos, D
To study regionalized acute injury services on an island with high seasonal fluctuation of the population at risk. Of 9432 individuals with traumatic injuries who contacted the hospital during 1996, 1204 were hospitalized. Information was recorded on several injury-related clinical and sociodemographic variables. Possible residual disabilities, 6 months after the injury, were also assessed. Injury Severity Score (ISS), clinical outcome and duration of hospitalization, odds of transfer to other institutions. Non-residents, whether Greek or foreign nationals are hospitalized for shorter periods. Motor vehicle accident victims are hospitalized on average for 15% longer. Injury victims admitted on a Friday are hospitalized for a longer period. Finally, ISS is a powerful positive predictor of duration of hospitalization. Male injury victims, those injured during late night or early morning and patients injured in July are more likely to be transferred to another institution. Age of the patient and ISS are powerful and independent predictors of an unfavourable outcome. The extra demand created by injured tourists is reflected in the seasonality of admissions for injuries. The district hospital of Kerkyra cannot be considered as deficient in comparison to other district hospitals. Nevertheless, the suboptimal function of the hospital, with respect to injuries, is reflected in the high proportion of injured patients transferred when the injury occurs outside the full working schedule of the hospital. Patients with burns, bone fractures or dislocations and head injuries or concussion are transferred with an overall frequency of about 15%--too high to be compatible with a well functioning secondary care institution.
Abt, Robert C.; Abt, Karen L.; Cubbage, Frederick W.; Henderson, Jesse D.
Key factors driving renewable energy demand are state and federal policies requiring the use of renewable feedstocks to produce energy (renewable portfolio standards) and liquid fuels (renewable fuel standards). However, over the next decade, the infrastructure for renewable energy supplies is unlikely to develop as fast as both policy- and market-motivated renewable energy demands. This will favor the use of existing wood as a feedstock in the first wave of bioenergy production. The ability to supply wood over the next decade is a function of the residual utilization, age class structure, and competition from traditional wood users. Using the North Carolina Renewable Portfolio Standard as a case study, combined with assumptions regarding energy efficiency, logging residual utilization, and traditional wood demands over time, we simulate the impacts of increased woody biomass demand on timber markets. We focus on the dynamics resulting from the interaction of short-run demand changes and long-term supply responses. We conclude that logging residuals alone may be unable to meet bioenergy demands from North Carolina's Renewable Portfolio Standard. Thus, small roundwood (pulpwood) may be used to meet remaining bioenergy demands, resulting in increased timber prices and removals; displacement of traditional products; higher forest landowner incomes; and changes in the structure of the forest resource. (author)
Thoumi, Andrea; Udayakumar, Krishna; Drobnick, Elizabeth; Taylor, Andrea; McClellan, Mark
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. Project HOPE—The People-to-People Health Foundation, Inc.
Collister, Barbara; Stein, Glenda; Katz, Deborah; DeBruyn, Joan; Andrusiw, Linda; Cloutier, Sheila
Increasing costs and budget reductions combined with increasing demand from our growing, aging population support the need to ensure that the scarce resources allocated to home care clients match client needs. This article details how Integrated Home Care for the Calgary Zone of Alberta Health Services considered ethical and economic principles and used data from the Resident Assessment Instrument for Home Care (RAI-HC) and case mix indices from the Resource Utilization Groups Version III for Home Care (RUG-III/HC) to formulate service guidelines. These explicit service guidelines formalize and support individual resource allocation decisions made by case managers and provide a consistent and transparent method of allocating limited resources.
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.
Bartholdson, Cecilia; Lützén, Kim; Blomgren, Klas; Pergert, Pernilla
Childhood cancer care involves many ethical concerns. Deciding on treatment levels and providing care that infringes on the child's growing autonomy are known ethical concerns that involve the whole professional team around the child's care. The purpose of this study was to explore healthcare professionals' experiences of participating in ethics case reflection sessions in childhood cancer care. Data collection by observations, individual interviews, and individual encounters. Data analysis were conducted following grounded theory methodology. Healthcare professionals working at a publicly funded children's hospital in Sweden participated in ethics case reflection sessions in which ethical issues concerning clinical cases were reflected on. The children's and their parents' integrity was preserved through measures taken to protect patient identity during ethics case reflection sessions. The study was approved by a regional ethical review board. Consolidating care by clarifying perspectives emerged. Consolidating care entails striving for common care goals and creating a shared view of care and the ethical concern in the specific case. The inter-professional perspectives on the ethical aspects of care are clarified by the participants' articulated views on the case. Different approaches for deliberating ethics are used during the sessions including raising values and making sense, leading to unifying interactions. The findings indicate that ethical concerns could be eased by implementing ethics case reflection sessions. Conflicting perspectives can be turned into unifying interactions in the healthcare professional team with the common aim to achieve good pediatric care. Ethics case reflection sessions is valuable as it permits the discussion of values in healthcare-related issues in childhood cancer care. Clarifying perspectives, on the ethical concerns, enables healthcare professionals to reflect on the most reasonable and ethically defensible care for the child
Dong, Diansheng; Gould, Brian W.
A Quadratic Almost Ideal Demand System is used to examine the structure of food demand for a sample of urban Chinese households. The dual choice of product quality and quantity is accounted for in the econometric model via the inclusion of simultaneously estimated unit-value equations.
te Kulve, Haico; Konrad, Kornelia Elke
Demand articulation plays a central role in innovation processes as it reduces uncertainties for innovating firms and offers guidance in innovation processes. Studies into demand articulation processes have mostly focused on users and user-producer interactions and paid less attention to the role of
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.
Byon, Ha Do; Harrington, Donna; Storr, Carla L; Lipscomb, Jane
Workplace violence research in health care settings using the Job Demands-Resources (JD-R) framework is hindered by the lack of comprehensive examination of the factor structure of the JD-R measure when it includes patient violence. Is patient violence a component of job demands or its own factor as an occupational outcome? Exploratory factor analysis and confirmatory factor analysis were conducted using a sample of direct care workers in the home setting (n = 961). The overall 2-construct JD-R structure persisted. Patient violence was not identified as a separate factor from job demands; rather, two demand factors emerged: violence/emotional and workload/physical demands. Although the three-factor model fits the data, the two-factor model with patient violence being a component of job demands is a parsimonious and effective measurement framework.
1University of Zambia, School of Medicine, Department of Medical Education Development ... University of Zambia ... becoming a growing health challenge in developing ... training of the nurses in chronic care nursing can ... the Corbin and Strauss Chronic Illness Trajectory ... their own with help from teachers both in the.
Verhaak, P.F.M.; Bensing, J.M.; Brink-Muinen, A. van den
Background: There is a large variation between different countries regarding the presentation of psychological symptoms, their diagnosis and treatment in general practice. A possible explanation for such variation might be the conditions of the health care system in different countries. A
Bolhaar, J.A.; van der Klaauw, B.; Lindeboom, M.
We find that asymmetric information is important for the uptake of supplementary private health insurance and health care utilization. We use dynamic panel data models to investigate the sources of asymmetric information and distinguish short-run selection effects into insurance from long-run
van Noort, Leendert Olivier; Schotanus, Fredo; van der Klundert, Joris; Telgen, Jan
In the Netherlands, home care services like district nursing and personal assistance are provided by private service provider organizations and covered by private health insurance companies which bear legal responsibility for purchasing these services. To improve value for money, their procurement
Ahmed, Osman I
With the changing landscape of health care delivery in the United States since the passage of the Patient Protection and Affordable Care Act in 2010, health care organizations have struggled to keep pace with the evolving paradigm, particularly as it pertains to population health management. New nomenclature emerged to describe components of the new environment, and familiar words were put to use in an entirely different context. This article proposes a working framework for activities performed in case management, disease management, care management, and care coordination. The author offers standard working definitions for some of the most frequently used words in the health care industry with the goal of increasing consistency for their use, especially in the backdrop of the Centers for Medicaid & Medicare Services offering a "chronic case management fee" to primary care providers for managing the sickest, high-cost Medicare patients. Health care organizations performing case management, care management, disease management, and care coordination. Road map for consistency among users, in reporting, comparison, and for success of care management/coordination programs. This article offers a working framework for disease managers, case and care managers, and care coordinators. It suggests standard definitions to use for disease management, case management, care management, and care coordination. Moreover, the use of clear terminology will facilitate comparing, contrasting, and evaluating all care programs and increase consistency. The article can improve understanding of care program components and success factors, estimate program value and effectiveness, heighten awareness of consumer engagement tools, recognize current state and challenges for care programs, understand the role of health information technology solutions in care programs, and use information and knowledge gained to assess and improve care programs to design the "next generation" of programs.
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.
Wertenberger, Sydney; Yerardi, Ruth; Drake, Audrey C; Parlier, Renee
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.
Full Text Available Due to the geographical location of Oman in an arid zone, agricultural production depends fully on irrigation. The traditional irrigation systems (Aflaj, sing. falaj supply more than one third of water for agriculture. Falaj is defined in the context of this paper as a canal system which provides water for domestic and agricultural uses. Oman has 3,107 active Aflaj producing about 680 Mm3 of water per year. The main objective of this study was to estimate the irrigation performance of Aflaj in Oman. Falaj al-Dariz and al-Nujaid were chosen as case studies. Both Aflaj are located in an extremely arid environment, where the rainfall is low and evapotranspiration is high. The study utilized an approach to estimate the irrigation performance of Aflaj by considering the falaj as a single unit of irrigation. The irrigation demand/supply ratio (D/S was used in the analysis as a tool of evaluation. Date palm, the dominant crop irrigated by Aflaj, was selected for the analysis. In falaj al-Dariz the date palms were slightly under irrigated on a yearly basis. On a monthly basis, in winter, the D/S was below 0.6 and in summer it was above 1.0. On the other hand, falaj al-Nujaid was supplying too much water than the date palms needed all round the year. In winter the D/S ratio was as low as 0.25. Even in summer, the D/S ratio did not much exceed 1.0.
Hugh M. Grant
Full Text Available In the 11 years since the Romanow Commission warned that the income of physicians was threatening to become a significant driver of Canadian health-care costs, doctors in this country proceeded to chalk up some of their most rapid gains in earnings since the implementation of medicare. Since 2000, the gap between what the average physician makes, and what the average fully employed Canadian worker earns, has diverged like never before. In the last decade, the average doctor went from earning three-and-a-half times the average Canadian worker’s salary, to earning nearly four-and-a-half times as much, a more than 25 per cent relative increase. In constant dollars, today’s average Canadian physician is earning about 30 per cent more than he or she was just a decade ago. All of this has occurred while physicians have actually provided slightly fewer services to patients. Since the implementation of medicare, the payment of doctors has been rather a matter of politics, as provinces became the ultimate paymasters for health-care personnel. The natural result was an ongoing competition between provinces and physicians for public support, each with its own claim to being the guardian of public health care. In the last two decades, however, doctors have succeeded in outmaneuvering governments, marshaling greater public support for higher pay for their work, even as provinces have been more often viewed as underfunding basic health care needs. There are signs that this may have finally gone too far: Ontario was recently able to freeze remuneration for doctors in a negotiated contract deal and Alberta shortly after imposed a unilateral settlement on its doctors after breaking off negotiations. Stories about “millionaire doctors” are now proliferating in the mainstream media and, as provinces across the countries struggle with deficits, the public’s sympathy appears to be shifting. There were periods, during the ’70s and ’90s, when governments
Ibragimov, M; Ibragimov, R; Kattuman, Paul Antony; Ma, J
This paper extends Ibragimov and Ibragimov (Econ Theory 32:579–587, 2007) in which the effect of changes income inequality on the price elasticity of market demand is characterized for the class of income distribution changes occurring through non-intersecting Lorenz curve shifts. We derive sufficient conditions for increase/decrease in price elasticity of market demand, under general changes in income distribution, allowing Lorenz curves to intersect as they shift. We conclude by drawing out...
Franziska L Ohnsorge; Nienke Oomes
Money demand in dollarized economies often appears to be highly unstable, making it difficult to forecast and control inflation. In this paper, we show that a stable money demand function for Russia can be found for "effective broad money," which includes an estimate of foreign cash holdings. Moreover, we find that an excess supply of effective broad money is inflationary, while other excess money measures are not, and that effective broad money growth has the strongest and most persistent ef...
Bjørnland, Hilde C.
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...
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.
The National Energy Board regulates the construction and operation of interprovincial and international oil and gas pipelines and power lines as well as the tolls and tariffs for the pipelines under its jurisdictions. The import and export of natural gas is also regulated by the NEB. The NEB examined the possible energy futures that might unfold for Canadians up to the year 2020. The factors that affect the supply of crude oil, natural gas, liquefied natural gas, electricity and coal in the short term were examined to determine the outlook for deliverability through 2020. The growing demand for energy was reviewed along with the adequacy of future energy supplies, and related issues of emerging technologies, energy infrastructure and energy exports. This assessment provided separate production outlooks for hydrocarbons, electricity and coal and outlined the key uncertainties to the supply outlook. The likely impact of recent economic, energy and policy trends on energy demand and supply were considered. It was concluded that energy markets in Canada will continue to function well. Energy prices will provide appropriate market signals for the development of energy resources to meet Canadian and export demand. A significant portion of Canadian demand for energy will be met by fossil fuels. However, the demand to move towards greener energy fuels should result in fewer greenhouse gas emissions. 1 tab., 27 figs.
H.P. van Dalen (Hendrik)
textabstractDoes medical insurance affect health care demand and in the end contribute to improvements in the health status? Evidence for China for the year 2004, by means of the China Health and Nutrition Survey (CHNS), shows that health insurance does not affect health care demand in a significant
Neumann, Anke; Holstein, Josiane; Le Gall, Jean-Roger; Lepage, Eric
The purpose of this paper is to investigate the suitability of boosted decision trees for the case-mix adjustment involved in comparing the performance of various health care entities. First, we present logistic regression, decision trees, and boosted decision trees in a unified framework. Second, we study in detail their application for two common performance indicators, the mortality rate in intensive care and the rate of potentially avoidable hospital readmissions. For both examples the technique of boosting decision trees outperformed standard prognostic models, in particular linear logistic regression models, with regard to predictive power. On the other hand, boosting decision trees was computationally demanding and the resulting models were rather complex and needed additional tools for interpretation. Boosting decision trees represents a powerful tool for case-mix adjustment in health care performance measurement. Depending on the specific priorities set in each context, the gain in predictive power might compensate for the inconvenience in the use of boosted decision trees.
Full Text Available Money exogeneity, stable money demand and its interest rates elasticity is basic condition of central banks’ monetary policy implementation and efficiency. The stable money demand function ensures that the money supply would have predictable impact on the macroeconomic variables such as inflation and real economic growth.This article deals with the money demand estimation under the keynesisan and postkeynesian theoretical approaches. Although central banks may have certain control over the money supply, they cannot fix the stock of money in a country, caused by multiplier effect of deposits. Different trends in monetary aggregates fluctuation contribute to reject the money exogeneity hypothesis. The author applies the CUSUM and Hansen’s stability tests to identify instability in the models of the Czech Republic and Eurozone.
This article summarises the evidence for an oil price shock and argues that oil producers, both OPEC and non-OPEC, need to cut back oil production more, in order to conserve oil for the future and to avert sudden extreme movements in oil prices in the next five-to-ten years. Four physical fundamentals determine long-run changes in oil prices: supply, demand, technology and substitutes. We show that supply, technology and substitutes are limited and demand is growing strongly. As demand pushes against supply, prices will rise rapidly. It would be better to conserve oil now, in order to have a smoother transition to higher-priced oil in the future. In addition, oil is such a valuable resource for the worlds economies in general, that we should conserve it for future generations. The world, in its haste for economic growth, should support OPEC conservation efforts. (author)
Yalçıntaş, Murat; Bulu, Melih; Küçükvar, Murat; Samadi, Hamidreza
Yayın, Endüstri Mühendisliği Bölümü ile ortak hazırlanmıştır; ancak tekrara düşmemek için ilk yazarın bölümü alınmıştır. 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, usi...
This paper estimates the demand for road fuel (petrol and auto-diesel) in the context of a small developing economy-Sri Lanka. The data set covers a period of 39 years from 1964 to 2002 representing both close economy and open economy policy regimes. The estimation procedure is based on seemingly unrelated regression equation (SURE) methodology mainly to capture substitutability of petrol and diesel in road transportation. The effect of auto-fuel prices on vehicle demand is also analyzed as a part of the analysis. In addition to confirming existing evidence on road-fuel demand, the findings reveal some interesting evidence with respect to own-price elasticity, cross-price elasticity, lag effects, income and vehicle mix variables
Gillian C. Scrymgeour
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.
de Graaf-Ruizendaal, Willemijn A; de Bakker, Dinny H
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 primary care and supply is missing. The research goal is to examine the construction of a decision tool which enables healthcare planners to analyse local supply and demand in order to arrive at a better match. National sample-based medical record data of general practitioners (GPs) were used to predict the local demand for GP care based on local populations using a synthetic estimation technique. Next, the surplus or deficit in local GP supply were calculated using the national GP registry. Subsequently, a dynamic internet tool was built to present demand, supply and the confrontation between supply and demand regarding GP care for local areas and their surroundings in the Netherlands. Regression analysis showed a significant relationship between sociodemographic predictors of postcode areas and GP consultation time (F [14, 269,467] = 2,852.24; P 1,000 inhabitants in the Netherlands covering 97% of the total population. Confronting these estimated demand figures with the actual GP supply resulted in the average GP workload and the number of full-time equivalent (FTE) GP too much/too few for local areas to cover the demand for GP care. An estimated shortage of one FTE GP or more was prevalent in about 19% of the postcode areas with >1,000 inhabitants if the surrounding postcode areas were taken into consideration. Underserved areas were mainly found in rural regions. The constructed decision tool is freely accessible on the Internet and can be used as a starting point in the discussion on primary care service provision in local communities and it can make a considerable contribution to a primary care system which provides care when and where people need it.
In the early 2000s, the Republic of Turkey has initiated an ambitious reform program in her electricity market, which requires privatization, liberalization as well as a radical restructuring. The most controversial reason behind, or justification for, recent reforms has been the rapid electricity demand growth; that is to say, the whole reform process has been a part of the endeavors to avoid the so-called 'energy crisis'. Using cointegration analysis and autoregressive integrated moving average (ARIMA) modelling, the present article focuses on this issue by both providing an electricity demand estimation and forecast, and comparing the results with official projections. The study concludes, first, that consumers' respond to price and income changes is quite limited and therefore there is a need for economic regulation in Turkish electricity market; and second, that the current official electricity demand projections highly overestimate the electricity demand, which may endanger the development of both a coherent energy policy in general and a healthy electricity market in particular
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...... of dealing with congestion problems, which might prove more sustainable and resilient in the long run....
de Vries, Siebrich; Roorda, Gerrit
Activating and cognitively demanding teaching behavior is problematic for many teachers in Dutch secondary education, in particular for the less experienced advanced beginners. In the context of a Professional Learning Community (PLC) for both less and more experienced teachers of mathematics,
Carbajales, Alejandro Ramos; Curti, Dardo
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.
Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle
Hospitals need to understand patient flows in an increasingly competitive health economy. New initiatives like Patient Choice and the Darzi Review further increase this demand. Essential to understanding patient flows are demographic and geographic profiles of health care service providers, known as 'catchment areas' and 'catchment populations'. This information helps Primary Care Trusts (PCTs) to review how their populations are accessing services, measure inequalities and commission services; likewise it assists Secondary Care Providers (SCPs) to measure and assess potential gains in market share, redesign services, evaluate admission thresholds and plan financial budgets. Unlike PCTs, SCPs do not operate within fixed geographic boundaries. Traditionally, SCPs have used administrative boundaries or arbitrary drive times to model catchment areas. Neither approach satisfactorily represents current patient flows. Furthermore, these techniques are time-consuming and can be challenging for healthcare managers to exploit. This paper presents three different approaches to define catchment areas, each more detailed than the previous method. The first approach 'First Past the Post' defines catchment areas by allocating a dominant SCP to each Census Output Area (OA). The SCP with the highest proportion of activity within each OA is considered the dominant SCP. The second approach 'Proportional Flow' allocates activity proportionally to each OA. This approach allows for cross-boundary flows to be captured in a catchment area. The third and final approach uses a gravity model to define a catchment area, which incorporates drive or travel time into the analysis. Comparing approaches helps healthcare providers to understand whether using more traditional and simplistic approaches to define catchment areas and populations achieves the same or similar results as complex mathematical modelling. This paper has demonstrated, using a case study of Manchester, that when estimating
Huang, Hui-Man; Liao, Chi-Chun
Nurses are expected to discharge their duty of care effectively and professionally to prevent medical negligence. Only three articles have previously focused on medical negligence. Duty of care and medical negligence in nursing are topics that have been neglected in Taiwan. (1) Classify the duty of care of professional nurses; (2) Investigate the facts and disputes in the current case; (3) Clarify the legal issues involved with regard to duty-of-care violations in the current case; (4) Explore the causal relationships in a legal context between nurses' duty-of-care violations and patient harm / injury. Literature analysis and a case study are used to analyze Supreme Court Verdict No.5550 (2010). Duty of care for nursing professionals may be classified into seven broad categories. Each category has its distinct correlatives. In nursing practice, every nursing behavior has a corresponding duty. In this case, the case study nurse did not discharge her obstetric professional duty and failed to inform the doctor in a timely manner. Negligence resulted in prenatal death and the case study nurse was found guilty. In order to prevent committing a crime, nurses should gain a better understanding of their duty of care and adequately discharge these duties in daily practice.
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.
Boehmer, Kasey R; Shippee, Nathan D; Beebe, Timothy J; Montori, Victor M
Chronic conditions burden patients with illness and treatments. We know little about the disruption of life by the work of dialysis in relation to the resources patients can mobilize, that is, their capacity, to deal with such demands. We sought to determine the disruption of life by dialysis and its relation to patient capacity to cope. We administered a survey to 137 patients on dialysis at an academic medical center. We captured disruption from illness and treatment, and physical, mental, personal, social, financial, and environmental aspects of patient capacity using validated scales. Covariates included number of prescriptions, hours spent on health care, existence of dependents, age, sex, and income level. On average, patients reported levels of capacity and disruption comparable to published levels. In multivariate regression models, limited physical, financial, and mental capacity were significantly associated with greater disruption. Patients in the top quartile of disruption had lower-than-expected physical, financial, and mental capacity. Our sample generally had capacity comparable to other populations and may be able to meet the demands imposed by treatment. Those with reduced physical, financial, and mental capacity reported higher disruption and represent a vulnerable group that may benefit from innovations in minimally disruptive medicine. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
Zito, Margherita; Colombo, Lara; Mura, Gabriella
Work-family conflict (wfc), that originates from an incompatibility between the job and the family demands, is a very relevant topic in health care context, as suggested by NEXT study. Work overload and schedule organization are dimensions that can affect wfc, and particularly, studies indicate work shifts as one of its main determinants, as they limit the work-family balance and represent one of the prime risk factors for workers' health. The aim of this study was to detect the role of some job demands (both general and specific) and of schedule organization in determining the wfc experience, with particular attention to work shifts. Respondents to our questionnaire are 207 nurses of a north Italian public health organization. They are mostly women (92.8%) and their average age is 42. Data analysis shows that wfc is mostly influenced by work shifts, but also by work overload, cognitive load and by on-call availability. Staff working on shifts and on-call availability perceive a higher wfc than their colleagues without work shifts and on-call availability. The central role of work shifts in determining wfc suggests the need to act on schedule organization and on training programs for supervisors and workers.
Gumrah, F.; Katircioglu, D.; Aykan, Y.; Okumus, S.; Kilincer, N.
The demand for natural gas is rapidly increasing in Turkey, as it is in the rest of the world. However, natural gas reserves and production are rather limited in Turkey.The bulk of the Turkish gas demand is met by imports. Russia currently accounts for 69% of Turkey's gas supplies. Physical shortages might occur; supplies for industrial production and household consumption could temporarily run short. Also, fluctuations in consumption might occur due to climatic reasons or peak daily industrial energy demand. Underground gas storage is a necessity in order to regulate these seasonal, daily, and hourly fluctuations. In order to effectively design and utilize underground gas storage, it is necessary to identify the market requirements. In this study, Ankara was chosen as a pilot region due to its strategical importance of being the capital city of Turkey, and a wide range of marketing surveys for the last seven years was performed. All of the factors influencing the gas consumption and the relationships between these factors were analyzed. How does gas demand behave in extremely cold weather? How does the industrial part of the city act in the consumption behavior? What are the plans of the Municipality of Ankara, responsible for the execution of the natural gas distribution project in Ankara? A model was developed based on degree-day (DD) concept, including the annual number of customers, average DDs, and the usage per customer. A history matching study was performed to verify the results of the model with the measured consumption data for the last seven years. Comparisons showed that the calculated consumption by DD model and measured daily consumption were in good agreement. Finally, by using the developed approach, the gas demand was forecasted for Ankara up to 2005. The results of this study can be used to design underground gas storage facility near Ankara. (author)
Hwang, Lisa Alice; Kuo, Chih-Yin; Yang, Jung-Wu; Chiang, Wei-Fan
Compound odontomas are common odontogenic tumors associated with permanent tooth impaction in the premaxilla. This report describes the case of a 14-year-old girl with an odontoma-associated impaction over the premaxilla that was treated using autotransplantation to satisfy an immediate esthetic demand. At postoperative follow-up conducted in the 14th month, a satisfactory cosmetic appearance with a healthy periodontal status was observed. In addition, the authors discuss the possible complications of autotransplantation and different treatment strategies for odontoma-associated impaction and for correcting bone defects in this case report. Autotransplantation for treating odontoma-associated impaction can be an alternative solution for satisfying an immediate cosmetic demand and providing a favorable outcome. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
Sharkey, Alyssa B; Martin, Sandrine; Cerveau, Teresa; Wetzler, Erica; Berzal, Rocio
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.
Miller, Amalia R.; Tucker, Catherine Elizabeth
Given the demand for authentic personal interactions over social media, it is unclear how much firms should actively manage their social media presence. We study this question empirically in a health care setting. We show that active social media management drives more user-generated content. However, we find that this is due to an incremental increase in user postings from an organization's employees rather than from its clients. This result holds when we explore exogenous variation in socia...
Röder, Mirjam; Thornley, Patricia; Campbell, Grant; Bows-Larkin, Alice
Highlights: • Conflicts between adapting to climate change, food security and reducing emissions. • Climate change likely to limit wheat production in the southern hemisphere. • Climate change yield benefits marginally increase emissions per unit of product. • Improved yield will result in higher total production emissions. • Production-based inventories discourage an increase in production. - Abstract: Climate change, population growth and socio-structural changes will make meeting future food demands extremely challenging. As wheat is a globally traded food commodity central to the food security of many nations, this paper uses it as an example to explore the impact of climate change on global food supply and quantify the resulting greenhouse gas emissions. Published data on projected wheat production is used to analyse how global production can be increased to match projected demand. The results show that the largest projected wheat demand increases are in areas most likely to suffer severe climate change impacts, but that global demand could be met if northern hemisphere producers exploit climate change benefits to increase production and narrow their yield gaps. Life cycle assessment of different climate change scenarios shows that in the case of one of the most important wheat producers (the UK) it may be possible to improve yields with an increase of only 0.6% in the emission intensity per unit of wheat produced in a 2 °C scenario. However, UK production would need to rise substantially, increasing total UK wheat production emissions by 26%. This demonstrates how national emission inventories and associated targets do not incentivise minimisation of global greenhouse gas emissions while meeting increased food demands, highlighting a triad of challenges: meeting the rising demand for food, adapting to climate change and reducing emissions
de Blok, Carolien; Meijboom, Bert; Luijkx, Katrien; Schols, Jos
Practical implementation of notions such as patient-orientation, client-centredness, and demand-driven care is far from straightforward in care and service supply to elderly clients living independently. This paper aims to provide preliminary insights into how it is possible to bridge the gap between policy intent, which reflects an increasing client orientation, and actual practice of care and service provision. Differences in personal objectives and characteristics generate different sets of needs among elderly clients that must have an appropriate response in the daily routines of care and service providers. From a study of the available literature and by conceptual reasoning, we identify several important operational implications of client-oriented care and service provision. To deal with these implications the authors turn to the field of operations management. This field has deepened the understanding of translating an organisation's policy into daily activities and working methods. More specifically, we elaborate on the concept of modularity, which stems from the field of operations management. With respect to elderly people who live independently, this concept, among others, seems to be particularly useful in providing options and variation in individual care and service packages. Based on our line of reasoning, we propose that modularity provides possibilities to enhance the provision of demand-based care and services. Furthermore, our findings offer direction on how organisations in housing, welfare and care can be guided in translating demand-based care to their operational processes.
Kocakülâh, Mehmet C; Austill, A David
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.
Yu Hsing (Southeastern Louisiana Univ., Hammond, LA (US). Dept. of Economics)
This paper tests the variable elasticity of the demand for gasoline by applying the well-known Box-Cox extended autoregressive (BCEA) model of Savin and White. This model can simultaneously test for functional form and autocorrelation in a time-series regression. Major findings are the log-linear form chosen a priori in most of previous studies can be rejected in favour of the BCEA model; long-run price elasticities varied from -1.118 in 1973 to -0.290 in 1981; and long-run income elasticities declined consistently from 0.944 in 1960 to 0.452 in 1985. These findings have policy implications for more accurate forecast of gasoline demand, gasoline taxes, energy conservation and others. (author).
Nuno Carlos LEITÃO
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.
Pablo Andres Neumeyer; Martín Gonzalez Rozada
This objective of this paper is to estimate the elasticity of substitution in the demand for non-tradable goods relative to tradable goods in Argentina. This parameter plays a crucial role in the analysis of the macroeconomic equilibrium of a small open economy (Mendoza, Galindo and Izquierdo (2003)). Using two data sets we found estimates for this elasticity of, approximately, 0.40 and 0.48.
Carnegie, Rachel Alison
Booming economic growth and rising consumer incomes have impacted food preferences and purchasing behavior in China. At the same time, several internationally publicized food safety incidents, particularly in the animal husbandry sector, have heightened awareness of and concern for food safety and quality in meat and dairy. Rising quality demand and safety concerns have been studied at length in the food retail sector, but also appear to be important in the food service industry. This researc...
Birner, Regina; Anderson, Jock R.
"Many countries have recognized the need to revive agricultural advisory or extension services (the terms are used interchangeably here) as a means of using agriculture as an engine of pro-poor growth; reaching marginalized, poor, and female farmers; and addressing new challenges, such as environmental degradation and climate change. In spite of ample experience with extension reform worldwide, identifying the reform options most likely to make extension more demand-driven remains a major cha...
EPAPHRA, Manamba; JILENGA, Moga Tano
Abstract. This paper estimates the magnitude of, and changes to the subterranean economy in Tanzania, as well as its adverse effect on tax revenue during the 1966-2015 period. To achieve this objective, the paper applies currency -ratio due to Gutmann and the traditional currency-demand approach à la Tanzi. Despite their differences, both approaches suggest the existence of a substantial size of the subterranean economy in Tanzania. This persistent large size of the subterranean economy is an...
Meredith Loomis Quinlan
Full Text Available Through face-to-face conversations and open-ended questions designed to elicit stories and deeper interactions, the Michigan People’s Campaign (MPC may have altered voting patterns more effectively than using traditional electoral engagement strategies. During the 2016 election, by campaigning on issues of family care, MPC helped elect a progressive state house candidate in a Downriver Detroit district that Republican presidential candidate Donald Trump carried by over 6,000 votes.
Alonso, Elisa; Sherman, Andrew M; Wallington, Timothy J; Everson, Mark P; Field, Frank R; Roth, Richard; Kirchain, Randolph E
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.
Full Text Available Highly efficient cogeneration and district heating systems have a significant potential for primary energy savings and the reduction of greenhouse gas emissions through the utilization of a waste heat and renewable energy sources. These potentials are still highly underutilized in most European countries. They also play a key role in the planning of future energy systems due to their positive impact on the increase of integration of intermittent renewable energy sources, for example wind and solar in a combination with power to heat technologies. In order to ensure optimal levels of district heating penetration into an energy system, a comprehensive analysis is necessary to determine the actual demands and the potential energy supply. Economical analysis of the grid expansion by using the GIS based mapping methods hasn’t been demonstrated so far. This paper presents a heat demand mapping methodology and the use of its output for the district heating network expansion analysis. The result are showing that more than 59% of the heat demand could be covered by the district heating in the city of Velika Gorica, which is two times more than the present share. The most important reason of the district heating's unfulfilled potential is already existing natural gas infrastructure.
Dorotić, Hrvoje; Novosel, Tomislav; Duić, Neven; Pukšec, Tomislav
Highly efficient cogeneration and district heating systems have a significant potential for primary energy savings and the reduction of greenhouse gas emissions through the utilization of a waste heat and renewable energy sources. These potentials are still highly underutilized in most European countries. They also play a key role in the planning of future energy systems due to their positive impact on the increase of integration of intermittent renewable energy sources, for example wind and solar in a combination with power to heat technologies. In order to ensure optimal levels of district heating penetration into an energy system, a comprehensive analysis is necessary to determine the actual demands and the potential energy supply. Economical analysis of the grid expansion by using the GIS based mapping methods hasn't been demonstrated so far. This paper presents a heat demand mapping methodology and the use of its output for the district heating network expansion analysis. The result are showing that more than 59% of the heat demand could be covered by the district heating in the city of Velika Gorica, which is two times more than the present share. The most important reason of the district heating's unfulfilled potential is already existing natural gas infrastructure.
Full Text Available Various factors can make predicting bus passenger demand uncertain. In this study, a bilevel programming model for optimizing bus frequencies based on uncertain bus passenger demand is formulated. There are two terms constituting the upper-level objective. The first is transit network cost, consisting of the passengers’ expected travel time and operating costs, and the second is transit network robustness performance, indicated by the variance in passenger travel time. The second term reflects the risk aversion of decision maker, and it can make the most uncertain demand be met by the bus operation with the optimal transit frequency. With transit link’s proportional flow eigenvalues (mean and covariance obtained from the lower-level model, the upper-level objective is formulated by the analytical method. In the lower-level model, the above two eigenvalues are calculated by analyzing the propagation of mean transit trips and their variation in the optimal strategy transit assignment process. The genetic algorithm (GA used to solve the model is tested in an example network. Finally, the model is applied to determining optimal bus frequencies in the city of Liupanshui, China. The total cost of the transit system in Liupanshui can be reduced by about 6% via this method.
morteza tahami pour zarandi
Full Text Available Limitations in water supply to meet the increasing demand have encouraged both planners and researchers to focus attention on water demand management, in which such economic tools as the water pricing system play a major role. A fundamental component of the pricing system is the estimation of the economic value of water, which reflects a firm’s maximum affordable water price or the ultimate elasticity of industrial water. The present study was conducted to estimate the economic value of water for basic chemical plants, excluding fertilizers and nitrogen compounds (code 2411, representing the four-digit ISIC industrial codes which account for about 14% of the total industrial water consumption. The econometric method of production function within the framework of panel data and the residual method were used. Data were collected from the Census of medium-sized businesses carried out by the Statistical Center of Iran over the period 1997–2013. Results showed that one cubic meter of water allocated to the plants surveyed creates a value of 3,7071 Rials, which shows a large gap with the current purchase price of 5685 Rials. Moreover, it was found that the present water prices account for only about 1.3 percent of the total production cost of basic chemicals, excluding fertilizers and nitrogen compounds. It may, thus, be concluded that it is reasonable to increase the present water tariffs and discriminate among the various manufacturing codes by differences in tariffs in order to achieve water demand management goals. Finally, the information emerging from the study may be exploited to improve the revenues earned by water authorities or to carry out feasibility studies of industrial water development projects.
Tak Cheung CHAN
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.
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.
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.
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.
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.
Battke, Benedikt; Schmidt, Tobias S.
Highlights: • A definition of multi-purpose technologies (MPTs) is proposed. • Opportunities for a cost-efficient demand-pull policy strategy for MPTs are derived. • The multi-purpose character of stationary electricity storage (SES) is shown. • An exemplary profitability assessment of one SES technology supports the argument. - Abstract: Stationary electricity storage technologies (SES) allow to increase the shares of intermittent renewable energy technologies in electricity networks. As SES currently exhibit high costs, policy makers have started introducing demand-pull policies in order to foster their diffusion and drive these technologies further down the learning curve. However, as observed in the case of renewable energy technologies, demand-pull policies for technologies can come at high costs in cases where the profitability gap that needs to be covered by the policy support is large. Yet, SES can create value in multiple distinct applications in the power system – making it a “multi-purpose technology”. We argue that policy makers can make use of the multi-purpose character of SES to limit costs of demand-pull policies. We propose a policy strategy which grants support based on the profitability gap in the different applications, thereby moving down the learning curve efficiently. To support our argumentation, we firstly conduct a comprehensive literature review of SES applications exemplifying the multi-purpose character of these technologies. Second, we assess the profitability of one SES technology (vanadium redox flow battery) in five SES applications, highlighting a strong variation of the profitability gap across these applications
Reardon, Cillian; Tobin, Daniel P.; Tierney, Peter; Delahunt, Eamonn
A number of studies have used global positioning systems (GPS) to report on positional differences in the physical game demands of rugby union both on an average and singular bout basis. However, the ability of these studies to report quantitative data is limited by a lack of validation of certain aspects of measurement by GPS micro-technology. Furthermore no study has analyzed the positional physical demands of the longest bouts of ball-in-play time in rugby union. The aim of the present study is to compare the demands of the single longest period of ball-in-play, termed “worst case scenario” (WCS) between positional groups, which have previously been reported to have distinguishable game demands. The results of this study indicate that WCS periods follow a similar sporadic pattern as average demands but are played at a far higher pace than previously reported for average game demands with average meters per minute of 116.8 m. The positional differences in running and collision activity previously reported are perpetuated within WCS periods. Backs covered greater total distances than forwards (318 m vs 289 m), carried out more high-speed running (11.1 m·min-1 vs 5.5 m·min-1) and achieved higher maximum velocities (MaxVel). Outside Backs achieved the highest MaxVel values (6.84 m·sec-1). Tight Five and Back Row forwards underwent significantly more collisions than Inside Back and Outside Backs (0.73 & 0.89 collisions·min-1 vs 0.28 & 0.41 collisions·min-1 respectively). The results of the present study provide information on the positional physical requirements of performance in prolonged periods involving multiple high intensity bursts of effort. Although the current state of GPS micro-technology as a measurement tool does not permit reporting of collision intensity or acceleration data, the combined use of video and GPS provides valuable information to the practitioner. This can be used to match and replicate game demands in training. PMID:28510582
Full Text Available A number of studies have used global positioning systems (GPS to report on positional differences in the physical game demands of rugby union both on an average and singular bout basis. However, the ability of these studies to report quantitative data is limited by a lack of validation of certain aspects of measurement by GPS micro-technology. Furthermore no study has analyzed the positional physical demands of the longest bouts of ball-in-play time in rugby union. The aim of the present study is to compare the demands of the single longest period of ball-in-play, termed "worst case scenario" (WCS between positional groups, which have previously been reported to have distinguishable game demands. The results of this study indicate that WCS periods follow a similar sporadic pattern as average demands but are played at a far higher pace than previously reported for average game demands with average meters per minute of 116.8 m. The positional differences in running and collision activity previously reported are perpetuated within WCS periods. Backs covered greater total distances than forwards (318 m vs 289 m, carried out more high-speed running (11.1 m·min-1 vs 5.5 m·min-1 and achieved higher maximum velocities (MaxVel. Outside Backs achieved the highest MaxVel values (6.84 m·sec-1. Tight Five and Back Row forwards underwent significantly more collisions than Inside Back and Outside Backs (0.73 & 0.89 collisions·min-1 vs 0.28 & 0.41 collisions·min-1 respectively. The results of the present study provide information on the positional physical requirements of performance in prolonged periods involving multiple high intensity bursts of effort. Although the current state of GPS micro-technology as a measurement tool does not permit reporting of collision intensity or acceleration data, the combined use of video and GPS provides valuable information to the practitioner. This can be used to match and replicate game demands in training.
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
Schmidt, Jean-Olivier; Ensor, Tim; Hossain, Atia; Khan, Salam
Demand side financing (DSF) mechanisms transfer purchasing power to specified groups for defined goods and services in order to increase access to specified services. This is an important innovation in health care systems where access remains poor despite substantial subsidies towards the supply side. In Bangladesh, a maternal health DSF pilot in 33 sub-districts was launched in 2007. We report the results of a rapid review of this scheme undertaken during 2008 after 1 year of its setup. Quantitative data collected by DSF committees, facilities and national information systems were assessed alongside qualitative data, i.e. key informant interviews and focus group discussions with beneficiaries and health service providers on the operation of the scheme in 6 sub-districts. The scheme provides vouchers to women distributed by health workers that entitle mainly poor women to receive skilled care at home or a facility and also provide payments for transport and food. After initial setbacks voucher distribution rose quickly. The data also suggest that the rise in facility based delivery appeared to be more rapid in DSF than in other non-DSF areas, although the methods do not allow for a strict causal attribution as there might be co-founding effects. Fears that the financial incentives for surgical delivery would lead to an over emphasis on Caesarean section appear to be unfounded although the trends need further monitoring. DSF provides substantial additional funding to facilities but remains complex to administer, requiring a parallel administrative mechanism putting additional work burden on the health workers. There is little evidence that the mechanism encourages competition due to the limited provision of health care services. The main question outstanding is whether the achievements of the DSF scheme could be achieved more efficiently by adapting the regular government funding rather than creating an entirely new mechanism. Also, improving the quality of health
Mataria, Awad; Luchini, Stéphane; Daoud, Yousef; Moatti, Jean-Paul
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. John Wiley & Sons, Ltd.
Full Text Available Interest in burnout has developed extensively worldwide, but there is scarce the literature regarding the consequences that new legal demands have on burnout and on organizational outcomes in physicians. The global context of the medical profession has been characterized in the recent years by changes in the employment patterns, profound intensification of work, and increment of labor flexibility. In this context, the study aims to analyze the influence of burnout on organizational outcomes in physicians, depending on new legal demands perception in Ecuador. Regarding the method, the research was cross sectional and in the first stage, studied the psychometric characteristics, validity and reliability of the instrument to assess burnout through a series of confirmatory factor analyses (CFA. In a second part, we assessed, the robustness of the model of causal relations between the burnout dimensions and organizational outcomes. We carried out a series of path analysis, structural equation model. The study was accomplished in five hospitals and the sample was incidental, comprising 435 physicians from Ecuador. We divided the group in two subcategories, Sample A, composed by participants that considered that new Criminal Code (COIP affects them and the Sample B, the group of physicians who believed that the COIP does not affect them. Burnout was assessed with the Spanish adaptation of the Maslach Burnout Inventory (MBI, the Organizational outcomes were measured with a seven-item self-report questionnaire, and we included an item regarding to the influence of new Criminal Code. We formulated four hypotheses, that considered that physicians who believed that the COIP affect them experience a greater negative influence of burnout on organizational outcomes. The results indicated that the group of physicians who believed that the COIP affects them (Sample A experienced a greater negative influence of cynicism on productivity than Sample B. Moreover
Interest in burnout has developed extensively worldwide, but there is scarce the literature regarding the consequences that new legal demands have on burnout and on organizational outcomes in physicians. The global context of the medical profession has been characterized in the recent years by changes in the employment patterns, profound intensification of work, and increment of labor flexibility. In this context, the study aims to analyze the influence of burnout on organizational outcomes in physicians, depending on new legal demands perception in Ecuador. Regarding the method, the research was cross sectional and in the first stage, studied the psychometric characteristics, validity and reliability of the instrument to assess burnout through a series of confirmatory factor analyses (CFA). In a second part, we assessed, the robustness of the model of causal relations between the burnout dimensions and organizational outcomes. We carried out a series of path analysis, structural equation model. The study was accomplished in five hospitals and the sample was incidental, comprising 435 physicians from Ecuador. We divided the group in two subcategories, Sample A, composed by participants that considered that new Criminal Code (COIP) affects them and the Sample B, the group of physicians who believed that the COIP does not affect them. Burnout was assessed with the Spanish adaptation of the Maslach Burnout Inventory (MBI), the Organizational outcomes were measured with a seven-item self-report questionnaire, and we included an item regarding to the influence of new Criminal Code. We formulated four hypotheses, that considered that physicians who believed that the COIP affect them experience a greater negative influence of burnout on organizational outcomes. The results indicated that the group of physicians who believed that the COIP affects them (Sample A) experienced a greater negative influence of cynicism on productivity than Sample B. Moreover, the lack of
Kiss, P.; Janosi, I. M.; Varga, L.
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 base load 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. (author)
Imre M. Jánosi
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.
Makowski, Marcin; Piotrowski, Edward W.; Sładkowski, Jan; Syska, Jacek
We consider properties of the measurement intensity ρ of a random variable for which the probability density function represented by the corresponding Wigner function attains negative values on a part of the domain. We consider a simple economic interpretation of this problem. This model is used to present the applicability of the method to the analysis of the negative probability on markets where there are anomalies in the law of supply and demand (e.g. Giffen's goods). It turns out that the new conditions to optimize the intensity ρ require a new strategy. We propose a strategy (so-called à rebours strategy) based on the fixed point method and explore its effectiveness.
Lee, Wen-Yi; Kuo, Shu-Yu
The use of illegal drugs in Taiwan is on the rise. Drug addicts often have complex physical, psychological, and social problems. In addition, they often avoid disclosing their illicit drug use by deceit, concealment, or under-reporting. Building and maintaining relationships of trust with drug-addict patients has become a critical issue in achieving better care quality. In this case report, we report on an anesthesia care process for a heroin addict who was admitted for open reduction and internal fixation surgery for the femur and patella fractures after a car accident. During the six-hour perioperative care period, starting from 11pm on November 30th to 5am on December 1st, 2015, the patient was not willing to disclose his illicit drug use before the surgery. However, the nurse anesthetist noticed signs and symptoms of drug use. The nurse empathized with the patient's worries, provided him with a safe communication environment, and gained trust from the patient in a timely manner, which then enabled the patient to fully disclose his illicit drug use with the nurse anesthetist. The anesthesia-care strategy was then modified according to client's condition. The nurse anesthetist played an important role of bridging communications between the patient and medical care staffs and of modifying the care strategies in a timely manner. During the care period, the blood-borne disease contamination was successfully prevented, the client received uneventful pain management, there was a lack of withdrawal symptoms, and the staffs and patient safety was maintained. The literature on the anesthetic care of heroin patients undergoing surgery is relatively limited in Taiwan. The findings in the current case report add information on providing anesthetic care to patients with drug addiction. Publishing additional case reports, research, and clinical recommendations is essential for improving care quality for this vulnerable population.
The advance of reproductive technologies, like surrogacy arrangements, confronts courts with new demands and dilemmas. This contribution analyses the potential of EU law towards a better and more balanced reconciliation of work, private and family life when no national law applies. In two recent cases of the Court of Justice of the EU on leave for surrogacy mothers, the Advocates General Kokott and Wahl published diverging opinions on similar prejudicial questions of national courts. These op...
Wortley Pascale M
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.
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.
Full Text Available selected for the analysis are mainly those that offered public primary health care services and acted as first point of contact with the health service delivery system. Attached to the facility data are attribute data indicating the capacity...-Based Accessibility Analysis in Determining Public Primary Health Care Demand in Metropolitan Areas Hunadi Mokgalaka July 2014 Contents • Service access planning • GIS-based accessibility analysis • Key challenges to application • Methodology...
Oosterholt, Robin I; Simonse, Lianne Wl; Boess, Stella U; Vehmeijer, Stephan Bw
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. The outpatient THA care pathway enables patients to be discharged on the day of surgery, shortening 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. 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. 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. 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 application (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.
Full Text Available Reasonable and effective power planning contributes a lot to energy efficiency improvement, as well as the formulation of future economic and energy policies for a region. Since only a few provinces in China have nuclear power plants so far, nuclear power plants were not considered in many provincial-level power planning models. As an extremely important source of power generation in the future, the role of nuclear power plants can never be overlooked. In this paper, a comprehensive and detailed optimization model of provincial-level power generation expansion considering biomass and nuclear power plants is established from the perspective of electricity demand uncertainty. This model has been successfully applied to the case study of Zhejiang Province. The findings suggest that the nuclear power plants will contribute 9.56% of the total installed capacity, and it will become the second stable electricity source. The lowest total discounted cost is 1033.28 billion RMB and the fuel cost accounts for a large part of the total cost (about 69%. Different key performance indicators (KPI differentiate electricity demand in scenarios that are used to test the model. Low electricity demand in the development mode of the comprehensive adjustment scenario (COML produces the optimal power development path, as it provides the lowest discounted cost.
Giuliani, M.; Li, Y.; Mainardi, M.; Arias Munoz, C.; Castelletti, A.; Gandolfi, C.
Exponentially growing water demands and increasing uncertainties in the hydrologic cycle due to changes in climate and land use will challenge water resources planning and management in the next decade. Improving agricultural productivity is particularly critical, being this sector the one characterized by the highest water demand. Moreover, to meet projected growth in human population and per-capita food demand, agricultural production will have to significantly increase in the next decades, even though water availability is expected to decrease due to climate change impacts. Agricultural systems are called to adapt their strategies (e.g., changing crop patterns and the corresponding water demand, or maximizing the efficiency in the water supply modifying irrigation scheduling and adopting high efficiency irrigation techniques) in order to re-optimize the use of limited water resources. Although many studies have assessed climate change impacts on agricultural practices and water management, most of them assume few scenarios of water demand or water supply separately, while an analysis of their reciprocal feedbacks is still missing. Moreover, current practices are generally established according to historical agreements and normative constraints and, in the absence of dramatic failures, the shift toward more efficient water management is not easily achievable. In this work, we propose to activate an information loop between farmers and water managers to improve the effectiveness of agricultural water management practices by matching the needs of the farmers with the design of water supply strategies. The proposed approach is tested on a real-world case study, namely the Lake Como serving the Muzza-Bassa Lodigiana irrigation district (Italy). A distributed-parameter, dynamic model of the system allows to simulate crop growth and the final yield over a range of hydro-climatic conditions, irrigation strategies and water-related stresses. The spatial component of the
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.
Full Text Available ABSTRACT Clustering is commonly used to group data in order to represent the behaviour of a system as accurately as possible by obtaining patterns and profiles. In this paper, clustering is applied with partitioning-clustering techniques, specifically, Partitioning around Medoids (PAM to analyse load curves from a city of South-eastern Brazil in São Paulo state. A top-down approach in time granularity is performed to detect and to label profiles which could be affected by seasonal trends and daily/hourly time blocks. Time-granularity patterns are useful to support the improvement of activities related to distribution, transmission and scheduling of energy supply. Results indicated four main patterns which were post-processed in hourly blocks by using shades of grey to help final-user to understand demand thresholds according to the meaning of dark grey, light grey and white colours. A particular and different behaviour of load curve was identified for the studied city if it is compared to the classical behaviour of urban cities.
Ya, Wei; Hamilton, Kelvin; Meboldt, Mirko; Klahn, Christoph
As additive manufacturing (AM) gains greater industrial exposure, there is a drive towards defining practical, high-value processes and products. Defining viable business cases is critical to ensure successful technology adoption. Given the marine industry’s slow uptake of AM, the potential of Wire
Borhan, Nurbaizura; Arsad, Zainudin
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.
Jan S. Jukema
Full Text Available Background: The practice of nursing is shaped partly by nurses’ professional perspective of good care, guided by a nursing framework. An example is the framework of preservative care, which defines good nursing care for vulnerable older people in nursing homes. Currently we lack an understanding of how this framework could help nurses in training; it may be a useful developmental aid for undergraduate nursing students but so far there are no empirical data to support this. Aim: The purpose of this study is to explore how helpful a particular framework can be in the learning journey of two undergraduate nursing students. The study draws on narrative and reflective accounts, guided by the question: ‘How does preservative care as a framework of good care help two undergraduate nursing students develop their caring for older people?’ Methods: This was a reflective case study, in which two students – experienced registered nurses (non-graduates following a part-time education programme – reflected on their practices, using preservative care as a framework for taking care of older people. They kept reflective journals and received constructive feedback from the author of the preservative care framework (the first author. Their data were analysed in three steps. Findings: Both students reported gaining profound help from the framework in their evaluations of daily practices, although they rated the help differently in terms of demanding and rewarding experiences. The framework was particularly helpful in developing qualities in three domains: person-centredness, professional role and specific nursing competencies. Conclusions: The results of our study indicate how using a particular nursing framework made a difference to the practice of two undergraduate nursing students. Exploring the meaning and place of particular nursing frameworks in nursing education is necessary to establish their potential benefits for students. Implications for
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
Daaleman, Timothy P; Hay, Sherry; Prentice, Amy; Gwynne, Mark D
Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period. An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.
Moini, Joy S; Zellman, Gail L; Gates, Susan M
.... Difficulty in obtaining child care creates conflicts between parental obligations and mission responsibilities, and if parents have no child care, they may fail to report for duty in order to care for their children...
Heidenreich, Kaja; Bremer, Anders; Materstvedt, Lars Johan; Tidefelt, Ulf; Svantesson, Mia
In Moral Case Deliberation (MCD), healthcare professionals discuss ethically difficult patient situations in their daily practice. There is a lack of knowledge regarding the content of MCD and there is a need to shed light on this ethical reflection in the midst of clinical practice. Thus, the aim of the study was to describe the content of healthcare professionals' moral reasoning during MCD. The design was qualitative and descriptive, and data consisted of 22 audio-recorded inter-professional MCDs, analysed with content analysis. The moral reasoning centred on how to strike the balance between personal convictions about what constitutes good care, and the perceived dissonant care preferences held by the patient. The healthcare professionals deliberated about good care in relation to demands considered to be unrealistic, justifications for influencing the patient, the incapacitated patient's nebulous interests, and coping with the conflict between using coercion to achieve good while protecting human dignity. Furthermore, as a basis for the reasoning, the healthcare professionals reflected on how to establish a responsible relationship with the vulnerable person. This comprised acknowledging the patient as a susceptible human being, protecting dignity and integrity, defining their own moral responsibility, and having patience to give the patient and family time to come to terms with illness and declining health. The profound struggle to respect the patient's autonomy in clinical practice can be understood through the concept of relational autonomy, to try to secure both patients' influence and at the same time take responsibility for their needs as vulnerable humans.
Purvis, Karyn; Cross, David; Jones, Daren; Buff, Gary
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.…
With the advances of technology and treatment in the field of neonatal care, researchers can now study how the brains of preterm infants are different from full-term infants. The differences are significant, and the outcomes are poor overall for premature infants as a whole. Caregivers at the bedside must know that every interaction with the preterm infant affects brain development-it is critical to the developmental outcome of the infant. The idea of neuroprotection is not new to the medical field but is a fairly new idea to the NICU. Neuroprotection encompasses all interventions that promote normal development of the brain. The concept of brain-oriented care is a necessary extension of developmental care in the NICU. By following the journey of 26-week preterm twin infants through a case study, one can better understand the necessity of brain-oriented care at the bedside.
Scandurra, Isabella; Liljequist, David
Current healthcare organizations often do not accomplish the intended effects of their eHealth systems due to inadequate usability. Commissioned by the Swedish Ministry of Health and Social Affairs, the usability of current eHealth systems in Swedish health and social care has been analysed from the perspective of their professionals. The objective of the study was to report on current problems, potential solutions as well as to relate these to research in relevant areas. Using a participatory approach, nine workshops were held where health informatics researchers guided staff from different care organizations, representatives of the national associations of health and social care professionals and the national eHealth system vendor organization. This paper presents ten demands that Swedish health and social care professionals find imperative to prioritize. The study emphasizes that development of eHealth systems must be integrated into the care practice improvement process and iteratively evaluated regarding usability.
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.
Full Text Available In recent years, an innovative public transportation (PT mode known as the customized bus (CB has been proposed and implemented in many cities in China to efficiently and effectively shift private car users to PT to alleviate traffic congestion and traffic-related environmental pollution. The route network design activity plays an important role in the CB operation planning process because it serves as the basis for other operation planning activities, for example, timetable development, vehicle scheduling, and crew scheduling. In this paper, according to the demand characteristics and operational purpose, a methodological framework that includes the elements of large-scale travel demand data processing and analysis, hierarchical clustering-based route origin-destination (OD region division, route OD region pairing, and a route selection model is proposed for CB network design. Considering the operating cost and social benefits, a route selection model is proposed and a branch-and-bound-based solution method is developed. In addition, a computer-aided program is developed to analyze a real-world Beijing CB route network design problem. The results of the case study demonstrate that the current CB network of Beijing can be significantly improved, thus demonstrating the effectiveness of the proposed methodology.
Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R
Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.
Full Text Available The fill rate is usually computed by using the traditional approach, which calculates it as the complement of the quotient between the expected unfulfilled demand and the expected demand per replenishment cycle, instead of directly the expected fraction of fulfilled demand. Furthermore the available methods to estimate the fill rate apply only under specific demand conditions. This paper shows the research gap regarding the estimation procedures to compute the fill rate and suggests: (i a new exact procedure to compute the traditional approximation for any discrete demand distribution; and (ii a new method to compute the fill rate directly as the fraction of fulfilled demand for any discrete demand distribution. Simulation results show that the latter methods outperform the traditional approach, which underestimates the simulated fill rate, over different demand patterns. This paper focuses on the traditional periodic review, base stock system when backlogged demands are allowed.
Hawthorne, Mary R; Dinh, An
There is a growing need for primary care physicians, but only a small percentage of graduating medical students enter careers in primary care. To assess whether a Primary Care Intraclerkship within the Medicine clerkship can significantly improve students' attitudes by analyzing scores on pre- and post-tests. Students on the Medicine clerkship at the University of Massachusetts Medical School participated in full-day 'intraclerkships',to demonstrate the importance of primary care and the management of chronic illness in various primary care settings. Pre-and post-tests containing students' self-reported, five-point Likert agreement scale evaluations to 26 items (measuring perceptions about the roles of primary care physicians in patient care and treatment) were collected before and after each session. Eleven intraclerkships with 383 students were held between June 2010 and June 2013. Responses were analyzed using the GLM Model Estimate. Results from the survey analysis showed significantly more positive attitudes toward primary care in the post-tests compared to the pre-tests. Students who were satisfied with their primary care physicians were significantly more likely to show an improvement in post-test attitudes toward primary care in the areas of physicians improving the quality of patient care, making a difference in overall patient health, finding primary care as an intellectually challenging field, and in needing to collaborate with specialists. Older students were more likely than younger students to show more favorable answers on questions concerning the relative value of primary care vs. specialty care. A curriculum in Primary Care Internal Medicine can provide a framework to positively influence students' attitudes toward the importance of primary care, and potentially to influence career decisions to enter careers in Primary Care Internal Medicine. Ensuring that medical students receive excellent primary care for themselves can also positively influence
McKinlay, Eileen M.; Morgan, Sonya J.; Gray, Ben V.; Macdonald, Lindsay M.; Pullon, Susan R.H.
Background The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care. Objective To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care. Design Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration. Results The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals. Conclusion Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them. PMID
Lunde, Lars-Kristian; Koch, Markus; Knardahl, Stein; Wærsted, Morten; Mathiassen, Svend Erik; Forsman, Mikael; Holtermann, Andreas; Veiersted, Kaj Bo
Musculoskeletal disorders have a profound impact on individual health, sickness absence and early retirement, particularly in physically demanding occupations. Demographics are changing in the developed countries, towards increasing proportions of senior workers. These senior workers may have particular difficulties coping with physically demanding occupations while maintaining good health. Previous studies investigating the relationship between physical work demands and musculoskeletal disorders are mainly based on self-reported exposures and lack a prospective design. The aim of this paper is to describe the background and methods and discuss challenges for a field study examining physical demands in construction and health care work and their prospective associations with musculoskeletal disorders, work ability and sickness absence. This protocol describes a prospective cohort study on 1200 construction and health care workers. Participants will answer a baseline questionnaire concerning musculoskeletal complaints, general health, psychosocial and organizational factors at work, work demands, work ability and physical activity during leisure. A shorter questionnaire will be answered every 6th months for a total of two years, together with continuous sickness absence monitoring during this period. Analysis will prospectively consider associations between self-reported physical demands and musculoskeletal disorders, work ability and sickness absence. To obtain objective data on physical exposures, technical measurements will be collected from two subgroups of N = 300 (Group A) and N = 160 (Group B) during work and leisure. Both group A and B will be given a physical health examination, be tested for physical capacity and physical activity will be measured for four days. Additionally, muscle activity, ground reaction force, body positions and physical activity will be examined during one workday for Group B. Analysis of associations between objectively measured
Eugenia BABILONI; Ester GUIJARRO; Manuel CARDÓS; Sofía ESTELLÉS
The fill rate is usually computed by using the traditional approach, which calculates it as the complement of the quotient between the expected unfulfilled demand and the expected demand per replenishment cycle, instead of directly the expected fraction of fulfilled demand. Furthermore the available methods to estimate the fill rate apply only under specific demand conditions. This paper shows the research gap regarding the estimation procedures to compute the fill rate and suggests: (i) a ne...
This research study combines qualitative and quantitative methodology in reflectively exploring positive case studies to ascertain strategies that...enabled patients to engage in self-management. Moreover, this study seeks to better understand how applying the ADA Standards of Care in a military
Hansen, Niklas; Sverke, Magnus; Näswall, Katharina
Health care organizations have changed dramatically over the last decades, with hospitals undergoing restructurings and privatizations. The aim of this study is to enhance the understanding of the origin and prevalence of burnout in health care by investigating factors in the psychosocial work environment and comparing three Swedish emergency hospitals with different types of ownership. A cross-sectional design was used. We selected a total sample of 1800 registered nurses from three acute care hospitals, one private for-profit, one private non-profit and one publicly administered. A total of 1102 questionnaires were included in the analyses. The examined ownership types were a private for-profit, a private non-profit and a traditional publicly administered hospital. All were situated in the Stockholm region, Sweden. Data were collected by questionnaires using validated instruments, in accordance with the Job Demands-Resources Model and Maslach's Burnout Inventory. Descriptive statistics, correlation analyses, multivariate covariance analyses and multiple regression analyses were conducted. The results showed that the burnout levels were the highest at the private for-profit hospital and lowest at the publicly administered hospital. However, in contrast to expectations the demands were not higher overall at the for-profit organization or lowest at the public administration unit, and overall, resources were not better in the private for-profit or worse at the publicly administered hospital. Multiple regression analyses showed that several of the demands included were related to higher burnout levels. Job resources were linked to lower burnout levels, but not for all variables. Profit orientation in health care seems to result in higher burnout levels for registered nurses compared to a publicly administered hospital. In general, demands were more predictive of burnout than resources, and there were only marginal differences in the pattern of predictors across
Strzelecki, S; Brobst, R
The authors describe the development of an inpatient acute care case manager orientation in a community hospital. Benner's application of the Dreyfus model of skill acquisition provides the basis for the orientation program. The candidates for the case manager position were expert clinicians. Because of the role change it was projected that they would function as advanced beginners. It was also predicted that, as the case managers progressed within the role, the educational process would need to be adapted to facilitate progression of skills to the proficient level. Feedback from participants reinforced that the model supported the case manager in the role transition. In addition, the model provided a predictive framework for ongoing educational activities.
Title of bachelor's thesis: Case of physiotherapy care for patient with rheumatoid arthritis diagnosed Objectives: The aim of this thesis is to show using of physiotherapeutistic methods on patient with rheumatoid arthritis. One part of this thesis is casuistry of patient with rheumatoid arthritis. The summary: The thesis is divided into two parts, the theoretical part and the special part. The theoretical part is focused on issue of rheumatoid arthritis, its characteristic, division, diagnos...
Title of bachelor's thesis: Case of physiotherapy care for patient diagnosed with rheumatoid arthritis Objectives: The aim is to emphasize the use of physiotherapy as a part of comprehensive treatment of a patient with rheumatoid arthritis. The thesis includes a detailed casuistry of a patient with rheumatoid arthritis. Methods: The thesis is divided into a general part and a special part. The general part is focused on description of rheumatoid arthritis. It discusses characteristics of the ...
Cerón-Serrano, Alicia; Jiménez-Castellano, Rafael; Gómez-Campos, Ana María
After the evacuation from Africa to Western hospitals of several international workers with the Ebola virus disease, the first case of contagion outside Africa occurred in Madrid, Spain. A nursing care assistant who had attended a missionary repatriated from Sierra Leone contracted the disease. On October 7 th 2014, the patient arrived at the University Hospital La Paz-Carlos III in Madrid. She remained in the hospital for 30 days, 25 of which were in strict isolation in a negative pressure room with air lock anteroom; personal protective equipment was required. During the last five days, the patient was moved to a standard room. Protection measures were used in accordance with the Hospital Occupational Health Department. According to its evolution, we differentiate three phases with specific care demands which were conditioned by the risk of transmission, forcing extreme measures of prevention. The largest numbers of direct interventions fall within the realm of the nursing profession. It is essential that specialized units with regular training be created for highly contagious diseases. In addition, this and other cases should be analyzed from the point of view of nursing, to allow standardized care. We also recognize the importance of managing communication to prevent social unrest and stigmatization of staff. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.
Giesen, Marie-Jeanne; Keizer, Ellen; van de Pol, Julia; Knoben, Joris; Wensing, Michel; Giesen, Paul
Objective To explore the potential impact of demand management strategies on patient decision-making in medically non-urgent and urgent scenarios during out-of-hours for children between the ages of 0 and 4 years. Design and methods We conducted a cross-sectional survey with paper-based case scenarios. A survey was sent to all 797 parents of children aged between 0 and 4 years from four Dutch general practitioner (GP) practices. Four demand management strategies (copayment, online advice, ove...
Acosta, R.; Rodriguez, J. P.
Water resources availability is a global concern due to increasing demands, decreasing quality and uncertain spatio-temporal variability (United Nations, 2009). In urban contexts research on efficient water use is a priority to cope with the future vulnerability of water supplies as a result of the impacts of climate change (Bates et al, 2008). Following the proposed methodologies of He and Kua (2013) for implementing programs to promote sustainable energy consumption, we focused on the use of educational strategies to promote a voluntary rationalization of residential water demand. We collaborated with three schools in Soacha (Colombia) where students ranging from 12 to 15 years participated in the project as promoters of educational campaigns inside their families, covering 120 low and middle-low income households. Three intervention or treatment strategies (i.e. e-learning, in-person active learning activities and graphical learning tools) were carried out over a period of 5 months. We analyzed the effects of the treatments strategies in reducing water consumption rates and the dependence of this variable on socio-demographic, economic, environmental, and life quality factors by using personal interviews and self reported water saving technics. The results showed that educational campaigns have a positive effect on reducing consumption in the households. Graphical learning tools accounted for the highest reduction in water consumption. Moreover, the results of the study suggests that socio-economic factors such as type of house, social level, income, and life quality variables significantly affect the variability in water consumption, which is an important fact to consider in similar cases where communities face difficult socio-economic conditions, displacement or high rates of urban growth.
This paper explores how Greece's household consumption has changed between 1990 and 2006 and its environmental implications in terms of fossil fuel demand and carbon dioxide (CO 2 ) emissions. The results show that the 44% increase in Greece's household expenditure between 1990 and 2006 was accompanied by a 67% increase in fossil fuel demand. Of this total, indirect demand accounted for approximately 60% throughout the 16-year period, increasing by 56% overall, whereas direct fossil fuel demand grew by 80%. The results also show that associated CO 2 emissions increased by 60%, resulting in a 'relative decoupling' from energy demand. This relative decoupling is shown to be due to fossil fuel mix changes from the supply side rather than action from consumers. These insights highlight the opportunities for demand-side policies to further reduce fossil fuel demand and CO 2 emissions, allowing Greece to set more proactive and ambitious post-Kyoto targets.
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)
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
Brunetti, Marie; Rajasekharan, Sathyanath; Ustero, Piluca; Ngo, Katherine; Sikhondze, Welile; Mzileni, Buli; Mandalakas, Anna; Kay, Alexander W
In Swaziland, as in many high HIV/TB burden settings, there is not information available regarding the household location of TB cases for identifying areas of increased TB incidence, limiting the development of targeted interventions. Data from "Butimba", a TB REACH active case finding project, was re-analyzed to provide insight into the location of TB cases surrounding Mbabane, Swaziland. The project aimed to identify geographical areas with high TB burdens to inform active case finding efforts. Butimba implemented household contact tracing; obtaining landmark based, informal directions, to index case homes, defined here as relative locations. The relative locations were matched to census enumeration areas (known location reference areas) using the Microsoft Excel Fuzzy Lookup function. Of 403 relative locations, an enumeration area reference was detected in 388 (96%). TB cases in each census enumeration area and the active case finders in each Tinkhundla, a local governmental region, were mapped using the geographic information system, QGIS 2.16. Urban Tinkhundla predictably accounted for most cases; however, after adjusting for population, the highest density of cases was found in rural Tinkhundla. There was no correlation between the number of active case finders currently assigned to the 7 Tinkhundla surrounding Mbabane and the total number of TB cases (Spearman rho = -0.57, p = 0.17) or the population adjusted TB cases (Spearman rho = 0.14, p = 0.75) per Tinkhundla. Reducing TB incidence in high-burden settings demands novel analytic approaches to study TB case locations. We demonstrated the feasibility of linking relative locations to more precise geographical areas, enabling data-driven guidance for National Tuberculosis Programs' resource allocation. In collaboration with the Swazi National Tuberculosis Control Program, this analysis highlighted opportunities to better align the active case finding national strategy with the TB disease
Farmer, Carrie M; Hosek, Susan D; Adamson, David M
In response to concerns that the Department of Veterans Affairs (VA) has faced about veterans' access to care and the quality of care delivered, Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 ("Veterans Choice Act") in August 2014. The law was passed to help address access issues by expanding the criteria through which veterans can seek care from civilian providers. In addition, the law called for a series of independent assessments of the VA health care system across a broad array of topics related to the delivery of health care services to veterans in VA-owned and -operated facilities, as well as those under contract to VA. RAND conducted three of these assessments: Veteran demographics and health care needs (A), VA health care capabilities (B), and VA authorities and mechanisms for purchasing care (C). This article summarizes the findings of our assessments and includes recommendations from the reports for improving the match between veterans' needs and VA's capabilities, including VA's ability to purchase necessary care from the private sector.
The public finance and foreign exchange crisis of the 1980s aggravated the unfavourable economic trends in many developing countries and resulted in budget cuts in the health sector. Policymakers, following the suggestions of World Bank experts, introduced user fees. Economic analysis of the demand for health care in these countries focused on the impact of price and income on health service utilisation. But the lesson to date from experiences in cost recovery is that without visible and fairly immediate improvements in the quality of care, the implementation of user fees will cause service utilisation to drop. For this reason, the role of quality of health care has been recently a subject of investigation in a number of health care demand studies. In spite of using the data from both households and facilities, recent studies are quite limited because they measure quality only by structural attributes (availability of drugs, equipment, number and qualifications of staff, and so on). Structural attributes of quality are necessary but not sufficient conditions for demand. A unique feature of this study is that it also considers the processes followed by practitioners and the outcome of care, to determine simultaneously the respective influence of price and quality on decision making. A nested multinomial logit was used to examine the choice between six alternatives (self-treatment, modern treatment at home, public hospital, public dispensary, for-profit facility and non-profit facility). The estimations are based on data from a statistically representative sample of 1104 patients from 1191 households and the data from a stratified random sample of 42 out of 84 facilities identified. The results indicate that omitting the process quality variables from the demand model produces a bias not only in the estimated coefficient of the "price" variable but also in coefficients of some structural attributes of the quality. The simulations suggest that price has a minor effect
Toksari, M. Duran
This paper presents Turkey's net electricity energy generation and demand based on economic indicators. Forecasting model for electricity energy generation and demand is first proposed by the ant colony optimization (ACO) approach. It is multi-agent system in which the behavior of each ant is inspired by the foraging behavior of real ants to solve optimization problem. Ant colony optimization electricity energy estimation (ACOEEE) model is developed using population, gross domestic product (GDP), import and export. All equations proposed here are linear electricity energy generation and demand (linear A COEEGE and linear ACOEEDE) and quadratic energy generation and demand (quadratic A COEEGE and quadratic ACOEEDE). Quadratic models for both generation and demand provided better fit solution due to the fluctuations of the economic indicators. The ACOEEGE and ACOEEDE models indicate Turkey's net electricity energy generation and demand until 2025 according to three scenarios. (author)
Klinge Jacobsen, Henrik
This paper discusses di!erent approaches to incorporating technological progress in energy-economy models and the e!ecton long-term energy demand projections. Approaches to modelling based on an exogenous annual change of energy e$ciencyto an endogenous explanation of innovation for energy...... 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...... description, two models of residential energy demand in Denmark are compared. A Danish macroeconometric model is compared to a technological vintage model that is covering electric appliances and residential heating demand. The energy demand projection of the two models diverges, and the underlying...
Schmidt, Klaus-Helmut; Diestel, Stefan
According to the influential Job Demands-Control (JD-C) model developed by Karasek (1979; Karasek and Theorell, 1990), job strain is expected to result from high job demands and low job control as well as an interaction between both job characteristics. Previous research, however, has found such an interaction only rarely or inconsistently.It has been suggested that the conceptualization of the control variable (formerly referred to as decision latitude) may be particularly responsible for the lack of supportive findings. The present study aimed at clarifying this issue by contrasting a focused measure of control with a traditional measure of decision latitude in their relations to job strain of health care workers. The measure of decision latitude encompassed a wide range of job characteristics including control, task variety, and learning opportunities. A cross-sectional questionnaire survey was conducted with job satisfaction, psychosomatic complaints and emotional exhaustion as criterion measures of job strain. A supra-regional organization for residential elderly care with 11 nursing homes located in a federal state in Germany. Questionnaires were distributed to the whole nursing staff, of which 379 filled in the questionnaire during normal working hours (68% participation rate). In addition to confirmatory factor analyses, descriptive statistics, and bivariate correlations, hierarchical multiple regression analyses were performed for testing the corresponding interaction effects. Findings confirmed the assumption that the focused measure of control and the traditional measure of decision latitude represent distinct, yet correlated factors. Furthermore, findings revealed a significant interaction effect between job demands and control on all outcomes considered. By way of contrast, there was no equivalent interaction effect between job demands and decision latitude. In line with the JD-C model, the adverse influence of increasing demands on job satisfaction
Full Text Available The spatial realities and dynamics of a changing population with changing health care needs require regular and logical methods to evaluate and assist in primary health care (PHC) planning. Geographical access is an important aspect in the planning...
Full Text Available The spatial realities and dynamics of a changing population with changing health care needs require regular and logical methods to evaluate and assist in primary health care (PHC) planning. Geographical access is an important aspect in the planning...
Marnes, Joanne; Hall, Pauline
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. Copyright © 2013 Australian College of Midwives. All rights reserved.
Andersen, Gunn Robstad; Bendal, Synne; Westgaard, Rolf H
This study of home care workers in a Norwegian municipality aimed to examine the effect of two measures involving organizational (job checklists) and technological (personal digital assistants) job aids on perceived work demands and musculoskeletal health. Questionnaire data was collected in 2009 (n = 138, response rate 76.2%) and 2011 (n = 80, response rate 54%). Forty-six home care workers responded at both waves. Respondents were assigned into 'high', 'moderate' and 'low' strain groups based on their responses to open and closed survey questions regarding impact of the two measures. One-way ANOVA with post-hoc t-tests and regression analyses investigated group differences and examined development in variables. Perceived work demands and health effects over the two-year study period were unchanged overall, yet significant differences between subgroups were highlighted. Work demands and shoulder-neck pain remained high for high-strain workers, but were reduced for low and moderate strain workers. Management should be aware of diversity in worker responses to rationalizations and give priority to supplementary, targeted measures to counteract adverse effects. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.
Soufiane, Boukarta; Ewa, Berezowska-Azzag
Housing is rated as one of the most commonly consuming energy field in terms of energy end-use with 41%. Regarding the transformations dealt by dwellers for functional and social uses. The aim of this paper is: Firstly, to highlight the non-controlled transformation process made by the occupant in Algeria; Secondly, to explore the impact of the energy load of such spatial transformations. The question is approached in two tracks, (i) Through Ecotect software's simulations (ii) and measurements through a collection of energy end-use data. Basically, the energy demand is bound to dwelling's spatial and socioeconomic criteria. Three cases studied showed consequently 2 positive and 1 negative energy load, in which two explanations may be given: Insulation quality that occupant is lacking facilities to improve may be stated as a physical explanation, as well as for the socio economic one, the density per dwelling plays a major role, but it is the income which explains within the two approaches more than 87% of the energy end use.
Abeysekera, John; Illankoon, Prasanna
Apparel exports bring in sizeable foreign income to Sri Lanka. To protect and promote this industry is a paramount need. This can be carried out by applying Human Factors/Ergonomics (HFE) which has proved to control negative effects at work places. This paper reports a case study which describes the demands and benefits of HFE in MAS Holdings which owns a large share of the apparel industry in Sri Lanka. The study consisted of walk through observation survey, a questionnaire survey and ergonomic work place analysis followed by a training programme to selected employees in three companies. Positive responses to questionnaires revealed good ergonomic practices in the work places surveyed. Ergonomically unfit chairs and potential hazards e.g. exposure to noise and hot environment were detected. It is seen that MAS have introduced strategies originated by Toyota Production System viz. 5S, Kaizen, six sigma etc., which are in fact ergonomic methods. A progressive project MAS boast of viz. 'MAS Operating System' (MOS) empowers training and development to employees. MAS Holdings has adequately realized the benefits of applying HFE as evident by the number of awards received. Relevant companies were advised to take appropriate corrective measures to control the potential hazards.
Bourgault, Claire; Johnson, Erin E.; Redihan, Stephen G.; Borgia, Matthew; Aiello, Riccardo; Kane, Vincent
Objectives. We compared service use among homeless and nonhomeless veterans newly enrolled in a medical home model and identified patterns of use among homeless veterans associated with reductions in emergency department (ED) use. Methods. We used case–control matching with a nested cohort analysis to measure 6-month health services use, new diagnoses, and care use patterns in veterans at the Providence, Rhode Island, Veterans Affairs Medical Center from 2008 to 2011. Results. We followed 127 homeless and 106 nonhomeless veterans. Both groups had similar rates of chronic medical and mental health diagnoses; 25.4% of the homeless and 18.1% of the nonhomeless group reported active substance abuse. Homeless veterans used significantly more primary, mental health, substance abuse, and ED care during the first 6 months. Homeless veterans who accessed primary care at higher rates (relative risk ratio [RRR] = 1.46; 95% confidence interval [CI] = 1.11, 1.92) or who used specialty and primary care (RRR = 10.95; 95% CI = 1.58, 75.78) had reduced ED usage. Homeless veterans in transitional housing or doubled-up at baseline (RRR = 3.41; 95% CI = 1.24, 9.42) had similar reductions in ED usage. Conclusions. Homeless adults had substantial health needs when presenting for care. High-intensity primary care and access to specialty care services could reduce ED use. PMID:24148042
Management demands on information and communication technology in process-oriented health-care organizations: the importance of understanding managers' expectations during early phases of systems design.
Andersson, Anna; Vimarlund, Vivian; Timpka, Toomas
There are numerous challenges to overcome before information and communication technology (ICT) can achieve its full potential in process-oriented health-care organizations. One of these challenges is designing systems that meet users' needs, while reflecting a continuously changing organizational environment. Another challenge is to develop ICT that supports both the internal and the external stakeholders' demands. In this study a qualitative research strategy was used to explore the demands on ICT expressed by managers from functional and process units at a community hospitaL The results reveal a multitude of partially competing goals that can make the ICT development process confusing, poor in quality, inefficient and unnecessarily costly. Therefore, from the perspective of ICT development, the main task appears to be to coordinate the different visions and in particular clarify them, as well as to establish the impact that these visions would have on the forthcoming ICT application.
Wilson, Robert C; McDonald, Jacqueline; Barrett, Brendan; Parfrey, Patrick S
Restructuring of institutional long-term care was undertaken using predictions of future bed need with assumptions made on incidence rates of clients defined by type of disability, survival, and demographic changes. Recent substantial increase in the population rate of clients seeking placement across all degrees of disability, coincident with new facilities for those with modest disability, occurred. Consequently, more appropriate housing and supervised care beds, and more limited downsizing of nursing homes will be required.
In October 2004, in Germany a pre-operating study was started in order to prove the feasibility and consequences of the use of personal budgets by persons who are in need of nursing care. About 1000 care dependent persons living in seven regions are included in this triannual study. For three years they receive a budget amounting to 100 percent of their right of benefit in kind according to the German compulsory long-term care insurance. This budget has to be used exclusively for care-related services and must not be spent for assistance delivered by family members or neighbours. From socio-economic perspectives, the personal budget will result in a promotion of individuals instead of certain services or service institutions. An analysis shows, that the consequences might be an increased efficiency and effectiveness as well as structural changes within the supply of nursing care services. But to achieve these advantages, certain conditions must be provided. At first, the amount of the budget has to correspond to the individual need of care, which can change over time. Secondly, a misapplication of the personal fund has to be prevented without to exclude the potential of local or family dedication. And finally, new ways of quality assurance are requested due to the scope for development, which arises through deregulation.
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....... This retooling addresses several shortcomings. First, the imperfect correlation of demands reconciles the sales variation observed in and across destinations. Second, since demands for the firm's output are correlated across destinations, a firm can use previously realized demands to forecast unknown demands...... in untested destinations. The option to forecast demands causes firms to delay exporting in order to gather more information about foreign demand. Third, since uncertainty is resolved after entry, many firms enter a destination and then exit after learning that they cannot profit. This prediction reconciles...
Critical examination of the processes by which we as nurses judge and reach clinical decisions is important. It facilitates the maintenance and refinement of good standards of nursing care and the pinpointing of areas where improvement is needed. In turn this potentially could support broader validation of nurse expertise and contribute to emancipation of the nursing profession. As pure theory, clinical decision-making may appear abstract and alien to nurses struggling in 'the swampy lowlands' (Schon 1983) of the realities of practice. This paper explores some of the key concepts in decision-making theory by introducing, then integrating, them in a reflective case study. The case study, which examines a 'snapshot' of the patient and practitioner's journey, interwoven with theory surrounding clinical decision-making, may aid understanding and utility of concepts and theories in practice.
Ozen, Asli; Balasubramanian, Hari
At the heart of the practice of primary care is the concept of a physician panel. A panel refers to the set of patients for whose long term, holistic care the physician is responsible. A physician's appointment burden is determined by the size and composition of the panel. Size refers to the number of patients in the panel while composition refers to the case-mix, or the type of patients (older versus younger, healthy versus chronic patients), in the panel. In this paper, we quantify the impact of the size and case-mix on the ability of a multi-provider practice to provide adequate access to its empanelled patients. We use overflow frequency, or the probability that the demand exceeds the capacity, as a measure of access. We formulate problem of minimizing the maximum overflow for a multi-physician practice as a non-linear integer programming problem and establish structural insights that enable us to create simple yet near optimal heuristic strategies to change panels. This optimization framework helps a practice: (1) quantify the imbalances across physicians due to the variation in case mix and panel size, and the resulting effect on access; and (2) determine how panels can be altered in the least disruptive way to improve access. We illustrate our methodology using four test practices created using patient level data from the primary care practice at Mayo Clinic, Rochester, Minnesota. An important advantage of our approach is that it can be implemented in an Excel Spreadsheet and used for aggregate level planning and panel management decisions.
Lundgrén-Laine, Heljä; Kontio, Elina; Kauko, Tommi; Korvenranta, Heikki; Forsström, Jari; Salanterä, Sanna
Although information technology adequately supports clinical care in many intensive care units (ICUs), it provides much poorer support for the managerial information needed to coordinate multi-professional care. To gain a general view of the most crucial multi-professional information needs of ICU shift leaders a national survey was conducted, focusing on the information needs of charge nurses and intensivists. Based on our previous observation study an online survey was developed, containing 122 information need statements related to the decision-making of ICU shift leaders. Information need statements were divided into six dimensions: patient admission, organisation and management of work, allocation of staff and material resources, special treatments, and patient discharge. This survey involved all ICU shift leaders (n = 738) who worked in any of the 17 highest level ICUs for adults in university hospitals in Finland during the autumn of 2009. Both charge nurses' and intensivists' crucial information needs for care coordination were evaluated. Two hundred and fifty-seven (50%) charge nurses and 96 (43%) intensivists responded to the survey. The consistency of the survey was found to be good (Cronbach's α scores between .87-.97, with a total explanatory power of 64.53%). Altogether, 57 crucial information needs for care coordination were found; 22 of which were shared between shift leaders. The most crucial of these information needs were related to organisation and management, patient admission, and allocation of staff resources. The associations between working experience, or shift leader acting frequencies, and crucial information needs were not statistically significant. However, a statistically significant difference was found between the number of ICU beds and the ICU experience of charge nurses with information needs, under the dimension of organisation and management of work. The information needs of charge nurses and intensivists differed. Charge nurses
Full Text Available Abstract Background Although information technology adequately supports clinical care in many intensive care units (ICUs, it provides much poorer support for the managerial information needed to coordinate multi-professional care. To gain a general view of the most crucial multi-professional information needs of ICU shift leaders a national survey was conducted, focusing on the information needs of charge nurses and intensivists. Methods Based on our previous observation study an online survey was developed, containing 122 information need statements related to the decision-making of ICU shift leaders. Information need statements were divided into six dimensions: patient admission, organisation and management of work, allocation of staff and material resources, special treatments, and patient discharge. This survey involved all ICU shift leaders (n = 738 who worked in any of the 17 highest level ICUs for adults in university hospitals in Finland during the autumn of 2009. Both charge nurses’ and intensivists’ crucial information needs for care coordination were evaluated. Results Two hundred and fifty-seven (50% charge nurses and 96 (43% intensivists responded to the survey. The consistency of the survey was found to be good (Cronbach’s α scores between .87–.97, with a total explanatory power of 64.53%. Altogether, 57 crucial information needs for care coordination were found; 22 of which were shared between shift leaders. The most crucial of these information needs were related to organisation and management, patient admission, and allocation of staff resources. The associations between working experience, or shift leader acting frequencies, and crucial information needs were not statistically significant. However, a statistically significant difference was found between the number of ICU beds and the ICU experience of charge nurses with information needs, under the dimension of organisation and management of work. The information
Wolfram, N; Hillger, C; Jüttler, G; Müller, C; Benterbusch, R; Kirch, W
The aim of this research project was to compile a significant database and information about the nutritional and catering situation concerning children aged between 4 and 6 years in Saxony. The project focused on the range of foods available in day-care centers. The actual food consumption was not assessed. Standardized interviews of the management of day-care centers were undertaken. Furthermore standardized questionnaires, which included a three-day-recall of the contents of the children's lunch boxes, were used to interview parents (n = 4082, response rate 49 %). In order to evaluate the lunch catering, the menus were analysed for 4 weeks. Hot lunches were delivered to the day-care centers. For the most part caterers and day-care center management did not translate the recommendations of an optimized mixed diet. Meat dishes were too often part of the menus. Salt-water fish was offered irregularly and the preparation did not fulfill the recommendations. Potatoes, fresh fruits, uncooked vegetarian food or salads were seldom offered on the menus. Regardless of the monthly household budget most children have lunch in day-care centers. The meal offerings, not only lunches, showed potential for improvement concerning a balanced energy and nutrient provision. Therefore all persons involved in providing children's meals should take on full responsibility.
West, Anne; Sparkes, Jo; Balabanov, Todor
The use of demand-side financing mechanisms and vouchers for postcompulsory secondary-level education was examined through case studies of funding practices in the following countries: Austria; France; the United Kingdom; the United States; and Wallonia (the French community of Belgium). Different models of voucher use were identified in the…
Silva, Daiane Medeiros da; Farias, Hérika Brito Gomes de; Villa, Tereza Cristina Scatena; Sá, Lenilde Duarte de; Brunello, Maria Eugênia Firmino; Nogueira, Jordana de Almeida
To analyze the care provided to tuberculosis cases in primary health care services according to the elements of the Chronic Care Model. Cross-sectional study conducted in a capital city of the northeastern region of Brazil involving 83 Family Health Strategy professionals.A structured tool adapted to tuberculosis-related care in Brazil was applied.Analysis was based on the development of indicators with capacity to produce care varying between limited and optimum. The organization of care for tuberculosis and supported self-care presented reasonable capacity.In the coordination with the community, the presence of the community agent presented optimum capacity.Partnership with organizations of the community and involvement of experts presented limited capacity.The qualification of professionals, the system for scheduling and monitoring tuberculosis in the community, and the clinical information system presented basic capacity. The capacity of the primary health care services to produce tuberculosis-related care according to the elements of the Chronic Care Model is still limited.Overcoming the fragmentation of care and prioritizing a systemic operation between actions and services of the health care network remains as a major challenge. Analisar,segundo os elementos doChronicCareModel,a produção do cuidado aos casos de tuberculose nos serviços de Atenção Primária à Saúde. Estudo transversal, realizado em capital do nordeste brasileiro, envolvendo 83 profissionais da Estratégia Saúde da Família. Aplicou-se um instrumento estruturado, adaptado para atenção à tuberculose no Brasil. A análise pautou-se na construção de indicadores, cujacapacidade para produção de cuidados variou entre limitada a ótima. A organização da atenção à tuberculose e o autocuidado apoiado apresentaram capacidade razoável. Na articulação com a comunidade, a presençadoagente comunitário de saúde apresentou capacidade ótima. A parceria com organizações da
Yu, Chai Ping; Whynes, David K; Sach, Tracey H
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. 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. 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 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). 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 understanding of the equity impact, in order to help
Sach Tracey H
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
Muhammad Tahir Khalily
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.
Muhammad Tahir Khalily
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.
Phillips, Charles D
Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.
Full Text Available dual system made up of private and public health care facilities. Private PHC is expensive and only affordable to affluent citizens or people with medical insurance, and does not form a part of this study. Two challenges regarding GIS...
O’Connell Kathryn A
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
Full Text Available Path-coefficient analysis is utilized to investigate the direct and indirect effects of economic growth, population growth, urbanization rate, industrialization level, and carbon intensity on electricity demand of China. To improve the projection accuracy of electricity demand, this study proposes a hybrid bat algorithm, Gaussian perturbations, and simulated annealing (BAG-SA optimization method. The proposed BAG-SA algorithm not only inherits the simplicity and efficiency of the standard BA with a capability of searching for global optimality but also enhances local search ability and speeds up the global convergence rate. The BAG-SA algorithm is employed to optimize the coefficients of the multiple linear and quadratic forms of electricity demand estimation model. Results indicate that the proposed algorithm has higher precision and reliability than the coefficients optimized by other single-optimization methods, such as genetic algorithm, particle swarm optimization algorithm, or bat algorithm. And the quadratic form of BAG-SA electricity demand estimation model has better fitting ability compared with the multiple linear form of the model. Therefore, the quadratic form of the model is applied to estimate electricity demand of China from 2016 to 2030. The findings of this study demonstrate that China’s electricity demand will reach 14925200 million KWh in 2030.
Dam, Alieske E H; Boots, Lizzy M M; van Boxtel, Martin P J; Verhey, Frans R J; de Vugt, Marjolein E
Access to social support contributes to feelings of independence and better social health. This qualitative study aims to investigate multi-informant perspectives on informal social support in dementia care networks. Ten spousal caregivers of people with dementia (PwD) completed an ecogram, a social network card and a semi-structured interview. The ecogram aimed to trigger subjective experiences regarding social support. Subsequently, 17 network members were interviewed. The qualitative analyses identified codes, categories, and themes. Sixth themes emerged: (1) barriers to ask for support; (2) facilitators to ask for support; (3) barriers to offer support; (4) facilitators to offer support; (5) a mismatch between supply and demand of social support; and (6) openness in communication to repair the imbalance. Integrating social network perspectives resulted in a novel model identifying a mismatch between the supply and demand of social support, strengthened by a cognitive bias: caregivers reported to think for other social network members and vice versa. Openness in communication in formal and informal care systems might repair this mismatch.
Tadeo Martin, A.; Rey Romero, P.
The High Speed Rail Line (HSRL) between Kuala Lumpur (KL) and Singapore (SP) is aimed at reducing to 90 minutes the travel time between two of Southeast Asia’s most vibrant and fast-growing economic engines. Ineco was hired by the Government of Malaysia to forecast the demand for the future HSRL. The Government of Malaysia played a key role when firstly defining the current situation on the corridor and the features of the HSRL, and then providing Ineco with the studies previously developed by them. Besides the obvious interest in connecting both capital cities, Malaysia wishes to promote the economic development of intermediate cities, whereas Singapore, a 718 square-kilometer city-state and island, is interested in improving its connection with Nusajaya - a Malaysian city that is being developed just across the border and regarded as land reserves. Two kinds of services will be provided on the new rail infrastructure: non-stop services between KL and SP, and services with 6 intermediate stops on the Malaysian side. The aim of this paper is to describe the process to forecast the demand for the HSRL Kuala Lumpur – Singapore by focusing on the peculiarities of an international HSRL. Identifying these aspects at an early stage is vital to get a better demand estimate and to reconsider the HSRL characteristics if necessary. The demand for the new line was calculated by applying a three-step model: generation model, distribution model and modal split model. In 2030, 10 years after the opening year, the HSRL is expected to move 23 - 26 million passengers – baseline and optimistic scenarios, respectively -, which represents an 18.5% share of the total demand on the corridor. The demand for the KL-SP pair will account for 30% the demand for the future HSRL. (Author)
Wang Yuanyuan; Wang Jianzhou; Zhao Ge; Dong Yao
Electricity demand forecasting could prove to be a useful policy tool for decision-makers; thus, accurate forecasting of electricity demand is valuable in allowing both power generators and consumers to make their plans. Although a seasonal ARIMA model is widely used in electricity demand analysis and is a high-precision approach for seasonal data forecasting, errors are unavoidable in the forecasting process. Consequently, a significant research goal is to further improve forecasting precision. To help people in the electricity sectors make more sensible decisions, this study proposes residual modification models to improve the precision of seasonal ARIMA for electricity demand forecasting. In this study, PSO optimal Fourier method, seasonal ARIMA model and combined models of PSO optimal Fourier method with seasonal ARIMA are applied in the Northwest electricity grid of China to correct the forecasting results of seasonal ARIMA. The modification models forecasting of the electricity demand appears to be more workable than that of the single seasonal ARIMA. The results indicate that the prediction accuracy of the three residual modification models is higher than the single seasonal ARIMA model and that the combined model is the most satisfactory of the three models. - Highlights: ► Three residual modification models are proposed to improve the precision of seasonal ARIMA. ► Accurate electricity demand forecast is helpful for a power production sector to come to a correct and reasonable decision. ► The results conclude that the residual modification approaches could enhance the prediction accuracy of seasonal ARIMA. ► The modification models could be applied to forecast electricity demand.
Whelan, Paul James; Walwyn, Rebecca; Gaughran, Fiona; Macdonald, Alastair
Legal frameworks are in place to protect those who lack the capacity to consent to research, such as the Mental Capacity Act in the UK. Assent is sought instead from a proxy, usually a relative. However, the same legislation may, perversely, affect the welfare of those who lack capacity and of others by hindering the process of recruitment into otherwise potentially beneficial research. In addition, the onus of responsibility is moved from those who know most about the study (ie, the scientific community) to those who know less (the proxies). In this paper, we describe the characteristics of a sample at different stages of the recruitment process of an influenza vaccine-based randomised control trial in elderly care home residents (the FEVER study). 62% (602/968) of potential subjects lacked capacity but only 29% (80/277) of those actually randomised. Older age, being female and living in an Elderly Mentally Ill care home were the only variables associated with lacking capacity. Considering this was a study based in a care home setting where the prevalence of dementia approximates 80%, the trial, like many others, was thus significantly biased. We believe that difficulties seeking proxy assent contributed significantly to this problem. Further thought should be given to how assent to enter research for those who lack capacity should be provided, and we suggest avenues for further discussion such as independent risk/benefit expert panels.
researcher and recipient relationship, specific to technology transfer. In this research, the evaluation criteria of several research organizations were assessed to understand the extent to which the success attributes that were identified in literature were considered when reviewing research proposals. While some of the organizations included a few of the success attributes, none of the organizations considered all of the attributes. In addition, none of the organizations quantified the value of the success attributes. The effectiveness of the model relies extensively on expert judgments to complete the model validation and quantification. Subject matter experts ranging from senior executives with extensive experience in technology transfer to principal research investigators from national labs, universities, utilities, and non-profit research organizations were used to ensure a comprehensive and cross-functional validation and quantification of the decision model. The quantified model was validated using a case study involving demand response (DR) technology proposals in the Pacific Northwest. The DR technologies were selected based on their potential to solve some of the region's most prevalent issues. In addition, several sensitivity scenarios were developed to test the model's response to extreme case scenarios, impact of perturbations in expert responses, and if it can be applied to other than demand response technologies. In other words, is the model technology agnostic? In addition, the flexibility of the model to be used as a tool for communicating which success attributes in a research proposal are deficient and need strengthening and how improvements would increase the overall technology transfer score were assessed. The low scoring success attributes in the case study proposals (e.g. project meetings, etc.) were clearly identified as the areas to be improved for increasing the technology transfer score. As a communication tool, the model could help a research
Izadi, Arman; Kimiagari, Ali Mohammad
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.
Phillips, Charles D.
Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large sta...
Pallegedara, Asankha; Grimm, Michael
Compared to its neighbors, Sri Lanka performs well in terms of health. Health care is provided for free in the public sector, yet households' out-of-pocket health expenditures are steadily increasing. We explore whether this increase can be explained by supply shortages and insufficient public health care financing or whether it is rather the result of an income-induced demand for supplementary and higher quality services from the private sector. We focus on total health care expenditures and health care expenditures for specific services such as expenses on private outpatient treatments and expenses on laboratory and other diagnostic services. Overall, we find little indication that limited supply of public health care per se pushes patients into the private sector. Yet income is identified as one key driver of rising health care expenditures, ie, as households get richer, they spend an increasing amount on private services suggesting a dissatisfaction with the quality offered by the public sector. Hence, quality improvements in the public sector seem to be necessary to ensure sustainability of the public health care sector. If the rich and the middle class increasingly opt out of public health care, the willingness to pay taxes to finance the free health care policy will certainly shrink. Copyright © 2018 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.
Generally speaking, marine organisms found along middle Atlantic shores are not considered threatening to people. However, some of these animals can cause problems, either upon simple contact with the skin, as in the case of some jellyfish, or through careless handling. In addition, larger inhabitants of coastal waters (such as sharks) must always…
Jacobson, C Jeff; Bolon, Shannon; Elder, Nancy; Schroer, Brian; Matthews, Gerald; Szaflarski, Jerzy P; Raphaelson, Marc; Horner, Ronnie D
Physician work intensity (WI) during office-based patient care affects quality of care and patient safety as well as physician job-satisfaction and reimbursement. Existing, brief work intensity measures have been used in physician studies, but their validity in clinical settings has not been established. Document and describe subjective and temporal WI dimensions for physicians in office-based clinical settings. Examine these in relation to the measurement procedures and dimensions of the SWAT and NASA-TLX intensity measures. A focused ethnographic study using interviews and direct observations. Five family physicians, 5 general internists, 5 neurologists, and 4 surgeons. Through interviews, each physician was asked to describe low and high intensity work responsibilities, patients, and events. To document time and task allotments, physicians were observed during a routine workday. Notes and transcripts were analyzed using the editing method in which categories are obtained from the data. WI factors identified by physicians matched dimensions assessed by standard, generic instruments of work intensity. Physicians also reported WI factors outside of the direct patient encounter. Across specialties, physician time spent in direct contact with patients averaged 61% for office-based services. Brief work intensity measures such as the SWAT and NASA-TLX can be used to assess WI in the office-based clinical setting. However, because these measures define the physician work "task" in terms of effort in the presence of the patient (ie, intraservice time), substantial physician effort dedicated to pre- and postservice activities is not captured.
Bleiweiss, L; Simson, S
This case study focuses on the efforts of three urban medical care institutions--a Health Maintenance Organization, a nursing home, and a university hospital--to form an interorganizational relationship. The purpose of the relationship was to utilize the services of the three organizations in order to respond to the comprehensive health needs of an urban geriatric population. Movements in this triadic organizational relationship are described and analyzed in terms of four conceptual stages--exploration, negotiation, interaction and performance, and termination. Problems arising during these stages were not resolved and the relationship was terminated after approximately two years of existence. A sociological discussion of the case focuses on why the relationship failed. The organizational relationship was disrupted by three stresses that occurred during the four stages of the relationship. Stresses emerged for each organization in the areas of organizational integration, professional coordination, and environmental adaptation, making it difficult for the three to become integrated into an organizational system. As a result, the HMO, the nursing home, and the hospital did not benefit from relationships that could have enabled them to develop the multi-organizational system necessary to sustain an innovative, comprehansive geriatric health project. If, as Whitehead said, the greatest invention of the nineteenth century was the invention of the method of invention, the task of the succedding century has been to organize inventiveness. The difference is not in the nature of invention or of inventors, but in the manner in which the context of social institutions is organized for their support.
Plas, A.G.M. van der; Francke, A.L.; Deliens, L.; Jansen, W.J.J.; Vissers, K.C.; Onwuteaka-Philipsen, B.D.
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
García-Martín, Guillermina; Martín-Reyes, Guillermina; Dawid-Milner, Marc Stefan; Chamorro-Muñoz, M Isabel; Pérez-Errazquin, Francisco; Romero-Acebal, Manuel
Epilepsy is a chronic illness that requires a long-term periodic follow-up of the patient and this means that as time goes by the number of patients attended increases, with the ensuing added cost for the healthcare system. To determine the factors involved in the time until an epileptic patient's next visit. Our sample consisted of a selection of patients who visited the epilepsy clinic at our hospital consecutively during one year. Their clinical situation and relationship with the medical advice they were given, together with the factors involved in the time elapsed until the next visit, were analysed by means of predictive econometric models. There is a clear association between the patient's clinical situation and the modification of the treatment proposed by the neurologist in the previous visit. The factors involved in the time until the next visit were the frequency of seizures, adverse side effects from medicines -above all those that affect cognition- and the medical advice given to the patient. Polytherapy, psychoaffective disorders or the patient's social situation were not found to be significant. Follow-up visits in a specific epilepsy clinic improves the patient's situation. This is the first analysis of the demand for healthcare in patients with epilepsy conducted by means of econometric methods and from a mixed physician-patient perspective. Since the factors that determine the time until the next visit can be modified, the number of visits per year could be reduced, thus improving patients' clinical situation. We suggest a greater amount of time should be spent per visit so as to be able to have a bearing on it and thereby cut costs in the long term.
Xue, Huaju; Fang, Chengjiang
It is vital to assess the regional tourist supply capability by suppliers and demand groups. The supply side’s evaluation of the regional supply capacity determines the direction of the supply investment in future, the demand side’s evaluation indicates their satisfaction degree of the destination supply and also effects their revisit the tourism destination. Therefore, the assessment of the supply and demand sides is an important reference for the reform of destination supply side, which helps us find the shortage of the destination supply factors and optimize tourism destination supply promptly. This paper through investigating tourism supply and demand groups in Shanghai, used the survey data and constructed tourism supply optimization model, analyzed the current situation of tourism supply factors in Shanghai. Results showed that the environment of Shanghai should be improved first, including improving urban air and water quality, up-grading public sanitation and increasing urban green coverage. Other supply factors improved priority were information and marketing, we should improve the information consultation of scenic spots, increase the intensity of tourism promotion and provide more free travel publicity brochures.
Education in a contemporary context increasingly requires students to engage with learning technologies. This can present a challenge to both students and teachers who at times struggle to engage with the technical processes involved in navigating these technologies. Outside of formal education settings, on-demand information facilitated through…
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
Despite the push for universal education, many disadvantaged and poor children in developing countries still do not have access to basic education. This among other reasons is due to poverty where poor families cannot afford the cost of basic education even when it is "free" of tuition (McDonald, 2007). Demand-side financing…
Ahmed Mohamed Semeida
Full Text Available In the last decades, there has been substantial development in modeling techniques of travel demand estimation. For low population areas the external trip estimation is important but usually neglected in travel demand modeling process. In Egypt, the researches in this field are scarce due to lack of data. Accordingly, this paper aims to identify and estimate the main variables that affect the travel demand in low population areas, and to develop models to predict them. The study focused on the Port Said Governorate in North East Egypt. A special questionnaire had been prepared in 2010 depending on interviews of passengers at basic taxi terminals in Port Said. And 2211 filled questionnaires were offering for research. To analyze the data, two modeling procedures were used. One is the multiple linear regression and the other is the generalized linear modeling (GLM applying normal distributions. It is found that GLM procedure offers more suitable and accurate approach than the linear regression for developing number of trips. The final demand models have statistics within the acceptable regions and, also, they are conceptually reasonable. These results are so important for Egyptian highway authorities to improve the efficiency of highway transportation system in Egypt.
Reyes Perez, M.F.
Water resources in tourist islands have been severely threatened, especially in the Galápagos Islands, where the increased local population has generated attractive income from the tourist services. In addition, the data regarding water supply and demand are scarce. This study investigates water
Ivan S. Milojević; Rade V. Guberinić
If demand is known for the whole planning period (complete information), then this type of demand or a supply system is deterministic. In the simplest cases, the demand per time unit is constant. If demand levels change over time following a precisely determined and pre-known principle, this type of demand is also classified as deterministic. This quality of demand is very rare. In most cases demand is the product of a process, for example TMS maintenance, whose progression cannot be predicte...
Ibrahim, Nagwa A; Björnsdottir, Ingunn; Al Alwan, Ashraf S; Honore, Per Hartvig
To highlight the health-related quality of life scale scores for Saudi patients with different types of cancer, to get understanding and foundation for improvements. To suggest suitable plans for quality of life improvement based on study outcome. The role of oncology pharmacy will be stressed. A cross-sectional descriptive study was conducted at a tertiary regional hospital using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. Attendees were patients diagnosed with any type of cancer and eligible for active anticancer treatment and/or palliative care. Quality of life was evaluated for 87 participants. Most of patients were aged between 51 and 60 years; and 50% had active treatment with chemotherapy. Patients seemed to perform well with respect to average scores in both the symptoms and the functional health status scales. The mean score for the global quality of life scale was 47.2 ± 27.1, while the range of mean scores for the five function subscales was 59.0 ± 27.1 to 81.6 ± 13.8, indicating average level of general wellbeing with above average to high level of functional health status, while >50% of the patients met the operational criterion having less severe symptoms. Outpatients generally had somewhat higher scores as compared to hospitalized patients. The general quality of life seemed satisfactory, but there is still need to improve care. Based on results from other studies, oncology pharmacists' roles are essential to improve quality of life through treatment counseling, follow-up on drug support therapy, stress on patient's education through specific programs, review and update the local guidelines, and conduct more research. © Prince Sultan Military Medical City, Saudi Arabia 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Mirasgedis, S.; Sarafidis, Y.; Georgopoulou, E.; Kotroni, V.; Lagouvardos, K.; Lalas, D.P.
This paper focuses on the potential upcoming impacts of climate change in the 21st century on electricity demand at regional/national levels for regions where topography and location result in large differences in local climate. To address this issue, a regional climate model, PRECIS, has been used to predict future climatic conditions under different emissions scenarios (namely A2 and B2 of the IPCC special report on emissions scenarios (SRES)) as an input to a multiple regression model of the sensitivity of electricity demand in the Greek interconnected power system to climate and socio-economic factors. The economic development input to the multiple regression model follows the same storylines of the SRES scenarios upto 2100 and includes sub-scenarios to cover larger and smaller economic development rates. The results of the analysis indicate an increase of the annual electricity demand attributable solely to climate change of 3.6-5.5% under all scenarios examined, most of which results from increased annual variability with substantial increases during the summer period that outweighs moderate declines estimated for the winter period. This becomes more pronounced if inter-annual variability, especially of summer months, is taken into consideration. It was also found that in the long run, economic development will have a strong effect on future electricity demand, thus increasing substantially the total amount of energy consumed for cooling and heating purposes. This substantial increase in energy demand with strong annual variability will lead to the need for inordinate increases of installed capacity, a large percentage of which will be under utilized. Thus, appropriate adaptation strategies (e.g. new investments, interconnections with other power systems, energy saving programmes, etc.) need to be developed at the state level in order to ensure the security of energy supply. (author)
The importance of energy demand estimation stems from energy planning, formulating strategies and recommending energy policies. Most often, energy demand is mathematically formulated by socio-economic indicators. The challenging problem is to determine the optimal or near optimal weighting factors. Inspired by social behavior of bird flocking or fish schooling, PSO (particle swarm optimization) is a population-based search technique which has attracted significant attention to tackle the complexity of difficult optimization problems. This paper studies the performance of different PSO variants for estimating Iran's electricity demand. Seven PSO variants namely, original PSO, PSO-w (PSO with weighting factor), PSO-cf (PSO with constriction factor), PSO-rf (PSO with repulsion factor), PSO-vc (PSO with velocity control), CLPSO (comprehensive learning PSO) and a MPSO (modified PSO), are used to find the unknown weighting factors based on the data from 1982 to 2003. The validation process is then conducted by testing the optimized models by using the data from 2004 to 2009. It is seen that PSO-vc produces more promising results than the other variants, HS (harmony search) and ABSO (artificial bee swarm optimization) algorithms in terms of MAPE (mean absolute percentage error). This value is obtained 2.47 and 2.50 for the exponential and quadratic models, respectively. - Highlights: • Electricity demand estimation is modelled using socio-economic indicators. • Different PSO variants are investigated in terms of accuracy. • Exponential model can estimate the Iran's electricity demand with high accuracy. • PSO with velocity control produces more accurate result than the others
Williams, T A; Ho, K M; Dobb, G J; Finn, J C; Knuiman, M W; Webb, S A R
Critical care service is expensive and the demand for such service is increasing in many developed countries. This study aimed to assess the changes in characteristics of critically ill patients and their effect on long-term outcome. This cohort study utilised linked data between the intensive care unit database and state-wide morbidity and mortality databases. Logistic and Cox regression was used to examine hospital survival and five-year survival of 22,298 intensive care unit patients, respectively. There was a significant increase in age, severity of illness and Charlson Comorbidity Index of the patients over a 16-year study period. Although hospital mortality and median length of intensive care unit and hospital stay remained unchanged, one- and five-year survival had significantly improved with time, after adjusting for age, gender; severity of illness, organ failure, comorbidity, 'new' cancer and diagnostic group. Stratified analyses showed that the improvement in five-year survival was particularly strong among patients admitted after cardiac surgery (P = 0.001). In conclusion, although critical care service is increasingly being provided to patients with a higher severity of acute and chronic illnesses, long-term survival outcome has improved with time suggesting that critical care service may still be cost-effectiveness despite the changes in case-mix.
van der Plas Annicka G M
Full Text Available Abstract Background Case management is a heterogeneous concept of care that consists of assessment, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet the client's health and service needs. This paper describes the result of an expert panel procedure to gain insight into the aims and characteristics of case management in palliative care in the Netherlands. Methods A modified version of the RAND®/University of California at Los Angeles (UCLA appropriateness method was used to formulate and rate a list of aims and characteristics of case management in palliative care. A total of 76 health care professionals, researchers and policy makers were invited to join the expert panel, of which 61% participated in at least one round. Results Nine out of ten aims of case management were met with agreement. The most important areas of disagreement with regard to characteristics of case management were hands-on nursing care by the case manager, target group of case management, performance of other tasks besides case management and accessibility of the case manager. Conclusions Although aims are agreed upon, case management in palliative care shows a high level of variability in implementation choices. Case management should aim at maintaining continuity of care to ensure that patients and those close to them experience care as personalised, coherent and consistent.
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.
Eric T. Anderson; Duncan I. Simester
We analyze a large-scale field test conducted with a mail-order catalog firm to investigate how customers react to premium prices for larger sizes of women's apparel. We find that customers who demand large sizes react unfavorably to paying a higher price than customers for small sizes. Further investigation suggests that these consumers perceive that the price premium is unfair. Overall, premium pricing led to a 6% to 8% decrease in gross profits.
The objective of this thesis research is to explore the US customer demand and seek better customer and market understanding, and consequently, facilitate implementing the optimal stock levels in the market. Additionally, this thesis investigates which improvements are necessary for utilizing the common stock supply model in the US, and how the maximal availability is achieved for the US customers. The research method in this thesis is qualitative. The theoretical framework was created th...
The present research focuses on the interaction of supply and demand of down-hill ski tourism in the province of Alberta. The main hypothesis is that the demand for skiing depends on the socio-economic and demographic characteristics of the population living in the province and outside it. A second, consequent hypothesis is that the development of ski resorts (supply) is a response to the demand for skiing. From the latter derives the hypothesis of a dynamic interaction between supply (ski resorts) and demand (skiers). Such interaction occurs in space, within a range determined by physical distance and the means available to overcome it. The above hypotheses implicitly define interactions that take place in space and evolve over time. The hypotheses are tested by temporal, spatial, and spatio-temporal regression models, using the best available data and the latest commercially available software. The main purpose of this research is to explore analytical techniques to model spatial, temporal, and spatio-temporal dynamics in the context of regional science. The completion of the present research has produced more significant contributions than was originally expected. Many of the unexpected contributions resulted from theoretical and applied needs arising from the application of spatial regression models. Spatial regression models are a new and largely under-applied technique. The models are fairly complex and a considerable amount of preparatory work is needed, prior to their specification and estimation. Most of this work is specific to the field of application. The originality of the solutions devised is increased by the lack of applications in the field of tourism. The scarcity of applications in other fields adds to their value for other applications. The estimation of spatio-temporal models has been only partially attained in the present research. This apparent limitation is due to the novelty and complexity of the analytical methods applied. This opens new
Gui, Kun-Peng; Xu, Jian-Gang; Zhang, Xiang
Urban green space has the functions of ecological and social services, and the two services levels are decided by the supply-demand relationship. However, the supply-demand of green space not only involves in quantity, but also refers to spatial distribution. Therefore, only greening indicators can not wholly reflect the true levels of green space services. Based on the supply-demand analysis and supported by the ArcGIS, this paper examined the ecological and social services levels of the urban green spaces in Nanjing City by using the evenness indicator and the rate the people could enjoy the public green space in their accessible area. Accordingly, the ecological and social services levels of the green space in the City were investigated. The results showed that in the east of Nanjing City, green spaces were rich, but high accessible ones were lack, which resulted in a moderate social service level. In the center of the City, green spaces were lack and distributed unevenly, resulting in the low levels of ecological and social services. In Hexi area, due to the shortage in ecological green space and its uneven distribution, the green spaces had a high level social service but a low level ecological service. In the southern and northern areas of the City, green spaces were in deficiency, uneven distribution, and lack in high accessible.
Sears, Nancy A
Case management has developed in a variety of health care, social service, and insurance industries. Its historical pattern of development has resulted in practices that are generally administrative and technical in nature as well as being relatively generic and often undifferentiated between being a role and process. Research over the last decade has resulted in the opportunity to move case management practice for home care into a structured theory-based model and practice. Design and implementation of a specialized advanced practice care management model reflective of care management research and theory design by British researchers is beginning to show clinical and systemic results that should be replicable in other regions.
Trastek, Victor F; Hamilton, Neil W; Niles, Emily E
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. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
Robin I. Oosterholt
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.
Kastrup, Marc; Seeling, Matthes; Barthel, Stefan; Bloch, Andy; le Claire, Marie; Spies, Claudia; Scheller, Matthias; Braun, Jan
There is an increasing demand for intensive care in hospitals, which can lead to capacity limitations in the intensive care unit (ICU). Due to postponement of elective surgery or delayed admission of emergency patients, outcome may be negatively influenced. To optimize the admission process to intensive care, the post-anaesthesia care unit (PACU) was staffed with intensivist coverage around the clock. The aim of this study is to demonstrate the impact of the PACU on the structure of ICU-patients and the contribution to overall hospital profit in terms of changes in the case mix index for all surgical patients. The administrative data of all surgical patients (n = 51,040) 20 months prior and 20 months after the introduction of a round-the-clock intensivist staffing of the PACU were evaluated and compared. The relative number of patients with longer length of stay (LOS) (more than seven days) in the ICU increased after the introduction of the PACU. The average monthly number of treatment days of patients staying less than 24 hours in the ICU decreased by about 50% (138.95 vs. 68.19 treatment days, P case mix index (CMI) per hospital day for all surgical patients was significantly higher after the introduction of a PACU: 0.286 (± 0.234) vs. 0.309 (± 0.272) P case mix index of the patients per hospital day, increased after the implementation of a PACU and more patients can be treated in the same time, due to a better use of resources.
Graham, R.L.; Liu, W.; Downing, M.; Noon, C.; Daly, M.; Moore, A.
Cost-supply curves for delivered wood chips from short rotation woody crops were calculated for 21 regularly-spaced locations spanning the state of Tennessee. These curves were used to systematically evaluate the combined effects of location and facility demand on wood chip feedstock costs in Tennessee. The cost-supply curves were developed using BRAVO, a GIS-based decision support system which calculates marginal cost of delivering wood chips to a specific location given road network maps and maps of farmgate prices and supplies of woody chips from short rotation energy crops. Marginal costs of delivered chips varied by both facility location in the state and facility demand. Marginal costs were lowest in central Tennessee unless the facility demand was greater than 2.7 million dry Mg per year (3 million dry tons per year) in which case west Tennessee was the lowest cost region. Marginal costs rose rapidly with increasing facility demand in the mountainous eastern portion of the state. Transportation costs accounted for 18 to 29% of the delivered cost and ranged between $8 and $18/dry Mg ($7 and $16/dry ton). Reducing the expected farmer participation rate from 100% to 50% or 25% dramatically raised the marginal costs of feedstock supply in the east and central regions of the state. The analysis demonstrates the need to use geographically-specific information when projecting the potential costs and supplies of biomass feedstock
Meyer-Zehnder, B; Barandun Schäfer, U; Albisser Schleger, H; Reiter-Theil, S; Pargger, H
The daily work of many healthcare professionals has become more complex and demanding in recent years. Apart from purely medical issues, ethical questions and problems arise quite often. Managing these problems requires ethical knowledge. Questions about the usefulness of a therapy and treatment occur especially at the end of life. So-called medical futility, a useless futile therapy, is often perceived by nurses and physicians in intensive care units who themselves often develop symptoms of depression or burnout. The clinical ethical model METAP (acronym from module, ethics, therapy decision, allocation and process) provides methods and criteria that allow the clinical team to treat and solve ethical issues according to a solution-oriented approach. The ethical decision-making of this model addresses these issues according to a series of sequential stages in the form of a so-called escalation model. When it is not possible to tackle and solve an ethical problem or dilemma in one stage, one moves to the next. The implementation of this approach in everyday practice requires the commitment of all team members in addition to certain basic conditions. In a surgical intensive care unit a fixed date in the schedule is reserved for ethical case discussions (level 3 of the escalation model). At this level a team member who has been specified according to a quarterly plan is responsible for the organization and performance of the discussion. All protocols of the 44 ethical case discussions in 41 patients between January 2011 and July 2012 were collected and summarized. A short questionnaire to all participants recorded their assessment of the benefits for the patient and the team as well as their perception of personal stress reduction. Also queried was the impact of this method on the collaboration between nurses and physicians and the ethical competence. Ethical case discussions among the care team took place regularly (44 case discussions between January 2011 and June
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
Kiil, Astrid; Houlberg, Kurt
This article reviews the quantitative evidence on the behavioural effects of copayment within the health area across a wide range of countries. The review distinguishes itself from previous similar reviews by having a high degree of transparency for the search strategy used to identify the studies included in the review as well as the criteria for inclusion and by including the most recent literature. Empirical studies were identified by performing searches in EconLit. The literature search identified a total of 47 studies of the behavioural effects of copayment. Considering the demand effects, the majority of the reviewed studies found that copayment reduces the use of prescription medicine, consultations with general practitioners and specialists, and ambulatory care, respectively. The literature found no significant effects of copayment on the prevalence of hospitalisations. The empirical evidence on whether copayment for some services, but not for others, causes substitution from the services that are subject to copayment to the 'free' services rather than lower total use is sparse and mixed. Likewise, the health effects of copayment have only been analysed empirically in a limited number of studies, of which half did not find any significant effects in the short term. Finally, the empirical evidence on the distributional consequences of copayment indicates that individuals with low income and in particular need of care generally reduce their use relatively more than the remaining population in consequence of copayment. Hence, it is clear that copayment involves some important economic and political trade-offs.
Zepeda, Lydia; Douthitt, Robin; You, So-Ye
This study is an econometric systems approach to modeling the factors and linkages affecting risk perceptions toward agricultural biotechnology, self-protection actions, and food demand. This model is applied to milk in the United States, but it can be adapted to other products as well as other categories of risk perceptions. The contribution of this formulation is the ability to examine how explanatory factors influence risk perceptions and whether they translate into behavior and ultimately what impact this has on aggregate markets. Hadden's outrage factors on heightening risk perceptions are among the factors examined. In particular, the article examines the role of labeling as a means of permitting informed consent to mitigate outrage factors. The effects of attitudinal, economic, and demographic factors on risk perceptions are also explored, as well as the linkage between risk perceptions, consumer behavior, and food demand. Because risk perceptions and self-protection actions are categorical variables and demand is a continuous variable, the model is estimated as a two-stage mixed system with a covariance correction procedure suggested by Amemiya. The findings indicate that it is the availability of labeling, not the price difference, between that labeled milk and milk produced with recombinant bovine Somatotropin (rbST) that significantly affects consumer's selection of rbST-free milk. The results indicate that greater availability of labeled milk would not only significantly increase the proportion of consumers who purchased labeled milk, its availability would also reduce the perception of risk associated with rbST, whether consumers purchase it or not. In other words, availability of rbST-free milk translates into lower risk perceptions toward milk produced with rbST.
Mavrotas, George; Diakoulaki, Danae; Florios, Kostas; Georgiou, Paraskevas
The aim of this paper is to provide an integrated modeling and optimization framework for energy planning in large consumers of the services' sector based on mathematical programming. The power demand is vaguely known and the underlying uncertainty is modeled using elements from fuzzy set theory. The defined fuzzy programming model is subsequently transformed to an equivalent multi-objective problem, where the minimization of cost and the maximization of demand satisfaction are the objective functions. The Pareto optimal solutions of this problem are obtained using a novel version of the ε-constraint method and represent the possibly optimal solutions of the original problem under uncertainty. In the present case, in order to select the most preferred Pareto optimal solution, the minimax regret criterion is properly used to indicate the preferred configuration of the system (i.e. the size of the installed units) given the load uncertainty. Furthermore, the paper proposes a model reduction technique that can be used in similar cases and further examines its effect in the final results. The above methodology is applied to the energy rehabilitation of a hospital in the Athens area. The technologies under consideration include a combined heat and power unit for providing power and heat, an absorption unit and/or a compression unit for providing cooling load. The obtained results demonstrate that, increasing the degree of demand satisfaction, the total annual cost increases almost linearly. Although data compression allows obtaining realistic results, the size of the proposed units might be slightly changed
Vos, Leti; Dückers, Michel L A; Wagner, Cordula; van Merode, Godefridus G
Reimbursement based on the total care of a patient during an acute episode of illness is believed to stimulate management and clinicians to reduce quality problems like waiting times and poor coordination of care delivery. Although many studies already show that this kind of case-mix based reimbursement leads to more efficiency, it remains unclear whether care coordination improved as well. This study aims to explore whether case-mix based reimbursement stimulates development of care coordination by the use of care programmes, and a process-oriented way of working. Data for this study were gathered during the winter of 2007/2008 in a survey involving all Dutch hospitals. Descriptive and structural equation modelling (SEM) analyses were conducted. SEM reveals that adoption of the case-mix reimbursement within hospitals' budgeting processes stimulates hospitals to establish care programmes by the use of process-oriented performance measures. However, the implementation of care programmes is not (yet) accompanied by a change in focus from function (the delivery of independent care activities) to process (the delivery of care activities as being connected to a chain of interdependent care activities). This study demonstrates that hospital management can stimulate the development of care programmes by the adoption of case-mix reimbursement within hospitals' budgeting processes. Future research is recommended to confirm this finding and to determine whether the establishment of care programmes will in time indeed lead to a more process-oriented view of professionals. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, Bert
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 Dutch care groups. An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model was used to study the relationship between context factors, mechanisms and outcomes. Dutch integrated care involves care groups, bundled payments, patient involvement, health professional cooperation and task substitution, evidence-based care protocols and a shared clinical information system. Community involvement is not (yet) part of Dutch integrated care. Barriers to the implementation of integrated care included insufficient integration between the patient databases, decreased earnings for some health professionals, patients' insufficient medical and policy-making expertise, resistance by general practitioner assistants due to perceived competition, too much care provided by practice nurses instead of general practitioners and the funding system incentivising the provision of care exactly as described in the care protocols. Facilitators included performance monitoring via the care chain information system, increased earnings for some health professionals, increased focus on self-management, innovators in primary and secondary care, diabetes nurses acting as integrators and financial incentives for guideline adherence. Economic and political context and health IT-related barriers were discussed as the most problematic areas of integrated care implementation. The implementation of integrated care led to improved communication and cooperation but also to insufficient and unnecessary care provision and deteriorated preconditions for person-centred care. Dutch integrated diabetes care is still a
Demand-side resources like demand response (DR) and energy efficiency (EE) can contribute to the capacity adequacy underpinning power system reliability. Forward capacity markets are established in many liberalised markets to procure capacity, with a strong interest in procuring DR and EE. With case studies of ISO New England, PJM and Great Britain, this paper examines the process and trends of procuring DR and EE in forward capacity markets, and the design for integration mechanisms. It finds that the contribution of DR and EE varies wildly across these three capacity markets, due to a set of factors regarding mechanism design, market conditions and regulatory provisions, and the offering of EE is more heavily influenced by regulatory utility EE obligation. DR and EE are complementary in targeting end-uses and customers for capacity resources, thus highlighting the value of procuring them both. System needs and resources’ market potential need to be considered in defining capacity products. Over the long-term, it is important to ensure the removal of barriers for these demand-side resources and the capability of providers in addressing risks of unstable funding and forward planning. For the EDR Pilot in the UK, better coordination with forward capacity auction needs to be achieved. - Highlights: • Trends of demand response and energy efficiency in capacity markets are analysed. • Integration mechanisms, market conditions and regulatory provisions are key factors. • Participation of energy efficiency is influenced by regulatory utility obligations. • Procuring both demand response and energy efficiency in capacity market is valuable. • Critical analysis of the design of capacity products and integration mechanisms.
Full Text Available The increase of energy consumption in the world is reflected in the consumption of natural gas. However, this increment requires additional investment. This effect leads imbalances in terms of demand forecasting, such as applying penalties in the case of error rates occurring beyond the acceptable limits. As the forecasting errors increase, penalties increase exponentially. Therefore, the optimal use of natural gas as a scarce resource is important. There are various demand forecast ranges for natural gas and the most difficult range among these demands is the day-ahead forecasting, since it is hard to implement and makes predictions with low error rates. The objective of this study is stabilizing gas tractions on day-ahead demand forecasting using low-consuming subscriber data for minimizing error using univariate artificial bee colony-based artificial neural networks (ANN-ABC. For this purpose, households and low-consuming commercial users’ four-year consumption data between the years of 2011–2014 are gathered in daily periods. Previous consumption values are used to forecast day-ahead consumption values with sliding window technique and other independent variables are not taken into account. Dataset is divided into two parts. First, three-year daily consumption values are used with a seven day window for training the networks, while the last year is used for the day-ahead demand forecasting. Results show that ANN-ABC is a strong, stable, and effective method with a low error rate of 14.9 mean absolute percentage error (MAPE for training utilizing MAPE with a univariate sliding window technique.
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...... compare the optimal Q(s,S) policy to the optimal uncoordinated (s,S) policies. The results indicate that the more negative the correlation the less advantageous it is to coordinate. Therefore, in some cases the degree of correlation determines whether to apply the coordinated Q(s,S) policy...... or the uncoordinated (s,S) policies. Finally, we compare the Q(s,S) policy and the closely connected P(s,S) policy. Here we explain why the Q(s,S) policy is a better choice if item-demands are correlated....
Koh, Siong Lee; Lim, Yun Seng [Department of Physical Science, Electrical and Electronic Engineering, Tunku Abdul Rahman University (Malaysia)
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)
Koh, Siong Lee; Lim, Yun Seng
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.
Martínez Ceseña, Eduardo A.; Good, Nicholas; Mancarella, Pierluigi
Demand Side Response (DSR) is recognised for its potential to bring economic benefits to various electricity sector actors, such as energy retailers, Transmission System Operators (TSOs) and Distribution Network Operators (DNOs). However, most DSR is provided by large industrial and commercial consumers, and little research has been directed to the quantification of the value that small (below 100 kW) commercial and residential end-users could accrue by providing DSR services. In particular, suitable models and studies are needed to quantify potential business cases for DSR from small commercial and residential end-users. Such models and studies should consider the technical and physical characteristics of the power system and demand resources, together with the economic conditions of the power market. In addition, the majority of research focuses on provision of energy arbitrage or ancillary services, with very little attention to DSR services for network capacity support. Accordingly, this paper presents comprehensive techno-economic methodologies for the quantification of three capacity-based business cases for DSR from small commercial and residential end-users. Case study results applied to a UK context indicate that, if the appropriate regulatory framework is put in place, services for capacity support to both DNOs and TSOs can result into potentially attractive business cases for DSR from small end-users with minimum impact on their comfort level. -- Highlights: •We present three business cases for DSR from domestic and commercial end-users. •A comprehensive techno-economic methodology is proposed for the quantification of each DSR business cases. •The regulatory implications associated with each business case are discussed
Sach Tracey H; Whynes David K; Yu Chai
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...
Di Duro Joseph O
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.
Karasek, Robert A.
Nineteen international case studies of workplace stress prevention initiatives are analyzed. The focus of these cases, which span a variety of workplaces and locations, is on preventing stress through work reorganization rather than remedial approaches for stress relief. It is found that the majority of the occupations represented in the case…
Divatia, Jigeeshu V; Amin, Pravin R; Ramakrishnan, Nagarajan; Kapadia, Farhad N; Todi, Subhash; Sahu, Samir; Govil, Deepak; Chawla, Rajesh; Kulkarni, Atul P; Samavedam, Srinivas; Jani, Charu K; Rungta, Narendra; Samaddar, Devi Prasad; Mehta, Sujata; Venkataraman, Ramesh; Hegde, Ashit; Bande, B D; Dhanuka, Sanjay; Singh, Virendra; Tewari, Reshma; Zirpe, Kapil; Sathe, Prachee
To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs). An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs. On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality. The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.
The advance of reproductive technologies, like surrogacy arrangements, confronts courts with new demands and dilemmas. This contribution analyses the potential of EU law towards a better and more balanced reconciliation of work, private and family life when no national law applies. In two recent
Jagt-van Kampen, Charissa T.; Kars, Marijke C.; Colenbrander, Derk A.; Bosman, Diederik K.; Grootenhuis, Martha A.; Caron, Huib N.; Schouten-van Meeteren, Antoinette Y. N.
Case management is a subject of interest within pediatric palliative care. Detailed descriptions of the content of this type of case management are lacking. We aim to describe the contents of care provided, utilization of different disciplines, and times of usage of a pediatric palliative care case
Title of bachelor's thesis: Case report physiotherapy care of a patient diagnosed with polyarthritis with early rheumatoid arthritis. Summary: The bachelor thesis deals with polyarthritis disease with early rheumatoid arthritis and its physiotherapy care. It consists of two parts. The general part contains a general joint anatomy, deals with the major problems of disease and polyarthritis rheumatoid arthritis, its diagnosis, treatment and physiotherapy care. Special part includes a case repor...
Schiøtz, Michaela L; Høst, Dorte; Christensen, Mikkel B; Domínguez, Helena; Hamid, Yasmin; Almind, Merete; Sørensen, Kim L; Saxild, Thomas; Holm, Rikke Høgsbro; Frølich, Anne
Multimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people with multimorbidity in the publicly funded healthcare system in Denmark. To investigate the quality of care for people with multimorbidity different groups of clinicians from the hospital, general practice and the municipality reviewed records from 23 persons with multimorbidity and discussed them in three focus groups. Before each focus group, clinicians were asked to review patients' medical records and assess their care by responding to a questionnaire. Medical records from 2013 from hospitals, general practice, and health centers in the local municipality were collected and linked for the 23 patients. Further, two clinical pharmacologists reviewed the appropriateness of medications listed in patient records. The review of the patients' records conducted by three groups of clinicians revealed that around half of the patients received adequate care for the single condition which prompted the episode of care such as a hospitalization, a visit to an outpatient clinic or the general practitioner. Further, the care provided to approximately two-thirds of the patients did not take comorbidities into account and insufficiently addressed more diffuse symptoms or problems. The review of the medication lists revealed that the majority of the medication lists contained inappropriate medications and that there were incongruity in medication listed in the primary and secondary care sector. Several barriers for providing high quality care were identified. These included relative short consultation times in general practice and outpatient clinics, lack of care coordinators, and lack of shared IT-system proving an overview of the treatment. Our findings reveal quality of care deficiencies for
Ayalon, Liat; Baum, Nehami
In Israel, the government partially supports personal home care services (grooming, feeding, assistance with transfers) as a means to maintain frail individuals in their home environment for as long as possible. Social workers capture a prominent position in these arrangements as initiators and supervisors of personal home care services. This…
In the Netherlands around 4000 – 6700 children with life-limiting diseases could benefit from paediatric palliative care (PPC). However, adequate PPC is often absent due to the lack of continuity and coordination of care and limited expertise among healthcare professionals (HCP). Consequently, many
This thesis has for object the evolution of the economic optimum in the electric industry under spatial equity constraint that present a strong spatial heterogeneity of its supply conditions. One analyses the evolution of the rural electrification regime in France both in terms of economic and social efficiency. We examine the rationality of extending the sectoral optimization under equity constraint to the rationalization of electricity end-uses in the heterogeneous space of rural electricity supply. To this question are given two responses. The firsts pertains to modify the incentives in the institutional regime of rural electrification so the MDE may be integrated in the strategies of rural electrification syndicates. One inspire from incentives mechanisms of the anglo-saxon DSM practice. The second is statistical zoning method of demand and distribution grid whose object is to localize action basins for large scale MDE projects. (author)
appropriate access to health care; technical quality is providing world-class care to our veterans; customer satisfaction is ensuring the STVHCS patients and...were not called. These results not only improved access to health care, but also positively affected customer service. 111 Case Study: South Texas...increased waiting times for the patient . With current regulatory requirements calling for improved access to health care services, many hospital and
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.
Rina D. Pasaribu
Full Text Available Broadband telecommunication is significantly important to support and improve countrys competitiveness level. However Indonesia performance especially in Fixed Broadband is poor as the penetration rate is very low and far behind from other ASEAN countries. The industry is served by multi operators with one dominant operator. This dominant operator will be studied representing the industry in this study. A qualitative study Pasaribu et al. 2015 related to this paper has found that poor fulfillment of Customer Demand and poor Supplier Performance are two dominant external factors that cause the low performance. A model is proposed to frame the work it consists of four variables Customer Demand Supplier Performance Competitive Strategy and Business Performance. This study aims is use that Pasaribu et al. model directly to business units level to identify and analyze the relationships within the model and significance level of each relationship accordingly. By understanding the priority levels the improvement program could be more effectively planned and implemented. This study is expected to contribute on Fixed Broadband research wich is still very rare especially in Indonesia The research methodology is quantitative methods using survey technique. The respondents are management and customers of the dominant operator business units. Clustering by province regions gave 32 samples from the population of 58 business units. Partial Least Square modelling was used to analise the datas. The main result of this study is that the most significant relationship in the model is Supplier Performance to Competitive Strategy. Furthermore from indicators of Supplier Performance it was found that Quality Relationship has a very high effect among other indicators. By prioritizing these significant constructs it could be expected the related improvement program could be more effective.
Jithitikulchai, Theepakorn; Andreyeva, Tatiana
Excessive consumption of sugar-sweetened beverages is a major concern in the efforts to improve diet and reduce obesity in USA, particularly among low-income populations. One of the most commonly proposed strategies to reduce sugar-sweetened beverage consumption is increasing beverage prices through taxation. The objective of this study was to evaluate whether and how price-based policies could reduce sugar-sweetened beverage consumption among participants in the federal Supplemental Nutrition Assistance Program. Using point-of-sale data from a regional supermarket chain (58 stores), we estimated the responsiveness of demand to sugar-sweetened beverage price changes among Supplemental Nutrition Assistance Program-participating families with young children. Own-price and cross-price elasticities for non-alcoholic beverages were estimated using a Quadratic Almost Ideal Demand System model. The study found evidence that a tax-induced sugar-sweetened beverage price increase would reduce total sugar-sweetened beverage purchases among Supplemental Nutrition Assistance Program participants, who were driven by purchase shifts away from taxed sodas and sports drinks to non-taxed beverages (bottled water, juice, milk). The substitution of non-taxed caloric beverages decreases the marginal effects of the sugar-sweetened beverage tax, yet the direct tax effects are large enough to reduce the overall caloric intake, with the average net reduction in monthly calories from sugar-sweetened beverages estimated at around 8% for a half-cent per ounce tax and 16% for a one cent per ounce tax. A beverage price increase in the form of an excise tax would reduce sugar-sweetened beverage consumption and increase healthier beverage purchases among low-income families.
In many western countries health care is a subject of increasing importance on the political agenda. Issues such as aging, development of medical technologies, equity and efficiency of care, increasing costs, market elements, etc. are leading to a review of existing health care systems. In The Netherlands the government has proposed fundamental changes in the structure and financing of care, based on a report by the so-called Dekker Committee. The final result of a step-wise process of change should be the introduction of a new insurance scheme and the strengthening of market elements. After a short description of the government proposals, this article gives an analysis of the process of decision-making for a restructuring of health care in the Netherlands. The analysis is based on a bureaupolitical model, as originally described by Allison.
Breedveld, Elly J; Meijboom, Bert R; de Roo, Aad A
Health organizations have started to become more market-driven. Therefore, it is important for health organizations to analyse the competitive dynamics of their industrial structure. However, relevant theories and models have mainly been developed for organizations acting in the profit sector. In this paper, we adapt Porter's 'five forces model' to the home care industry. In particular, we modify the (determinants of the) bargaining power of labour suppliers. We then apply the modified Porter-model to the home care industry in the Netherlands for the period of 1987-1997 with special attention for labour supply. The new instrument clarifies the complexity of the supply chains and value systems of the home care industry. As can be illustrated by developments in the home care industry in the province of North Brabant during the 1990s, competition between home care providers has influenced labour market relations, but so do other factors as well. Between 1987 and 1997, the bargaining power of labour suppliers was relatively limited. After 1997, however, the demand for home care personnel has increased strongly. In spite of the present economic recession, scarcity on this labour market seems to prevail in the longer term due to a growing demand for home care services.
Phillips, Charles D.
Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges. PMID:26740744
Charles D. Phillips
Full Text Available Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.
Full Text Available A recent advancement in location-allocation modeling formulates a two-step approach to a new problem of minimizing disparity of spatial accessibility. Our field work in a health care planning project in a rural county in China indicated that residents valued distance or travel time from the nearest hospital foremost and then considered quality of care including less waiting time as a secondary desirability. Based on the case study, this paper further clarifies the sequential decision-making approach, termed “two-step optimization for spatial accessibility improvement (2SO4SAI.” The first step is to find the best locations to site new facilities by emphasizing accessibility as proximity to the nearest facilities with several alternative objectives under consideration. The second step adjusts the capacities of facilities for minimal inequality in accessibility, where the measure of accessibility accounts for the match ratio of supply and demand and complex spatial interaction between them. The case study illustrates how the two-step optimization method improves both aspects of spatial accessibility for health care access in rural China.
Christianson, J B; Applebaum, R; Carcagno, G; Phillips, B
This article discusses issues relating to the design and internal administration of a case-management agency for community based home care for the elderly. Included in the article are issues relating to screening procedures, assessment and case management activities, cost controls, automated management information systems, and personnel matters. The analysis is based on the experience of the National Long Term Care Demonstration ("Channeling") which established and evaluated ten case management projects nationwide under federal funding.
Bailit, Michael; Dyer, Mary Beth
To address widespread deficiencies in the quality of health care, the authors argue that health care organizations need to be able to make a "business case" for improving quality--a compelling rationale for financial investment in quality improvement programs. The authors' framework for such a business case is organized around three broad areas: direct financial considerations, strategic considerations, and internal organizational considerations. Within these categories, they offer a total of 10 specific business case arguments, with examples, for investing in quality improvement.
Al-Iriani, Mahmoud A.
The oil crisis of the 1970s has increased the concern about the continuity of oil imports flow to major oil-importing developed countries. Numerous policy measures including electricity demand-side management (DSM) programs have been adopted in such countries. These measures aim at reducing the growing need for electricity power that increases the dependency on imported foreign oil and damages the environment. On the other hand, the perception that energy can be obtained at very low cost in oil-rich countries led to less attention being paid to the potential of DSM policies in these countries. This paper discusses such potential using the case of the United Arab Emirates (UAE). Since air conditioning is a major source of electric energy consumption, the relationship between climate conditions and electric energy consumption is considered. An electricity demand model is constructed using time series techniques. The fitted model seems to represent these relationships rather well. Forecasts for electricity consumption using the estimated model indicate that a small reduction in cooling degrees requirement might induce a significant reduction in electric energy demand. Hence, a DSM program is proposed with policy actions to include, among others, measures to reduce cooling degrees requirement
Skytte, K.; Birk Mortensen, J.
Improving the ability of energy demand to respond to wholesale prices during critical periods of the spot market can reduce the total costs of reliably meeting demand, and the level and volatility of the prices. This fact has lead to a growing interest in the short-run demand response. There has especially been a growing interest in the electricity market where peak-load periods with high spot prices and occasional local blackouts have recently been seen. Market concentration at the supply side can result in even higher peak-load prices. Demand response by shifting demand from peak to base-load periods can counteract the market power in the peak-load. However, demand response has so far been modest since the current short-term price elasticity seems to be small. This is also the case for related markets, for example, green certificates where the demand is determined as a percentage of the power demand, or for heat and natural gas markets. This raises a number of interesting research issues: 1) Demand response in different energy markets, 2) Estimation of price elasticity and flexibility, 3) Stimulation of demand response, 4) Regulation, policy and modelling aspects, 5) Demand response and market power at the supply side, 6) Energy security of supply, 7) Demand response in forward, spot, ancillary service, balance and capacity markets, 8) Demand response in deviated markets, e.g., emission, futures, and green certificate markets, 9) Value of increased demand response, 10) Flexible households. (BA)
Vermeltfoort, Pit B. J.; Hooymans, Johanna M. M.; Busscher, Henk J.; van der Mei, Henny C.
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
Andrade, Edson de Oliveira; Andrade, Elizabeth Nogueira de, E-mail: email@example.com [Universidade Federal do Amazonas (UFAM), Manaus, AM (Brazil); Gallo, Jose Hiran [Universidade do Porto (U.Porto) (Portugal)
Objective: to present the experience of a health plan operator (Unimed-Manaus) in Manaus, Amazonas, Brazil, with the accreditation of imaging services and the demand induced by the supply of new services (Roemer's Law). Methods: this is a retrospective work studying a time series covering the period from January 1998 to June 2004, in which the computed tomography and the magnetic resonance imaging services were implemented as part of the services offered by that health plan operator. Statistical analysis consisted of a descriptive and an inferential part, with the latter using a mean parametric test (Student T-test and ANOVA) and the Pearson correlation test. A 5% alpha and a 95% confidence interval were adopted. Results: at Unimed-Manaus, the supply of new imaging services, by itself, was identified as capable of generating an increased service demand, thus characterizing the phenomenon described by Roemer. Conclusion: the results underscore the need to be aware of the fact that the supply of new health services could bring about their increased use without a real demand. (author)
Andrade, Edson de Oliveira; Andrade, Elizabeth Nogueira de; Gallo, Jose Hiran
Objective: to present the experience of a health plan operator (Unimed-Manaus) in Manaus, Amazonas, Brazil, with the accreditation of imaging services and the demand induced by the supply of new services (Roemer's Law). Methods: this is a retrospective work studying a time series covering the period from January 1998 to June 2004, in which the computed tomography and the magnetic resonance imaging services were implemented as part of the services offered by that health plan operator. Statistical analysis consisted of a descriptive and an inferential part, with the latter using a mean parametric test (Student T-test and ANOVA) and the Pearson correlation test. A 5% alpha and a 95% confidence interval were adopted. Results: at Unimed-Manaus, the supply of new imaging services, by itself, was identified as capable of generating an increased service demand, thus characterizing the phenomenon described by Roemer. Conclusion: the results underscore the need to be aware of the fact that the supply of new health services could bring about their increased use without a real demand. (author)
Andrade, Edson de Oliveira; Andrade, Elizabeth Nogueira de; Gallo, José Hiran
To present the experience of a health plan operator (Unimed-Manaus) in Manaus, Amazonas, Brazil, with the accreditation of imaging services and the demand induced by the supply of new services (Roemer's Law). This is a retrospective work studying a time series covering the period from January 1998 to June 2004, in which the computed tomography and the magnetic resonance imaging services were implemented as part of the services offered by that health plan operator. Statistical analysis consisted of a descriptive and an inferential part, with the latter using a mean parametric test (Student T-test and ANOVA) and the Pearson correlation test. A 5% alpha and a 95% confidence interval were adopted. At Unimed-Manaus, the supply of new imaging services, by itself, was identified as capable of generating an increased service demand, thus characterizing the phenomenon described by Roemer. The results underscore the need to be aware of the fact that the supply of new health services could bring about their increased use without a real demand.
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)
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.
Jonrinaldi, Primadi, M. Yugo; Hadiguna, Rika Ampuh
Inventory cannot be avoided by organizations. One of them is a hospital which has a functional unit to manage the drugs and other medical supplies such as disposable and laboratory material. The unit is called Pharmacy Department which is responsible to do all of pharmacy services in the hospital. The current problem in Pharmacy Department is that the level of drugs and medical supplies inventory is too high. Inventory is needed to keep the service level to customers but at the same time it increases the cost of holding the items, so there should be a policy to keep the inventory on an optimal condition. To solve such problem, this paper proposes an inventory policy in Pharmacy Department of Pariaman Hospital. The inventory policy is determined by using Economic Order Quantity (EOQ) model under condition of permissible delay in payment for multiple products considering safety stock to anticipate stochastic demand. This policy is developed based on the actual condition of the system studied where suppliers provided a certain period to Pharmacy Department to complete the payment of the order. Based on implementation using software Lingo 13.0, total inventory cost of proposed policy of IDR 137,334,815.34 is 37.4% lower than the total inventory cost of current policy of IDR 219,511,519.45. Therefore, the proposed inventory policy is applicable to the system to minimize the total inventory cost.
Palomar, Esther; Chen, Xiaohong; Liu, Zhiming; Maharjan, Sabita; Bowen, Jonathan
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.
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)
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.
Coleman, B. [Bridgestone Ltd. (United Kingdom)
The paper explains how good relationships can help alleviate potential tyre shortages. Demand for large dump truck tyres (largely for China) has increased by 50% within 12 months. Bridgestone's manufacturing plants are operating at maximum capacity. The company supplies tyres to all vehicles at Scottish Coal's opencast coal mines. Its Tyre Management System (TMS) supplied free of charge to customers helps maximise tyre life and minimise downtime from data on pressure, tread and general conditions fed into the hand-held TMS computer. 3 photos.
Prata, Ndola; Weidert, Karen; Fraser, Ashley; Gessessew, Amanuel
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. 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. 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. 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 tailor interventions to match family
Lambert, G. [Suncor Energy, Fort McMurray, AB (Canada); Pollock, D. [Pembina Institute for Appropriate Development, Drayton Valley, AB (Canada)
This paper highlights the opportunity for new partnerships between business and non-governmental organizations in the field of sustainable development through the growing convergence of interests. The authors also briefly describe both Suncor Energy and the Pembina Institute for Appropriate Development stances on sustainable development. Since 1990, both organizations have collaborated on the future of the emerging renewable energy industry. Renewable energy represents an energy source diversification through the regional creation of jobs and improved air quality and associated benefits resulting from the reductions in greenhouse gas emissions. The Clean Air Renewable Energy Coalition (Coalition) was established in December 2000 in order to assess the barriers to capital investment in the renewable energy industry. It was revealed that the international community as a whole was further ahead than Canada in terms of renewable support, production and export of technology and services. Some of the challenges facing the industry are: low demand for renewables and low supply. The coalition allowed for the joint identification of desired policy changes, such as new tax incentives for renewable energy supply and demand. Efforts were made in inviting the support of industry, municipalities and environmental non governmental organizations. The list of members that have joined the coalition to date was shown. The coalition is asking for consumer green energy credit, designed for the creation of demand and the education of the general public, and producer incentives to increase supply. The proposals were explained, as well as the strategic principles underlying them. A new tax incentive was announced in the December 2001 Canadian federal budget. The authors concluded by mentioning some future opportunities and the lessons learned on the importance of the right partners, of broad-based advocacy, of targeted and focuses messages, and of evolutionary change.
Lambert, G.; Pollock, D.
This paper highlights the opportunity for new partnerships between business and non-governmental organizations in the field of sustainable development through the growing convergence of interests. The authors also briefly describe both Suncor Energy and the Pembina Institute for Appropriate Development stances on sustainable development. Since 1990, both organizations have collaborated on the future of the emerging renewable energy industry. Renewable energy represents an energy source diversification through the regional creation of jobs and improved air quality and associated benefits resulting from the reductions in greenhouse gas emissions. The Clean Air Renewable Energy Coalition (Coalition) was established in December 2000 in order to assess the barriers to capital investment in the renewable energy industry. It was revealed that the international community as a whole was further ahead than Canada in terms of renewable support, production and export of technology and services. Some of the challenges facing the industry are: low demand for renewables and low supply. The coalition allowed for the joint identification of desired policy changes, such as new tax incentives for renewable energy supply and demand. Efforts were made in inviting the support of industry, municipalities and environmental non governmental organizations. The list of members that have joined the coalition to date was shown. The coalition is asking for consumer green energy credit, designed for the creation of demand and the education of the general public, and producer incentives to increase supply. The proposals were explained, as well as the strategic principles underlying them. A new tax incentive was announced in the December 2001 Canadian federal budget. The authors concluded by mentioning some future opportunities and the lessons learned on the importance of the right partners, of broad-based advocacy, of targeted and focuses messages, and of evolutionary change
Abstract: The Halal meat selling concept is still quite new in the Finnish market. But it is a quite successful business nowadays. The product quality, freshness and the religious issues are the main reasons behind it. The researcher has chosen a very famous halal meat shop in Finland “Hakaniemen Lihakauppa” as a case company. The company’s business activities, customer services, product quality etc. issues will be discussed in this study. The data of Hakaniemen Lihakauppa had been col...
Full Text Available No abstract available. Article truncated after the first page. A 32 year-old, previously healthy, female hospital visitor had been participating in a family care conference regarding her critically ill grandmother admitted to the cardiac intensive care unit. During the care conference, she felt unwell and had some mild chest discomfort; she collapsed and cardiopulmonary resuscitation (CPR was initiated (1. Upon arrival of the code team, she was attached to the monitor and mask ventilation was initiated. Her initial rhythm is shown in Figure 1. In addition to DC cardioversion which of the following should be administered immediately? 1. Lidocaine; 2. Magnesium sulfate; 3. Procainamide ; 4. 1 and 3; 5. All of the above. ...
Vellinga, A; van Melle-Baaijens, E A H
Nowadays, reflecting on ethics, which we choose to call moral case deliberation, is occurring more and more frequently in psychiatric institutions. We have personal experience of organising and supervising moral case deliberation in a large psychiatric institute and we can confirm the positive effects of moral case deliberation which have been reported in the literature. To describe a structured method for moral case deliberation which enables care-givers in health care and/or addiction care to reflect on moral dilemmas. We refer to the main findings in relevant literature and describe how we developed a structured method for implementing moral case deliberation. Our studies of the literature indicate that systematic reflection about ethical dilemmas can improve the quality of care and make care-givers more satisfied with their work. This is why we have developed our own method which is applicable particularly to psychiatric and/or addition care and which can be used systematically in discussions of moral dilemmas. Our method for discussing ethical issues works well in clinical practice, particularly when it is embedded in a multidisciplinary context. Of course, to ensure the continuity of the system, deliberation about moral and ethical issues needs to be financially safeguarded and embedded in the organisation. Discussion of moral issues improves the quality of care and increases care-givers' satisfaction with their work.
Opinnäytetyön toimeksiantaja oli Harmonia Care Oy. Tutkimuksessa käytettiin kvantitatiivista tutkimusmenetelmää. Opinnäytetyö oli luonteeltaan toiminnallinen opinnäytetyö, jossa samalla suunniteltiin, toteutettiin ja kehitettiin yrityksen sähköistä markkinointia. Tutkimuksessa haettiin vastausta seuraaviin kysymyksiin: ” Onko Facebook-mainonnasta hyötyä Harmonia Care Oy:lle?” ja ”Millainen markkinointikampanja tukee yrityksen strategiaa parhaiten?” Opinnäytetyössä suunniteltiin ja toteute...
Finance Project, Washington, DC.
The quality of child care in the United States has important implications for school preparedness, welfare reform, economic vitality, and the quality of family life. In this 8-minute videotape, business leaders describe why child care makes good business sense. Visuals explain the importance of early childhood for school and life success, and the…
Kumar, Pranay; Sarkar, Prabhajit Kumar
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.
Saavedra-Avendaño, Biani; Darney, Blair G; Reyes-Morales, Hortensia; Serván-Mori, Edson
To test the association between public health insurance and adequate prenatal care among female adolescents in Mexico. Cross-sectional study, using the National Health and Nutrition Survey 2000, 2006, and 2012.We included 3 978 (N=4 522 296) adolescent (12-19) women who reported a live birth.We used logistic regression models to test the association of insurance and adequate (timeliness, frequency and content) prenatal care. The multivariable predicted probability of timely and frequent prenatal care improved over time, from 0.60 (IC95%:0.56;0.64) in 2000 to 0.71 (IC95%:0.66;0.76) in 2012. In 2012, the probability of adequate prenatal care was 0.54 (IC95%:0.49;0.58); women with Social Security had higher probability than women with Seguro Popular and without health insurance. Having Social Security is associated with receipt of adequate prenatal care among adolescents in Mexico.
Park, Hayoung; Shin, Youngsoo
The objectives of the study were to develop a model that measures and evaluates case-mix complexity of tertiary care hospitals, and to examine the characteristics of such a model. Physician panels defined three classes of case complexity and assigned disease categories represented by Adjacent Diagnosis Related Groups (ADRGs) to one of three case complexity classes. Three types of scores, indicating proportions of inpatients in each case complexity class standardized by the proportions at the national level, were defined to measure the case-mix complexity of a hospital. Discharge information for about 10% of inpatient episodes at 85 hospitals with bed size larger than 400 and their input structure and research and education activity were used to evaluate the case-mix complexity model. Results show its power to predict hospitals with the expected functions of tertiary care hospitals, i.e. resource intensive care, expensive input structure, and high levels of research and education activities.
Aceti, Franca; Carluccio, Giuseppe Mattia; Meuti, Valentina; Piperno, Francesca; Sogos, Carla; Straniero Sergio, Bianca; Nicolis, Sara
The post partum depression (PPD) is a severe risk factor for the emotional and cognitive development of offspring. The Authors describe the relationship between mother with PPD and her two-year old child. The mother repeats patterns of parental care experienced during her own childhood.
Staring, A.J.; Meertens, L. O.; Sikkel, N.
Point-Of-Care Testing (POCT) enables clinical tests at or near the patient, with test results that are available instantly or in a very short time frame, to assist caregivers with immediate diagnosis and/or clinical intervention. The goal of POCT is to provide accurate, reliable, fast, and
Larsen, Eli; Mydske, Per Kristen
Many countries aim to create electronic cooperational tools in health care, but the progress is rather slow. The study aimed to uncover how the authoritys' financing policies influence the development of electronic cooperational tools within public health care. An interpretative approach was used in this study. We performed 30 semistructured interviews with vendors, policy makers, and public authorities. Additionally, we conducted an extensive documentation study and participated in 18 workshops concerning information and communication technology (ICT) in Norwegian health care. We found that the interorganizational communication in sectors like health care, that have undergone an independent development of their internal information infrastructure would find it difficult to create electronic services that interconnect the organizations because such connections would affect all interconnected organizations within the heterogenic structure. The organizations would, to a large extent, depend on new functionality in existing information systems. Electronic patient records play a central role in all parts of the health care sector and therefore dependence is established to the information systems and theirs vendors. The Norwegian government authorities, which run more than 80% of the Norwegian health care, have not taken extraordinary steps to compensate for this dependency-the government's political philosophy is that each health care institution should pay for further electronic patient record development. However, cooperational tools are complex due to the number of players involved and the way they are intertwined with the overall workflow. The customers are not able to buy new functionalities on the drawing table, while the electronic patient record vendors are not willing to take the economic risk in developing cooperational tools. Thus, the market mechanisms in the domain are challenged. We also found that public projects that were only financed for the first
Cunha-Cruz, Joana; Milgrom, Peter; Huebner, Colleen E; Scott, JoAnna; Ludwig, Sharity; Dysert, Jeanne; Mitchell, Melissa; Allen, Gary; Shirtcliff, R Mike
Dental care delivery systems in the United States are consolidating and large practice organizations are becoming more common. At the same time, greater accountability for addressing disparities in access to care is being demanded when public funds are used to pay for care. As change occurs within these new practice structures, attempts to implement change in the delivery system may be hampered by failure to understand the organizational climate or fail to prepare employees to accommodate new goals or processes. Studies of organizational behavior within oral health care are sparse and have not addressed consolidation of current delivery systems. The objective of this case study was to assess organizational readiness for implementing change in a large dental care organization consisting of staff model clinics and affiliated dental practices and test associations of readiness with workforce characteristics and work environment. A dental care organization implemented a multifaceted quality improvement program, called PREDICT, in which community-based mobile and clinic-based dental services were integrated and the team compensated based in part on meeting performance targets. Dental care providers and supporting staff members (N = 181) were surveyed before program implementation and organizational readiness for implementing change (ORIC) was assessed by two 5-point scales: change commitment and efficacy. Providers and staff demonstrated high organizational readiness for change. Median change commitment was 3.8 (Interquartile range [IQR]: 3.3-4.3) and change efficacy was 3.8 (IQR: 3.0-4.2). In the adjusted regression model, change commitment was associated with organizational climate, support for methods to arrest tooth decay and was inversely related to office chaos. Change efficacy was associated with organizational climate, support for the company's mission and was inversely related to burnout. Each unit increase in the organizational climate scale predicted 0
de Jonge, P; Huyse, FJ; Slaets, JPJ; Sollner, W; Stiefel, FC
Objective: Lack of operationalization of the biopsychosocial model hinders its effective application to the increasingly prevalent problems of comorbidities in clinical presentations. Here, we describe the INTERMED, an instrument to assess biopsychosocial case complexity in general health care, and
Motivation Of Health Care Workers In Tanzania: A Case Study Of Muhimbili National Hospital. ... workers were female. ... between workers and management, lack of participation in decision-making processes, and a general lack of concern for ...
Vos, L.; Dückers, M.L.A.; Wagner, C.; Merode, G.G. van
Objectives: Reimbursement based on the total care of a patient during an acute episode of illness is believed to stimulate management and clinicians to reduce quality problems like waiting times and poor coordination of care delivery. Although many studies already show that this kind of case-mix
Feder, J; Scanlon, W
Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients. This paper evaluates one such system, adopted by the state of Maryland in 1983 as part of an overall reimbursement reform. Using data on nursing home patient characteristics, costs, and staffing, as well as interviews with officials and various providers of care, the article shows that Maryland's system was successful in shifting nursing home service away from light-care and toward heavy-care patients. Furthermore, the shift occurred without inducing readily measurable declines in quality of care and with little additional administrative cost (partly because the state built its case-mix system on preexisting patient review activities). Although states could learn from and improve upon Maryland's experience--most notably in offering incentives to improve quality of care and in targeting community care on the light-care patients that nursing homes become less willing to serve--Maryland demonstrates that case-mix payment can change nursing home behavior in desired directions without substantial negative consequences.
Full Text Available We apply several estimators to Indonesian household data to estimate the relationship between health insurance and the number of outpatient visits to public and private providers. Once endogeneity of insurance is taken into account, there is a 63 percent increase in the average number of public visits by the beneficiaries of mandatory insurance for civil servants. Individuals' decisions to make first contact with private providers is affected by private insurance membership. However, insurance status does not make any difference for the number of future outpatient visits.
Naveen S Salins
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.
Priya Darshini Kulkarni
Full Text Available The reason that probably prompted Dame Cicely Saunders to launch the palliative care movement was the need to move away from the impersonal, technocratic approach to death that had become the norm in hospitals after the Second World War. Palliative care focuses on relieving the suffering of patients and families. Not limited to just management of pain, it includes comprehensive management of any symptom, which affects the quality of life. Care is optimized through early initiation and comprehensive implementation throughout the disease trajectory. Effective palliative care at the outset can help accelerate a positive clinical outcome. At the end of life, it can enhance the opportunity for the patient and family to achieve a sense of growth, resolve differences, and find a comfortable closure. It helps to reduce the suffering and fear associated with dying and prepares the family for bereavement.
This thesis looks at creating service concept by evaluating the research project of Virtual Interactive Care Service. The research project was initiated and implemented by the author together with Hovi Group Oy and Suomen kotilääkäripalvelu Oy. The goal was to provide a virtual care service business that uses interactive and stimulating activities to improve the wellbeing of elderly people in Finland. The study employed qualitative research method by reviewing existing works particularly...
Colón-Emeric, Cathleen S; Lekan-Rutledge, Deborah; Utley-Smith, Queen; Ammarell, Natalie; Bailey, Donald; Piven, Mary L; Corazzini, Kirsten; Anderson, Ruth A
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.
Günter, Tuğçe; Alpat, Sibel Kılınç
The purpose of this study was to investigate the effect of the case-based learning (CBL) method used in "biochemical oxygen demand (BOD)," which is a topic taught in the environmental chemistry course, at Dokuz Eylul University, on the academic achievement and opinions of students. The research had a quasi-experimental design and the study group consisted of 4th and 5th grade students (N = 18) attending the Chemistry Teaching Program in a university in Izmir. The "Biochemical Oxygen Demand Achievement Test (BODAT)" and the structured interview form were used as data collection tools. The results of BODAT post-test showed the higher increase in the achievement scores of the experimental group may be an indication of the effectiveness of the CBL method in improving academic achievement in the relevant topic. In addition, the experimental and control group students had positive opinions regarding the method, the scenario, and the material. The students found the method, the scenario, and the material to be interesting, understandable/instructional, relatable with everyday life, suitable for the topic, and enhancing active participation.
J.T. van Wyk (Jacobus); M.A.M. van Wijk (Marc); P.W. Moorman (Peter); M. Mosseveld (Mees); J. van der Lei (Johan)
textabstractAutomated and on-demand decision support systems integrated into an electronic medical record have proven to be an effective implementation strategy for guidelines. Cholgate is a randomized controlled trial comparing the effect of automated and on-demand decision
Jue, Joshua S; Spector, Sydney A; Spector, Seth A
Surgical and nonsurgical specialists are highly centralized, making access to high-quality care difficult for many Americans. We explored the feasibility, benefits, preliminary outcomes, and patient satisfaction with a new type of health visit, in which a surgical oncologist used video telecommunication to manage and treat complex cancer diseases, including patients with severe comorbidities. Patients visited local VA medical centers throughout Florida to engage in video telecommunication visits with a centralized surgical oncologist in Miami, who directed their oncology treatment. The average length of stay and rate of unplanned readmission were calculated within each organ. The total mileage saved was calculated by subtracting the distance between the patient's home address and the local VA from the distance between the patient's home address and the Miami VA. Travel costs were determined by the VA's reimbursement of $0.415/mile for health-related travel and reimbursement of $150.00 for an overnight hotel stay. A Likert scale with both positively and negatively keyed questions was used to assess patient satisfaction. In 24 mo, seven unplanned readmissions occurred among 195 operations. Patients experienced an 80.7% reduction in travel distance and saved a total of 213,007.58 miles by visiting their local VA instead of the Miami VA. Survey results indicate that 86% of patients believed that the telemedicine program made medical care more accessible. The Specialist-Directed Telemedicine Model can save patients substantial time and money by not traveling to centralized areas, while delivering greater continuity of care and patient satisfaction. Copyright © 2017 Elsevier Inc. All rights reserved.
Katherine E. Nelson
Full Text Available Given the broad focus of pediatric palliative care (PPC on the physical, emotional, and spiritual needs of children with potentially life-limiting illnesses and their families, PPC research requires creative methodological approaches. This manuscript, written by experienced PPC researchers, describes issues encountered in our own areas of research and the novel methods we have identified to target them. Specifically, we discuss potential approaches to: assessing symptoms among nonverbal children, evaluating medical interventions, identifying and treating problems related to polypharmacy, addressing missing data in longitudinal studies, evaluating longer-term efficacy of PPC interventions, and monitoring for inequities in PPC service delivery.
Nelson, Katherine E.; Gerhardt, Cynthia A.; Rosenberg, Abby R.; Widger, Kimberley; Faerber, Jennifer A.; Feudtner, Chris
Given the broad focus of pediatric palliative care (PPC) on the physical, emotional, and spiritual needs of children with potentially life-limiting illnesses and their families, PPC research requires creative methodological approaches. This manuscript, written by experienced PPC researchers, describes issues encountered in our own areas of research and the novel methods we have identified to target them. Specifically, we discuss potential approaches to: assessing symptoms among nonverbal children, evaluating medical interventions, identifying and treating problems related to polypharmacy, addressing missing data in longitudinal studies, evaluating longer-term efficacy of PPC interventions, and monitoring for inequities in PPC service delivery. PMID:29495384
Cunningham, Daniel J.; Shearer, David A.; Carter, Neil; Drawer, Scott; Pollard, Ben; Bennett, Mark; Eager, Robin; Cook, Christian J.; Farrell, John; Russell, Mark
significantly different to FR. For relative distance covered all other position groups were greater than the FR (p < 0.05). The FIXED method underestimated both relative distance (~11%) and HSR values (up to ~20%) compared to the ROLL method. These differences were exaggerated for the HSR variable in the backs position who covered the greatest HSR distance; highlighting important consideration for those implementing the FIXED method of analysis. The data provides coaches with a worst-case scenario reference on the running demands required for periods of 60–300 s in length. This information offers novel insight into game demands and can be used to inform the design of training games to increase specificity of preparation for the most demanding phases of matches. PMID:29621279
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.
Bennis, Sandy; Costanzo, Diane; Flynn, Ann Marie; Reidy, Agatha; Tronni, Catherine
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.
Corvol, A; Balard, F; Moutel, G; Somme, D
Case management is a new professional field in France. It is addressed to elderly persons living in community whose situation is regarded as particularly complex. Case managers have to assess needs and coordinate necessary services. One common criteria of complexity is refusal of care. The objective of this study is to compare the words of users with those of case managers about refusal of care, in order to understand its meaning, professionals' attitudes and ethical challenges. Two researchers have cooperated on this qualitative research: the first one, anthropologist, interviewed 19 individuals, and 11 of their caregivers. The second one, geriatrician and researcher in medical ethics, lead four focus groups gathering a total of 18 case managers. Refusal of care often is the result of the will of preserving one's identity, compromised by illness. Individuals seek control on their life. Facing this behaviour, case managers try to secure the individual, by establishing a personal relationship that respects their choices, even if care has to be delayed. Refusal of care may sometimes disclose a desire to vanish, in front of which professionals meet their own limits. To recognise an elderly person that refuses care as a unique individual who can make choices secure his identity, and allow him to change. Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.
Ideally, national energy supply and demand choices would be based on comprehensive models and predictions of the energy sources, energy transformations, energy carriers and energy end-uses expected to play major roles into the foreseeable future (20-40 years). However, in many cases, the necessary detailed, high quality, consistent and timely data is not available for such comprehensive models to be constructed, in particular in large and complex developing economies expected to be major energy users in the near future. In the developing countries that are the focus of UNIDO's work, attention has been concentrated on making progress simultaneously on two fronts: (a) a dramatic decrease in energy intensity, particularly in activities linked to industrial production and (b) a major increase in the contribution of local renewable energy to limit growth in fossil fuel use. National policies need to be oriented towards a strict and strategic monitoring of the respective energy matrices with a simultaneous focus on both fronts. Robust assessments of industrial development trends throughout the whole 20-40 year transition phase are needed to achieve both objectives. Until more comprehensive energy-related models can be built up, to overcome the limited availability of data at country level it is proposed that a simple energy supply and demand model analysis consisting of three phases be used for identifying the consistency of future scenarios and corresponding policy requirements. This model analysis, which is a dynamic exercise, consists, first, of an analysis at aggregate level of the current and future national energy matrices; secondly, an analysis of perspectives for decreasing the energy intensity of the most inefficient systems or industrial sectors; and thirdly, an analysis of perspectives for increasing the supply and cost-effectiveness of sustainable energy sources. As an illustration of this model approach, the case of China is analysed with emphasis on the
Background Implicit rationing of nursing care is the withholding of or failure to carry out all necessary nursing measures due to lack of resources. There is evidence supporting a link between rationing of nursing care, nurses’ perceptions of their professional environment, negative patient outcomes, and placing patient safety at risk. The aims of the study were: a) To explore whether patient satisfaction is linked to nurse-reported rationing of nursing care and to nurses’ perceptions of their practice environment while adjusting for patient and nurse characteristics. b) To identify the threshold score of rationing by comparing the level of patient satisfaction factors across rationing levels. Methods A descriptive, correlational design was employed. Participants in this study included 352 patients and 318 nurses from ten medical and surgical units of five general hospitals. Three measurement instruments were used: the BERNCA scale for rationing of care, the RPPE scale to explore nurses’ perceptions of their work environment and the Patient Satisfaction scale to assess the level of patient satisfaction with nursing care. The statistical analysis included the use of Kendall’s correlation coefficient to explore a possible relationship between the variables and multiple regression analysis to assess the effects of implicit rationing of nursing care together with organizational characteristics on patient satisfaction. Results The mean score of implicit rationing of nursing care was 0.83 (SD = 0.52, range = 0–3), the overall mean of RPPE was 2.76 (SD = 0.32, range = 1.28 – 3.69) and the two scales were significantly correlated (τ = −0.234, p patient satisfaction, even after controlling for nurse and patient characteristics. The results from the adjusted regression models showed that even at the lowest level of rationing (i.e. 0.5) patients indicated low satisfaction. Conclusions The results support the relationships between
Javanparast, Sara; Maddern, Janny; Baum, Fran; Freeman, Toby; Lawless, Angela; Labonté, Ronald; Sanders, David
Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers. As part of a 5-year project, we interviewed PHC practitioners and managers of services in 7 Australian PHC services. Our findings revealed a policy shift away from the principles of comprehensive PHC including health promotion and action on social determinants of health to one-to-one disease management during the course of study. Analysis of the process of change shows that overall, rapid, and top-down radical reforms of policies and directions were the main characteristic of changes with minimal communication with practitioners and service managers. The study showed that services with community-controlled model of governance had more autonomy to use an emergent model of change and to maintain their comprehensive PHC services. Change is an inevitable feature of PHC systems continually trying to respond to health care demand and cost pressures. The implementation of change in complex settings such as PHC requires appropriate change management strategies to ensure that the proposed reforms are understood, accepted, and implemented successfully. Copyright © 2017 John Wiley & Sons, Ltd.
Green, Dale E; Hamory, Bruce H; Terrell, Grace E; O'Connell, Jasmine
Over the course of a single year, Cornerstone Health Care, a multispecialty group practice in North Carolina, redesigned the underlying care models for 5 of its highest-risk populations-late-stage congestive heart failure, oncology, Medicare-Medicaid dual eligibles, those with 5 or more chronic conditions, and the most complex patients with multiple late-stage chronic conditions. At the 1-year mark, the results of the program were analyzed. Overall costs for the patients studied were reduced by 12.7% compared to the year before enrollment. All fully implemented programs delivered between 10% and 16% cost savings. The key area for savings factor was hospitalization, which was reduced by 30% across all programs. The greatest area of cost increase was "other," a category that consisted in large part of hospice services. Full implementation was key; 2 primary care sites that reverted to more traditional models failed to show the same pattern of savings.
Four methodologies for forecasting energy demand are reviewed here after considering the role of energy in the economy and the analysis of energy use in different economic sectors. The special case of Israel is considered throughout, and some forecasts for energy demands in the year 2000 are presented. An energy supply mix that may be considered feasible is proposed. (author)
Daniel López Gómez
Full Text Available The deinstitutionalization of society is in part associated with the growing implementation of new information and communication technologies. These new technologies bring about new collective formations. if the social sciences are succesfully to understand the impact of these technologies, we will need new ways of thinking about institutions and power. We shall take the case of telephone helplines as a test-bed for Foucault's proposals for understanding institutions' operation of power. Specifically, we use the Foucaultian notion that space, body and norms are constitutive elements of the corporeality of institutions. We report how this applies to the case of telephone helplines, and we claim that Foucault's concepts do not go far enough. Instead, we propose the new concept of 'extitution'. Extuition helps understand new anatomies of power anatomy and new kinds of social practices.
M. R. Restuccia
Full Text Available Purple urine bag syndrome (PUBS is a rare condition in which purple discoloration of the collecting bag and its associated tubing occurs. It is considered a benign condition. PUBS is usually associated with urinary tract infection occurring in elderly bedridden women, with chronic urinary catheterization. This syndrome is usually reported to occur in alkaline urine, but here we describe a rare case of PUBS involving acidic urine.
Restuccia, M. R.; Blasi, M.
Purple urine bag syndrome (PUBS) is a rare condition in which purple discoloration of the collecting bag and its associated tubing occurs. It is considered a benign condition. PUBS is usually associated with urinary tract infection occurring in elderly bedridden women, with chronic urinary catheterization. This syndrome is usually reported to occur in alkaline urine, but here we describe a rare case of PUBS involving acidic urine.
Offenheiser, R C
For the past 15 years, the Fundac Esperanca, a private organization founded in Santarem by a North American Franciscan priest, has been working to provide the widely scattered rural residents in the mid-Amazon region of Brazil with effective health care. Early efforts focused on Esperanca's hospital boat, which traveled up and down the river to reach the remote settlements. During the 1st decade of operation, Esperanca vaccinated some 150,000 people and provided general medical and surgical services to countless others. Yet, by the late 1970s, the program's staff were beginning to question the longterm effectiveness of their efforts. In 1979, Esperanca decided it could have a longer lasting impact on health in the mid-Amazon region if it could mobilize rural communities to improve family diets and sanitary practices and carry out comprehensive vaccination campaigns. Supported by a grant from Private Agencies Collaborating Together (PACT), it launched its own primary health care program. This initiative began with a health survey of the region. The studies revealed that 1/3 of the children under age 6 were malnourished, 90% had untreated cavities, and 2/3 of the 10,000 people tested showed evidence of parasitosis. There were higher than normal incidences of malaria, anemia, tuberculosis, diphtheria, uterine cancer in women, smallpox, and visual problems. The social, cultural, and demographic characteristics of the region also were discouraging. Most people lived in widely scattered river villages and were illiterate, with little understanding of hygiene, nutrition, or public health. None of the settlements had formal health care systems. Esperanca chose to make the community paramedic the keystone of its program, stating clearly that the outreach worker is the conduit to clinical services in Santarem. In time, it was decided to phase out the hospital boat's activities. It had come to signal the wrong message, i.e., the doctors were coming and good health was on the
Zúñiga Fajuri, Alejandra
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.
Liu, Chang; Feng, Zhanlian; Mor, Vincent
To assess the association between ownership of Chinese elder care facilities and their performance quality and to compare the case-mix profile of residents and facility characteristics in government-owned and private-sector homes. Cross-sectional study. Census of elder care homes surveyed in Nanjing (2009) and Tianjin (2010). Elder care facilities located in urban Nanjing (n = 140, 95% of all) and urban Tianjin (n = 157, 97% of all). A summary case-mix index based on activity of daily living (ADL) limitations and cognitive impairment was created to measure levels of care needs of residents in each facility. Structure, process, and outcome measures were selected to assess facility-level quality of care. A structural quality measure, understaffing relative to resident levels of care needs, which indicates potentially inadequate staffing given resident case-mix, was also developed. Government-owned homes had significantly higher occupancy rates, presumably reflecting popular demand for publicly subsidized beds, but served residents who, on average, have fewer ADL and cognitive functioning limitations than those in private-sector facilities. Across a range of structure, process, and outcome measures of quality, there is no clear evidence suggesting advantages or disadvantages of either ownership type, although when staffing-to-resident ratio is gauged relative to resident case-mix, private-sector facilities were more likely to be understaffed than government-owned facilities. In Nanjing and Tianjin, private-sector homes were more likely to be understaffed, although their residents were sicker and frailer on average than those in government facilities. It is likely that the case-mix differences are the result of selective admission policies that favor healthier residents in government facilities than in private-sector homes. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.
Almeida, A.T. de; Carvalho, A.; Mariano, J.; Broege, M.
The aim of this paper is to demonstrate how integrated resource planning (IRP) oriented to the gas sector can be applied both in new networks and in mature networks, and to present the advantages of its application. One case study is described, in the western central region of Portugal, to illustrate the results of a pilot project on natural gas IRP implementation in a new network in the European Union (EU). The city of Burg, Germany, with a mature gas network with district heating was also analysed in terms of IRP potential. The most important phases of the integrated resource plan definition and implementation (especially those oriented to the demand-side) are presented, namely, the definition of the most efficient technologies (including solar energy), fuel-switching possibilities, a detailed study of the impacts in the economy, environment and society, and the policy incentives necessary to motivate the gas utility companies to perform IRP. In the main case study, the suggested implementation plan would lead to a reduction of around 4.7% in natural gas consumption. Additionally, 13.3% of cost-effective fuel switching from other competing forms of energy to natural gas can be achieved. A proposed EU energy services directive on mandatory energy-efficiency activities for gas and electricity distribution utilities in the EU, will promote the large-scale implementation of the proposed approach in Europe. (author)
Alyssa B Sharkey
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.
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. ...
Full Text Available No abstract available. Article truncated after 150 words. Clinical History: A 57-year-old man with no known previous medical history was brought to the emergency room via ambulance and admitted to the intensive care unit with a compliant of severe chest pain in the substernal region and epigastrium. The patient was awake and alert and did not complain of shortness of breath. Physical examination was largely unremarkable and the patient’s oxygen saturation was 98% on room air. The patient’s vital signs revealed tachycardia (105 bpm and his blood pressure was 108 mmHg / 60 mmHg. Laboratory evaluation showed a slightly elevated white blood cell count (13 x 109 cells/L, but his hemoglobin and hematocrit values were with within normal limits, as was his platelet count. Which of the following diagnoses are appropriate considerations for this patient’s condition? 1.\tAcute pericarditis 2.\tAortic dissection 3.\tCommunity-acquired pneumonia 4.\tMyocardial infarction 5.\tAll of the above …
Full Text Available No abstract available. Article truncated after 150 words. History of Present Illness: A 20-year-old woman was transferred from another medical center for care. She was pregnant and initially presented with a one day history of crampy abdominal pain with nausea and vomiting after eating old, bad tasting chicken two days previously. She had pain of her right arm and a non-displaced humeral fracture was seen on x-ray. The etiology of the fracture was unclear. Her illness rapidly progressed to respiratory distress requiring intubation. The fetus had deceleration of heart tones leading to a cesarean section and delivery of a non-viable infant. Subsequently, she had rapid progression of shock and anuria. Past Medical History: She had a previous history of a seizure disorder which was managed with levetiracetam, clonazepam, and folic acid. There was a previous intentional opiate overdose 2 years earlier. One month prior to admission she had visited her husband in Iraq. After returning to the US …
Alexandre R. Vieira
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.
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
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.
Miguel Ángel González-Block
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
Ben Oumlil, A; Rao, C P
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.
Vermeltfoort, Pit B J; Hooymans, Johanna M M; Busscher, Henk J; van der Mei, Henny C
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 transmission studies, biofilms of Staphylococcus aureus 835 or Pseudomonas aeruginosa no. 3 were grown on lens storage cases and incubated with a contact lens in different multipurpose lens care solutions (Opti-Free(R)Express(R), ReNu(R) MultiPlus(R), and SoloCare Aquatrade mark) or 0.9% NaCl. In addition, planktonic bacteria were directly suspended in multipurpose solutions and their killing efficacies were determined. The numbers of transmitted live and dead bacteria on the lenses were measured using a combination of plate counting and fluorescence microscopy. The highest killing efficacies were shown by Opti-Free(R) Express(R) for planktonic as well as for biofilm bacteria. Silver impregnation of lens cases in combination with the prescribed solution increased the killing efficacy for P. aeruginosa in biofilms, whereas effects for S. aureus were minor. Lowest numbers of live and dead bacteria were transmitted to a lens in Opti-Free(R) Express(R) multipurpose solution, with no significant differences between lens types and no effects of silver impregnation. (c) 2008 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 2008. (c) 2008 Wiley Periodicals, Inc.
Vos, L.; Oostenbrugge, R.J. van; Limburg, M.; Merode, G.G. van; Groothuis, S.
Dutch hospitals are in the midst of a transition towards process-oriented organisation to realise optimal and undisturbed care processes. Between 2004 and 2007, the University Hospital of Maastricht conducted a case study implementing process-oriented in-hospital stroke unit care. The case study
Azimah, Mn; Khairani, O
To describe the management of mild conduct problems in an adolescent at the primary care level. A 16 year old girl presented with conduct problems with impending school suspension. The cause of her behavioural problems was mainly related to poor parenting skills of her parents and anger in herself. She was successfully managed with counselling and improvement of parenting styles in her parents. This case report illustrates the opportunity for family physicians to manage simple conduct problems at primary care level.
Wood, V R; Robertson, K R
Numerous health care facilities, located in downtown metropolitan areas, now find themselves surrounded by a decaying inner-city environment. Consumers may perceive these facilities as "old," and catering to an "urban poor" consumer. These same consumers may, therefore, prefer to patronize more modern facilities located in suburban areas. This paper presents a case study of such a health care facility and how strategic planning and marketing research were conducted in order to identify market opportunities and new strategic directions.
Zhu, Yueniu; Qiu, Wenjuan; Deng, Mengyan; Zhu, Xiaodong
Myxedema coma (MC) is extremely rare but lethal in pediatric patients with hypothyroidism leading to altered mental status and hypothermia. But there is no clinical guideline for such cases. A 6-year-old Chinese girl presented with coma and hypothermia preceded by pneumonia. Her lab results were: free thyroxin (T4) 4.18 pmol/L and thyroid-stimulating hormone (TSH) > 150 μIU/mL with extremely elevated anti-thyroid peroxidase (TPO-Ab) and anti-thyroglobulin. Pneumonia, mild pleural, and pericardial effusion were seen on computed tomographic (CT) scan. MC, autoimmune hypothyroidism, pneumonia and sepsis were diagnosed. Gastric levothyroxine, intravenous dexamethasone and antibiotics were administered. Her consciousness was restored and temperature returned to normal 2 days after starting levothyroxine. She was discharged two weeks later. MC is rare but may be the initial presentation in pediatric patients with prolonged untreated hypothyroidism. Autoimmune thyroiditis could cause hypothyroidism in children. MC should be suspected in pediatric patients with altered mental status, hypothermia and cardiovascular instability. Treatment with 100 mg/m of gastric levothyroxine is an option for pediatric patients with MC.
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.
Carolan, Clare M; Forbat, Liz; Smith, Annetta
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. © The Author(s) 2015.
Wheatley, Laura; Doyle, Winnie; Evans, Cheryl; Gosse, Carolyn; Smith, Kevin
Calls for transformational change of our healthcare system are increasingly clear, persuasive and insistent. They resonate at all levels, with those who fund, deliver, provide and receive care, and they are rooted in a deep understanding that the system, as currently rigidly structured, most often lacks the necessary flexibility to comprehensively meet the needs of patients across the continuum of care. The St. Joseph's Health System (SJHS) Integrated Comprehensive Care (ICC) Program, which bundles care and funding across the hospital to home continuum, has reduced fragmentation of care, and it has delivered improved outcomes for patients, providers and the system. This case study explores the essential contribution of nursing leadership to this successful transformation of healthcare service delivery.
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.
Evelien Eggink; Debbie Oudijk; Isolde Woittiez
Original title: Zorgen voor Zorg. The Dutch population will become increasingly older over the coming decades. This will have consequences for the use of care and consequently the demand for staff, especially in the nursing and care sectors (home care, nursing homes and residential care
Wulff, Christian N; Vedsted, Peter; Søndergaard, Jens
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...... and out of hours were collected 9 months after recruitment and the data from the two groups were compared quarterly. RESULTS: CM was associated with an overall tendency towards more positive GP evaluations, which for 3 of 20 items reached statistical significance. Statistically significantly fewer GPs...
Silvers, J B; Haslinger, J
Faced with numerous health care options, corporations are searching for plans which provide necessary benefits while containing costs. This article examines the case of the American Can Company where, since 1978, a new approach has produced mutual economic gains and employee satisfaction. American Can's efforts involved differential pricing and encouraged responsible selection by employees. The company was one of several studied by the Health Systems Management Center at Case Western Reserve University under contract with the Business Roundtable Health Initiatives Task Force. Such studies provide insight for other companies seeking ways to attack burgeoning corporate health care costs. This article is one of a series reporting the results of these studies.
Medical care in case of disasters means being pressed for time, facing difficult structures and a shortage of resources while trying to attend to many injured at a time. The knowledge required must be immediately available, and this is where this book comes in handy. The guide addresses primarily doctors and medical staff. It answers medical questions, lists contacts, provides information on disaster management, and goes into legal and ethical aspects as well. (orig.)
Mavronicolas, Heather A; Laraque, Fabienne; Shankar, Arti; Campbell, Claudia
Care coordination programmes are an important aspect of HIV management whose success depends largely on HIV primary care provider (PCP) and case manager collaboration. Factors influencing collaboration among HIV PCPs and case managers remain to be studied. The study objective was to test an existing theoretical model of interprofessional collaborative practice and determine which factors play the most important role in facilitating collaboration. A self-administered, anonymous mail survey was sent to HIV PCPs and case managers in New York City. An adapted survey instrument elicited information on demographic, contextual, and perceived social exchange (trustworthiness, role specification, and relationship initiation) characteristics. The dependent variable, perceived interprofessional practice, was constructed from a validated scale. A sequential block wise regression model specifying variable entry order examined the relative importance of each group of factors and of individual variables. The analysis showed that social exchange factors were the dominant drivers of collaboration. Relationship initiation was the most important predictor of interprofessional collaboration. Additional influential factors included organisational leadership support of collaboration, practice settings, and frequency of interprofessional meetings. Addressing factors influencing collaboration among providers will help public health programmes optimally design their structural, hiring, and training strategies to foster effective social exchanges and promote collaborative working relationships.
The purpose of this study is to analyze the impacts of final demand changes on total output of Japanese Information and Communication Technologies (ICT) sectors in future time. This study employs one of analysis tool in Input-Output (IO) analysis, demand-pull IO quantity model, in achieving the purpose. There are three final demand changes used in this study, namely (1) export, (2) import, and (3) outside households consumption changes. This study focuses on "pure change" condition, the condition that final demand changes only appear in analyzed sectors. The results show that export and outside households consumption modifications give positive impact while opposite impact could be seen in import change.
Bruno, Sergio; De Benedictis, Michele; La Scala, Massimo; Wangensteen, Ivar
The paper is aimed at showing how demand-side policies for increasing inner demand elasticity could help in reducing market inefficiencies generated by transfer limits on interconnections, with a special regard to energy imports dependent countries. In order to develop the studies in a realistic environment, a model for the Italian electricity market has been developed. Test results show effects of variations in demand elasticity on the national social surplus and congestion costs. It will be shown how an increase of demand elasticity can counterbalance the need of additional transfer capacity in reducing cross-border congestions. (author)
Kinsperger, Laura; Mayrhofer, Stefanie Maria; Pichler, Birgit; Qin, Hong; Rheinfrank, Iris; Schrems, Berta
This case report deals with the unsatisfying pain management of a 44 year old patient with cardiac arrest and subsequent cardiopulmonary resuscitation. The patient has (1) a reduced consciousness, (2) is isolated due to an infection with multi-resistant germs, (3) has a tracheotomy and (4) contractures of the muscles in fingers and hands. During nursing care he shows facial expressions and body postures that indicate pain which is insufficiently addressed. The case was processed according to the model of reflexive case report by Johns (1995) and interpreted by theoretical expertise and the change of the perspective. Therefore the following questions were answered: Which factors made the nurse who brought the case to the case deliberation feeling dissatisfied with the pain management? Insufficient pain management due to a lack of knowledge, no assessment of the state of consciousness, pain and isolation probably led to unnecessary burden of the patient, next of kin and nurses. Training, systematic pain management and multi-disciplinary case conferences might facilitate dealing with comparable complex situations of caring in the future. The present case report shows that pain can only be treated successfully if pain-triggering factors are recognized, systematically assessed and treated. An adequate external assessment of the pain situation is especially important when dealing with patients who suffer from disorders of consciousness. In complex cases, in which multiple factors influence the pain situation, interdisciplinary case conferences may help to improve the quality of pain management.
Hallberg, Ingalill Rahm; Kristensson, Jimmie
Preventive actions targeting community-dwelling frail older people will be increasingly important with the growing number of very old and thereby also frail older people. This study aimed to explore and summarize the empirical literature on recent studies of case/care management interventions for community-dwelling frail older people and especially with regard to the content of the interventions and the nurse's role and outcome of it. Very few of the interventions took either a preventive or a rehabilitative approach using psycho-educative interventions focusing, for instance, on self-care activities, risk prevention, health complaints management or how to preserve or strengthen social activities, community involvement and functional ability. Moreover, it was striking that very few included a family-oriented approach also including support and education for informal caregivers. Thus it seems that the content of case/care management needs to be expanded and more influenced by a salutogenic health care perspective. Targeting frail older people seemed to benefit from a standardized two-stage strategy for inclusion and for planning the interventions. A comprehensive geriatric assessment seemed useful as a base. Nurses, preferably trained in gerontological practice, have a key role in case/care management for frail older people. This approach calls for developing the content of case/care management so that it involves a more salutogenic, rehabilitative and family-oriented approach. To this end it may be useful for nurses to strengthen their psychosocial skills or develop close collaboration with social workers. The outcome measures examined in this study represented one of three perspectives: the consumer's perspective, the perspective of health care consumption or the recipient's health and functional ability. Perhaps effects would be expected in all three areas and thus these should be included in evaluative studies in addition to measures for family and/or informal
de Graaf-Ruizendaal, Willemijn A.; de Bakker, Dinny H.
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 primary
Full Text Available Introduction: Increasing numbers of persons are living with multiple chronic diseases and unmet medical needs in Bulgaria. The Bulgarian ‘Diabetic care’ non-profit (DCNPO programme aims to provide comprehensive integrated care focusing on people with diabetes and their co-morbidities. Methods: The DCNPO programme was selected as one of eight ‘high potential’ programmes in the Innovating Care for People with Multiple Chronic Conditions (ICARE4EU project, covering 31 European countries. Data was first gathered with a questionnaire after which semi-structured interviews with project staff and participants were conducted during a site visit. Results: The programme trains diabetic patients to act as carers, case managers, self-management trainers and health system navigators for diabetic patients and their family. The programme improved care coordination and patient-centered care by offering free care delivered by a multidisciplinary team. It facilitates the collaboration between patients, volunteers, health providers and the community. Internal evaluations demonstrate reduced hospital admissions and avoidable amputations, with consequent cost savings for the health care system. Conclusion: Integrated care provided by volunteering patients can empower people suffering from diabetes and their co-morbidities and address health and social inequalities in resource-poor settings. It can also contribute to an increased trust and improved satisfaction among vulnerable patients with complex care needs.
Lawn, Sharon; Zabeen, Sara; Rowlands, Nikki; Picot, Sharon
People with severe mental illness (SMI) are widely reported to be at an increased risk of morbidity and premature death due to physical health conditions. Mental health nurses are ideally placed to address physical and mental health comorbidity as part of their day-to-day practice. This study involved an audit of hardcopy and electronic clinical case-notes of a random sample of 100 people with SMI case managed by community mental health service in metropolitan South Australia, to determine how well physical health conditions and risk factors, screening, and follow-up are recorded within their service records. Every contact between 1 July 2015 and 30 June 2016 was read. One-way ANOVA, Scheffe's test, and Fisher's exact test determined any significant associations across audit variables, which included gender, age, income, living arrangement, diagnosis, lifestyle factors, recording of physical health measures, and carer status. A focus on physical health care was evident from everyday case-note records; however, because this information was 'buried' within the plethora of entries and not brought to the fore with other key information about the person's psychiatric needs, it remained difficult to gain a full picture of potential gaps in physical health care for this population. Under-reporting, gaps and inconsistencies in the systematic recording of physical health information for this population are likely to undermine the quality of care they receive from mental health services, the ability of mental health service providers to respond in a timely way to their physical healthcare needs, and their communication with other healthcare providers. © 2018 Australian College of Mental Health Nurses Inc.
Title: Case report of physiotherapy care in patient with facial nervus peripheral palsy. Objective: Summary of theoretical knowledge and working out the case report of patient diagnosed with peripheral palsy of right facial nerve. Methode and result: This thesis comprehensively summarizes the findings of peripheral facial nerve palsy and its treatment, especially with physiotherapeutic methods. It gives a wide view at the issue of physiotherapy in facial nerve palsy which is a symptom of many...
The title of the thesis: Case report of physiotherapy care for a patient with facial nervus peripheral palsy The aim of the thesis: The aim is to get acquainted with theoretical knowledge on the issues and the development of case studies, including design and the course of therapy for a patient with a diagnosis of facial nervus peripheral palsy. Methodology and evaluation: The content of this thesis is to introduce theoretical knowledge of facial nervus peripheral palsy, its treatment and reh...
Troché, Gilles; Marque Juillet, Stephanie; Burrel, Sonia; Boutolleau, David; Bédos, Jean-Pierre; Legriel, Stephane
Herpes simplex viruses, which are associated with various clinical manifestations, can be transmitted to critically ill patients from other patients or health care staff. We report an apparent outbreak of mucocutaneous herpes simplex virus 2 infections (5 cases in 10 weeks). An epidemiologic investigation and genotype analysis showed no connections among the 5 cases. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
opinions, emotional responses, and systems such as ethical relativism ,87 divine command theory,88 utilitarianism,89 deontology,90 and virtue ethics .91...TO TAKE CARE OF THEM: AN ETHICAL CASE STUDY OF THE CANAL INCIDENT A... ETHICAL CASE STUDY OF THE CANAL INCIDENT 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Emmitt Maxwell Furner II 5d. PROJECT
Stanley, Ava; Cantor, Joel C; Guarnaccia, Peter
The health care safety net in the United States is intended to fill gaps in health care services for uninsured and other vulnerable populations. This paper presents a case study of New Brunswick, NJ, a small city rich in safety net resources, to examine the adequacy of the American model of safety net care. We find substantial gaps in access to care despite the presence of a medical school, an abundance of primary care and specialty physicians, two major teaching hospitals, a large federally qualified health center and other safety net resources in this community of about 50,000 residents. Using a blend of random-digit-dial and area probability sampling, a survey of 595 households was conducted in 2001 generating detailed information about the health, access to care, demographic and other characteristics of 1,572 individuals. Confirming the great depth of the New Brunswick health care safety net, the survey showed that more than one quarter of local residents reported a hospital or community clinic as their usual source of care. Still, barriers to prescription drugs were reported for 11.0% of the area population and more than two in five (42.8%) local residents who perceived a need for specialty care reported difficulty getting those services. Bivariate analyses show significantly elevated risk of access problems among Hispanic and black residents, those in poor health, those relying on hospital and community clinics or with no usual source of care, and those living at or below poverty. In multivariate analysis, lack of health insurance was the greatest risk factor associated with both prescription drug and specialty access problems. Few local areas can claim the depth of safety net resources as New Brunswick, NJ, raising serious concerns about the adequacy of the American safety net model, especially for people with complex and chronic health care needs.
van Eeghen, Constance O; Littenberg, Benjamin; Kessler, Rodger
Patients with chronic conditions frequently experience behavioral comorbidities to which primary care cannot easily respond. This study observed a Vermont family medicine practice with integrated medical and behavioral health services that use a structured approach to implement a chronic care management system with Lean. The practice chose to pilot a population-based approach to improve outcomes for patients with poorly controlled Type 2 diabetes using a stepped-care model with an interprofessional team including a community health nurse. This case study observed the team's use of Lean, with which it designed and piloted a clinical algorithm composed of patient self-assessment, endorsement of behavioral goals, shared documentation of goals and plans, and follow-up. The team redesigned workflows and measured reach (patients who engaged to the end of the pilot), outcomes (HbA1c results), and process (days between HbA1c tests). The researchers evaluated practice member self-reports about the use of Lean and facilitators and barriers to move from pilot to larger scale applications. Of 20 eligible patients recruited over 3 months, 10 agreed to participate and 9 engaged fully (45%); 106 patients were controls. Relative to controls, outcomes and process measures improved but lacked significance. Practice members identified barriers that prevented implementation of all changes needed but were in agreement that the pilot produced useful outcomes. A systematized, population-based, chronic care management service is feasible in a busy primary care practice. To test at scale, practice leadership will need to allocate staffing, invest in shared documentation, and standardize workflows to streamline office practice responsibilities.
Verhaak, P.F.M.; Brink-Muinen, A. van den; Bensing, J.M.; Gask, L.
The general practitioner is usually the first health care contact for mental problems. The position of a general practitioner may vary between health care systems, depending on the referral system (gatekeepers versus directly accessible specialists), presence of fixed lists and the payment system.
Burn, Anne-Marie; Fleming, Jane; Brayne, Carol; Fox, Chris; Bunn, Frances
In 2012-2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges. Qualitative study involving interviews, focus groups and thematic content analysis. Primary care and secondary care across six counties in the East of England. Hospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals. We recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs' lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding. The study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care
ter Meulen, Ruud; Wright, Katharine
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. © 2012 Blackwell Publishing Ltd.
Møller, Niels Framroze; Møller Andersen, Frits
The use of renewable energy implies a more variable supply of power. Market effciency 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 a...
FitzGerald Murphy, Maggie
Despite the fact that over fifty years have passed since its publication, Stuart Hall's article "The Supply of Demand" (1960), is remarkably relevant today. The central message that society must not be blinded by "prosperity" such that it no longer envisions and demands a better world is especially pertinent in light of the…
The increasing number of trucks traveling on Virginia highways has led to a growing demand for public rest areas and private truck stops. This study developed a methodology to determine the supply and demand for commercial heavy truck parking using I...
Asci, Ozlem; Hazar, Guleser; Sercan, Isa
The objective of this study is to determine the states of health care personnel, working at 112 emergency stations in the province of Artvin, to encounter with regarding forensic cases and determine their practices aimed at recognizing, protecting, and reporting the evidences that may affect the forensic process. This descriptive study was conducted with nurses and emergency medicine technicians working at 112 emergency stations in Artvin between January 2013 and February 2014. Of 141 health personnel that constituted sample of the study, 48.9% were nurses, 9.9% emergency medicine technicians, and 41.1% ambulance and emergency care technicians. The rate of feeling sufficient in coping with forensic cases and incidents was 20.6%. There was a lower rate of receiving education about the approach towards forensic cases (15.6%). In the study, the frequency of encountering with at least one forensic case was 88.7%. Traffic accidents (72.5%), suicides (41.5%) and assaults (41.5%) were among the most frequent reasons of forensic cases. The practices of nurses were more successful in woundings by firearms compared to other health personnel (p forensic cases. The personnel with higher educational level and nurses have more successful practices in forensic cases. Health personnel have approaches that may negatively affect the solution of forensic cases.
Dauwerse, L.; Stolper, M.M.; Widdershoven, G.; Molewijk, A.C.
The attention for Moral case deliberation (MCD) has increased over the past years. Previous research on MCD is often written from the perspective of MCD experts or MCD participants and we lack a more distant view to the role of MCD in Dutch health care institutions in general. The purpose of this
Lemay, Celeste A; Tobias, Carol; Umez-Eronini, Amarachi A; Brown, Carolyn; McCluskey, Amanda; Fox, Jane E; Bednarsh, Helene; Cabral, Howard J
Little is known about dental case managers as few programs have been scientifically evaluated. The goal of this study was to explore the impact of dental case manager on retention in dental care and completion of treatment plans, while specifically exploring the number of dental case manager encounters. Fourteen programs enrolled people with HIV/AIDS (PLWHA) in dental care and a longitudinal study between 2007 and 2009. The 758 participants had a total of 2715 encounters with a dental case manager over twelve months: 29% had a single encounter; 21% had two; 27% had 3-4 and; 23% had 5-29 encounters. Adjusting for baseline characteristics, participants receiving more encounters were significantly more likely to complete their Phase 1 treatment plan, be retained in dental care, and experience improvements in overall oral health status. Organizations considering efforts to improve the oral health of vulnerable, hard-to-engage populations should consider these findings when planning interventions. ©2012 Special Care Dentistry Association and Wiley Periodicals, Inc.
Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily
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:…
Niemeijer, G.C.; Does, R.J.M.M.; de Mast, J.; Trip, A.; van den Heuvel, J.
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
Latour-Delfgaauw, C.H.M.; van der Windt, D.A.W.M.; de Jonge, P.; Riphagen, II; Vos, R.; Huyse, F.J.; Stalman, W.A.B.
Objective: The aim of this study was to summarize the available literature on the effectiveness of ambulatory nurse-led case management for complex patients in general health care. Method: We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and Cinahl. We included randomized
Stolper, M.M.; Molewijk, A.C.; Widdershoven, G.
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
John, Christine Marie
This qualitative, multiple case study was an exploration of the professional development (PD) experience of consultation as it occurred within infant and toddler child care settings. Consultation is dependent upon the establishment of a relationship between the consultant and the consultee and offers opportunities for professional growth and…
Reid, Christine; Riddick-Grisham, Susan
Abstract INTRODUCTION: The importance of work or productive activity for the well-being, community integration, and quality of life of people living with disabilities is addressed, with implications for life care planning and case management. BACKGROUND: The role of work or productive activity in our society, and consequences of deprivation if rehabilitation services do not address vocational effects of disabilities, is explored. A continuum of productivity options is introduced; types of vocational rehabilitation assessment processes and interventions are described. PURPOSE: The role of vocational rehabilitation services in life care planning and case management is discussed, focusing on quality of life for people living with disabilities. CONCLUSION: Rehabilitation and health care professionals should understand the importance of work or other productive activity, and support the development of appropriate plans to address those needs among people who have disabilities. PMID:26409330
Reid, Christine; Riddick-Grisham, Susan
The importance of work or productive activity for the well-being, community integration, and quality of life of people living with disabilities is addressed, with implications for life care planning and case management. The role of work or productive activity in our society, and consequences of deprivation if rehabilitation services do not address vocational effects of disabilities, is explored. A continuum of productivity options is introduced; types of vocational rehabilitation assessment processes and interventions are described. The role of vocational rehabilitation services in life care planning and case management is discussed, focusing on quality of life for people living with disabilities. Rehabilitation and health care professionals should understand the importance of work or other productive activity, and support the development of appropriate plans to address those needs among people who have disabilities.
Günay, M. Erdem
In this work, the annual gross electricity demand of Turkey was modeled by multiple linear regression and artificial neural networks as a function population, gross domestic product per capita, inflation percentage, unemployment percentage, average summer temperature and average winter temperature. Among these, the unemployment percentage and the average winter temperature were found to be insignificant to determine the demand for the years between 1975 and 2013. Next, the future values of the statistically significant variables were predicted by time series ANN models, and these were simulated in a multilayer perceptron ANN model to forecast the future annual electricity demand. The results were validated with a very high accuracy for the years that the electricity demand was known (2007–2013), and they were also superior to the official predictions (done by Ministry of Energy and Natural Resources of Turkey). The model was then used to forecast the annual gross electricity demand for the future years, and it was found that, the demand will be doubled reaching about 460 TW h in the year 2028. Finally, it was concluded that the approach applied in this work can easily be implemented for other countries to make accurate predictions for the future. - Highlights: • Electricity demand of Turkey increased from 15.6 to 246.4 TW h in 1975–2013 period. • Population, GDP per capita, inflation and average summer temperature influence demand. • Future values of descriptor variables can be predicted by time series ANN models. • ANN model simulated by the predicted values of descriptors can forecast the demand. • Demand is forecasted to be doubled reaching about 460 TW h in the year 2028.
Reblin, Maija; Otis-Green, Shirley; Ellington, Lee; Clayton, Margaret F
Although there is growing recognition of the importance of integrating spirituality within health care, there is little evidence to guide clinicians in how to best communicate with patients and family about their spiritual or existential concerns. Using an audio-recorded home hospice nurse visit immediately following the death of a patient as a case-study, we identify spiritually-sensitive communication strategies. The nurse incorporates spirituality in her support of the family by 1) creating space to allow for the expression of emotions and spiritual beliefs and 2) encouraging meaning-based coping, including emphasizing the caregivers' strengths and reframing negative experiences. Hospice provides an excellent venue for modeling successful examples of spiritual communication. Health care professionals can learn these techniques to support patients and families in their own holistic practice. All health care professionals benefit from proficiency in spiritual communication skills. Attention to spiritual concerns ultimately improves care. © The Author(s) 2014.
Bainbridge, Daryl; Brazil, Kevin; Krueger, Paul; Ploeg, Jenny; Taniguchi, Alan; Darnay, Julie
There is increasing global interest in using regional palliative care networks (PCNs) to integrate care and create systems that are more cost-effective and responsive. We examined a PCN that used a community development approach to build capacity for palliative care in each distinct community in a region of southern Ontario, Canada, with the goal of achieving a competent integrated system. Using a case study methodology, we examined a PCN at the structural level through a document review, a survey of 20 organizational administrators, and an interview with the network director. The PCN identified 14 distinct communities at different stages of development within the region. Despite the lack of some key features that would facilitate efficient palliative care delivery across these communities, administrators largely viewed the network partnership as beneficial and collaborative. The PCN has attempted to recognize specific needs in each local area. Change is gradual but participatory. There remain structural issues that may negatively affect the functioning of the PCN.
Banning, Maggi; Gumley, Virginia
Caring is a complex phenomenon. Nurses aim to relieve patient suffering, acknowledge subjective experiences, display empathy but also manage emotions related to care provision. This study explored nurses' perceptions, experiences and emotions related to caring for cancer patients. This qualitative study used semi-structured interviews to explore the emotions management of 32 nurses working in a cancer hospital in Pakistan. Data saturation occurred after 20 interviews. Three themes emerged from the data related to caring, acknowledgement of patients' feelings, professional behaviour, patient involvement and emotional control. Some nurses repressed their emotions and feelings over patients who had difficulties sustaining hope. In such cases nurses require supportive networks to assist their emotions management and intra-personal skills. Educational support is needed to help nurses express their views in relation to emotional contagion, significance of repressed emotions and to identify supportive ways to assist nurses to communicate their experiences.
María Eugenia Monte
Full Text Available In Argentina, women and feminist movements concentrated abortion liberalization demand repertories of action in state juridical institutions displacing other repertories of action focused on the politicization of sexuality. This switch implied a change in the construction of abortion. From being constructed as part of sexual liberation demands during the 1960s and the 1970s, to being constructed as part of reproductive rights and broader human rights discourses during the 1980s and the 1990s, and particularly at Courts since 2000s. Precisely, the objective of this article is to analyze how abortion demand was constructed by a women’s organization defending a structural case at Court in Córdoba province (Argentina between 2012-2013. En Argentina, los movimientos de mujeres y feministas concentraron los repertorios de acción de la demanda por la liberalización del aborto en las instituciones jurídicas estatales, desplazando otros repertorios de acción concentrados en la politización de la sexualidad. Este desplazamiento implicó una modificación en la construcción del aborto. De construirse como parte de las demandas por la liberación sexual durante las décadas de 1960 y 1970, durante las décadas de 1980 y 1990 pasó a construirse como parte de los discursos sobre derechos reproductivos y, más ampliamente, de los derechos humanos, y sobre todo como parte de disputas judiciales a partir del año 2000. Precisamente, el objetivo de este artículo es analizar cómo construyó la demanda de aborto por una organización de mujeres en defensa de un caso estructural en la provincia de Córdoba (Argentina entre 2012-2013. DOWNLOAD THIS PAPER FROM SSRN: http://ssrn.com/abstract=2707027
Schellevis François G
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
Bender, Miriam; Spiva, LeeAnna; Su, Wei; Hites, Lisle
To determine the power of a conceptual clinical nurse leader practice model to explain the care model's enactment and trajectory in real world settings. How nursing, organised into specific models of care, functions as an organisational strategy for quality is not well specified. Clinical nurse leader integrated care delivery is one emerging model with growing adoption. A recently validated clinical nurse leader practice model conceptualizes the care model's characteristics and hypothesizes their mechanisms of action. Pattern matching case study design and mixed methods were used to determine how the care model's constructs were operationalized in one regional United States health system that integrated clinical nurse leaders into their care delivery system in 2010. The findings confirmed the empirical presence of all clinical nurse leader practice model constructs and provided a rich description of how the health system operationalized the constructs in practice. The findings support the hypothesized model pathway from Clinical Nurse Leader structuring to Clinical Nurse Leader practice and outcomes. The findings indicate analytic generalizability of the clinical nurse leader practice model. Nursing practice organised to focus on microsystem care processes can catalyse multidisciplinary engagement with, and consistent enactment of, quality practices. The model has great potential for transferability across diverse health systems. © 2018 John Wiley & Sons Ltd.
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.
Williams, Allison M; Crooks, Valorie A; Whitfield, Kyle; Kelley, Mary-Lou; Richards, Judy-Lynn; DeMiglio, Lily; Dykeman, Sarah
, 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. 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.
This article: : Applicable to all health care sectors where case management is practiced. Few topics are more intimate and multifaceted for case managers than engaging with today's culturally diverse patient populations around end-of-life processes. The already prominent focus of this issue has been further elevated by a series of events to receive public attention. These include the Institute of Medicine's 2014 report-Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, rising numbers of patients around the globe requesting to end life on their own terms, and corresponding death with dignity initiatives and legislation.Another vital factor in the end-of-life equation involves how the latest generation of shared decision making influences the management of treatment dialogues among practitioners, patients, as well as insurance companies. Case managers are at the intersection of these complex interactions, working to achieve ethical, as well as legal accountability to the patient, employer, and profession while balancing personal perspectives. Professionals strive to effectively intervene with patients and their support systems facing end-of-life care decisions. It is essential case managers actively consider the intricacies of ethical practice and current contexts including death with dignity legislation, shared decision making, and shifts in regulations and reimbursement for end-of-life care.Case management's ethical envelope will continue to be pushed. To that end amid shifting societal constructs, professionals must have mastery of applicable codes, standards, principles, and rules essential for adherence to ethical practice.
Taris, Toon W; Schreurs, Paul J G
This study examined the added value of emotional job demands in explaining worker well-being, relative to the effects of task characteristics, such as quantitative job demands, job control, and coworker support. Emotional job demands were expected to account for an additional proportion of the variance in well-being. Cross-sectional data were obtained from 11,361 female Dutch home care employees. Hierarchical stepwise regression analysis demonstrated that low control, low support and high quantitative demands were generally associated with lower well-being (as measured in terms of emotional exhaustion, dedication, professional accomplishment and learning). Moreover, high emotional demands were in three out of four cases significantly associated with adverse well-being, in these cases accounting for an additional 1-6% of the variance in the outcome variables. In three out of eight cases the main effects of emotional demands on well-being were qualified by support and control, such that high control and high support either buffered the adverse effects of high emotional demands on well-being or increased the positive effects thereof. All in all, high emotional demands are as important a risk factor for worker well-being as well-established concepts like low job control and high quantitative job demands.
Physical Therapy, Optometry, Audiology, Tele-Dermatology and Eyes, Nose & Throat (ENT); (3) Dental Care, i.e., General Dentistry , Oral Surgery...Physical Therapy, Chiropractic, Optometry, Audiology, Public Health and Eyes, Nose & Throat (ENT); (3) Dental Care, including General Dentistry ...guidelines. Version 3.2. Unified biostatistical utility. Retrieved September 14, 2010, from http://www.dtic.mil/whs/directives/corres/pdf/601517p.pdf
van der Plas, Annicka G M; Vissers, Kris C; Francke, Anneke L; Donker, Gé A; Jansen, Wim J J; Deliens, Luc; Onwuteaka-Philipsen, Bregje D
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 carers in addition to the care provided by the general practitioner (GP) and home-care nurse. To compare cancer patients with and without additional support from a case manager on: 1) the patients' general characteristics, 2) characteristics of care and support given by the GP, 3) palliative care outcomes. This article is based on questionnaire data provided by GPs participating in two different studies: the Sentimelc study (280 cancer patients) and the Capalca study (167 cancer patients). The Sentimelc study is a mortality follow-back study amongst a representative sample of GPs that monitors the care provided via GPs to a general population of end-of-life patients. Data from 2011 and 2012 were analysed. The Capalca study is a prospective study investigating the implementation and outcome of the support provided by case managers in primary palliative care. Data were gathered between March 2011 and December 2013. The GP is more likely to know the preferred place of death (OR 7.06; CI 3.47-14.36), the place of death is more likely to be at the home (OR 2.16; CI 1.33-3.51) and less likely to be the hospital (OR 0.26; CI 0.13-0.52), and there are fewer hospitalisations in the last 30 days of life (none: OR 1.99; CI 1.12-3.56 and one: OR 0.54; CI 0.30-0.96), when cancer patients receive additional support from a case manager compared with patients receiving the standard GP care. Involvement of a case manager has added value in addition to palliative care provided by the GP, even though the role of the case manager is 'only' advisory and he or she does not provide hands-on care or prescribe medication.
Mathur, Medha; Goyal, Ram Chandra; Mathur, Navgeet
Quality of sterilization services is a matter of concern in India because population control is a necessity. Family Planning Sterilization (FPS) services provided at public health care facilities need to be as per Standard Operating Procedures. To assess the quality of FPS services by audit of case records at selected health care facilities. This cross-sectional study was conducted for two and a half year duration at selected public health care facilities of central India by simple random sampling where FPS services were provided. As per the standards of Government of India, case records were audited and compliance was calculated to assess the quality of services. Results of record audit were satisfactory but important criteria like previous contraceptive history and postoperative counselling were found to be deviated from standards. At Primary Health Centres (PHCs) only 89.5% and at Community Health Centres (CHCs) 58.7% of records were having details of previous contraceptive history. Other criteria like mental illness (only 70% at CHCs) assessment were also inadequate. Although informed consent was found to be having 100% compliance in all records. Quality of care in FPS services is the matter of concern in present scenario for better quality of services. This study may enlighten the policy makers regarding improvements needed for providing quality care.
Seekles, Wike; Widdershoven, Guy; Robben, Paul; van Dalfsen, Gonny; Molewijk, Bert
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 regulatory bodies are regularly confronted with moral challenges. This pilot study describes and evaluates the use of MCD at the Dutch Health Care Inspectorate (IGZ). The objective of this pilot study is to investigate: 1) the current way of dealing with moral issues at the IGZ; 2) experience with and evaluation of MCD as clinical ethics support, and 3) future preferences and (perceived) needs regarding clinical ethics support for dealing with moral questions at the IGZ. We performed an explorative pilot study. The research questions were assessed by means of: 1) interviews with MCD participants during four focus groups; and 2) interviews with six key stakeholders at the IGZ. De qualitative data is illustrated by data from questionnaires on MCD outcomes, perspective taking and MCD evaluation. Professionals do not always recognize moral issues. Employees report a need for regular and structured moral support in health care regulation. The MCD meetings are evaluated positively. The most important outcomes of MCD are feeling secure and learning from others. Additional support is needed to successfully implement MCD at the Inspectorate. We conclude that the respondents perceive moral case deliberation as a useful form of clinical ethics support for dealing with moral questions and issues in health care regulation.
The purpose of this study is to analyze the impacts of final demand changes on total output of Japanese Information and Communication Technologies (ICT) sectors in future time. This study employs one of analysis tool in Input-Output (IO) analysis, demand-pull IO quantity model, in achieving the purpose. There are three final demand changes used in this study, namely (1) export, (2) import, and (3) outside households consumption changes. This study focuses on ''pure change'' condition, the condition that final demand changes only appear in analyzed sectors. The results show that export and outside households consumption modifications give positive impact while opposite impact could be seen in import change
Christensen, Anna L; Petersen, Dana M; Burton, Rachel A; Forsberg, Vanessa C; Devers, Kelly J
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.
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
Bartoli, A.; Cavicchioli, D.; Kremmydas, D.; Rozakis, S.; Olper, A.
The growing demand of maize silage for biogas production in Northern Italy has triggered an intense debate concerning land rents, maize prices and their possible negative consequences on important agri-food chains. The aim of this work is to quantify the extent to which the rapid spread of biogas raised the maize price at regional level, increasing the demand of land for energy crops. For this purpose we applied a partial-equilibrium framework simulating the agricultural sector and the biogas industry in Lombardy, under two alternative schemes of subsidization policy. Results show that policy measures implemented in 2013 – reducing the average subsidy per kWh – may contribute to enforce the complementarity of the sector with agri-food chains, decreasing the competition between energy and non-energy uses. Compared to the old scheme, maize demand for biogas would decrease, lessening the market clearing price (as well as feed opportunity cost for livestock sector) and reducing land demand for energy purposes. - Highlights: •We investigate biogas production in Lombardy under two alternative policy scenarios. •We model the biogas sector using a partial equilibrium approach. •Past legislation significantly increases maize demand and its market clearing price. •New incentive system favors manure based plants (130 kWe) decreasing maize demand. •Wider, new policy mitigates past distortions and negative effects on maize price.
Williams, Geraint; Dean, Phil; Williams, Elisabeth
In their definition of modern nursing, the Royal College of Nursing emphasizes the importance of caring. However, there is little other than anecdotal evidence that female qualified staff nurses are more caring and compassionate than average individuals. A study was carried out to test, under scientific conditions with a case control study, the hypothesis that staff nurses are no more caring than average female individuals. Using the ten-item personality inventory (TIPI) questionnaire, a statistical comparison was made between 174 volunteer female staff nurses and data for 760 adult female controls extracted from the TIPI instrument's original validation study. The questionnaire measures each of the five major facets of personality: openness, extroversion, conscientiousness, agreeableness and neuroticism. Agreeableness, which is a tendency to be compassionate, considerate and cooperative, was used as a proxy measure for 'caring'. Data were analysed using unpaired Student's t-tests. Female staff nurses recorded significantly higher scores than female controls concerning the personality traits extroversion, agreeableness, conscientiousness and emotional stability (Pnurses are significantly more caring, conscientious and resilient individuals. The personality traits found in female staff nurses complement their profession and to some extent justify the caring, compassionate nurse stereotype. Whether career nursing self-selects these qualities or to what extent nursing staff develop aspects of their personality as a product of experience is a subject for debate.
Kanerva, Mari; Ollgren, Jukka; Lyytikäinen, Outi
It is difficult to draw conclusions about the prudence of antibiotic use in different hospitals by directly comparing usage figures. We present a patient case-mix adjustment model of antibiotic use to rank hospitals while taking patient characteristics into account. Data on antibiotic use were collected during the national healthcare-associated infection (HAI) prevalence survey in 2005 in Finland in all 5 tertiary care, all 15 secondary care and 10 (25% of 40) other acute care hospitals. The use of antibiotics was measured using use-days/100 patient-days during a 7day period and the prevalence of patients receiving at least two antimicrobials during the study day. Case-mix-adjusted antibiotic use was calculated by using multivariate models and an indirect standardization method. Parameters in the model included age, sex, severity of underlying diseases, intensive care, haematology, preceding surgery, respirator, central venous and urinary catheters, community-associated infection, HAI and contact isolation due to methicillin-resistant Staphylococcus aureus. The ranking order changed one position in 12 (40%) hospitals and more than two positions in 13 (43%) hospitals when the case-mix-adjusted figures were compared with those observed. In 24 hospitals (80%), the antibiotic use density observed was lower than expected by the case-mix-adjusted use density. The patient case-mix adjustment of antibiotic use ranked the hospitals differently from the ranking according to observed use, and may be a useful tool for benchmarking hospital antibiotic use. However, the best set of easily and widely available parameters that would describe both patient material and hospital activities remains to be determined.
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.
Zielinski, Andrzej; Kronogård, Maria; Lenhoff, Håkan; Halling, Anders
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. 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. 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%. 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.
KATHRYN JEAN EASTWOOD
Increasing demand for emergency ambulances places a substantial burden on ambulance services. Many cases are low-acuity, having no urgent clinical need for paramedic treatment. Ambulance Victoria implemented a secondary telephone triage services to divert low-acuity cases away from emergency ambulances to more appropriate care. This research found this ‘Referral Service’ has had a substantial impact upon emergency operations, referring over 70% of the cases it managed away from emergency am...
Full Text Available PURPOSE: To investigate the ability of Canadian intensive care units (ICUs and ventilators to handle widespread re-emergence of the swine-origin H1N1 virus in the context of an aggressive strategy of vaccination.
Conclusion: The present study suggests that the work context has a central importance in relation to the experience of WLI among health-care workers. The results indicated that intervention in the work context may help to contain WLI. Such interventions would especially be aimed at improving the social climate within the unit and quality of the organizational process.
[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.
Full Text Available Nasal ala pressure sores are among complications of nasogastric tube in Pediatric Intensive Care Unit (PICU. The severity of the injury is usually minor and easily ignored. However, the complication could be easily avoided. This is a case of nasal ala sore after the place-ment of nasal enteral tube in a pediatric intensive care unit in our center. A 5-month-old female with pulmonary hypertension secondary to bronchiectasis with nasal ala pressure sore were reported. She was hospitalized in pediatric intensive care unit at Tabriz Children Hospital in 2010.After 53 days of PICU hospitalization she had nasal ala sore. Conclusion: We know that nasal ala pressure sores could easily be avoided when preventive procedures were performed during nasogastric tube insertion.
Willemain, T R
The trend in payment for nursing home services has been toward making finer distinctions amont patients and the rates at which their care is reimbursed. The ultimate in differentiation is patient-centered reimbursement, whereas each patient's rate is individually determined. This paper introduces a model of overpayment and under-payment for comparing the potential performance of alternative reimbursement schemes. The model is used in comparing the patient-centered approach with case-mix reimbursement, which assigns a single rate to all patients in a nursing home on the basis of the facility's case mix. Roughly speaking, the case-mix approach is preferable whenever the differences between patient's needs are smaller than the errors in needs assessment. Since this condition appears to hold in practice today, case-mix reimbursement seems preferable for the short term.
Wendelboe, Aaron M; Avery, Catherine; Andrade, Bernardo; Baumbach, Joan; Landen, Michael G
Employees of long-term care facilities (LTCFs) who have contact with residents should be vaccinated against influenza annually to reduce influenza incidence among residents. This investigation estimated the magnitude of the benefit of this recommendation. The New Mexico Department of Health implemented active surveillance in all of its 75 LTCFs during influenza seasons 2006-2007 and 2007-2008. Information about the number of laboratory-confirmed cases of influenza and the proportion vaccinated of both residents and direct-care employees in each facility was collected monthly. LTCFs reporting at least 1 case of influenza (defined alternately by laboratory confirmation or symptoms of influenza-like illness [ILI]) among residents were compared with LTCFs reporting no cases of influenza. Regression modeling was used to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between employee vaccination coverage and the occurrence of influenza outbreaks. Covariates included vaccination coverage among residents, the staff-to-resident ratio, and the proportion of filled beds. Seventeen influenza outbreaks were reported during this 2-year period of surveillance. Eleven of these were laboratory confirmed (n = 21 residents) and 6 were defined by ILI (n = 40 residents). Mean influenza vaccination coverage among direct-care employees was 51% in facilities reporting outbreaks and 60% in facilities not reporting outbreaks (P = .12). Increased vaccination coverage among direct-care employees was associated with fewer reported outbreaks of laboratory-confirmed influenza (aOR, 0.97 [95% CI, 0.95-0.99]) and ILI (aOR, 0.98 [95% CI, 0.96-1.00]). High vaccination coverage among direct-care employees helps to prevent influenza in LTCFs.
Gagnier, Joel J; Kienle, Gunver; Altman, Douglas G; Moher, David; Sox, Harold; Riley, David
A case report is a narrative that describes, for medical, scientific, or educational purposes, a medical problem experienced by one or more patients. Case reports written without guidance from reporting standards are insufficiently rigorous to guide clinical practice or to inform clinical study design. Develop, disseminate, and implement systematic reporting guidelines for case reports. We used a three-phase consensus process consisting of (1) pre-meeting literature review and interviews to generate items for the reporting guidelines, (2) a face-to-face consensus meeting to draft the reporting guidelines, and (3) post-meeting feedback, review, and pilot testing, followed by finalization of the case report guidelines. This consensus process involved 27 participants and resulted in a 13-item checklist-a reporting guideline for case reports. The primary items of the checklist are title, key words, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective, and informed consent. We believe the implementation of the CARE (CAse REport) guidelines by medical journals will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports will inform clinical study design, provide early signals of effectiveness and harms, and improve healthcare delivery. Copyright © 2014 Reproduced with permission of Global Advances in Health and Medicine. Published by Elsevier Inc. All rights reserved.
Full Text Available Kevin C Lee,1 Hanyuan Shi,2 Brian C Lee3 1Columbia University College of Dental Medicine, New York, NY, 2Vanderbilt University School of Medicine, Nashville, TN, 3Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA Abstract: A 21-year-old male (body mass index: 28.3 with a history of asthma and reactive airway disease since childhood underwent left shoulder arthroscopy and labral repair surgery under monitored anesthesia care. Because the procedure was performed in the beach chair position, access to the patient’s airway was limited throughout. To avoid general anesthesia and to limit potential complications associated with monitored anesthesia care, a ketofol admixture was used. This case demonstrates that, in conjunction with regional anesthesia, ketofol may be an acceptable alternative to propofol for maintenance in outpatient orthopedic procedures. Keywords: ketamine, propofol, ketofol, sedation, case report
Donaldson, Abigail A; Hall, Allison; Neukirch, Jodie; Kasper, Vania; Simones, Shannon; Gagnon, Sherry; Reich, Steven; Forcier, Michelle
Gender nonconforming youth are at risk for body dissatisfaction and disordered eating. Currently, only a small body of literature addresses this high-risk group. The five cases in this series highlight important themes for this patient population from an interdisciplinary perspective. Identified themes include increased risk for self-harm/suicide, complex psychiatric, and medical implications of delay to treatment for either gender dysphoria or disordered eating, and the importance of collaborative management to maximize care and facilitate healthy development to adulthood. The purpose of this case series is to expand the interdisciplinary discussion regarding the breadth of presentation and management considerations for gender nonconforming adolescents with disordered eating. An interdisciplinary approach to care might enhance access to comprehensive, collaborative treatment for disordered eating, and gender dysphoria in this unique population. © 2018 Wiley Periodicals, Inc.
Full Text Available Abstract Background As the populations of many developed nations continue to age at rapid rates it is becoming increasingly important to enhance palliative care service delivery in order to meet anticipated demand. Rural areas face a number of challenges in doing this, and thus dedicated attention must be given to determining how to best enhance service delivery in ways that are sensitive to their particular needs. The purposes of this article are to determine the vision for establishing secondary palliative care service hubs (SPCH in rural communities through undertaking a case study, and to ascertain the criteria that need to be considered when siting such hubs. Methods A rural region of British Columbia, Canada was selected for primary data collection, which took place over a five-month period in 2008. Formal and informal palliative care providers (n = 31 were interviewed. A purposeful recruitment strategy was used to maximize occupational and practice diversity. Interviews were conducted by phone using a semi-structured guide. Interviews were audio recorded and transcribed verbatim. Data were managed using NVivo8™ software and analyzed thematically, using investigator triangulation to strengthen interpretation. Results Four themes emerged from the dataset: (1 main SPCH features; (2 determining a location; (3 value-added outcomes; and (4 key considerations. It was found that participants generally supported implementing a SPCH in the rural region of focus. Several consistent messages emerged, including that: (1 SPCHs must create opportunities for two-way information exchange between specialists and generalists and communities; (2 SPCHs should diffuse information and ideas throughout the region, thus serving as a locus for education and a means of enhancing training opportunities; and (3 hubs need not be physical sites in the community (e.g., an office in a hospice or hospital, but may be virtual or take other forms based upon local needs
Baldwin, Kathleen M; Black, Denice; Hammond, Sheri
This quality improvement project developed a community nursing case management program to decrease preventable readmissions to the hospital and emergency department by providing telephonic case management and, if needed, onsite assessment and treatment by a clinical nurse specialist (CNS) with prescriptive authority. As more people reach Medicare age, the number of individuals with worsening chronic diseases with dramatically increases unless appropriate disease management programs are developed. Care transitions can result in breakdown in continuity of care, resulting in increased preventable readmissions, particularly for indigent patients. The CNS is uniquely educated to managing care transitions and coordination of community resources to prevent readmissions. After a thorough SWOT (strengths, weaknesses, opportunities, and threats) analysis, we developed and implemented a cost-avoidance model to prevent readmissions in our uninsured and underinsured patients. The project CNS used a wide array of interventions to decrease readmissions. In the last 2 years, there have been a total of 22 less than 30-day readmissions to the emergency department or hospital in 13 patients, a significant decrease from readmissions in these patients prior to the program. Three of them required transfer to a larger hospital for a higher level of care. Using advanced practice nurses in transitional care can prevent readmissions, resulting in cost avoidance. The coordination of community resources during transition from hospital to home is a job best suited to CNSs, because they are educated to work within organizations/systems. The money we saved with this project more than justified the cost of hiring a CNS to lead it. More research is needed into this technology. Guidelines for this intervention need to be developed. Replicating our cost-avoidance transitional care model can help other facilities limit that loss.
Hess, Rosanna F
This case report describes the phases of an Amish Burn Care Project and the lessons learned throughout the process. Data sources to construct the case report included participant observation, interviews, archival documents, and a focus group. The narrative is organized into five phases of a participatory research approach: engagement, formalization, mobilization, maintenance, and expansion. Community-initiated research led to legitimate change, working together for change took time, team members grew in mutual trust and respect for each other, cultural humility brought personal and professional growth, and capacity building took place through mutually supported efforts.
Full Text Available The Children’s Act 38 of 2005 contains provisions enabling utilisation of alternative dispute resolution (ADR in cases involving children. This article focuses on the specialised training required to prepare social workers to be effective ADR practitioners. By drawing on comparative data, the article demonstrates that it is essential for social workers to receive such training in South Africa. The nature of the training that would be required to empower South African social workers to be effective ADR facilitators in care and protection cases is explored. Proposals for a South African training programme are put forward.
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.
Full Text Available On-street parking is an urgent issue to address in a fast-growing city of a developing country, such as Yogyakarta City in Indonesia. However, this issue has not been satisfactorily studied due to a lack of relevant parking data. Using a sample of 21 street segments that are currently used for on-street parking in the central district of the city, this study analyzes how the parking duration and demand are differentiated by street and land use characteristics. The characteristics are evaluated through a field survey, which is supplemented by remote sensing and GIS. Specifically, QuickBird imagery is used to roughly examine the length and angle of the street segments and GIS data to calculate parking capacity and demand as well as to confirm the street length and angle. Regression models find that the parking duration is affected by the street length, parking volume, and commercial type of land use, while the street length also differentiates the parking demand. Although the model for the parking demand has only one significant variable—street length—its variation is better accounted for by the same set of variables than the variation in the parking duration. Regarding the street length, it is found to be the only significant variable in the demand model, but it becomes the weakest among those significant in the duration model, where the land use type has the highest magnitude.
Sánchez-Herrero, Héctor; Duarte-Clíments, Gonzalo; González-Pérez, Teodoro; Sánchez-Gómez, María Begoña; Gomariz-Bolarín, David
This article describes a clinical case of a patient attended at a continuous care point for a generalized anxiety disorder, principally due to abuse suffered from her ex partner. The patient was followed up at family nursing clinic, and the appropriate nursing interventions were developed to cover a series of needs prioritized by nurses using the AREA method and taking into account the prioritization of the user herself. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Ozlem Asci; Guleser Hazar; Isa Sercan
Objectives: The objective of this study is to determine the states of health care personnel, working at 112 emergency stations in the province of Artvin, to encounter with regarding forensic cases and determine their practices aimed at recognizing, protecting, and reporting the evidences that may affect the forensic process. Materials and methods: This descriptive study was conducted with nurses and emergency medicine technicians working at 112 emergency stations in Artvin between January 201...
Eselius, Laura L; Cleary, Paul D; Zaslavsky, Alan M; Huskamp, Haiden A; Busch, Susan H
To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO) survey to allow for fair comparisons across health plans. Survey responses from 4,068 individuals enrolled in 21 managed behavioral health plans who received behavioral health care within the previous year (response rate = 48 percent). Potential case-mix adjustors were evaluated by combining information about their predictive power and the amount of within- and between-plan variability. Changes in plan scores and rankings due to case-mix adjustment were quantified. The final case-mix adjustment model included self-reported mental health status, self-reported general health status, alcohol/drug treatment, age, education, and race/ethnicity. The impact of adjustment on plan report scores was modest, but large enough to change some plan rankings. Adjusting plan report scores on the ECHO survey for differences in patient characteristics had modest effects, but still may be important to maintain the credibility of patient reports as a quality metric. Differences between those with self-reported fair/poor health compared with those in excellent/very good health varied by plan, suggesting quality differences associated with health status and underscoring the importance of collecting quality information.