WorldWideScience

Sample records for care demand case

  1. Managed care demands flexibility, creativity.

    Science.gov (United States)

    1996-05-01

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

  2. Disaggregation of the demand for hospital care

    NARCIS (Netherlands)

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

    1988-01-01

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

  3. [Supply and demand in home health care].

    Science.gov (United States)

    Braga, Patrícia Pinto; de Sena, Roseni Rosângela; Seixas, Clarissa Terenzi; de Castro, Edna Aparecida Barbosa; Andrade, Angélica Mônica; Silva, Yara Cardoso

    2016-03-01

    The changes in the demographic and epidemiologic profiles of the Brazilian population and the need to rethink the health care model have led many countries like Brazil to consider Home Care (HC) as a care strategy. However, there is a gap between the supply of HC services, the demand for care and the health needs manifested by the population. Thus, this article analyzes scientific output regarding the status of the relation between supply, demand and the needs related to home health care. This work is based on an integrative review of the literature in the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin America and the Caribbean Literature on Health and Science (Lilacs), Medical Literature Analysis and Retrieval System Online (Medline) and Web of Science. Despite the fact that few articles refer to the issue in question, there is evidence indicating that health demands and needs are seldom taken into account either in a quantitative or qualitative approach when developing the organization of HC services. The analysis would indicate that there is a national and international deficit in the supply of HC services considering the demand for health care and needs currently prevailing. PMID:26960102

  4. Demand for antenatal care in South Africa.

    Science.gov (United States)

    Kirigia, J M; Lambo, E; Sambo, L G

    2000-01-01

    On May,24 1994, the then South African president, Mr. Nelson Mandela, declared that all health care for children under the age of 6 years, and pregnant women would be free. Unfortunately, there has been no significant decrease in maternal, perinatal and infant mortality. Thus, there is a need of research into the factors that influence the demand for antenatal services. The objectives of this paper are to (a) establish the determinants of individual pregnant women's choice to seek antenatal care; and (b) deal with potential endogeneity bias in the relationship between the decision to seek pre-natal care and perceived health status. The joint determination of consumption of antenatal care and pregnant woman's health status requires estimation of a simultaneous system. To help mitigate the simultaneity bias and avoid the inconsistency inherent in the application of Ordinary least Squares (OLS) method to simultaneous equations systems, we used Two-Stage Probit Maximum Likelihood Estimator Method. In the antenatal structural-form equation, the coefficients for TOILET, AGE, OCCUPATION, EMPLOYMENT, SMOKER, METHODS and QUALITY were statistically significant at P risk-lovers or risk-neutral are unlikely to consume preventive and promotive health care, including antenatal care. Thus, there is need to put in place incentives that would convert seemingly risk-lovers to risk-averters. (2) Programmes aimed at reducing women unemployment and general working conditions would improve use of pre-natal care. (3) Improvements in perceived quality of care at the health facilities that offer antenatal care is needed to boost the consumption of antenatal care and probably other forms of health care. PMID:17650027

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

    NARCIS (Netherlands)

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

    2006-01-01

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

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

    Science.gov (United States)

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

    2016-10-01

    Forecasts of the demand for medical supplies both directly and indirectly affect the operating costs and the quality of the care provided by health care institutions. Specifically, overestimating demand induces an inventory surplus, whereas underestimating demand possibly compromises patient safety. Uncertainty in forecasting the consumption of medical supplies generates intermittent demand events. The intermittent demand patterns for medical supplies are generally classified as lumpy, erratic, smooth, and slow-moving demand. This study was conducted with the purpose of advancing a tertiary pediatric intensive care unit's efforts to achieve a high level of accuracy in its forecasting of the demand for medical supplies. On this point, several demand forecasting methods were compared in terms of the forecast accuracy of each. The results confirm that applying Croston's method combined with a single exponential smoothing method yields the most accurate results for forecasting lumpy, erratic, and slow-moving demand, whereas the Simple Moving Average (SMA) method is the most suitable for forecasting smooth demand. In addition, when the classification of demand consumption patterns were combined with the demand forecasting models, the forecasting errors were minimized, indicating that this classification framework can play a role in improving patient safety and reducing inventory management costs in health care institutions. PMID:27562485

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

    Science.gov (United States)

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

    2016-10-01

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

  8. Preparing Psychotherapy Students for the New Demands of Managed Care.

    Science.gov (United States)

    Chambliss, Catherine

    The wildly varying utilization and quality control practices that make up "managed care" make it difficult to generalize new rules and requirements. Information that can aid counselor trainees in understanding the demands of managed health care is presented. The text explores the following questions: (1) "What do managed care companies want?" and…

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

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Greve, Jane

    or obese individuals demand more medical care than normal weight individuals by estimating a finite mixture model which splits the population into frequent and non-frequent users of primary physician (GP) services according to the individual's latent health status. Based on a sample of wage-earners aged 25...... and show that being obese or overweight does not increase the demand for primary physician care among infrequent users but does so among frequent users.......The standard economic model for the demand for health care predicts that unhealthy behaviour such as being overweight or obese should increase the demand for medical care, particularly as clinical studies link obesity to a number of serious diseases. In this paper, we investigate whether overweight...

  10. The Demand for Child Care Services in Canada

    OpenAIRE

    Henriques, I; Vaillancourt, F.

    1986-01-01

    This Paper Examines the Determinants of the Demand for Child Care Services in Canada. Using Survey Data Collected for 1981 by Statistics Canada and Probit Analysis We Find That the Likelihood of Using Child Care Services Increases with Variables Such As the Education of the Mother and the Age of the Child and Decreases with the Number of Children in the Family.

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

    NARCIS (Netherlands)

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

    2004-01-01

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

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

    Science.gov (United States)

    Samoliński, Bolesław

    2015-01-01

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

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

    OpenAIRE

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

    2004-01-01

    OBJECTIVE: To investigate the demand for orthodontic treatment among 9-18 olds seeking dental care in Dar-es-Salaam, Tanzania. DESIGN: Case-control, interview and clinical study. SETTINGS: Children seeking dental care. MAIN OUTCOME MEASURES: Demand for orthodontic treatment. RESULTS: Most of the children (85%) in the case group attended the dental clinic because of crowding. Aesthetic impairment (AC grades 8-10) and severe malocclusions (DHC grades 4-5) were higher in cases than in controls b...

  14. Hypertensive patients in primary health care: access, connection and care involved in spontaneous demands.

    Science.gov (United States)

    Girão, Ana Lívia Araújo; Freitas, Consuelo Helena Aires de

    2016-06-01

    Objective To assess the impacts of inclusion of care for spontaneous demands in the treatment of hypertensive patients in primary health care. Methods Third generation qualitative assessment survey conducted with 16 workers in a Primary Care Health Unit (PHCU) of the city of Fortaleza, state of Ceara, in the period between July and September of 2015. To collect data, systematic field observation and semi-structured interviews were used, and the stages of thematic content analysis were adopted for data analysis. Results Participants revealed that access, connection and care are fundamental to the treatment of hypertension. However, they said that the introduction of free access for spontaneous demands compromised the flow of care in the hypertension programs. Conclusion A dichotomy between the practice of care recommended by health policies and the one existing in the reality of PHCUs was shown, causing evident losses to the care of hypertensive patients in primary care. PMID:27253602

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

    Consumers who are accustomed to on-demand, virtual services are looking for more convenient ways to access health care. Giving patients the opportunity to connect with physicians remotely can promote higher patient satisfaction and engagement. Telehealth options may have a high start-up cost, but that cost is likely well-justified by the potential to enhance quality, outcomes, and customer attraction and satisfaction/retention over the long-term. PMID:26863834

  17. Supplier-Induced Demand in Japan's At-home Care Industry: Evidence from Micro-level Survey on Care Receivers

    OpenAIRE

    NOGUCHI Haruko; SATOSHI Shimizutani

    2005-01-01

    We observed a remarkable increase in elderly care expenses in Japan after the introduction of public elderly care insurance in 2000. This study explores the possibility that a greater number of care providers under the deregulation of the entry policy stimulated care utilization. We take advantage of an original household-level survey data on care receivers to address the existence of supplier-induced demand in Japan's elderly at-home care market, by distinguishing between demand for care rec...

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

    Science.gov (United States)

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

    2013-12-06

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

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

    Science.gov (United States)

    Bloechliger, Olivia R.; Bauer, Georg F.

    2016-01-01

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

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

    DEFF Research Database (Denmark)

    Datta Gupta, Nabanita; Greve, Jane

    overweight or obese individuals demand more medical care than their normal weight individuals by estimating a finite mixture model which splits the population into frequent and non-frequent users of primary physician (GP) services according to the individual's latent health status. Based on a sample of wage...... classes and show that being obese or overweight does not increase the demand for primary physician care care among infrequent users but does so among frequent users.......The standard economic model for the demand for health care predicts that unhealthy behaviour such as being  overweight or obese should increase the demand for medical care, particularly as clinical studies link obesity to a number of serious diseases. In this paper, we investigate whether...

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

    Science.gov (United States)

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

    2016-02-01

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

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

    Science.gov (United States)

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

    1999-12-01

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

  3. Health insurance and the demand for medical care: Instrumental variable estimates using health insurer claims data.

    Science.gov (United States)

    Dunn, Abe

    2016-07-01

    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. PMID:27107371

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

    Science.gov (United States)

    Reynaud, Arnaud; Renzetti, Steven; Villeneuve, Michel

    2005-11-01

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

  5. Estimates of Price and Income Elasticities of At-home Care Demand in Japan: Evidence Based on a Contingent Valuation Method and Actual Demand(in Japanese)

    OpenAIRE

    SHIMIZUTANI Satoshi; Noguchi, Haruko

    2004-01-01

    Due to rapid aging of the country's citizens, Japan faces an enormous long-term care future demand. To control care demand and maintain the current long-term care insurance, policies should be based on price and income elasticities obtained from empirical studies in Japan. This study is meant to provide valuable information that should be incorporated into actual policy-making; it aims to prevent a catastrophe due to explosion of care demand. In the paper we focus on estimating price and inco...

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

    Directory of Open Access Journals (Sweden)

    A.K. Bhardwaj and R.C. Bansal

    2011-03-01

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

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

    Science.gov (United States)

    Wouters, A V

    1992-01-01

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

  8. The roles of Medicaid and economic factors in the demand for nursing home care.

    OpenAIRE

    Reschovsky, J D

    1998-01-01

    OBJECTIVE: To examine nursing home demand, focusing on how Medicaid affects demand, the role of economic variables, and on important interactions between explanatory factors. DATA SOURCES: From the 1989 National Long Term Care Survey, a nationally representative sample of community-based and institutionalized elderly persons with disabilities (N = 3,837). Survey data are merged with state- and county-level data on Medicaid policy and local market conditions. STUDY DESIGN: Sample members are c...

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

    Science.gov (United States)

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

    2012-09-01

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

  10. Inventory control in case of unknown demand and control parameters.

    OpenAIRE

    Janssen, E.

    2010-01-01

    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 that a certain service level is achieved. However, in real life the demand information is not known completely. Often, only some historical demand observations are available, and these are used to...

  11. Improving Forecasting Accuracy in the Case of Intermittent Demand Forecasting

    Directory of Open Access Journals (Sweden)

    Daisuke Takeyasu

    2014-06-01

    Full Text Available In making forecasting, there are many kinds of data. Stationary time series data are relatively easy to make forecasting but random data are very difficult in its execution for forecasting. Intermittent data are often seen in industries. But it is rather difficult to make forecasting in general. In recent years, the needs for intermittent demand forecasting are increasing because of the constraints of strict Supply Chain Management. How to improve the forecasting accuracy is an important issue. There are many researches made on this. But there are rooms for improvement. In this paper, a new method for cumulative forecasting method is proposed. The data is cumulated and to this cumulated time series, the following method is applied to improve the forecasting accuracy. Trend removing by the combination of linear and 2nd order non-linear function and 3rd order non-linear function is executed to the production data of X-ray image intensifier tube device and Diagnostic X-ray image processing apparatus. The forecasting result is compared with those of the non-cumulative forecasting method. The new method shows that it is useful for the forecasting of intermittent demand data. The effectiveness of this method should be examined in various cases.

  12. Issues facing the future health care workforce: the importance of demand modelling.

    Science.gov (United States)

    Segal, Leonie; Bolton, Tom

    2009-01-01

    This article examines issues facing the future health care workforce in Australia in light of factors such as population ageing. It has been argued that population ageing in Australia is affecting the supply of health care professionals as the health workforce ages and at the same time increasing the demand for health care services and the health care workforce.However, the picture is not that simple. The health workforce market in Australia is influenced by a wide range of factors; on the demand side by increasing levels of income and wealth, emergence of new technologies, changing disease profiles, changing public health priorities and a focus on the prevention of chronic disease. While a strong correlation is observed between age and use of health care services (and thus health care workforce), this is mediated through illness, as typified by the consistent finding of higher health care costs in the months preceding death.On the supply side, the health workforce is highly influenced by policy drivers; both national policies (eg funded education and training places) and local policies (eg work place-based retention policies). Population ageing and ageing of the health workforce is not a dominant influence. In recent years, the Australian health care workforce has grown in excess of overall workforce growth, despite an ageing health workforce. We also note that current levels of workforce supply compare favourably with many OECD countries. The future of the health workforce will be shaped by a number of complex interacting factors.Market failure, a key feature of the market for health care services which is also observed in the health care labour market - means that imbalances between demand and supply can develop and persist, and suggests a role for health workforce planning to improve efficiency in the health services sector. Current approaches to health workforce planning, especially on the demand side, tend to be highly simplistic. These include historical

  13. Demand and Supply–Based Operating Modes—A Framework for Analyzing Health Care Service Production

    Science.gov (United States)

    Lillrank, Paul; Groop, P Johan; Malmström, Tomi J

    2010-01-01

    Context: 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. Methods: The arguments in this article apply new reasoning to the previous literature. Findings: The method used in this article to classify health care provision distinguishes different types of health problems that share generic constraints of production. Conclusions: 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. PMID:21166870

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Science.gov (United States)

    Shutes, Isabel; Walsh, Kieran

    2012-01-01

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

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

    Science.gov (United States)

    Grytten, J; Lund, E

    1999-10-01

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

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

    NARCIS (Netherlands)

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

    1985-01-01

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

  18. An analysis of the demand for regular dental health care: implications for marketing.

    Science.gov (United States)

    Rutsohn, P; Ibrahim, N A

    2000-01-01

    The more information a dentist has concerning factors that affect the demand or lack of demand for dental care the greater his or her capability to profile client markets. Logically the more exact the profiling of clients (potential clients) the better able the dentist is to develop a marketing program that is responsive to various market segments. In this paper the authors report findings extracted from an extensive health assessment survey which shed light on factors influencing the demand for dental services. Responses from 1934 residents of a large southeastern metropolitan area were analyzed. Statistical analyses of the data were conducted to determine whether or not a relationship existed between dental care utilization and the presence/absence of dental insurance, gender, racial/ethnic background, and household income. The potential implications these factors may have on marketing a dental practice are explored and recommendations presented. PMID:11010218

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

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hui-min; JIANG Hui-ming

    2005-01-01

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

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

    Science.gov (United States)

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

    2016-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Bernardo Reynolds Pacheco de Carvalho

    2014-08-01

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

  2. Integrated care as an organisational challenge: an exploratory case study (poster presentation)

    OpenAIRE

    Pless, Sam; Dessers, Ezra; Corvers, Benny; Van Hootegem, Geert

    2014-01-01

    Introduction: Integrated care is aimed towards more demand-driven and cost-conscious health systems. The multidisciplinary research project CORTEXS brings together expertise on organization sciences and integrated care [1]. Aims: In order to gain a better grasp of the connection of the concept of integrated care with principles of organisational design, we conducted an exploratory case study on task division and allocation in a regional hospital [2]. Case study: The study is specifica...

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

    Science.gov (United States)

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

    2012-01-01

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

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

    OpenAIRE

    Töres Theorell; Annica Kempe; Fatoom Noor-Aldin Alwazer

    2011-01-01

    Background. Utilization of professional care during childbirth by women in low-income countries is important for the progress towards MDG 5. In Yemen, home births have decreased minimally during the past decades. Objective. The study investigates the influence of socio-demographic, birth outcome and demand factors on women's future preference of a home or institutional childbirth. Method. We interviewed 220 women with childbirth experience in urban/rural Yemen. We performed bivariate chi-squa...

  5. Nonparametric checks for count data models: an application to demand for health care in Spain

    OpenAIRE

    Álvarez, Begoña; Delgado, Miguel A.

    1997-01-01

    This paper presents model specification checking procedures for count data regression models which are consistent in the direction of nonparametric alternatives. The discussion is motivated in the context of a model of demand for health care in Spain. The parameters of the regression model are estimated by maximum likelihood based on Poisson and Negative Binomial specifications as well as by ordinary least squares and semiparametric generalized least squares. However, our interest is not only...

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

    Science.gov (United States)

    Palangkaraya, Alfons; Yong, Jongsay

    2009-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Bruna Antoniassi Silva

    2015-03-01

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

  8. Overcoming job demands to deliver high quality care in a hospital setting across Europe: The role of teamwork and positivity

    OpenAIRE

    Montgomery Anthony; Panagopoulou Efharis; Costa Patricia

    2014-01-01

    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 ...

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

    OpenAIRE

    Mackenzie, James

    2011-01-01

    There are many challenges facing the health system in the 21st century – the majority of which are related to managing demand for health services. To meet these challenges emerging GP commissioning consortia will need to take a new approach to commissioning health services – an approach that moves beyond the current acute-centred curative paradigm of care to a new sustainable paradigm of care that focuses on primary care, integrated services and upstream prevention to manage demand. A key par...

  10. Energy demand modelling and GHG emission reduction: case study Croatia

    DEFF Research Database (Denmark)

    Pukšec, Tomislav; Mathiesen, Brian Vad; Novosel, Tomislav;

    2013-01-01

    In the light of new European energy-climate package and its measures for increasing security of supply, decreasing the impact on environment and stimulating sustainable development with special emphasis on job creation and regional growth, Croatia as a future EU member state, needs to reconsider...... and develop new energy policy towards energy efficiency and renewable energy sources, in order to comply with all of the presented tasks. Planning future energy demand, considering various policy options like regulation, fiscal and financial measures, becomes one of the crucial issues of future national...... energy strategy. This paper analyses Croatian long term energy demand and its effect on the future national GHG emissions. For that purpose the national energy demand model was constructed (NeD model). The model is comprised out of six modules each representing one sector, following Croatian national...

  11. Managing the growing energy demand - The case of Egypt

    Energy Technology Data Exchange (ETDEWEB)

    El-Kholy, Hosni; Faried, Ragy

    2010-09-15

    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.

  12. Musculoskeletal Disorders and Perceived Work Demands among Female Nurses at a Tertiary Care Hospital in India.

    Science.gov (United States)

    Raithatha, Apexa S; Mishra, Daxa G

    2016-01-01

    Introduction. Musculoskeletal disorders (MSD) are common among nurses and can affect patient outcomes. There is a dearth of literature on MSD among Indian nurses. The study objective was to measure prevalence of MSD and their association with perceived work demands and sociodemographic variables among female nurses at a tertiary care hospital in rural India. Methods. A cross-sectional study was undertaken in 2013 through interviewer administered questionnaires which comprised three parts: sociodemographic data, modified Nordic questionnaire, and perceived physical and psychological work demands. Results. 296 nurses with a mean age of 30.4 years participated. Prevalence of any MSD in the last seven days was 60.5% with low back pain being the most common and elbow pain the least common. Occurrence of any MSD was associated with age, number of children, working hours at home, BMI, and total work experience. High perceived physical demands score was associated with lower back (OR: 3.06) and knee pain (OR: 7.73). Conclusion. Prevalence of MSD was high and occurrence of lower back and knee MSD was associated with perceived physical demands. This information should be used as a benchmark and guiding tool for designing work place interventions to improve working conditions and health of nurses. PMID:27493990

  13. Musculoskeletal Disorders and Perceived Work Demands among Female Nurses at a Tertiary Care Hospital in India

    Directory of Open Access Journals (Sweden)

    Apexa S. Raithatha

    2016-01-01

    Full Text Available Introduction. Musculoskeletal disorders (MSD are common among nurses and can affect patient outcomes. There is a dearth of literature on MSD among Indian nurses. The study objective was to measure prevalence of MSD and their association with perceived work demands and sociodemographic variables among female nurses at a tertiary care hospital in rural India. Methods. A cross-sectional study was undertaken in 2013 through interviewer administered questionnaires which comprised three parts: sociodemographic data, modified Nordic questionnaire, and perceived physical and psychological work demands. Results. 296 nurses with a mean age of 30.4 years participated. Prevalence of any MSD in the last seven days was 60.5% with low back pain being the most common and elbow pain the least common. Occurrence of any MSD was associated with age, number of children, working hours at home, BMI, and total work experience. High perceived physical demands score was associated with lower back (OR: 3.06 and knee pain (OR: 7.73. Conclusion. Prevalence of MSD was high and occurrence of lower back and knee MSD was associated with perceived physical demands. This information should be used as a benchmark and guiding tool for designing work place interventions to improve working conditions and health of nurses.

  14. Price elasticity of demand for cigarettes : The Case of Sweden

    OpenAIRE

    Ahmed, Sadeq Mohamed; Vaziri, Kamran

    2014-01-01

    Due to health problems and the negative externalities associated with cigarette consumption, many governments try to discourage cigarette consumption by increasing its price through taxation. However, cigarette, like the other addictive goods, is viewed as that it is not sensitive to demand rules and the market forces. This study analyses the effect of price increase on cigarette consumption. We used Swedish time series data from 1970 to 2010. Our results reveal that though cigarette is addic...

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

    Science.gov (United States)

    DeCicca, Philip; Kenkel, Don

    2015-06-01

    Econometric estimates of the responsiveness of health-related consumer demand to higher prices are often key ingredients for risk policy analysis. We review the potential advantages and challenges of synthesizing econometric evidence on the price-responsiveness of consumer demand. We draw on examples of research on consumer demand for health-related goods, especially cigarettes. We argue that the overarching goal of research synthesis in this context is to provide policy-relevant evidence for broad-brush conclusions. We propose three main criteria to select among research synthesis methods. We discuss how in principle and in current practice synthesis of research on the price-elasticity of smoking meets our proposed criteria. Our analysis of current practice also contributes to academic research on the specific policy question of the effectiveness of higher cigarette prices to reduce smoking. Although we point out challenges and limitations, we believe more work on research synthesis in this area will be productive and important. PMID:25809022

  16. Characterization of the elastic displacement demand: Case study - Sofia city

    International Nuclear Information System (INIS)

    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)

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

    Directory of Open Access Journals (Sweden)

    Seng Sophal

    2006-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Fernanda dos Reis

    2014-05-01

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

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

    Science.gov (United States)

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

    2016-02-01

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

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

    Science.gov (United States)

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

    2016-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Natalia Szozda

    2013-06-01

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

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

    Science.gov (United States)

    Walani, Laila

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

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

    Science.gov (United States)

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

    2016-10-01

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

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

    Science.gov (United States)

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

    2016-10-01

    We investigated how two types of care setting (home care and nursing home) and type of ownership (for-profit vs. public/non-profit) of geriatric care services interacted in influencing registered nurses' intention to give up their profession. In prior research, employment in for-profit-organizations, high job demands, and low job control were important antecedents of nurses' intent to leave. However, the impact of care setting on these associations was inconclusive. Therefore, we tested a mediated moderation model predicting that adverse work characteristics would drive professional leaving intentions, particularly in for-profit services and in nursing homes. A representative German sample of 304 registered nurses working in 78 different teams participated in our cross-sectional study. As predicted, lower job control and higher job demands were associated with higher professional leaving intentions, and nurses reported higher job demands in public/non-profit care than in for-profit care, and in nursing homes compared to home care. Overall, RNs in nursing homes and home care reported similar intent to leave, but in for-profit settings only, nurses working in nursing homes reported higher professional leaving intentions than did nurses in home care, which was linked to lower job control in the for-profit nursing home setting, supporting mediated moderation. Taken together, our results indicate that the interplay of care setting and type of ownership is important when explaining nurses' intentions to give up their profession. © 2016 Wiley Periodicals, Inc. PMID:27223817

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    NARCIS (Netherlands)

    Chambwera, M.

    2004-01-01

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

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

    OpenAIRE

    Gambo, Ramatu Bashiru

    2016-01-01

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

  8. Use of demand forecast in operational purchasing : case: Vaisala corporation component level forecast purchasing

    OpenAIRE

    Oksanen, Tuomas

    2015-01-01

    This thesis is a case study of Vaisala, a Finnish technology company. Vaisala uses LEAN manufacturing models and assemble-to-order production strategy to better serve its customers. Material availability is ensured by using an enterprise resource planning program and component specific forecasting that is derived from demand forecast. A demand forecast offers the possibility to make the operations more efficient but still offer the customers’ higher value through better delivery times. It...

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

    Directory of Open Access Journals (Sweden)

    MINAKSHI SHRIVASTAVA

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2006-01-01

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

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

    NARCIS (Netherlands)

    Bacic, I.L.Z.

    2003-01-01

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

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

    Science.gov (United States)

    Boggatz, Thomas; Dassen, Theo

    2006-04-01

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

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

    Institute of Scientific and Technical Information of China (English)

    翟绍果; 郭锦龙

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Catharina J van Oostveen

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

  15. Care production for tuberculosis cases:analysis according to the elements of the Chronic Care Model

    OpenAIRE

    Daiane Medeiros da Silva; Hérika Brito Gomes de Farias; Tereza Cristina Scatena Villa; Lenilde Duarte de Sá; Maria Eugênia Firmino Brunello; Jordana Almeida Nogueira

    2016-01-01

    Abstract OBJECTIVE: To analyze the care provided to tuberculosis cases in primary health care services according to the elements of the Chronic Care Model. METHOD: 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...

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

    Directory of Open Access Journals (Sweden)

    Gustavo Diniz Ferreira Gusso

    2013-04-01

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

  17. Simulating the impact of pricing policies on residential water demand: a Southern France case study

    OpenAIRE

    Rinaudo, J.D.; Neverre, N.; Montginoul, M.

    2012-01-01

    The case study conducted in this paper looks at residential water pricing from three different points of view. It first describes existing urban water-pricing practices in Southern France, emphasizing that pricing is not yet being used as a tool for providing economic incentives to save water. It then looks at the observed impact of pricing on water consumption, through an econometric analysis of a cross-sectional data set. The analysis suggests that demand, with an estimated price elasticity...

  18. DEMAND FLUCTUATION IN OFF SEASON : Case Study of Summit Hotel, Lalitpur, Nepal

    OpenAIRE

    Maharjan, Anju

    2012-01-01

    Seasonality is known as one of the most typical features of the tourism industry, affecting positively or negatively on tourism including the hotel industry. Seasonality demands have been a major problem for the hotel industry and have had a negative impact, such as, difficulties in gaining access to capital, low returns on investment and the inefficient use of resources. The phenomenon of seasonality imposes greater risks for tourism. This thesis concerned with a case study of a three st...

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

    Science.gov (United States)

    Ceci, Christine

    2006-03-01

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

  20. Labor Supply Heterogeneity and Demand for Child Care of Mothers with Young Children

    NARCIS (Netherlands)

    Apps, Patricia F.; Kabátek, J.; Rees, Ray; van Soest, A.H.O.

    2012-01-01

    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 sensiti

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

    Institute of Scientific and Technical Information of China (English)

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

    2003-01-01

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

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

    Science.gov (United States)

    Mackenzie, James

    2011-07-01

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

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

    Science.gov (United States)

    Mackenzie, James

    2011-07-01

    There are many challenges facing the health system in the 21st century - the majority of which are related to managing demand for health services. To meet these challenges emerging GP commissioning consortia will need to take a new approach to commissioning health services - an approach that moves beyond the current acute-centred curative paradigm of care to a new sustainable paradigm of care that focuses on primary care, integrated services and upstream prevention to manage demand. A key part of this shift is the recognition that the health system does not operate in a vacuum and that strategic commissioning decisions must take account of wider determinants of health and well-being, and operate within the finite limits of the planet's natural resources. The sustainable development principle of balancing financial, social and environmental considerations is crucial in managing demand for health services and ensuring that the health system is resilient to risks of resource uncertainty and a changing climate. Building sustainability into the governance and contracting processes of GP commissioning consortia will help deliver efficiency savings, impact on system productivity, manage system risk and help manage demand through the health co-benefits of taking a whole systems approach to commissioning decisions. Commissioning services from providers committed to corporate social responsibility and sustainable business practices allows us to move beyond a health system that cures people reactively to one in which the health of individuals and populations is managed proactively through prevention and education. The opportunity to build sustainability principles into the culture of GP commissioning consortia upfront should be seized now to ensure the new model of commissioning endures and is fit for the future. PMID:25949650

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

    Directory of Open Access Journals (Sweden)

    Henrike Viehrig

    2008-04-01

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

  5. When Health Care Insurance Does Not Make A Difference – The Case of Health Care ‘Made in China’

    NARCIS (Netherlands)

    H.P. van Dalen (Hendrik)

    2006-01-01

    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

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

    Science.gov (United States)

    Nanda, P

    1999-08-01

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

  7. The caregiving bind: concealing the demands of informal care can undermine the caregiving identity.

    Science.gov (United States)

    Moore, Helen; Gillespie, Alex

    2014-09-01

    Disagreements and misunderstandings between informal caregivers and care-receivers have been widely reported, but the causes are unclear. The present article compares the views of people with acquired brain injury and their main informal caregivers (28 dyads, n = 56). First, we report a quantitative analysis finding that the majority of disagreements were about caregivers' identity. Caregivers saw themselves as less confident, less intelligent, more embarrassed, more independent and more overprotective than care-receivers rated them to be. Caregivers understood the care-receivers' ratings but disagreed with them' Second, we report a qualitative analysis focussing on how caregivers felt themselves to be perceived by significant others. Caregivers felt that the care-receiver, family members, the general public, health services and even friends often have negative views of them. The 'caregiving bind' is proposed as a cause of caregivers' negative identity. It arises when caregivers try to protect the care-receiver's identity by concealing the extent of informal care provision, with the unintended consequence of undermining the prospects of the caregiver receiving positive social recognition for the challenging work of caregiving. The caregiving bind has implications for therapy and points to the potential of friends and health services to provide caregivers with positive social recognition. PMID:24996218

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

    Directory of Open Access Journals (Sweden)

    Pedro Domingos Antoniolli

    2016-01-01

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

  9. Determining the effectiveness of the Delphi method for quantifying the drivers of demand for health and social care

    OpenAIRE

    Yang, He

    2013-01-01

    This paper focuses on research of the Delphi method used in the Centre for Workforce Intelligence (CfWI). In the CfWI, the Delphi method is applied to quantify the uncertainties for the future workforce demand and supply modelling in health and social care. The objective of this research is to review and assess the strengths and weaknesses of the Delphi method as applied to recent CfWI projects, and to make recommendations for improving this method. The Strategic Options Development and Analy...

  10. Parents and offspring in an evolutionary game: the effect of supply on demand when costs of care vary

    OpenAIRE

    Grodzinski, Uri; Johnstone, Rufus A

    2011-01-01

    Current models of parent–offspring communication do not explicitly predict the effect of parental food supply on offspring demand (ESD). However, existing theory is frequently interpreted as predicting a negative ESD, such that offspring beg less when parental supply is high. While empirical evidence largely supports this interpretation, several studies have identified the opposite case, with well-fed offspring begging more than those in poorer condition. Here, we show that signalling theory ...

  11. Managing Medical Costs by Reducing Demand for Services: The Missing Element in Health Care Reform.

    Science.gov (United States)

    Kelly, Edward K.; And Others

    1994-01-01

    It is argued that higher education institutions can play a major role in health care reform by providing campus cultures that foster healthy lifestyle choices and in turn reduce medical costs. Specific issues discussed include elimination of unnecessary tests, focus on special high-risk populations, and use of advance directives. (MSE)

  12. Modelling catchment areas for secondary care providers: a case study.

    Science.gov (United States)

    Jones, Simon; Wardlaw, Jessica; Crouch, Susan; Carolan, Michelle

    2011-09-01

    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

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

    Science.gov (United States)

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

    2012-12-01

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

  14. Primary care psychiatry: the case for action.

    OpenAIRE

    Shepherd, M.

    1991-01-01

    Since the introduction of the National Health Service a number of epidemiological enquiries have established the importance of mental disorders in the field of primary care. Examples are provided from the work of the General Practice Research Unit at the Institute of Psychiatry in London. The results furnish a rational basis for collaborative action between research workers, general practitioners and policy makers.

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

    Science.gov (United States)

    Kocakülâh, Mehmet C; Austill, A David

    2007-01-01

    Balanced scorecards became a popular strategic performance measurement and management tool in the 1990s by Robert Kaplan and David Norton. Mainline companies accepted balanced scorecards quickly, but health care organizations were slow to adopt them for use. A number of problems face the health care industry, including cost structure, payor limitations and constraints, and performance and quality issues that require changes in how health care organizations, both profit and nonprofit, manage operations. This article discusses balanced scorecards generally from theoretical and technical views, and why they should be used by health care organizations. The authors argue that balanced scorecards are particularly applicable to hospitals, clinics, and other health care companies. Finally, the authors perform a case study of the development, implementation, and use of balance scorecards by a regional Midwestern health care system. The positive and negative aspects of the subject's balanced scorecard are discussed. Leaders in today's health care industry are under great pressure to meet their financial goals. The industry is faced with financial pressures from consumers, insurers, and governments. Inflation in the industry is much higher than it is within the overall economy. Employers can no longer bear the burden of rising group health insurance costs for its employees. Too many large companies have used bankruptcy law as a shield to reduce or shift some of their legal obligations to provide health insurance coverage to present or retired employees. Stakeholders of health care providers are demanding greater control over costs. As the segment of un- or underinsured within the United States becomes larger as a percentage of the population, voters are seriously beginning to demand some form of national health insurance, which will drastically change the health care industry. PMID:18972988

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

    Science.gov (United States)

    Kocakülâh, Mehmet C; Austill, A David

    2007-01-01

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

  17. The Effect Of Supplemental Insurance On Health Care Demand With Multiple Information: A Latent Class Analysis

    OpenAIRE

    Dardanoni V; Li Donni P

    2009-01-01

    The Medicare program, which provides insurance coverage to the elderly in the United States, does not protect them fully against high out-of-pocket costs. For this reason private supplementary insurance, named Medigap, has been available to cover Medicare gaps. This paper studies how Medigap affects the utilization of health care services. The decision to take out supplemental insurance is likely to be infuenced by unobservable attributes such as actual risk type and insurance preferences. Em...

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

    Directory of Open Access Journals (Sweden)

    Gillian C. Scrymgeour

    2016-06-01

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

  19. Students experienced help from preservative care. A reflective case study of two nursing students caring from a nursing framework on good care for older people

    Directory of Open Access Journals (Sweden)

    Jan S. Jukema

    2015-11-01

    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

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

    Science.gov (United States)

    Ormond, Meghann

    2015-01-01

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

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

    LENUS (Irish Health Repository)

    Ryan, P

    2014-11-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

    An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy. PMID:27137415

  4. School attributes, household characteristics, and demand for schooling: A case study of rural Peru

    Science.gov (United States)

    Ilon, Lynn; Moock, Peter

    1991-12-01

    Educational expansion, long a goal of many LDCs, has become a difficult policy to pursue. Growing populations, shrinking national incomes and higher marginal costs of schooling as schooling reaches more rural dwellers have caused policy makers to take a hard look at factors which influence educational demand and expansion. This paper examines the case of Peru where rural areas have yet to attain the nearly universal enrollment of urban areas. The study examines 2500 rural households to explore reasons why children do not attend school, drop out of school, and begin school at later ages. The study finds that the monetary costs of schools (fees and other costs) have a substantial influence on parental decisions regarding school attendance and continuation. Sensitivity analysis reveals that mother's education has a bearing on their children's educational participation, particularly in low-income households. Sensitivity analysis also reveals that school attendance of low income and female children are most strongly affected by simulated changes in school fees.

  5. Integrated dementia care in The Netherlands: a multiple case study of case management programmes.

    Science.gov (United States)

    Minkman, Mirella M N; Ligthart, Suzanne A; Huijsman, Robbert

    2009-09-01

    The number of dementia patients is growing, and they require a variety of services, making integrated care essential for the ability to continue living in the community. Many healthcare systems in developed countries are exploring new approaches for delivering health and social care. The purpose of this study was to describe and analyse a new approach in extensive case management programmes concerned with long-term dementia care in The Netherlands. The focus is on the characteristics, and success and failure factors of these programmes.A multiple case study was conducted in eight regional dementia care provider networks in The Netherlands. Based on a literature study, a questionnaire was developed for the responsible managers and case managers of the eight case management programmes. During 16 semistructured face-to-face interviews with both respondent groups, a deeper insight into the dementia care programmes was provided. Project documentation for all the cases was studied. The eight programmes were developed independently to improve the quality and continuity of long-term dementia care. The programmes show overlap in terms of their vision, tasks of case managers, case management process and the participating partners in the local dementia care networks. Differences concern the targeted dementia patient groups as well as the background of the case managers and their position in the local dementia care provider network. Factors for success concern the expert knowledge of case managers, investment in a strong provider network and coherent conditions for effective inter-organizational cooperation to deliver integrated care. When explored, caregiver and patient satisfaction was high. Further research into the effects on client outcomes, service use and costs is recommended in order to further analyse the impact of this approach in long-term care. To facilitate implementation, with a focus on joint responsibilities of the involved care providers, policy

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Mehdi Alinaghian

    2014-08-01

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

  8. Improvement of energy demand forecasts using swarm intelligence: The case of Turkey with projections to 2025

    Energy Technology Data Exchange (ETDEWEB)

    Uenler, Alper [Department of Information Management Systems, KKK Per. Bsk., Yuecetepe 06100, Ankara (Turkey)

    2008-06-15

    The energy supply and demand should be closely monitored and revised the forecasts to take account of the progress of liberalization, energy efficiency improvements, structural changes in industry and other major factors. Medium and long-term forecasting of energy demand, which is based on realistic indicators, is a prerequisite to become an industrialized country and to have high living standards. Energy planning is not possible without a reasonable knowledge of past and present energy consumption and likely future demands. Energy demand management activities should bring the demand and supply closer to a perceived optimum. Turkey's energy demand has grown rapidly almost every year and is expected to continue growing. However, the energy demand forecasts prepared by the Turkey Ministry of Energy and Natural Resources overestimate the demand. Recently many studies are performed by researchers to forecast the energy demand of Turkey. Particle swarm optimization (PSO) technique has never been used for such a study. In this study a model is proposed, using PSO-based energy demand forecasting (PSOEDF), to forecast the energy demand of Turkey more efficiently. Although there are other indicators as well, gross domestic product (GDP), population, import and export are used as basic energy indicators of energy demand. In order to show the accuracy of the algorithm, a comparison is made with the ant colony optimization (ACO) energy demand estimation model which is developed for the same problem. (author)

  9. Improvement of energy demand forecasts using swarm intelligence: The case of Turkey with projections to 2025

    International Nuclear Information System (INIS)

    The energy supply and demand should be closely monitored and revised the forecasts to take account of the progress of liberalization, energy efficiency improvements, structural changes in industry and other major factors. Medium and long-term forecasting of energy demand, which is based on realistic indicators, is a prerequisite to become an industrialized country and to have high living standards. Energy planning is not possible without a reasonable knowledge of past and present energy consumption and likely future demands. Energy demand management activities should bring the demand and supply closer to a perceived optimum. Turkey's energy demand has grown rapidly almost every year and is expected to continue growing. However, the energy demand forecasts prepared by the Turkey Ministry of Energy and Natural Resources overestimate the demand. Recently many studies are performed by researchers to forecast the energy demand of Turkey. Particle swarm optimization (PSO) technique has never been used for such a study. In this study a model is proposed, using PSO-based energy demand forecasting (PSOEDF), to forecast the energy demand of Turkey more efficiently. Although there are other indicators as well, gross domestic product (GDP), population, import and export are used as basic energy indicators of energy demand. In order to show the accuracy of the algorithm, a comparison is made with the ant colony optimization (ACO) energy demand estimation model which is developed for the same problem

  10. Improvement of energy demand forecasts using swarm intelligence: The case of Turkey with projections to 2025

    Energy Technology Data Exchange (ETDEWEB)

    Unler, Alper [Department of Information Management Systems, KKK Per. Bsk., Yuecetepe 06100, Ankara (Turkey)], E-mail: aunler@kkk.tsk.mil.tr

    2008-06-15

    The energy supply and demand should be closely monitored and revised the forecasts to take account of the progress of liberalization, energy efficiency improvements, structural changes in industry and other major factors. Medium and long-term forecasting of energy demand, which is based on realistic indicators, is a prerequisite to become an industrialized country and to have high living standards. Energy planning is not possible without a reasonable knowledge of past and present energy consumption and likely future demands. Energy demand management activities should bring the demand and supply closer to a perceived optimum. Turkey's energy demand has grown rapidly almost every year and is expected to continue growing. However, the energy demand forecasts prepared by the Turkey Ministry of Energy and Natural Resources overestimate the demand. Recently many studies are performed by researchers to forecast the energy demand of Turkey. Particle swarm optimization (PSO) technique has never been used for such a study. In this study a model is proposed, using PSO-based energy demand forecasting (PSOEDF), to forecast the energy demand of Turkey more efficiently. Although there are other indicators as well, gross domestic product (GDP), population, import and export are used as basic energy indicators of energy demand. In order to show the accuracy of the algorithm, a comparison is made with the ant colony optimization (ACO) energy demand estimation model which is developed for the same problem.

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

    OpenAIRE

    Murat Yalçıntaş; Melih Bulu; Murat Küçükvar; Hamidreza Samadi

    2015-01-01

    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 ...

  12. The case against segregation in "specialized" care units.

    Science.gov (United States)

    Lines, R

    Canadian public officials are demanding that prisons segregate HIV-positive individuals and require mandatory HIV testing similar to the procedures used in correctional institutions in the United States. These measures have been consistently rejected as ineffective and punitive in Canada. The commissioner of the Correctional Service of Canada (CSC) does not consider forced testing or segregation as a useful part of their HIV/AIDS strategy. The issue raises concerns about prisoners' rights. Proponents of segregation say that creating specialized care units in some Federal institutions would guarantee state-of-the-art care; others charge that it is an admission of substandard care throughout the system. Voluntary segregation forces prisoners to choose between health care and proximity to family. It also deters voluntary testing, as some prisoners will decline testing if they do not want to be moved to another facility. Segregation stigmatizes everyone associated with an institution that has a specialized care unit. There are also problems associated with combining prisoners of varying security levels in the same unit. Compassionate release is preferable to segregation. PMID:11365291

  13. From demand side management (DSM) to energy efficiency services: A Finnish case study

    International Nuclear Information System (INIS)

    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

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

    Science.gov (United States)

    Ranger, N.; Surminski, S.

    2012-04-01

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

  15. The impact of future energy demand on renewable energy production – Case of Norway

    International Nuclear Information System (INIS)

    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

  16. Brain-oriented care in the NICU: a case study.

    Science.gov (United States)

    Bader, Lisa

    2014-01-01

    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. PMID:25161134

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

    Directory of Open Access Journals (Sweden)

    Ozayr H. Mahomed

    2016-02-01

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

  18. Integrated Care in College Health: A Case Study

    Science.gov (United States)

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

    2008-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  20. Urban water demand with fixed volumetric charging in a large municipality: the case of Brisbane, Australia

    OpenAIRE

    Hoffmann, Mark; Worthington, Andrew; Higgs, Helen

    2006-01-01

    This paper uses suburb-level quarterly data to model residential water demand in Brisbane, Australia, from 1998 to 2003. In this system, residential consumption is charged using a fixed annual service fee with no water entitlement followed by a fixed volumetric charge per kilolitre. Water demand is specified as average quarterly household water consumption and the demand characteristics include the marginal price of water, household income and size, and the number of rainy and warm days. The ...

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

    OpenAIRE

    Othman, Jamal

    2003-01-01

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

  2. Linking activity-based travel demand models and traffic assignment: A Flemish case study

    OpenAIRE

    Ramaekers, Katrien; Kochan, Bruno; BELLEMANS, Tom; JANSSENS, Davy; Wets, Geert

    2008-01-01

    A custom agent-based simulation framework is developed that combines the fields of traffic demand modeling and traffic assignment, applied to the region of Flanders (Belgium). The framework uses an activity-based approach to model traffic demand and an assignment module that is linked to the traffic demand module. Activity data for the framework is provided by a large scale survey, conducted on 2500 households in the study area. The agent-based simulation model consists of over six million ag...

  3. Modeling and Dynamical Analysis of the Water Resources Supply-Demand System: A Case Study in Haihe River Basin

    Directory of Open Access Journals (Sweden)

    Chongli Di

    2014-01-01

    Full Text Available The relationship between water resources supply and demand is very complex and exhibits nonlinear characteristics, which leads to fewer models that can adequately manage the dynamic evolution process of the water resources supply-demand system. In this paper, we propose a new four-dimensional dynamical model to simulate the internal dynamic evolution process and predict future trends of water supply and demand. At the beginning, a new four-dimensional dynamical model with uncertain parameters is established. Then, the gray code hybrid accelerating genetic algorithm (GHAGA is adopted to identify the unknown parameters of the system based on the statistic data (1998–2009. Finally, the dynamical analysis of the system is further studied by Lyapunov-exponent, phase portraits, and Lyapunov exponent theory. Numerical simulation results demonstrate that the proposed water resources supply-demand system is in a steady state and is suitable for simulating the dynamical characteristics of a complex water supply and demand system. According to the trends of the water supply and demand of several nonlinear simulation cases, the corresponding measures can be proposed to improve the steady development of the water resources supply-demand system.

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

    Directory of Open Access Journals (Sweden)

    Murat Yalçıntaş

    2015-08-01

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

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

    Science.gov (United States)

    Pommer, Wolfgang

    2008-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Wortley Pascale M

    2009-11-01

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

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

    Science.gov (United States)

    2009-01-01

    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 < 0.001). Of the 64,272 MCV4 doses administered from March-December 2005, 73% were administered June-August. Fifty-nine percent of all MPSV4 doses and 38% of all Td doses were administered during June-August. 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. PMID:19887009

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

    Science.gov (United States)

    Altringer, Beth

    2010-07-01

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

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

    Science.gov (United States)

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

    2013-03-01

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

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

    Science.gov (United States)

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

    2013-03-01

    The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance. PMID:23429226

  11. Culturally responsive middle school science: A case study of needs, demands, and challenges

    Science.gov (United States)

    Woodrow, Kelli Ellen

    2007-12-01

    Culturally responsive programming has been proposed as a remedy for the well-documented disconnect between schools and the ethnically and culturally diverse students who attend them. These programs often focus on creating instructional materials and pedagogical practices that are aligned with the knowledges, perspectives and practices of these students. This study builds on that literature and examines the needs, demands, and challenges of developing a culturally responsive health science program for ethnically and culturally diverse urban middle school students. I approached this problem through a content analysis of the intended curriculum and a microethnography of the enacted curriculum. In my analysis of the intended curriculum, I adapted a science textbook analysis instrument created by the American Association for the Advancement of Science (AAAS) to include criteria related to identified features of culturally responsive education. Using these modified analytic criteria, I found that the pilot drafts of the curricular materials excelled in the areas of engaging students in relevant phenomenon but lacked many of these specifically culturally responsive elements. Recommendations were made to redress these deficiencies. In my analysis of the enacted curriculum, I observed in five eighth grade classrooms where the program was being implemented. I used participant observation, audio and video tape recordings, artifacts, and interviews over a six-month period to investigate teacher/student interactions, the social organization of the classrooms, and students' culturally distinctive knowledge resources---or what is sometimes referred to as their "funds of knowledge." I found that the affective interactions between teachers and students were precursors to any reform, and that students and teachers similarly defined these interactions as "teacher care." In addition, I found that the social organization of the classroom often privileged official content and ways of

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

    OpenAIRE

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

    2015-01-01

    Background Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. Methods An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model...

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

    OpenAIRE

    Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, Bert

    2015-01-01

    Background Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. Methods An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model...

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

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hongwei; ZHANG Xuehua; ZHANG Baoan

    2009-01-01

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

  15. A nexus perspective on competing land demands: wider lessons from a UK policy case study

    OpenAIRE

    Sharmina, Maria; Hoolohan, Claire; Bows-Larkin, Alice; Burgess, Paul J.; Colwill, James; Gilbert, Paul; Howard, David; Knox, Jerry; Anderson, Kevin

    2016-01-01

    As nations develop policies for low-carbon transitions, conflicts with existing policies and planning tools are leading to competing demands for land and other resources. This raises fundamental questions over how multiple demands can best be managed. Taking the UK as an empirical example, this paper critiques current policies and practices to explore the interdependencies at the water-energy-food nexus. It considers how current land uses and related policies affect the UK’s resilience to cli...

  16. MICROECONOMETRIC MODELING OF HOUSEHOLD FOOD DEMAND: THE CASE OF TRANSITION BULGARIA

    OpenAIRE

    Goodwin, Barry K.; Phaneuf, Daniel J.

    2001-01-01

    Considerable optimism has been expressed about the outlook for increased exports of food products to Central and Eastern Europe. A clear understanding of the potential for increased exports to this region requires comprehension of consumers' demands for food products. This analysis resents detailed elasticity estimate for food commodities in transition Bulgaria. The analysis is conducted in two segments. The first considers demand for five aggregate food commodities---cereals, fruits and vege...

  17. DEMAND ESTIMATION IN THE PRESENCE OF AN UNOBSERVABLE PRODUCT ATTRIBUTE: THE CASE OF MINT QUALITY

    OpenAIRE

    Toro-Gonzalez, Daniel; Yan, Jia; Gallardo, Rosa Karina; McCluskey, Jill J.

    2012-01-01

    This article estimates the demand for mint-flavored gum products using grocery store sales data and accounting for consumers’ valuation of quality. Unobserved product attributes, such as flavor quality, are important elements to consider when estimating the demand for gum. The estimation results suggest that gum is an inelastic product. A positive relationship between willingness to pay and unobserved quality was identified, implying that gum industry should be able to command a premium for h...

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

    OpenAIRE

    Bjørnland, Hilde C.

    2003-01-01

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

  19. Diagnosis of penile fracture in primary care: a case report

    OpenAIRE

    Ozcan, Sevgi; Akpinar, Ersin

    2009-01-01

    Introduction Penile fracture has been reported with sexual intercourse, masturbation, rolling over or falling on to the erect penis. Classically the history is with a sudden snap, pain, detumescence and a hematoma of the penis with deformity. Immediate surgical treatment is recommended. The patients may delay the admission due to fear and embarrassment or the condition may usually be underreported. Case presentation A 32-year-old man presented to primary care complaining of discoloration of p...

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

    Science.gov (United States)

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

    1992-01-01

    Less money spent on health services, cost-effectiveness, better productivity and more efficiency are some of the driving forces of contemporary "neo-liberalism" and political trends. How can nursing services and the profession's human values adapt in this difficult context? The authors describe the newest modality of patient care delivery system: nursing case management. They examine the factors and assumptions that led up to its development and point out the validity of asking some serious questions before embarking on the euphoria of case management. PMID:1291932

  1. 2009 reference case scenario : Canadian energy demand and supply to 2020 : an energy market assessment

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-07-01

    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.

  2. Demand for road-fuel in a small developing economy: The case of Sri Lanka

    Energy Technology Data Exchange (ETDEWEB)

    Chandrasiri, Sunil [Department of Economics, University of Colombo, P.O. Box. 1490, Colombo 3 (Sri Lanka)]. E-mail: sunilch@sltnet.lk

    2006-09-15

    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.

  3. Demand for road-fuel in a small developing economy: The case of Sri Lanka

    International Nuclear Information System (INIS)

    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

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

    NARCIS (Netherlands)

    Hutschemaekers, Giel J.M.; Tiemens, Bea G.; Winter, M. de

    2007-01-01

    Purpose Description and analysis of the effects and side-effects of integrated mental health care in the Netherlands. Context of case Due to a number of large-scale mergers, Dutch mental health care has become an illustration of integration and coherence of care services. This process of integrati

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

    DEFF Research Database (Denmark)

    Nicolaisen, Morten Skou; Næss, Petter

    study of 35 road projects in Denmark and the United Kingdom. The sample is based on road projects for which traffic impact studies have been prepared for the no-build alternative, but where the projects had not yet been built at the time of the forecast target year. Data sources for expected travel...... underestimation of travel demand observed in previous studies of build alternatives. These results indicate that the problem of systematic biases in travel demand forecasts for road projects have more problematic implications than previously assumed. The effect inflates rather than diminishes the problem...

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

    Science.gov (United States)

    Carbajales, Alejandro Ramos; Curti, Dardo

    2010-01-01

    Uruguay, a country with a solid tobacco control policy since 2005 shows, contrary to expectations, an insignificant decrease in total tobacco products' sales in the last five years. The hypothesis is that on one side, changes in household income and the income elasticity of the demand for cigarettes were important countervailing factors in the demand of both products. The period 2005-2009 shows a large increase of 36% in household real income in Uruguay due to fast economic recovery after the 2002 crisis. The second factor is the interchangeability of roll your own and cigarettes and the impact on the demand of each product as a reaction to tax and price changes. The tax and price of roll your own tobacco remains substantially lower than that of cigarettes. This fact, and the increased substitution of roll your own for cigarettes seems to be the main reasons for the low impact of the policy of tobacco tax and price increases. This paper then consists of a revision of a 2004 study to estimate separate demands for both main tobacco products and obtain estimates for own price, cross price and income elasticities. Then, a simulation study was performed using the elasticities found and two scenarios of increases in household income: moderate (2.5% per year) and high (5% per year) confirming that countries where income is growing fast and with a potential for substitution towards cheaper products require substantial cigarette tax and price increases for a fiscal tobacco control policy to become effective. PMID:21243189

  7. Modeling of gas demand using degree-day concept: case study for Ankara

    International Nuclear Information System (INIS)

    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)

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

    Directory of Open Access Journals (Sweden)

    Giel J.M. Hutschemaekers

    2007-08-01

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

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

    Science.gov (United States)

    Makoka, Donald; Kaluwa, Ben; Kambewa, Patrick

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

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

    Directory of Open Access Journals (Sweden)

    Nuno Carlos LEITÃO

    2010-03-01

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

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

    OpenAIRE

    Shaopeng Zhong; Lihui Zhang; Max Bushell

    2013-01-01

    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 impo...

  12. Estimating demand in search markets: the case of online hotel bookings

    OpenAIRE

    Koulayev, Sergei

    2009-01-01

    In this paper, we emphasize that choice sets generated by a search process have two properties: first, they are limited; second, they are endogenous to preferences. Both factors lead to biased estimates in a static demand framework that takes choice sets as given. To correct for this bias, we estimate a structural model of search for differentiated products, using a unique dataset of consumer online search for hotels. Within a nested logit utility model, we show that the mean utility function...

  13. Implementing Innovation in Planning Practice: The Case of Travel Demand Forecasting

    OpenAIRE

    Newmark, Gregory Louis

    2011-01-01

    Travel demand modeling is a core technology of transportation planning and has been so for half a century. This technology refers to the structured use of mathematical formulae and spatial data to forecast the likely travel impacts of possible transportation, land use, and demographic scenarios. Although this planning practice is pervasive, critics have long argued that is has been resistant to innovation. As the policy scenarios explored through modeling become increasingly complex, parti...

  14. Opportunities for Western Food Products in China: The Case of Orange Juice Demand

    OpenAIRE

    Chen, Xuqi; Gao, Zhifeng; House, Lisa

    2013-01-01

    The rapid income per capita of Chinese consumers and increasing demand for nearly all agricultural products have attracted western food industries to focus on this booming and huge market. This research investigated the perspectives of western food products in China's market, with focus on one representative western food-orange juice, by studying the Chinese consumer knowledge, perceptions, and willingness to pay (WTP) for different types of orange juice products. Though the Chinese consumers...

  15. Building energy demand aggregation and simulation tools:a Danish case study

    OpenAIRE

    GIANNIOU, Panagiota; Heller, Alfred; Rode, Carsten

    2015-01-01

    Nowadays, the minimization of energy consumption and the optimization of efficiency of the overall energy grid have been in the agenda of most national and international energy policies. At the same time, urbanization has put cities under the microscope towards achieving cost-effective energy savings due to their compact and highly dense form. Thus, accurate estimation of energy demand of cities is of high importance to policy-makers and energy planners. This calls for automated methods that ...

  16. The role of income in money demand during hyper-inflation: the case of Yugoslavia

    OpenAIRE

    Mladenović, Zorica; Nielsen, Bent

    2009-01-01

    During extreme hyper-inflations productivity tends to fall dramatically. Yet, in models of money demand in hyper-inflation variables such as real income has been given a somewhat passive role, either assuming it exogenous or to have a negligible role. In this paper we use an empirical methodology based on cointegrated vector autoregressions to analyse data from the extreme Yugoslavian episode to investigate the role of income. The analysis suggests that even in extreme hyper-in...

  17. The role of income in money demand during hyper-inflation: the case of Yugoslavia.

    OpenAIRE

    Mladenović, Zorica; Nielsen, Bent

    2009-01-01

    During extreme hyper-inflations productivity tends to fall dramatically. Yet, in models of money demand in hyper-inflation variables such as real income has been given a somewhat passive role, either assuming it exogenous or to have a negligible role. In this paper we use an empirical methodology based on cointegrated vector autoregressions to analyse data from the extreme Yugoslavian episode to investigate the role of income. The analysis suggests that even in extreme hyper-in...

  18. Anticipated Inflation, Real Disturbances and Money Demand: The Case of Chinese Hyperinflation, 1946-49

    OpenAIRE

    Tallman, Ellis W; De-piao Tang; Ping Wang

    2001-01-01

    This paper re-examines the dynamics of hyperinflation extending the standard Cagan framework. In our theoretical model, we allow the relative price of capital goods in units of consumption goods to vary in order to examine interactions between the real and monetary sectors. The theory generates empirically testable implications that suggest expanding the standard Caganian money demand function to include both anticipated inflation and relative price effects in a nonlinear fashion. Employing d...

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

    Energy Technology Data Exchange (ETDEWEB)

    1993-06-01

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

  20. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    OpenAIRE

    Phillips, Charles D

    2015-01-01

    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...

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

    Directory of Open Access Journals (Sweden)

    Muhammad Tahir Khalily

    2011-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Muhammad Tahir Khalily

    2011-10-01

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

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

    NARCIS (Netherlands)

    Ormond, M.E.

    2015-01-01

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

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

    Science.gov (United States)

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

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Sach Tracey H

    2008-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Javad Nematian

    2015-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Tak Cheung CHAN

    2009-02-01

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

  8. Cost-efficient demand-pull policies for multi-purpose technologies – The case of stationary electricity storage

    International Nuclear Information System (INIS)

    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

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

    Directory of Open Access Journals (Sweden)

    Mehmet KAÇAR

    2014-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Shaopeng Zhong

    2013-01-01

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

  11. 25 CFR 20.506 - What information is required in the foster care case file?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false What information is required in the foster care case file... FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.506 What information is required in the foster care case file? At a minimum the following information is required: (a)...

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

    Science.gov (United States)

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

    2014-03-01

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

  13. Anaphylaxis cases presenting to primary care paramedics in Quebec.

    Science.gov (United States)

    Kimchi, Nofar; Clarke, Ann; Moisan, Jocelyn; Lachaine, Colette; La Vieille, Sebastien; Asai, Yuka; Joseph, Lawrence; Mill, Chris; Ben-Shoshan, Moshe

    2015-12-01

    Data on anaphylaxis cases in pre-hospital settings is limited. As part of the Cross Canada Anaphylaxis Registry (C-CARE), we assessed anaphylaxis cases managed by paramedics in Outaouais, Quebec. A software program was developed to prospectively record demographic and clinical characteristics as well as management of cases meeting the definition of the anaphylaxis. Univariate and multivariate logistic regressions were compared to assess factors associated with severity of reactions and epinephrine use. Among 33,788 ambulance calls of which 23,486 required transport, 104 anaphylaxis cases were identified (anaphylaxis rate of 0.31% [95%CI, 0.25%, 0.37%] among all ambulance calls and 0.44% [95%CI, 0.36%, 0.54%] among those requiring transport). The median age was 46.8 years and 41.3% were males. The common triggers included food (32.7% [95%CI, 24.0%, 42.7%]), drugs (24.0% [16.4%, 33.6%]), and venom (17.3% [10.8%, 26.2%]). Among all reactions, 37.5% (95%CI, 28.4%, 47.6%) were severe. Epinephrine was not administered in 35.6% (95%CI, 26.6%, 45.6%) of all cases. Males were more likely to have severe reactions (Odds ratio [OR]: 2.50 [95%CI, 1.03, 6.01]). Venom-induced reactions and severe anaphylaxis were more likely to be managed with epinephrine (OR: 6.9 [95%CI, 1.3, 35.3] and 4.2 [95%CI, 1.5, 12.0], respectively). This is the first prospective study evaluating anaphylaxis managed by paramedics. Anaphylaxis accounts for a substantial proportion of the cases managed by paramedics in Outaouais, Quebec and exceeds prior reports of the proportion of Quebec emergency room visits attributed to anaphylaxis. Although guidelines recommend prompt use of epinephrine for all cases of anaphylaxis, more than a third of cases did not receive epinephrine. It is crucial to develop educational programs targeting paramedics to promote the use of epinephrine in all cases of anaphylaxis regardless of the specific trigger. PMID:26734462

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

    Directory of Open Access Journals (Sweden)

    Ivanov Mile

    2015-03-01

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

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

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    Rehan Ali

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Imre M. Jánosi

    2009-09-01

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

  17. Contrasting electricity demand with wind power supply: case study in Hungary

    International Nuclear Information System (INIS)

    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)

  18. Contrasting electricity demand with wind power supply: case study in Hungary

    Energy Technology Data Exchange (ETDEWEB)

    Kiss, P.; Janosi, I. M. [Department of Physics of Complex Systems, Lorand Eotvos University, Pazmany P. s. 1/A, H-1117 Budapest (Hungary); Varga, L. [E.ON Hungaria Ltd., Roosevelt ter 7-8, H-1051 Budapest (Hungary)

    2009-07-01

    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)

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

    Science.gov (United States)

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

    2016-08-01

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

  20. Co-Adapting Water Demand and Supply to Changing Climate in Agricultural Water Systems, A Case Study in Northern Italy

    Science.gov (United States)

    Giuliani, M.; Li, Y.; Mainardi, M.; Arias Munoz, C.; Castelletti, A.; Gandolfi, C.

    2013-12-01

    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

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

    Directory of Open Access Journals (Sweden)

    Bloom Judy

    2012-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Constantin Bob

    2008-03-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  4. A Dynamic Interactive Social Chart in Dementia CareAttuning Demand and Supply in the Care for Persons with Dementia and their Carers.

    Science.gov (United States)

    Dröes, R M; Meiland, F J M; Doruff, C; Varodi, I; Akkermans, H; Baida, Z; Faber, E; Haaker, T; Moelaert, F; Kartseva, V; Tan, Y H

    2005-01-01

    We-centric services may play an important role in the field of care and support for elderly persons with dementia and their carers. They may solve problems, such as fragmentation of care, gaps in the continuum of care and welfare services, and inefficient and uncustomized service delivery to patients and carers. In the FRUX Health Care pilot opportunities for we-centric, context-sensitive service bundles in the field of dementia care will be explored. The service on which we focus in this paper is a dynamic interactive social chart for dementia care (DEM-DISC). The feasibility of DEM-DISC will be investigated from a domain specific content perspective (needs, offerings, information and advice), an ICT perspective (ontology and application), a user perspective (persons with dementia, their carers and professionals/organizations), and an organisational perspective (necessary collaboration, governance and control, business modelling). A first demonstrator (validator) of the DEM-DISC will be designed, built and evaluated. Future possibilities to connect DEM-DISC to actual service delivery will be explored. In this paper we discuss the most important research questions from the different perspectives and the methods used to answer them. PMID:15923777

  5. Demand and Supply Trends and Construction Industry Development: A Case Study in the Sri Lankan Construction Industry

    Directory of Open Access Journals (Sweden)

    Citra Weddikkara

    2001-09-01

    Full Text Available The construction sectors in the developing countries (DCs have recently demonstratednumerous trends towards globalisation, raising considerable concern in the field.However, the nature of the effect of demand on supply characteristics of the domesticindustry has not been sufficiently discussed with respect to what development measuresare needed in the context of constraints that originate locally to accommodate the globaltrends in DCs. This paper therefore analyses reasons for these trends and attempts toidentify the necessary industry developments to benefit from them locally. For thispurpose, the Sri Lankan construction industry has been taken as a case study and ademand and supply framework is being used to analyse the case. The analysis revealsthat while government policies contribute intrusively in stimulating demand side trends,the role of the contracting firms together with project delivery process and projectprocurement process are also subject to change as a result of these demanddeterminants. In this context, the main focus is concentrated on corporatedevelopments, while wider industry development is also necessary to support them. Asa consequence, both institutional reforms and capacity building are required to enhancefirms’ technological and managerial capacity. The necessity for these developmentmeasures reflects in partly the underdeveloped framework of the construction industry inDCs. Nevertheless, they could still foster indigenous construction capacity within thecontext of global trends.91

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

    Directory of Open Access Journals (Sweden)

    Sina Waibel

    2015-07-01

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

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

    Science.gov (United States)

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

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

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

    Science.gov (United States)

    Culhane, Thomas Henry

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

  9. Interactive Energy Demand Analysis: A Case Study of Shanxi Province, PRC

    OpenAIRE

    Vallance, B.; Weigkricht, E.

    1988-01-01

    Within the framework of collaboration between IIASA's Advanced Computer Applications project (ACA) and the State Science and Technology Commission of the People's Republic of China (SSTCC), ACA has developed an integrated set of information and decision support system for development planning in China. The system is implemented for a case study of Shanxi, a province in north central China, which is very rich in coal and several mineral resources, but is still at an early stage of development,...

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

    Science.gov (United States)

    MacRae, Nancy; Strout, Kelley

    2015-01-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    BACKGROUND: Case management (CM) models based on experienced nurses are increasingly used to improve coordination and continuity of care for patients with complex health care needs. Anyway, little is known about the effects of hospital-based CM in cancer care.Aim.To analyse the effects of hospital...

  12. Is there a demand for physical activity interventions provided by the health care sector? Findings from a population survey

    Directory of Open Access Journals (Sweden)

    Walter Lars

    2010-01-01

    Full Text Available Abstract Background Health care providers in many countries have delivered interventions to improve physical activity levels among their patients. Thus far, less is known about the population's interest to increase their physical activity levels and their opinion about the health care provider's role in physical activity promotion. The aims of this paper were to investigate the self-reported physical activity levels of the population and intention to increase physical activity levels, self-perceived need for support, and opinions about the responsibilities of both individuals and health care providers to promote physical activity. Methods A regional public health survey was mailed to 13 440 adults (aged 18-84 years living in Östergötland County (Sweden in 2006. The survey was part of the regular effort by the regional Health Authorities. Results About 25% of the population was categorised as physically active, 38% as moderately active, 27% as somewhat active, and 11% as low active. More than one-third (37% had no intentions to increase their physical activity levels, 36% had thought about change, while 27% were determined to change. Lower intention to change was mainly associated with increased age and lower education levels. 28% answered that physical activity was the most important health-related behaviour to change "right now" and 15% of those answered that they wanted or needed support to make this change. Of respondents who might be assumed to be in greatest need of increased activity (i.e. respondents reporting poor general health, BMI>30, and inactivity more than one-quarter wanted support to make improvements to their health. About half of the respondents who wanted support to increase their physical activity levels listed health care providers as a primary source for support. Conclusions These findings suggest that there is considerable need for physical activity interventions in this population. Adults feel great responsibility for

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

    Science.gov (United States)

    Serefoglu, E C

    2016-02-01

    Premature ejaculation (PE) is considered to be the most common form of male sexual dysfunction. Given that acute oral administration of d-isomer of modafinil (d-modafinil) can extend the latency to ejaculation in rats without suppressing sexual behaviour, the effects of on-demand d-modafinil treatment were examined on a 30-year-old male patient with lifelong PE. The patient was instructed to take d-modafinil 100 mg 3 h prior to the sexual relation for four times and was invited for a control visit. The patient was re-evaluated 2 weeks later. He reported that his IELT increased to 15 min. He reported heartburn and insomnia when he used d-modafinil for the first time; however, these symptoms were transient and did not recur after the initial dose. Overall, he reported considerable improvement and noted that he feels much better with the treatment. Based on this limited data, on-demand d-modafinil seems to be an effective treatment for men with lifelong PE. The side effects were transient and mild in the reported case. Further randomised clinical trials are necessary to elucidate the therapeutic concept of this drug in patients with lifelong PE. PMID:25735219

  14. Technology and Logistics in Health Care Services : A Case Study of Länssjukhuset Ryhov

    OpenAIRE

    Tolic, Biljana; Hanaeus, Amanda

    2015-01-01

    Background: Swedish hospitals face intensified challenges due to elevated demands from patients, demographic changes and cost constraints. Furthermore, patient safety is negatively affected by the relatively high rate of health care associated infections (HAIs). Thus, enforced preventive measures have to be undertaken to improve medical institutions’ ability to provide a qualitative and safe health care. Hence, logistics and technology solutions are gaining presence in modern day medical inst...

  15. Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study

    Directory of Open Access Journals (Sweden)

    Jigeeshu V Divatia

    2016-01-01

    Full Text Available Aims: To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs. Patients and Methods: 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. Results: 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. Conclusions: 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.

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

    Directory of Open Access Journals (Sweden)

    Yusuke Kishita

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Gray Leonard C

    2012-03-01

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

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

    OpenAIRE

    Sach Tracey H; Whynes David K; Yu Chai

    2008-01-01

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

  19. Reforming health care : a case for stay well health insurance

    OpenAIRE

    Bogetic, Zeljko; Heffley, Dennis

    1993-01-01

    All countries - whether industrial, developing, or in transition to a market economy - are interested in health care reform. A central focus of reform everywhere is to make patients more responsive to health care costs without diluting the protection offered by public or private insurance. Conventional insurance offers customers little incentive to monitor their own use of health care services or to adopt and maintain better health habits. The authors describe an alternative health insurance ...

  20. Nurse Practitioner Mental Health Care in the Primary Context: A Californian Case Study

    Directory of Open Access Journals (Sweden)

    Theane Theophilos

    2015-03-01

    Full Text Available In America, mental health needs surpass the availability of specialized providers. This vulnerable population also has other obstacles for comprehensive care including gaps in medical coverage, stigma, economic barriers, and a geographical mal‑distribution of qualified mental health professionals. A wide availability of primary care providers, including primary care and family nurse practitioners, are well-positioned to deliver integrated mental and physical health care. A case study from a Southern California Coachella Valley primary care clinic with integrated services is used to demonstrate the much-needed approach of care to address health disparities that face low‑income immigrants, migrant workers, and others without access to specialized care centers and providers. It is argued that mental health care should be part of all holistic treatment provided by primary care and family nurse practitioners. This has implications for curricula and practice development.

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

    Directory of Open Access Journals (Sweden)

    Di Duro Joseph O

    2006-01-01

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

  2. Labour supply in the home care industry: A case study in a Dutch region.

    Science.gov (United States)

    Breedveld, Elly J; Meijboom, Bert R; de Roo, Aad A

    2006-04-01

    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. PMID:16011857

  3. Palliative care communication curriculum: what can students learn from an unfolding case?

    Science.gov (United States)

    Goldsmith, Joy; Wittenberg-Lyles, Elaine; Shaunfield, Sara; Sanchez-Reilly, Sandra

    2011-06-01

    Limited attention to palliative care communication training is offered to medical students. In this work, we pursued unfolding case responses and what they indicated about student tendencies to use palliative care communication as well as what medical students can learn from their own reflective practice about palliative care. Findings showed an overwhelming trend for students to avoid palliative care communication or inclusion of topics including advance directives, place of care, family support, and dying. Instead, students relied heavily on the SPIKES protocol, communication that was strategically vague and ambiguous, and discussions that centered on specialty care and referral. In reflecting on their own case study responses, students noted an absence of direct communication about prognosis, no coordination of care, late hospice entry, and patient pain resulting from communication inefficacies. Future research should focus on the development of formal and adaptive curriculum structures to address these communication needs. PMID:21071434

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

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, Daniel; Goli, Sasank; Faulkner, David; McKane, Aimee

    2012-12-20

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

  5. Care in Family Relations : The Case of Surrogacy Leave

    NARCIS (Netherlands)

    Burri, Susanne

    2015-01-01

    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 cas

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

    Science.gov (United States)

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

    1985-01-01

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

  7. Managed care and medical education: hard cases and hard choices.

    Science.gov (United States)

    Friedman, E

    1997-05-01

    As managed care becomes more and more dominant in U.S. health care, it is coming into conflict with medical education. There are historical reasons for this: medical education traditionally excluded physicians who chose to work in health plans, and for profit managed care has tended to avoid subsidizing medical education. In order to improve the climate, three changes are necessary: medical education must understand the tense history of discord between the two; distinctions must be made between responsible and irresponsible managed care plans; and medical educators should not assume they own the moral high ground. Arrogance, a gross oversupply of physicians and especially specialists, scandals and fraud, an often callous attitude toward the poor, and other sins can be laid at medical education's door. The worse threat for both sides is that the public and payers could simply abandon both, leading to underfunding for health professions education, a society that does not trust its health care system, and the loss of superb teaching organizations. To prevent this, managed care and medical education should work together to solve several difficult problems: how to shrink the medical education infrastructure; how to report honestly the uses to which medical education funds are put; and how to identify and end irresponsible behavior on the part of health plans and medical education entities alike. If the two sides can exercise leadership in these areas, they will be able to protect and enhance the singular place of honor that medical education holds in this society. PMID:9159575

  8. Expanding access to primary care without additional budgets? A case study from Burkina Faso.

    Science.gov (United States)

    Marschall, Paul; Flessa, Steffen

    2008-11-01

    The aim of this study is to demonstrate the impact of increased access to primary care on provider costs in the rural health district of Nouna, Burkina Faso. This study question is crucial for health care planning in this district, as other research work shows that the population has a higher need for health care services. From a public health perspective, an increase of utilisation of first-line health facilities would be necessary. However, the governmental budget that is needed to finance improved access was not known. The study is based on data of 2004 of a comprehensive provider cost information system. This database provides us with the actual costs of each primary health care facility (Centre de Santé et de Promotion Sociale, CSPS) in the health district. We determine the fixed and variable costs of each institution and calculate the average cost per service unit rendered in 2004. Based on the cost structure of each CSPS, we calculate the total costs if the demand for health care services increased. We conclude that the total provider costs of primary care (and therefore the governmental budget) would hardly rise if the coverage of the population were increased. This is mainly due to the fact that the highest variable costs are drugs, which are fully paid for by the customers (Bamako Initiative). The majority of other costs are fixed. Consequently, health care reforms that improve access to health care institutions must not fear dramatically increasing the costs of health care services. PMID:18197447

  9. Estimating the net electricity energy generation and demand using the ant colony optimization approach: Case of Turkey

    International Nuclear Information System (INIS)

    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 (linearACOEEGE and linear ACOEEDE) and quadratic energy generation and demand (quadraticACOEEGE 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

  10. Estimating the net electricity energy generation and demand using the ant colony optimization approach. Case of Turkey

    Energy Technology Data Exchange (ETDEWEB)

    Toksari, M. Duran [Engineering Faculty, Industrial Engineering Department, Erciyes University, 38039 Kayseri (Turkey)

    2009-03-15

    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{sub A}COEEGE and linear ACOEEDE) and quadratic energy generation and demand (quadratic{sub 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)

  11. Estimating the net electricity energy generation and demand using the ant colony optimization approach: Case of Turkey

    Energy Technology Data Exchange (ETDEWEB)

    Toksari, M. Duran [Engineering Faculty, Industrial Engineering Department, Erciyes University, 38039 Kayseri (Turkey)], E-mail: dtoksari@erciyes.edu.tr

    2009-03-15

    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{sub A}COEEGE and linear ACOEEDE) and quadratic energy generation and demand (quadratic{sub 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.

  12. Some new evidence on the determinants of money demand in developing countries – A case study of Tunisia

    OpenAIRE

    Ben Salha, Ousama; Jaidi, Zied

    2013-01-01

    The present paper aims at examining the money demand function in Tunisia during the period 1981-2011. Unlike previous conventional money demand studies, the major components of real income are considered in this paper. Using the ARDL bounds testing approach, results reveal evidence of cointegration between broad money demand and its determinants, namely final consumption expenditure, expenditure on investment goods, export expenditure and interest rate. In the long-run, final consumption expe...

  13. Factor Input Demand Subject to Economic and Environmental Risk: The Case of Nitrogen Fertilizer in Corn Production

    OpenAIRE

    Carriker, Gordon L.

    1993-01-01

    Nitrogen (N) fertilizer demand in relation to economic and environmental risks associated with N-fertilizer management are examined. Both nominal and environmental damage-adjusted net returns distributions are evaluated using stochastic dominance analysis. Results suggest that, in the absence of environmental risk, N demand becomes more elastic as farmers become more risk averse. When environmental risk is introduced to the decision-making process, N demand becomes even more elastic.

  14. Energy Demand

    NARCIS (Netherlands)

    Stehfest, E. et al.

    2014-01-01

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

  15. Energy Demand

    OpenAIRE

    Stehfest, E. et al.

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Masoud Kianpour

    2013-02-01

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

  17. Why caretakers bypass Primary Health Care facilities for child care - a case from rural Tanzania

    Directory of Open Access Journals (Sweden)

    Kahabuka Catherine

    2011-11-01

    Full Text Available Abstract Background Research on health care utilization in low income countries suggests that patients frequently bypass PHC facilities in favour of higher-level hospitals - despite substantial additional time and financial costs. There are limited number of studies focusing on user's experiences at such facilities and reasons for bypassing them. This study aimed to identify factors associated with bypassing PHC facilities among caretakers seeking care for their underfive children and to explore experiences at such facilities among those who utilize them. Methods The study employed a mixed-method approach consisting of an interviewer administered questionnaires and in-depth interviews among selected care-takers seeking care for their underfive children at Korogwe and Muheza district hospitals in north-eastern Tanzania. Results The questionnaire survey included 560 caretakers. Of these 30 in-depth interviews were conducted. Fifty nine percent (206/348 of caretakers had not utilized their nearer PHC facilities during the index child's sickness episode. The reasons given for bypassing PHC facilities were lack of possibilities for diagnostic facilities (42.2%, lack of drugs (15.5%, closed health facility (10.2%, poor services (9.7% and lack of skilled health workers (3.4%. In a regression model, the frequency of bypassing a PHC facility for child care increased significantly with decreasing travel time to the district hospital, shorter duration of symptoms and low disease severity. Findings from the in-depth interviews revealed how the lack of quality services at PHC facilities caused delays in accessing appropriate care and how the experiences of inadequate care caused users to lose trust in them. Conclusion The observation that people are willing to travel long distances to get better quality services calls for health policies that prioritize quality of care before quantity. In a situation with limited resources, utilizing available resources to

  18. Why caretakers bypass Primary Health Care facilities for child care - a case from rural Tanzania

    OpenAIRE

    Kahabuka Catherine; Kvåle Gunnar; Moland Karen; Hinderaker Sven

    2011-01-01

    Abstract Background Research on health care utilization in low income countries suggests that patients frequently bypass PHC facilities in favour of higher-level hospitals - despite substantial additional time and financial costs. There are limited number of studies focusing on user's experiences at such facilities and reasons for bypassing them. This study aimed to identify factors associated with bypassing PHC facilities among caretakers seeking care for their underfive children and to expl...

  19. February 2016 critical care case of the month

    Directory of Open Access Journals (Sweden)

    Stewart TM

    2016-02-01

    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. ...

  20. Economic evaluation in primary health care: the case of Western Kenya community based health care project.

    Science.gov (United States)

    Wang'ombe, J K

    1984-01-01

    This paper describes the methodology and presents preliminary results of an economic appraisal of a community based health care project in Kenya. Community health workers, trained for 12 weeks and deployed in two locations in Kenya's Western Province, act as first contact providers of basic health care and promoters of selected health, sanitation and nutrition practices. A Cost Benefit Analysis has been undertaken using the Willingness to Pay approach to compare the costs of the project and its benefits. The benefits are in the form of more easily accessible basic health care and are measured as consumer surplus accruing to the community. Gain in consumer surplus is consequent on the fall of average user costs and rise in utilisation of the project established points of first contact with primary health care. The argument for the economic viability of the project is validated by the large Net Present Value and Benefit Cost Ratio obtained for the whole of the project area and for the two locations separately. Although the evaluation technique used faces the problem of valuation of community time, aggregation of health care services at all points of first contact and the partial nature of cost benefit analysis evaluations, the results are strongly in favour of decentralisation of primary health care on similar lines in the rest of the country. PMID:6427933

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  2. 45 CFR 302.52 - Distribution of support collected in Title IV-E foster care maintenance cases.

    Science.gov (United States)

    2010-10-01

    ... foster care maintenance cases. 302.52 Section 302.52 Public Welfare Regulations Relating to Public... Distribution of support collected in Title IV-E foster care maintenance cases. Effective October 1, 1984, the... collected in foster care maintenance cases shall be treated in accordance with the provisions of §...

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

    Directory of Open Access Journals (Sweden)

    Ljupko Šimunović

    2013-03-01

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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

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

    Science.gov (United States)

    Rico, Rachelle G.

    2009-01-01

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

  6. Neonatal Intensive Care for Low Birthweight Infants: Costs and Effectiveness. Health Technology Case Study 38.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Office of Technology Assessment.

    After a brief introduction delineating the scope of the case study, chapter 1 summarizes findings and conclusions about the costs and effectiveness of neonatal intensive care in the United States. Chapter 2 inventories the national supply of neonatal intensive care units and describes recent trends in use and costs. Chapter 3 reviews mortality and…

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    O’Connell Kathryn A

    2012-10-01

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

  9. Clean air renewable energy (CARE) coalition : a case study

    International Nuclear Information System (INIS)

    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

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

    Institute of Scientific and Technical Information of China (English)

    余学红

    2016-01-01

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

  11. 35 cases ventilator-associated pneumonia of prevention and care measures

    Institute of Scientific and Technical Information of China (English)

    杨文斌

    2014-01-01

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

  12. Obtaining a critical care pharmacist position: a marketing case study.

    Science.gov (United States)

    Stratton, T P; Wu, B; Nakagawa, R S

    1993-06-01

    Marketing theory is used to explain how Pharmacy Department managers at a Vancouver-area hospital secured a new ICU pharmacist position in a period of severe fiscal constraint. Market segmentation, target marketing and pull marketing strategy were combined to obtain support for the new position. Improved drug information services for ICU nurses were promoted to Nursing Administration and enhanced pharmacotherapy monitoring was promoted to the two critical care physicians primarily responsible for patient care in the ICU. These physicians and Nursing Administration voiced their support for the new position to the V.P. of Nursing (the functional officer for Pharmacy), who then promoted the new position to Hospital Administration. A half-time DUR commitment by the ICU pharmacist was offered to Hospital Administration, expanding this already successful service and guaranteeing cost recovery for the new position. Hospital Administration approved the new ICU clinical pharmacist position in a budget which saw other hospital departments lose several positions. PMID:10126865

  13. Intrathecal analgesia and palliative care: A case study

    Directory of Open Access Journals (Sweden)

    Naveen S Salins

    2010-01-01

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

  14. Pattern of Care Before Presentation Among the Psychiatric Emergency Cases at a Tertiary Health Care Center in Nigeria

    Science.gov (United States)

    Aina, Israel Odunmayowa; Otakpor, Alex Ndubisi; Israel-Aina, Yetunde Tinuola

    2016-01-01

    Objective: To determine the pattern of care sought in cases of psychiatric emergency before presentation to a tertiary health care center. Method: Consecutive recruitment of 180 emergency psychiatric cases, which comprised a total of 156 patients, presenting to the accident and emergency unit of the University of Benin Teaching Hospital (UBTH), Edo State, Nigeria, was conducted from June 2008 to January 2009. A structured instrument was used to gather the patients’ information including their sociodemographic characteristics, their care before presentation, and the relations accompanying them to the hospital. Results: The mean ± SD patient age was 33.82 ± 12.64 years, with an age range of 18–73 years and a modal age of 23 years. The male to female ratio was 1:1.05. Of the patients, 121 (77.6%) were not married, while 35 (22.4%) were married. Most identified as Christian (96.2%). The majority of the patients (70.0%) presented to the hospital through self-referral. Eighty (44.4%) of the patients had not sought any treatment before coming to UBTH. Forty-seven patients (26.1%) had sought care in churches, 39 (21.7%) had sought treatment in other hospitals, and 12 (6.7%) had sought traditional care before presenting to UBTH. Seventy-four patients (41.1%) were accompanied by parents and 44 (24.4%) were accompanied by siblings, while the spouse accompanied 23 (12.8%) patients. Conclusions: Most patients with psychiatric emergencies at UBTH prefer to present directly to the tertiary health care center in Benin City, and they are usually supported by their immediate family members. PMID:27486541

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

    Institute of Scientific and Technical Information of China (English)

    张宇平; 诸海燕; 马红丽

    2016-01-01

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

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

    Science.gov (United States)

    Jones, Sarahjane

    2015-12-01

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

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

    Science.gov (United States)

    Jones, Sarahjane

    2015-12-01

    Perceptions on safety in community care have been relatively unexplored. A project that sought to understand the multiple perspectives on safety in the NHS case-management programme was carried out in relation to the structure, process, and outcome of care. This article presents a component of the nursing perspective that highlights an important element in the structure of nursing care that could potentially impede the nurses' ability to be fully effective and safe. A single case study of the case-management programme was undertaken. Three primary care organisations from three strategic health authorities participated, and three focus groups were conducted (one within each organisation). In total, 17 case management nurses participated. Data were audiotaped and transcribed verbatim and subjected to framework analysis. Nursing staff attitudes were identified as a structure of care that influence safety outcomes, particularly their perceptions of the care setting and the implications it has on their role and patient behaviour. Greater understanding of the expected role of the community nurse is necessary, and relevant training is required for nurses to be successful in empowering patients to perform more safely. In addition, efforts need to be made to improve patients' trust in the health-care system to prevent harm and promote more effective utilisation of resources. PMID:26636894

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

    Science.gov (United States)

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

    2014-01-01

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

  19. EFFECT OF GENERIC ADVERTISING ON THE DEMAND FOR FLUID MILK: THE CASE OF THE TEXAS MARKET ORDER

    OpenAIRE

    Capps, Oral, Jr.; Schmitz, John D.

    1991-01-01

    This analysis indicates that generic advertising expenditures, ceteris paribus, generated rightward shifts in demand for fluid milk in the Texas Market Order over the period January 1980 to September 1988. Generally, the results from this study are in agreement with previous research efforts which suggest that generic advertising can increase the demand for fluid milk. Importantly, in this analysis, the impacts of television and radio advertising have been effectively disentangled. Television...

  20. Nitrate Pollution Externality Associated with Increased Corn Demand for Ethanol: a Case Study of Olmsted County in Minnesota

    OpenAIRE

    Harpankar, Kshama

    2008-01-01

    Land use practices generate various environmental externalities. With the increased interest in biofuel production, it is imperative to understand the benefits and costs associated with resource allocation choices made for biofuel production. This paper contributes to the full cost accounting of biofuels research by estimating potential nitrate pollution cost associated with land use change that may result from increasing corn prices due to demand from ethanol producers. The increased demand ...

  1. Case finding for COPD in primary care: a qualitative study of the views of health professionals

    Directory of Open Access Journals (Sweden)

    Haroon S

    2015-08-01

    Full Text Available Shamil Haroon, Rachel E Jordan, David A Fitzmaurice, Peymane AdabSchool of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UKBackground: Chronic obstructive pulmonary disease (COPD is common but largely underdiagnosed. Case-finding initiatives have been evaluated in primary care, but few studies have explored the views of service providers on implementing them in practice.Aim: To explore the views of primary health care providers on case finding for COPD.Methods: A total of 20 semi-structured interviews were conducted from March 2014 to September 2014 among general practitioners, nurses, and managers from practices participating in a large COPD case-finding trial based in primary care in the West Midlands, UK. Participants’ views were sought to explore perceived benefits, harms, barriers, and facilitators to implementing COPD case finding in practice. Interviews were transcribed and analyzed using the framework method.Results: Participants felt that case finding improves patient care but also acknowledged potential harms to providers (increase in workload and to patients (overdiagnosis. Insufficient resources, poor knowledge of COPD, and limited access to diagnostic services were viewed as barriers to diagnosis, while provision of community respiratory services, including COPD specialist nurses, and support from secondary care were thought to be facilitators. Participants also expressed a need for more education on COPD for both patients and clinicians.Conclusion: Care providers believe that early detection of COPD improves patient care but also has accompanying harms. Barriers to diagnosing COPD, such as insufficient expertise in primary care and limited access to diagnostic services in the community, should be explored and addressed. The knowledge and attitudes of the public about COPD and its symptoms should also be investigated to inform future education and awareness-raising strategies.Keywords: chronic

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

    Indian Academy of Sciences (India)

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

    2015-02-01

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

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

    OpenAIRE

    Onyeka, Tonia C

    2010-01-01

    Palliative care is not just vital in controlling symptoms of the patient’s disease condition, but also aims to extend the patient’s life, giving it a better quality. However, several times in the course of management, the psychosocial impact of cancer, HIV/AIDS, and other life-limiting disease conditions may not be noticed and dealt with during the admission period, thereby giving rise to a more complex situation than the disease condition itself. This article aims to review some psychosocial...

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

    Institute of Scientific and Technical Information of China (English)

    李玲玲

    2015-01-01

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

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

    Science.gov (United States)

    Hsieh, Chang-Ming

    2009-01-01

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

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

    Science.gov (United States)

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

    2007-01-01

    Simply implementing software and technology does not assure that an organization's targeted clinical and financial goals will be realized. No longer is it possible to roll out a new system--by solely providing end user training and overlaying it on top of already inefficient workflows and outdated roles--and know with certainty that targets will be met. At Virtua Health's Home Care, based in south New Jersey, implementation of their electronic system initially followed this more traditional approach. Unable to completely attain their earlier identified return on investment, they enlisted the help of a new role within their health system, that of the nurse informaticist. Knowledgeable in complex clinical processes and not bound by the technology at hand, the informaticist analyzed physical workflow, digital workflow, roles and physical layout. Leveraging specific tools such as change acceleration, workouts and LEAN, the informaticist was able to redesign workflow and support new levels of functionality. This article provides a view from the "finish line", recounting how this role worked with home care to assimilate information delivery into more efficient processes and align resources to support the new workflow, ultimately achieving real tangible returns. PMID:19195281

  7. Reasons for not finalising child sexual abuse cases in alternative care : social workers' perceptions / Veronica Grunder

    OpenAIRE

    Grunder, Veronica

    2014-01-01

    Dealing with child sexual abuse cases, is an integral part of the social workers job. Due to the nature of the abuse and the provisions made by the Children’s Act, 38 of 2005, as amended, to safeguard the child victim, many social workers remove children of child sexual abuse cases and place them in alternative care. The aim of this study is to explore the perceptions of social workers on the reasons why child sexual abuse cases in alternative care is not finalized. Some of the factors tha...

  8. Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care.

    Directory of Open Access Journals (Sweden)

    Pim van den Dungen

    Full Text Available Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes.In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1 resulted in more mild cognitive impairment (MCI and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2 added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2. FPs of 15 primary care practices (PCPs = clusters judged the cognitive status of all persons ≥ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual.Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3% (138/326 of persons in the intervention, and in 30.5% (98/321 in the control group (estimated difference GEE: 10.8%, OR: 1.51, 95%-CI 0.60-3.76. Among patients and relatives who consented to stage 2 of the trial (n = 145; 25%, there were no differences in mental health between the intervention and control group.We found a non-significant increase in the number of new MCI diagnoses. As we cannot exclude

  9. Case Finding of Mild Cognitive Impairment and Dementia and Subsequent Care; Results of a Cluster RCT in Primary Care

    Science.gov (United States)

    van den Dungen, Pim; Moll van Charante, Eric P.; van de Ven, Peter M.; van Marwijk, Harm W. J.; van der Horst, Henriëtte E.; van Hout, Hein P. J.

    2016-01-01

    Purpose Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes. Methods In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1) resulted in more mild cognitive impairment (MCI) and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2) added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2). FPs of 15 primary care practices (PCPs = clusters) judged the cognitive status of all persons ≥ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual. Results Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3% (138/326) of persons in the intervention, and in 30.5% (98/321) in the control group (estimated difference GEE: 10.8%, OR: 1.51, 95%-CI 0.60–3.76). Among patients and relatives who consented to stage 2 of the trial (n = 145; 25%), there were no differences in mental health between the intervention and control group. Conclusions We found a non-significant increase in the number of new MCI

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

    Science.gov (United States)

    Zúñiga Fajuri, Alejandra

    2014-01-01

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

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

    Science.gov (United States)

    Izadi, Arman; Kimiagari, Ali Mohammad

    2014-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Tonia C Onyeka

    2010-01-01

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

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

    OpenAIRE

    Carreras, Marc; Sánchez-Pérez, Inma; Ibern, Pere; Coderch, Jordi; Inoriza, José María

    2016-01-01

    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 burd...

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

    DEFF Research Database (Denmark)

    Klinge Jacobsen, Henrik

    2001-01-01

    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...... assumptions regarding technological progress must be made comparable in order to demonstrate whether or not these assumptions are the reason. Assumptions about energy e$ciency improvement in the vintage models are found to be important for the projection. The vintage modelling approach is found to be less...... important for long-term projections. A limitation of the vintage modelling approach applied in the long term explains some of the di!erences in projections among the two types of models. The applied vintage model of electric appliances does not adequately describe the category of new energy...

  15. Fecal indicator bacteria contamination of fomites and household demand for surface disinfection products: a case study from Peru.

    Science.gov (United States)

    Julian, Timothy R; MacDonald, Luke H; Guo, Yayi; Marks, Sara J; Kosek, Margaret; Yori, Pablo P; Pinedo, Silvia Rengifo; Schwab, Kellogg J

    2013-11-01

    Surface-mediated disease transmission is understudied in developing countries, particularly in light of the evidence that surface concentrations of fecal bacteria typically exceed concentrations in developed countries by 10- to 100-fold. In this study, we examined fecal indicator bacterial contamination of dinner plates at 21 households in four peri-urban communities in the Peruvian Amazon. We also used surveys to estimate household use of and demand for surface disinfectants at 280 households. Despite detecting total coliform, enterococci, and Escherichia coli on 86%, 43%, and 24% of plates sampled, respectively, less than one-third of households were regularly using bleach to disinfect surfaces. Among non-users of bleach, only 3.2% of respondents reported a new demand for bleach, defined as a high likelihood of using bleach within the next year. This study highlights the potential for marketing approaches to increase use of and demand for surface disinfectants to improve domestic hygiene.

  16. Monitored anesthesia care in a case of pheochromocytoma and atrial myxoma

    OpenAIRE

    Manvikar, Laxmi P.; Adhye, Bharati A.

    2012-01-01

    Anesthesia for a patient with pheochromocytoma is challenging; irrespective of whether it is a diagnosed case for planned surgery or an occult case, it can be a nightmare. The patient may be given anesthesia for removal of the primary tumor or for surgery other than for the removal of the primary tumor. Hemodynamic derangements like hypertension and arrhythmia can be catastrophic. Monitored anesthesia care, though used for many cases, is unusual for a patient with diagnosed pheochromocytoma, ...

  17. End-of-life care in a COPD patient awaiting lung transplantation: a case report

    Directory of Open Access Journals (Sweden)

    Schols Jos MGA

    2010-04-01

    Full Text Available Abstract COPD is nowadays the main indication for lung transplantation. In appropriately selected patients with end stage COPD, lung transplantation may improve quality of life and prognosis of survival. However, patients with end stage COPD may die while waiting for lung transplantation. Palliative care is important to address the needs of patients with end stage COPD. This case report shows that in a patient with end stage COPD listed for lung transplantation offering palliative care and curative-restorative care concurrently may be problematic. If the requirements to remain a transplantation candidate need to be met, the possibilities for palliative care may be limited. Discussing the possibilities of palliative care and the patient's treatment preferences is necessary to prevent that end-of-life care needs of COPD patients dying while listed for lung transplantation are not optimally addressed. The patient's end-of-life care preferences may ask for a clear distinction between the period in which palliative and curative-restorative care are offered concurrently and the end-of-life care period. This may be necessary to allow a patient to spend the last stage of life according to his or her wishes, even when this implicates that lung transplantation is not possible anymore and the patient will die because of end stage COPD.

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

    Directory of Open Access Journals (Sweden)

    Marc Carreras

    2016-08-01

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

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

    Science.gov (United States)

    Ben Oumlil, A; Rao, C P

    1992-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Campbell Stephen

    2008-03-01

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

  1. A case study: the clinical application of quadrangular dialogue--a caring in nursing teaching model.

    Science.gov (United States)

    Sumner, Jane F

    2004-01-01

    Teaching caring in nursing is expected of nursing faculty, but the practical application is rarely explained. It has been regarded as the moral responsibility of faculty to teach in a caring way. This case study relates how one faculty applied the concepts to quadrangular dialogue a caring model of nursing education to the experience of baccalaureate student nurses in their first clinical rotation. The components of quadrangular dialogue will be described, and applied to a specific patient who was cared for by students in one semester. This model is developed from Habermas' (1995) Theory of Communicative Action and Moral Consciousness, Bishop and Scudder's (1990) Triadic Dialogue and a caring in nursing paradigm developed by this author. It explains how the patient, nursing student and nursing faculty are all first person in the interaction, while the illness is object. By acknowledging the humanness of participants, validation and fulfillment for each follow. PMID:16646898

  2. Saving More Teeth—A Case for Personalized Care

    Directory of Open Access Journals (Sweden)

    Alexandre R. Vieira

    2015-02-01

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

  3. August 2016 critical care case of the month

    Directory of Open Access Journals (Sweden)

    Deangelis JL

    2016-08-01

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

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

    NARCIS (Netherlands)

    Verstegen, J.A.

    2016-01-01

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

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

    Science.gov (United States)

    Blacksin, Beth A; Kelly, Patricia J

    2015-01-01

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

  6. Comparison of particle swarm optimization and other metaheuristics on electricity demand estimation: A case study of Iran

    International Nuclear Information System (INIS)

    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

  7. Modeling framework for estimating impacts of climate change on electricity demand at regional level: Case of Greece

    International Nuclear Information System (INIS)

    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 underutilized. 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

  8. Short-run and long-run elasticities of electricity demand in the public sector: A case study of the United States Navy bases

    Science.gov (United States)

    Choi, Jino

    Numerous studies have examined the elasticities of electricity demand---residential as well as commercial and industrial---in the private sector. However, no one appears to have examined the behavior of the public sector demand. This study aims to fill that gap and to provide insights into the electricity demand in the public sector, using the U.S. Navy bases as a case study. This study examines electricity demand data of 38 Navy activities within the United States for a 16-year time period from 1985 through 2000. The Navy maintains a highly diverse shore infrastructure to conduct its mission and to support the fleet. The types of shore facilities include shipyards, air stations, aviation depots, hospital, and many others. These Navy activities are analogous to commercial or industrial organizations in the private sector. In this study, I used a number of analytical approaches to estimate short-run and long-run elasticities of electricity demand. Estimation using pooled data was rejected because it failed the test for homogeneity. Estimation using the time series data of each Navy activity had several wrong signs for coefficients. The Stein-rule estimator did not differ significantly from the separate cross-section estimates because of the strong rejection of the homogeneity assumption. The iterative Bayesian shrinkage estimator provided the most reasonable results. The empirical findings from this study are as follows. First, the Navy's electricity demand is price elastic. Second, the price elasticities appear to be lower than those of the private sector. The short-run price elasticities for the Navy activities ranged from -0.083 to -0.157. The long-run price elasticities ranged from -0.151 to -0.769.

  9. Streptococcus salivarius meningitis after dental care: case report

    Directory of Open Access Journals (Sweden)

    Maira Zoppelletto

    2012-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Ishrat Jahan

    2011-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Ackchai Sirikijpanichkul

    2015-01-01

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

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

    OpenAIRE

    Verstegen, J.A.

    2016-01-01

    Land use change is a central issue in the sustainability debate, because of its impacts on e.g. climate change, water availability and quality, soil quality and erosion, and biodiversity. Continuing population growth, shifting diets towards higher meat consumption and increasing bioenergy demands call for the exploration of possibilities for sustainable land use change pathways with minimal negative impacts. Land use change models are tools that support such explorations by projecting the spa...

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

    OpenAIRE

    Ackchai Sirikijpanichkul; Sarintorn Winyoopadit

    2015-01-01

    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 influenc...

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

    OpenAIRE

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

    2015-01-01

    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 n...

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

    OpenAIRE

    Yan, D. H.; Wang, G; H. Wang; T. L. Qin

    2012-01-01

    Economic and social development has greatly increased ecological water demand and modified land use of river systems worldwide, causing overall degradation of many of these systems. In this study, theoretical and technical frameworks for regionalization on the eco-environmental function of river systems are formulated and applied to the Luanhe River system. Based on its eco-environmental functions, this river can be regionalized into four types of first-class functional areas: ecological pres...

  16. Comprehensive evaluation on housing market supply and demand based on principal component analysis: the case of Xi'an, China

    Directory of Open Access Journals (Sweden)

    Jianping Yang

    2013-01-01

    Full Text Available At present, China's housing prices and structures have been severe distorted, which have been done serious harm on the development of national economy and people's lives, the government has implemented the most strictest macro-control. This paper applies the correlation and principal component analysis on the supply demand of housing market. Aims to points out clear direction for the implementation of macro-control policies in the future.

  17. Improving Supply Chain in North -American Liner Board market through Demand Chain managment : Case of Metsä Board

    OpenAIRE

    Sakko, Auli

    2014-01-01

    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...

  18. The effect of location and facility demand on the marginal cost of delivered wood chips from energy crops: a case study of the State of Tennessee

    International Nuclear Information System (INIS)

    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 farm-gate prices and supplies of wood 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 2,700 000 dry Mg/y (3 000 000 dry t/y) 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 18-29% of the delivered cost and ranged between $8 and 18/dry Mg ($7 and 16/dry t). 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. (author)

  19. The effect of location and facility demand on the marginal cost of delivered wood chips from energy crops: A case study of the state of Tennessee

    International Nuclear Information System (INIS)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-08-20

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

  1. Opportunities for Automated Demand Response in California Agricultural Irrigation

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-08-01

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

  2. Using New Instruments of Clustering Policy in the Health Care System. The Case of Poland

    Science.gov (United States)

    Romaniuk, Piotr; Holecki, Tomasz; Woźniak-Holecka, Joanna

    2016-01-01

    The issue of clusters as a form of organization of market entities has recently attracted an increasing attention of health care management theoreticians and practitioners. In our opinion the existing theoretical basis gives a foundation for considering clusters as a source of potential for increasing the effectiveness of health policy and health care organizations. It can be assumed that in case of health care clusters there is a possibility of interregional diffusion of innovation, based on ventures undertaken on the health care market, increasing not only the potential of the entities in the cluster, but also of its surroundings and subcontractors. It is possible to realize the idea of a flexible health care implemented regionally with the use of modern techniques of communication, knowledge transfer and high specialization. Nonetheless, in case of Poland the potential of clustrification remains untapped, being characterized by a limited actions of public and private bodies, marginal role of non-profit sector organizations and limited engagement of R&D sector. This is because a general distrust in the cluster formula, and the lack of relevant knowledge among local officials and health business leaders. For this reason the process of clustrification among health care entities requires external support through the increased efforts to create a system of legal and tax preferences for cluster initiatives and provision of organizational support in terms of know-how, targeted particularly at bodies and individuals, who may act as cluster leaders.

  3. Using New Instruments of Clustering Policy in the Health Care System. The Case of Poland.

    Science.gov (United States)

    Romaniuk, Piotr; Holecki, Tomasz; Woźniak-Holecka, Joanna

    2016-01-01

    The issue of clusters as a form of organization of market entities has recently attracted an increasing attention of health care management theoreticians and practitioners. In our opinion the existing theoretical basis gives a foundation for considering clusters as a source of potential for increasing the effectiveness of health policy and health care organizations. It can be assumed that in case of health care clusters there is a possibility of interregional diffusion of innovation, based on ventures undertaken on the health care market, increasing not only the potential of the entities in the cluster, but also of its surroundings and subcontractors. It is possible to realize the idea of a flexible health care implemented regionally with the use of modern techniques of communication, knowledge transfer and high specialization. Nonetheless, in case of Poland the potential of clustrification remains untapped, being characterized by a limited actions of public and private bodies, marginal role of non-profit sector organizations and limited engagement of R&D sector. This is because a general distrust in the cluster formula, and the lack of relevant knowledge among local officials and health business leaders. For this reason the process of clustrification among health care entities requires external support through the increased efforts to create a system of legal and tax preferences for cluster initiatives and provision of organizational support in terms of know-how, targeted particularly at bodies and individuals, who may act as cluster leaders. PMID:27445815

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

    Science.gov (United States)

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

    2008-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    张志霞; 罗菊英; 汪娟; 叶艳胜; 孔令磷

    2016-01-01

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

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

    Science.gov (United States)

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

    2010-01-01

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

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

    Science.gov (United States)

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

    2009-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  9. Integration of economic appraisal and health care policy in a health insurance system; The Dutch case

    NARCIS (Netherlands)

    F.F.H. Rutten (Frans); J.-W. van der Linden (J.)

    1994-01-01

    textabstractThis article discusses the role of economic appraisal in insurance based health care systems, taking the case of the Netherlands as an example. The public health insurance system in this country is governed by the Health Insurance Executive Board, which policies are firmly based on the r

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

    Science.gov (United States)

    Yan, D. H.; Wang, G.; Wang, H.; Qin, T. L.

    2012-08-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-08-15

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

  12. Electrical network capacity support from demand side response: Techno-economic assessment of potential business cases for small commercial and residential end-users

    International Nuclear Information System (INIS)

    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

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

    Directory of Open Access Journals (Sweden)

    Martin Roland

    2012-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Martin Roland

    2012-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Graham Palmer

    2012-07-01

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

  16. 锦州市围生期妇女保健需求的调查分析%Survey of perinatal health care demand in Jinzhou

    Institute of Scientific and Technical Information of China (English)

    王怡涵; 王红霞; 侯晓瑛; 卢静; 宫建美

    2016-01-01

    Objective To understand perinatal health care and demand status, and explore the influence factors of perinatal health in Jinzhou area. Methods Randomly investigate 996 mothers from three hospital in Jinzhou. Results Seeking pregnancy health service demand rate: general hospital of obstetrics and gynecology accounted for 52.2%(520/996), maternity hospitals accounted for 39.5%(393/996), family planning services accounted for 8.3% (83/996). Good crowd in pregnancy cognition, > 30 65.3% (297/455), 30 years old or less accounted for 34.7% (158/455). Medical personnel in maternal knowledge acquirement accounted for 33.2% (331/996), pregnant women school training accounted for 23.9% (238/996), network way accounted for 16.2% (161/996), the relatives and friends accounted for 10.7% (107/996), books accounted for 10.8% (108/996), the other way accounted for 5.1% (51/996).The related factors of postpartum depression are marital status, antenatal education, the way of breastfeeding. Conclusions The family planning service has not fully played its efficiency. Women under t he age of 30 need to enhance conciousness about health care before pregnancy. The network platform still has space to play education function. It′s necessary that puerperal nursing routine should add postnatal depression questionnaire in the future.%目的:了解锦州地区妇女围生期保健需求,并探讨影响妇女围生期健康的相关因素。方法随机选取996例产后复查的产妇,对其一般情况、孕前保健认知和信息获取途径情况、孕产期知识获取途径情况和产后抑郁情况进行问卷调查。结果寻求孕前保健服务的需求率:综合性医院妇产科占52.2%(520/996),妇产科专科医院占39.5%(393/996),计划生育服务所占8.3%(83/996)。在围孕期认知良好的人群中,>30岁占65.3%(297/455),≤30岁占34.7%(158/455)。在孕产期知识获取途径中医务人员占33.2%(331/996

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

    Directory of Open Access Journals (Sweden)

    Richards Judy-Lynn

    2010-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Schellevis François G

    2009-09-01

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

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

    Science.gov (United States)

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

    2016-09-01

    In anticipation of the growing need for adequate mental health care for older adults in residential aged care facilities, psychologists are challenged to overcome several barriers that impede the uptake and delivery of their services in such settings. Information and communication technologies (ICT) have strong potential to overcome some of these barriers by supporting the delivery of evidence-based psychosocial treatments for common psychogeriatric issues. This paper presents two case studies that illustrate when and how psychologists can use various ICT applications (e.g., tablet devices, web-based applications) integrated with cognitive behavioural and reminiscence-based therapies. Both case studies demonstrate that ICT can effectively support the therapeutic alliance, enhance therapeutic engagement, and individualize treatment delivery to accommodate the needs of elderly patients. It is hoped that these case studies will encourage clinicians to consider using ICT to augment therapy with their elderly patients. PMID:27073103

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

    Directory of Open Access Journals (Sweden)

    Y Brouh

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    D. H. Yan

    2012-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Ramesha K

    2009-01-01

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

  3. Spatial heterogeneity in utilities, equity and collective efficiency: the case of rural electrification and demand side management

    International Nuclear Information System (INIS)

    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)

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

    Institute of Scientific and Technical Information of China (English)

    Lipeng; GUO; Haiyan; CAI

    2014-01-01

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

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

    Science.gov (United States)

    Wang, Daniel W L

    2013-01-01

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

  6. The Effect Of Customer Demand And Supplier Performance In Competitive Strategy And Business Performance Case Of Fixed Broadband In Indonesia

    Directory of Open Access Journals (Sweden)

    Rina D. Pasaribu

    2015-08-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Atsushi Fukuda

    2011-01-01

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

  8. Case-management for nursing care of patient with stroke: a cross-cultural critical reflective analysis

    OpenAIRE

    Theofanidis, Dimitrios

    2016-01-01

    Introduction: Stroke remains a heavy financial burden on health care systems around the world. Yet, health care reforms have called for sophisticated management systems in order to provide high-quality care on equal terms for the entire population within a cost-conscious environment.  Aim: The main aim of this discussion paper is to define and reflect cross-culturally on the merits of the Case-Management (CM) approach for contemporary stroke care delivery. Methods: Critical refle...

  9. Transforming Perioperative Care: The Case for a Novel Curriculum for Anesthesiology Resident Training.

    Science.gov (United States)

    Alem, Navid; Cohen, Neal; Cannesson, Maxime; Kain, Zeev

    2016-06-15

    Currently, perioperative health care is undergoing transformative changes. One prospect for the specialty of anesthesiology is a reorientation of resident education to focus more on the entire spectrum of perioperative care as exemplified by the perioperative surgical home (PSH). To advance this novel paradigm for patients and anesthesiologists, one must also consider further incorporating the competencies fundamental to the PSH during residency training. As such, the purpose of this case report is to outline the successful implementation of a comprehensive PSH curriculum for anesthesiology residents. PMID:27166744

  10. Cultural responsiveness in long-term-care case management: moving beyond competence.

    Science.gov (United States)

    Werkmeister-Rozas, Lisa; Klein, Waldo C

    2009-01-01

    Case mangers must deal with the ever-changing makeup of their client population as well as those who provide managed services to these clients. There is great ethnocultural diversity in the elder population, and statistics contend that it will only increase with time. Similarly, the majority of long-term-care providers have been consistently female and of color. Providing culturally competent services becomes more complex when long-term-care providers and clients possess different identities, countries of origins, and social statuses. This article examines a framework that addresses the complex, multidimensional and bidirectional process that occurs between providers and consumers of any cultural makeup called cultural responsiveness. PMID:19353981

  11. Barriers to implementation of a redesign of information transfer and feedback in acute care: results from a multiple case study

    OpenAIRE

    van Leijen-Zeelenberg, Janneke E; van Raak, Arno JA; Duimel-Peeters, Inge GP; Kroese, Mariëlle EAL; Brink, Peter RG; Ruwaard, Dirk; Vrijhoef, Hubertus JM

    2014-01-01

    Background Accurate information transfer is an important element of continuity of care and patient safety. Despite the demonstrated urge for improvement of communication in acute care, there is a lack of data on improvements of communication. This study aims to describe the barriers to implementation of a redesign of the existing model for information transfer and feedback. Methods A case study with six cases (i.e. acute care chains), using mixed methods was carried out in the Netherlands. Th...

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

    Science.gov (United States)

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

    2016-04-01

    Rising human demand and climatic variability have created greater uncertainty regarding global food trade and its effects on the food security of nations. To reduce reliance on imported food, many countries have focused on increasing their domestic food production in recent years. With clear goals for the complete self-sufficiency of rice production, Sri Lanka provides an ideal case study for examining the projected growth in domestic rice supply, how this compares to future national demand, and what the associated impacts from water and fertilizer demands may be. Using national rice statistics and estimates of intensification, this study finds that improvements in rice production can feed 25.3 million Sri Lankans (compared to a projected population of 23.8 million people) by 2050. However, to achieve this growth, consumptive water use and nitrogen fertilizer application may need to increase by as much as 69 and 23 %, respectively. This assessment demonstrates that targets for maintaining self-sufficiency should better incorporate avenues for improving resource use efficiency. PMID:26474766

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

    Directory of Open Access Journals (Sweden)

    Sue Hignett

    2010-01-01

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

  14. Demand and supply for psychological help in general practice in different European countries: access to primary mental health care in six European countries.

    NARCIS (Netherlands)

    Verhaak, P.F.M.; Brink-Muinen, A. van den; Bensing, J.M.; Gask, L.

    2004-01-01

    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. T

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

    Science.gov (United States)

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

    2005-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Tomstad ST

    2013-05-01

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

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

    Science.gov (United States)

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

    2015-01-01

    Specialist palliative care (PC) often embraces a “less is more” philosophy that runs counter to the revenue-centric nature of most health care financing in the U.S. A special business case is needed in which the financial benefits for organizations such as hospitals and payers are aligned with the demonstrable clinical benefits for patients. Based on published studies and our work with PC programs over the past 15 years, we identified 10 principles that together form a business model for specialist PC. These principles are relatively well established for inpatient PC but are only now emerging for community-based PC. Three developments that are key for the latter are the increasing penalties from payers for overutilization of hospital stays, the variety of alternative payment models such as accountable care organizations, which foster a population health management perspective, and payer-provider partnerships that allow for greater access to and funding of community-based PC. PMID:26297853

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

    Science.gov (United States)

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

    2015-12-01

    Specialist palliative care (PC) often embraces a "less is more" philosophy that runs counter to the revenue-centric nature of most health care financing in the U.S. A special business case is needed in which the financial benefits for organizations such as hospitals and payers are aligned with the demonstrable clinical benefits for patients. Based on published studies and our work with PC programs over the past 15 years, we identified 10 principles that together form a business model for specialist PC. These principles are relatively well established for inpatient PC but are only now emerging for community-based PC. Three developments that are key for the latter are the increasing penalties from payers for overutilization of hospital stays, the variety of alternative payment models such as accountable care organizations, which foster a population health management perspective, and payer-provider partnerships that allow for greater access to and funding of community-based PC. PMID:26297853

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

    Science.gov (United States)

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

    2015-12-01

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

  20. Demand Uncertainty

    DEFF Research Database (Denmark)

    Nguyen, Daniel Xuyen

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

  1. Case study of supply induced demand: the case of provision of imaging scans (computed tomography and magnetic resonance) at Unimed-Manaus

    Energy Technology Data Exchange (ETDEWEB)

    Andrade, Edson de Oliveira; Andrade, Elizabeth Nogueira de, E-mail: dredsonandrade@gmail.co [Universidade Federal do Amazonas (UFAM), Manaus, AM (Brazil); Gallo, Jose Hiran [Universidade do Porto (U.Porto) (Portugal)

    2011-03-15

    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)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-07-20

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

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

    Directory of Open Access Journals (Sweden)

    Ernest Kuchar

    2013-10-01

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

  4. Building integrated care systems: a case study of Bidasoa Integrated Health Organisation

    Directory of Open Access Journals (Sweden)

    Nuria Toro Polanco

    2015-06-01

    Full Text Available Introduction: This paper analyses the implementation of integrated care policies in the Basque Country through the deployment of an Integrated Health Organisation in Bidasoa area during the period 2011–2014. Structural, functional and clinical integration policies have been employed with the aim to deliver integrated and person-centred care for patients, especially for those living with chronic conditions. Methods: This organisational case study used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the organisational development over a 4-year period. In order to measure the progress of integration three concepts have been measured: (i readiness for chronicity measured with Assessment of Readiness for Chronicity in Healthcare Organisations tool; (ii collaboration between clinicians from different care levels measured with the D'Amour Questionnaire, and (iii overall impact of integration through several indicators based on the Triple Aim Framework. Results: The measurement of organisational readiness for chronicity showed improvements in five of the six areas under evaluation. Similarly the collaboration between professionals of different care levels showed a steady improvement in each of the 10 items. Furthermore, the Triple Aim-based indicators showed a better experience of care in terms of patients’ perceptions of care coordination; a reduction in hospital utilisation, particularly for patients with complex chronic conditions; and cost-containment in terms of per capita expenditure. Conclusion: There is a significant amount of data that shows that Bidasoa Integrated Health Organisation has progressed in terms of delivering integrated care for chronic conditions with a positive impact on several Triple Aim outcomes.

  5. Building integrated care systems: a case study of Bidasoa Integrated Health Organisation

    Directory of Open Access Journals (Sweden)

    Nuria Toro Polanco

    2015-06-01

    Full Text Available Introduction: This paper analyses the implementation of integrated care policies in the Basque Country through the deployment of an Integrated Health Organisation in Bidasoa area during the period 2011–2014. Structural, functional and clinical integration policies have been employed with the aim to deliver integrated and person-centred care for patients, especially for those living with chronic conditions.Methods: This organisational case study used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the organisational development over a 4-year period. In order to measure the progress of integration three concepts have been measured: (i readiness for chronicity measured with Assessment of Readiness for Chronicity in Healthcare Organisations tool; (ii collaboration between clinicians from different care levels measured with the D'Amour Questionnaire, and (iii overall impact of integration through several indicators based on the Triple Aim Framework.Results: The measurement of organisational readiness for chronicity showed improvements in five of the six areas under evaluation. Similarly the collaboration between professionals of different care levels showed a steady improvement in each of the 10 items. Furthermore, the Triple Aim-based indicators showed a better experience of care in terms of patients’ perceptions of care coordination; a reduction in hospital utilisation, particularly for patients with complex chronic conditions; and cost-containment in terms of per capita expenditure.Conclusion: There is a significant amount of data that shows that Bidasoa Integrated Health Organisation has progressed in terms of delivering integrated care for chronic conditions with a positive impact on several Triple Aim outcomes.

  6. The Nursing Care And Education Plan For A Child With Epidermolys is Bullosa (A Case Report

    Directory of Open Access Journals (Sweden)

    Esra Karaca Çiftçi

    2016-05-01

    Full Text Available Epidermolysis Bullosa (EBis a chronic disease, some types of which may have morbidity and mortality. That is why the patients must receive multidisciplinary care in case any complications arise. Families must be informed about the disease, about home care and receive genetic counselling. The importance of genetic counselling cannot be stressed enough, since both M.C. and his younger brother were diagnosed with EB. If the family had received genetic counselling, this tragic situation could have been prevented. Home care education for the families of EB patients is also of great importance. Relatives of the patient must also be educated about wound care, infection control, patient nutrition and physical treatment. They must also be educated about how to use the medications and about bandaging, dressing, Vaseline bandages, antiseptics, bathing procedures, and the use of antibiotic cream ointment. It was obvious, therefore, that the nursing care given at home enhanced both the patient’s and the family’s quality of life.

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

    Science.gov (United States)

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

    2011-09-01

    There has been broad agreement about how to characterise the processes of 'modernisation' of the public sector in welfare societies, but rather less consensus on the impact of this modernisation on professionals. This paper takes critical care in England as a case study to explore how professionals in one setting account for the changes associated with modernisation. In contrast to reports from other arenas, critical care professionals were positive about the processes and outcomes of 'modernisation' in general, and there was a surprising lack of nostalgia in their accounts of organisational changes. However, joking comments suggested considerable scepticism about the initiatives explicitly associated with the national organisation that was charged with 'modernising' critical care, the Modernisation Agency. We suggest that the relative optimism of staff is in part explained by historical and political contingencies which meant that critical care, as a relatively new clinical specialty, benefited in tangible ways from modernisation. Further, all staff groups were able to attribute gains, rather than losses, in autonomy and authority to the modernisation of critical care. Their accounts suggest that modernisation can be a professionalising strategy, with responses to change being neither resistant nor compliant, but sceptically strategic. PMID:21314690

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

    Science.gov (United States)

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

    2011-09-01

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

  9. A case of intensive care unit-acquired weakness after emergency surgery for acute abdomen

    OpenAIRE

    Tominaga, Tetsuro; Nonaka, Takashi; Takeshita, Hiroaki; Honda, Yuichiro; Nagura, Hiroki; Shiraishi, Toshio; Kunizaki, Masaki; Sumida, Yorihisa; Hidaka, Shigekazu; Sawai,Terumitsu; Nagayasu, Takeshi

    2016-01-01

    Introduction Surgeons often perform surgery for patients who are critically ill. Intensive care unit (ICU)-acquired weakness (ICUAW) is a condition in which systemic and prolonged muscle weakness occurs and causes worse short-term and long-term outcomes. Presentation of case A 60-year-old woman with sudden nausea and vomiting presented to our hospital and developed shock. Abdominal CT showed thickness of the descending colon and ascites. She was diagnosed with sepsis due to descending colon c...

  10. A case of intensive care unit-acquired weakness after emergency surgery for acute abdomen

    OpenAIRE

    Tetsuro Tominaga; Takashi Nonaka; Hiroaki Takeshita; Yuichiro Honda; Hiroki Nagura; Toshio Shiraishi; Masaki Kunizaki; Yorihisa Sumida; Shigekazu Hidaka; Terumitsu Sawai; Takeshi Nagayasu

    2016-01-01

    Introduction: Surgeons often perform surgery for patients who are critically ill. Intensive care unit (ICU)-acquired weakness (ICUAW) is a condition in which systemic and prolonged muscle weakness occurs and causes worse short-term and long-term outcomes. Presentation of case: A 60-year-old woman with sudden nausea and vomiting presented to our hospital and developed shock. Abdominal CT showed thickness of the descending colon and ascites. She was diagnosed with sepsis due to descending co...

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

    OpenAIRE

    Vanderpyl TH

    2012-01-01

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

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

    Science.gov (United States)

    Hyde, Cheryl A

    2008-01-01

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

  13. Connection, Regulation, and Care Plan Innovation: A Case Study of Four Nursing Homes

    OpenAIRE

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

    2006-01-01

    We describe how connections among nursing home staff impact the care planning process using a complexity science framework. We completed six-month case studies of four nursing homes. Field observations (n = 274), shadowing encounters (n = 69), and in-depth interviews (n = 122) of 390 staff at all levels were conducted. Qualitative analysis produced a conceptual/thematic description and complexity science concepts were used to produce conceptual insights. We observed that greater levels of sta...

  14. Notation of Depression in Case Records of Older Adults in Community Long-Term Care

    OpenAIRE

    Proctor, Enola K

    2008-01-01

    Although significant numbers of social service clients experience mental health problems, virtually no research has examined the responsiveness of social service agencies to mental disorder. This article examines the extent to which client depression is reflected in records of a public social service agency, community long-term care (CLTC). Researchers assessed new, consenting CLTC clients for depression using standardized research criteria in a telephone interview. Agency case records were a...

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

    Science.gov (United States)

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

    2013-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Ndola Prata

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

  17. Assessing CSR and Applying Social Life Cycle Assessment: A case study on Biochemical Oxygen Demand Online Monitor

    OpenAIRE

    Wan, He

    2012-01-01

    Wuhan China and Borlänge Sweden collaborate to promote sustainable business growths. This thesis, being part of sustainable business project, aims to understand how business can contribute to sustainable development and explore mechanisms of social life cycle assessment. In an effort to answer research questions and further to achieve the general purpose, a BOD online monitor case study is described and analyzed by applying both qualitative and quantitative approaches. Data collection is base...

  18. Public procurement as a demand-side innovation policy tool in China - a national level case study

    OpenAIRE

    Yanchao Li

    2011-01-01

    The Chinese government announced explicitly in the National S&T Program (2006-2020) to utilize public procurement to spur 'endogenous innovation', following which many actions have been taken by related government agencies. This paper aims to answer two questions through a qualitative case study at the national level: How has IOPP become an innovation policy tool in China under the circumstances and development trends of its national innovation system? What is China's current national IOPP me...

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

    Directory of Open Access Journals (Sweden)

    N. Preethi

    2012-05-01

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

  20. Prudent care of head trauma in the elderly: a case report

    OpenAIRE

    Ross, Allen GP

    2014-01-01

    Introduction Severe traumatic brain injury is a major public health problem that accounts for one-third of all deaths due to trauma in the United States. This case report illustrates some of the challenges faced by the elderly in accessing essential emergency services for traumatic brain injury. Case presentation A 74-year-old Caucasian man presented with head trauma at his local acute care hospital (level III/IV) in Canada at 2:30 PM. He was triaged at 4:00 PM and was seen by the emergency r...

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

    LENUS (Irish Health Repository)

    Pieper, Hans-Olaf

    2011-05-15

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

  2. [Dental care in cross-cultural networks-- case management--approaches in group prevention].

    Science.gov (United States)

    Robke, F J

    2000-01-01

    Oral epidemiology studies of previous years have shown an increasing difference in caries cases in respect of different social strata. Thus, frequency of caries cases is related to social status. High rates of caries prevalence are found especially among children from typical areas of welfare problems. Already, today every fifth child is born into a family of immigrants. In areas of typical social deprivation their share is about 40% and more. Since the previous educational campaigns for social fringe groups have hardly shown any positive effect on dental health, new strategies are necessary. In a community of Hanover with low socio-economic status and a generally high caries level, the treatment strategies of dental care for the young have centred on the case-management approaches of social welfare programmes since the early 90s. Beside the expanded basic preventive programme, which includes application of a fluoride varnish for children, social compensatory measures with intercultural networks are also being taken. This concept shows very clearly that the dental health of children living in areas of social disorganisation can be effectively improved by means of these strategies. For the future, dental care for these children requires more intercultural competence and more knowledge of social welfare work by adolescent dental care providers. PMID:11037670

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

    Directory of Open Access Journals (Sweden)

    Subhakar Kandi

    2013-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Søndergaard Jens

    2008-11-01

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

  6. 海南省长期照护保险需求分析与制度构想%Analysis on the Demands of Long-term Care and the Construction of Insurance System in ;Hainan

    Institute of Scientific and Technical Information of China (English)

    雷丽华

    2015-01-01

    With the growing problems of population aging in Hainan, the long-term care for the disabled older people has been shifted from family responsibilities to social problems. In this paper, the author analyzes the demands of long-term care in Hainan, calculates the expenditures of long-term care, and puts forward suggestions to build a long-term care insurance system on the aspects of financing channels of insurance funds and standardized care assessment system.%随着海南省老龄化的日趋严重,老年失能人员的长期照护问题已从家庭责任转变为社会问题。本文分析了海南老年长期照护服务的需求,测算了长期照护的费用,从保险资金的筹资渠道、规范化的护理评估体系等方面提出了建立长期照护保险制度的建议。

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

    Science.gov (United States)

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

    2016-01-01

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

  8. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    OpenAIRE

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

    2016-01-01

    Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. Background: For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for co...

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  10. Complex Care Management to Decrease Emergency Department Utilization: A Case Study of the Homeless Patient Aligned Care Team Demonstration Project at VA Greater Los Angeles Healthcare System

    OpenAIRE

    Patel, Beena Ishwar

    2013-01-01

    This quality improvement (QI) dissertation is a case study of the homeless-oriented Patient Centered Medical Home demonstration program, referred to as the Homeless Patient Aligned Care Team (HPACT) at West Los Angeles VA Medical Center (WLA). The WLA HPACT program was implemented to address the complex needs of the homeless and at-risk for homelessness population using the Patient Centered Medical Home model (PCMH) - a multi-disciplinary, team-based approach to primary care. Unlike tradition...

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

    Science.gov (United States)

    Foth, Thomas

    2013-10-01

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

  12. Participatory Demand-supply Systems

    OpenAIRE

    Rezaee, S.A.; Oey, M.A.; Nevejan, C.I.M.; Brazier, F.M.

    2015-01-01

    Introducing the notion of Participatory Demand-Supply (PDS) systems as socio-technical systems, this paper focuses on a new approach to coordinating demand and supply in dynamic environments. A participatory approach to demand and supply provides a new frame of reference for system design, for which the engagement of all stakeholders plays an important role, as does distributed ICT. This approach has been applied to an industrial case to explore new opportunities enabled by distributed ICT fo...

  13. Introducing competition principles into health care through EU law and policy: a case study of the Netherlands.

    Science.gov (United States)

    van de Gronden, Johan; Szyszczak, Erika

    2014-01-01

    A national health care service is one of the central pillars of the welfare state in Europe. Recent moves to modernise health care, alongside introducing efficiencies through competition have resulted in experimentation and a re-organisation of national health care systems. The experimental nature of the reforms has brought health care into the focus, but uncertain territory, of EU economic law, especially competition law. Added to these pressures, the new EU fiscal measures oblige Member States to avoid excessive budgets and macro-economic imbalances. One constraint on an EU-based system of competition in health care is the effect of decentralisation, resulting in variations at the national level. Thus a case study is taken of the experience in The Netherlands. From this case study, we argue that a new form of Euro-national competition law is emerging for the health care sector with national authorities taking the lead in shaping the contours of this law. PMID:24841529

  14. Health policy and the policymaking system: A case study of primary care in Ireland.

    Science.gov (United States)

    Kelly, Niall; Garvey, John; Palcic, Dónal

    2016-08-01

    In 2001 the Irish government published a reforming policy intended to modernise and expand the delivery of primary care in Ireland. Fifteen years later, the Irish health system remains beset by problems indicative of a fragmented and underdeveloped primary care system. This case study examines the formation and implementation of the 2001 primary care policy and identifies key risk categories within the policymaking process itself that inhibited the timely achievement of policy objectives. Our methodology includes a directed content analysis of the policy formation and implementation documents and the influencing academic literature, as well as semi-structured interviews with key personnel involved in the process. We identify three broad risk categories - power, resources and capability - within the policymaking process that strongly influenced policy formation and implementation. We additionally show that the disjoint between policy formation and policy implementation was a contested issue among those involved in the policy process and provided space for these risks to critically undermine Ireland's primary care policy. PMID:27342835

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

    Directory of Open Access Journals (Sweden)

    Anbar Ran D

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Vanderpyl TH

    2012-02-01

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

  17. A simulation model approach to analysis of the business case for eliminating health care disparities

    Directory of Open Access Journals (Sweden)

    Tunceli Kaan

    2011-03-01

    Full Text Available Abstract Background Purchasers can play an important role in eliminating racial and ethnic disparities in health care. A need exists to develop a compelling "business case" from the employer perspective to put, and keep, the issue of racial/ethnic disparities in health care on the quality improvement agenda for health plans and providers. Methods To illustrate a method for calculating an employer business case for disparity reduction and to compare the business case in two clinical areas, we conducted analyses of the direct (medical care costs paid by employers and indirect (absenteeism, productivity effects of eliminating known racial/ethnic disparities in mammography screening and appropriate medication use for patients with asthma. We used Markov simulation models to estimate the consequences, for defined populations of African-American employees or health plan members, of a 10% increase in HEDIS mammography rates or a 10% increase in appropriate medication use among either adults or children/adolescents with asthma. Results The savings per employed African-American woman aged 50-65 associated with a 10% increase in HEDIS mammography rate, from direct medical expenses and indirect costs (absenteeism, productivity combined, was $50. The findings for asthma were more favorable from an employer point of view at approximately $1,660 per person if raising medication adherence rates in African-American employees or dependents by 10%. Conclusions For the employer business case, both clinical scenarios modeled showed positive results. There is a greater potential financial gain related to eliminating a disparity in asthma medications than there is for eliminating a disparity in mammography rates.

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

    Science.gov (United States)

    Edoh, Thierry Oscar; Teege, Gunnar

    2011-10-01

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

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

    Science.gov (United States)

    Edoh, Thierry Oscar; Teege, Gunnar

    2011-10-01

    One of the problems in health care in developing countries is the bad accessibility of medicine in pharmacies for patients. Since this is mainly due to a lack of organization and information, it should be possible to improve the situation by introducing information and communication technology. However, for several reasons, standard solutions are not applicable here. In this paper, we describe a case study in Benin, a West African developing country. We identify the problem and the existing obstacles for applying standard ECommerce solutions. We develop an adapted system approach and describe a practical test which has shown that the approach has the potential of actually improving the pharmaceutical care delivery. Finally, we consider the security aspects of the system and propose an organizational solution for some specific security problems. PMID:21519942

  20. PROFILE OF POISONING CASES IN A TERTIARY CARE HOSPITAL , TELANGANA , INDIA

    Directory of Open Access Journals (Sweden)

    Naresh

    2015-05-01

    Full Text Available BACKGROUND : Poisoning with various substances is an important cause of death and disability worldwide . The types of poisons that are encountered in the emergency medicine departments encompass a wide range of substances . Apparently , geographic location , socio - demographic factors , ease of availability of poisons and many other cryptic factors contribute to the wide spectrum of substances that cause poisoning . Pesticides , drugs and chemicals are reported to be the most commo nly used poisons in India . Management of poisoning is quite challenging for the health care professionals globally . Factors such as the uncertainty in the identification of allegedly consumed poison , varied clinical features and the need for timely access to specific information for treatment , complicates poisoning management . This study was therefore conducted to explore the clinical features , management and outcomes of poisoning cases reporting to a tertiary care centre in south India . OBJECTIVE : To ident ify the spectrum of poisons and evaluate their clinical manifestations , medical management and clinical outcomes . METHODOLOGY : All cases of poisoning that were reported at a tertiary care hospital in South India for a period of 18 months from January 1 , 20 13 to June 30 , 2014 were included in this study . A data abstraction sheet was designed to document demographic details ( age and gender , poison consumed , duration of stay in the hospital , clinical features , treatment administered , need for life support and patient outcomes . RESULTS : A total of 145 poisoning cases were reported during the study period . Among them , 58 . 5% were males and 41 . 3% were females . Majority of victims were in the age group of 21 - 30 years . Intentional poisoning was observed in 86 . 2% , whereas the rest were accidental poisonings . Organophosphorus ( OP poisoning was the most common poisoning encountered in this study . It accounted for 25 . 5% of the total

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

    Institute of Scientific and Technical Information of China (English)

    LI Jie; WU Xue-fei

    2003-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nitin Joseph

    2013-01-01

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

  3. Towards personalized integrated dementia care: a qualitative study into the implementation of different models of case management

    OpenAIRE

    Van Mierlo, Lisa D; Meiland, Franka JM; van Hout, Hein PJ; Dröes, Rose-Marie

    2014-01-01

    Background The aim of this process evaluation was to provide insight into facilitators and barriers to the delivery of community-based personalized dementia care of two different case management models, i.e. the linkage model and the combined intensive case management/joint agency model. These two emerging dementia care models differ considerably in the way they are organized and implemented. Insight into facilitators and barriers in the implementation of different models is needed to create ...

  4. An HMO-Sponsored Primary Care-Based Disease Management and Case Management Initiative: Economic and Selected Clinical Outcomes

    OpenAIRE

    Jaan Sidorov; Franz Joseph Fisher; Sabrina Girolami; Otto Wolke

    2002-01-01

    Objective: To describe the cost savings achieved in a health maintenance organization (HMO)-sponsored primary care-based case management and disease management programs. Methods: The HMO-sponsored programs recruited patients in the primary care setting and relied on clinical guidelines and HMO-employed patient education nurses and case management nurses. Total per member per month (PMPM) charges for medical services and changes in selected clinical outcomes before and after entry into HMO-spo...

  5. Pulmonary interstitial emphysema presenting in a woman on the intensive care unit: case report and review of literature

    OpenAIRE

    Jovaisa Tomas; Sherren Peter B

    2011-01-01

    Abstract Introduction Pulmonary interstitial emphysema is a life-threatening form of ventilator-induced lung injury. We present one of the few reported adult cases of pulmonary interstitial emphysema in a woman with respiratory failure admitted to our intensive care unit. Case presentation An 87-year-old Caucasian woman with a diagnosis of community-acquired pneumonia was admitted to our intensive care unit requiring invasive ventilation. The combination of a poor oxygenation index and bilate...

  6. Demand and characteristics of a psychiatric 24-hour emergency service performed by mandatory rotation of licensed psychiatrists in Swiss primary care

    OpenAIRE

    Chmiel C; Rosemann T; Senn O

    2014-01-01

    Corinne Chmiel, Thomas Rosemann, Oliver SennInstitute of General Practice and Health Services Research, University of Zurich, Raemistrasse, Zurich, SwitzerlandBackground: To investigate characteristics of and satisfaction with psychiatric 24-hour emergency primary care performed by mandatory rotation of licensed psychiatrists as a viable baseline for possible reorganizational measures.Methods: This was a questionnaire-based cross-sectional study (November 2010–April 2011). The numbe...

  7. Measures of spatial accessibility to health care in a GIS environment: synthesis and a case study in the Chicago region

    OpenAIRE

    Wei Luo; Fahui Wang

    2003-01-01

    This article synthesizes two GIS-based accessibility measures into one framework, and applies the methods to examining spatial accessibility to primary health care in the Chicago ten-county region. The floating catchment area (FCA) method defines the service area of physicians by a threshold travel time while accounting for the availability of physicians by their surrounded demands. The gravity-based method considers a nearby physician more accessible than a remote one and discounts a physici...

  8. Validating Design Knowledge in the Home: A Successful Case-study Of Dementia Care

    OpenAIRE

    Long, J; Brostoff, S

    2004-01-01

    This paper reports research, which aims to validate design knowledge, as the products of a structured analysis and design method (MUSE – Lim and Long, 1994). The products or ‘containers’ of the method (MUSE(C)) are used in the re-design of a range of domestic technologies, intended to support dementia care in the home. The case-study is judged a success. An evaluation showed the technologies to be more effective following re-design. The design products were shown to be correctly operationalis...

  9. Antimicrobial Stewardship in the Post-Acute Long-Term Care Setting: Case Discussion and Updates.

    Science.gov (United States)

    Brandt, Nicole J; Heil, Emily

    2016-07-01

    Improving the use of antimicrobial medications in the post-acute long-term care setting is critical for combating resistance and reducing adverse events in older adults. Antimicrobial stewardship refers to a set of commitments and actions designed to optimize the treatment of infectious diseases while minimizing the adverse effects associated with antimicrobial medication use. The Centers for Disease Control and Prevention recommend all nursing homes take steps to improve antimicrobial prescribing practices and reduce inappropriate use. The current article highlights initiatives and clinical considerations through a case discussion. [Journal of Gerontological Nursing, 42 (7), 10-14.]. PMID:27337183

  10. Economic techniques to estimate the demand for sustainable products: a case study for fair trade and organic coffee in the United Kingdom

    OpenAIRE

    Galarraga, Ibon; Markandya, Anil

    2004-01-01

    The hedonic approach is used in this paper to estimate how much is paid for the fair trade/organic characteristic of the coffee in the British market. This information is later combined with the Quantity Based Demand System (QBDS) model -developed by the authors- and the Almost Ideal Demand System (AIDS) (Deaton and Muellbauer, 1980) to completely determine the demand function for different coffees. The QBDS model is easier to handle and less data demanding than the AIDS model in this study. ...

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

    Directory of Open Access Journals (Sweden)

    Elizabeth McVicker

    2011-01-01

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

  12. Analysis on status and demand of home-based elderly care in Baoshan District of Shanghai%上海市宝山区居家养老现状与需求分析

    Institute of Scientific and Technical Information of China (English)

    孟杨; 郑康杰; 李明珠; 徐巍; 李琳; 李越

    2015-01-01

    [Objective] To learn the prevalence rate of chronic disease inelderly people in Baoshan District of Shanghai,understand the status of elderly care and the demands of community home-based elderly care,and provide the basis for government departments to formulate the relevant policies.[Methods] Using a self-designed questionnaire,625 elderly people in Baoshan District of Shanghai were investigated to analyze the status and demand of home-based elderly care.[Results] The prevalence rate of chronic disease in elderly people was 69.3%,and the top five chronic diseases were hypertension,arthritis,chronic bronchitis,diabetes and coronary heart disease,which the prevalence rate was respectively 17.0%,18.6%,20.2%,50.4% and 14.4%.The main way of old-age care was self support,accounting 71.2%,42.1% of respondents were more likely to receive the home-based elderly care,and the difference was statistically significant (x2=14.765,P<0.01).There was significant difference in the demands of community elderly care services between different age groups,and the difference was statistically significant (x2=6.07,P<0.05).The main demands of community elderly care services included door-to-door doctor service (73.8%),home cleaning (72.5%) and health lecture (44.1%).32.5% of respondents have known the home-based elderly care subsidies,but only 2.6% have successfully applied.[Conclusion] The prevalence rate of chronic disease is higher in elderly people of Baoshan District.The main way of old-age care was self support,most of elderly people are more likely to receive the home-based elderly care,and the demands of community elderly care services are increasing.It is suggested that the government should improve the publicity efforts to change the traditional concept of home-based elderly care,and expand service model to increase the chronic disease interventions.%目的 了解上海市宝山区老年人慢性病患病和养老现状及社区居家养老服务需

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

    Directory of Open Access Journals (Sweden)

    MacNeil Vroomen Janet

    2012-05-01

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

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

    Science.gov (United States)

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

    2009-08-01

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

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

    Institute of Scientific and Technical Information of China (English)

    苏群; 彭斌霞

    2014-01-01

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

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

    Science.gov (United States)

    Humphrey, Lisa; Dell, Mary Lynn

    2015-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Alyssa B Sharkey

    2014-11-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  19. Disaster medicine. A guide for medical care in case of disasters. 3. rev. ed.

    International Nuclear Information System (INIS)

    This guide was first published in 1982. The 2003 edition takes account of new research, of practical experience in natural disasters, and of the organisational plans of the German civil service units. All factors are considered which are important for successful medical care in case of natural disasters, large-scale accidents, and war. Among the new issues that are considered in this volume is the new European situation with regard to national safety, the new German legislation on civil safety, the hazards of an increasingly technological society, and the options and requirements for protection of the population in case of emergencies. After the Chernobyl accident, the focus in the field of nuclear radiation has shifted to radiation protection problems. There are new chapters on stress management during and after emergency shifts which take account of the experience gained in major disasters. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Filipski Marta I

    2009-12-01

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

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

    Institute of Scientific and Technical Information of China (English)

    李兵水; 肖伊雪; 姜晨卉

    2011-01-01

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

  2. Addressing barriers to perinatal care: a case study of the Access to Maternity Care Committee in Washington State.

    OpenAIRE

    Schleuning, D; Rice, G.; Rosenblatt, R. A.

    1991-01-01

    Access to obstetrical services has deteriorated in recent years, as large numbers of physicians have discontinued or restricted obstetrical practice. In Washington State, one response to this access crisis has been the establishment of the Access to Maternity Care Committee (AMCC), an ad hoc group composed primarily of private sector obstetrical providers and representatives of State government responsible for the delivery of health care to women and children. The major objectives of the AMCC...

  3. Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Jonathan Stokes

    Full Text Available An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care 'at-risk' of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis.We carried out a systematic review and meta-analysis of the effectiveness of case management for 'at-risk' patients in primary care. Six bibliographic databases were searched using terms for 'case management', 'primary care', and a methodology filter (Cochrane EPOC group. Effectiveness compared to usual care was measured across a number of relevant outcomes: Health--self-assessed health status, mortality; Cost--total cost of care, healthcare utilisation (primary and non-specialist care and secondary care separately, and; Satisfaction--patient satisfaction. We conducted secondary subgroup analyses to assess whether effectiveness was moderated by the particular model of case management, context, and study design. A total of 15,327 titles and abstracts were screened, 36 unique studies were included. Meta-analyses showed no significant differences in total cost, mortality, utilisation of primary or secondary care. A very small significant effect favouring case management was found for self-reported health status in the short-term (0.07, 95% CI 0.00 to 0.14. A small significant effect favouring case management was found for patient satisfaction in the short- (0.26, 0.16 to 0.36 and long-term (0.35, 0.04 to 0.66. Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team, when a social worker was involved, and when delivered in a setting rated as low in initial 'strength' of primary care.This was the first meta-analytic review which examined the effects of case management on a wide range of outcomes and

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

    Science.gov (United States)

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

    2016-03-01

    This study was conducted to evaluate the availability of antidotes/key emergency drugs in tertiary care hospitals of the Punjab province, and to assess the knowledge of health care professionals in the stocking and administration of antidotes in the proper management of poisoning cases. Seventeen (n=17) tertiary care hospitals of Punjab Pakistan were selected. Two performas (A and B) were designed for 26 antidotes/key emergency drugs and given to the hospital pharmacists and physicians respectively. It was observed that Activated Charcoal, being the universal antidote was found only in 6 hospitals (41%). Digoxin Immune Fab, Edentate Calcium disodium and Glucagon were not available in emergency department of any hospital and even not included in the formulary of any hospital. About 80% pharmacists were aware of the method of preparation of Activated Charcoal and 85% physicians were familiar with its route of administration. Data showed that tertiary care hospitals of Punjab do not stock antidotes according to national drug policy. Moreover the study strongly suggests the development of health care centers and professional by organizing antidote awareness programs, continuous education and record keeping of poisonous cases and availability of emergency drugs around the clock. PMID:27087082

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

    Science.gov (United States)

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

    2016-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Lisa S. Patchner

    2002-05-01

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

  7. Estimates of Elasticity of Rural Residents' Demand for Health Care%农村居民卫生服务需求弹性研究

    Institute of Scientific and Technical Information of China (English)

    周忠良; 苏延芳; 高建民; 周志英; 徐玲; 张耀光

    2011-01-01

    文章利用第三次和第四次国家卫生服务入户调查在县级层面的数据,采用固定效应模型对面板数据进行分析,测算了县级层面门诊服务和住院服务的自价格弹性、交叉价格弹性和收入弹性.针对如何提高农村居民基本医疗卫生服务利用给出了相应的政策建议.%Using the county-level panel data from the third and the fourth National Health Service Surveys, the fixed effect models were employed to calculate the own-price elasticity, cross-price elasticity and the income elasticity of demand for outpatient service and inpatient service. Some political recommendations were made to improve the basic health service utilization in rural areas.

  8. Differences in clinical and epidemiological features between tuberculosis cases notified in primary and tertiary health care

    Directory of Open Access Journals (Sweden)

    Pâmela Curbani

    2014-04-01

    Full Text Available Objective: To compare, on the basis of clinical, radiological and epidemiological aspects, all cases of tuberculosis (TB diagnosed in the tertiary healthcare services to those diagnosed at the primary healthcare providers in the municipality of Vitória-ES. Methods: Cross- sectional, retrospective study, with analysis of the SINAN’s database, to identify all cases among residents of the municipality of Vitória-ES and diagnosed with TB in 2006 and 2007. Patients were divided into two groups: cases diagnosed in Primary Health Care (PHC and those diagnosed in Tertiary Health Care (THC. For statistical analysis, it was used the software STATA CORP 9.0. Results: 338 patients were identified; 207 (61.24% of these were diagnosed in PHC and 131 (38.76% in THC. The pulmonary form was predominant in both groups. However, the extrapulmonary form presented higher frequency in the THC group. When analyzing the results of sputum smear, the positivity was found in 114 (55.07% patients of the PHC and in 57 (43.51% of THC. Regarding the positive cultures, 119 (57.48% patients diagnosed in PHC and only 38 (29% in THC tested positive. Conclusion: There is evidence of high proportion of patients with TB communicated as “new cases” in THC in the city and it was observed a predominance of the pulmonary form in both groups - PHC and THC, although the extrapulmonary form was more frequent in the latter. doi:10.5020/18061230.2013.p251

  9. Analyzing the impacts of final demand changes on total output using input-output approach: The case of Japanese ICT sectors

    Science.gov (United States)

    Zuhdi, Ubaidillah

    2014-03-01

    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.

  10. Cerebral Malaria Treated with Artemisinin in the Intensive Care Unit: A Case Report.

    Science.gov (United States)

    Çizmeci, Elif Ayşe; Kelebek Girgin, Nermin; Ceylan, Ilkay; Tuncel, Tekin; Alver, Oktay; Akalin, Emin Halis

    2016-01-01

    Malaria is a parasitic disease that is starting to be encountered in intensive care units (ICU) worldwide, owing to increasing globalisation. Severe malaria caused by Plasmodium falciparum, is characterised by cerebral malaria, acute renal failure, hypoglycaemia, severe anaemia, splenomegaly and alveolar oedema. We present the case of a 25-yr old male patient who presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of fever for three days. His medical history revealed a 14-month stay in Tanzania. Staining of blood smears revealed characteristic gametocytes in accordance with P. falciparum infection. The day after admission, he had an epileptic seizure after which his Glasgow Coma Scale was 6, so he was intubated and transferred to the ICU. A computerized tomography scan revealed findings of cerebral oedema. Intravenous mannitol was administered for 6 days. Intravenous artemisinin was continued for 10 days. Due to refractory fevers, anti-malarial treatment was switched to quinine and doxycycline on the 14th day and on the 16th day the fevers ceased. This case emphasizes that cerebral malaria should be suspected in cases of seizures accompanying malaria, and treatment should be initiated in the ICU. Furthermore, resistance of P. falciparum to artemisinin should be in mind when a response to therapy is lacking. PMID:27095978

  11. Cerebral Malaria Treated with Artemisinin in the Intensive Care Unit: A Case Report

    Directory of Open Access Journals (Sweden)

    Elif Ayşe ÇİZMECİ

    2016-03-01

    Full Text Available Malaria is a parasitic disease that is starting to be encountered in intensive care units (ICU worldwide, owing to increasing globalisation. Severe malaria caused by Plasmodium falciparum, is characterised by cerebral malaria, acute renal failure, hypoglycaemia, severe anaemia, splenomegaly and alveolar oedema. We present the case of a 25-yr old male patient who presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of fe­ver for three days. His medical history revealed a 14-month stay in Tanzania. Staining of blood smears revealed characteristic gametocytes in accordance with P. falciparum infection. The day after admission, he had an epileptic seizure after which his Glasgow Coma Scale was 6, so he was intubated and transferred to the ICU. A computerized tomography scan revealed findings of cerebral oedema. Intravenous mannitol was administered for 6 days. Intravenous artemisinin was continued for 10 days. Due to refractory fevers, anti-malarial treatment was switched to quinine and doxycycline on the 14th day and on the 16th day the fe­vers ceased. This case emphasizes that cerebral malaria should be suspected in cases of seizures accompanying malaria, and treatment should be initiated in the ICU. Furthermore, resistance of P. falciparum to artemisinin should be in mind when a response to therapy is lacking.

  12. Cerebral Malaria Treated with Artemisinin in the Intensive Care Unit: A Case Report.

    Science.gov (United States)

    Çizmeci, Elif Ayşe; Kelebek Girgin, Nermin; Ceylan, Ilkay; Tuncel, Tekin; Alver, Oktay; Akalin, Emin Halis

    2016-01-01

    Malaria is a parasitic disease that is starting to be encountered in intensive care units (ICU) worldwide, owing to increasing globalisation. Severe malaria caused by Plasmodium falciparum, is characterised by cerebral malaria, acute renal failure, hypoglycaemia, severe anaemia, splenomegaly and alveolar oedema. We present the case of a 25-yr old male patient who presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of fever for three days. His medical history revealed a 14-month stay in Tanzania. Staining of blood smears revealed characteristic gametocytes in accordance with P. falciparum infection. The day after admission, he had an epileptic seizure after which his Glasgow Coma Scale was 6, so he was intubated and transferred to the ICU. A computerized tomography scan revealed findings of cerebral oedema. Intravenous mannitol was administered for 6 days. Intravenous artemisinin was continued for 10 days. Due to refractory fevers, anti-malarial treatment was switched to quinine and doxycycline on the 14th day and on the 16th day the fevers ceased. This case emphasizes that cerebral malaria should be suspected in cases of seizures accompanying malaria, and treatment should be initiated in the ICU. Furthermore, resistance of P. falciparum to artemisinin should be in mind when a response to therapy is lacking.

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

    Institute of Scientific and Technical Information of China (English)

    冯艺萍

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nalan Muhammedoğlu

    2014-09-01

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

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

    Science.gov (United States)

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

    2015-05-01

    From twenty years of information and communication technology (ICT) projects in the health sector, we have learned one thing: most projects remain projects. The problem of pilotism in e-health and telemedicine is a growing concern, both in medical literature and among policy makers, who now ask for large-scale implementation of ICT in routine health service delivery. In this article, we turn the question of failing projects upside down. Instead of investigating the obstacles to implementing ICT and realising permanent changes in health care routines, we ask what makes the temporary ICT project survive, despite an apparent lack of success. Our empirical material is based on Norwegian telemedicine. Through a case study, we take an in-depth look into the history of one particular telemedical initiative and highlight how ICT projects matter on a managerial level. Our analysis reveals how management tasks were delegated to the ICT project, which thus contributed to four processes of organisational control: allocating resources, generating and managing enthusiasm, system correction and aligning local practice and national policies. We argue that the innovation project in itself can be considered an innovation that has become normalised in health care, not in clinical, but in management work. In everyday management, the ICT project appears to be a convenient tool suited to ease the tensions between state regulatory practices and claims of professional autonomy that arise in the wake of new public management reforms. Separating project management and funding from routine practice handles the conceptualised heterogeneity between innovation and routine within contemporary health care delivery. Whilst this separation eases the execution of both normal routines and innovative projects, it also delays expected diffusion of technology. PMID:25795426

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

    Science.gov (United States)

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

    2015-05-01

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

  17. Grassroots inter-professional networks: the case of organizing care for older cancer patients.

    Science.gov (United States)

    Bagayogo, Fatou Farima; Lepage, Annick; Denis, Jean-Louis; Lamothe, Lise; Lapointe, Liette; Vedel, Isabelle

    2016-09-19

    Purpose The purpose of this paper of inter-professional networks is to analyze the evolution of relationships between professional groups enacting new forms of collaboration to address clinical imperatives. Design/methodology/approach This paper uses a case study based on semi-structured interviews with physicians and nurses, document analysis and informal discussions. Findings This study documents how two inter-professional networks were developed through professional agency. The findings show that the means by which networks are developed influence the form of collaboration therein. One of the networks developed from day-to-day, immediately relevant, exchange, for patient care. The other one developed from more formal and infrequent research and training exchanges that were seen as less decisive in facilitating patient care. The latter resulted in a loosely knit network based on a small number of ad hoc referrals while the other resulted in a tightly knit network based on frequent referrals and advice seeking. Practical implications Developing inter-professional networks likely require a sustained phase of interpersonal contacts characterized by persuasion, knowledge sharing, skill demonstration and trust building from less powerful professional groups to obtain buy-in from more powerful professional groups. The nature of the collaboration in any resulting network depends largely on the nature of these initial contacts. Originality/value The literature on inter-professional healthcare networks focusses on mandated networks such as NHS managed care networks. There is a lack of research on inter-professional networks that emerged from the bottom up at the initiative of healthcare professionals in response to clinical imperatives. This study looks at some forms of collaboration that these "grass-root" initiatives engender and how they are consolidated. PMID:27681028

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

    Science.gov (United States)

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

    2016-01-01

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

  19. Socio-political constraints on primary health care: a case study from Java.

    Science.gov (United States)

    Williams, G; Satoto

    1980-01-01

    The Alma-Ata 1978 conference emphasized the importance of the concept of primary health care in the health system and overall socioeconomic development of the community. However, theories of development generally do not allow for the complexity of human conditions, and the relevance of contact with the village people. This paper presents the experience of a PHC (primary health care) project on the northern coast of central Java. The case illustrates some of the institutional and sociopolitical constraints which the Indonesian government may face in implementing a PHC program in the next few years, such as village politics; the reluctance of men to allow women to participate in the decision-making process of the program, and; the reluctance of land-owning farmers to allow landless villagers in the decision-making process. The following conditions would create a most favorable sociopolitical climate for starting a PHC program in Indonesia: 1) at the village level, non-pamong desa (village elders), women and landless villagers are encouraged to participate in decision-making processes which affect their interests and to take on positions of responsibility in village affairs; 2) there is a process of frank, 2-way communication marked by mutual respect between government agencies at regency and subdistrict levels village-level organization, and 3) supra-village authorities allow village institution to develop at their own pace, intervening only when interests of poor and underprivileged groups are endangered. PMID:12261889

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

    Directory of Open Access Journals (Sweden)

    M Sadr-Bafghi

    2009-01-01

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

  1. Insights into the impact and use of research results in a residential long-term care facility: a case study

    OpenAIRE

    Cranley Lisa A; Birdsell Judy M; Norton Peter G; Morgan Debra G; Estabrooks Carole A

    2012-01-01

    Abstract Background Engaging end-users of research in the process of disseminating findings may increase the relevance of findings and their impact for users. We report findings from a case study that explored how involvement with the Translating Research in Elder Care (TREC) study influenced management and staff at one of 36 TREC facilities. We conducted the study at ‘Restwood’ (pseudonym) nursing home because the Director of Care engaged actively in the study and TREC data showed that this ...

  2. 'Healthy gums do matter': A case study of clinical leadership within primary dental care.

    Science.gov (United States)

    Moore, D; Saleem, S; Hawthorn, E; Pealing, R; Ashley, M; Bridgman, C

    2015-09-25

    The Health and Social Care Act 2012 heralded wide reaching reforms intended to place clinicians at the heart of the health service. For NHS general dental practice, the conduits for this clinical leadership are the NHS England local professional networks. In Greater Manchester, the local professional network has developed and piloted a clinician led quality improvement project: 'Healthy Gums DO Matter, a Practitioner's Toolkit'. Used as a case study, the project highlighted the following facilitators to clinical leadership in dentistry: supportive environment; mentoring and transformational leadership; alignment of project goals with national policy; funding allowance; cross-boundary collaboration; determination; altruism; and support from wider academic and specialist colleagues. Barriers to clinical leadership identified were: the hierarchical nature of healthcare, territorialism and competing clinical commitments. PMID:26404983

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

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Garg

    2015-01-01

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

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

    OpenAIRE

    Sunil Kumar Garg

    2015-01-01

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

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

    Science.gov (United States)

    Garg, Sunil Kumar

    2015-04-01

    Bodybuilding is the use of progressive resistance exercise to control and develop one's musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects. PMID:25878431

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

    Science.gov (United States)

    Garg, Sunil Kumar

    2015-04-01

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

  7. A review of 151 cases of pediatric noncystic fibrosis bronchiectasis in a tertiary care center

    Directory of Open Access Journals (Sweden)

    Banjar Hanaa

    2007-01-01

    Full Text Available Objective: This study was conducted to review the etiological factors and diseases associated with pediatric noncystic fibrosis bronchiectasis in a tertiary care center in Saudi Arabia. Materials and Methods: A retrospective review of all patients with confirmed noncystic fibrosis (Non-CF bronchiectasis by chest X-ray and/or CT chest in a pulmonary clinic during the period 1993-2005 at a tertiary care center in Riyadh. Results: A total of 151 cases were diagnosed as Non-CF bronchiectasis. Seventy-five (49.7% were male, 76 (50.3% were female; 148 (98% are alive and 3 (2% died. The southwestern regions constituted 72 (50% of the cases. There was a period of (5 ± 3.2 years between the start of symptoms and diagnosis of bronchiectasis. More than two-thirds of the patients had cough, tachypnea, wheezing, sputum production and failure to thrive. Ninety-one (60% had associated diseases: Pulmonary diseases in 48 (32%, immunodeficiency in 27 (18%, central nervous system anomalies in 10 (7%, cardiac in 10 (7% and asthma in 103 (68% of the patients. Left lower lobe was commonly involved in 114 (76% patients. Sixty-eight (67% were found to have sinusitis. More than two-thirds of patients had two or more associated diseases. Forty-nine (32% developed gastroesophageal reflux. Hemophilus influenza was cultured in 56 (37%, strept pneumoniae in 25 (17% and pseudomonas aeruginosa in 24 (16% of the patients. Eighty percent of the patients who had pulmonary function test had abnormal changes. Disease progression was related to development of symptoms before 5 years of age, persistent atelectasis and right lower lobe involvement ( P < 0.05. Conclusion: Non-CF bronchiectasis should be included in the differential diagnosis of recurrent chest infection in Saudi Arabia. Early diagnosis and identification of associated diseases is needed to prevent progression of the disease.

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

    Directory of Open Access Journals (Sweden)

    van den Dungen Pim

    2012-08-01

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

  9. An Ode to Stuart Hall's "The Supply of Demand": The Case of Post-Secondary Education in Ontario Fifty Years Later

    Science.gov (United States)

    FitzGerald Murphy, Maggie

    2016-01-01

    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…

  10. The accuracy of clinical malaria case reporting at primary health care facilities in Honiara, Solomon Islands

    Directory of Open Access Journals (Sweden)

    Kunimitsu Ayano

    2009-04-01

    Full Text Available Abstract Background The accuracy of malaria case reporting is challenging due to restricted human and material resources in many countries. The reporting often depends on the clinical diagnosis because of the scarcity of microscopic examinations. Particularly, clinical malaria case reporting by primary health care facilities (local clinics, which constitutes the baseline data of surveillance, has never previously been sufficiently evaluated. In order to improve the malaria reporting system to the level required to eventually eliminate this disease, this study estimates the gaps between the records of clinics and government statistics regarding the incidence of clinical malaria, and then also examines some factors that might explain the data discrepancy, including such variables as clinic staffing and record keeping. Methods All medical records for outpatients in 2007, handwritten by nurses, were collected from local clinics in Honiara, the capital of the Solomon Islands. The all-monthly clinical malaria cases were then recalculated. The corresponding monthly data in official statistics were provided by the government. Next, in order to estimate any data discrepancy, the ratio of the cases recorded at clinics to the cases reported to the government was determined on the monthly basis. Finally, the associations between the monthly discrepancy and other variables were evaluated by a multiple regression analysis. Results The mean data discrepancy between the records of clinics and government statistics was 21.2% (n = 96. Significant associations were observed between the discrepancy and the average number of patients (coefficient: 0.05, 95%CI: 0.31, 0.07, illegible handwriting (coefficient: 0.09, 95%CI: 0.04, 0.15, the use of tally sheets (coefficient:-0.38, 95%CI: -0.54, -0.22, and the clinic level (coefficient:-0.48, 95%CI:-0.89,-0.06. Conclusion The findings of this study demonstrate the huge data discrepancy between the records of clinics and

  11. The accuracy of clinical malaria case reporting at primary health care facilities in Honiara, Solomon Islands

    Science.gov (United States)

    Kunimitsu, Ayano

    2009-01-01

    Background The accuracy of malaria case reporting is challenging due to restricted human and material resources in many countries. The reporting often depends on the clinical diagnosis because of the scarcity of microscopic examinations. Particularly, clinical malaria case reporting by primary health care facilities (local clinics), which constitutes the baseline data of surveillance, has never previously been sufficiently evaluated. In order to improve the malaria reporting system to the level required to eventually eliminate this disease, this study estimates the gaps between the records of clinics and government statistics regarding the incidence of clinical malaria, and then also examines some factors that might explain the data discrepancy, including such variables as clinic staffing and record keeping. Methods All medical records for outpatients in 2007, handwritten by nurses, were collected from local clinics in Honiara, the capital of the Solomon Islands. The all-monthly clinical malaria cases were then recalculated. The corresponding monthly data in official statistics were provided by the government. Next, in order to estimate any data discrepancy, the ratio of the cases recorded at clinics to the cases reported to the government was determined on the monthly basis. Finally, the associations between the monthly discrepancy and other variables were evaluated by a multiple regression analysis. Results The mean data discrepancy between the records of clinics and government statistics was 21.2% (n = 96). Significant associations were observed between the discrepancy and the average number of patients (coefficient: 0.05, 95%CI: 0.31, 0.07), illegible handwriting (coefficient: 0.09, 95%CI: 0.04, 0.15), the use of tally sheets (coefficient:-0.38, 95%CI: -0.54, -0.22), and the clinic level (coefficient:-0.48, 95%CI:-0.89,-0.06). Conclusion The findings of this study demonstrate the huge data discrepancy between the records of clinics and government statistics in

  12. Case managers discuss ethics: dilemmas of an emerging occupation in long-term care in the United States.

    Science.gov (United States)

    Kane, R A; Penrod, J D; Kivnick, H Q

    1994-01-01

    As case management programs mature, ethical questions undoubtedly arise. Yet there are few, if any, standards by which case managers can guide their actions and decisions. In this article, the authors present the results of a survey of 251 frontline case managers in 10 states who were asked to describe the ethical challenges they face. The respondents were conscious of struggling with difficult, even life-and-death decisions involving important choices in their clients' lives. Generally, the case managers were committed to the ideology of respect for client autonomy but found themselves making uneasy compromises with the concept at every turn. Ethical issues arose not only with the client but also with the client's family, colleagues, and providers. Case managers, long-term care providers, and governmental policymakers could all benefit from both theoretical and practical explorations of desirable approaches to individual and societal long-term care decisions. PMID:8000320

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

    Directory of Open Access Journals (Sweden)

    Jayant D Deshpande , Kailash K Singh , Deepak B Phalke

    2012-01-01

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

  14. Seniors’ perspectives on care: a case study of the Alex Seniors health clinic, Calgary

    OpenAIRE

    Shaw, Marta; Rypien, Candace; Drummond, Neil; Harasym, Patricia; Nixon, Lara

    2015-01-01

    Background Primary care initiatives face an imperative to not only reduce barriers to care for their patients but also to uniquely accommodate the complex needs of at-risk patient populations. Patient-centered multidisciplinary care team models for primary care, like the Alex Seniors Clinic, are one approach for providing comprehensive care for marginalized seniors. The purpose of this qualitative study was to explore patient perspectives on the responsiveness of the Alex Seniors Clinic to th...

  15. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    NARCIS (Netherlands)

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

    2016-01-01

    Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case managemen

  16. Investigation on Health Care Service Demand Among Elderly People in the Minority Area%少数民族地区老年人健康保健服务需求调查

    Institute of Scientific and Technical Information of China (English)

    陈先波; 叶亚怀; 高红; 金新政

    2011-01-01

    Objective To understand health care service demand among elderly people in the minority area, and to provide reference for enacting relevant measure.Method Cluster random sampling method was used to conduct a household survey on the elderly in Luoping Country, Yunnan.Result Only 30.0% of the elderly people who felt mild diseases went to community health service center or street health service center.Medical skill was chosen as a primary consideration of medical institutions in 30.9% participants.The most wanted health care services were self-help first -aid, real time health monitoring, regular examination,health education, and health record.Conclusion It is urgent to improve the community health service system to meet the increasing demand of health care service among the elderly population in the minority area.%目的 了解少数民族地区老年人健康服务需求状况,为制定相关措施提供参考.方法 采用整群随机抽样的方法,对云南省罗平县的老年人进行入户问卷调查.用PASW Statistics 18.0统计软件进行分析处理.结果老年人选择到社区、街道卫生服务中心就诊仅占30.0%,将医疗水平作为选择就诊要考虑因素的响应比为30.9%,最希望得到的健康保健服务项目是自助呼救、健康实时监测、定期检查、健康教育、健康档案等.结论 急需完善社区卫生服务体系以满足少数民族地区老年人较高的健康保健服务需求.

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

    Institute of Scientific and Technical Information of China (English)

    姜向群; 刘妮娜; 魏蒙

    2014-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    廖晓春

    2009-01-01

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

  19. Cytopathology of neoplastic meningitis: A series of 66 cases from a tertiary care center

    Directory of Open Access Journals (Sweden)

    Gurdeep Singh

    2013-01-01

    Full Text Available Background: Neoplastic meningitis (NM is a condition characterized by leptomeningeal involvement by metastatic carcinoma. Detection of exfoliated malignant cells in cerebrospinal fluid (CSF due to meningeal metastasis is frequently associated with diverse neurologic presentations. Materials and Methods: In this retrospective study of all cases of NM diagnosed in CSF samples over a 20-year period at a tertiary care referral center, the cytomorphologic features were reviewed. Results: Sixty six cases of NM were identified of which 36 already had an established diagnosis of malignancy while in 30 patients, there was no previously known tumor. The most common known primary in the former group was breast followed by ovary. Single cell pattern, cellular cannibalism, moderate cytoplasm and rounded nuclei were seen in breast and lung tumors. Papillary architecture and cytoplasmic vacuolation were seen in the ovarian primaries. Melanin pigment was seen in malignant melanoma. Conclusion: CSF cytology is an important tool for diagnosis of NM. Cytomorphologic features helped in diagnosis and for prediction of the primary site. Correct identification of this condition is important as it has therapeutic and prognostic implications.

  20. DOES GENERIC ADVERTISING WRAP DEMAND CURVATURE?

    OpenAIRE

    Weaver, Robert D.; Chin, Ming-Chin

    2002-01-01

    This paper reconsiders the impacts of generic advertising on commodity prices that may be induced through demand effects. Rather than considering a simple demand shift, we consider the possibility that advertising leads to a change in the curvature of the demand curve. In this case, generic advertising is shown to affect both the level of market prices as well as their volatility. Based on parametric tests, we find that the demand elasticity appears to be affected by the intensity of generic ...

  1. Case management for patients with chronic systolic heart failure in primary care: The HICMan exploratory randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Kunz Cornelia U

    2010-05-01

    Full Text Available Abstract Background Chronic (systolic heart failure (CHF represents a clinical syndrome with high individual and societal burden of disease. Multifaceted interventions like case management are seen as promising ways of improving patient outcomes, but lack a robust evidence base, especially for primary care. The aim of the study was to explore the effectiveness of a new model of CHF case management conducted by doctors' assistants (DAs, equivalent to a nursing role and supported by general practitioners (GPs. Methods This patient-randomised controlled trial (phase II included 31 DAs and employing GPs from 29 small office-based practices in Germany. Patients with CHF received either case management (n = 99 consisting of telephone monitoring and home visits or usual care (n = 100 for 12 months. We obtained clinical data, health care utilisation data, and patient-reported data on generic and disease-specific quality of life (QoL, SF-36 and KCCQ, CHF self-care (EHFScBS and on quality of care (PACIC-5A. To compare between groups at follow-up, we performed analyses of covariance and logistic regression models. Results Baseline measurement showed high guideline adherence to evidence-based pharmacotherapy and good patient self-care: Patients received angiotensin converting enzyme inhibitors (or angiotensin-2 receptor antagonists in 93.8% and 95%, and betablockers in 72.2% and 84%, and received both in combination in 68% and 80% of cases respectively. EHFScBS scores (SD were 25.4 (8.4 and 25.0 (7.1. KCCQ overall summary scores (SD were 65.4 (22.6 and 64.7 (22.7. We found low hospital admission and mortality rates. EHFScBS scores (-3.6 [-5.7;-1.6] and PACIC and 5A scores (both 0.5, [0.3;0.7/0.8] improved in favour of CM but QoL scores showed no significant group differences (Physical/Mental SF-36 summary scores/KCCQ-os [95%CI]: -0.3 [-3.0;2.5]/-0.1 [-3.4;3.1]/1.7 [-3.0;6.4]. Conclusions In this sample, with little room for improvement regarding evidence

  2. Case Study: Evidence-Based Interventions Enhancing Diabetic Foot Care Behaviors among Hospitalized DM Patients

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    Titis Kurniawan

    2011-01-01

    Full Text Available Background: Improving diabetic patients’ foot care behaviors is one of the most effective strategies in minimizing diabetic foot ulceration and its further negative impacts, either in diabetic hospitalized patients or outpatients.Purpose: To describe foot care knowledge and behaviors among hospitalized diabetic patients, to apply selected foot care knowledge and behaviors improvement evidence, and to evaluate its effectiveness.Method: Four diabetic patients who were under our care for at least three days and could communicate in Thai language were selected from a surgical ward in a university hospital. The authors applied educational program based on patients’ learning needs, provided diabetic foot care leaflet, and assisted patients to set their goal and action plans. In the third day of treatment, we evaluated patients’ foot care knowledge and their goal and action plan statements in improving foot care behaviors.Result: Based on the data collected among four hospitalized diabetic patients, it was shown that all patients needed foot care behaviors improvement and the educational program improved hospitalized patients’ foot care knowledge and their perceived foot care behaviors. The educational program that combined with goal setting and action plans method was easy, safe, and seemed feasibly applicable for diabetic hospitalized patients.Conclusion: The results of this study provide valuable information for improvement of hospitalized diabetic patients’ foot care knowledge and behaviors. The authors recommend nurses to use this evidence-based practice to contribute in improving the quality of diabetic care.Keywords: Intervention, diabetic foot care, hospitalized diabetic patients

  3. A Study in Child Care (Case Study from Volume II-A): "A Rolls-Royce of Day Care." Day Care Programs Reprint Series.

    Science.gov (United States)

    O'Farrell, Brigid

    The Amalgamated Day Care Center is an independent trust established through a collective bargaining agreement between the Amalgamated Clothing Workers of America, AFL-CIO, and the employers of the garment industry. The free center, open from 6:00 a.m. to 6:00 p.m., is located near the Chicago garment industries to minimize transportation problems…

  4. Analyzing the impacts of final demand changes on total output using input-output approach: The case of Japanese ICT sectors

    International Nuclear Information System (INIS)

    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

  5. Perceptions of Nursing Care for Cardiovascular Cases, Knowledge on the Telehealth and Telecardiology in Indonesia

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    Rr. Tutik Sri Hariyati

    2012-02-01

    Full Text Available Background: Nowadays, the life-style displacement promotes the increasing of degenerative disease, such as cardiovascular disease, which since 1995, has been stated as the main cause of fatality in Indonesia. Telehealth was defined as the use of the telecommunication technology to support the health information and increase the health service. Telehealth in developed countries can improve the behavior of healthy living. Telehealth in Indonesia is expected to increase healthy lifestyles that can reduce the risk of cardiovascular disease and other degenerative diseases.Objectives: This study aimed to explore perceptions of related experience in the nursing care of cardiovascular cases, experience in the use of telehealth and hopes in telehealth implementation in Indonesia.Study Design: This study used a qualitative study with focus group discussions approach. Participants in this study are 64 nurses. The selection of participants was carried out using purposive sampling. The data of this research, which were in the form of transcript and field report from each group discussion of the FGD, was analyzed using the phenomenology method developed by Collaizi.Results: The theme of nursing care was divided into 4 sub-themes that were: assessment, diagnosis, planning, implementation and evaluation. The subtheme of definition and hopes to telehealth was stated, “As far as I know, the heart hospital has used online system, so that if we want to do referral, the patient can consultation directly, but t I don’t know about the system. With Telehealth, nurses could observe the sign and symptoms from patient’s home.Conclusion: The results of qualitative studies show that telehealth In Indonesia was limited. Expectations for the development of telehealth/telecardiology is to further facilitate consultation, communication and education can support the patient or a nurse

  6. VESICOVAGINAL FISTULA: OUR EXPERIENCE OF 47 CASES IN A TERTIARY CARE HOSPITAL OF WEST BENGAL

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    Biswajit

    2016-06-01

    Full Text Available Vesicovaginal Fistula (VVF, an abnormal communication between the urinary bladder and vagina, is one of the most distressing and embarrassing health problem for the ladies. The present observational study was planned to inquire into the demographic and aetiologic pattern of vesicovaginal fistula and the long-term success rate of its surgical management following different techniques of repair in a tertiary care centre of West Bengal, India. MATERIAL AND METHODS A total of 47 patients with vesicovaginal fistula presented at our hospital over a span of nine years, were observed during their course of treatment. The patients were evaluated with clinical history, physical examination, routine laboratory investigations, intravenous urogram and cystoscopy. Then the patients had undergone operation by vaginal or abdominal route. Patients were discharged from the hospital with per urethral catheter. On 21st post-operative day, routine cystogram was done in every patient before catheter removal to exclude the failure of the operation. RESULT Of the observed 47 patients, 66% were tracked back to their obstetric causes and 34% patients could be linked up to gynaecological aetiology like a complication of hysterectomy or after brachytherapy for carcinoma of cervix. In 23.4% of patients, the repair of fistula was done by vaginal route, whereas in 76.6% cases by abdominal approach. Overall success rate of surgical repair was 87.3%, which is comparable to the success rate mentioned in literature. CONCLUSION In spite of a decline in the incidence of vesicovaginal fistula in the western world, it is still highly prevalent in the developing countries. Prolonged obstructive labour was found as the most common aetiology of this devastating condition in our region. Timely intervention with meticulous surgical technique is essential for an acceptable success rate in fistula repair surgery. However, improved obstetric care, institutional delivery, high literacy rate

  7. Observation on dengue cases from a virus diagnostic laboratory of a tertiary care hospital in north India

    OpenAIRE

    Om Prakash; Desh Deepak Singh; Geetika Mishra; Shantanu Prakash; Arvind Singh; Shikha Gupta; Jasmeet Singh; Danish Nasar Khan; Parul Jain; Anamika Vishal; Manoj Kumar Pandey; Amita Jain

    2015-01-01

    Background & objectives: The epidemiology of dengue fever (DF) is complex in the Indian subcontinent as all the four serotypes are circulating. This study reports observations on dengue cases from a virus diagnostic laboratory of a north Indian tertiary care hospital catering to areas in and around Lucknow, Uttar Pradesh. Methods: Serum samples were obtained from suspected cases of dengue referred to the virus diagnostic laboratory during 2011 to 2013, and detailed history was taken on a ...

  8. Familial Dysautonomia, Report of 3 Cases from Iran and a Discussion about Their General and Anaesthesia Care

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    Badiozaman Radpay

    2015-04-01

    Full Text Available Background: Familial Dysautonomia (FD is a rare hereditary syndrome which is an autosomal recessive trait that typically affects Jewish children. Important signs and symptoms of the disorder include; diminished pain perception, absence of overflow tears, hypotonia, fainting cardiac arrhythmias and autonomic crisis.Cases Report: In this article we reported 3 cases of FD syndrome which had presented for surgical operation followed by a discussion about general care of these patients as well as Anesthesia considerations.

  9. Familial Dysautonomia, Report of 3 Cases from Iran and a Discussion about Their General and Anaesthesia Care

    OpenAIRE

    Badiozaman Radpay; Mahtab Poor Zamany Nejat Kermany; Ali Asghar Halimi-Asl

    2015-01-01

    Background: Familial Dysautonomia (FD) is a rare hereditary syndrome which is an autosomal recessive trait that typically affects Jewish children. Important signs and symptoms of the disorder include; diminished pain perception, absence of overflow tears, hypotonia, fainting cardiac arrhythmias and autonomic crisis.Cases Report: In this article we reported 3 cases of FD syndrome which had presented for surgical operation followed by a discussion about general care of these patients as well as...

  10. Ombudsmen in health care: case study of a municipal health ombudsman

    Science.gov (United States)

    da Silva, Rita de Cássia Costa; Pedroso, Marcelo Caldeira; Zucchi, Paola

    2014-01-01

    OBJECTIVE To analyze the role of a Municipal Health Ombudsman and its contribution to the public health management from the perspective of the public health system users and the municipal health counselors. METHODS Qualitative research approach using the case study, descriptive and transversal methods. The unit of analysis was a Municipal Health Ombudsman, in the state of Minas Gerais, Southeastern Brazil, between May and August 2010. The study was observational in nature and data were collected through interviews with two groups of stakeholders: users and municipal health counselors. We interviewed 44 Brazilian Unified Health System users who had made direct use of the Municipal Health Ombudsman and all 20 municipal health counselors. The data obtained were analyzed based on three issues: (1) nature of the data obtained; (2) discussion of subsidies to qualify the ombudsman’s functioning as a management tool; (3) proposals for actions to improve democratic management in the area of public health. RESULTS The complaints to the ombudsman denoted difficulties in access to health care services running the risk of their being perceived as shortcuts to gaining accessibility, disregarding the principle of social justice. The role of the ombudsman has the citizens’ approval. Users reported the following main functions of the ombudsman: to support the resolution of health problems, to listen and to clarify issues regarding Brazilian Unified Health System operations and procedures. Information was emphasized by health counselors as an instrument of power and access to the rights of Brazilian Unified Health System users. They highlighted that the ombudsman has the role of ensuring justice to foster an effective health policy, besides playing an important mediating role between the board of the municipal health system, its managers and citizens. Furthermore, the ombudsman was shown to have an execution role that transcends its regular functions. CONCLUSIONS The study found

  11. Estimation of the building energy loads and LNG demand for a cogeneration-based community energy system: A case study in Korea

    International Nuclear Information System (INIS)

    Highlights: • We estimated energy demand of building groups in a town using an in-house tool. • We developed an operation simulator to match supply–demand processes of energy. • Detailed technological information to operate the CES is provided by the simulation. • LNG demand is forecasted for the expansion of the CES up to 14 years in the future. - Abstract: We analyzed energy consumption by a newly constructed part of a city in Korea to forecast the LNG demand for 14 years. The electricity, heating, cooling, and hot-water demands for a cogeneration-based CES (Community Energy System) accommodating 86,000 people in 29,000 houses are estimated using load models developed through direct measurements and statistical surveys. Based on published occupancy rates and forecasts of the rate of increase in energy consumption by third parties through independent study, the energy demands were driven in the form of 8760-h time series for each of the 14 years. Next, we simulate the demand–supply matching processes of a specifically chosen cogeneration engine for the CES to forecast the LNG consumption and the electricity trade for each year. We simulated the demand–supply matching processes with an automation tool specifically developed for this study. The methodology we established in this study can be applied to similar problems which may arise anywhere in the world

  12. Economic crisis and counter-reform of universal health care systems: Spanish case

    OpenAIRE

    Paulo Antônio de Carvalho Fortes; Regina Ribeiro Parizi Carvalho; Marília Cristina Prado Louvison

    2015-01-01

    The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, ...

  13. Transforming Medical Care: Case Study of an Exemplary, Small Medical Group

    OpenAIRE

    Solberg, Leif I.; Hroscikoski, Mary C.; Sperl-Hillen, JoAnn M.; Harper, Peter G.; Crabtree, Benjamin F.

    2006-01-01

    PURPOSE Most published descriptions of organizations providing or improving quality of care concern large medical groups or systems; however, 90% of the medical care in the United States is provided by groups of no more than 20 physicians. We studied one such group to determine the organizational and cultural attributes that seem related to its achievements in care quality.

  14. Depression case management by practice nurses in primary care: an audit

    OpenAIRE

    Ekers, David; Wilson, Rea

    2008-01-01

    Introduction Depression is a common and debilitating condition. A body of evidence exists about improving depression outcomes in primary care, using collaborative care models. Such approaches, however, have not been routinely adopted within general practice settings. In this paper we outline the results of an audit of an enhanced care initiative that trained practice nurses to deliver such approaches.

  15. Oferta e demanda por média complexidade/SUS: relação com atenção básica Supply and demand of the medium-complexity/SUS: relation with primary health care

    Directory of Open Access Journals (Sweden)

    Maria Raquel Gomes Maia Pires

    2010-06-01

    Full Text Available Investiga-se a configuração da oferta e demanda por serviços de média complexidade do Distrito Federal (DF e municípios de Goiás próximos à Brasília - entorno. Nossa hipótese é de que a organização da oferta dos serviços de atenção básica (AB do DF e entorno sobrecarrega os serviços de média complexidade (MC, diminuindo a equidade no acesso. Objetivamos analisar a demanda por serviços de MC no DF e sua relação com a AB; quantificar a procedência, problema de saúde, motivo da procura, tempo de deslocamento e procedimentos realizados em pessoas que buscam atendimento nos hospitais do DF; indicar prioridades de mudanças na gestão do SUS para ampliação do acesso. Avaliação por triangulação de métodos, complementaridade das abordagens qualitativa e quantitativa. Estudo da oferta mediante análise dos sistemas de informação do SUS e da demanda por meio de survey com 1.585 usuários de sete hospitais do DF. Ocorre subutilização da oferta de serviços do DF, com duplicidade de ações básicas entre os hospitais e os centros de saúde. Recomenda-se revisão na regionalização e hierarquização dos serviços de saúde do DF e Goiás, bem como investimentos na incorporação de tecnologias para a atenção básica.This work aims at investigating the supply and demand of the medium-complexity services from the Federal District and surrounding municipalities from the state of Goiás. Our hypothesis is that the services organization offer of primary care (PC from the Federal District (DF and its surroundings overloads the medium-complexity services (MC, contributing to less equity in terms of communities access. Our objective is to analyze the demand for MC (medium-complexity services in DF (Federal District and its relation with PC (Primary Care; to quantify the origin, health problem, reason, transportation time and performed procedures of the ones who go to the Federal District hospitals; to set up priorities of

  16. Fashioning the Reciprocal Norms of Elder Care: A Case of Immigrants in the United States and Their Parents in Taiwan

    Science.gov (United States)

    Sun, Ken C.

    2012-01-01

    In this study, the author uses the changing practice of geriatric care within transnational Taiwanese families as a case to examine the processes through which a family ideology "travels," varies, and operates across worlds. Specifically, the author argues that family members across generations reconstruct "rules of reciprocity" to facilitate the…

  17. Electroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit--five cases and a review

    DEFF Research Database (Denmark)

    Nielsen, R M; Olsen, K S; Lauritsen, Anne Øberg;

    2014-01-01

    PURPOSE: Delirium in the intensive care unit (ICU) is conventionally treated pharmacologically but can progress into a protracted state refractory to medical treatment--a potentially life-threatening condition in itself. METHODS: We treated 5 cases of severe protracted delirium in our ICU with el...

  18. To what extent do primary care practice nurses act as case managers life style counselling regarding weight management?

    NARCIS (Netherlands)

    Dillen, van S.; Hiddink, G.J.

    2014-01-01

    Background - In this review study, we are the first to explore whether the practice nurse (PN) can act as case manager lifestyle counselling regarding weight management in primary care. Methods - Multiple electronic databases (MEDLINE, PsycINFO) were searched to identify relevant literature after 19

  19. Process evaluation to explore internal and external validity of the "Act in Case of Depression" care program in nursing homes.

    NARCIS (Netherlands)

    Leontjevas, R.; Gerritsen, D.L.; Koopmans, R.T.C.M.; Smalbrugge, M.; Vernooij-Dassen, M.J.F.J.

    2012-01-01

    BACKGROUND: A multidisciplinary, evidence-based care program to improve the management of depression in nursing home residents was implemented and tested using a stepped-wedge design in 23 nursing homes (NHs): "Act in case of Depression" (AiD). OBJECTIVE: Before effect analyses, to evaluate AiD proc

  20. Pluralist social constraints on the development of a health care system: the case of Israel.

    Science.gov (United States)

    Palley, H A; Yishai, Y; Ever-Hadani, P

    1983-01-01

    The effectiveness of Israel's health care system is hindered by pluralism, in terms both of its many separate health service institutions and of the particularism of those institutions. Although the health care system provides modern health care to a widely insured population, it does so inefficiently and at unnecessary expense. The lack of vertical and horizontal integration of the health care system has led to problems of fragmentation, duplication, and lack of coordination of services. Because of its limited resources, Israel must work to surmount this pluralism and achieve integrated planning if it is to succeed in providing the efficient and cost-effective care its population needs.

  1. A retrospective study of 296 cases of intra uterine fetal deaths at a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Neetu Singh

    2013-04-01

    Full Text Available Background: To identify the risk factors and to streamline preventive and management protocols for IUD. Methods: This was a retrospective study from January 2011 to December 2012 which was conducted at G.S.V.M. Medical College, Kanpur. IUD was defined as fetal death beyond 20 weeks of gestation and/or birth weight > 500g. Maternal and fetal records were analysed. Mode of delivery and associated complications were studied. Results: Total number of deliveries were 7310.Incidence of IUD at our centre was 40 per 1000. 55.73% were antepartum and 11.06% were intra partum. In 33.44% cases, no causes were identified. Among the identifiable causes, very severe anemia (16.55% and hypertensive disorders (10.81% were most common followed by placental causes (12.16%.Congenital malformations were responsible for 9.45% cases .Induction was done in 151 patients,111 patients had spontaneous onset of labour and caesarean section was done in 34 patients. The most devastating complication of IUD was DIC found in 14 patients (3.71%. Conclusions: The present study is an effort to compile a profile of maternal, fetal and placental causes culminating to IUD at our centre. This emphasizes the importance of proper antenatal care and identification of risk factors and its treatment. Institutional deliveries should be promoted to prevent intrapartum fetal deaths .A substantial number of IUD are still labeled as unexplained, hence cannot be prevented. Decrease in the incidence of IUD would significantly reduce the perinatal mortality. [Int J Reprod Contracept Obstet Gynecol 2013; 2(2.000: 141-146

  2. The evaluation of cases with pneumothorax in the neonatal intensive care unit

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    Müsemma Karabel

    2013-09-01

    Full Text Available Objectives: Early diagnosis and treatment is essentialin reducing mortality in newborns with pneumothorax. Inthis study, newborns with a diagnosis of pneumothorax inneonatal intensive care unit of our hospital were evaluatedand aimed to increase the awareness of physicians.Methods: 12 cases with pneumothorax were evaluatedretrospectively. The gender, birth weight, gestational age,mode of delivery, the presence of underlying disease,pneumothorax localization, implementation of the surfactantand mechanical ventilation and existence or absenceof mortality were recorded.Results: During the study, pneumothorax was detected12 patients. Male/female ratio was 1.4. Eight of the patientshad born with cesarean delivery, the mean birthweight of cases was 2623±912 g and, 66.7% of caseswere term babies. Pneumothorax was observed in thefirst week of life in all patients and it occurred spontaneouslyin 4 patients. The frequency of bilateral pneumothoraxwas 41.7%. For the treatment, closed tube drainagewas performed in 9 patients. The overall mortality ratewas 66.7%. Half of the patients who died had congenitalanomalies such as diaphragmatic eventration (n=1,hydrocephalus (n=1, encephalocel (n=1, non-immunehydrops fetalis (n=1.Conclusion: Additional congenital anomalies, such asPDAs and persistent pulmonary hypertension were foundto be effective on mortality in neonates with pneumothorax.Although, it is a life-threatening condition, the emergencytreatment is life saving. Therefore, in patients withrisk factors, keeping pneumothorax in mind is also thefirst step of the treatment. J Clin Exp Invest 2013; 4 (3:289-292Key words: Newborn, respiratuar distress, pneumothorax,treatment, outcome

  3. Opposite Drug Prescription and Cost Trajectories following Integrative and Conventional Care for Pain – A Case-Control Study

    Science.gov (United States)

    Sundberg, Tobias; Petzold, Max; Kohls, Niko; Falkenberg, Torkel

    2014-01-01

    Objectives Pharmacotherapy may have a limited role in long-term pain management. Comparative trajectories of drug prescriptions and costs, two quality-of-care indicators for pain conditions, are largely unknown subsequent to conventional or integrative care (IC) management. The objectives of this study were to compare prescribed defined daily doses (DDD) and cost of first line drugs for pain patients referred to conventional or anthroposophic IC in Stockholm County, Sweden. Methods In this retrospective high quality registry case-control study, IC and conventional care patients were identified through inpatient care registries and matched on pain diagnosis (ICD-10: M79), age, gender and socio-demographics. National drug registry data was used to investigate changes in DDD and costs from 90/180 days before, to 90/180 days after, index visits to IC and conventional care. The primary selected drug category was analgesics, complemented by musculo-skeletal system drugs (e.g. anti-inflammatories, muscle relaxants) and psycholeptics (e.g. hypnotics, sedatives). Results After index care visits, conventional care pain patients (n = 1050) compared to IC patients (n = 213), were prescribed significantly more analgesics. The average (95% CI) group difference was 15.2 (6.0 to 24.3), p = 0.001, DDD/patient after 90 days; and 21.5 (7.4 to 35.6), p = 0.003, DDD/patient after 180 days. The cost of the prescribed and sold analgesics was significantly higher for conventional care after 90 days: euro/patient 10.7 (1.3 to 20.0), p = 0.025. Changes in drug prescription and costs for the other drug categories were not significantly different between groups. Conclusions Drug prescriptions and costs of analgesics increased following conventional care and decreased following IC, indicating potentially fewer adverse drug events and beneficial societal cost savings with IC. PMID:24827981

  4. Integration of the leprosy programme into primary health care: a case study of perceptions of primary health care workers.

    Science.gov (United States)

    Raju, M S; Dongre, V V

    2003-01-01

    Integration of the vertical leprosy programme into the existing horizontal health programme poses various administrative and operational challenges to programmers. In order to understand the preparedness of the PHC workers for integration of leprosy into primary health care services, 71 PHC workers were interviewed using a structured interview schedule. The results showed that about 42% of the staff have heard of the concept of integration earlier and 90% of the PHC staff are willing to treat leprosy patients in the primary health care centre, but only 72% were in favour of integration. The reasons for favouring integration were (1) wider coverage with MDT, (2) frequent field visits by the worker, (3) better rapport with the community, (4) timely treatment and (5) cost-effectiveness. About 28% of the staff members did not favour integration for the reasons that the leprosy programme would suffer, targets cannot be met, supervision would be difficult, knowledge of the staff was inadequate and importance cannot be given to leprosy as family planning is always a priority in PHC centres. About 43% of the staff felt that the performance of the leprosy programme would be better after integration. With regard to workload, 60% of the sample felt that there would be increase in the workload in the field, record maintenance and supervision. The difficulties foreseen by the workers were grouped into 6 categories, viz., administrative, managerial, technical, personnel, social and miscellaneous. It is worth noting that 91% of the staff that included all categories said they were not afraid of leprosy, but needed training in leprosy work. About 50% of the staff expected increase in salaries and promotions if integration took place.

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

    Directory of Open Access Journals (Sweden)

    Hossein Sadeghi

    2014-11-01

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

  6. Efficiency and quality of care in nursing homes: an Italian case study.

    Science.gov (United States)

    Garavaglia, Giulia; Lettieri, Emanuele; Agasisti, Tommaso; Lopez, Silvano

    2011-03-01

    This study investigates efficiency and quality of care in nursing homes. By means of Data Envelopment Analysis (DEA), the efficiency of 40 nursing homes that deliver their services in the north-western area of the Lombardy Region was assessed over a 3-year period (2005-2007). Lombardy is a very peculiar setting, since it is the only Region in Italy where the healthcare industry is organised as a quasi-market, in which the public authority buys health and nursing services from independent providers-establishing a reimbursement system for this purpose. The analysis is conducted by generating bootstrapped DEA efficiency scores for each nursing home (stage one), then regressing those scores on explanatory variables (stage two). Our DEA model employed two input (i.e. costs for health and nursing services and costs for residential services) and three output variables (case mix, extra nursing hours and residential charges). In the second-stage analysis, Tobit regressions and the Kruskall-Wallis tests of hypothesis to the efficiency scores were applied to define what are the factors that affect efficiency: (a) the ownership (private nursing houses outperform their public counterparts); and (b) the capability to implement strategies for labour cost and nursing costs containment, since the efficiency heavily depends upon the alignment of the costs to the public reimbursement system. Lastly, even though the public institutions are less efficient than the private ones, the results suggest that public nursing homes are moving towards their private counterparts, and thus competition is benefiting efficiency. PMID:20922483

  7. Up against the System: A Case Study of Young Adult Perspectives Transitioning from Pediatric Palliative Care

    Directory of Open Access Journals (Sweden)

    Karen Cook

    2013-01-01

    Full Text Available Advances in pediatric care have not provided the interdisciplinary support services required by those young adults with pediatric life-threatening conditions (pedLTCs who live beyond childhood but have limited expectations to live past early adulthood. These young adults, the first generation to live into adulthood, face multiple challenges transitioning from a plethora of pediatric palliative services to scant adult health services. In a case study, using an innovative bulletin board focus group, we describe the complex interplay of the health, education, and social service sectors in this transition. Our descriptions include system deficits and strengths and the young adults’ resilience and coping strategies to overcome those deficits and move forward with their lives. Young adults with pedLTC need knowledgeable providers, coordinated and accessible services, being respected and valued, and services and supports that promote independence. We recommend implementation of multidisciplinary solutions that are focused on young adult priorities to ensure seamless access to resources to support these young adults’ health, educational, vocational, and social goals. The input and voice of young adults in the development of these services are imperative to ensure that multisystem services support their needs and life goals.

  8. Punica granatum L. Hydrogel for Wound Care Treatment: From Case Study to Phytomedicine Standardization

    Directory of Open Access Journals (Sweden)

    Aline Fleck

    2016-08-01

    Full Text Available The pharmacological activities of many Punica granatum L. components suggest a wide range of clinical applications for the prevention and treatment of diseases where chronic inflammation is believed to play an essential etiologic role. The current work reports a case study analyzing the effect produced by a magistral formulation of ethanolic extracts of Punica granatum peels on a non-healing chronic ulcer. The complete closure of the chronic ulcer that was initially not responsive to standard medical care was observed. A 2% (w/w P. granatum peels ethanolic extract hydrogel-based formulation (PGHF was standardized and subjected to physicochemical studies to establish the quality control parameters using, among others, assessment criteria such as optimum appearance, pH range, viscosity and hydrogel disintegration. The stability and quantitative chromatographic data was assessed in storage for six months under two temperature regimes. An efficient HPLC-DAD method was established distinguishing the biomarkers punicalin and punicalagin simultaneously in a single 8 min run. PGHF presented suitable sensorial and physicochemical performance, showing that punicalagin was not significantly affected by storage (p > 0.05. Formulations containing extracts with not less than 0.49% (w/w total punicalagin might find good use in wound healing therapy.

  9. Evaluation of point-of-care testing of C-reactive protein in forensic autopsy cases.

    Science.gov (United States)

    Soejima, Mikiko; Koda, Yoshiro

    2014-04-01

    We assessed the technical performance and robustness of the point-of-care test for C-reactive protein (CRP) NycoCard CRP for use in forensic autopsy cases. The results of 17 of 39 cadaver blood samples that had CRP in the range effectively measured by the NycoCard (5-120mg/l) correlated well (r=0.99) with those of quantitative latex agglutination immunoassay (turbidimetry), and the out-of-range NycoCard results were fully consistent with those obtained by turbidimetry. For the ten sera whose CRP >120mg/l according to NycoCard, a significant correlation (r=0.98) was observed between values multiplied by the dilution ratio and those of turbidimetry. No significant differences were observed after a freeze-thaw procedure. In addition, CRP results using recombinant human CRP spiked with hemoglobin up to 80g/l were not significantly different from the unspiked results in PBS. The test allows reliable and cost-effective on-site measurement of CRP from a small volume of serum (5μl) with simple equipment. This semi-quantification method of CRP should be useful for diagnosis during autopsy.

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

    Directory of Open Access Journals (Sweden)

    Niels Framroze Møller

    2015-06-01

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

  11. Severe imported malaria in an intensive care unit: a review of 59 cases

    Directory of Open Access Journals (Sweden)

    Santos Lurdes C

    2012-03-01

    Full Text Available Abstract Background In view of the close relationship of Portugal with African countries, particularly former Portuguese colonies, the diagnosis of malaria is not a rare thing. When a traveller returns ill from endemic areas, malaria should be the number one suspect. World Health Organization treatment guidelines recommend that adults with severe malaria should be admitted to an intensive care unit (ICU. Methods Severe cases of malaria in patients admitted to an ICU were reviewed retrospectively (1990-2011 and identification of variables associated with in-ICU mortality performed. Malaria prediction score (MPS, malaria score for adults (MSA, simplified acute physiology score (SAPSII and a score based on WHO's malaria severe criteria were applied. Statistical analysis was performed using StataV12. Results Fifty nine patients were included in the study, all but three were adults; 47 (79,6% were male; parasitaemia on admission, quantified in 48/59 (81.3% patients, was equal or greater than 2% in 47 of them (97.9%; the most common complications were thrombocytopaenia in 54 (91.5% patients, associated with disseminated intravascular coagulation (DIC in seven (11.8%, renal failure in 31 (52.5% patients, 18 of which (30.5% oliguric, shock in 29 (49.1% patients, liver dysfunction in 27 (45.7% patients, acidaemia in 23 (38.9% patients, cerebral dysfunction in 22 (37.2% patients, 11 of whom with unrousable coma, pulmonary oedema/ARDS in 22 (37.2% patients, hypoglycaemia in 18 (30.5% patients; 29 (49.1% patients presented five or more dysfunctions. The case fatality rate was 15.2%. Comparing the four scores, the SAPS II and the WHO score were the most sensitive to death prediction. In the univariate analysis, death was associated with the SAPS II score, cerebral malaria, acute renal and respiratory failure, DIC, spontaneous bleeding, acidosis and hypoglycaemia. Age, partial immunity to malaria, delay in malaria diagnosis and the level of parasitaemia were

  12. Intensive medical student involvement in short-term surgical trips provides safe and effective patient care: a case review

    Directory of Open Access Journals (Sweden)

    Macleod Jana B

    2011-09-01

    Full Text Available Abstract Background The hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. We report on a student-faculty collaboration that has successfully operated an annual, short-term surgical intervention in Haiti for the last three years. Medical students were responsible for logistics and were overseen by faculty members for patient care. Substantial planning with local partners ensured that trip activities supplemented existing surgical services. A case review was performed hypothesizing that such trips could provide effective surgical care while also providing a suitable educational experience. Findings Over three week-long trips, 64 cases were performed without any reported complications, and no immediate perioperative morbidity or mortality. A plurality of cases were complex urological procedures that required surgical skills that were locally unavailable (43%. Surgical productivity was twice that of comparable peer institutions in the region. Student roles in patient care were greatly expanded in comparison to those at U.S. academic medical centers and appropriate supervision was maintained. Discussion This demonstration project suggests that a properly designed surgical trip model can effectively balance the surgical needs of the community with an opportunity to expose young trainees to a clinical and cross-cultural experience rarely provided at this early stage of medical education. Few formalized programs currently exist although the experience above suggests the rewarding potential for broad-based adoption.

  13. "Because somebody cared about me. That's how it changed things": homeless, chronically ill patients' perspectives on case management.

    Directory of Open Access Journals (Sweden)

    Elizabeth Davis

    Full Text Available BACKGROUND: Case management programs for chronically ill, homeless people improve health and resource utilization by linking patients with case managers focused on improving management of medical and psychosocial problems. Little is known about participants' perspectives on case management interventions. METHODS: This qualitative study used in-depth, one-on-one interviews to understand the impact of a case management program from the perspective of participants. A standardized interview guide with open-ended questions explored experiences with the case management program and feelings about readiness to leave the program. RESULTS: FOUR RECURRENT THEMES EMERGED: (1 Participants described profound social isolation prior to case management program enrollment; (2 Participants perceived that caring personal relationships with case managers were key to the program; (3 Participants valued assistance with navigating medical and social systems; and (4 Participants perceived that their health improved through both the interpersonal and the practical aspects of case management. CONCLUSIONS: Chronically ill, homeless people enrolled in a case management program perceived that social support from case managers resulted in improved health. Programs for this population should consider explicitly including comprehensive social support interventions. Further research on case management should explore the impact of different types of social support on outcomes for homeless chronically ill patients.

  14. The Nordic maintenance care program – case management of chiropractic patients with low back pain: A survey of Swedish chiropractors

    Directory of Open Access Journals (Sweden)

    Jørgensen Kristian

    2008-06-01

    Full Text Available Abstract Background Chiropractic treatment for low back pain (LBP can often be divided into two phases: Initial treatment of the problem to attempt to remove pain and bring it back into its pre-clinical or maximum improvement status, and "maintenance care", during which it is attempted to maintain this status. Although the use of chiropractic maintenance care has been described and discussed in the literature, there is no information as to its precise indications. The objective of this study is to investigate if there is agreement among Swedish chiropractors on the overall patient management for various types of LBP-scenarios, with a special emphasis on maintenance care. Method The design was a mailed questionnaire survey. Members of the Swedish Chiropractors' Association, who were participants in previous practice-based research, were sent a closed-end questionnaire consisting of nine case scenarios and six clinical management alternatives and the possibility to create one's own alternative, resulting in a "nine-by-seven" table. The research team defined its own pre hoc choice of "clinically logical" answers based on the team's clinical experience. The frequency of findings was compared to the suggestions of the research team. Results Replies were received from 59 (60% of the 99 persons who were invited to take part in the study. A pattern of self-reported clinical management strategies emerged, largely corresponding to the "clinically logical" answers suggested by the research team. In general, patients of concern would be referred out for a second opinion, cases with early recovery and without a history of previous low back pain would be quickly closed, and cases with quick recovery and a history of recurring events would be considered for maintenance care. However, also other management patterns were noted, in particular in the direction of maintenance care. Conclusion To a reasonable extent, Swedish chiropractors participating in this

  15. Towards healthcare business intelligence in long-term care: an explorative case study in the Netherlands.

    OpenAIRE

    Spruit, M; Vroon, R.; Batenburg, R.

    2014-01-01

    This research contributes to the domain of long-term care by exploring knowledge discovery techniques based on a large dataset and guided by representative information needs to better manage both quality of care and financial spendings, as a next step towards more mature healthcare business intelligence in long-term care. We structure this exploratory research according to the steps of the CRoss Industry Standard Process for Data Mining (CRISP-DM) process. Firstly, we interview 22 experts to ...

  16. Developing Occupational Health Care Services For Better Customer Satisfaction : a case-study- Lohja Occupational Health

    OpenAIRE

    Pulliainen, Petra

    2015-01-01

    The renewal of Good Occupational Health Practice in Finland brings new challenges and triggers self-examination among occupational health care providers. Successful renewal of occupational health care practices emphasizes activity, commitment and trustworthiness from occupational health care providers but also from the customer companies. For this co-operation to work effectively, communication in a common language increases its’ importance furthermore. Since purchasing occupational health ca...

  17. Economic crisis and counter-reform of universal health care systems: Spanish case

    Science.gov (United States)

    Fortes, Paulo Antônio de Carvalho; Carvalho, Regina Ribeiro Parizi; Louvison, Marília Cristina Prado

    2015-01-01

    The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities. PMID:26083942

  18. Economic crisis and counter-reform of universal health care systems: Spanish case

    Directory of Open Access Journals (Sweden)

    Paulo Antônio de Carvalho Fortes

    2015-01-01

    Full Text Available The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities.

  19. Economic crisis and counter-reform of universal health care systems: Spanish case.

    Science.gov (United States)

    Fortes, Paulo Antônio de Carvalho; Carvalho, Regina Ribeiro Parizi; Louvison, Marília Cristina Prado

    2015-01-01

    The economic crisis that has been affecting Europe in the 21st century has modified social protection systems in the countries that adopted, in the 20th century, universal health care system models, such as Spain. This communication presents some recent transformations, which were caused by changes in Spanish law. Those changes relate to the access to health care services, mainly in regards to the provision of care to foreigners, to financial contribution from users for health care services, and to pharmaceutical assistance. In crisis situations, reforms are observed to follow a trend which restricts rights and deepens social inequalities. PMID:26083942

  20. Demandas de atendimento psiquiátrico em um hospital universitário Demandas de lo atendimiento psiquiátrico en un hospital universitario Demands of psychiatric care in a university hospital

    Directory of Open Access Journals (Sweden)

    Naiara Gajo Silva

    2011-09-01

    la necesidad de la interconsulta de enfermería psiquiátrica en este hospital.This is a cross-sectional study that aimed to describe the psychiatric demand in a university hospital in the city of Cuiabá, state of Mato Grosso, Brazil, and to know the current situation of the service to this demand. The data were collected from the inpatient medical records in a university hospital, from June to August, 2009, in a total of 551 records. Despite being considered by the literature as unprepared, nursing is the professional category that most identifies the psychiatric demand in this hospital. The treatment plan to this demand was restricted to medication, nine evaluations of psychology and thirteen consultation-liaison psychiatric service, without a significant involvement of nursing. The approach of emotional and/or mental aspects results in the improvement in the quality of nursing care, and there is a need for the nurses to qualify for that. To make it happen, we propose a reflection on the need for the consultation-liaison psychiatric service in this hospital.

  1. Piped water consumption in Ghana: A case study of temporal and spatial patterns of clean water demand relative to alternative water sources in rural small towns.

    Science.gov (United States)

    Kulinkina, Alexandra V; Kosinski, Karen C; Liss, Alexander; Adjei, Michael N; Ayamgah, Gilbert A; Webb, Patrick; Gute, David M; Plummer, Jeanine D; Naumova, Elena N

    2016-07-15

    Continuous access to adequate quantities of safe water is essential for human health and socioeconomic development. Piped water systems (PWSs) are an increasingly common type of water supply in rural African small towns. We assessed temporal and spatial patterns in water consumption from public standpipes of four PWSs in Ghana in order to assess clean water demand relative to other available water sources. Low water consumption was evident in all study towns, which manifested temporally and spatially. Temporal variability in water consumption that is negatively correlated with rainfall is an indicator of rainwater preference when it is available. Furthermore, our findings show that standpipes in close proximity to alternative water sources such as streams and hand-dug wells suffer further reductions in water consumption. Qualitative data suggest that consumer demand in the study towns appears to be driven more by water quantity, accessibility, and perceived aesthetic water quality, as compared to microbiological water quality or price. In settings with chronic under-utilization of improved water sources, increasing water demand through household connections, improving water quality with respect to taste and appropriateness for laundry, and educating residents about health benefits of using piped water should be prioritized. Continued consumer demand and sufficient revenue generation are important attributes of a water service that ensure its function over time. Our findings suggest that analyzing water consumption of existing metered PWSs in combination with qualitative approaches may enable more efficient planning of community-based water supplies and support sustainable development.

  2. Piped water consumption in Ghana: A case study of temporal and spatial patterns of clean water demand relative to alternative water sources in rural small towns.

    Science.gov (United States)

    Kulinkina, Alexandra V; Kosinski, Karen C; Liss, Alexander; Adjei, Michael N; Ayamgah, Gilbert A; Webb, Patrick; Gute, David M; Plummer, Jeanine D; Naumova, Elena N

    2016-07-15

    Continuous access to adequate quantities of safe water is essential for human health and socioeconomic development. Piped water systems (PWSs) are an increasingly common type of water supply in rural African small towns. We assessed temporal and spatial patterns in water consumption from public standpipes of four PWSs in Ghana in order to assess clean water demand relative to other available water sources. Low water consumption was evident in all study towns, which manifested temporally and spatially. Temporal variability in water consumption that is negatively correlated with rainfall is an indicator of rainwater preference when it is available. Furthermore, our findings show that standpipes in close proximity to alternative water sources such as streams and hand-dug wells suffer further reductions in water consumption. Qualitative data suggest that consumer demand in the study towns appears to be driven more by water quantity, accessibility, and perceived aesthetic water quality, as compared to microbiological water quality or price. In settings with chronic under-utilization of improved water sources, increasing water demand through household connections, improving water quality with respect to taste and appropriateness for laundry, and educating residents about health benefits of using piped water should be prioritized. Continued consumer demand and sufficient revenue generation are important attributes of a water service that ensure its function over time. Our findings suggest that analyzing water consumption of existing metered PWSs in combination with qualitative approaches may enable more efficient planning of community-based water supplies and support sustainable development. PMID:27070382

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

    DEFF Research Database (Denmark)

    Larsen, Christian

    2009-01-01

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

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

    DEFF Research Database (Denmark)

    Larsen, Christian

      We develop an algorithm to compute an optimal Q(s,S) policy for the joint replenishment problem when demands follow a compound correlated Poisson process. It is a non-trivial generalization of the work by Nielsen and Larsen (2005). We make some numerical analyses on two-item problems where we...

  5. Estimating irrigation water demand using an improved method and optimizing reservoir operation for water supply and hydropower generation: a case study of the Xinfengjiang reservoir in southern China

    Science.gov (United States)

    Wu, Yiping; Chen, Ji

    2013-01-01

    The ever-increasing demand for water due to growth of population and socioeconomic development in the past several decades has posed a worldwide threat to water supply security and to the environmental health of rivers. This study aims to derive reservoir operating rules through establishing a multi-objective optimization model for the Xinfengjiang (XFJ) reservoir in the East River Basin in southern China to minimize water supply deficit and maximize hydropower generation. Additionally, to enhance the estimation of irrigation water demand from the downstream agricultural area of the XFJ reservoir, a conventional method for calculating crop water demand is improved using hydrological model simulation results. Although the optimal reservoir operating rules are derived for the XFJ reservoir with three priority scenarios (water supply only, hydropower generation only, and equal priority), the river environmental health is set as the basic demand no matter which scenario is adopted. The results show that the new rules derived under the three scenarios can improve the reservoir operation for both water supply and hydropower generation when comparing to the historical performance. Moreover, these alternative reservoir operating policies provide the flexibility for the reservoir authority to choose the most appropriate one. Although changing the current operating rules may influence its hydropower-oriented functions, the new rules can be significant to cope with the increasingly prominent water shortage and degradation in the aquatic environment. Overall, our results and methods (improved estimation of irrigation water demand and formulation of the reservoir optimization model) can be useful for local watershed managers and valuable for other researchers worldwide.

  6. The Kinked Demand Curve When Demand Shifts.

    Science.gov (United States)

    Frasco, Gregg P.

    1993-01-01

    Reviews recent research into the theory of the kinked demand curve in economics. Applies this theory to economic concepts such as marginal cost and price flexibility. Discusses the implications for corporations and government policymakers. (CFR)

  7. Integration of health and social care: a case of learning and knowledge management.

    Science.gov (United States)

    Williams, Paul M

    2012-09-01

    This paper considers integration of health and social care as an exercise in learning and knowledge management (KM). Integration assembles diverse actors and organisations in a collective effort to design and deliver new service models underpinned by multidisciplinary working and generic practice. Learning and KM are integral to this process. A critical review of the literature is undertaken to identify theoretical insights and models in this field, albeit grounded mainly in a private sector context. The findings from a research study involving two integrated services are then used to explore the role of, and approach to, learning and KM. This case study research was qualitative in nature and involved an interrogation of relevant documentary material, together with 25 in-depth interviews with a cross-section of strategic managers and professionals undertaken between March and May 2011. The evidence emerging indicated no planned strategies for learning and KM, but rather, interventions and mechanisms at different levels to support integration processes. These included formal activities, particularly around training and appraisal, but also informal ones within communities of practice and networking. Although structural enablers such as a co-location of facilities and joint appointments were important, the value of trust and inter-personal relationships was highlighted especially for tacit knowledge exchange. The infrastructure for learning and KM was constructed around a collaborative culture characterised by a coherent strategic framework; clarity of purpose based on new models of service; a collaborative leadership approach that was facilitative and distributed; and, a focus on team working to exploit the potential of multidisciplinary practice, generic working and integrated management. The discussion and conclusion use Nonaka's knowledge conversation model to reflect on the research findings, to comment on the absence of an explicit approach to learning and KM

  8. Improving quality for maternal care - a case study from Kerala, India

    Science.gov (United States)

    Vlad, Ioana; Paily, VP; Sadanandan, Rajeev; Cluzeau, Françoise; Beena, M; Nair, Rajasekharan; Newbatt, Emma; Ghosh, Sujit; Sandeep, K; Chalkidou, Kalipso

    2016-01-01

    Background: The implementation of maternal health guidelines remains unsatisfactory, even for simple, well established interventions. In settings where most births occur in health facilities, as is the case in Kerala, India, preventing maternal mortality is linked to quality of care improvements. Context: Evidence-informed quality standards (QS), including quality statements and measurable structure and process indicators, are one innovative way of tackling the guideline implementation gap. Having adopted a zero tolerance policy to maternal deaths, the Government of Kerala worked in partnership with the Kerala Federation of Obstetricians & Gynaecologists (KFOG) and NICE International to select the clinical topic, develop and initiate implementation of the first clinical QS for reducing maternal mortality in the state. Description of practice: The NICE QS development framework was adapted to the Kerala context, with local ownership being a key principle. Locally generated evidence identified post-partum haemorrhage as the leading cause of maternal death, and as the key priority for the QS. A multidisciplinary group (including policy-makers, gynaecologists and obstetricians, nurses and administrators) was established. Multi-stakeholder workshops convened by the group ensured that the statements, derived from global and local guidelines, and their corresponding indicators were relevant and acceptable to clinicians and policy-makers in Kerala. Furthermore, it helped identify practical methods for implementing the standards and monitoring outcomes. Lessons learned: An independent evaluation of the project highlighted the equal importance of a strong evidence-base and an inclusive development process. There is no one-size-fits-all process for QS development; a principle-based approach might be a better guide for countries to adapt global evidence to their local context.

  9. Integration of health and social care: a case of learning and knowledge management.

    Science.gov (United States)

    Williams, Paul M

    2012-09-01

    This paper considers integration of health and social care as an exercise in learning and knowledge management (KM). Integration assembles diverse actors and organisations in a collective effort to design and deliver new service models underpinned by multidisciplinary working and generic practice. Learning and KM are integral to this process. A critical review of the literature is undertaken to identify theoretical insights and models in this field, albeit grounded mainly in a private sector context. The findings from a research study involving two integrated services are then used to explore the role of, and approach to, learning and KM. This case study research was qualitative in nature and involved an interrogation of relevant documentary material, together with 25 in-depth interviews with a cross-section of strategic managers and professionals undertaken between March and May 2011. The evidence emerging indicated no planned strategies for learning and KM, but rather, interventions and mechanisms at different levels to support integration processes. These included formal activities, particularly around training and appraisal, but also informal ones within communities of practice and networking. Although structural enablers such as a co-location of facilities and joint appointments were important, the value of trust and inter-personal relationships was highlighted especially for tacit knowledge exchange. The infrastructure for learning and KM was constructed around a collaborative culture characterised by a coherent strategic framework; clarity of purpose based on new models of service; a collaborative leadership approach that was facilitative and distributed; and, a focus on team working to exploit the potential of multidisciplinary practice, generic working and integrated management. The discussion and conclusion use Nonaka's knowledge conversation model to reflect on the research findings, to comment on the absence of an explicit approach to learning and KM

  10. Improving quality for maternal care - a case study from Kerala, India [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Ioana Vlad

    2016-02-01

    Full Text Available Background: The implementation of maternal health guidelines remains unsatisfactory, even for simple, well established interventions. In settings where most births occur in health facilities, as is the case in Kerala, India, preventing maternal mortality is linked to quality of care improvements. Context: Evidence-informed quality standards (QS, including quality statements and measurable structure and process indicators, are one innovative way of tackling the guideline implementation gap. Having adopted a zero tolerance policy to maternal deaths, the Government of Kerala worked in partnership with the Kerala Federation of Obstetricians & Gynaecologists (KFOG and NICE International to select the clinical topic, develop and initiate implementation of the first clinical QS for reducing maternal mortality in the state. Description of practice: The NICE QS development framework was adapted to the Kerala context, with local ownership being a key principle. Locally generated evidence identified post-partum haemorrhage as the leading cause of maternal death, and as the key priority for the QS. A multidisciplinary group (including policy-makers, gynaecologists and obstetricians, nurses and administrators was established. Multi-stakeholder workshops convened by the group ensured that the statements, derived from global and local guidelines, and their corresponding indicators were relevant and acceptable to clinicians and policy-makers in Kerala. Furthermore, it helped identify practical methods for implementing the standards and monitoring outcomes. Lessons learned: An independent evaluation of the project highlighted the equal importance of a strong evidence-base and an inclusive development process. There is no one-size-fits-all process for QS development; a principle-based approach might be a better guide for countries to adapt global evidence to their local context.

  11. Palliative care in the home: a case study of secondary histiocytic sarcoma in a 3-year-old child

    Directory of Open Access Journals (Sweden)

    Zuzana Karabová

    2013-12-01

    Full Text Available This article describes the medical, psychological, and social challenges encountered during home-based, family-centred palliative care of a 3-year-old female with secondary histiocytic sarcoma diagnosed during treatment for T-cell acute lymphoblastic leukaemia. Histiocytic sarcoma is an exceedingly rare cancer in adults, but even less frequent and highly aggressive when presenting as a secondary cancer in children. Comprehensive, multidisciplinary paediatric hospice care services are not widely available across Slovakia,thus limiting the number of patients and families offered such highly specialized end-of-life care. This case study illustrates the primary benefits for the child and family of such a program as well as the impact on the medical and nursing professionals working in the fi eld of paediatric haematology-oncology.

  12. Promoting Collaboration in Health Care Teams through Interprofessional Education: A Simulation Case Study

    Science.gov (United States)

    Ekmekci, Ozgur

    2013-01-01

    This simulation study explores how the integration of interprofessional components into health care curriculum may impact professional stereotyping and collaborative behavior in care delivery teams comprised of a physician, a registered nurse, a physician's assistant, a physical therapist, and a radiation therapist. As part of the agent-based…

  13. Towards healthcare business intelligence in long-term care: an explorative case study in the Netherlands.

    NARCIS (Netherlands)

    Spruit, M.; Vroon, R.; Batenburg, R.

    2014-01-01

    This research contributes to the domain of long-term care by exploring knowledge discovery techniques based on a large dataset and guided by representative information needs to better manage both quality of care and financial spendings, as a next step towards more mature healthcare business intellig

  14. Towards healthcare business intelligence in long-term care: an explorative case study in the Netherlands

    NARCIS (Netherlands)

    Spruit, M.R.; Vroon, R.; Batenburg, R.S.

    2014-01-01

    This research contributes to the domain of long-term care by exploring knowledge discovery techniques based on a large dataset and guided by representative information needs to better manage both quality of care and financial spendings, as a next step towards more mature healthcare business intellig

  15. Reducing Disparities through Culturally Competent Health Care: An Analysis of the Business Case

    Science.gov (United States)

    Brach, Cindy; Fraser, Irene

    2016-01-01

    Finding ways to deliver high-quality health care to an increasingly diverse population is a major challenge for the American health care system. The persistence of racial and ethnic disparities in health care access, quality, and outcomes has prompted considerable interest in increasing the cultural competence of health care, both as an end in its own right and as a potential means to reduce disparities. This article reviews the potential role of cultural competence in reducing racial and ethnic health disparities, the strength of health care organizations’ current incentives to adopt cultural competence techniques, and the limitations inherent in these incentives that will need to be overcome if cultural competence techniques are to become widely adopted. PMID:12938253

  16. Children with chickenpox:a care of 42 cases%42例小儿水痘护理体会

    Institute of Scientific and Technical Information of China (English)

    陈玉婷

    2014-01-01

    Objective To investigate the methods of care chickenpox in children. Methods Isolation of children, and to give calamine lotion and topical acyclovir ointment, pruritus obvious oral antihistamines. Care items including general care, barrier nursing, nursing fever, skin and blister care, diet care, psychological care, and close observation the changes to prevent complications. Results Of the 42 patients were cured after treatment 7d 23 cases, the cure rate was 54.76%, the total effective 33 cases, the total effective rate was 78.75%, 14d after treatment cured 37 cases, the cure rate was 88.1%, the total effective 42 cases, the total efficiency was 100.00%. Rash face healed without scar formation. Conclusion Variety attentive care measures and calamine lotion and ointment acyclovir topical, has good efficacy, fewer side effects, is one of the better way to treat children with chickenpox.%目的:探讨小儿水痘的护理方法。方法隔离患儿,并给予炉甘石洗剂及阿昔洛韦软膏外用,皮肤瘙痒明显者可口服抗组胺药。包括:一般护理、隔离护理、发热护理、皮肤与水疱护理、饮食护理、心理护理,并密切观察病情变化,以防并发症的发生。结果42例患儿治疗7d后痊愈23例,痊愈率为54.76%,总有效33例,总有效率78.75%,治疗14d后痊愈37例,痊愈率为88.1%,总有效率42例,总有效率为100.00%。皮疹面愈合良好,无瘢痕形成。结论多种细心护理措施和炉甘石洗剂及阿昔洛韦软膏外用,疗效好,副作用较少,是治疗小儿水痘的较好方法之一。

  17. Difficult but necessary conversations--the case for advance care planning.

    Science.gov (United States)

    Scott, Ian A; Mitchell, Geoffrey K; Reymond, Elizabeth J; Daly, Michael P

    2013-11-18

    Many patients at the end of life receive care that is inappropriate or futile and, if given the opportunity to discuss their care preferences well ahead of death, may well have chosen to forgo such care. Advance care planning (ACP) is a process of making decisions about future health care for patients in consultation with clinicians, family members and important others, and to safeguard such decisions if patients were to lose decisional capacity. Although ACP has existed as an idea for decades, acceptance and operationalisation of ACP within routine practice has been slow, despite evidence of its benefits. The chief barriers have been social and personal taboos about discussing the dying process, avoidance by medical professionals of responsibility for initiating, coordinating and documenting discussions about ACP, absence of robust and standardised procedures for recording and retrieving ACP documents across multiple care settings, and legal and ethical concerns about the validity of such documents. For ACP to become part of mainstream patient-centred care, accountable clinicians working in primary care, hospitals and nursing homes must effectively educate colleagues and patients about the purpose and mechanics of ACP, mandate ACP for all eligible patients, document ACP in accessible formats that enable patient wishes to accurately guide clinical management, devise methods for reviewing ACP decisions when clinically appropriate, and evaluate congruence between expressed patient wishes and actual care received. Public awareness campaigns coupled with implementation of ACP programs sponsored by collaborations between hospital and health services, Medicare locals and residential care facilities will be needed in making system-wide ACP a reality.

  18. Maternal care in rural China: a case study from Anhui province

    Directory of Open Access Journals (Sweden)

    Li Xiaohong

    2008-03-01

    Full Text Available Abstract Background Studies on prenatal care in China have focused on the timing and frequency of prenatal care and relatively little information can be found on how maternal care has been organized and funded or on the actual content of the visits, especially in the less developed rural areas. This study explored maternal care in a rural county from Anhui province in terms of care organization, provision and utilization. Methods A total of 699 mothers of infants under one year of age were interviewed with structured questionnaires; the county health bureau officials and managers of township hospitals (n = 10 and county level hospitals (n = 2 were interviewed; the process of the maternal care services was observed by the researchers. In addition, statistics from the local government were used. Results The county level hospitals were well staffed and equipped and served as a referral centre for women with a high-risk pregnancy. Township hospitals had, on average, 1.7 midwives serving an average population of 15,000 people. Only 10–20% of the current costs in county level hospitals and township hospitals were funded by the local government, and women paid for delivery care. There was no systematic organized prenatal care and referrals were not mandatory. About half of the women had their first prenatal visit before the 13th gestational week, 36% had fewer than 5 prenatal visits, and about 9% had no prenatal visits. A major reason for not having prenatal care visits was that women considered it unnecessary. Most women (87% gave birth in public health facilities, and the rest in a private clinic or at home. A total of 8% of births were delivered by caesarean section. Very few women had any postnatal visits. About half of the women received the recommended number of prenatal blood pressure and haemoglobin measurements. Conclusion Delivery care was better provided than both prenatal and postnatal care in the study area. Reliance on user fees gave

  19. Intracranial halo pin penetration causing brain injury secondary to poor halo care technique: a case report and literature review.

    Science.gov (United States)

    Male, Kishore Reddy; Guha, Abhijit; James, Stuart; Ahuja, Sashin

    2008-01-01

    : This is a case report of intra cranial penetration by halo pins resulting in cerebritis and fits secondary to incorrect halo care by the patient and his family. Halo pin penetration into the skull with brain injury is itself a rare incident. Previously documented case reports were in patients with a previous cranioplasties and they were highlight the fact that halo not to be used in cranioplasty patients. Cranial penetration of the halo pins has generally been secondary to a fall/medical condition as epilepsy. This incident how ever highlights the fact the halo care itself along with proper techniques used for tightening the halo pins by the carer plays a crucial role in preventing complications such as this. PMID:19068118

  20. The impact of black market exchange rate on the demand for money Case of Algeria during 1980-2010 : Econometric study

    Directory of Open Access Journals (Sweden)

    Ali BENDOB

    2014-06-01

    Full Text Available The main objective of this study is to analyze the relationship between the exchange rate and the parallel circulation of money (M1 in Algeria during the period 1980-2010. For this purpose, we use the proposed especially by Pesaran et al ARDL model. (2001. the results confirm the convergence of long-term determinants of the demand for money (income, consumption price index, interest rate deposits, the parallel exchange rate. In addition, the CUSUM test and CUSUMSQ clearly show the stability of the long-term relationship during the estimation period between the parallel exchange rate and demand for the currency in Algeria. Instead, the relationship becomes unstable once we use the official exchange rate.

  1. THE STUDY OF INFLUENCE ON SUPPLY AND DEMAND OF WOOD AND CARBON STOCK CHANGING WOODEN HOUSE LIFE - CASE STUDY FOR WAKAYAMA PREFECTURE USING GEOGRAPHICAL INFORMATION -

    Science.gov (United States)

    Arikawa, Miho; Taenaka, Sayuri; Tanikawa, Hiroki

    The study evaluated the influence of supply and demand of residential wood on the amounts of carbon fixation and CO2 absorption by forests. The residential wood occupies most of all wood demand. The result of the analysis revealed that both the amounts of carbon fixation in the forest and the residence decreased. Moreover, it was clarified that the wood utilization for long-lived houses made the amounts of carbon fixation in the forests and residences the maximum. On the other hand, the amounts of CO2 absorption by the man-made forest would decrease in the future. However, the study showed the possibility of the increase in CO2 absorption admitted in the Kyoto Protocol.

  2. Nonmaternal Care's Association With Mother's Parenting Sensitivity: A Case of Self-Selection Bias?

    Science.gov (United States)

    Nomaguchi, Kei M; Demaris, Alfred

    2013-06-01

    Although attachment theory posits that the use of nonmaternal care undermines quality of mothers' parenting, empirical evidence for this link is inconclusive. Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,233), the authors examined the associations between nonmaternal care characteristics and maternal sensitivity during the first 3 years of children's lives, with special attention to selection effects and moderation by resource levels. Findings from fixed-effects regression models suggested that, on average, there is little relationship between nonmaternal care characteristics and maternal sensitivity, once selection factors are held constant. Some evidence of moderation effects was found, however. Excellent-quality care is related to more sensitivity for mothers with lower family income. Poor-quality care is related to lower sensitivity for single mothers, but not partnered mothers. In sum, nonmaternal care characteristics do not seem to have as much influence on mothers' parenting as attachment theory claims. PMID:23772093

  3. The case for home based telehealth in pediatric palliative care: a systematic review

    Directory of Open Access Journals (Sweden)

    Bradford Natalie

    2013-02-01

    Full Text Available Abstract Background Over the last decade technology has rapidly changed the ability to provide home telehealth services. At the same time, pediatric palliative care has developed as a small, but distinct speciality. Understanding the experiences of providing home telehealth services in pediatric palliative care is therefore important. Methods A literature review was undertaken to identify and critically appraise published work relevant to the area. Studies were identified by searching the electronic databases Medline, CINAHL and Google Scholar. The reference list of each paper was also inspected to identify any further studies. Results There were 33 studies that met the inclusion criteria of which only six were pediatric focussed. Outcome measures included effects on quality of life and anxiety, substitution of home visits, economic factors, barriers, feasibility, acceptability, satisfaction and readiness for telehealth. While studies generally identified benefits of using home telehealth in palliative care, the utilisation of home telehealth programs was limited by numerous challenges. Conclusion Research in this area is challenging; ethical issues and logistical factors such as recruitment and attrition because of patient death make determining effectiveness of telehealth interventions difficult. Future research in home telehealth for the pediatric palliative care population should focus on the factors that influence acceptance of telehealth applications, including goals of care, access to alternative modes of care, perceived need for care, and comfort with using technology.

  4. Citizenship and people living with dementia: A case for the ethics of care.

    Science.gov (United States)

    Brannelly, Tula

    2016-05-01

    The ethics of care is an emerging field of interest in many disciplines, including care for people with dementia. The ethics of care as proposed by Joan Tronto is a political argument for care together with a set of principles, the integrity of care, to guide and critique practice. This two-pronged approach enables on one hand, a political, complex and situated examination of inequality, and on the other hand the integrity of care provides a set of principles to guide inclusive citizenship practices. This approach has the significant advantage of recognition of the fight that people with dementia face to achieve rights and citizenship as an issue of social justice. In this paper, three challenges to citizenship are discussed in relation to people with dementia using an ethics of care lens: (a) citizenship as a relationship between the individual and the state; (b) citizenship as a practice and (c) citizenship as identity and belonging. I propose that citizenship can be achieved by promoting inclusion in defining and creating policy, research and practice.

  5. New Trends in Business Intelligence : A case study on the impact of organizational demands of information and new technologies on BI

    OpenAIRE

    Naghdipour, Navid Naghdipour

    2014-01-01

    When the data warehouse concept was first introduced by IBM as a part of their new information system in 1988, the first step in the field of modern decision support systems or business intelligence was taken. Since then, academics, practitioners and solution developers have put a considerable effort in introducing new trends of these systems. Each new trend has roots in what enterprises demand from these systems. The advances in Web technologies and social media, has led to introduction of n...

  6. Exploring malaria case mangement of underfive children at households and public primary health care facilities in Kibaha district, Tanzania

    OpenAIRE

    Nsimba, Stephen ED

    2003-01-01

    Background: Chloroquine (CQ) was the first line drug for treating malaria in Tanzania until 2001 when it was replaced with sulfadoxine/pyrimethamine (SP). The first four studies (I -IV) were conducted before the policy change, and the last one (V) after. Aim: To explore different aspects of malaria case management of underfives in households and at primary health care facilities in the Kibaha district. Materials and methods: Four cross-sectional studies (I, II, IV & V) we...

  7. Prolonged high-dose intravenous magnesium therapy for severe tetanus in the intensive care unit: a case series

    Directory of Open Access Journals (Sweden)

    Fligou Fotini

    2010-03-01

    Full Text Available Abstract Introduction Tetanus rarely occurs in developed countries, but it can result in fatal complications including respiratory failure due to generalized muscle spasms. Magnesium infusion has been used to treat spasticity in tetanus, and its effectiveness is supported by several case reports and a recent randomized controlled trial. Case presentations Three Caucasian Greek men aged 30, 50 and 77 years old were diagnosed with tetanus and admitted to a general 12-bed intensive care unit in 2006 and 2007 for respiratory failure due to generalized spasticity. Intensive care unit treatment included antibiotics, hydration, enteral nutrition, early tracheostomy and mechanical ventilation. Intravenous magnesium therapy controlled spasticity without the need for additional muscle relaxants. Their medications were continued for up to 26 days, and adjusted as needed to control spasticity. Plasma magnesium levels, which were measured twice a day, remained in the 3 to 4.5 mmol/L range. We did not observe hemodynamic instability, arrhythmias or other complications related to magnesium therapy in these patients. All patients improved, came off mechanical ventilation, and were discharged from the intensive care unit in a stable condition. Conclusion In comparison with previous reports, our case series contributes the following meaningful additional information: intravenous magnesium therapy was used on patients already requiring mechanical ventilation and remained effective for up to 26 days (significantly longer than in previous reports without significant toxicity in two patients. The overall outcome was good in all our patients. However, the optimal dose, optimal duration and maximum safe duration of intravenous magnesium therapy are unknown. Therefore, until more data on the safety and efficacy of magnesium therapy are available, its use should be limited to carefully selected tetanus cases.

  8. To what extent do primary care practice nurses act as case managers life style counselling regarding weight management?

    OpenAIRE

    Dillen, van, J.; Hiddink, G.J.

    2014-01-01

    Background - In this review study, we are the first to explore whether the practice nurse (PN) can act as case manager lifestyle counselling regarding weight management in primary care. Methods - Multiple electronic databases (MEDLINE, PsycINFO) were searched to identify relevant literature after 1995. Forty-five studies fulfilled the inclusion criteria. In addition, all studies were judged on ten quality criteria by two independent reviewers. Results - Especially in the last three years, man...

  9. Expanding the primary health care workforce through contracting with nongovernmental entities: the cases of Bahia and Rio de Janeiro

    OpenAIRE

    Ireland, Megan; Cavalini, Luciana; Girardi, Sabado; Araujo, Edson C.; Lindelow, Magnus

    2016-01-01

    Background Brazil has experienced difficulties in attracting health professionals (especially doctors and nurses) to practice at the primary health care (PHC) level and in rural and remote areas. This study presents two case studies, each a current initiative in contracting for primary health services in Brazil: one for the state of Bahia and the other for the city of Rio de Janeiro. The two models differ considerably in context, needs, modalities, and outcomes. This article does not attempt ...

  10. Love and the Value of Life in Health Care: A Narrative Medicine Case Study in Medical Education

    OpenAIRE

    Pentiado, Jorge Alberto Martins; de Almeida, Helcia Oliveira; Amorim, Fábio Ferreira; Facioli, Adriano Machado; Trindade, Eliana Mendonça Vilar; de Almeida, Karlo Jozefo Quadros

    2016-01-01

    This case study is an example of narrative medicine applied to promote self-awareness and develop humanistic contents in medical education. The impact and the human appeal of the narrative lie in the maturity and empathy shown by a student when reporting his dramatic experience during the care given to a newborn (with Patau syndrome and multiple malformations diagnosed at birth) and to her mother. The narrative approach helped the student to be successful in bringing out the meaning behind th...

  11. 灾害护理相关知识技能掌握、培训现状及学习需求调查分析%Analysis of training and learning demand on disaster related nursing care skills

    Institute of Scientific and Technical Information of China (English)

    张卫青; 罗希芝; 郑惠敏; 张颖霞; 王月琴

    2011-01-01

    目的 了解临床一线护理人员对灾害护理基本知识和技能掌握情况、培训现状及学习需求、探讨提高我国灾害护理整体水平的对策.方法 采取在护理学术会议发放问卷和在部分医院各病区随机发放问卷的方式,对河南省22所三级甲等、二级甲等和一级医院涉及22个专业共104名护士进行"灾害护理相关知识技能掌握、培训现状及学习需求"的问卷调查.结果 被调查的104人中有10人(9.6%)在5.12汶川地震前对灾害护理有所了解;29人(27.9%)通过教科书了解灾害护理;测试中不及格人数达72人(69.2%),平均成绩52.94分;82人(78.8%)未经过灾害护理相关知识、技能培训;103人(99.0%)认为护士有必要进行灾害护理相关知识、技能培训.结论 护理人员对灾害护理认识不足,灾害护理相关知识技能掌握欠缺,灾害护理教育缺失,护理人员对灾害相关知识技能学习需求迫切.%Objective To understand current level of disaster related nursing care skills and techniques the clinical nurses grasp and their demand on the training and learning, enhance the national disaster related nursing strength at strategic level as a whole. Methods A questionnaire survey was randomly conducted among 104 nurses who worked ranging 22 specialties in different levels of hospital. Results Only 10 of them (9.6%) had basic knowledge on disaster nursing care prior to occurrence of Wenchuan earthquake; 29 (27.9%) learned about it through textbooks; 72 (69.2%)failed on the test with an average score of 52.94 points; 82 (78.8%) had never received training of disaster related nursing care skill and technique; 103 (99.0%) realized they should be given such trainings. Conclusion Lack of knowledge on disaster related nursing care skills and techniques is obvious, and it becomes imperative to get the clinical nurses educated of the skills.

  12. Intracranial halo pin penetration causing brain injury secondary to poor halo care technique: a case report and literature review

    OpenAIRE

    Male, Kishore Reddy; Guha, Abhijit; James, Stuart; Ahuja, Sashin

    2008-01-01

    This is a case report of intra cranial penetration by halo pins resulting in cerebritis and fits secondary to incorrect halo care by the patient and his family. Halo pin penetration into the skull with brain injury is itself a rare incident. Previously documented case reports were in patients with a previous cranioplasties and they were highlight the fact that halo not to be used in cranioplasty patients. Cranial penetration of the halo pins has generally been secondary to a fall/medical cond...

  13. and lsquo;WhatsApp' as an adjunct to home based pin tract care: a case report

    Directory of Open Access Journals (Sweden)

    Ganesh Singh Dharmshaktu

    2014-08-01

    Full Text Available Mobile based technology can be a cheap and handy adjunct to a home based programme for managing pin tract care in chronic orthopaedic cases. The text message and image based mobile platforms may serve as an evaluation tool relieving patient of agony of long and painful commutes on simple health issues like wound dressings. A case report depicting versatility of the idea with regard to its efficacy in clinical scenario is presented here. [Int J Res Med Sci 2014; 2(4.000: 1746-1747

  14. Critical care during epidemics

    OpenAIRE

    Rubinson, Lewis; O'Toole, Tara

    2005-01-01

    We recommend several actions that could improve hospitals' abilities to deliver critical care during epidemics involving large numbers of victims. In the absence of careful pre-event planning, demand for critical care services may quickly exceed available intensive care unit (ICU) staff, beds and equipment, leaving the bulk of the infected populace without benefit of potentially lifesaving critical care. The toll of death may be inversely proportional to the ability to augment critical care c...

  15. Case Control Analyses of Acute Endophthalmitis after Cataract Surgery in South India Associated with Technique, Patient Care, and Socioeconomic Status

    Directory of Open Access Journals (Sweden)

    Taraprasad Das

    2012-01-01

    Full Text Available Purpose. We investigated acute endophthalmitis incidence following cataract surgery vis-a-vis the current technological and postoperative care changes in higher and lower socioeconomic categories of patients in South India. Methods. In a retrospective case control study, we analyzed 62 cases of acute endophthalmitis and 5 controls for each endophthalmitis case from 46,095 cataract surgeries done between years 1993 and 1998. The time period covered the transition of surgical technique and after care. In addition, we analyzed systemic diseases, surgeon factor, habitat, and socioeconomic status. Results. Clinical and culture positive endophthalmitis incidence were 0.13% and 0.07%, respectively. Differential incidence of 0.10% and 0.17% for in- and ambulatory care surgeries, respectively, was close to statistical significance (=0.054. Lower economy category ambulatory patients had higher risk of infection. Conclusion. Ambulatory cataract surgery carried additional risk for post-operative infection in lower socioeconomic group. Improved health education could ensure greater safety.

  16. 医改中规避供方诱导需求的补偿方式研究%The Compensation Way in Health Care Reform for Evading Supplier Induced Demand

    Institute of Scientific and Technical Information of China (English)

    蒋涌; 王智

    2014-01-01

    In the current medical insurance system, supplier induced demand is regarded as the major inducement for the increase of hos-pitalization costs and is the most serious ethical risk in the medical field. As ethical risks in the medical field are caused by information asymmetry between supply and requisitioning parties, health economics put forward that rational compensation design is necessary. Health care reform departments shall pay close attention on the ethical risks in the current medical insurance system. The design of compensation approach shall be the focus of policy making with the analysis of utility models. In conclusion, payment by capitation is a better way than payment by items in evading the ethical risks.%在现行的医疗保障制度中,供方诱导需求被认为是导致医疗费用上涨的重要诱因,同时也是我国医疗领域最严重的道德风险问题。医疗领域的道德风险根源于供需双方的信息不对称,因此卫生经济学认为合理的补偿方式设计是必要的。我国现行医疗保障制度中的医疗供方的道德风险问题应该引起医改部门的重视,通过效用模型分析,政府对医疗供方的补偿方式的设计应该成为政策制定的重点。结论显示,用按固定人头付费相对于现行的按项目付费制能够更有效的规避道德风险。

  17. Percutaneous dilatational tracheostomy without fiber optic bronchoscopy-Evaluation of 80 intensive care units cases

    NARCIS (Netherlands)

    J.A. Calvache (Jose Andrés); R.A. Molina García (Rodrigo); A.L. Trochez (Adolfo); J. Benitez (Javier); L.A. Flga (Lucía Arroyo)

    2013-01-01

    textabstractBackground: The development of percutaneous dilatational tracheostomy techniques (PDT) has facilitated the procedure in Intensive Care Units (ICU). Objective: To describe the early intra and post-operative complications in ICU patients requiring percutaneous dilatational tracheostomy usi

  18. Health care institution labor law: case law developments, 1974-78.

    Science.gov (United States)

    Shepard, I M

    1978-01-01

    This Article examines the key National Labor Relations Board and federal court interpretations of the much-heralded 1974 Health Care Institution Amendments to the National Labor Relations Act. It analyzes NLRB decisions that have resulted in a proliferation of separate employee bargaining units at health care facilities, and that have applied the strike notice provisions of the NLRA to labor disputes involving building trade employees engaged in construction at operating health care facilities. In addition, the Article examines the Board's decision to decline jurisdiction over employee unions representing interns and residents, and summarizes both the special NLRB rules designed to apply to union solicitation of employees at health care facilities and the conflicting circuit court decisions that have modified the Board's specialized solicitation rules.

  19. Patient Safety Incidents in Hospice Care: Observations from Interdisciplinary Case Conferences

    OpenAIRE

    Oliver, Debra Parker; Demiris, George; Wittenberg-Lyles, Elaine; Gage, Ashley; Dewsnap-Dreisinger, Mariah L.; Luetkemeyer, Jamie

    2013-01-01

    Background: In the home hospice environment, issues arise every day presenting challenges to the safety, care, and quality of the dying experience. The literature pertaining to the safety challenges in this environment is limited.

  20. A semantic cache for enhancing Web services communities activities: Health care case study

    OpenAIRE

    Hela Limam; Jalel Akaichi

    2012-01-01

    Collective memories are strong support for enhancing the activities of capitalization, management and dissemination inside a Web services community. To take advantages of collective memory, we propose an approach for indexing a health care Web services community’s’ resources with semantic annotations explaining and formalizing its informative content. Then we show how the health care Web services community’ members exploit their collective memory by expressing their queries allowing them sear...