WorldWideScience

Sample records for care facility performance

  1. A study protocol for performance evaluation of a new academic intensive care unit facility: impact on patient care.

    Science.gov (United States)

    Ferri, Mauricio; Zygun, David A; Harrison, Alexandra; Stelfox, Henry T

    2013-01-01

    Healthcare facility construction is increasing because of population demand and the need to replace ageing infrastructure. Research suggests that there may be a relationship between healthcare environment and patient care. To date, most evaluations of new healthcare facilities are derived from techniques used in other industries and focus on physical, financial and architectural performance. However, few studies have evaluated the impact of healthcare facility design on processes and outcomes of patient care. The primary objective of this study was to investigate the impact of relocation to a new intensive care unit (ICU) facility on clinical performance measures. This study also proposes to develop and test a framework for facility performance evaluation using accepted ICU design guidelines and Donabedian's model for healthcare quality. We will utilise a mixed-methods, observational, retrospective, controlled, before-and-after design to take advantage of the quasiexperimental conditions created with the construction of a new ICU facility in Calgary, Canada. For the qualitative substudy, we will conduct individual interviews with end-users to understand their impressions and experiences with the new environment and perform thematic analysis. For the quantitative substudy, we will compare process of care indicators and patient outcomes for the 12-month period before and after relocation to the new facility. Two other local ICU facilities that did not undergo structural change during the study period will serve as controls. We will triangulate qualitative and quantitative results utilising a novel framework. The results of this study will contribute in understanding the impact of new ICU facilities on clinical performance measures centred on patients, their families and healthcare providers. The framework will complement existing building performance evaluation techniques and help healthcare administrators plan new ICU facilities. The University of Calgary Research

  2. Factors Influencing New RNs' Supervisory Performance in Long-Term Care Facilities.

    Science.gov (United States)

    Prentice, Dawn; Boscart, Veronique; McGilton, Katherine S; Escrig, Astrid

    2017-12-01

    In long-term care facilities (LTCF), registered nurses (RNs) perform both clinical and supervisory roles as part of a team aiming to provide high-quality care to residents. The residents have several co-morbidities and complex care needs. Unfortunately, new RNs receive minimal preparation in gerontology and supervisory experience during their program, leading to low retention rates and affecting resident outcomes. This qualitative study explored factors that influence supervisory performance of new RNs in LTCF from the perspective of 24 participants from Ontario, Canada. Data were collected through individual interviews, followed by a directed content analysis. Three levels of influences were identified: personal influences, organizational influences, and external influences. Each level presented with sub-elements, further describing the factors that impact the supervisory performance of the new RN. To retain new RNs in LTC, organizations must provide additional gerontological education and mentoring for new RNs to flourish in their supervisory roles.

  3. Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand.

    Science.gov (United States)

    Kitreerawutiwong, Nithra; Jordan, Sue; Hughes, David

    2017-01-01

    Poor and middle-income Thai people rely heavily on primary care health services. These are staffed by a range of professionals. However, it is unknown whether the performance of primary care varies according to the staffing and organization of local service delivery units. Tambon (sub-district) health promotion hospitals (THPHs) were introduced in 2009 to upgrade the services offered by the previous health centres, but were faced with continuing shortages of doctors and nurses. The Ministry of Public Health (MoPH) designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. This study aimed to compare the performance of primary care offered by the three different types of primary care facilities in one public health region of Northern Thailand (Public Health Region 2). A cross-sectional survey was undertaken in 2013. Data were collected on accessibility, continuity, comprehensiveness, co-ordination and community orientation of care from 825 patients attending 23 primary care facilities. These were selected to include the three officially-designated types of Tambon (sub-district) health promotion hospitals (THPHs) led by medical, nursing or public health personnel. Survey scores were compared in unadjusted and adjusted analyses. THPHs staffed only by public health officers achieved the highest performance score (Mean = 85.14, SD. = 7.30), followed by THPHs staffed by qualified nurses (Mean = 82.86, SD. = 7.06). THPHs staffed by a doctor on rotation returned the lowest scores (Mean = 81.63, SD. = 7.22). Differences in overall scores resulted mainly from differences in reported accessibility, continuity, and comprehensiveness of care, rather than staff skill-mix per se. Policy on quality improvement should therefore focus on improving performance in these areas.

  4. Pathways to high and low performance: factors differentiating primary care facilities under performance-based financing in Nigeria.

    Science.gov (United States)

    Mabuchi, Shunsuke; Sesan, Temilade; Bennett, Sara C

    2018-01-01

    The determinants of primary health facility performance in developing countries have not been well studied. One of the most under-researched areas is health facility management. This study investigated health facilities under the pilot performance-based financing (PBF) scheme in Nigeria, and aimed to understand which factors differentiated primary health care centres (PHCCs) which had performed well, vs those which had not, with a focus on health facility management practices. We used a multiple case study where we compared two high-performing PHCCs and two low-performing PHCCs for each of the two PBF target states. Two teams of two trained local researchers spent 1 week at each PHCC and collected semi-structured interview, observation and documentary data. Data from interviews were transcribed, translated and coded using a framework approach. The data for each PHCC were synthesized to understand dynamic interactions of different elements in each case. We then compared the characteristics of high and low performers. The areas in which critical differences between high and low-performers emerged were: community engagement and support; and performance and staff management. We also found that (i) contextual and health system factors particularly staffing, access and competition with other providers; (ii) health centre management including community engagement, performance management and staff management; and (iii) community leader support interacted and drove performance improvement among the PHCCs. Among them, we found that good health centre management can overcome some contextual and health system barriers and enhance community leader support. This study findings suggest a strong need to select capable and motivated health centre managers, provide long-term coaching in managerial skills, and motivate them to improve their practices. The study also highlights the need to position engagement with community leaders as a key management practice and a central element

  5. Textiles Performance Testing Facilities

    Data.gov (United States)

    Federal Laboratory Consortium — The Textiles Performance Testing Facilities has the capabilities to perform all physical wet and dry performance testing, and visual and instrumental color analysis...

  6. Improving primary health care facility performance in Ghana: efficiency analysis and fiscal space implications.

    Science.gov (United States)

    Novignon, Jacob; Nonvignon, Justice

    2017-06-12

    Health centers in Ghana play an important role in health care delivery especially in deprived communities. They usually serve as the first line of service and meet basic health care needs. Unfortunately, these facilities are faced with inadequate resources. While health policy makers seek to increase resources committed to primary healthcare, it is important to understand the nature of inefficiencies that exist in these facilities. Therefore, the objectives of this study are threefold; (i) estimate efficiency among primary health facilities (health centers), (ii) examine the potential fiscal space from improved efficiency and (iii) investigate the efficiency disparities in public and private facilities. Data was from the 2015 Access Bottlenecks, Cost and Equity (ABCE) project conducted by the Institute for Health Metrics and Evaluation. The Stochastic Frontier Analysis (SFA) was used to estimate efficiency of health facilities. Efficiency scores were then used to compute potential savings from improved efficiency. Outpatient visits was used as output while number of personnel, hospital beds, expenditure on other capital items and administration were used as inputs. Disparities in efficiency between public and private facilities was estimated using the Nopo matching decomposition procedure. Average efficiency score across all health centers included in the sample was estimated to be 0.51. Also, average efficiency was estimated to be about 0.65 and 0.50 for private and public facilities, respectively. Significant disparities in efficiency were identified across the various administrative regions. With regards to potential fiscal space, we found that, on average, facilities could save about GH₵11,450.70 (US$7633.80) if efficiency was improved. We also found that fiscal space from efficiency gains varies across rural/urban as well as private/public facilities, if best practices are followed. The matching decomposition showed an efficiency gap of 0.29 between private

  7. The effect of group-based exercise on cognitive performance and mood in seniors residing in intermediate care and self-care retirement facilities: a randomised controlled trial.

    Science.gov (United States)

    Brown, A K; Liu-Ambrose, T; Tate, R; Lord, S R

    2009-08-01

    To determine the effect of a general group-based exercise programme on cognitive performance and mood among seniors without dementia living in retirement villages. Randomised controlled trial. Four intermediate care and four self-care retirement village sites in Sydney, Australia. 154 seniors (19 men, 135 women; age range 62 to 95 years), who were residents of intermediate care and self-care retirement facilities. Participants were randomised to one of three experimental groups: (1) a general group-based exercise (GE) programme composed of resistance training and balance training exercises; (2) a flexibility exercise and relaxation technique (FR) programme; or (3) no-exercise control (NEC). The intervention groups (GE and FR) participated in 1-hour exercise classes twice a week for a total period of 6 months. Using standard neuropsychological tests, we assessed cognitive performance at baseline and at 6-month re-test in three domains: (1) fluid intelligence; (2) visual, verbal and working memory; and (3) executive functioning. We also assessed mood using the Geriatric Depression Scale (GDS) and the Positive and Negative Affect Schedule (PANAS). The GE programme significantly improved cognitive performance of fluid intelligence compared with FR or NEC. There were also significant improvements in the positive PANAS scale within both the GE and FR groups and an indication that the two exercise programmes reduced depression in those with initially high GDS scores. Our GE programme significantly improved cognitive performance of fluid intelligence in seniors residing in retirement villages compared with our FR programme and the NEC group. Furthermore, both group-based exercise programmes were beneficial for certain aspects of mood within the 6-month intervention period.

  8. Cross-sectional relationship between physical fitness components and functional performance in older persons living in long-term care facilities

    Directory of Open Access Journals (Sweden)

    van Mechelen Willem

    2006-02-01

    Full Text Available Abstract Background The age-related deterioration of physiological capacities such as muscle strength and balance is associated with increased dependence. Understanding the contribution of physical fitness components to functional performance facilitates the development of adequate exercise interventions aiming at preservation of function and independence of older people. The aim of the study was to investigate the relationship between physical fitness components and functional performance in older people living in long-term care facilities. Methods Design cross-sectional study Subjects 226 persons living in long-term care facilities (mean age: 81.6 ± 5.6. Outcome measures Physical fitness and functional performance were measured by performance-based tests. Results Knee and elbow extension strength were significantly higher in men (difference = 44.5 and 50.0 N, respectively, whereas women were more flexible (difference sit & reach test = 7.2 cm. Functional performance was not significantly different between the genders. In men, motor coordination (eye-hand coordination and measures of strength were the main contributors to functional performance, whereas in women flexibility (sit and reach test and motor coordination (tandem stance and eye-hand coordination played a major role. Conclusion The results of this study show that besides muscle strength, fitness components such as coordination and flexibility are associated with functional performance of older people living in long-term care facilities. This suggests that men and women living in long-term care facilities, differ considerably concerning the fitness factors contributing to functional performance. Women and men may, therefore, need exercise programs emphasizing different fitness aspects in order to improve functional performance.

  9. Descriptive analysis of the medical care performed in the Spanish military Role 1 Medical Treatment Facility deployed in Operation 'Inherent Resolve' (Iraq), 2015-2016.

    Science.gov (United States)

    García Cañas, Rafael; Navarro Suay, R

    2017-12-01

    Operation 'Inherent Resolve' was approved by the United Nations in August 2014 with the objective of suppressing the Islamic State in Iraq and the Levant and increasing the region's stability. The mission of the Spanish military forces within this was to direct training missions for the Iraqi Army. The aim of this study is to analyse the medical care provided in the Spanish Role 1 deployed medical treatment facility during Operation 'Apoyo a Irak'. A cross-sectional, descriptive and retrospective study was conducted between 15 December 2015 and 18 November 2016. The study population comprised all personnel treated at the Spanish Role 1 medical treatment facility of the 'Gran Capitan' base in Besmaya, Iraq. During the study period, a total of 2208 consultations were performed, 1547 of which were first consultations. The predominant type of medical care was categorised as 'traumatology' (n=438; 19.8%), followed by 'healing of wounds and minor surgical processes' (n=332; 15%), 'acute upper respiratory tract infections' (n=267; 12%), 'dermatology' (n=214; 9.6%) and 'gastroenterology' (n=214; 9.6%). Twenty-eight patients (1.2%) required care in the upper medical echelon of care, three of whom were urgently evacuated. Oral diseases were the main reason for evacuation to the next medical echelon. Four patients were repatriated to the national territory for medical reasons. One death was recorded due to a vehicle accident. The results of our study reinforce those found in similar recent international missions in which the Spanish Armed Forces and other allied armies have deployed a Role 1 medical treatment facility. Military physicians deploying on operations such as Iraq should have up-to-date training in emergency and primary care medicine, with special emphasis on basic trauma knowledge and performing minor surgical processes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is

  10. Long-term care facilities: important participants of the acute care facility social network?

    Directory of Open Access Journals (Sweden)

    Bruce Y Lee

    Full Text Available Acute care facilities are connected via patient sharing, forming a network. However, patient sharing extends beyond this immediate network to include sharing with long-term care facilities. The extent of long-term care facility patient sharing on the acute care facility network is unknown. The objective of this study was to characterize and determine the extent and pattern of patient transfers to, from, and between long-term care facilities on the network of acute care facilities in a large metropolitan county.We applied social network constructs principles, measures, and frameworks to all 2007 annual adult and pediatric patient transfers among the healthcare facilities in Orange County, California, using data from surveys and several datasets. We evaluated general network and centrality measures as well as individual ego measures and further constructed sociograms. Our results show that over the course of a year, 66 of 72 long-term care facilities directly sent and 67 directly received patients from other long-term care facilities. Long-term care facilities added 1,524 ties between the acute care facilities when ties represented at least one patient transfer. Geodesic distance did not closely correlate with the geographic distance among facilities.This study demonstrates the extent to which long-term care facilities are connected to the acute care facility patient sharing network. Many long-term care facilities were connected by patient transfers and further added many connections to the acute care facility network. This suggests that policy-makers and health officials should account for patient sharing with and among long-term care facilities as well as those among acute care facilities when evaluating policies and interventions.

  11. Indicators of Dysphagia in Aged Care Facilities

    Science.gov (United States)

    Pu, Dai; Murry, Thomas; Wong, May C. M.; Yiu, Edwin M. L.; Chan, Karen M. K.

    2017-01-01

    Purpose: The current cross-sectional study aimed to investigate risk factors for dysphagia in elderly individuals in aged care facilities. Method: A total of 878 individuals from 42 aged care facilities were recruited for this study. The dependent outcome was speech therapist-determined swallowing function. Independent factors were Eating…

  12. Effect of Educational Outreach Timing and Duration on Facility Performance for Infectious Disease Care in Uganda: A Trial with Pre-Post and Cluster Randomized Controlled Components

    Science.gov (United States)

    Burnett, Sarah M.; Mbonye, Martin K.; Naikoba, Sarah; Zawedde-Muyanja, Stella; Kinoti, Stephen N.; Ronald, Allan; Rubashembusya, Timothy; Willis, Kelly S.; Colebunders, Robert; Manabe, Yukari C.; Weaver, Marcia R.

    2015-01-01

    Background Classroom-based learning is often insufficient to ensure high quality care and application of health care guidelines. Educational outreach is garnering attention as a supplemental method to enhance health care worker capacity, yet there is little information about the timing and duration required to improve facility performance. We sought to evaluate the effects of an infectious disease training program followed by either immediate or delayed on-site support (OSS), an educational outreach approach, on nine facility performance indicators for emergency triage, assessment, and treatment; malaria; and pneumonia. We also compared the effects of nine monthly OSS visits to extended OSS, with three additional visits over six months. Methods This study was conducted at 36 health facilities in Uganda, covering 1,275,960 outpatient visits over 23 months. From April 2010 to December 2010, 36 sites received infectious disease training; 18 randomly selected sites in arm A received nine monthly OSS visits (immediate OSS) and 18 sites in arm B did not. From March 2011 to September 2011, arm A sites received three additional visits every two months (extended OSS), while the arm B sites received eight monthly OSS visits (delayed OSS). We compared the combined effect of training and delayed OSS to training followed by immediate OSS to determine the effect of delaying OSS implementation by nine months. We also compared facility performance in arm A during the extended OSS to immediate OSS to examine the effect of additional, less frequent OSS. Results Delayed OSS, when combined with training, was associated with significant pre/post improvements in four indicators: outpatients triaged (44% vs. 87%, aRR = 1.54, 99% CI = 1.11, 2.15); emergency and priority patients admitted, detained, or referred (16% vs. 31%, aRR = 1.74, 99% CI = 1.10, 2.75); patients with a negative malaria test result prescribed an antimalarial (53% vs. 34%, aRR = 0.67, 99% CI = 0.55, 0.82); and pneumonia

  13. VA Health Care Facilities Locator

    Science.gov (United States)

    ... map [a-z] More VA More VA Health Health Care Information A-Z Health Topic Finder My Health ... General QUICK LIST Apply for Benefits Apply for Health Care Prescriptions My Health e Vet eBenefits Life Insurance ...

  14. Payment methods for outpatient care facilities.

    Science.gov (United States)

    Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

    2017-03-03

    Outpatient care facilities provide a variety of basic healthcare services to individuals who do not require hospitalisation or institutionalisation, and are usually the patient's first contact. The provision of outpatient care contributes to immediate and large gains in health status, and a large portion of total health expenditure goes to outpatient healthcare services. Payment method is one of the most important incentive methods applied by purchasers to guide the performance of outpatient care providers. To assess the impact of different payment methods on the performance of outpatient care facilities and to analyse the differences in impact of payment methods in different settings. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), 2016, Issue 3, part of the Cochrane Library (searched 8 March 2016); MEDLINE, OvidSP (searched 8 March 2016); Embase, OvidSP (searched 24 April 2014); PubMed (NCBI) (searched 8 March 2016); Dissertations and Theses Database, ProQuest (searched 8 March 2016); Conference Proceedings Citation Index (ISI Web of Science) (searched 8 March 2016); IDEAS (searched 8 March 2016); EconLit, ProQuest (searched 8 March 2016); POPLINE, K4Health (searched 8 March 2016); China National Knowledge Infrastructure (searched 8 March 2016); Chinese Medicine Premier (searched 8 March 2016); OpenGrey (searched 8 March 2016); ClinicalTrials.gov, US National Institutes of Health (NIH) (searched 8 March 2016); World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 8 March 2016); and the website of the World Bank (searched 8 March 2016).In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via ISI Web of Science to find other potentially relevant studies. We also contacted authors of the main included studies regarding any further published or unpublished work. Randomised trials, non-randomised trials, controlled before

  15. Optimization of preventive health care facility locations

    Directory of Open Access Journals (Sweden)

    McGregor S

    2010-03-01

    Full Text Available Abstract Background Preventive health care programs can save lives and contribute to a better quality of life by diagnosing serious medical conditions early. The Preventive Health Care Facility Location (PHCFL problem is to identify optimal locations for preventive health care facilities so as to maximize participation. When identifying locations for preventive health care facilities, we need to consider the characteristics of the preventive health care services. First, people should have more flexibility to select service locations. Second, each preventive health care facility needs to have a minimum number of clients in order to retain accreditation. Results This paper presents a new methodology for solving the PHCFL problem. In order to capture the characteristics of preventive health care services, we define a new accessibility measurement that combines the two-step floating catchment area method, distance factor, and the Huff-based competitive model. We assume that the accessibility of preventive health care services is a major determinant for participation in the service. Based on the new accessibility measurement, the PHCFL problem is formalized as a bi-objective model based on efficiency and coverage. The bi-objective model is solved using the Interchange algorithm. In order to accelerate the solving process, we implement the Interchange algorithm by building two new data structures, which captures the spatial structure of the PHCFL problem. In addition, in order to measure the spatial barrier between clients and preventive health care facilities accurately and dynamically, this paper estimates travelling distance and travelling time by calling the Google Maps Application Programming Interface (API. Conclusions Experiments based on a real application for the Alberta breast cancer screening program show that our work can increase the accessibility of breast cancer screening services in the province.

  16. Optimization of preventive health care facility locations.

    Science.gov (United States)

    Gu, Wei; Wang, Xin; McGregor, S Elizabeth

    2010-03-18

    Preventive health care programs can save lives and contribute to a better quality of life by diagnosing serious medical conditions early. The Preventive Health Care Facility Location (PHCFL) problem is to identify optimal locations for preventive health care facilities so as to maximize participation. When identifying locations for preventive health care facilities, we need to consider the characteristics of the preventive health care services. First, people should have more flexibility to select service locations. Second, each preventive health care facility needs to have a minimum number of clients in order to retain accreditation. This paper presents a new methodology for solving the PHCFL problem. In order to capture the characteristics of preventive health care services, we define a new accessibility measurement that combines the two-step floating catchment area method, distance factor, and the Huff-based competitive model. We assume that the accessibility of preventive health care services is a major determinant for participation in the service. Based on the new accessibility measurement, the PHCFL problem is formalized as a bi-objective model based on efficiency and coverage. The bi-objective model is solved using the Interchange algorithm. In order to accelerate the solving process, we implement the Interchange algorithm by building two new data structures, which captures the spatial structure of the PHCFL problem. In addition, in order to measure the spatial barrier between clients and preventive health care facilities accurately and dynamically, this paper estimates travelling distance and travelling time by calling the Google Maps Application Programming Interface (API). Experiments based on a real application for the Alberta breast cancer screening program show that our work can increase the accessibility of breast cancer screening services in the province.

  17. Associations Among Health Care Workplace Safety, Resident Satisfaction, and Quality of Care in Long-Term Care Facilities.

    Science.gov (United States)

    Boakye-Dankwa, Ernest; Teeple, Erin; Gore, Rebecca; Punnett, Laura

    2017-11-01

    We performed an integrated cross-sectional analysis of relationships between long-term care work environments, employee and resident satisfaction, and quality of patient care. Facility-level data came from a network of 203 skilled nursing facilities in 13 states in the eastern United States owned or managed by one company. K-means cluster analysis was applied to investigate clustered associations between safe resident handling program (SRHP) performance, resident care outcomes, employee satisfaction, rates of workers' compensation claims, and resident satisfaction. Facilities in the better-performing cluster were found to have better patient care outcomes and resident satisfaction; lower rates of workers compensation claims; better SRHP performance; higher employee retention; and greater worker job satisfaction and engagement. The observed clustered relationships support the utility of integrated performance assessment in long-term care facilities.

  18. Assisted Living Facilities - CARE_LONG_TERM_FACILITIES_ISDH_IN: Residential Care Facilities, Nursing Homes, and Hospices in Indiana in 2007 (Indiana State Department of Health, Point Shapefile)

    Data.gov (United States)

    NSGIC State | GIS Inventory — CARE_LONG_TERM_FACILITIES_ISDH_IN is a point shapefile showing the locations of 86 residential care facilities, 525 long-term care facilities (nursing homes), and 81...

  19. Winning market positioning strategies for long term care facilities.

    Science.gov (United States)

    Higgins, L F; Weinstein, K; Arndt, K

    1997-01-01

    The decision to develop an aggressive marketing strategy for its long term care facility has become a priority for the management of a one-hundred bed facility in the Rocky Mountain West. Financial success and lasting competitiveness require that the facility in question (Deer Haven) establish itself as the preferred provider of long term care for its target market. By performing a marketing communications audit, Deer Haven evaluated its present market position and created a strategy for solidifying and dramatizing this position. After an overview of present conditions in the industry, we offer a seven step process that provides practical guidance for positioning a long term care facility. We conclude by providing an example application.

  20. Sound & Vibration 20 Design Guidelines for Health Care Facilities

    CERN Document Server

    Tocci, Gregory; Cavanaugh, William

    2013-01-01

    Sound, vibration, noise and privacy have significant impacts on health and performance. As a result, they are recognized as essential components of effective health care environments. However, acoustics has only recently become a prominent consideration in the design, construction, and operation of healthcare facilities owing to the absence, prior to 2010, of clear and objective guidance based on research and best practices. Sound & Vibration 2.0 is the first publication to comprehensively address this need. Sound & Vibration 2.0 is the sole reference standard for acoustics in health care facilities and is recognized by: the 2010 FGI Guidelines for the Design and Construction of Health Care Facilities (used in 60 countries); the US Green Building Council’s LEED for Health Care (used in 87 countries); The Green Guide for Health Care V2.2; and the International Code Council (2011). Sound & Vibration 2.0 was commissioned by the Facility Guidelines Institute in 2005, written by the Health Care Acous...

  1. Performance specifications for proton medical facility

    Energy Technology Data Exchange (ETDEWEB)

    Chu, W.T.; Staples, J.W.; Ludewigt, B.A.; Renner, T.R.; Singh, R.P.; Nyman, M.A.; Collier, J.M.; Daftari, I.K.; Petti, P.L.; Alonso, J.R. [Lawrence Berkeley Lab., CA (United States); Kubo, H.; Verhey, L.J. [University of California Davis Medical Center, Sacramento, CA (United States). Cancer Center]|[California Univ., San Francisco, CA (United States). School of Medicine; Castro, J.R. [Lawrence Berkeley Lab., CA (United States)]|[University of California Davis Medical Center, Sacramento, CA (United States). Cancer Center]|[California Univ., San Francisco, CA (United States). School of Medicine

    1993-03-01

    Performance specifications of technical components of a modern proton radiotherapy facility are presented. The technical items specified include: the accelerator; the beam transport system including rotating gantry; the treatment beamline systems including beam scattering, beam scanning, and dosimetric instrumentation; and an integrated treatment and accelerator control system. Also included are treatment ancillary facilities such as diagnostic tools, patient positioning and alignment devices, and treatment planning systems. The facility specified will accommodate beam scanning enabling the three-dimensional conformal therapy deliver .

  2. 42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

    Science.gov (United States)

    2010-10-01

    ... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals age 65 or older in institutions for...

  3. Genotoxicity of wastewater from health care facilities.

    Science.gov (United States)

    Vlková, Alena; Wittlingerová, Zdeňka; Zimová, Magdalena; Jírová, Gabriela; Kejlová, Kristina; Janoušek, Stanislav; Jírová, Dagmar

    2016-12-18

    Health care facilities use for therapeutic purposes, diagnostics, research, and disinfection a high number of chemical compounds, such as pharmaceuticals (e.g. antibiotics, cytostatics, antidepressants), disinfectants, surfactants, metals, radioactive elements, bleach preparations, etc. Hospitals consume significant amounts of water (in the range of 400 to 1200 liters/day/bed) corresponding to the amount of wastewater discharge. Some of these chemicals are not eliminated in wastewater treatment plants and are the source of pollution for surface and groundwater supplies. Hospital wastewater represents chemical and biological risks for public and environmental health as many of these compounds might be genotoxic and are suspected to contribute to the increased incidence of cancer observed during the last decades. The changes of the genetic information can have a lethal effect, but more often cause tumor processes or mutations in embryonic development causing serious defects. A review of the available literature on the mutagenicity/genotoxicity of medical facilities wastewater is presented in this article.

  4. A descriptive study of primary health care practices in Ontario’s youth custody facilities

    Science.gov (United States)

    Cossy, Lisa S; Miller, Linda T

    2013-01-01

    BACKGROUND: Adolescents admitted to youth custody facilities are often in need of physical and mental health care. OBJECTIVES: To describe primary health care practices in Ontario’s youth custody facilities. METHOD: A questionnaire regarding facility characteristics and primary health care practices was distributed to the directors of all youth custody facilities in Ontario. RESULTS: Most (87.8%) facilities obtained medical histories after the youth arrived, and 92% used health care professionals to perform that assessment. Intake medical examinations were performed on each youth admitted to custody at 94% of all facilities; however, only 57.2% of facilities reported that these examinations were performed by a doctor within 72 h of admission. Performing suicide assessments on all youth at intake was reported by 77.6% of facilities. Continuous health education was provided by 76% of facilities. Facility type and type of management appear to be related to some areas of health services provision. CONCLUSIONS: Youth custody facilities in Ontario are providing primary health care services. Weaknesses are, however, evident, particularly in relation to untimely intake medical examinations, failure to provide continuous health education and failure to conduct suicide assessments on all youth at intake. Future research on barriers to health service provision in Canadian youth custody facilities is recommended. PMID:24497778

  5. A descriptive study of primary health care practices in Ontario's youth custody facilities.

    Science.gov (United States)

    Cossy, Lisa S; Miller, Linda T

    2013-12-01

    Adolescents admitted to youth custody facilities are often in need of physical and mental health care. To describe primary health care practices in Ontario's youth custody facilities. A questionnaire regarding facility characteristics and primary health care practices was distributed to the directors of all youth custody facilities in Ontario. Most (87.8%) facilities obtained medical histories after the youth arrived, and 92% used health care professionals to perform that assessment. Intake medical examinations were performed on each youth admitted to custody at 94% of all facilities; however, only 57.2% of facilities reported that these examinations were performed by a doctor within 72 h of admission. Performing suicide assessments on all youth at intake was reported by 77.6% of facilities. Continuous health education was provided by 76% of facilities. Facility type and type of management appear to be related to some areas of health services provision. Youth custody facilities in Ontario are providing primary health care services. Weaknesses are, however, evident, particularly in relation to untimely intake medical examinations, failure to provide continuous health education and failure to conduct suicide assessments on all youth at intake. Future research on barriers to health service provision in Canadian youth custody facilities is recommended.

  6. Primary health care facility infrastructure and services and the ...

    African Journals Online (AJOL)

    Primary health care facility infrastructure and services and the nutritional status of children 0 to 71 months old and their caregivers attending these facilities in four rural districts in the Eastern Cape and KwaZulu-Natal provinces, South Africa.

  7. Differences in essential newborn care at birth between private and public health facilities in eastern Uganda.

    Science.gov (United States)

    Waiswa, Peter; Akuze, Joseph; Peterson, Stefan; Kerber, Kate; Tetui, Moses; Forsberg, Birger C; Hanson, Claudia

    2015-01-01

    In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (pnewborn care practices was slightly lower in private compared to public facilities, calling for quality improvement in both private and public sector facilities, and a greater emphasis on tracking access to and quality of care in private sector facilities.

  8. factors influencing the choice of health care providing facility among

    African Journals Online (AJOL)

    Chi Square and logistic regression analysis was done. ... utilized public health facilities attributing the choice to the low cost of services. Respondents who are satisfied with their usual care providing facilities are 12.2 times more likely to have used public ... to health care the cost of services and the waiting time are important.

  9. Quality of drug prescription in primary health care facilities in ...

    African Journals Online (AJOL)

    Background: Drug therapy can improve a patient's quality of life and health outcomes if only used properly. However, data on prescription quality at primary health care facilities in Tanzania is scanty. The objective of this study was to assess the quality of drug prescriptions in selected health care facilities in two districts of ...

  10. Utilization of primary health care facilities: Lessons from a rural ...

    African Journals Online (AJOL)

    Utilization of primary health care facilities: Lessons from a rural community in southwest Nigeria. ... Nigerian Journal of Medicine ... Background: This study assessed service/organisational factors and clients' perceptions that influenced utilisation of Primary Health Care (PHC) facilities in a rural community in Nigeria.

  11. Adverse event reporting in Czech long-term care facilities.

    Science.gov (United States)

    Hěib, Zdenřk; Vychytil, Pavel; Marx, David

    2013-04-01

    To describe adverse event reporting processes in long-term care facilities in the Czech Republic. Prospective cohort study involving a written questionnaire followed by in-person structured interviews with selected respondents. Long-term care facilities located in the Czech Republic. Staff of 111 long-term care facilities (87% of long-term care facilities in the Czech Republic). None. Sixty-three percent of long-term health-care facilities in the Czech Republic have adverse event-reporting processes already established, but these were frequently very immature programs sometimes consisting only of paper recording of incidents. Compared to questionnaire responses, in-person interview responses only partially tended to confirm the results of the written survey. Twenty-one facilities (33%) had at most 1 unconfirmed response, 31 facilities (49%) had 2 or 3 unconfirmed responses and the remaining 11 facilities (17%) had 4 or more unconfirmed responses. In-person interviews suggest that use of a written questionnaire to assess the adverse event-reporting process may have limited validity. Staff of the facilities we studied expressed an understanding of the importance of adverse event reporting and prevention, but interviews also suggested a lack of knowledge necessary for establishing a good institutional reporting system in long-term care.

  12. Dare to Care, Care to Perform

    DEFF Research Database (Denmark)

    Giangreco, Antonio; Sebastiano, Antnio; Carugati, Andrea

    2010-01-01

    -driven modernization process of an Italian nursing home. Based on qualitative research methods, our aim is to identify what are the elements of a designing approach of an IT-tool meant to enhance a process of modernization in a health care organization. Our results show that a patient-centered, user-friendly, bottomup...... (patients and users), then it will produce positive results for the organization. In other words, who dares to care, will perform....

  13. Health care facilities resilient to climate change impacts.

    Science.gov (United States)

    Paterson, Jaclyn; Berry, Peter; Ebi, Kristie; Varangu, Linda

    2014-12-01

    Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator's guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change.

  14. Health Care Facilities Resilient to Climate Change Impacts

    Directory of Open Access Journals (Sweden)

    Jaclyn Paterson

    2014-12-01

    Full Text Available Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator’s guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change.

  15. Respectful maternity care in Ethiopian public health facilities.

    Science.gov (United States)

    Sheferaw, Ephrem D; Bazant, Eva; Gibson, Hannah; Fenta, Hone B; Ayalew, Firew; Belay, Tsigereda B; Worku, Maria M; Kebebu, Aelaf E; Woldie, Sintayehu A; Kim, Young-Mi; van den Akker, T; Stekelenburg, Jelle

    2017-05-16

    Disrespect and abuse of women during institutional childbirth services is one of the deterrents to utilization of maternity care services in Ethiopia and other low- and middle-income countries. This paper describes the prevalence of respectful maternity care (RMC) and mistreatment of women in hospitals and health centers, and identifies factors associated with occurrence of RMC and mistreatment of women during institutional labor and childbirth services. This study had a cross sectional study design. Trained external observers assessed care provided to 240 women in 28 health centers and hospitals during labor and childbirth using structured observation checklists. The outcome variable, providers' RMC performance, was measured by nine behavioral descriptors. The outcome, any mistreatment, was measured by four items related to mistreatment of women: physical abuse, verbal abuse, absence of privacy during examination and abandonment. We present percentages of the nine RMC indicators, mean score of providers' RMC performance and the adjusted multilevel model regression coefficients to determine the association with a quality improvement program and other facility and provider characteristics. Women on average received 5.9 (66%) of the nine recommended RMC practices. Health centers demonstrated higher RMC performance than hospitals. At least one form of mistreatment of women was committed in 36% of the observations (38% in health centers and 32% in hospitals). Higher likelihood of performing high level of RMC was found among male vs. female providers ([Formula: see text], p = 0.012), midwives vs. other cadres ([Formula: see text], p = 0.002), facilities implementing a quality improvement approach, Standards-based Management and Recognition (SBM-R©) ([Formula: see text], p = 0.003), and among laboring women accompanied by a companion [Formula: see text], p = 0.003). No factor was associated with observed mistreatment of women. Quality improvement using

  16. 75 FR 54627 - Best Management Practices for Unused Pharmaceuticals at Health Care Facilities

    Science.gov (United States)

    2010-09-08

    ... AGENCY Best Management Practices for Unused Pharmaceuticals at Health Care Facilities AGENCY... guidance document entitled, Best Management Practices for Unused Pharmaceuticals at Health Care Facilities. The guidance is targeted at hospitals, medical clinics, doctors' offices, long-term care facilities...

  17. Satisfaction with health facility delivery care services and ssociated ...

    African Journals Online (AJOL)

    Satisfaction with health facility delivery care services and ssociated factors: The case of Lindi and Mtwara rural districts, southern Tanzania. RNM Mpembeni, SN Massawe, MT Leshabari, DV Kakoko, E Duysburgh, P Wangwe, F Sukums, H Saronga, S Loukanova ...

  18. Antibiotic use and resistance in long term care facilities.

    NARCIS (Netherlands)

    Buul, L.W. van; Steen, J.T. van der; Veenhuizen, R.B.; Achterberg, W.P.; Schellevis, F.G.; Essink, R.T.G.M.; Benthem, B.H.B. van; Natsch, S.; Hertogh, C.M.P.M.

    2012-01-01

    Introduction: The common occurrence of infectious diseases in nursing homes and residential care facilities may result in substantial antibiotic use, and consequently antibiotic resistance. Focusing on these settings, this article aims to provide a comprehensive overview of the literature available

  19. Antibiotic use and resistance in long term care facilities

    NARCIS (Netherlands)

    van Buul, L.W.; van der Steen, J.T.; Veenhuizen, R.B.; Achterberg, W.P.; Schellevis, F.G.; Essink, R.T.G.M.; Benthem, B.H. van; Natsch, S.S.; Hertogh, C.M.P.M.

    2012-01-01

    INTRODUCTION: The common occurrence of infectious diseases in nursing homes and residential care facilities may result in substantial antibiotic use, and consequently antibiotic resistance. Focusing on these settings, this article aims to provide a comprehensive overview of the literature available

  20. Prescribing practices in two health care facilities in Warri, Southern ...

    African Journals Online (AJOL)

    Purpose: Inappropriate prescribing has been identified in many health facilities in developing countries. The purpose of this study was to evaluate the prescribing practices in two health care facilities in Warri located in south-south geopolitical region of Nigeria and identify factors influencing the practices. Method: WHO ...

  1. Vitrification Facility integrated system performance testing report

    Energy Technology Data Exchange (ETDEWEB)

    Elliott, D.

    1997-05-01

    This report provides a summary of component and system performance testing associated with the Vitrification Facility (VF) following construction turnover. The VF at the West Valley Demonstration Project (WVDP) was designed to convert stored radioactive waste into a stable glass form for eventual disposal in a federal repository. Following an initial Functional and Checkout Testing of Systems (FACTS) Program and subsequent conversion of test stand equipment into the final VF, a testing program was executed to demonstrate successful performance of the components, subsystems, and systems that make up the vitrification process. Systems were started up and brought on line as construction was completed, until integrated system operation could be demonstrated to produce borosilicate glass using nonradioactive waste simulant. Integrated system testing and operation culminated with a successful Operational Readiness Review (ORR) and Department of Energy (DOE) approval to initiate vitrification of high-level waste (HLW) on June 19, 1996. Performance and integrated operational test runs conducted during the test program provided a means for critical examination, observation, and evaluation of the vitrification system. Test data taken for each Test Instruction Procedure (TIP) was used to evaluate component performance against system design and acceptance criteria, while test observations were used to correct, modify, or improve system operation. This process was critical in establishing operating conditions for the entire vitrification process.

  2. Cross-sectional relationship between physical fitness components and functional performance in oder persons living in long-term care facilities

    NARCIS (Netherlands)

    Singh, A.S.; Chin A Paw, M.J.M.; Bosscher, R.J.; van Mechelen, W.

    2006-01-01

    Background: The age-related deterioration of physiological capacities such as muscle strength and balance is associated with increased dependence. Understanding the contribution of physical fitness components to functional performance facilitates the development of adequate exercise interventions

  3. Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management.

    Science.gov (United States)

    Scholz, Stefan; Ngoli, Baltazar; Flessa, Steffen

    2015-05-01

    Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.

  4. Health care facility preparation for weapons of mass destruction.

    Science.gov (United States)

    Bradley, R N

    2000-01-01

    Weapons of mass destruction (WMD) are a threat that all health care facilities must be prepared for. Every health care facility is a vital part of the community response system and must be ready to respond. A terrorist attack using WMD can occur in any location, urban or rural. Private vehicles or buses may transport the majority of patients, with only a small percentage arriving by emergency medical services. Most will go to the hospitals closest to the incident, even if this results in overcrowding. Others will go directly to their private physicians' offices or primary hospitals, even if these facilities are not part of the local disaster plan. Most of these victims will not be decontaminated before arrival. If a hospital allows any of these patients in, the staff may become ill from the toxic exposure and the facility may require closure for decontamination. Since the risk is universal, all health care facilities must plan for the care of victims of a WMD incident. They must plan for communications that allow local government to transmit alerts regarding the emergency. Health care facilities must also communicate their status and emergency needs to local officials during the emergency. They must be prepared to establish a single entry control point and attempt to secure all other entrances. They must be able to establish a patient decontamination team from on-duty staff with only a few minutes' notice at any time of the day or night.

  5. Hepatitis B infection in black children from residential care facilities ...

    African Journals Online (AJOL)

    KwaZulu-Natal. Implications for adoption and foster care. G. c. Solarsh, N. McKerrow, K. P. Mlisana,. W. E. K. Loening, E. Gouws. Objectives. A study was undertaken to assess the prevalence of hepatitis B infection in selected residential child care facilmes in Natal. Design. All residents at three facilities in the Durban and.

  6. Quality of drug prescription in primary health care facilities in ...

    African Journals Online (AJOL)

    DR Marwa

    Conclusion: Prescribing of higher number of drugs than the WHO recommendations and overuse of antibiotics is still a problem at health care facilities in Mwanza Tanzania. The frequency of occurrence of prescription errors found during the study was considerably high. Keywords: drug prescription, primary health care ...

  7. Benchmarking facilities providing care: An international overview of initiatives

    Science.gov (United States)

    Thonon, Frédérique; Watson, Jonathan; Saghatchian, Mahasti

    2015-01-01

    We performed a literature review of existing benchmarking projects of health facilities to explore (1) the rationales for those projects, (2) the motivation for health facilities to participate, (3) the indicators used and (4) the success and threat factors linked to those projects. We studied both peer-reviewed and grey literature. We examined 23 benchmarking projects of different medical specialities. The majority of projects used a mix of structure, process and outcome indicators. For some projects, participants had a direct or indirect financial incentive to participate (such as reimbursement by Medicaid/Medicare or litigation costs related to quality of care). A positive impact was reported for most projects, mainly in terms of improvement of practice and adoption of guidelines and, to a lesser extent, improvement in communication. Only 1 project reported positive impact in terms of clinical outcomes. Success factors and threats are linked to both the benchmarking process (such as organisation of meetings, link with existing projects) and indicators used (such as adjustment for diagnostic-related groups). The results of this review will help coordinators of a benchmarking project to set it up successfully. PMID:26770800

  8. [Animal- assisted therapy in health care facilities].

    Science.gov (United States)

    Jofré M, Leonor

    2005-09-01

    Animal-assisted therapy is a novel interventional program with important benefits in the management of patients with chronic diseases and prolonged hospitalization. The relationship between animals and patients facilitates adaptation to a new, stressing hospital environment, helps in diminishing anxiety, stress, pain and blood pressure and increases mobility and muscular strength. This therapy can be developed by pets themselves or by specially trained animals. Dogs are the most frequently used animals because of their training and sociability skills. Patients and animals participating in these programs require special care in order to avoid transmission of infectious diseases associated with pets, hypersensitivity and accidents during their visits. Implementation of animal - assisted therapy in care centers requires a permanent revision of suggested guidelines and program objectives.

  9. An Application of Business Process Management to Health Care Facilities.

    Science.gov (United States)

    Hassan, Mohsen M D

    The purpose of this article is to help health care facility managers and personnel identify significant elements of their facilities to address, and steps and actions to follow, when applying business process management to them. The ABPMP (Association of Business Process Management Professionals) life-cycle model of business process management is adopted, and steps from Lean, business process reengineering, and Six Sigma, and actions from operations management are presented to implement it. Managers of health care facilities can find in business process management a more comprehensive approach to improving their facilities than Lean, Six Sigma, business process reengineering, and ad hoc approaches that does not conflict with them because many of their elements can be included under its umbrella. Furthermore, the suggested application of business process management can guide and relieve them from selecting among these approaches, as well as provide them with specific steps and actions that they can follow. This article fills a gap in the literature by presenting a much needed comprehensive application of business process management to health care facilities that has specific steps and actions for implementation.

  10. Support Care Facility Prague House, Freshford, Kilkenny.

    LENUS (Irish Health Repository)

    Cleary, A

    2012-01-01

    The aim of this audit was to review current practice within a rural mental health service area on the monitoring and documentation of side effects of antipsychotic depot medication. Following a review of the literature on best practice internationally, an evidence based audit tool was adapted. A sample of 60 case files, care plans and prescriptions were audited between January and May 2010. This represented 31% of the total number of service users receiving depot injections in the mental health service region (n=181). The audit results revealed that most service users had an annual documented medical review and a documented prescription. However, only 5 (8%) case notes examined had documentation recorded describing the condition of the injection site and alternation of the injection site was recorded in only 28 (47%) case notes. No case notes examined had written consent to commence treatment recorded, and only 3 (5%) of case notes had documented that information on the depot injection and side effects was given. In 57 (95%) of case notes no documentation of recorded information on the depot and on side effects was given. Documentation of physical observations and tests revealed that 58% of cases had full blood count, liver function tests, thyroid function tests and fasting lipids recorded. All other tests (i.e. temperature, pulse, respirations, blood pressure, ECG) were recorded in less than 50% of cases. Prolactin levels were not recorded in any case. The lack of written consent was partly attributed to lack of recording of consent. The failure to monitor and record some\\r\

  11. Suicidal Behavior in Long-Term Care Facilities.

    Science.gov (United States)

    Osgood, Nancy J.; Brant, Barbara A.

    1990-01-01

    Surveyed administrators of 463 long-term care facilities concerning overt suicides and intentional life-threatening behaviors. Data revealed that White males were highest risk group. Refusal to eat, drink, or take medications were most common suicidal behaviors. Depression, loneliness, feelings of family rejection, and loss were significant…

  12. Costing health care interventions at primary health facilities in ...

    African Journals Online (AJOL)

    The main objective was to estimate sector wide disease specific cost of health care intervention at health facilities in Nouna, Burkina Faso. A step-down full costing procedure was used to estimate the costs of interventions for 33 ICD-9 diseases using the diagnosis and treatment algorithms developed by the Ministry of ...

  13. Antimicrobial use in long-term-care facilities

    NARCIS (Netherlands)

    Nicolle, LE; Bentley, DW; Garibaldi, R; Neuhaus, EG; Smith, PW

    There is intense antimicrobial use in long-term-care facilities (LTCFs), and studies repeatedly document that much of this use is inappropriate. The current crisis in antimicrobial resistance, which encompasses the LTCF, heightens concerns of antimicrobial use. Attempts to improve antimicrobial use

  14. Planning Phase - Strengthening Community to Health Facility Care ...

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

    The UK medical journal, Lancet, noted that the province also has lower usage of health facility delivery and postnatal care services compared to the rest of the country. Research partnership for health. The Universidade Lurio will collaborate with the University of Saskatchewan to design research to address these ...

  15. Caring behaviors perceived by elderly residents of long-term care facilities: scale development and psychometric assessment.

    Science.gov (United States)

    Hwang, Huei-Lih; Tu, Chin-Tang; Chen, Shiue; Wang, Hsiu-Hung

    2012-02-01

    To meet the growing need for relationship-centered nursing practice and for nursing school accreditation in Taiwan, nursing school curricula must include training in care for elderly populations in institutional settings. However, educators lack tools for evaluating student performance in such settings. The few tools currently available for measuring the caring in nurses perceived by elderly residents of long-term care facilities (LTCFs) are either inappropriate for education purposes or are culturally inappropriate for elderly populations in Taiwan. To develop a scale for measuring the caring behaviors of caregivers or student volunteers as perceived by a Taiwanese population of elderly residents of LTCFs and to establish the psychometric characteristics of the scale. This study was conducted in two phases. In Phase 1, the researchers comprehensively reviewed the literature on caring. Based on the review, an Elderly Resident-Perceived Caring Scale (EPCS) was developed to measure the caring behaviors perceived by LTCF residents. To establish content and face validity, the items on the scale were reviewed by six experts in two rounds of Delphi study and by four elderly laypersons. In Phase 2, a convenience sample of 297 elderly residents from 18 representative elderly care facilities (i.e., skilled nursing facilities, independent living facilities, and assisted living facilities) in Taiwan were recruited to test the construct validity and reliability of the EPCS. The 14-item, 2-dimension questionnaire developed in this study explained 64.33% of the variance in caring perceived by the residents. Factor I, Comforting, included 11 items. Factor II, Encouraging, included 3 items. Cronbach's α values were .924 for the total scale and .930 and .844 for the Comforting and Encouraging, respectively. The psychometric qualities of the EPCS were supported. However, further testing of the scale is needed to confirm its psychometric properties in a larger sample. Copyright

  16. Examining clinical performance feedback in Patient-Aligned Care Teams.

    Science.gov (United States)

    Hysong, Sylvia J; Knox, Melissa K; Haidet, Paul

    2014-07-01

    The move to team-based models of health care represents a fundamental shift in healthcare delivery, including major changes in the roles and relationships among clinical personnel. Audit and feedback of clinical performance has traditionally focused on the provider; however, a team-based model of care may require different approaches. Identify changes in audit and feedback of clinical performance to primary care clinical personnel resulting from implementing team-based care in their clinics. Semi-structured interviews with primary care clinicians, their department heads, and facility leadership at 16 geographically diverse VA Medical Centers, selected purposively by their clinical performance profile. An average of three interviewees per VA medical center, selected from physicians, nurses, and primary care and facility directors who participated in 1-hour interviews. Interviews focused on how clinical performance information is fed back to clinicians, with particular emphasis on external peer-review program measures and changes in feedback associated with team-based care implementation. Interview transcripts were analyzed, using techniques adapted from grounded theory and content analysis. Ownership of clinical performance still rests largely with the provider, despite transitioning to team-based care. A panel-management information tool emerged as the most prominent change to clinical performance feedback dissemination, and existing feedback tools were seen as most effective when monitored by the nurse members of the team. Facilities reported few, if any, appreciable changes to the assessment of clinical performance since transitioning to team-based care. Although new tools have been created to support higher-quality clinical performance feedback to primary care teams, such tools have not necessarily delivered feedback consistent with a team-based approach to health care. Audit and feedback of clinical performance has remained largely unchanged, despite material

  17. CERN n_TOF facility Performance report

    CERN Document Server

    Abbondanno, U; Cennini, P; Chiaveri, Enrico; Dario, M; Mengoni, A; Pavlopoulos, P; Saldaña, F; Vlachoudis, V; Wendler, H; CERN. Geneva; CERN. Geneva. ISOLDE and Neutron Time-of-Flight Experiments Committee; INTC

    2002-01-01

    An innovative neutron Time-of-Flight facility (n_TOF) has recently become operative at CERN. The high neutron flux is obtained by the spallation of 20 GeV/c protons onto a solid lead target. The proton beam is delivered by the Proton Synchrotron (PS) at CERN capable of providing up to four sharp bunches (RMS 6 ns) with an intensity of 7x10^12 protons per bunch within a 14.4s supercycle. The present report describes the outstanding characteristics of this facility: high neutron flux of 10^6 n/cm^2/7x10^12 p at 185 m, wide spectral function from 1 eV up to 250 MeV, low repetition rates, an excellent energy resolution of 2x10^-4 in the resonance region and low background conditions. These unique features open new possibilities for high precision neutron induced cross section measurements relevant to Nuclear Technology, Nuclear Astrophysics and fundamental Nuclear Physics.

  18. Using Workflow Diagrams to Address Hand Hygiene in Pediatric Long-Term Care Facilities.

    Science.gov (United States)

    Carter, Eileen J; Cohen, Bevin; Murray, Meghan T; Saiman, Lisa; Larson, Elaine L

    2015-01-01

    Hand hygiene (HH) in pediatric long-term care settings has been found to be sub-optimal. Multidisciplinary teams at three pediatric long-term care facilities developed step-by-step workflow diagrams of commonly performed tasks highlighting HH opportunities. Diagrams were validated through observation of tasks and concurrent diagram assessment. Facility teams developed six workflow diagrams that underwent 22 validation observations. Four main themes emerged: 1) diagram specificity, 2) wording and layout, 3) timing of HH indications, and 4) environmental hygiene. The development of workflow diagrams is an opportunity to identify and address the complexity of HH in pediatric long-term care facilities. Copyright © 2015. Published by Elsevier Inc.

  19. Reducing and/or minimising physical restraint in a high care, rural aged care facility.

    Science.gov (United States)

    Darcy, Lynette

    2007-12-01

    Background  This report takes you through a journey of implementing evidence-based best practice guidelines in relation to physical restraint in an aged care facility. It describes the processes involved in making changes to an existing system, introducing evidence-based guidelines and collaboratively achieving compliance with best practice. The project formed part of a combined initiative between the Joanna Briggs Institute and the Commonwealth Department of Health and Ageing, called the Aged Care Clinical Fellowship Program. The Joanna Briggs Institute Practical Application of Clinical Evidence System, an online audit-based tool that includes an action research process Getting Research Into Practice was used to facilitate audit data collection and analysis. This report demonstrates that effective clinical leadership and evidence-based research, combined with a strategy of audit, feedback and re-audit, can become an effective change agent to improve clinical practice in residential aged care facilities. Aims/objectives  The aims of this project were to increase staff knowledge and awareness of restraints, improve practices in restraint assessment and usage, reduce or minimise the amount and type of restraints used and ensure the least restrictive device possible was utilised in a rural aged care facility. Methods  A system of audit, feedback and re-audit was performed using the Joanna Briggs Institute Practical Application of Clinical Evidence System software. This was completed in a series of stages over a period of 6 months. The first stage was to apply defining characteristics to each of the evidence-based audit criteria to determine compliance. A team of staff was set up to assist with the project. An initial audit was conducted, followed by a situational analysis of the findings. From this an action plan for improvement using Getting Research Into Practice was developed. The action plan was then implemented and the criteria re-audited and reviewed

  20. Characteristics and Performance of Minority-Serving Dialysis Facilities

    Science.gov (United States)

    Hall, Yoshio N; Xu, Ping; Chertow, Glenn M; Himmelfarb, Jonathan

    2014-01-01

    Objective To examine the structure, processes, and outcomes of American dialysis facilities that predominantly treat racial-ethnic minority patients. Data Sources/Study Setting Secondary analysis of data from all patients who initiated dialysis during 2005–2008 in the United States. Study Design In this retrospective cohort study, we examined the associations of the racial-ethnic composition of the dialysis facility with facility-level survival and achievement of performance targets for anemia and dialysis adequacy. Data Collection/Extraction Methods We obtained dialysis facility- and patient-level data from the national data registry of patients with end-stage renal disease. We linked these data with clinical performance measures from the Centers for Medicare and Medicaid Services. Principal Findings Overall, minority-serving facilities were markedly larger, more often community based, and less likely to offer home dialysis than facilities serving predominantly white patients. A significantly higher proportion of minority-serving dialysis facilities exhibited worse than expected survival as compared with facilities serving predominantly white patients (p dialysis adequacy were similar across minority-serving status. Conclusions While minority-serving facilities generally met dialysis performance targets mandated by Medicare, they exhibited worse than expected patient survival. PMID:24354718

  1. Measuring facility capability to provide routine and emergency childbirth care to mothers and newborns: An appeal to adjust for delivery caseload of facilities.

    Directory of Open Access Journals (Sweden)

    Stephanie M Allen

    Full Text Available Measurement of Emergency Obstetric Care capability is common, and measurement of newborn and overall routine childbirth care has begun in recent years. These assessments of facility capabilities can be used to identify geographic inequalities in access to functional health services and to monitor improvements over time. This paper develops an approach for monitoring the childbirth environment that accounts for the delivery caseload of the facility.We used data from the Kenya Service Provision Assessment to examine facility capability to provide quality childbirth care, including infrastructure, routine maternal and newborn care, and emergency obstetric and newborn care. A facility was considered capable of providing a function if necessary tracer items were present and, for emergency functions, if the function had been performed in the previous three months. We weighted facility capability by delivery caseload, and compared results with those generated using traditional "survey weights".Of the 403 facilities providing childbirth care, the proportion meeting criteria for capability were: 13% for general infrastructure, 6% for basic emergency obstetric care, 3% for basic emergency newborn care, 13% and 11% for routine maternal and newborn care, respectively. When the new caseload weights accounting for delivery volume were applied, capability improved and the proportions of deliveries occurring in a facility meeting capability criteria were: 51% for general infrastructure, 46% for basic emergency obstetric care, 12% for basic emergency newborn care, 36% and 18% for routine maternal and newborn care, respectively. This is because most of the caseload was in hospitals, which generally had better capability. Despite these findings, fewer than 2% of deliveries occurred in a facility capable of providing all functions.Reporting on the percentage of facilities capable of providing certain functions misrepresents the capacity to provide care at the

  2. Nonlicensed employee turnover in a long-term care facility.

    Science.gov (United States)

    Gaddy, T; Bechtel, G A

    1995-06-01

    The purpose of this study was to analyze nonlicensed employee turnover in a long-term care facility using Maslow's hierarchy of needs as a framework. During exit interviews, a convenience sample of 34 employees completed an attitudes and beliefs survey regarding their work environment. Findings were mixed; 39.6 percent of the employees stated positive personal relationships were a strength of the organization, although 24.3 percent resigned because of personal/staff conflicts. Financial concerns were not a major factor in their resignations. The study suggests that decreasing nonlicensed employee stress and increasing their personal satisfaction with patient care may decrease employee turnover.

  3. Health-Care Waste Practices in Selected Health-Care Facilities in ...

    African Journals Online (AJOL)

    Although constituting a relatively small proportion of waste matter, the waste produced during medical treatment and routine dispensing of medical care is potentially the most infectious and environmentally hazardous. Health-Care Facilities (HCF) are, therefore, duty-bound to effectively manage the waste that they produce ...

  4. Operationalising emergency care delivery in sub-Saharan Africa: consensus-based recommendations for healthcare facilities.

    Science.gov (United States)

    Calvello, Emilie J B; Tenner, Andrea G; Broccoli, Morgan C; Skog, Alexander P; Muck, Andrew E; Tupesis, Janis P; Brysiewicz, Petra; Teklu, Sisay; Wallis, Lee; Reynolds, Teri

    2016-08-01

    A major barrier to successful integration of acute care into health systems is the lack of consensus on the essential components of emergency care within resource-limited environments. The 2013 African Federation of Emergency Medicine Consensus Conference was convened to address the growing need for practical solutions to further implementation of emergency care in sub-Saharan Africa. Over 40 participants from 15 countries participated in the working group that focused on emergency care delivery at health facilities. Using the well-established approach developed in the WHO's Monitoring Emergency Obstetric Care, the workgroup identified the essential services delivered-signal functions-associated with each emergency care sentinel condition. Levels of emergency care were assigned based on the expected capacity of the facility to perform signal functions, and the necessary human, equipment and infrastructure resources identified. These consensus-based recommendations provide the foundation for objective facility capacity assessment in developing emergency health systems that can bolster strategic planning as well as facilitate monitoring and evaluation of service delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  5. Green Schools as High Performance Learning Facilities

    Science.gov (United States)

    Gordon, Douglas E.

    2010-01-01

    In practice, a green school is the physical result of a consensus process of planning, design, and construction that takes into account a building's performance over its entire 50- to 60-year life cycle. The main focus of the process is to reinforce optimal learning, a goal very much in keeping with the parallel goals of resource efficiency and…

  6. 77 FR 21580 - Changes in Certain Multifamily Housing and Health Care Facility Mortgage Insurance Premiums for...

    Science.gov (United States)

    2012-04-10

    ... URBAN DEVELOPMENT Changes in Certain Multifamily Housing and Health Care Facility Mortgage Insurance...) Multifamily Housing, Health Care Facilities, and Hospital Mortgage Insurance programs for commitments to be... multifamily housing, health care facility, and hospital loans. The increases will not apply to Low Income...

  7. HIV Subspecialty Care in Correctional Facilities Using Telemedicine.

    Science.gov (United States)

    Young, Jeremy D; Patel, Mahesh

    2015-04-01

    In the United States, prisons and jails contain a population at high risk for HIV infection with a relatively large proportion known to be HIV positive. However, many incarcerated persons lack access to subspecialty HIV care due to barriers of geography and travel. Telemedicine clinics can remove these barriers, increasing access to expert, multidisciplinary care. With telemedicine, correctional facilities can provide up-to-date, evidence-based HIV management, which may lead to improved compliance, greater virologic suppression, improved CD4 T-cell counts, fewer adverse drug interactions, and decreased transmission in the community. While HIV care in prisons is an example of harnessing this technology, telemedicine can be used for the diagnosis and management of multiple acute and chronic diseases for underserved populations. © The Author(s) 2015.

  8. Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey.

    Directory of Open Access Journals (Sweden)

    Naoko Kozuki

    Full Text Available This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi's Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing

  9. Assessment of primary health care facilities' service readiness in Nigeria.

    Science.gov (United States)

    Oyekale, Abayomi Samuel

    2017-03-01

    Effective delivery of healthcare services requires availability of adequate infrastructure, diagnostic medical equipment, drugs and well-trained medical personnel. In Nigeria, poor funding and mismanagement often characterize healthcare service delivery thereby affecting coverage and quality of healthcare services. Therefore, the state of service delivery in Nigeria's health sector has come under some persistent criticisms. This paper analyzed service readiness of Primary Health Care (PHC) facilities in Nigeria with focus on availability of some essential drugs and medical equipment. Service Delivery Indicator (SDI) data for PHC in Nigeria were used. The data were collected from 2480 healthcare facilities from 12 states in the Nigeria's 6 geopolitical zones between 2013 and 2014. Data were analyzed with descriptive statistics, Principal Component Analysis (PCA) and Ordinary Least Square regression. Medical disposables such as hand gloves and male condoms were reported to be available in 77.18 and 44.03% of all the healthcare facilities respectively, while immunization services were provided by 86.57%. Functional stethoscopes were reported by 77.22% of the healthcare facilities, while only 68.10% had sphygmomanometers. In the combined healthcare facilities, availability of some basic drugs such as Azithromycin, Nifedipine, Dexamethasone and Misoprostol was low with 10.48, 25.20, 21.94 and 17.06%, respectively, while paracetamol and folic acid both had high availability with 74.31%. Regression results showed that indices of drug and medical equipment availability increased significantly (p Nigeria and with presence of some power sources (electricity, generators, batteries and solar), but decreased among dispensaries/health posts. Travel time to headquarters and rural facilities significantly reduced indices of equipment availability (p Nigeria to ensure better equity in access to healthcare facilities, which would facilitate achievement of some health

  10. Types of health care facilities and the quality of primary care: a study of characteristics and experiences of Chinese patients in Guangdong Province, China.

    Science.gov (United States)

    Hu, Ruwei; Liao, Yu; Du, Zhicheng; Hao, Yuantao; Liang, Hailun; Shi, Leiyu

    2016-08-02

    In China, most people tend to use hospitals rather than health centers for their primary care generally due to the perception that quality of care provided in the hospital setting is superior to that provided at the health centers. No studies have been conducted in China to compare the quality of primary care provided at different health care settings. The purpose of this study is to compare the quality of primary care provided in different types of health care facilities in China. A cross-sectional survey with patients was conducted in Guangdong province of China, using the validated Chinese Primary Care Assessment Tool (PCAT). ANOVA was performed to compare the overall and 10 domains of primary care quality for patients in tertiary, secondary, and primary health care settings. Multivariate analyses were used to assess the association between types of facility and quality of primary care attributes while controlling for sociodemographic and health care characteristics. The final number of respondents was 864 including 161 from county hospitals, 190 from rural community health centers (CHCs), 164 from tertiary hospitals, 80 from secondary hospitals, and 269 from urban CHCs. Type of health care facilities was significantly associated with total PCAT score and domain scores. CHC was associated with higher total PCAT score and scores for first contact-access, ongoing care, comprehensiveness-services available, and community orientation than secondary and/or tertiary hospitals, after controlling for patients' demographic and health characteristics. Higher PCAT score was associated with greater satisfaction with primary care received. CHC patients were more likely to report satisfactory experiences compared to patients from secondary and tertiary facilities. The study demonstrated that CHCs provided better quality primary care when compared with secondary and tertiary health care facilities, justifying CHCs as a model of primary care delivery.

  11. Management considerations in the care of elderly heart failure patients in long-term care facilities.

    Science.gov (United States)

    Heckman, George A; Boscart, Veronique M; McKelvie, Robert S

    2014-07-01

    Heart failure, a condition that affects up to 20% of older persons residing in long-term care facilities, is an important cause of morbidity, health service utilization and death. Effective and interprofessional heart failure care processes could potentially improve care, outcomes and quality of life and delay decline or hospital admission. This article reviews the clinical aspects of heart failure, and the challenges to the diagnosis and management of this condition in long-term care residents who are frail and are affected by multiple comorbidities.

  12. Assessing the quality of care in a new nation: South Sudan's first national health facility assessment.

    Science.gov (United States)

    Berendes, Sima; Lako, Richard L; Whitson, Donald; Gould, Simon; Valadez, Joseph J

    2014-10-01

    We adapted a rapid quality of care monitoring method to a fragile state with two aims: to assess the delivery of child health services in South Sudan at the time of independence and to strengthen local capacity to perform regular rapid health facility assessments. Using a two-stage lot quality assurance sampling (LQAS) design, we conducted a national cross-sectional survey among 156 randomly selected health facilities in 10 states. In each of these facilities, we obtained information on a range of access, input, process and performance indicators during structured interviews and observations. Quality of care was poor with all states failing to achieve the 80% target for 14 of 19 indicators. For example, only 12% of facilities were classified as acceptable for their adequate utilisation by the population for sick-child consultations, 16% for staffing, 3% for having infection control supplies available and 0% for having all child care guidelines. Health worker performance was categorised as acceptable in only 6% of cases related to sick-child assessments, 38% related to medical treatment for the given diagnosis and 33% related to patient counselling on how to administer the prescribed drugs. Best performance was recorded for availability of in-service training and supervision, for seven and ten states, respectively. Despite ongoing instability, the Ministry of Health developed capacity to use LQAS for measuring quality of care nationally and state-by-state, which will support efficient and equitable resource allocation. Overall, our data revealed a desperate need for improving the quality of care in all states. © 2014 John Wiley & Sons Ltd.

  13. Prevalence of oral pain and barriers to use of emergency oral care facilities among adult Tanzanians

    Directory of Open Access Journals (Sweden)

    Kahabuka Febronia

    2008-09-01

    Full Text Available Abstract Background Oral pain has been the major cause of the attendances in the dental clinics in Tanzania. Some patients postpone seeing the dentist for as long as two to five days. This study determines the prevalence of oral pain and barriers to use of emergency oral care in Tanzania. Methods Questionnaire data were collected from 1,759 adult respondents aged 18 years and above. The study area covered six urban and eight rural study clusters, which had been selected using the WHO Pathfinder methodology. Chi-square tests and logistic regression analyses were performed to identify associations. Results Forty two percent of the respondents had utilized the oral health care facilities sometimes in their lifetime. About 59% of the respondents revealed that they had suffered from oral pain and/or discomfort within the twelve months that preceded the study, but only 26.5% of these had sought treatment from oral health care facilities. The reasons for not seeking emergency care were: lack of money to pay for treatment (27.9%; self medication (17.6%; respondents thinking that pain would disappear with time (15.7%; and lack of money to pay for transport to the dental clinic (15.0%. Older adults were more likely to report that they had experienced oral pain during the last 12 months than the younger adults (OR = 1.57, CI 1.07–1.57, P dental clinics far from home (OR = 5.31, CI = 2.09–13.54, P and being treated by traditional healer (OR = 5.31, CI = 2.25–12.49, P as reasons for not seeking emergency care from the oral health care facilities than their counterparts from urban areas. Conclusion Oral pain and discomfort were prevalent among adult Tanzanians. Only a quarter of those who experienced oral pain or discomfort sought emergency oral care from oral health care facilities. Self medication was used as an alternative to using oral care facilities mainly by rural residents. Establishing oral care facilities in rural areas is recommended.

  14. 42 CFR 409.85 - Skilled nursing facility (SNF) care coinsurance.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Skilled nursing facility (SNF) care coinsurance... Coinsurance § 409.85 Skilled nursing facility (SNF) care coinsurance. (a) General provisions. (1) SNF care coinsurance is the amount chargeable to a beneficiary after the first 20 days of SNF care in a benefit period...

  15. Osteoporosis Diagnosis and Management in Long-Term Care Facility.

    Science.gov (United States)

    Aguilar, Erwin A; Barry, Sean D; Cefalu, Charles A; Abdo, Abir; Hudson, William P; Campbell, James S; Reske, Thomas M; Bonafede, Machaon; Wilson, Kathleen; Stolshek, Bradley S; Paoli, Carly J; Tran, Nguyet; Cheng, Lung-I

    2015-11-01

    Contemporary estimates of the prevalence of diagnosed osteoporosis among long-term care facility residents are limited. This chart review collected data between April 1, 2012 and August 31, 2013 for adult (age ≥ 30 years) residents of 11 long-term care facilities affiliated with the Louisiana State University Health Sciences Center in the New Orleans metropolitan area. Data (demographics; comorbidities; osteoporosis diagnosis, risk factors, diagnostic assessments, treatments; fracture history; fall risk; activities of daily living) were summarized. Data for residents with and without diagnosed osteoporosis were compared using χ tests and t tests. The study included 746 residents (69% women, mean [SD] age: 76.3 [13.9] years, median length of stay approximately 18.5 months). An osteoporosis diagnosis was recorded for 132 residents (18%), 30% of whom received a pharmacologic osteoporosis therapy. Fewer than 2% of residents had bone mineral density assessments; 10% had previous fracture. Calcium and vitamin D use was more prevalent in residents with diagnosed osteoporosis compared with other residents (calcium: 49% versus 12%, vitamin D: 52% versus 28%; both P assessed residents had a high fall risk. Activities of daily living were similarly limited regardless of osteoporosis status. The prevalence of diagnosed osteoporosis was higher than previously reported for long-term care residents, but lower than epidemiologic estimates of osteoporosis prevalence for the noninstitutional U.S. In our sample, osteoporosis diagnostic testing was rare and treatment rates were low. Our results suggest that osteoporosis may be underdiagnosed and undertreated in long-term care settings.

  16. Annual Summary of the Integrated Disposal Facility Performance Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Lehman, L. L. [CH2M HILL Plateau Remediation Company, Richland, WA (United States)

    2011-01-11

    An annual summary on the adequacy of the Hanford Imnmobilized Low-Activity Waste (RLAW) Performance Assessment (PA) is required for each year in which a PA is not issued (DOE 0 435.1, Radioactive Waste Management; DOE M 435.1-1, Radioactive Waste Management Manual; DOE/ORP-2000-0 1, Maintenance Plan For The Hanford Immobilized Low-Activity Tank Waste Performance Assessment). The most recently approved PA is DOE/ORP-2000-24, Hanford Immobilized Low-Activity Waste Performance Assessment: 2001 Version. The ELAW PA evaluated the adequacy of the ILAW disposal facility, now referred to as the Integrated Disposal Facility (11DF), for the safe disposal of vitrified Hanford Site tank waste. More recently, a preliminary evaluation for the disposal of offsite low-level waste and mixed low-level waste was considered in 12 RPP- 15834, Integrated Disposal Facility Risk Assessment.

  17. What is the methodological rigour of palliative care research in long-term care facilities in Europe? A systematic review

    NARCIS (Netherlands)

    Albers, G.; Harding, R.; Pasman, H.R.W.; Onwuteaka-Philipsen, B.D.; Hall, S.; Toscani, F.; Ribbe, M.W.; Deliens, L.

    2012-01-01

    Background: The European population is rapidly ageing, resulting in increasing numbers of older people dying in longterm care facilities. There is an urgent need for palliative care in long-term care facilities. Aim: The aim of this study was to systematically review the literature on palliative

  18. The better model to predict and improve pediatric health care quality: performance or importance-performance?

    Science.gov (United States)

    Olsen, Rebecca M; Bryant, Carol A; McDermott, Robert J; Ortinau, David

    2013-01-01

    The perpetual search for ways to improve pediatric health care quality has resulted in a multitude of assessments and strategies; however, there is little research evidence as to their conditions for maximum effectiveness. A major reason for the lack of evaluation research and successful quality improvement initiatives is the methodological challenge of measuring quality from the parent perspective. Comparison of performance-only and importance-performance models was done to determine the better predictor of pediatric health care quality and more successful method for improving the quality of care provided to children. Fourteen pediatric health care centers serving approximately 250,000 patients in 70,000 households in three West Central Florida counties were studied. A cross-sectional design was used to determine the importance and performance of 50 pediatric health care attributes and four global assessments of pediatric health care quality. Exploratory factor analysis revealed five dimensions of care (physician care, access, customer service, timeliness of services, and health care facility). Hierarchical multiple regression compared the performance-only and the importance-performance models. In-depth interviews, participant observations, and a direct cognitive structural analysis identified 50 health care attributes included in a mailed survey to parents(n = 1,030). The tailored design method guided survey development and data collection. The importance-performance multiplicative additive model was a better predictor of pediatric health care quality. Attribute importance moderates performance and quality, making the importance-performance model superior for measuring and providing a deeper understanding of pediatric health care quality and a better method for improving the quality of care provided to children. Regardless of attribute performance, if the level of attribute importance is not taken into consideration, health care organizations may spend valuable

  19. Facility Management Child Care Resource Book. Child Care Operations Center of Expertise.

    Science.gov (United States)

    General Services Administration, Washington, DC. Public Buildings Service.

    This guidebook provides maintenance and operations guidelines for managing General Services Administration (GSA) child care centers within the same standards and level of a GSA operated facility. Areas covered address cleaning standards and guidelines; equipment funding and inventory; maintenance of living environments and problem areas;…

  20. Organisational culture in residential aged care facilities: a cross-sectional observational study.

    Science.gov (United States)

    Etherton-Beer, Christopher; Venturato, Lorraine; Horner, Barbara

    2013-01-01

    Organisational culture is increasingly recognised as important for provision of high-quality long-term care. We undertook this study to measure organisational culture in residential aged care facilities in two Australian states. Cross-sectional observational study in 21 residential aged care facilities in Western Australia (n = 14) and Queensland (n = 7), Australia. Staff and next-of-kin of residents participated. Measurement comprised surveys of facility staff and residents' next-of-kin, and structured observation of indicators of care quality. Staff tended to rate organisational culture positively. Some qualitative feedback from staff emphasised negative perceptions of communication, leadership and teamwork. Staffing levels were perceived as a dominant challenge, threatening care quality. Direct observation revealed variability within and between facilities but suggested that most facilities (n = 12) were in the typical range, or were quality facilities (n = 8). There was scope to strengthen organisational culture in participating aged care facilities.

  1. Performance assessment for the class L-II disposal facility

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-03-01

    This draft radiological performance assessment (PA) for the proposed Class L-II Disposal Facility (CIIDF) on the Oak Ridge Reservation (ORR) has been prepared to demonstrate compliance with the requirements of the US Department of Energy Order 5820.2A. This PA considers the disposal of low-level radioactive wastes (LLW) over the operating life of the facility and the long-term performance of the facility in providing protection to public health and the environment. The performance objectives contained in the order require that the facility be managed to accomplish the following: (1) Protect public health and safety in accordance with standards specified in environmental health orders and other DOE orders. (2) Ensure that external exposure to the waste and concentrations of radioactive material that may be released into surface water, groundwater, soil, plants, and animals results in an effective dose equivalent (EDE) that does not exceed 25 mrem/year to a member of the public. Releases to the atmosphere shall meet the requirements of 40 CFR Pt. 61. Reasonable effort should be made to maintain releases of radioactivity in effluents to the general environment as low as reasonably achievable. (1) Ensure that the committed EDEs received by individual who inadvertently may intrude into the facility after the loss of active institutional control (100 years) will not exceed 100 mrem/year for continuous exposure of 500 mrem for a single acute exposure. (4) Protect groundwater resources, consistent with federal, state, and local requirements.

  2. [Alcohol and drug misuse of the elderly in health care facilities].

    Science.gov (United States)

    Kuhn, S; Haasen, C

    2012-05-01

    A nationwide representative survey was conducted in residential care facilities and facilities offering care for the elderly in their homes (home care facilities) with the aim to estimate the rate of alcohol and drug misuse among this population and to evaluate the way in which nursing staff deal with the problem. A total of 5000 randomly selected facilities were contacted with a 2-page questionnaire. Reliable data were obtained from 550 residential care facilities and from 436 home care facilities. According to the investigated facilities, the mean rate of misuse among the elderly was 14%. Nearly all facilities acknowledge the necessity to react to these facts, but only a quarter of them considered their staff to be sufficiently trained. 38.4% of the residential care facilities and 26.9% of the home care facilities have a concept on how to react to misuse problems. Addiction services are rarely contacted. The prevalence of alcohol and drug misuse among the elderly in health care facilities is high compared to the same age cohort of the total population. The lack of networking between facilities for the elderly and addiction services is remarkable. © Georg Thieme Verlag KG Stuttgart · New York.

  3. Hospital Palliative Care Teams and Post-Acute Care in Nursing Facilities: An Integrative Review.

    Science.gov (United States)

    Carpenter, Joan G

    2017-01-01

    Although palliative care consultation teams are common in U.S. hospitals, follow up and outcomes of consultations for frail older adults discharged to nursing facilities are unclear. To summarize and critique research on the care of patients discharged to nursing facilities following a hospital-based palliative care consult, a systematic search of PubMed, CINAHL, Ageline, and PsycINFO was conducted in February 2016. Data from the articles (N = 12) were abstracted and analyzed. The results of 12 articles reflecting research conducted in five countries are presented in narrative form. Two studies focused on nurse perceptions only, three described patient/family/caregiver experiences and needs, and seven described patient-focused outcomes. Collectively, these articles demonstrate that disruption in palliative care service on hospital discharge and nursing facility admission may result in high symptom burden, poor communication, and inadequate coordination of care. High mortality was also noted. [Res Gerontol Nurs. 2017; 10(1):25-34.]. Copyright 2017, SLACK Incorporated.

  4. Evaluation of individual and facility factors that promote hand washing in aged-care facilities in Japan.

    Science.gov (United States)

    Takahashi, Ikuko; Turale, Sue

    2010-03-01

    Internationally, it has been found that regular and timely hand washing is part of hand-hygiene practices that can reduce rates of infection in health-care facilities, but research has shown that there is a low level of compliance with hand washing in hospitals worldwide, including Japan. The number of aged-care facilities is growing throughout the world as our populations age, but hand-washing compliance appears even lower in such settings where there are vulnerable and frail elderly persons. This study used a correlational, cross-sectional design to clarify, for the first time, individual and facility factors related to the hand-washing behaviors of care staff at Japanese aged-care facilities. In 56 facilities (31 special nursing homes and 25 health-service facilities) in Yamaguchi Prefecture, data were gathered through survey questionnaires from care staff and facility managers. A total of 1323 (79.6%) questionnaires were returned and 1016 (61.1%) were analyzed. Using logistical regression analysis, two individual factors were investigated ("willingness to practice standard precautions" and "attendance at seminars") and two facility factors were investigated ("implementation of hand-washing evaluation" and "hand-washing environment"). These factors were found to promote hand washing, but no single factor was particularly related to its promotion in aged-care settings. If the health of elderly residents is to be better protected and infection rates lowered, especially in an era of increasing pandemics and epidemics, the compliance rate of health-care workers needs to be increased. We conclude that diverse approaches to both individual and facility factors are necessary to improve compliance with hand washing.

  5. Relationship between Regulatory Status, Quality of Care, and Three‐Year Mortality in Canadian Residential Care Facilities: A Longitudinal Study

    National Research Council Canada - National Science Library

    Bravo, Gina; Dubois, Marie‐France; De Wals, Philippe; Hébert, Réjean; Messier, Lise

    2002-01-01

    Objectives. To compare the mortality rate in regulated and unregulated facilities, controlling for confounding variables, and investigate the effect of care quality on residents' length of survival...

  6. Evaluating building performance in healthcare facilities: an organizational perspective.

    Science.gov (United States)

    Steinke, Claudia; Webster, Lynn; Fontaine, Marie

    2010-01-01

    Using the environment as a strategic tool is one of the most cost-effective and enduring approaches for improving public health; however, it is one that requires multiple perspectives. The purpose of this article is to highlight an innovative methodology that has been developed for conducting comprehensive performance evaluations in public sector health facilities in Canada. The building performance evaluation methodology described in this paper is a government initiative. The project team developed a comprehensive building evaluation process for all new capital health projects that would respond to the aforementioned need for stakeholders to be more accountable and to better integrate the larger organizational strategy of facilities. The Balanced Scorecard, which is a multiparadigmatic, performance-based business framework, serves as the underlying theoretical framework for this initiative. It was applied in the development of the conceptual model entitled the Building Performance Evaluation Scorecard, which provides the following benefits: (1) It illustrates a process to link facilities more effectively to the overall mission and goals of an organization; (2) It is both a measurement and a management system that has the ability to link regional facilities to measures of success and larger business goals; (3) It provides a standardized methodology that ensures consistency in assessing building performance; and (4) It is more comprehensive than traditional building evaluations. The methodology presented in this paper is both a measurement and management system that integrates the principles of evidence-based design with the practices of pre- and post-occupancy evaluation. It promotes accountability and continues throughout the life cycle of a project. The advantage of applying this framework is that it engages health organizations in clarifying a vision and strategy for their facilities and helps translate those strategies into action and measurable performance

  7. [Preoperational study for the improvement of hygiene conditions in long-term care facilities].

    Science.gov (United States)

    Adler, A C; Spegel, H; Kolb, S; Hierl, W; Müller, C; Höller, C; Liebl, B; Rudolph, P; Herr, C

    2014-12-01

    Hygiene is becoming more and more important in long-term care facilities. Long-term care facilities are subject to monitoring by the Public Health Service (PHS) and other authorities. For the PHS in Bavaria the Bavarian Health and Food Safety Authority (Landesamt für Gesundheit und Lebensmittelsicherheit, LGL) published a hygiene monitoring concept and there exists an inspection guide developed by a specialist department for nursing homes and institutions for the handicapped (Fachstelle für Pflege und Behinderteneinrichtungen, FQA). Because inspections are performed in multiprofessional teams, it makes sense to use a coordinated inspection catalog. The aim was to integrate hygienic requirements specified in the Bavarian guidelines for hygiene by the LGL into the inspection guide published by the FQA to obtain a quality assured surveillance. The involved parties were questioned about the inspection guide and their hygiene management and then the hygiene criteria of the LGL were implemented into the inspection guide. Questions dealing with hygiene requirements concerning intensive care, management of multidrug resistant bacteria and interviews with the person responsible for infection control in the facility itself were developed for the first time and were integrated into the inspection guide. The revised inspection guide was tested for its applicability. With the revised inspection guide there now exists a tool which allows not only comprehensive inspections of the facilities including hygiene issues but also a good cooperation of the various parties involved. There are many actions which have to be conveyed into the future, especially programs to train staff to apply the inspection guide and to enhance the ability of all participants to act in cooperation. The guide will also allow the facilities to cooperate more easily and more closely, as the guide takes the respective problems and challenges of the different facilities into consideration. Additionally the

  8. Development of a tool to measure women's perception of respectful maternity care in public health facilities.

    Science.gov (United States)

    Sheferaw, Ephrem D; Mengesha, Teka Z; Wase, Solomon B

    2016-03-29

    Maternal mortality continues to be the biggest challenge facing Ethiopia and other developing countries. Although progress has been made in making maternity services available closer to the community, the rate of deliveries attended by skilled birth attendants has remained very low. Absence of respectful maternity care (RMC) is believed to have contributed to low utilization of facility delivery services. This study outlines steps undertaken to construct and validate a scale that measures women's perception of respectful maternity care provided in health facilities. An inductive item generation process that included a literature review and in-depth interviews with labor and delivery clients, followed by an expert review, assured face validity and content validity of the tool. A draft RMC scale with 37 items and two additional measures of global satisfaction items, measured on a five-point Likert scale, were administered to a developmental sample of 509 postnatal care clients visiting facilities immediately after childbirth to 7 weeks postpartum. IBM SPSS 20 was used to perform exploratory factor analysis (EFA) using principal component analysis (PCA) with oblique rotation method. The final RMC scale with 15 items was loaded on four components. The extracted components were labeled as friendly care, abuse-free care, timely care, and discrimination-free care. The final RMC scale correlated strongly with the global satisfaction measures, indicating criterion-related validity of the scale. Content-related validity was assured by the process of item generation. Construct validity of the RMC scale was confirmed by high average factor loading of the four components ranging from 0.76 to 0.82 and low correlation between the components. Stability of the scale was confirmed by running PCA in a randomly selected split sample of 320 samples from the validation sample. The final 15-item scale showed an adequate reliability with α = 0.845. The 15-item RMC scale is a valid and

  9. Measuring the diffusion of palliative care in long-term care facilities – a death census

    Directory of Open Access Journals (Sweden)

    Santos-Eggimann Brigitte

    2009-01-01

    Full Text Available Abstract Background The dissemination of palliative care for patients presenting complex chronic diseases at various stages has become an important matter of public health. A death census in Swiss long-term care facilities (LTC was set up with the aim of monitoring the frequency of selected indicators of palliative care. Methods The survey covered 150 LTC facilities (105 nursing homes and 45 home health services, each of which was asked to complete a questionnaire for every non-accidental death over a period of six months. The frequency of 4 selected indicators of palliative care (resort to a specialized palliative care service, the administration of opiates, use of any pain measurement scale or other symptom measurement scale was monitored in respect of the stages of care and analysed based on gender, age, medical condition and place of residence. Results Overall, 1200 deaths were reported, 29.1% of which were related to cancer. The frequencies of each indicator varied according to the type of LTC, mostly regarding the administration of opiate. It appeared that the access to palliative care remained associated with cancer, terminal care and partly with age, whereas gender and the presence of mental disorders had no effect on the indicators. In addition, the use of drugs was much more frequent than the other indicators. Conclusion The profile of patients with access to palliative care must become more diversified. Among other recommendations, equal access to opiates in nursing homes and in home health services, palliative care at an earlier stage and the systematic use of symptom management scales when resorting to opiates have to become of prime concern.

  10. Annual Summary of the Integrated Disposal Facility Performance Assessment 2012

    Energy Technology Data Exchange (ETDEWEB)

    Khaleel, R. [INTERA, Austin, TX (United States); Nichols, W. E. [CH2M HILL Plateau Remediation Company, Richland, WA (United States)

    2012-12-27

    An annual summary of the adequacy of the Hanford Immobilized Low-Activity Waste (ILAW) Performance Assessment (PA) is required each year (DOE O 435.1 Chg 1,1 DOE M 435.1-1 Chg 1;2 and DOE/ORP-2000-013). The most recently approved PA is DOE/ORP-2000-24.4 The ILAW PA evaluated the adequacy of the ILAW disposal facility, now referred to as the Integrated Disposal Facility (IDF), for the safe disposal of vitrified Hanford Site tank waste.

  11. Strategic planning and marketing research for older, inner-city health care facilities: a case study.

    Science.gov (United States)

    Wood, V R; Robertson, K R

    1992-01-01

    Numerous health care facilities, located in downtown metropolitan areas, now find themselves surrounded by a decaying inner-city environment. Consumers may perceive these facilities as "old," and catering to an "urban poor" consumer. These same consumers may, therefore, prefer to patronize more modern facilities located in suburban areas. This paper presents a case study of such a health care facility and how strategic planning and marketing research were conducted in order to identify market opportunities and new strategic directions.

  12. Biofilm-based infections in long-term care facilities.

    Science.gov (United States)

    Donelli, Gianfranco; Vuotto, Claudia

    2014-01-01

    The recent trend in the early admittance to long-term care facilities (LTCFs) of severely injured patients transferred from general hospitals has given a new dynamic to the incidence of healthcare-associated infections, including biofilm-based infections related to the implant of urinary and intravascular catheters, and the onset of pressure ulcers. Catheter-associated urinary tract infections lead in most of the surveys on LTCFs, approximately 80% of urinary tract infections in these settings being due to the short- or long-term insertion of a urinary catheter. Furthermore, the implantation of intravascular catheters is often responsible for catheter-related bloodstream infections caused by the development of an intraluminal biofilm. Pressure ulcers, frequently occurring in bedridden patients admitted to LTCFs, are also susceptible to infection by biofilm-growing aerobic and anaerobic bacteria, the biofilm formation on the wound being the main reason for its delayed healing.

  13. The state of affairs at primary health care facilities in Pakistan: where is the state's stewardship?

    Science.gov (United States)

    Ahmed, J; Shaikh, B T

    2011-07-01

    Primary health care (PHC) services in Pakistan, particularly in rural areas, are in a dismal state. Inadequacies, unfairness and ignorance about the importance of the basic health care provided by these facilitates have led to a disorganized and poorly performing system. This paper reviews the situation in certain PHC facilities in Sindh province. Inadequate medicines and supplies, underutilized family planning services, lack of human resources, faulty equipment, and absence of a proper referral mechanism were some of the key findings. There is therefore an urgent need for radical improvement in the PHC system in order to maximize the appropriate use of PHC facilities. In order to do this, the paper argues that the stewardship role of the State must be strengthened.

  14. [Palliative care practices in residential facilities for the elderly requiring full-time care].

    Science.gov (United States)

    Degois, Marc; Grillot, Aurélie; Boyraci, Elife; Saillard, Valérie; Jandard, Anne-Charlotte; Prévalet-Courlet, Laetitia; Ngamba, Esmaël; Faivre, Fanny; Barrandon, Olivier; Aubry, Régis

    2015-01-01

    The purpose of this study was to assess palliative care practices for residents of Larmont residential facilities for the elderly requiring full-time care (Doubs, France) throughout their stay. This was a healthcare peer review based on a retrospective clinical audit in compliance with the recommendations of the French Health Authority. The 252-bed Larmont residential care facilities for the elderly is a public institution, attached to the local Hospital. The 72 residents of the Larmont residential care facilities for the elderly who died during 2012 were included in the study. Death occurred on the premises for 95.8 percent of residents. The proposal to appoint a support person was recorded in 27.6 percent of audited cases. End-of-life instructions were recorded in 23.2 percent of cases. In 31.8 percent of cases, the medical record referred to a multidisciplinary procedure, which complied with regulations in less than one half of cases. The residents’ pain at the end of their life was insufficiently assessed and managed. A discomfort other than pain was identified in 89.2 percent of cases. This healthcare peer review led to a quality improvement plan focusing on three areas : ensure that medical practices are in line with patients’ rights, anticipate identification of the end of life and improve management of pain and suffering at the end of life.

  15. Dutch health care performance report 2008.

    NARCIS (Netherlands)

    Westert, G.P.; Berg, M.J. van den; Koolman, X.; Verkleij, H.

    2008-01-01

    This is the second national report on the performance of the Dutch health care system. Its focus is on quality, access and costs in 2006/7. The Dutch Health Care Performance Report presents a broad picture based on 110 indicators. Where possible, comparisons in time and between countries are

  16. Patient education and emotional support practices in abortion care facilities in the United States.

    Science.gov (United States)

    Gould, Heather; Perrucci, Alissa; Barar, Rana; Sinkford, Danielle; Foster, Diana Greene

    2012-01-01

    Little is known about how patient education and emotional support is provided at abortion facilities. This pilot study documents 27 facilities' practices in this aspect of abortion care. We conducted confidential telephone interviews with staff from 27 abortion facilities about their practices. The majority of facilities reported they rely primarily on trained nonclinician staff to educate patients and provide emotional support. As part of their informed consent and counseling processes, facilities reported that staff always provide patients with information about the procedure (96%), assess the certainty of their abortion decisions (92%), assess their feelings and provide emotional support (74%), and provide contraceptive health education (92%). Time spent providing these components of care varied across facilities and patients. When describing their facility's care philosophy, many respondents expressed support for "patient-centered," "supportive," "nonjudgmental" care. Eighty-two percent agreed that it is the facility's role to provide counseling for emotional issues related to abortion. All facilities valued informed consent, patient education, and emotional support. Although the majority of facilities considered counseling for emotional issues to be a part of their role, some did not. Future research should examine patients' preferences regarding abortion care and counseling and how different approaches to care affect women's emotional well-being after having an abortion. This information is important in light of current, widespread legislative efforts that aim to regulate abortion counseling, which are being proposed without an understanding of patient needs or facility practices. Copyright © 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  17. Care Facilities Licensed by LDHH, Geographic NAD83, LDHH (2006) [LDHH_care_facilities_06_07_full_LDHH_2006

    Data.gov (United States)

    Louisiana Geographic Information Center — A portion of the facilities licensed by the Louisiana Department of Health and Hospitals, Health Standards Section. This database includes Adult Day Cares, Adult Day...

  18. Economic evaluation of pharmacist-led medication reviews in residential aged care facilities.

    Science.gov (United States)

    Hasan, Syed Shahzad; Thiruchelvam, Kaeshaelya; Kow, Chia Siang; Ghori, Muhammad Usman; Babar, Zaheer-Ud-Din

    2017-10-01

    Medication reviews is a widely accepted approach known to have a substantial impact on patients' pharmacotherapy and safety. Numerous options to optimise pharmacotherapy in older people have been reported in literature and they include medication reviews, computerised decision support systems, management teams, and educational approaches. Pharmacist-led medication reviews are increasingly being conducted, aimed at attaining patient safety and medication optimisation. Cost effectiveness is an essential aspect of a medication review evaluation. Areas covered: A systematic searching of articles that examined the cost-effectiveness of medication reviews conducted in aged care facilities was performed using the relevant databases. Pharmacist-led medication reviews confer many benefits such as attainment of biomarker targets for improved clinical outcomes, and other clinical parameters, as well as depict concrete financial advantages in terms of decrement in total medication costs and associated cost savings. Expert commentary: The cost-effectiveness of medication reviews are more consequential than ever before. A critical evaluation of pharmacist-led medication reviews in residential aged care facilities from an economical aspect is crucial in determining if the time, effort, and direct and indirect costs involved in the review rationalise the significance of conducting medication reviews for older people in aged care facilities.

  19. The performance impact of context in TQM implementation: the nursing facility industry.

    Science.gov (United States)

    Weech-Maldonado, R; Zinn, J E; Hamilton, R D

    2001-08-01

    This study develops a model and empirically assesses how# organizational context mediates the impact of total quality management (TQM) implementation on perceived performance in the nursing facility industry. Outcomes are analysed for financial, human resources and resident-care performance. Contextual factors related to TQM implementation include managerial control, reward systems, organizational structure and the extent of implementation. Duration of TQM implementation is included as a control variable. Benchmarking has a positive impact on financial outcomes, and the extent of TQM implementation and required reporting of quality improvement activity results have a positive impact on both financial and human resources performance. The presence of a Quality Steering Council has a positive impact on financial performance, but only among larger facilities.

  20. Facilities management added value in closing the energy performance gap

    Directory of Open Access Journals (Sweden)

    Zaw Min

    2016-12-01

    Full Text Available Existing non-domestic buildings tend to use more energy than expected. This paper investigates how the operational strategies of facilities management can contribute to reducing building energy use. A longitudinal case study of a higher education (HE campus which was conceptualised with the objective of being environmentally friendly and energy efficient is presented. The paper reflects on the energy performance of the campus since its operation in 2001, based on 14 years of energy data and a detailed record of all initiatives undertaken by the campus’s facilities management (FM team in order to optimise energy performance. The integrated FM strategy composed of low- and no-cost strategies, continuous improvements, ongoing commissioning and retrofits succeeded in reducing campus energy intensity from 174 to 87 kWh/(m2*yr, now outperforming most relevant benchmarks. This finding highlights the importance of operations and maintenance in reducing the energy usage of existing buildings. This presented findings draw on a single case only, which excels through a very detailed longitudinal dataset. Going forwards, the analysis of further cases is recommended to corroborate the findings. The presented results suggest that proactive operations and maintenance strategies in existing buildings can contribute towards significantly improving energy performance. The profile and competency level of facilities management personnel should consequently be raised strategically at the organisational and national/industrial policy level, whilst integrated design processes should be further expanded to include FM’s operational control and management in a holistically fashion.

  1. Annual Summary of the Integrated Disposal Facility Performance Assessment 2008

    Energy Technology Data Exchange (ETDEWEB)

    Wood, M. I. [Hanford Site (HNF), Richland, WA (United States)

    2009-12-15

    The U.S. Department of Energy (DOE) order on radioactive waste management (DOE 1 999a) as well as the Maintenance Plan for the Hanford Immobilized Low-Activity Tank Waste Performance Assessment (Mann 2004) require an annual summary on the adequacy of the Hanford Immobilized Low-Activity Tank Waste Performance Assessment (RLAW PA) in each year in which a performance assessment is not issued. The most recent approved PA is the Hanford Immobilized Low-Activity Waste Performance Assessment: 2001 Version (Mann et al 2001). The RLAW PA evaluated the adequacy of the ILAW disposal facility, now referred to as the Integrated Disposal Facility (IDF), to safely dispose vitrified Hanford Site tank waste. More recently, a preliminary evaluation for the disposal of offsite low-level and mixed low-level waste was considered in the Integrated Disposal Facility Risk Assessment (Mann et al. 2003a). The first phase of IDF construction was completed on April 28, 2006 and included the installation of the cell liners and leachate collection tanks. The IDF is now in a preoperational maintenance mode and will not receive treated tank waste for several years. In view of these circumstances, the RCRA Part B Permit for the Integrated Disposal Facility has been modified to recognize that the facility will not be receiving waste in the near future. A subsequent modification indicated transfer of the IiDF from the DOE Office of River Protection (DOE/ORP) operation to the DOE Richland Operations Field Office (DOE/RL). This summary is the latest in a succession of sumnmaries that have been published since 2000 (Mann, 2000b, 2002, 2003b, 2004, 2005, 2006 and 2007) and approved by the Field Manager, Office of River Protection (e.g., Schepens 2005c). This annual summary compares new data collected during Fiscal Year 2008 with the Hanford Immobilized Low-Activity Waste Performance Assessment: 2001 Version (Mann et al 2001), which has been approved by DOE (DOE 2003a). Most of the data collected during

  2. Hepatitis B infection in black children from residential care facilities ...

    African Journals Online (AJOL)

    country. S Atr Med J 1996; 86; 345-349. A 1985 study of the prevalence of hepatitis 8 infection in. South African children, which included a sample from a .... 60% (Table IQ. Although the infection rates at all three facilities were very high, the rate at facility C was significantly lower than rates at facilities A and B (P = 0.013).

  3. 21 CFR 58.43 - Animal care facilities.

    Science.gov (United States)

    2010-04-01

    ... shall exist for the collection and disposal of all animal waste and refuse or for safe sanitary storage of waste before removal from the testing facility. Disposal facilities shall be so provided and... testing facility shall have a sufficient number of animal rooms or areas, as needed, to assure proper: (1...

  4. Examining the role of information exchange in residential aged care work practices-a survey of residential aged care facilities

    Directory of Open Access Journals (Sweden)

    Gaskin Sarah

    2012-08-01

    Full Text Available Abstract Background The provision of residential aged care is underpinned by information, and is reliant upon systems that adequately capture and effectively utilise and communicate this information. The aim of this study was to explicate and quantify the volume and method by which information is collected, exchanged within facilities and with external providers, and retrieved from facility information systems and hospitals. Methods A survey of staff (n = 119, including managers, health informatics officers (HIOs, quality improvement staff, registered nurses (RNs, enrolled nurses (ENs/endorsed enrolled nurses (EENs and assistants in nursing (AINs was carried out in four residential aged care facilities in New South Wales and Victoria, Australia. Sites varied in size and displayed a range of information technology (IT capabilities. The survey investigated how and by whom information is collected, retrieved and exchanged, and the frequency and amount of time devoted to these tasks. Descriptive analysis was performed using SPSS, and open responses to questions were coded into key themes. Results Staff completed a median of six forms each, taking a median of 30 min per shift. 68.8% of staff reported transferring information from paper to a computer system, which took a median of 30 min per shift. Handover and face-to-face communication was the most frequently used form of information exchange within facilities. There was a large amount of faxing and telephone communication between facility staff and General Practitioners and community pharmacists, with staff reporting sending a median of 2 faxes to pharmacy and 1.5 faxes to General Practitioners, and initiating 2 telephone calls to pharmacies and 1.5 calls to General Practitioners per shift. Only 38.5% of respondents reported that they always had information available at the point-of-care and only 35.4% of respondents reported that they always had access to hospital stay information of residents

  5. Communities Putting Prevention to Work: Results of an Obesity Prevention Initiative in Child Care Facilities

    Science.gov (United States)

    Natale, Ruby; Camejo, Stephanie; Sanders, Lee M.

    2016-01-01

    Obesity is a significant public health issue affecting even our youngest children. Given that a significant amount of young children are enrolled in child care, the goal of this project was to evaluate the effectiveness of a child care facility-based obesity prevention program. Over 1,000 facilities participated in the study. The intervention…

  6. Uses of inorganic hypochlorite (bleach) in health-care facilities.

    Science.gov (United States)

    Rutala, W A; Weber, D J

    1997-10-01

    Hypochlorite has been used as a disinfectant for more than 100 years. It has many of the properties of an ideal disinfectant, including a broad antimicrobial activity, rapid bactericidal action, reasonable persistence in treated potable water, ease of use, solubility in water, relative stability, relative nontoxicity at use concentrations, no poisonous residuals, no color, no staining, and low cost. The active species is undissociated hypochlorous acid (HOCl). Hypochlorites are lethal to most microbes, although viruses and vegetative bacteria are more susceptible than endospore-forming bacteria, fungi, and protozoa. Activity is reduced by the presence of heavy metal ions, a biofilm, organic material, low temperature, low pH, or UV radiation. Clinical uses in health-care facilities include hyperchlorination of potable water to prevent Legionella colonization, chlorination of water distribution systems used in hemodialysis centers, cleaning of environmental surfaces, disinfection of laundry, local use to decontaminate blood spills, disinfection of equipment, decontamination of medical waste prior to disposal, and dental therapy. Despite the increasing availability of other disinfectants, hypochlorites continue to find wide use in hospitals.

  7. Annual Summary of the Integrated Disposal Facility Performance Assessment 2011

    Energy Technology Data Exchange (ETDEWEB)

    Lehman, L. L. [CH2M HILL Plateau Remediation Company, Richland, WA (United States)

    2012-03-12

    An annual summary of the adequacy of the Hanford Immobilized Low-Activity Waste (ILAW) Performance Assessment (PA) is required each year (DOE O 435.1 Chg 1,1 DOE M 435.1-1 Chg 1,2 DOE/ORP-2000-013). The most recently approved PA is DOE/ORP-2000-24.4 The ILAW PA evaluated the adequacy of the ILAW disposal facility, now referred to as the Integrated Disposal Facility (IDF), for the safe disposal of vitrified Hanford Site tank waste. More recently, a preliminary evaluation for the disposal of offsite low-level waste and mixed low-level waste was considered in RPP-1583.

  8. Supporting residents' expression of sexuality: the initial construction of a sexuality assessment tool for residential aged care facilities

    National Research Council Canada - National Science Library

    Bauer, Michael; Fetherstonhaugh, Deirdre; Tarzia, Laura; Nay, Rhonda; Beattie, Elizabeth

    2014-01-01

    .... Staff and families in residential aged care facilities often find expressions of sexuality by residents, particularly those living with dementia, challenging and facilities often struggle to address...

  9. [Nosocomial infections in long-term health care facilities].

    Science.gov (United States)

    Serrano, Marcos; Barcenilla, Fernando; Limón, Enrique

    2014-03-01

    The long-term care facilities (LTCF) are the health care level that integrates medical assistance and social services according to the requirements of its beneficiaries. There is a great variability depending on the users profile, the professional staff and accessibility to technical resources for diagnosis, treatment or rehabilitation. In LTCF different factors are shaping a challenge in the infection control. These factors are high prevalence of infection and colonization by multiresistant microorganisms (MROs), a high rate of, often inadequate, antibiotic prescriptions, the high transfer of hospital patients, and the lack of diagnostic resources. In infection studies in LTCF, one of the main problems is the lack of standard, and well defined, infection criteria. The special features of infections in the elderly population, together with the limited resources, make it necessary to establish standard and worldwide validated criteria in order achieve appropriate monitoring and control of infection. The most common infection is the respiratory, followed by the urinary, skin and soft tissue, gastro-intestinal tract, and eyes. The problematic microorganisms most frequently identified in LTCF are enterobacteriaceae extended spectrum beta lactamase, Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA). A successful infection control mainly depends on two actions. First, a high compliance of standard precautions and second, patient organization according to the risk of transmission of a particular MROs infection, especially MRSA. This risk classification may be a way to rationalize application measures, and the incorporation of ethical and legal issues. The level of stratification is established mainly according to the condition of being colonized or infected, the MROs anatomical location, and the degree of behavioral disorders suffered by the patient. Implementation of extensive screening programs or complex monitoring programs, as in acute care

  10. Electronic Medical Record and Quality Ratings of Long Term Care Facilities Long-Term Care Facility Characteristics and Reasons and Barriers for Adoption of Electronic Medical Record

    Science.gov (United States)

    Daniels, Cheryl Andrea

    2013-01-01

    With the growing elderly population, compounded by the retirement of the babyboomers, the need for long-term care (LTC) facilities is expected to grow. An area of great concern for those that are seeking a home for their family member is the quality of care provided by the nursing home to the residents. Electronic medical records (EMR) are often…

  11. Performance and burnout in intensive care units

    OpenAIRE

    Keijsers, G.J.; Schaufeli, W.B.; Leblanc, P; Zwerts, C.; Miranda, D.R.

    1995-01-01

    The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit performance. Subjective performance measures relate negatively to burnout levels of nurses, whereas an objective performance measure relates positively to burnout. Furthermore, subjectively assessed...

  12. Effects of intervention program for systematic use of transfer equipment on care workers' low back pain in elderly care facilities.

    Science.gov (United States)

    Iwakiri, Kazuyuki; Matsudaira, Ko; Ichikawa, Kiyosi; Takahashi, Masaya

    2017-05-31

    The purpose of this study was to investigate the effects of an intervention program to prevent care workers' low back pain by the systematic use of transfer equipment at elderly care facilities. Questionnaire surveys were administered to administrators and care workers before (baseline), 1 year after, and 2.5 year after starting the program at two elderly care facilities. Care workers at the intervention facility were requested to ensure the use of a transfer's hoist, sliding board, and sliding sheet when assisting in the transfer of residents who were judged as appropriate to use the equipment (27.5% of residents living the intervention facility). Care workers at the control facility received no instructions on the use of transfer equipment. The average response rate of administrators and care workers was 100% and 90.3%, respectively. The number of care workers who responded during all three survey periods was 29 at the intervention facility and 23 at the control facility, and they were subjected to the current analysis. At baseline, transfer equipment was already introduced in both facilities, but it was found that the care workers did not regularly use it for assisting transfer. At 2.5-year follow-up, 31.0% of the intervention group and 4.3% of the control group always used the transfer's hoist. Similarly, 27.6% of the intervention group and 4.3% of the control group always used the sliding board and sliding sheet. Further, 60%-70% of the care workers at both facilities reported of having low back pain, but no statistically significant difference was found between the facilities or over the measurement periods. Among the intervention group, however, the care workers who reported an active use of the transfer's hoist, sliding board, and sliding sheet showed an improvement in low back pain. In the control group, no significant association was found between the active use of transfer equipment and low back pain. These results indicated that the prevention of care

  13. Medicare Managed Care plan Performance, A Comparison...

    Data.gov (United States)

    U.S. Department of Health & Human Services — The study evaluates the performance of Medicare managed care, Medicare Advantage, Plans in comparison to Medicare fee-for-service Plans in three states with...

  14. Oral health care in older people in long term care facilities : A systematic review of implementation strategies

    NARCIS (Netherlands)

    Weening-Verbree, L.; Huisman-de Waal, G.; van Dusseldorp, L.; van Achterberg, T.; Schoonhoven, L.

    Objectives: Oral hygiene is necessary to maintain oral health and quality of life. However, the oral hygiene and the oral health care of older people in long term care facilities are poor. This indicates that care is not in compliance with the available guidelines and protocols, and stresses the

  15. Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service.

    Science.gov (United States)

    Dwyer, Trudy; Craswell, Alison; Rossi, Dolene; Holzberger, Darren

    2017-01-13

    Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. This study provides valuable insights into the contribution of the NP model of care within an aged care

  16. A rapid assessment of the availability and use of obstetric care in Nigerian healthcare facilities.

    Directory of Open Access Journals (Sweden)

    Daniel O Erim

    Full Text Available BACKGROUND: As part of efforts to reduce maternal deaths in Nigeria, pregnant women are being encouraged to give birth in healthcare facilities. However, little is known about whether or not available healthcare facilities can cope with an increasing demand for obstetric care. We thus carried out this survey as a rapid and tactical assessment of facility quality. We visited 121 healthcare facilities, and used the opportunity to interview over 700 women seeking care at these facilities. FINDINGS: Most of the primary healthcare facilities we visited were unable to provide all basic Emergency Obstetric Care (bEmOC services. In general, they lack clinical staff needed to dispense maternal and neonatal care services, ambulances and uninterrupted electricity supply whenever there were obstetric emergencies. Secondary healthcare facilities fared better, but, like their primary counterparts, lack neonatal care infrastructure. Among patients, most lived within 30 minutes of the visited facilities and still reported some difficulty getting there. Of those who had had two or more childbirths, the conditional probability of a delivery occurring in a healthcare facility was 0.91 if the previous delivery occurred in a healthcare facility, and 0.24 if it occurred at home. The crude risk of an adverse neonatal outcome did not significantly vary by delivery site or birth attendant, and the occurrence of such an outcome during an in-facility delivery may influence the mother to have her next delivery outside. Such an outcome during a home delivery may not prompt a subsequent in-facility delivery. CONCLUSIONS: In conclusion, reducing maternal deaths in Nigeria will require attention to both increasing the number of facilities with high-quality EmOC capability and also assuring Nigerian women have access to these facilities regardless of where they live.

  17. The prevention and management of constipation in older adults in a residential aged care facility.

    Science.gov (United States)

    Grieve, Jennifer

    2006-03-01

    The need to implement programs for developing leadership and practice improvement skills using an evidence-based practice approach to practice change is becoming more apparent in the health and aged care services. This is no more apparent than in high care residential health and aged care services, where health professionals are increasingly required to provide care for older people with multifocal and complex healthcare needs. This paper describes one of the projects undertaken as part of the Joanna Briggs Institute Commonwealth Department of Health and Ageing Clinical Aged Care Fellowship program from February 2005 to June 2005. This purpose of this particular project was twofold. First it sought to improve the local practice in the prevention and management of constipation and that this practice was performed according to the best available evidence. Second to use the Joanna Briggs Institute Practical Application of Clinical Guidance (PACES) program to implement a process of audit and feedback as a strategy to improve practice. The project was designed to link in with the facility's existing quality improvement program and better practice continence management project. The project was conducted over 6 months and was divided into six stages involving the identification of evidence-based standards of care, an initial audit to determine appropriate sample size, a clinical audit across the facility, planning of the implementation process, implementation of the action plan and re-audit to assess practice change. Overall, the results were extremely positive and demonstrated a real improvement in practice relating to constipation in the project facility. This success, however, needs to be seen in the context of the benefits of having the support of senior management, an existing quality improvement and continence management better practice project, and a culture of clinical review. Although there will always be more work to be done, the success of this project can be

  18. Characteristics of sheltered care facility operators in California in 1973 and 1985

    OpenAIRE

    Segal, SP; Hazan, AR; Kotler, PL

    1990-01-01

    During the past 20 years, sheltered care homes have become the primary supervised community residence for mentally ill patients outside of licensed hospitals. To determine factors associated with sheltered care operators' remaining in business, follow-up interviews were conducted in 1985 with operators of 151 sheltered care facilities in California whose operators had been surveyed in 1973. Fifty-five of the original operators continued to operate the facility at 12-year follow-up, and 96 wer...

  19. Legionnaires' Disease: a Problem for Health Care Facilities

    Science.gov (United States)

    ... with them to investigate and prevent additional cases. *Leaders may include infection control practitioners, facility managers, hospital administrators, quality assurance staff, or others. Top ...

  20. Cost-analysis of teledentistry in residential aged care facilities.

    Science.gov (United States)

    Mariño, Rodrigo; Tonmukayakul, Utsana; Manton, David; Stranieri, Andrew; Clarke, Ken

    2016-09-01

    The purpose of this research was to conduct a cost-analysis, from a public healthcare perspective, comparing the cost and benefits of face-to-face patient examination assessments conducted by a dentist at a residential aged care facility (RACF) situated in rural areas of the Australian state of Victoria, with two teledentistry approaches utilizing virtual oral examination. The costs associated with implementing and operating the teledentistry approach were identified and measured using 2014 prices in Australian dollars. Costs were measured as direct intervention costs and programme costs. A population of 100 RACF residents was used as a basis to estimate the cost of oral examination and treatment plan development for the traditional face-to-face model vs. two teledentistry models: an asynchronous review and treatment plan preparation; and real-time communication with a remotely located oral health professional. It was estimated that if 100 residents received an asynchronous oral health assessment and treatment plan, the net cost from a healthcare perspective would be AU$32.35 (AU$27.19-AU$38.49) per resident. The total cost of the conventional face-to-face examinations by a dentist would be AU$36.59 ($30.67-AU$42.98) per resident using realistic assumptions. Meanwhile, the total cost of real-time remote oral examination would be AU$41.28 (AU$34.30-AU$48.87) per resident. Teledental asynchronous patient assessments were the lowest cost service model. Access to oral health professionals is generally low in RACFs; however, the real-time consultation could potentially achieve better outcomes due to two-way communication between the nurse and a remote oral health professional via health promotion/disease prevention delivered in conjunction with the oral examination. © The Author(s) 2015.

  1. Predictors of hospital discharge to an extended care facility after major general thoracic surgery.

    Science.gov (United States)

    Walters, Dustin M; Nagji, Alykhan S; Stukenborg, George J; Peluso, Melissa R; Taylor, Matthew D; Kozower, Benjamin D; Lau, Christine L; Jones, David R

    2014-03-01

    Failure to anticipate the need to discharge patients to rehabilitation centers and skilled nursing facilities results in expensive delays in the discharge of patients after surgery. Early identification of patients at high risk for discharge to these extended care facilities could mitigate these delays and expenditures. The purpose of this study was to identify preoperative patient factors associated with discharge to extended care facilities after major general thoracic surgery. Discharge records were identified for all patients undergoing major general thoracic surgery admitted to a university hospital between January 2006 and May 2009 who had a stay of longer than one day. The following risk factors were selected a priori based on clinical judgment: age, preoperative albumin, preoperative Zubrod score, history of peripheral vascular disease, and use of home oxygen. Multiple logistic regression analysis was used to estimate the statistical significance and magnitude of risk associated with each predictor of patient discharge to extended care facilities. Of the 1646 patients identified, 68 (4.1%) were discharged to extended care facilities. Hospital length of stay was on average six days longer for patients discharged to these facilities than for patients discharged home (P discharge to extended care facilities. Age, preoperative nutritional status, and functional status are strong predictors of patient discharge to extended care facilities. Early identification of these patients may improve patient discharge planning and reduce hospital length of stay after major thoracic surgery.

  2. Prevalence of healthcare-associated infections in long-term care facilities in Catalonia. VINCat Program.

    Science.gov (United States)

    Serrano, Marcos; Barcenilla, Fernando; Limón, Enrique; Pujol, Miquel; Gudiol, Francesc

    2017-10-01

    Long-term care facilities (LTCFs) have become receptors of patients with a high risk of healthcare-associated infections (HAIs). To determine the prevalence of HAIs in LTCFs. During the period 2011-2014 2 annual prevalence studies were performed according to Healthcare-associated infections in long-term-care facilities (HALT) study definitions and methodology. A total of 28,360 patients were included in the study. The overall prevalence rate of HAIs was 10.2%. Subacute units and palliative care units showed the highest rates, 22.3% and 18.7%, respectively. Main infections were respiratory tract infection (35.8%) and urinary tract infection (35.8%). These results were higher than other similar experiences, a fact that suggests the need to extend the specific strategies and programs to LTCFs, and ensuring a sufficient number of specialised staff in infection control. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  3. Primary health care facility infrastructure and services and the ...

    African Journals Online (AJOL)

    The PHC facilities had access to the following: safe drinking water (EC: 20%; KZN: 25%); electricity (EC: ... and the adults' at the family planning or TB treatment points at the. PHC facilities. Nought to 71-month-old ..... Breastfeeding for 2 years or longer. Transmission of HIV infection through breast milk if HIV positive. 20. 18.

  4. Cultures for performance in health care

    National Research Council Canada - National Science Library

    Mannion, Russell; Davies, Huw T.O; Marshall, Martin N

    2005-01-01

    ... in performance are intrinsically linked to cultural changes within health care settings. Using theories from a wide range of disciplines including economics, management and organization studies, policy studies and the health sciences, this book sets out definitions of cultures and performance, in particular the specific characteristics that help...

  5. Performance and burnout in intensive care units

    NARCIS (Netherlands)

    Keijsers, GJ; Schaufeli, WB; LeBlanc, P; Zwerts, C; Miranda, DR

    1995-01-01

    The relationship between three different performance measures and burnout was explored in 20 Dutch Intensive Care Units (ICUs). Burnout (i.e. emotional exhaustion and depersonalization) proved to be significantly related to nurses' perceptions of performance as well as to objectively assessed unit

  6. Low back pain among workers in care facilities for the elderly after introducing welfare equipment.

    Science.gov (United States)

    Iwakiri, Kazuyuki; Takahashi, Masaya; Sotoyama, Midori; Liu, Xinxin; Koda, Shigeki

    2016-07-29

    The purpose of this study was to clarify the causes of low back pain among workers in care facilities for the elderly after the introduction of welfare equipment. We conducted anonymous questionnaire surveys among administrators and care workers in eight elderly care facilities. The questionnaires were designed to investigate the status of both the care workers and facility. In reference to the care facility, the questionnaires were comprised items for investigating basic information, occupational safety, and health activities. For care workers, in addition to basic information, occupational safety, and health activities, the questionnaires also comprised items for investigating resident transfer and bathing methods, low back pain, and occupational stress. Completed questionnaires were returned by eight care facility administrators (response rate: 100%) and 373 care workers (response rate: 92.3%), among which 367 were used for analyses. Many care workers participated in a variety of occupational safety and health activities that were conducted in the facilities. Various types of welfare equipment were introduced into the care facilities and subsequently used by many care workers during resident transfer and bathing. As a result, 89.9% of the care workers reported having only slight or no low back pain. The remaining 10.1% reported having serious low back pain that interfered with their work. On the basis of logistic regression analysis, low back pain was associated with the following variables: failure to provide the appropriate method of care to each resident, failure of colleagues to discuss methods for improving care, lack of instructions regarding the use of welfare equipment, and inappropriate job rotation. An association was also found between low back pain and poor posture, poor resident-lifting technique, insufficient time to complete work, and a shortage of workers to assist with resident transfer or bathing. Although care workers received instructions on

  7. [Application of empowering education in long-term care facilities: the experience with foreign nurse aides].

    Science.gov (United States)

    Li, I-Chuan; Wu, Li-Yu; Chang, Li-Chun; Chen, Yu-Chi

    2005-12-01

    The concept of empowerment, widely accepted and utilized in many health-related disciplines, connotes a process of gaining control over one's life and influencing the organizational and social structures in which one lives. This article demonstrates an example of how empowering education can be applied on foreign nursing aides working in long-term care facilities and how differing empowering strategies, processes and effects can be adopted to address differing situations and ethnic backgrounds. How high priority issues of concern for foreign nurses are handled impacts upon their ability to perform their jobs well. Empowering strategies can help deal with such issues more effectively and, as a result, reduce work stress and improve on-the-job performance. During the preparation stage, the empowerment process focuses on building a trusting partner relationship. During the work stage, the process focuses on inspiring foreign nurses' self-awareness, encouraging their perceiving the barriers and needs at work, and, most importantly, encouraging nurses to think critically and positively and to provide feedback. The effects of empowering education include enhanced problem solving abilities, rising nurse self-confidence in his/her caretaking abilities, enhanced self-esteem, and improved adaptation to the work environment. This paper provides empirical experiences with regard to the application of empowering education in clinical settings as well as process and management strategies related to foreign nursing aides employed in long-term care facilities.

  8. Organisational culture in residential aged care facilities: a cross-sectional observational study.

    Directory of Open Access Journals (Sweden)

    Christopher Etherton-Beer

    Full Text Available BACKGROUND: Organisational culture is increasingly recognised as important for provision of high-quality long-term care. We undertook this study to measure organisational culture in residential aged care facilities in two Australian states. METHODOLOGY/PRINCIPAL FINDINGS: Cross-sectional observational study in 21 residential aged care facilities in Western Australia (n = 14 and Queensland (n = 7, Australia. Staff and next-of-kin of residents participated. Measurement comprised surveys of facility staff and residents' next-of-kin, and structured observation of indicators of care quality. Staff tended to rate organisational culture positively. Some qualitative feedback from staff emphasised negative perceptions of communication, leadership and teamwork. Staffing levels were perceived as a dominant challenge, threatening care quality. Direct observation revealed variability within and between facilities but suggested that most facilities (n = 12 were in the typical range, or were quality facilities (n = 8. CONCLUSION: There was scope to strengthen organisational culture in participating aged care facilities.

  9. 25 CFR 20.502 - Can Child Assistance funds be used to place Indian children in residential care facilities?

    Science.gov (United States)

    2010-04-01

    ... children in residential care facilities? 20.502 Section 20.502 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT... in residential care facilities? You, the social service program, can use Child Assistance funds to purchase or contract for room and board in licensed residential care facilities. (a) You can use Child...

  10. The state of emergency obstetric care services in Nairobi informal settlements and environs: Results from a maternity health facility survey

    Directory of Open Access Journals (Sweden)

    Saliku Teresa

    2009-03-01

    Full Text Available Abstract Background Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1 delay in making the decision to seek care; 2 delay in reaching an appropriate obstetric facility; and 3 delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies. Methods We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system. Results Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden

  11. Health Seeking Behaviour and Access to Health Care Facilities at ...

    African Journals Online (AJOL)

    Context: Health care at the primary level is accepted as the model for delivering basic health care to low income populations especially in developing countries such as Nigeria. Despite all the efforts and strategiesadapted in Nigeria, there is still high level of morbidity and mortality from the diseases primary health care ...

  12. The language needs of residents from linguistically diverse backgrounds in Victorian aged care facilities.

    Science.gov (United States)

    Runci, Susannah J; Eppingstall, Barbara J; van der Ploeg, Eva S; Graham, Georgia; O'Connor, Daniel W

    2015-09-01

    To investigate the language needs of residents of aged care facilities within the State of Victoria, Australia, and determine what language resources were accessible to them. Postal questionnaires were sent to 586 aged care facilities, enquiring about residents' and staff members' languages and language-specific resources. The response rate was 38%. The majority of facilities had residents who spoke non-English languages, and 55 different languages were represented. Three-quarters of the facilities employed staff members who spoke to residents in non-English languages and employed language-specific resources. The metropolitan and ethnospecific facilities had a greater presence of non-English-speaking residents and staff and more commonly used language-specific resources in comparison with regional and mainstream facilities. We found a large number of languages used by many residents from non-English-speaking backgrounds, with evidence of a large unmet language resource need. Unmet need was greatest in rural areas. © 2015 AJA Inc.

  13. Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review.

    Science.gov (United States)

    Jusela, Cheryl; Struble, Laura; Gallagher, Nancy Ambrose; Redman, Richard W; Ziemba, Rosemary A

    2017-03-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review" found on pages 19-28, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 29, 2020. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Discuss problematic barriers during care transitions

  14. Designing Medical Facilities to Care for Patients with Highly Hazardous Communicable Diseases

    Science.gov (United States)

    2017-07-14

    required countries around the world to reassess their ability to manage highly hazardous contagious pathogens. Care facilities often serve as...with strategically located facilities around the country as part of an overall strategy to manage such diseases. Coordination with containment...Health and Human Services has designated one facility in each of 10 Federal Emergency Management Agency (FEMA) regions around the US as regional “Ebola

  15. Factors Associated With Leisure Participation Among the Elderly Living in Long-term Care Facilities

    Directory of Open Access Journals (Sweden)

    Li Li

    2010-06-01

    Conclusion: Based on the self-reported interests, health status and level of cognitive skill of elderly residents, long-term care facilities should arrange appropriate leisure activities to prevent depression and to improve quality of life.

  16. 78 FR 38594 - Medicare and Medicaid Programs; Requirements for Long Term Care Facilities; Hospice Services

    Science.gov (United States)

    2013-06-27

    ...) must provide, or arrange for the provision of, nursing and related services and specialized...), dietary services, physician services, dental services, pharmacy services, specialized rehabilitative... hospices to provide care for LTC facility residents largely parallels the language and intent of the...

  17. School performance of children in kinship care.

    Science.gov (United States)

    Sawyer, R J; Dubowitz, H

    1994-07-01

    This study represents the first comprehensive assessment of the school performance of children placed in the care of a relative, an arrangement termed kinship care. The educational programs, academic achievement, and cognitive and language skills of the children were assessed with a teacher questionnaire and standardized tests. Compared to their peers, high rates of grade retention and participation in special and remedial education, as well as significant academic achievement, cognitive, and language deficits were found. Most teachers, however, reported that educational services were appropriate and several interventions had proven successful. Analyses of predictor variables showed that placement at a later age and fewer children in the home were associated with higher academic achievement. Results are reviewed in the context of other foster care studies, and recommendations are made regarding future research and educational needs of children in kinship care.

  18. Natural course of care dependency in residents of long-term care facilities: prospective follow-up study.

    Science.gov (United States)

    Caljouw, Monique A A; Cools, Herman J M; Gussekloo, Jacobijn

    2014-05-22

    Insight in the natural course of care dependency of vulnerable older persons in long-term care facilities (LTCF) is essential to organize and optimize individual tailored care. We examined changes in care dependency in LTCF residents over two 6-month periods, explored the possible predictive factors of change and the effect of care dependency on mortality. A prospective follow-up study in 21 Dutch long-term care facilities. 890 LTCF residents, median age 84 (Interquartile range 79-88) years participated. At baseline, 6 and 12 months, care dependency was assessed by the nursing staff with the Care Dependency Scale (CDS), range 15-75 points. Since the median CDS score differed between men and women (47.5 vs. 43.0, P = 0.013), CDS groups (low, middle and high) were based on gender-specific 33% of CDS scores at baseline and 6 months. At baseline, the CDS groups differed in median length of stay on the ward, urine incontinence and dementia (all P dependency status, predicted an increase in care dependency over time. The majority of residents were stable in their care dependency status over two subsequent 6-month periods. Highly care dependent residents showed an increased mortality risk. Awareness of the natural course of care dependency is essential to residents and their formal and informal caregivers when considering therapeutic and end-of-life care options.

  19. Outbreaks of influenza?like illness in long?term care facilities in Winnipeg, Canada

    OpenAIRE

    Mahmud, Salaheddin M.; Thompson, Laura H; Nowicki, Deborah L.; Plourde, Pierre J.

    2012-01-01

    Please cite this paper as: Mahmud et?al. (2012) Outbreaks of influenza?like illness in long?term care facilities in Winnipeg, Canada. Influenza and Other Respiratory Viruses 10.1111/irv.12052 Background? Outbreaks of influenza?like illness (ILI) are common in long?term care facilities (LTCFs) and result in significant morbidity and mortality among residents. Objectives? We describe patterns of reported ILI outbreaks in LTCFs in Winnipeg, Canada, and examine LTCF and outbreak characteristics t...

  20. Texture-modified food and fluids in dementia and residential aged care facilities

    Directory of Open Access Journals (Sweden)

    Painter V

    2017-08-01

    Full Text Available Virginia Painter,1 David G Le Couteur,1–3 Louise M Waite1–3 1Aged and Chronic Care Department, Concord Repatriation General Hospital, Concord, NSW, Australia; 2Ageing and Alzheimer’s Institute, Concord Repatriation General Hospital, Concord, NSW, Australia; 3Centre for Education and Research on Ageing, University of Sydney, Concord, NSW, Australia Introduction: Dysphagia is common in people living with dementia and associated with increased risk of aspiration pneumonia, dehydration, malnutrition, and death. Treatment options are limited and the use of texture-modified food and fluids (TMF is a widespread clinical practice. This review aimed to evaluate the evidence for TMF in dementia.Methods: A literature search using terms “dysphagia,” “texture-modified food and fluids,” “dementia,” and “aged care” was performed by using three electronic databases from 1990 to March 2017. Studies were assessed for suitability, then reviewed with data extracted, and grouped by categories of outcome measures.Results: A total of 3,722 publications were identified, and 22 studies met the inclusion criteria. Studies were heterogeneous in design and methodology. There were no publications examining dementia exclusively; however, many subjects with dementia were included in studies of residential aged care facilities. TMF reduced the risk of aspiration seen on videofluoroscopy but not clinical aspiration and pneumonia. TMF was associated with lower daily energy and fluid intake and variable adherence.Conclusion: There is a lack of evidence for people living with dementia and in residential care facilities that TMF improves clinical outcomes such as aspiration pneumonia, nutrition, hydration, morbidity, and mortality. Adverse effects including poorer energy and fluid intake were identified. Keywords: modified diet, dysphagia, aspiration, aged care, nursing homes, dehydration, nutrition

  1. High Performance Computing Facility Operational Assessment, CY 2011 Oak Ridge Leadership Computing Facility

    Energy Technology Data Exchange (ETDEWEB)

    Baker, Ann E [ORNL; Barker, Ashley D [ORNL; Bland, Arthur S Buddy [ORNL; Boudwin, Kathlyn J. [ORNL; Hack, James J [ORNL; Kendall, Ricky A [ORNL; Messer, Bronson [ORNL; Rogers, James H [ORNL; Shipman, Galen M [ORNL; Wells, Jack C [ORNL; White, Julia C [ORNL; Hudson, Douglas L [ORNL

    2012-02-01

    Oak Ridge National Laboratory's Leadership Computing Facility (OLCF) continues to deliver the most powerful resources in the U.S. for open science. At 2.33 petaflops peak performance, the Cray XT Jaguar delivered more than 1.4 billion core hours in calendar year (CY) 2011 to researchers around the world for computational simulations relevant to national and energy security; advancing the frontiers of knowledge in physical sciences and areas of biological, medical, environmental, and computer sciences; and providing world-class research facilities for the nation's science enterprise. Users reported more than 670 publications this year arising from their use of OLCF resources. Of these we report the 300 in this review that are consistent with guidance provided. Scientific achievements by OLCF users cut across all range scales from atomic to molecular to large-scale structures. At the atomic scale, researchers discovered that the anomalously long half-life of Carbon-14 can be explained by calculating, for the first time, the very complex three-body interactions between all the neutrons and protons in the nucleus. At the molecular scale, researchers combined experimental results from LBL's light source and simulations on Jaguar to discover how DNA replication continues past a damaged site so a mutation can be repaired later. Other researchers combined experimental results from ORNL's Spallation Neutron Source and simulations on Jaguar to reveal the molecular structure of ligno-cellulosic material used in bioethanol production. This year, Jaguar has been used to do billion-cell CFD calculations to develop shock wave compression turbo machinery as a means to meet DOE goals for reducing carbon sequestration costs. General Electric used Jaguar to calculate the unsteady flow through turbo machinery to learn what efficiencies the traditional steady flow assumption is hiding from designers. Even a 1% improvement in turbine design can save the nation

  2. Caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD.

    Science.gov (United States)

    Ericson-Lidman, Eva; Larsson, Lise-Lotte Franklin; Norberg, Astrid

    2014-06-01

    Caring for people with dementia and working in dementia care is described as having both rewarding and unpleasant aspects and has been studied to a minor extent. This study aims to explore care providers' narrated experiences of caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD. Nine care providers were interviewed about their experiences, the interviews were recorded, transcribed and analysed using thematic analysis. The analysis revealed that participants were struggling to perform person-centred care, which meant trying to see the person behind the disease, dealing with troublesome situations in the daily care, a two-edged interaction with relatives, feelings of shortcomings and troubled conscience, and the need for improvements in dementia care. The analysis also revealed an ambiguous work situation, which meant a challenging value base, the differently judged work environment, feelings of job satisfaction and the need for a functional leadership and management. The results illuminate participants' positive as well as negative experiences and have identified areas requiring improvements. It seems of great importance to strive for a supportive and attendant leadership, a leadership which aims to empower care providers in their difficult work. Using conscience as a driving force together in the work group may benefit care providers' health. © 2013 Nordic College of Caring Science.

  3. Treating and Preventing Influenza in Aged Care Facilities: A Cluster Randomised Controlled Trial

    Science.gov (United States)

    Booy, Robert; Lindley, Richard I.; Dwyer, Dominic E.; Yin, Jiehui K.; Heron, Leon G.; Moffatt, Cameron R. M.; Chiu, Clayton K.; Rosewell, Alexander E.; Dean, Anna S.; Dobbins, Timothy; Philp, David J.; Gao, Zhanhai; MacIntyre, C. Raina

    2012-01-01

    Background Influenza is an important cause of morbidity and mortality for frail older people. Whilst the antiviral drug oseltamivir (a neuraminidase inhibitor) is approved for treatment and prophylaxis of influenza during outbreaks, there have been no trials comparing treatment only (T) versus treatment and prophylaxis (T&P) in Aged Care Facilities (ACFs). Our objective was to compare a policy of T versus T&P for influenza outbreaks in ACFs. Methods and Findings We performed a cluster randomised controlled trial in 16 ACFs, that followed a policy of either “T”—oseltamivir treatment (75 mg twice a day for 5 days)—or “T&P”—treatment and prophylaxis (75 mg once a day for 10 days) for influenza outbreaks over three years, in addition to enhanced surveillance. The primary outcome measure was the attack rate of influenza. Secondary outcomes measures were deaths, hospitalisation, pneumonia and adverse events. Laboratory testing was performed to identify the viral cause of influenza-like illness (ILI) outbreaks. The study period 30 June 2006 to 23 December 2008 included three southern hemisphere winters. During that time, influenza was confirmed as the cause of nine of the 23 ILI outbreaks that occurred amongst the 16 ACFs. The policy of T&P resulted in a significant reduction in the influenza attack rate amongst residents: 93/255 (36%) in residents in T facilities versus 91/397 (23%) in T&P facilities (p = 0.002). We observed a non-significant reduction in staff: 46/216 (21%) in T facilities versus 47/350 (13%) in T&P facilities (p = 0.5). There was a significant reduction in mean duration of outbreaks (T = 24 days, T&P = 11 days, p = 0.04). Deaths, hospitalisations and pneumonia were non-significantly reduced in the T&P allocated facilities. Drug adverse events were common but tolerated. Conclusion Our trial lacked power but these results provide some support for a policy of “treatment and prophylaxis” with oseltamivir in controlling

  4. Palliative care in mental health facilities from the perspective of nurses: a mixed-methods study.

    Science.gov (United States)

    Evenblij, K; Widdershoven, G A M; Onwuteaka-Philipsen, B D; de Kam, H; Pasman, H R W

    2016-08-01

    WHAT IS KNOWN ON THE SUBJECT?: Nurses play an important role in monitoring and supporting patients and their relatives at the end of life. To date, there is a lack of recent empirical research on the experiences of psychiatric nurses in providing palliative care to psychiatric patients who suffer from life-threatening physical co-morbidity. The limited literature available indicates that palliative care for psychiatric patients needs to be improved. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This explorative study is unique in offering an insight into current palliative care practice for psychiatric patients and showed that one in three nurses working in Dutch mental health facilities is involved in palliative care provision. Important elements of palliative care, i.e.: care domains, multidisciplinary approach, early recognition and family care are recognized by nurses. Moreover, in palliative care for psychiatric patients there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders. Patient characteristics and little attention for palliative care within mental health facilities were found to hamper timely and adequate palliative care provision by nurses. WHAT ARE THE IMPLICATIONS FOR RESEARCH AND PRACTICE?: Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of this vulnerable patient group. Since mental health care is increasingly provided ambulatory, the development of palliative care for psychiatric patients outside mental health facilities should be closely monitored. Introduction Recent empirical research on palliative care for psychiatric patients is lacking. Aim The aim of this study was to explore nurses' experiences with and identify barriers to providing palliative care to psychiatric patients in Dutch mental health facilities. Methods Mixed-methods; 137 nurses working in

  5. Distance to care, facility delivery and early neonatal mortality in Malawi and Zambia.

    Directory of Open Access Journals (Sweden)

    Terhi J Lohela

    Full Text Available BACKGROUND: Globally, approximately 3 million babies die annually within their first month. Access to adequate care at birth is needed to reduce newborn as well as maternal deaths. We explore the influence of distance to delivery care and of level of care on early neonatal mortality in rural Zambia and Malawi, the influence of distance (and level of care on facility delivery, and the influence of facility delivery on early neonatal mortality. METHODS AND FINDINGS: National Health Facility Censuses were used to classify the level of obstetric care for 1131 Zambian and 446 Malawian delivery facilities. Straight-line distances to facilities were calculated for 3771 newborns in the 2007 Zambia DHS and 8842 newborns in the 2004 Malawi DHS. There was no association between distance to care and early neonatal mortality in Malawi (OR 0.97, 95%CI 0.58-1.60, while in Zambia, further distance (per 10 km was associated with lower mortality (OR 0.55, 95%CI 0.35-0.87. The level of care provided in the closest facility showed no association with early neonatal mortality in either Malawi (OR 1.02, 95%CI 0.90-1.16 or Zambia (OR 1.02, 95%CI 0.82-1.26. In both countries, distance to care was strongly associated with facility use for delivery (Malawi: OR 0.35 per 10km, 95%CI 0.26-0.46. All results are adjusted for available confounders. Early neonatal mortality did not differ by frequency of facility delivery in the community. CONCLUSIONS: While better geographic access and higher level of care were associated with more frequent facility delivery, there was no association with lower early neonatal mortality. This could be due to low quality of care for newborns at health facilities, but differential underreporting of early neonatal deaths in the DHS is an alternative explanation. Improved data sources are needed to monitor progress in the provision of obstetric and newborn care and its impact on mortality.

  6. Respectful maternity care in Ethiopian public health facilities

    NARCIS (Netherlands)

    Sheferaw, Ephrem D.; Bazant, Eva; Gibson, Hannah; Fenta, Hone B.; Ayalew, Firew; Belay, Tsigereda B.; Worku, Maria M.; Kebebu, Aelaf E.; Woldie, Sintayehu A.; Kim, Young-Mi; van den Akker, T.; Stekelenburg, Jelle

    2017-01-01

    Background: Disrespect and abuse of women during institutional childbirth services is one of the deterrents to utilization of maternity care services in Ethiopia and other low- and middle-income countries. This paper describes the prevalence of respectful maternity care (RMC) and mistreatment of

  7. Costing health care interventions at primary health facilities in ...

    African Journals Online (AJOL)

    The main objective was to estimate sector wide disease specific cost of health care intervention at health ... [Afr J. Health Sci. 2002; 9: 69-79]. Introduction interest in the costs of health care interventions derives from the desire to undertake economic evaluation that are input in health .... accounting procedure. It is based on ...

  8. Support Care Facility Prague House, Chapel Street, Freshford, Kilkenny.

    LENUS (Irish Health Repository)

    O'Reilly, Martina

    2016-07-01

    Assessment in palliative care settings should be focused, sensitive, specific, and effective to minimize discomfort to vulnerable and often highly morbid patients. This report describes the development of an admission assessment protocol for a Specialist Palliative Care Inpatient Unit and its implementation into clinical practice.

  9. Prescription Pattern at a Secondary Health Care Facility in Ilorin ...

    African Journals Online (AJOL)

    ANNALS

    One of the objectives of preparation of essential drugs list is to develop and follow a system of rational use of drugs. ... The facility has the essential drug list but this is not made available to prescribers. Three hundred and ... were used for writing the prescription. The number of items prescribed per prescription sheet for the ...

  10. Breastfeeding policies and practices in health care facilities in the ...

    African Journals Online (AJOL)

    hospital groups and the La Leche League SA. In both studies, the full sampling frame was approached to participate. In the initial study, a maximum of three HCWs and five mothers were selected at each facility using purposive sampling. HCWs (one doctor, one sister in charge and one nurse) working in the maternity.

  11. An overview of the distribution of dental care facilities in Mangalore taluk, India.

    Directory of Open Access Journals (Sweden)

    Rekha Prashanth Shenoy

    2015-09-01

    Full Text Available Objective: Equitable distribution of health care facilities is a guiding principle of Primary Heath Care. Although Mangalore taluk is a reputed center for medical education and health care, location of these facilities has not been evaluated to date. Therefore, a systematic survey was conducted to evaluate distribution of dental care facilities in Mangalore taluk, India. Material and Methods: List of Primary Health Centers, Community Health Centers and government hospitals, and details of the dental personnel and dental care facilities available at these centers was obtained from the District Health Officer (DHO. Data on registered private dental practitioners was obtained from the DHO and the Indian Dental Association. Information was obtained from dental colleges in the taluk regarding outreach activities and collaborations with the public sector. Descriptive statistics were used for data analysis. Results: Dentists are posted only at the CHCs and the District Hospital where they provide only basic dental services due to a lack of infrastructure. Of the 189 private dental clinics, 91% are located in urban areas of the taluk. They provide all modalities of dental care but are inaccessible to a majority of the rural population. Dental schools provide dental services to people in their vicinity, conduct outreach camps and have adopted four PHCs. Conclusion: An uneven distribution of dental care facilities exists with an overwhelming majority concentrated in the urban areas of the taluk. [J Contemp Med 2015; 5(3.000: 163-166

  12. Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators.

    Science.gov (United States)

    Vlaeyen, Ellen; Stas, Joke; Leysens, Greet; Van der Elst, Elisa; Janssens, Elise; Dejaeger, Eddy; Dobbels, Fabienne; Milisen, Koen

    2017-05-01

    To identify the barriers and facilitators for fall prevention implementation in residential care facilities. Systematic review. Review registration number on PROSPERO: CRD42013004655. Two independent reviewers systematically searched five databases (i.e. MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science) and the reference lists of relevant articles. This systematic review was conducted in line with the Center for Reviews and Dissemination Handbook and reported according to the PRISMA guideline. Only original research focusing on determinants of fall prevention implementation in residential care facilities was included. We used the Mixed Method Appraisal Tool for quality appraisal. Thematic analysis was performed for qualitative data; quantitative data were analyzed descriptively. To synthesize the results, we used the framework of Grol and colleagues that describes six healthcare levels wherein implementation barriers and facilitators can be identified. We found eight relevant studies, identifying 44 determinants that influence implementation. Of these, 17 were facilitators and 27 were barriers. Results indicated that the social and organizational levels have the greatest number of influencing factors (9 and 14, respectively), whereas resident and economical/political levels have the least (3 and 4, respectively). The most cited facilitators were good communication and facility equipment availability, while staff feeling overwhelmed, helpless, frustrated and concerned about their ability to control fall management, staffing issues, limited knowledge and skills (i.e., general clinical skill deficiencies, poor fall management skills or lack of computer skills); and poor communication were the most cited barriers. Successful implementation of fall prevention depends on many factors across different healthcare levels. The focus of implementation interventions, however, should be on modifiable barriers and facilitators such as communication, knowledge, and skills

  13. Agism and burnout among nurses in long-term care facilities in Israel.

    Science.gov (United States)

    Iecovich, Esther; Avivi, Michal

    2017-03-01

    The extent to which agism and professional qualifications are associated with nurses' burnout in long-term care facilities for older adults has been barely examined. This study is aimed to examine the extent to which agism, professional education, and geriatric training explain work burnout. The study included a convenience sample of 154 nurses working in 17 long-term care facilities in the Tel Aviv area in Israel. To examine agism, Kogan's Attitudes toward Old People Scale was used, and to probe burnout, the Maslach Burnout Inventory was used. Overall burnout was significantly explained by agism, nurses' professional education, length of working as a nurse, and type of facility ownership. When examining each dimension of burnout, agism was a significant predictor of depersonalization and personal achievement. Agism plays a role in overall burnout. Therefore, training programs that can combat agism can reduce burnout of nurses in long-term care facilities.

  14. Advanced practice nursing in performing arts health care.

    Science.gov (United States)

    Weslin, Anna T; Silva-Smith, Amy

    2010-06-01

    Performing arts medicine is a growing health care profession specializing in the needs of performing artists. As part of the performing arts venue, the dancer, a combination of athlete and artist, presents with unique health care needs requiring a more collaborative and holistic health care program. Currently there are relatively few advanced practice nurses (APNs) who specialize in performing arts health care. APNs, with focus on collaborative and holistic health care, are ideally suited to join other health care professionals in developing and implementing comprehensive health care programs for the performing artist. This article focuses on the dancer as the client in an APN practice that specializes in performing arts health care.

  15. Antenatal Care as a Means of Increasing Birth in the Health Facility ...

    African Journals Online (AJOL)

    Antenatal Care as a Means of Increasing Birth in the Health Facility and Reducing Maternal Mortality: A Systematic Review. ... Data were accessed via a computer based search from MEDLINE, African Journals Online, HINARI and Google Scholar databases. RESULTS: The regression analysis of antenatal care with health ...

  16. State Estimates of Organized Child Care Facilities. Population Division Working Paper Series No. 21.

    Science.gov (United States)

    Casper, Lynne M.; O'Connell, Martin

    Census Bureau data have traditionally focused on national estimates of the numbers of children in organized child care facilities using various household surveys. In contrast, this paper presents data on the characteristics of child care businesses for individual states from the Census of Service Industries. Although focusing primarily on the most…

  17. Workplace Violence and Safety Issues in Long-Term Medical Care Facilities: Nurses' Perspectives

    Directory of Open Access Journals (Sweden)

    Bankole K. Fasanya

    2016-06-01

    Conclusion: WPV is an epidemic problem that affects all health-care professionals. The findings of this study could help long-term medical care facilities' management identify the areas to focus on mitigating, controlling, and/or eliminating incidents of WPV.

  18. Evaluation of care of the Newborn in delivery facilities at Osogbo ...

    African Journals Online (AJOL)

    In a prospective study of 193 consecutive neonates brought to the immunization clinic for vaccination at the State Hospital, Osogbo, evaluation of the neonatal care received at the facility, where the neonates were delivered was conducted. Information concerning the place of delivery of the neonates, the specifics of the care ...

  19. Health system support for childbirth care in Southern Tanzania: results from a health facility census.

    Science.gov (United States)

    Hanson, Claudia; Ronsmans, Carine; Penfold, Suzanne; Maokola, Werner; Manzi, Fatuma; Jaribu, Jenny; Mbaruku, Godfrey; Mshinda, Hassan; Tanner, Marcel; Schellenberg, Joanna

    2013-10-30

    Progress towards reaching Millennium Development Goals four (child health) and five (maternal health) is lagging behind, particularly in sub-Saharan Africa, despite increasing efforts to scale up high impact interventions. Increasing the proportion of birth attended by a skilled attendant is a main indicator of progress, but not much is known about the quality of childbirth care delivered by these skilled attendants. With a view to reducing maternal mortality through health systems improvement we describe the care routinely offered in childbirth at dispensaries, health centres and hospitals in five districts in rural Southern Tanzania. We use data from a health facility census assessing 159 facilities in five districts in early 2009. A structural and operational assessment was undertaken based on staff reports using a modular questionnaire assessing staffing, work load, equipment and supplies as well as interventions routinely implemented during childbirth. Health centres and dispensaries attended a median of eight and four deliveries every month respectively. Dispensaries had a median of 2.5 (IQR 2-3) health workers including auxiliary staff instead of the recommended four clinical officer and certified nurses. Only 28% of first-line facilities (dispensaries and health centres) reported offering active management in the third stage of labour (AMTSL). Essential childbirth care comprising eight interventions including AMTSL, infection prevention, partograph use including foetal monitoring and newborn care including early breastfeeding, thermal care at birth and prevention of ophthalmia neonatorum was offered by 5% of dispensaries, 38% of health centres and 50% of hospitals consistently. No first-line facility had provided all signal functions for emergency obstetric complications in the previous six months. Essential interventions for childbirth care are not routinely implemented in first-line facilities or hospitals. Dispensaries have both low staffing and low

  20. Respectful maternity care in Ethiopian public health facilities

    National Research Council Canada - National Science Library

    Ephrem D Sheferaw; Eva Bazant; Hannah Gibson; Hone B Fenta; Firew Ayalew; Tsigereda B Belay; Maria M Worku; Aelaf E Kebebu; Sintayehu A Woldie; Young-Mi Kim; T van den Akker; Jelle Stekelenburg

    2017-01-01

    Background Disrespect and abuse of women during institutional childbirth services is one of the deterrents to utilization of maternity care services in Ethiopia and other low- and middle-income countries...

  1. Respectful maternity care in Ethiopian public health facilities

    OpenAIRE

    Sheferaw, Ephrem D.; Bazant, Eva; Gibson, Hannah; Fenta, Hone B.; Ayalew, Firew; Belay, Tsigereda B.; Worku, Maria M.; Kebebu, Aelaf E.; Sintayehu A. Woldie; Kim, Young-Mi; van den Akker, T.; Stekelenburg, Jelle

    2017-01-01

    Background Disrespect and abuse of women during institutional childbirth services is one of the deterrents to utilization of maternity care services in Ethiopia and other low- and middle-income countries. This paper describes the prevalence of respectful maternity care (RMC) and mistreatment of women in hospitals and health centers, and identifies factors associated with occurrence of RMC and mistreatment of women during institutional labor and childbirth services. Methods This study had a cr...

  2. Metrics for Success: Strategies for Enabling Core Facility Performance and Assessing Outcomes.

    Science.gov (United States)

    Turpen, Paula B; Hockberger, Philip E; Meyn, Susan M; Nicklin, Connie; Tabarini, Diane; Auger, Julie A

    2016-04-01

    Core Facilities are key elements in the research portfolio of academic and private research institutions. Administrators overseeing core facilities (core administrators) require assessment tools for evaluating the need and effectiveness of these facilities at their institutions. This article discusses ways to promote best practices in core facilities as well as ways to evaluate their performance across 8 of the following categories: general management, research and technical staff, financial management, customer base and satisfaction, resource management, communications, institutional impact, and strategic planning. For each category, we provide lessons learned that we believe contribute to the effective and efficient overall management of core facilities. If done well, we believe that encouraging best practices and evaluating performance in core facilities will demonstrate and reinforce the importance of core facilities in the research and educational mission of institutions. It will also increase job satisfaction of those working in core facilities and improve the likelihood of sustainability of both facilities and personnel.

  3. [Availability of psychotropic medications in health care facilities of the Ministry of Health of Peru, 2011].

    Science.gov (United States)

    Hodgkin, Dominic; Piazza, Marina; Crisante, Maruja; Gallo, Carla; Fiestas, Fabián

    2014-01-01

    Describe the availability of psychotropic medications for the treatment of mental disorders in the health care facilities of the Ministry of Health of Peru. Monthly inventory reports of the availability and consumption of medications in facilities of the Ministry of Health during 2011 were analyzed. Using a cross sectional design, the availability of seven classes of psychotropic medications was determined. Also, the level of care of the establishments and the level of decisional autonomy to purchase medications were determined. Anti-anxiety medications were available in health facilities of all levels of care. Antidepressants and antipsychotics were available in about two thirds of hospitals and in less than 20% of health centers and small health clinics. The other four classes of psychotropic medications (lithium, hypnotics and sedatives, psychostimulants/ADHD, and anti-dementia drugs) were only available in hospitals and not in health centers and small health clinics. 5% of hospitals had a sufficient supply to meet the demand for the year. There is a significant gap in the availability of psychotropic medications in the health care facilities of the Ministry of Health of Peru. This was observed both in hospitals and in primary care facilities. Actions are needed in health policy and management, including more funding and greater mental health training for staff in primary care, among other initiatives.

  4. Experiences of registered nurses as managers and leaders in residential aged care facilities: a systematic review.

    Science.gov (United States)

    Dwyer, Drew

    2011-12-01

    The phenomenon of an ageing population is being experienced globally, as countries struggle to change and improve residential models of care and provide services to the elderly. The role of the registered nurse (RN) is considered crucial to the clinical governance and management of care given. To date, however, no systematic review has examined the RN's experience in leadership and management. The objective of this review is to critically appraise, synthesise and present best available evidence on the experiences of RNs as clinical leaders and managers in residential aged care facilities. This review considered qualitative research papers that addressed the experiences of RNs as clinical leaders and managers in residential aged care facilities. Participants of interest were RNs, nurse leaders, nurses holding registration and or regulation under a board of nursing, nurses working in residential aged care and long-term care facilities. The diversity and use of language to describe nurses' roles and models of care for the elderly care environment were considered in the review. The search strategy sought to find both published studies and papers, limited to the English language and published between January 1997 and February 2011. An initial limited search was done in Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cumulative Index to Nursing and Allied Health Literature databases to identify the key words contained in the title or abstract and index terms used to describe the relevant terms in the article. A second extensive search was undertaken and extended to other relevant databases using all identified keywords and index terms. The third step involved searching reference lists and bibliographies of chosen articles for additional studies. Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using an appropriate critical appraisal instrument from the System for the Unified Management

  5. Historical and cultural aspects of the provision of care at an indigenous healthcare service facility.

    Science.gov (United States)

    Ribeiro, Aridiane Alves; Arantes, Cássia Irene Spinelli; Gualda, Dulce Maria Rosa; Rossi, Lídia Aparecida

    2017-06-01

    This case study aimed to interpret the underlying historical and cultural aspects of the provision of care at an indigenous healthcare service facility. This is an interpretive, case study-type research with qualitative approach, which was conducted in 2012 at the Indigenous Health Support Center (CASAI) of the State of Mato Grosso do Sul, Brazil. Data were collected by means systematic observation, documentary analyses and semi-structured interviews with ten health professionals. Data review was performed according to an approach based on social anthropology and health anthropology. The anthropological concepts of social code and ethnocentrism underpinned the interpretation of outcomes. Two categories were identified: CASAI, a space between streets and village; Ethnocentrism and indigenous health care. Healthcare practice and current social code are influenced by each other. The street social code prevails in the social environment under study. The institutional organization and professionals' appreciation of the indigenous biological body are decisive to provision of care under the streets social code perspective. Professionals' concepts evidence ethnocentrism in healthcare. Workers, however, try to adopt a relativized view vis-à-vis indigenous people at CASAI.

  6. Quality of Tuberculosis Care in Private Health Facilities of Addis Ababa, Ethiopia

    Directory of Open Access Journals (Sweden)

    Gezahegn Gebrekidan

    2014-01-01

    Full Text Available Ensuring provision of good quality tuberculosis (TB care, especially in private for profit health facilities, is an important component of TB control strategy to reduce poor medical practice which results in multidrug resistant TB (MDR-TB. The aim of this study was to investigate quality of TB care in private health facilities of Addis Ababa. A facility based cross-sectional study was conducted based on Donabedian’s structure-process-outcome model of health care quality. Quality of care was determined by adherence to National TB Program guidelines, treatment success rate, and client satisfaction. Exit interview was conducted on 292 patients on the intensive phase of treatment and 384 patient records were reviewed in eight private health facilities. Initial diagnostic AFB test was done for 95.4% of pulmonary TB patients. Most important components of TB care recommended by national guidelines were delivered for a significant proportion of patients. Majority (75% of the clients were found to be satisfied with each component of TB care. The treatment success rate was 90.9%. The quality of TB care was fairly good. However, only 77.7% of the patients were counseled for HIV testing. Strengthening HIV counseling and testing, tackling shortage of streptomycin and laboratory reagent at private TB clinic is crucial.

  7. High Performance Computing Facility Operational Assessment, FY 2011 Oak Ridge Leadership Computing Facility

    Energy Technology Data Exchange (ETDEWEB)

    Baker, Ann E [ORNL; Bland, Arthur S Buddy [ORNL; Hack, James J [ORNL; Barker, Ashley D [ORNL; Boudwin, Kathlyn J. [ORNL; Kendall, Ricky A [ORNL; Messer, Bronson [ORNL; Rogers, James H [ORNL; Shipman, Galen M [ORNL; Wells, Jack C [ORNL; White, Julia C [ORNL

    2011-08-01

    Oak Ridge National Laboratory's Leadership Computing Facility (OLCF) continues to deliver the most powerful resources in the U.S. for open science. At 2.33 petaflops peak performance, the Cray XT Jaguar delivered more than 1.5 billion core hours in calendar year (CY) 2010 to researchers around the world for computational simulations relevant to national and energy security; advancing the frontiers of knowledge in physical sciences and areas of biological, medical, environmental, and computer sciences; and providing world-class research facilities for the nation's science enterprise. Scientific achievements by OLCF users range from collaboration with university experimentalists to produce a working supercapacitor that uses atom-thick sheets of carbon materials to finely determining the resolution requirements for simulations of coal gasifiers and their components, thus laying the foundation for development of commercial-scale gasifiers. OLCF users are pushing the boundaries with software applications sustaining more than one petaflop of performance in the quest to illuminate the fundamental nature of electronic devices. Other teams of researchers are working to resolve predictive capabilities of climate models, to refine and validate genome sequencing, and to explore the most fundamental materials in nature - quarks and gluons - and their unique properties. Details of these scientific endeavors - not possible without access to leadership-class computing resources - are detailed in Section 4 of this report and in the INCITE in Review. Effective operations of the OLCF play a key role in the scientific missions and accomplishments of its users. This Operational Assessment Report (OAR) will delineate the policies, procedures, and innovations implemented by the OLCF to continue delivering a petaflop-scale resource for cutting-edge research. The 2010 operational assessment of the OLCF yielded recommendations that have been addressed (Reference Section 1) and

  8. Lessons learned from Hurricane Andrew: recommendations for care of the elderly in long-term care facilities.

    Science.gov (United States)

    Silverman, M A; Weston, M; Llorente, M; Beber, C; Tam, R

    1995-06-01

    We report on the experience of a 500-bed, long-term care facility in Miami, Fla, which provides housing and nursing care units for patients--ranging from those who are independently ambulatory to those who are acutely ill and feeble--in preparing for, during, and in the immediate aftermath of Hurricane Andrew, which struck on August 24, 1992. The problems encountered included a massive influx of evacuated elderly to the facility, facility isolation, loss of electrical power, loss of running water, special dietary needs, and limited professional staffing due to personal property losses or loss of transportation. Overwhelmed county emergency medical services, limited access to hospitals and patient care, and difficulty in procuring supplies exacerbated the already complicated situation resulting from the storm. As a result of these catastrophic conditions, a number of challenges specific to the care of the elderly were identified. In conjunction with the Florida Department of Elder Affairs, we drafted a comprehensive blueprint that could serve as a disaster plan for other long-term care facilities facing a similar threat during the hurricane season.

  9. High Performance Computing Facility Operational Assessment, FY 2010 Oak Ridge Leadership Computing Facility

    Energy Technology Data Exchange (ETDEWEB)

    Bland, Arthur S Buddy [ORNL; Hack, James J [ORNL; Baker, Ann E [ORNL; Barker, Ashley D [ORNL; Boudwin, Kathlyn J. [ORNL; Kendall, Ricky A [ORNL; Messer, Bronson [ORNL; Rogers, James H [ORNL; Shipman, Galen M [ORNL; White, Julia C [ORNL

    2010-08-01

    Oak Ridge National Laboratory's (ORNL's) Cray XT5 supercomputer, Jaguar, kicked off the era of petascale scientific computing in 2008 with applications that sustained more than a thousand trillion floating point calculations per second - or 1 petaflop. Jaguar continues to grow even more powerful as it helps researchers broaden the boundaries of knowledge in virtually every domain of computational science, including weather and climate, nuclear energy, geosciences, combustion, bioenergy, fusion, and materials science. Their insights promise to broaden our knowledge in areas that are vitally important to the Department of Energy (DOE) and the nation as a whole, particularly energy assurance and climate change. The science of the 21st century, however, will demand further revolutions in computing, supercomputers capable of a million trillion calculations a second - 1 exaflop - and beyond. These systems will allow investigators to continue attacking global challenges through modeling and simulation and to unravel longstanding scientific questions. Creating such systems will also require new approaches to daunting challenges. High-performance systems of the future will need to be codesigned for scientific and engineering applications with best-in-class communications networks and data-management infrastructures and teams of skilled researchers able to take full advantage of these new resources. The Oak Ridge Leadership Computing Facility (OLCF) provides the nation's most powerful open resource for capability computing, with a sustainable path that will maintain and extend national leadership for DOE's Office of Science (SC). The OLCF has engaged a world-class team to support petascale science and to take a dramatic step forward, fielding new capabilities for high-end science. This report highlights the successful delivery and operation of a petascale system and shows how the OLCF fosters application development teams, developing cutting-edge tools

  10. Potentially inappropriate prescribing in older patients discharged from acute care hospitals to residential aged care facilities.

    Science.gov (United States)

    Poudel, Arjun; Peel, Nancye M; Nissen, Lisa; Mitchell, Charles; Gray, Len C; Hubbard, Ruth E

    2014-11-01

    The frequency of prescribing potentially inappropriate medications (PIMs) in older patients remains high despite evidence of adverse outcomes from their use. Little is known about whether admission to hospital has any effect on appropriateness of prescribing. This study aimed to identify the prevalence and nature of PIMs and explore the association of risk factors for receiving a PIM. This was a prospective study of 206 patients discharged to residential aged care facilities from acute care. All patients were at least 70 years old and were admitted between July 2005 and May 2010; their admission and discharge medications were evaluated. Mean patient age was 84.8±6.7 years; the majority (57%) were older than 85 years, and mean (SD) Frailty Index was 0.42 (0.15). At least 1 PIM was identified in 112 (54.4%) patients on admission and 102 (49.5%) patients on discharge. Of all medications prescribed at admission (1728), 10.8% were PIMs, and at discharge, of 1759 medications, 9.6% were PIMs. Of the total 187 PIMs on admission, 56 (30%) were stopped and 131 were continued; 32 new PIMs were introduced. Of the potential risk factors considered, in-hospital cognitive decline and frailty status were the only significant predictors of PIMs. Although admission to hospital is an opportunity to review the indications for specific medications, a high prevalence of inappropriate drug use was observed. The only associations with PIM use were the frailty status and in-hospital cognitive decline. Additional studies are needed to further evaluate this association. © The Author(s) 2014.

  11. Physical Profiling Performance of Air Force Primary Care Providers

    Science.gov (United States)

    2017-08-09

    MTF medical treatment facility OR odds ratio PCP primary care provider PHA Periodic Health Assessment SE standard error SME subject matter expert ...ascertain if predictors existed to augment PCP screening. This study was a cross-sectional, retrospective medical records review of active duty U.S. Air...Force (AF) members receiving care in an AF medical treatment facility (MTF) between October 31, 2013, and September 30, 2014, who had at least one

  12. Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

    Science.gov (United States)

    de Graft-Johnson, Joseph; Vesel, Linda; Rosen, Heather E; Rawlins, Barbara; Abwao, Stella; Mazia, Goldy; Bozsa, Robert; Mwebesa, Winifrede; Khadka, Neena; Kamunya, Rosemary; Getachew, Ashebir; Tibaijuka, Gaudiosa; Rakotovao, Jean Pierre; Tekleberhan, Alemnesh

    2017-01-01

    Objective To present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills. Design Cross-sectional observational health facility assessment. Setting Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania. Participants Health workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed. Main outcome measures Indicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation. Results Sterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly. Conclusions The findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have

  13. Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries.

    Science.gov (United States)

    de Graft-Johnson, Joseph; Vesel, Linda; Rosen, Heather E; Rawlins, Barbara; Abwao, Stella; Mazia, Goldy; Bozsa, Robert; Mwebesa, Winifrede; Khadka, Neena; Kamunya, Rosemary; Getachew, Ashebir; Tibaijuka, Gaudiosa; Rakotovao, Jean Pierre; Tekleberhan, Alemnesh

    2017-03-27

    To present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills. Cross-sectional observational health facility assessment. Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania. Health workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed. Indicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation. Sterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly. The findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have the necessary equipment, supplies, knowledge and skills that are critical to

  14. Water, sanitation and hygiene in health care facilities: Challenges and priorities

    Directory of Open Access Journals (Sweden)

    Jovanović Dragana

    2017-01-01

    Full Text Available The microbial agents that cause infectious diseases are highly prevalent in health care facilities. Adequate water supply, sanitation and hygiene are the key elements for the provision of basic health services. The consequences of poor sanitary and hygienic conditions and inadequate water supply are numerous in health care facilities. The importance of improving water supply, sanitation and hygiene in health care facilities has been recognized as an international priority and set in the 2030 Agenda for Sustainable Development, particularly through goal 3.8 and 6. The establishment and maintenance of safe water supply and adequate sanitary and hygienic conditions has multiple benefits for health care facilities. It is necessary to introduce and implement risk assessment and risk management approach as effective way of continuously ensuring and maintaining the safety of drinking water quality in health care facilities as recommended by the World Health Organization, in order to reduce the risks associated with inadequate water supply and protect health of patients and staff. Realization of activities on the improvement requires a multidisciplinary approach and good inter-sectoral cooperation at all levels local, national and global.

  15. Use of Antiviral Prophylaxis in Influenza Outbreaks in Long Term Care Facilities

    Directory of Open Access Journals (Sweden)

    Allison McGeer

    2000-01-01

    Full Text Available Influenza is a major cause of illness and death in residents of long term care facilities for the elderly, in part because residents' age and underlying illness increase the risk of serious complications, and in part because institutional living increases the risk of influenza outbreaks. The administration of antiviral medications active against influenza to persons exposed to influenza has been shown to protect them effectively from illness, and mass antiviral prophylaxis of residents is an effective means of terminating influenza A outbreaks in long term care facilities. The only antiviral currently licensed in Canada for influenza prophylaxis is amantadine, a medication active against influenza A but not influenza B. The National Advisory Committee on Immunization recommends that amantadine prophylaxis be offered to residents when influenza A outbreaks occur in long term care facilities. However, there remain a number of unanswered questions about how best to use amantadine for controlling influenza A outbreaks in long term care facilities. In addition, two members of a new class of antivirals called neuraminidase inhibitors have recently been licensed in Canada for the treatment of influenza, and are effective in prophylaxis. Issues in the use of amantadine in the control of outbreaks of influenza A in long term care facilities for the elderly are reviewed, and the potential uses of neuraminidase inhibitors in this setting are discussed.

  16. Technological Advances, Human Performance, and the Operation of Nuclear Facilities

    Science.gov (United States)

    Corrado, Jonathan K.

    Many unfortunate and unintended adverse industrial incidents occur across the United States each year, and the nuclear industry is no exception. Depending on their severity, these incidents can be problematic for people, the facilities, and surrounding environments. Human error is a contributing factor in many such incidents. This dissertation first explored the hypothesis that technological changes that affect how operators interact within the systems of the nuclear facilities exacerbate the cost of incidents caused by human error. I conducted a review of nuclear incidents in the United States from 1955 through 2010 that reached Level 3 (serious incident) or higher on the International Nuclear Events Scale (INES). The cost of each incident at facilities that had recently undergone technological changes affecting plant operators' jobs was compared to the cost of events at facilities that had not undergone changes. A t-test determined a statistically significant difference between the two groups, confirming the hypothesis. Next, I conducted a follow-on study to determine the impact of the incorporation of new technologies into nuclear facilities. The data indicated that spending more money on upgrades increased the facility's capacity as well as the number of incidents reported, but the incident severity was minor. Finally, I discuss the impact of human error on plant operations and the impact of evolving technology on the 21st-century operator, proposing a methodology to overcome these challenges by applying the systems engineering process.

  17. Methicillin-resistant Staphylococcus aureus in resident animals of a long-term care facility.

    Science.gov (United States)

    Coughlan, K; Olsen, K E; Boxrud, D; Bender, J B

    2010-05-01

    Animals provide benefits to elderly and chronically ill people by decreasing loneliness, increasing social interactions, and improving mental health. As a result, many hospitals and long-term care facilities allow family pets to visit ill or convalescing patients or support animal-assisted therapy programs. These include programs that have resident animals in long-term care facilities. Despite the benefits, there are concerns about disease transmission between pets and patients. Antibiotic-resistant bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), are a recognized problem in healthcare settings leading to refractory infections and potentially life-threatening illnesses. MRSA has been isolated from numerous animal species, yet few studies are available on the carriage of this pathogen in animals residing in long-term care facilities. Our objective was to characterize MRSA carriage among resident animals in a long-term care facility. To document MRSA colonization, nasal swabs from 12 resident animals (one dogs and 11 cats) of a long-term care facility were collected weekly for 8 weeks. Staphylococcus isolates were characterized by antimicrobial susceptibility and MRSA isolates were further characterized by pulsed-field gel electrophoresis (PFGE). PFGE isolate patterns were compared with an existing database of MRSA isolate patterns at the Minnesota Department of Health. Two of 11 cats were colonized with MRSA. MRSA was recovered from five of eight weekly samples in one cat and two of eight weekly samples in the other cat. All isolates were classified as USA100 (healthcare-associated strains). Long-term care resident animals may acquire MRSA. Clonally related strains were identified over the 8-week sampling period. It is unclear if pets serve as an on-going source of infection to their human companions in long-term care facilities.

  18. Educational Needs of Health Care Providers Working in Long-Term Care Facilities with Regard to Pain Management

    Directory of Open Access Journals (Sweden)

    Yannick Tousignant-Laflamme

    2012-01-01

    Full Text Available BACKGROUND: The prevalence of chronic pain ranges from 40% to 80% in long-term care facilities (LTCF, with the highest proportion being found among older adults and residents with dementia. Unfortunately, pain in older adults is underdiagnosed, undertreated, inadequately treated or not treated at all. A solution to this problem would be to provide effective and innovative interdisciplinary continuing education to health care providers (HCPs.

  19. High Performance Computing Facility Operational Assessment 2015: Oak Ridge Leadership Computing Facility

    Energy Technology Data Exchange (ETDEWEB)

    Barker, Ashley D. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility; Bernholdt, David E. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility; Bland, Arthur S. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility; Gary, Jeff D. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility; Hack, James J. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility; McNally, Stephen T. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility; Rogers, James H. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility; Smith, Brian E. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility; Straatsma, T. P. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility; Sukumar, Sreenivas Rangan [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility; Thach, Kevin G. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility; Tichenor, Suzy [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility; Vazhkudai, Sudharshan S. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility; Wells, Jack C. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States). Oak Ridge Leadership Computing Facility

    2016-03-01

    Oak Ridge National Laboratory’s (ORNL’s) Leadership Computing Facility (OLCF) continues to surpass its operational target goals: supporting users; delivering fast, reliable systems; creating innovative solutions for high-performance computing (HPC) needs; and managing risks, safety, and security aspects associated with operating one of the most powerful computers in the world. The results can be seen in the cutting-edge science delivered by users and the praise from the research community. Calendar year (CY) 2015 was filled with outstanding operational results and accomplishments: a very high rating from users on overall satisfaction that ties the highest-ever mark set in CY 2014; the greatest number of core-hours delivered to research projects; the largest percentage of capability usage since the OLCF began tracking the metric in 2009; and success in delivering on the allocation of 60, 30, and 10% of core hours offered for the INCITE (Innovative and Novel Computational Impact on Theory and Experiment), ALCC (Advanced Scientific Computing Research Leadership Computing Challenge), and Director’s Discretionary programs, respectively. These accomplishments, coupled with the extremely high utilization rate, represent the fulfillment of the promise of Titan: maximum use by maximum-size simulations. The impact of all of these successes and more is reflected in the accomplishments of OLCF users, with publications this year in notable journals Nature, Nature Materials, Nature Chemistry, Nature Physics, Nature Climate Change, ACS Nano, Journal of the American Chemical Society, and Physical Review Letters, as well as many others. The achievements included in the 2015 OLCF Operational Assessment Report reflect first-ever or largest simulations in their communities; for example Titan enabled engineers in Los Angeles and the surrounding region to design and begin building improved critical infrastructure by enabling the highest-resolution Cybershake map for Southern

  20. Administrative days in acute care facilities: a queueing-analytic approach.

    Science.gov (United States)

    Weiss, E N; McClain, J O

    1987-01-01

    After acute care services are no longer required, a patient in an acute care hospital often must remain there while he or she awaits the provision of extended care services by a nursing home, through social support services, or by a home health care service. This waiting period is often referred to as "administrative days" because the time is spent in the acute facility not for medical reasons, but rather for administrative reasons. In this paper we use a queueing-analytic approach to describe the process by which patients await placement. We model the situation using a state-dependent placement rate for patients backed up in the acute care facility. We compare our model results with data collected from a convenience sample of 7 hospitals in New York State. We conclude with a discussion of the policy implications of our models.

  1. Does size matter in aged care facilities? A literature review of the relationship between the number of facility beds and quality.

    Science.gov (United States)

    Baldwin, Richard; Chenoweth, Lynnette; Dela Rama, Marie; Wang, Alex Y

    Theory suggests that structural factors such as aged care facility size (bed numbers) will influence service quality. There have been no recent published studies in support of this theory, and consequently, the available literature has not been useful in assisting decision makers with investment decisions on facility size. The study aimed to address that deficit by reviewing the international literature on the relationships between the size of residential aged care facilities, measured by number of beds, and service quality. A systematic review identified 30 studies that reported a relationship between facility size and quality and provided sufficient details to enable comparison. There are three groups of studies based on measurement of quality-those measuring only resident outcomes, those measuring care and resident outcomes using composite tools, and those focused on regulatory compliance. The overall findings support the posited theory to a large extent, that size is a factor in quality and smaller facilities yield the most favorable results. Studies using multiple indicators of service quality produced more consistent results in favor of smaller facilities, as did most studies of regulatory compliance. The theory that aged care facility size (bed numbers) will influence service quality was supported by 26 of the 30 studies reviewed. The review findings indicate that aged care facility size (number of beds) may be one important factor related to service quality. Smaller facilities are more likely to result in higher quality and better outcomes for residents than larger facilities. This has implications for those who make investment decisions concerning aged care facilities. The findings also raise implications for funders and policy makers to ensure that regulations and policies do not encourage the building of facilities inconsistent with these findings.

  2. Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study.

    Science.gov (United States)

    Magnavita, Nicola; Heponiemi, Tarja

    2012-05-02

    Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention. All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75% in 2005, 71% in 2007, and 94% in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form) for reporting violent incidents, the DCS (demand/control/support) model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health. One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress. Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.

  3. Blastocystis hominis infection in long-term care facilities in Taiwan: prevalence and associated clinical factors.

    Science.gov (United States)

    Su, Fu-Hsiung; Chu, Fang-Yeh; Li, Chung-Yi; Tang, Hui-Fei; Lin, Yu-Shiang; Peng, Yu-Ju; Su, Yih-Ming; Lee, Shyh-Dye

    2009-10-01

    Blastocystis hominis is probably the most common protozoan found in the human gut worldwide. In Taiwan, the prevalence of B. hominis infection is yet to be determined but is expected to be relatively higher among foreign workers. No data is available on the prevalence of B. hominis infection in long-term care facilities in Taiwan. This study included 713 subjects (552 residents and 161 care workers) from ten long-term care facilities in Taiwan who completed stool microscopic examinations with Merthiolate-iodine-formalin stain technique. The prevalence rate of blastocystosis was the highest among foreign and domestic care workers followed by residents (12.2%, 4.6%, and 2.7%, respectively). Older age (p = 0.04) and lower educational level (p = 0.008) were significantly associated with blastocystosis among care workers. Among residents, B. hominis infection was negatively associated with prolonged use of antibiotics within 3 months prior to examination (p = 0.05) and positively associated with tracheostomy in-place (p = 0.028). In conclusion, B. hominis infection was the most prevalent intestinal parasitic infection among both care workers and residents of long-term care facilities in Taiwan. Use of antibiotics was negatively associated with B. hominis infection among residents. Additionally, appropriate preventive measures should be implemented to older care workers with lesser educational attainment in order to reduce the risk of blastocystosis infection.

  4. [Elderly arrested people in correctional facilities Challenge for health care].

    Science.gov (United States)

    Meyer, L

    2016-01-01

    At present there is no systematic, nationwide collection of data about the health status and health care of elderly persons imprisoned in Germany. The health status is highly significant with regard to the (re)socialization of elderly prisoners. From an ethical point of view a highly developed country should provide a good quality health care even in prisons. Using the example of male prisoners in the Federal State of Rhineland-Palatinate, a survey was carried out on the health status of elderly prisoners and the presence of functional handicaps. A total of 222 elderly male prisoners in Rhineland-Palatinate who were at least 50 years old at the time of the quantitative analyses participated in the anonymous comprehensive survey by completing a questionnaire. The elderly prisoners in Rhineland-Palatinate are concerned by age-related chronic diseases and functional handicaps significantly more often than the general extramural population. The data obtained in this survey are essential for the development and implementation of targeted strategies of prevention and health promotion and for improvement in the health care of elderly prisoners.

  5. Communication between residential aged care facilities and the emergency department: a review of the literature.

    Science.gov (United States)

    Griffiths, Debra; Morphet, Julia; Innes, Kelli; Crawford, Kimberley; Williams, Allison

    2014-11-01

    Western countries have encountered an increase in elderly patients transferred from residential aged care facilities to emergency departments. This patient cohort frequently experiences impaired physical and cognitive function. Emergency department staff require important clinical and personal patient information to provide quality care. International studies show that documentation and handover deficiencies are common. The purpose of this literature review was to explore transitional communication practices, and to consider the specific patient information deemed essential for the management of residents in the emergency department. A literature review was conducted to examine the studies exploring the documentation accompanying elderly people who were transferred from residential aged care facilities to emergency departments. Scopus, OVID Medline and Cinahl Plus data bases were searched using combinations of the following key words: 'nursing home', 'long-term care', 'skilled nursing facility', 'aged care facility', 'communication', 'documentation', 'emergency department', 'emergency room', 'hospital', 'acute', 'transfer', and 'transition'. Additional data was located with the use of Google Scholar. Review of titles and exclusion of duplicates identified 69 relevant studies. These 69 papers were independently reviewed by three members of the research team for eligibility for inclusion in the review, and seven papers were retained. There is currently no consensus regarding what information is essential when residents are transferred from aged care facilities to emergency departments, and practices vary. Key information which should accompany the resident has been reported by various authors and include the reason for transfer, past medical history, current medications, cognitive function and advance directives. Some authors also suggest that facility contact details are essential. Without agreement by key stakeholders as to what constitutes 'essential transfer

  6. Children's hand hygiene behaviour and available facilities: an observational study in Dutch day care centres.

    Science.gov (United States)

    van Beeck, A H Elise; Zomer, Tizza P; van Beeck, Eduard F; Richardus, Jan Hendrik; Voeten, Helene A C M; Erasmus, Vicki

    2016-04-01

    Children attending day care centres are at increased risk of infectious diseases, in particular gastrointestinal and respiratory infections. Hand hygiene of both caregivers and children is an effective prevention measure. This study examined hand hygiene behaviour of children attending day care centres, and describes hygiene facilities at day care centres. Data were collected at 115 Dutch day care centres, among 2318 children cared for by 231 caregivers (August to October 2010). Children's hand hygiene behaviour was observed and data on hand hygiene facilities of the day care centres collected by direct unobtrusive observation. National guidelines indicate hand hygiene is required before eating, after toilet use and after playing outside. Among 1930 observed hand hygiene opportunities for children, overall adherence to hand hygiene guidelines was 31% (95% CI: 29-33%). Adherence after both toilet use and playing outside was 48%. Hands were less frequently washed before eating, where guideline adherence was 15%. In 38% of the playrooms there was no soap within reach of children and 17% had no towel facilities. In over 40% of the playrooms, appropriate hand hygiene facilities for children were lacking. Adequate hand washing facilities were available for children in only half of the participating day care centres in our study and children washed their hands in only 15-48% of the occasions defined by official guidelines. More attention is needed to hand hygiene of children attending day care centres in the prevention of infectious diseases. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  7. Assessment of disease profiles and drug prescribing patterns of health care facilities in Edo State, Nigeria

    Directory of Open Access Journals (Sweden)

    Ehijie F.O. Enato

    2012-10-01

    Full Text Available Few studies have systematically characterized drug-prescribing patterns, particularly at the primary care level in Nigeria, a country disproportionately burdened with disease. The aim of this study was to assess the disease profiles and drug-prescribing pattern in two health care facilities in Edo State, Nigeria. The medical records of 495 patients who attended a primary or secondary health care facility in Owan-East Local Government Area of Edo State, Nigeria, between June and November 2009 were reviewed. Disease profiles and drug prescribing patterns were assessed. Data were analyzed based on the World Health Organization Anatomic Therapeutic Chemical classification system, and core drug prescribing indicators. Five hundred and twelve clinical conditions were identified. Infectious disease was most prevalent (38.3%, followed by disorder of the alimentary tract (16.4%. Malaria was responsible for 55.6% of the infectious diseases seen, and 21.3% (109/512 of the total clinical conditions managed at the two health facilities during the study period. Consequently, anti-infective medications were the most frequently prescribed medicines (21.5%, followed by vitamins (18.2%. Use of artesunate monotherapy at both facilities (15.7%, and chloroquine at the primary health facility (24.9% were common. Paracetamol (41.8% and non-steroidal anti-inflammatory drugs (24.9% were the most frequently used analgesic/antipyretic. At the primary health care facility, dipyrone was used in 21.6% of cases. The core drug prescribing use indicators showed inappropriate prescribing, indicating poly-pharmacy, overuse of antibiotics and injectio. Inappropriate drug use patterns were identified at both health care facilities, especially with regard to the use of ineffective antimalarial drugs and the use of dipyrone.

  8. Dual indices for prioritizing investment in decentralized HIV services at Nigerian primary health care facilities.

    Science.gov (United States)

    Fronczak, Nancy; Oyediran, Kola' A; Mullen, Stephanie; Kolapo, Usman M

    2016-04-01

    Decentralizing health services, including those for HIV prevention and treatment, is one strategy for maximizing the use of limited resources and expanding treatment options; yet few methods exist for systematically identifying where investments for service expansion might be most effective, in terms of meeting needs and rapid availability of improved services. The Nigerian Government, the United States Government under the President's Emergency Plan for AIDS Relief (PEPFAR) program and other donors are expanding services for prevention of mother-to-child transmission (PMTCT) of HIV to primary health care facilities in Nigeria. Nigerian primary care facilities vary greatly in their readiness to deliver HIV/AIDS services. In 2012, MEASURE Evaluation assessed 268 PEPFAR-supported primary health care facilities in Nigeria and developed a systematic method for prioritizing these facilities for expansion of PMTCT services. Each assessed facility was scored based on two indices with multiple, weighted variables: one measured facility readiness to provide PMTCT services, the other measured local need for the services and feasibility of expansion. These two scores were compiled and the summary score used as the basis for prioritizing facilities for PMTCT service expansion. The rationale was that using need and readiness to identify where to expand PMTCT services would result in more efficient allocation of resources. A review of the results showed that the indices achieved the desired effect-that is prioritizing facilities with high need even when readiness was problematic and also prioritizing facilities where rapid scale-up was feasible. This article describes the development of the two-part index and discusses advantages of using this approach when planning service expansion. The authors' objective is to contribute to development of methodologies for prioritizing investments in HIV, as well as other public health arenas, that should improve cost-effectiveness and

  9. Development of key performance indicators for prehospital emergency care.

    Science.gov (United States)

    Murphy, Adrian; Wakai, Abel; Walsh, Cathal; Cummins, Fergal; O'Sullivan, Ronan

    2016-04-01

    Key performance indicators (KPIs) are used to monitor and evaluate critical areas of clinical and support functions that influence patient outcome. Traditional prehospital emergency care performance monitoring has focused solely on response time metrics. The landscape of emergency care delivery in Ireland is in the process of significant national reconfiguration. The development of KPIs is therefore considered one of the key priorities in prehospital research. The aim of this study was to develop a suite of KPIs for prehospital emergency care in Ireland. A systematic literature review of prehospital care performance measurement was undertaken followed by a three-round Delphi consensus process facilitated by a broad-based multidisciplinary group of panellists. The consensus process was conducted between June 2012 and October 2013. Each candidate indicator on the Delphi survey questionnaire was rated using a 5-point Likert-type rating scale. Agreement was defined as at least 70% of responders rating an indicator as 'agree' or 'strongly agree' on the rating scale. Data were analysed using descriptive statistics. Sensitivity of the ratings was examined for robustness by bootstrapping the original sample. Of the 78 citations identified by the systematic review, 5 relevant publications were used to select candidate indicators for the Delphi round 1 questionnaire. Response rates in Delphi rounds 1 and 2 were 89% and 83%, respectively. Following the consensus development conference, 101 KPIs reached consensus. Based on the Donabedian framework for quality-of-care indicators, 7 of the KPIs which reached agreement were structure KPIs, 74 were process KPIs and 20 were outcome KPIs. The highest ranked indicator was a process KPI ('Direct transport of ST-elevation myocardial infarction patients to a primary percutaneous intervention (PCI)-capable facility for ECG to PCI time KPIs. Employing a Delphi panel of key multidisciplinary Emergency Medical Service stakeholders, it was

  10. Impact of HIV care facility characteristics on the cascade of care in HIV-infected patients in the Netherlands

    NARCIS (Netherlands)

    Engelhard, Esther A. N.; Smit, Colette; van Sighem, Ard; Reiss, Peter; Nieuwkerk, Pythia T.; Kroon, Frank P.; Brinkman, Kees; Geerlings, Suzanne E.

    2016-01-01

    Successful treatment of people infected with HIV requires that patients are retained in HIV care, use combination antiretroviral therapy (cART) and ultimately reach and sustain viral suppression. Our aim was to identify health facility characteristics associated with these steps in the cascade of

  11. HUMAN CALICIVIRUS OUTBREAK OF ACUTE GASTROENTERITIS IN AN AGED-CARE FACILITY

    Directory of Open Access Journals (Sweden)

    Iztok Štrumbelj

    2003-05-01

    Full Text Available Background. Human caliciviruses represent a genetically and antigenetically diverse group of single-stranded RNA viruses associated with acute gastroenteritis in humans. In last two years the number of notified gastroenteric cases in Slovenia is increasing. From January till November 2002 already 574 calicivirus cases have been confirmed. Majority of cases were observed in preschool and school children but no cases were described in the aged-care facility.Methods. An outbreak of gastroenteritis in an aged-care facility occured. After onset of the outbreak an epidemiological questionnaire and inspection of local conditions were realized. Stool samples from home residents were analysed to find out bacteriological and/or viral aetiology. Direct electron microscopy and RT-PCR assay was performed to detect caliciviruses. Viral RNA was amplified using specific primers and PCR products were identified in hybridisation test.Results. The outbreak started suddenly on the second floor, where the attack rate was the highest. On the other floors the illness started later and the attack rate was lower. Sixty-one (40,1% residents from 152 became ill and additionally 15 (22,4% employees from 67. The outbreak ended after ten days. Electron microscopy or/and RT-PCR revealed Norovirus members of family Caliciviridae in 9 of 10 stool specimens. As determined by RT-PCR and hybridisation assay viruses corresponded to genogroup II, genetic cluster 1 (closely related to the Hawaii virus and genetic cluster 4 (closely related to the Lordsdale virus.Conclusions. Presented data support a significant role for caliciviruses as causative agents of gastroenteritis in elderly persons in Slovenia.

  12. Research Support Facility (RSF): Leadership in Building Performance (Brochure)

    Energy Technology Data Exchange (ETDEWEB)

    2011-09-01

    This brochure/poster provides information on the features of the Research Support Facility including a detailed illustration of the facility with call outs of energy efficiency and renewable energy technologies. Imagine an office building so energy efficient that its occupants consume only the amount of energy generated by renewable power on the building site. The building, the Research Support Facility (RSF) occupied by the U.S. Department of Energy's National Renewable Energy Laboratory (NREL) employees, uses 50% less energy than if it were built to current commercial code and achieves the U.S. Green Building Council's Leadership in Energy and Environmental Design (LEED{reg_sign}) Platinum rating. With 19% of the primary energy in the U.S. consumed by commercial buildings, the RSF is changing the way commercial office buildings are designed and built.

  13. Article 1: Supervision, Performance Assessment, and Recognition Strategy (SPARS) - a multipronged intervention strategy for strengthening medicines management in Uganda: method presentation and facility performance at baseline.

    Science.gov (United States)

    Trap, Birna; Ladwar, Denis Okidi; Oteba, Martin Olowo; Embrey, Martha; Khalid, Mohammed; Wagner, Anita Katharina

    2016-01-01

    Uganda introduced a multipronged intervention, the supervision, performance assessment, and recognition strategy (SPARS), to improve medicines management (MM) in public and not-for-profit health facilities. This paper, the first in a series, describes the SPARS intervention and reports on the MM situation in Uganda before SPARS (baseline). To build MM capacity at health facilities, health workers were trained as MM supervisors to visit health facilities, assess MM performance, and use the findings to provide support and standardize MM practices. Performance is assessed based on 25 MM indicators covering five domains: dispensing quality (7 indicators), prescribing quality (5), stock management (4), storage management (5) and ordering and reporting (4). From the end of 2010 to 2013, MM supervisors assessed baseline MM performance of 1384 government (85 %) and private not-for-profit facilities at all levels of care in about half of Uganda's districts. The overall MM baseline median score was 10.3 out of a maximum of 25 with inter-quartile range (IQR) of 8.7-11.7. Facility domain scores (out of a maximum of 5) were as follows: storage management, median score of 2.9 (IQR 2.3-3.4); stock management 2.3 (IQR 2.0-2.8), ordering and reporting 2.2 (IQR 1.3-2.5), and dispensing quality 2.1 (IQR 1.7-2.7). Performance in prescribing quality was 0.9 (IQR 0.4-1.4). Significant regional differences were found: overall scores were highest in the Northern region (10.7; IQR 9.2-12.4) and lowest in the Eastern region (9.6; (IQR 7.8-11.2) (p Assessing and building national capacity in MM is needed in both private not-for-profit and government facilities at all levels of care. The indicator-based, multipronged SPARS assessment has been described here, while the strategy's impact has yet to be documented.

  14. The Dutch Health Care Performance Report: seven years of health care performance assessment in the Netherlands.

    Science.gov (United States)

    van den Berg, Michael J; Kringos, Dionne S; Marks, Lisanne K; Klazinga, Niek S

    2014-01-09

    In 2006, the first edition of a monitoring tool for the performance of the Dutch health care system was released: the Dutch Health Care Performance Report (DHCPR). The Netherlands was among the first countries in the world developing such a comprehensive tool for reporting performance on quality, access, and affordability of health care. The tool contains 125 performance indicators; the choice for specific indicators resulted from a dialogue between researchers and policy makers. In the 'policy cycle', the DHCPR can rationally be placed between evaluation (accountability) and agenda-setting (for strategic decision making). In this paper, we reflect on important lessons learned after seven years of health care system performance assessment. These lessons entail the importance of a good conceptual framework for health system performance assessment, the importance of repeated measurement, the strength of combining multiple perspectives (e.g., patient, professional, objective, subjective) on the same issue, the importance of a central role for the patients' perspective in performance assessment, how to deal with the absence of data in relevant domains, the value of international benchmarking and the continuous exchange between researchers and policy makers.

  15. The emergence of care facilities in Thailand for older German-speaking people: structural backgrounds and facility operators as transnational actors.

    Science.gov (United States)

    Bender, Désirée; Hollstein, Tina; Schweppe, Cornelia

    2017-12-01

    This paper presents findings from an ethnographic study of old age care facilities for German-speaking people in Thailand. It analyses the conditions and processes behind the development and specific designs of such facilities. It first looks at the intertwinement, at the socio-structural level, of different transborder developments in which the facilities' emergence is embedded. Second, it analyses the processes that accompany the emergence, development and organisation of these facilities at the local level. In this regard, it points out the central role of the facility operators as transnational actors who mediate between different frames of reference and groups of actors involved in these facilities. It concludes that the processes of mediation and intertwining are an important and distinctive feature of the emergence of these facilities, necessitated by the fact that, although the facilities are located in Thailand, their 'markets' are in the German-speaking countries of their target groups.

  16. Effects of person-centered care on residents and staff in aged-care facilities: a systematic review

    Directory of Open Access Journals (Sweden)

    Brownie S

    2013-01-01

    Full Text Available Sonya Brownie, Susan NancarrowSchool of Health and Human Sciences, Southern Cross University, Lismore, NSW, AustraliaBackground: Several residential aged-care facilities have replaced the institutional model of care to one that accepts person-centered care as the guiding standard of practice. This culture change is impacting the provision of aged-care services around the world. This systematic review evaluates the evidence for an impact of person-centered interventions on aged-care residents and nursing staff.Methods: We searched Medline, Cinahl, Academic Search Premier, Scopus, Proquest, and Expanded Academic ASAP databases for studies published between January 1995 and October 2012, using subject headings and free-text search terms (in UK and US English spelling including person-centered care, patient-centered care, resident-oriented care, Eden Alternative, Green House model, Wellspring model, long-term care, and nursing homes.Results: The search identified 323 potentially relevant articles. Once duplicates were removed, 146 were screened for inclusion in this review; 21 were assessed for methodological quality, resulting in nine articles (seven studies that met our inclusion criteria. There was only one randomized, controlled trial. The majority of studies were quasi-experimental pre-post test designs, with a control group (n = 4. The studies in this review incorporated a range of different outcome measures (ie, dependent variables to evaluate the impact of person-centered interventions on aged-care residents and staff. One person-centered intervention, ie, the Eden Alternative, was associated with significant improvements in residents' levels of boredom and helplessness. In contrast, facility-specific person-centered interventions were found to impact nurses' sense of job satisfaction and their capacity to meet the individual needs of residents in a positive way. Two studies found that person-centered care was actually associated with an

  17. Effectiveness of professional oral health care intervention on the oral health of residents with dementia in residential aged care facilities: a systematic review protocol.

    Science.gov (United States)

    Yi Mohammadi, Joanna Jin; Franks, Kay; Hines, Sonia

    2015-10-01

    aged care facilities, with the model of care involving dental hygienists/oral health therapists having merit.The concept of professional oral care involves an oral health professional such as a dental hygienist or oral health therapist supervising or assisting residents with their oral care. Oral care involves the mechanical removal of plaque and food debris using a toothbrush, interproximal brush and floss.In 2014, Morino et al. explored the efficacy of short term professional oral care from dental hygienists once a week after breakfast for one month. In this study, the dental hygienists did not perform dental scaling but brushed subjects' teeth using a toothbrush and interdental brush. Dental plaque scores decreased significantly (Fisher's two-tailed tests, pconducted by Amerine et al. and utilized the dental hygienist as the "oral health champion" in the residential aged care facility using the Oral Health Assessment Tool (OHAT) and Geriatric Oral Health Assessment Index (GOHAI) scores to measure oral health. The results from this study showed improvements in three measured areas (tongue health, denture status and oral cleanliness) in the dental hygiene champion group. These findings suggest that the presence of a dental hygiene champion in long term care facilities may positively impact the oral health of residents requiring assistance with their oral care. However, the authors noted further research in this concept is required.Van Der Putten GJ et al. explored the effectiveness of a supervised implementation of an oral health care guideline in care homes. In each ward of the care homes, a nurse who acted as the ward oral health care organiser (WOO) was appointed. The dental hygienist and an investigator would attend the RACFs every six weeks to support them. The dental hygienist would train the WOO, and the WOO would train the ward nurses and nurse assistants. Participants were allocated into an intervention or a control group. The intervention group received

  18. Hypertension management in rural primary care facilities in Zambia: a mixed methods study.

    Science.gov (United States)

    Yan, Lily D; Chirwa, Cindy; Chi, Benjamin H; Bosomprah, Samuel; Sindano, Ntazana; Mwanza, Moses; Musatwe, Dennis; Mulenga, Mary; Chilengi, Roma

    2017-02-03

    Improved primary health care is needed in developing countries to effectively manage the growing burden of hypertension. Our objective was to evaluate hypertension management in Zambian rural primary care clinics using process and outcome indicators to assess the screening, monitoring, treatment and control of high blood pressure. Better Health Outcomes through Mentoring and Assessment (BHOMA) is a 5-year, randomized stepped-wedge trial of improved clinical service delivery underway in 46 rural Zambian clinics. Clinical data were collected as part of routine patient care from an electronic medical record system, and reviewed for site performance over time according to hypertension related indicators: screening (blood pressure measurement), management (recorded diagnosis, physical exam or urinalysis), treatment (on medication), and control. Quantitative data was used to develop guides for qualitative in-depth interviews, conducted with health care providers at a proportional sample of half (20) of clinics. Qualitative data was iteratively analyzed for thematic content. From January 2011 to December 2014, 318,380 visits to 46 primary care clinics by adults aged ≥ 25 years with blood pressure measurements were included. Blood pressure measurement at vital sign screening was initially high at 89.1% overall (range: 70.1-100%), but decreased to 62.1% (range: 0-100%) by 48 months after intervention start. The majority of hypertensive patients made only one visit to the clinics (57.8%). Out of 9022 patients with at least two visits with an elevated blood pressure, only 49.3% had a chart recorded hypertension diagnosis. Process indicators for monitoring hypertension were hypertension management included 1) equipment and personnel shortages, 2) provider belief that multiple visits were needed before official management, 3) medication stock-outs, leading to improper prescriptions and 4) poor patient visit attendance. Our findings suggest that numerous barriers stand

  19. An Old Challenge with New Promises: A Systematic Review on Comprehensive Geriatric Assessment in Long-Term Care Facilities.

    Science.gov (United States)

    Panza, Francesco; Solfrizzi, Vincenzo; Lozupone, Madia; Barulli, Maria Rosaria; D'Urso, Francesca; Stallone, Roberta; Dibello, Vittorio; Noia, Alessia; Di Dio, Cristina; Daniele, Antonio; Bellomo, Antonello; Seripa, Davide; Greco, Antonio; Logroscino, Giancarlo

    2017-07-28

    Comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary diagnostic process focused on determining the clinical profile, pathological risk, residual skills, short- and long-term prognosis, and personalized therapeutic and care plan of the functionally compromised and frail older subjects. Previous evidence suggested that the effectiveness of CGA programs may be influenced by settings where the CGA is performed [i.e., hospital, posthospital discharge/long-term care facilities (LTCFs), or community/home] as well as the specific clinical conditions of older frail individuals. In this scenario, CGA and quality of care in LTCFs have been a challenge for decades. In the present article, we systematically reviewed evidence from the last three decades of clinical research devoted to systematic implementation of CGA programs in LTCFs, that is, nursing homes, care homes, residential homes, and rehabilitation facilities. In the United States, all LTC residents must undergo a CGA on a regular basis on admission to a facility, prompting the development of the Resident Assessment Instrument (RAI) Minimum Data Set, a specific CGA-based assessment tool in this population. In the LTCF setting, the present reviewed evidence suggested that most complex older subjects may benefit from a CGA in terms of improved quality of care and reduced hospitalization events and that CGA must be standardized across healthcare settings to promote greater health system integration and coordination. In the LTCF setting, particularly in nursing homes, other new and promising CGA programs have also been proposed to develop rapid screening CGA-based tools to enhance in the future the ability of primary care physicians to recognize and treat geriatric syndromes in this setting. However, at present, the interRAI suite of instruments represented an integrated health information system that has the potential to provide person-centered information transcending healthcare settings.

  20. School Types, Facilities and Academic Performance of Students in Senior Secondary Schools in Ondo State, Nigeria

    Science.gov (United States)

    Alimi, Olatunji Sabitu; Ehinola, Gabriel Babatunde; Alabi, Festus Oluwole

    2012-01-01

    The study investigated the influence of school types and facilities on students' academic performance in Ondo State. It was designed to find out whether facilities and students' academic performance are related in private and public secondary schools respectively. Descriptive survey design was used. Proportionate random sampling technique was used…

  1. Health Care, Heal Thyself! An Exploration of What Drives (and Sustains) High Performance in Organizations Today

    Science.gov (United States)

    Wolf, Jason A.

    2008-01-01

    What happens when researching the radical unveils the simplest of solutions? This article tells the story of the 2007 ISPI Annual Conference Encore Presentation, Healthcare, Heal Thyself, sharing the findings of an exploration into high-performance health care facilities and their relevance to all organizations today. It shows how to overcome…

  2. Preventive dental care among Medicaid-enrolled senior adults: from community to nursing facility residence.

    Science.gov (United States)

    Kelly, Mary C; Caplan, Daniel J; Bern-Klug, Mercedes; Cowen, Howard J; Cunningham-Ford, Marsha A; Marchini, Leonardo; Momany, Elizabeth T

    2017-09-08

    The primary objective of this study was to determine whether the utilization rate of preventive oral health care services while senior adults were community-dwelling differed from the rate after those same senior adults were admitted to nursing facilities. A secondary objective was to evaluate other significant predictors of receipt of preventive oral health procedures after nursing facility entry. Iowa Medicaid claims from 2007-2014 were accessed for adults who were 68+ years upon entry to a nursing facility and continuously enrolled in Medicaid for at least three years before and at least two years after admission (n = 874). Univariate, bivariate and multivariable analyses were conducted. During the five years that subjects were followed, 52.8% never received a dental exam and 75.9% never received a dental hygiene procedure. More Medicaid-enrolled senior adults received ≥1 preventive dental procedure in the two years while residing in a nursing facility compared to the three years before entry. In multivariable analyses, the strongest predictor of preventive oral health care utilization after entry was the receipt of preventive oral health services before entry (p < 0.01). The strongest predictor of receipt of dental procedures in the two years after nursing facility entry was the receipt of dental procedures in the three years before entry while community-dwelling. This underscores the importance of the senior adult establishing a source of dental care while community-dwelling. © 2017 American Association of Public Health Dentistry.

  3. Preparedness of elderly long-term care facilities in HSE East for influenza outbreaks.

    LENUS (Irish Health Repository)

    O'Connor, L

    2015-01-01

    Abstract We assessed preparedness of HSE East elderly long-term care facilities for an influenza outbreak, and identified Public Health Department support needs. We surveyed 166 facilities based on the HSE checklist document for influenza outbreaks, with 58% response rate. Client flu vaccination rates were > 75%; leading barriers were client anxiety and consent issues. Target flu vaccine uptake of 40% in staff occurred in 43% of facilities and was associated with staff vaccine administration by afacility-attached GP (p = 0.035), having a facility outbreak plan (p = 0.013) and being anon-HSE run facility (p = 0.013). Leading barriers were staff personal anxiety (94%) and lack of awareness of the protective effect on clients (21%). Eighty-nine percent found Public Health helpful, and requested further educational support and advocacy. Staff vaccine uptake focus, organisational leadership, optimal vaccine provision models, outbreak plans and Public Health support are central to the influenza campaign in elderly long-term care facilities.

  4. Emergency care facility access in rural areas within the golden hour?: Western Cape case study.

    Science.gov (United States)

    Vanderschuren, Marianne; McKune, Duncan

    2015-01-16

    Road Safety is a major cause of death around the world and South Africa has one of the highest road fatality rates. Many measures, engineering and medical, are investigated. However, analysis of the accessibility of emergency care facilities is often overlooked. This paper aims to fill the gap between pre-crash engineering solutions and literature on trauma injuries and emergency care procedures. The focus is on the role that accessibility to emergency care facilities in rural areas plays, given that 50% of the world's population lives in rural areas, which are often omitted from international research. The Western Cape (a rural province with low population volumes and high volume roads in South Africa) is analysed as an example of access to trauma care in rural areas. It is internationally accepted that the time to emergency care facilities influences the survival chances. However, the international literature still debates the exact time period. In this paper, the 'Golden Hour' is used to analyse the accessibility of emergency care facilities in rural areas and establish a geographical analysis method which identifies risk areas. The analysis can be repeated if the international literature debates regarding the exact time period changes. A Geographical Information System (GIS) tool revealed that 53% of the fatalities in the rural parts of the Western Cape occur outside the Golden Hour. In high risk crash areas, the fatality risk is up to nine times higher than the province's rural average. People in need of trauma care after a road crash are most likely to survive if they receive definitive care timeously. At the time of the study, the rural areas in the Western Cape had 44 Emergency Medical Services stations and 29 medical facilities that can assist to provide definitive (trauma) care. Further optimisation of the facility locations is recommended and research has begun.More advanced geographical modelling is possible when improved data becomes available on the

  5. Antimicrobial susceptibility and molecular characteristics of methicillin-resistant Staphylococcus aureus in a Japanese secondary care facility.

    Science.gov (United States)

    Kimura, Yumiko; Morinaga, Yoshitomo; Akamatsu, Norihiko; Matsuda, Junichi; Yamaryo, Takeshi; Kawakami, Kenji; Matsuo, Hidenori; Kosai, Kosuke; Uno, Naoki; Hasegawa, Hiroo; Yanagihara, Katsunori

    2016-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is prevalent in Japan, and the Staphylococcus cassette chromosome mec (SCCmec) type II is common among hospital-acquired MRSA isolates. Information pertaining to MRSA characteristics is limited, including SCCmec types, in primary or secondary care facilities. A total of 128 MRSA isolates (90 skin and soft tissue isolates and 38 blood isolates) were collected at a secondary care facility, Kawatana Medical Center, from 2005 to 2011. Antimicrobial susceptibility testing for anti-MRSA antibiotics and molecular testing for SCCmec and virulence genes (tst, sec, etb, lukS/F-PV) were performed. Strains positive for lukS/F-PV were analyzed by multilocus sequence typing and phage open-reading frame typing. SCCmec typing in skin and soft tissue isolates revealed that 65.6% had type IV, 22.2% had type II, 8.9% had type I, and 3.3% had type III. In blood isolates, 50.0% had type IV, 47.4% had type II, and 2.6% had type III. Minimum inhibitory concentrations, MIC(50)/MIC(90), against vancomycin, teicoplanin, linezolid, and arbekacin increased slightly in SCCmec II isolates from skin and soft tissue. MICs against daptomycin were similar between sites of isolation. SCCmec type II isolates possess tst and sec genes at a greater frequently than SCCmec type IV isolates. Four lukS/F-PV-positive isolates were divided into two clonal patterns and USA300 was not included. In conclusion, SCCmec type IV was dominant in blood, skin, and soft tissue isolates in a secondary care facility in Japan. Because antimicrobial susceptibility varies with the SCCmec type, SCCmec typing of clinical isolates should be monitored in primary or secondary care facilities. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  6. An outbreak of norovirus infection in an Italian residential-care facility for the elderly.

    Science.gov (United States)

    Medici, M C; Morelli, A; Arcangeletti, M C; Calderaro, A; De Conto, F; Martinelli, M; Abelli, L A; Dettori, G; Chezzi, C

    2009-01-01

    On December 2006, an outbreak of gastroenteritis occurred at a residential-care facility for the elderly in northern Italy. Thirty-five of 61 individuals interviewed (attack rate, 57.4%) fell ill. In 94.3% of cases, the onset of illness was within 48 h of a Christmas party at the facility. Norovirus (NoV) was detected by RT-PCR in 24 of 31 individuals examined, including three asymptomatic food-handlers, in whom there was evidence of long-lasting excretion of viral particles. The identification of a sequence referring to the '2006a GII.4 NoV variant' in all examined strains supported the hypothesis of a common point source. This retrospective cohort study is the first report on an outbreak of NoV gastroenteritis in an Italian residential-care facility for the elderly.

  7. Factors influencing antibiotic prescribing in long-term care facilities: a qualitative in-depth study

    NARCIS (Netherlands)

    van Buul, L.W.; van der Steen, J.T.; Doncker, S.M.; Achterberg, W.P.; Schellevis, F.G.; Veenhuizen, R.B.; Hertogh, C.M.P.M.

    2014-01-01

    Background: Insight into factors that influence antibiotic prescribing is crucial when developing interventions aimed at a more rational use of antibiotics. We examined factors that influence antibiotic prescribing in long-term care facilities, and present a conceptual model that integrates these

  8. Malnutrition in the elderly residing in long-term care facilities: a cross ...

    African Journals Online (AJOL)

    Objectives: The objective of this study was to determine and compare the nutritional status of the elderly in two long-term care facilities - one situated in a ...... nursing home residents: the influence of nursing home environmental stressors, coping, and acceptance of group and individual therapy. Aging Ment Health. 2008 ...

  9. Drug use indicators at a secondary health care facility in Lagos ...

    African Journals Online (AJOL)

    Antibiotics were prescribed largely for presumed infections. Conclusion: These indicators show that the level of drug use at the hospital is sub-optimal and need to be improved upon. Key Words: Drug-use; Indicators; Secondary health facilities; Lagos Journal of Community Medicine & Primary Health Care Vol.16(1) 2004: ...

  10. [3D printing in health care facilities: What legislation in France?].

    Science.gov (United States)

    Montmartin, M; Meyer, C; Euvrard, E; Pazart, L; Weber, E; Benassarou, M

    2015-11-01

    Health care facilities more and more use 3D printing, including making their own medical devices (MDs). However, production and marketing of MDs are regulated. The goal of our work was to clarify what is the current French regulation that should be applied concerning the production of custom-made MDs produced by 3D printing in a health care facility. MDs consist of all devices used for diagnosis, prevention, or treatment of diseases in patients. Prototypes and anatomic models are not considered as MDs and no specific laws apply to them. Cutting guides, splints, osteosynthesis plates or prosthesis are MDs. In order to become a MD manufacturer in France, a health care facility has to follow the requirements of the 93/42/CEE directive. In addition, custom-made 3D-printed MDs must follow the annex VIII of the directive. This needs the writing of a declaration of conformity and the respect of the essential requirements (proving that a MD is secure and conform to what is expected), the procedure has to be qualified, a risk analysis and a control of the biocompatibility of the material have to be fulfilled. The documents proving that these rules have been respected have to be available. Becoming a regulatory manufacturer of MD in France is possible for a health care facility but the specifications have to be respected. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  11. Drug prescribing pattern in three levels of health care facilities in the ...

    African Journals Online (AJOL)

    This retrospective cross- sectional survey critically assessed the drug prescribing pattern of doctors at the three levels of health care facilities (HFs) in the North and Central senatorial districts of Edo State, Nigeria, and compares the findings with a similar study ... Thirty percent (30%) of hospitals was selected for the study.

  12. Insomnia, Sleepiness, and Depression in Adolescents Living in Residential Care Facilities

    Science.gov (United States)

    Moreau, Vincent; Belanger, Lynda; Begin, Gilles; Morin, Charles M.

    2009-01-01

    The main objective of this study was to document sleep patterns and disturbances reported by youths temporarily living in residential care facilities. A secondary objective was to examine the relationships between sleep disturbances and mood and daytime sleepiness. A self-reported questionnaire on sleep patterns and habits assessing duration,…

  13. Surveillance of antimicrobial use in Dutch long-term care facilities

    NARCIS (Netherlands)

    Roukens, M.M.; Verhoef, L.; Stobberingh, E.; Natsch, S.S.

    2017-01-01

    Objectives: : Residents living in a long-term care facility (LTCF) are more susceptible to infections. Treatment with antimicrobials is sometimes necessary; however, antibiotic use is considered one of the most important drivers of the development of antibiotic resistance. Surveillance data on

  14. Malnutrition in the elderly residing in long-term care facilities: a cross ...

    African Journals Online (AJOL)

    Objectives: The objective of this study was to determine and compare the nutritional status of the elderly in two long-term care facilities - one situated in a higher socio-economic area and one in a lower socio-economic area. Design: A cross-sectional study was undertaken. Setting: The study setting comprised two urban ...

  15. Well-being, the Decision making process in residential care facilities and accommodation in Denmark

    DEFF Research Database (Denmark)

    Knudstrup, Mary-Ann; Harder, Henrik

    making process. The research is commissioned and financed by the Danish National Board of Social Services conducted by CAST University of Southern Denmark in collaboration with the Institute for Architecture & Design at Aalborg University in Denmark. Granted with 1.07 million €. Results: 1. More research...... residential space and less space for public life in the residential care facilities and accommodation....

  16. Frontline staff motivation levels and health care quality in rural and urban primary health facilities: a baseline study in the Greater Accra and Western regions of Ghana.

    Science.gov (United States)

    Alhassan, Robert Kaba; Nketiah-Amponsah, Edward

    2016-12-01

    The population of Ghana is increasingly becoming urbanized with about 70 % of the estimated 26.9 million people living in urban and peri-urban areas. Nonetheless, eight out of the ten regions in Ghana remain predominantly rural where only 32.1 % of the national health sector workforce works. Doctor-patient ratio in a predominantly rural region is about 1:18,257 compared to 1:4,099 in an urban region. These rural-urban inequities significantly account for the inability of Ghana to attain the health related Millennium Development Goals (MDGs) before the end of 2015. To ascertain whether or not rural-urban differences exist in health worker motivation levels and quality of health care in health facilities accredited by the National Health Insurance Authority in Ghana. This is a baseline quantitative study conducted in 2012 among 324 health workers in 64 accredited clinics located in 9 rural and 7 urban districts in Ghana. Ordered logistic regression was performed to determine the relationship between facility geographic location (rural/urban) and staff motivation levels, and quality health care standards. Quality health care and patient safety standards were averagely low in the sampled health facilities. Even though health workers in rural facilities were more de-motivated by poor availability of resources and drugs than their counterparts in urban facilities (p health care and patient safety standards were relatively better in rural facilities. For Ghana to attain the newly formulated sustainable development goals on health, there is the need for health authorities to address the existing rural-urban imbalances in health worker motivation and quality health care standards in primary healthcare facilities. Future studies should compare staff motivation levels and quality standards in accredited and non-accredited health facilities since the current study was limited to health facilities accredited by the National Health Insurance Authority.

  17. [The effects of multimedia-assisted instruction on the skin care learning of nurse aides in long-term care facilities].

    Science.gov (United States)

    Wu, Yu-Ling; Kao, Yu-Hsiu

    2014-08-01

    Skin care is an important responsibility of nurse aides in long-term care facilities, and the nursing knowledge, attitudes, and skills of these aides significantly affects quality of care. However, the work schedule of nurse aides often limits their ability to obtain further education and training. Therefore, developing appropriate and effective training programs for nurse aides is critical to maintaining and improving quality of care in long-term care facilities. This study investigates the effects of multimedia assisted instruction on the skin care learning of nurse aides working in long-term care facilities. A quasi-experimental design and convenient sampling were adopted in this study. Participants included 96 nurse aides recruited from 5 long-term care facilities in Taoyuan County, Taiwan. The experimental group received 3 weeks of multimedia assisted instruction. The control group did not receive this instruction. The Skin Care Questionnaire for Nurse Aides in Long-term Care Facilities and the Skin Care Behavior Checklist were used for assessment before and after the intervention. (1) Posttest scores for skin care knowledge, attitudes, behavior, and the skin care checklist were significantly higher than pretest scores for the intervention group. There was no significant difference between pretest and posttest scores for the control group. (2) A covariance analysis of pretest scores for the two groups showed that the experimental group earned significantly higher average scores than their control group peers for skin care knowledge, attitudes, behavior, and the skin care checklist. The multimedia assisted instruction demonstrated significant and positive effects on the skin care leaning of nurse aides in long-term care facilities. This finding supports the use of multimedia assisted instruction in the education and training of nurse aides in long-term care facilities in the future.

  18. Relationship Status and Long-Term Care Facility Use in Later Life.

    Science.gov (United States)

    Thomeer, Mieke Beth; Mudrazija, Stipica; Angel, Jacqueline L

    2016-07-01

    Most older adults prefer to "age in place" and avoid formal long-term care. Yet demographic shifts, including population aging and an increasing prevalence of remarried and unmarried older adults, could undermine these goals, making it important to consider carefully how and why relationship status relates to long-term care risk. We fit hazard models to a sample of adults aged 65 and older from eight waves (1998-2012) of the Health and Retirement Study (N = 21,564). We consider risk of any long-term care facility admission, as well as risk of long-duration stays. Widowed, divorced, and never married adults have the highest risks of long-term care admission. Remarried and partnered adults have similar risks of long-term care admission as continuously married adults. Relationship status is more important for men than for women, especially when considering long-duration stays. Relationship status is also more significant for non-Hispanic White and Hispanic adults compared with non-Hispanic Black adults. Economic resources and, to some extent, social ties partially explain the association between relationship status and long-term care use. By addressing the prohibitive costs of long-term care services which enable aging in place (e.g., home health care), relationship status disparities in long-term care may be reduced. Future studies should consider the link between long-term care facility use and relationship status in future cohorts as well as examine how relationship status structures access to a range of long-term care options. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Hospice utilization in nursing homes: association with facility end-of-life care practices.

    Science.gov (United States)

    Zheng, Nan Tracy; Mukamel, Dana B; Caprio, Thomas V; Temkin-Greener, Helena

    2013-10-01

    Hospice care provided to nursing home (NH) residents has been shown to improve the quality of end-of-life (EOL) care. However, hospice utilization in NHs is typically low. This study examined the relationship between facility self-reported EOL practices and residents' hospice use and length of stay. The study was based on a retrospective cohort of NH residents. Medicare hospice claims, Minimum Data Set, Online Survey, Certification, and Reporting system and the Area Resource File were linked with a survey of directors of nursing (DON) regarding institutional EOL practice patterns (EOLC Survey). In total, 4,540 long-term-care residents who died in 2007 in 290 facilities which participated in the EOLC Survey were included in this study. We measured NHs' tendency to offer hospice to residents and to initiate aggressive treatments (hospital transfers and feeding tubes) for EOL residents based on DON's responses to survey items. Residents' hospice utilization was determined using Medicare hospice claims. The prevalence of hospice use was 18%. The average length of stay was 93 days. After controlling for individual risk factors, facilities' self-reported practice measures associated with residents' likelihood of using hospice were tendency to offer hospice (p = .048) and tendency to hospitalize (p = .002). Residents in NHs reporting higher tendency to hospitalize tended to enroll in hospice closer to death. Residents' hospice utilization is not only associated with individual and facility characteristics but also with NHs' self-reported EOL care practices. Potential interventions to effect greater use of hospice may need to focus on facility-level care processes and practices.

  20. Non-health care facility medication errors resulting in serious medical outcomes.

    Science.gov (United States)

    Hodges, Nichole L; Spiller, Henry A; Casavant, Marcel J; Chounthirath, Thiphalak; Smith, Gary A

    2018-01-01

    The objective of this study is to provide an epidemiologic analysis of medication errors occurring outside of health care facilities that result in serious medical outcomes (defined by the National Poison Database System as "moderate effect," "major effect," "death," or "death, indirect report"). National Poison Database System data from 2000 through 2012 were used for this retrospective analysis of non-health care facility medication errors. From 2000 through 2012, Poison Control Centers in the United States received data on 67,603 exposures related to unintentional therapeutic pharmaceutical errors that occurred outside of health care facilities that resulted in serious medical outcomes. The overall average rate of these medication errors was 1.73 per 100,000 population, and there was a 100.0% rate increase during the 13-year study period. Medication error frequency and rates increased for all age groups except children younger than 6 years of age. Medical outcome was most commonly reported as moderate effect (93.5%), followed by major effect (5.8%) and death (0.6%). Common types of medication errors included incorrect dose, taking or administering the wrong medication, and inadvertently taking the medication twice. The medication categories most frequently associated with serious outcomes were cardiovascular drugs (20.6%) (primarily beta blockers, calcium antagonists, and clonidine), analgesics (12.0%) (most often opioids and acetaminophen, alone and combination products), and hormones/hormone antagonists (11.0%) (in particular, insulin, and sulfonylurea). This study analyzed non-health care facility medication errors resulting in serious medical outcomes. The rate of non-health care facility medication errors resulting in serious medical outcomes is increasing, and additional efforts are needed to prevent these errors.

  1. Prevalence of type 2 diabetes mellitus in elderly in a primary care facility: An ideal facility

    Directory of Open Access Journals (Sweden)

    Archana Jain

    2013-01-01

    Full Text Available In 2011 census, 5.3% of the Indian population was > 65 years of age. This number has steadily grown over past few years and is steeply growing. Healthcare burden of elderly diabetics is immense and proper diagnosis and treatment alone can prevent further complications. According to the most recent surveillance data in U.S., the prevalence of diabetes among U.S. adults aged ≥65 years varies from 22 to 33%, depending on the diagnostic criteria used. In CSIR-NEERI, India, we have healthcare system wherein a fixed and limited number of patients are treated for their lifetime by qualified practitioners with negligible financial burden of the treatment costs. The patients have regular monthly follow up and hence we diagnose Diabetes and evaluate the control and diagnose micro vascular and macro vascular complications in all patients. We did retrospective analysis of all elderly patients following up in NEERI Hospital to find the exact prevalence of T2DM in elderly. It was observed that from total 585 elderly people, 178 had T2DM (30.42%- Prevalence.The sex ratio of Diabetic males to females was almost equal (1:0.97.Obesity was present in 114 people (64%.High prevalence of hypertension was found in Diabetic elderly population (80%. Comparing our prevalence rates with few other studies, it was found that our prevalence rates are quite high. The contributing factors may be urban living, with high prevalence of central obesity and Asian ethnicity, over and above, data of all patients undergoing treatment is available. We treated all diabetics with persistent values of Systolic BP > 130 mm of Hg and Diastolic values of BP > 80mm of Hg as Hypertensives, in order to achieve reduction in cardiovascular mortality and morbidity. This paper is for awareness of disease burden, in real primary care setup. It is not cross-sectional study but study with 100% inclusion of beneficiaries′. This is real world urban diabetes prevalence, also associated hypertension

  2. Quality of newborn care: a health facility assessment in rural Ghana using survey, vignette and surveillance data

    NARCIS (Netherlands)

    Vesel, Linda; Manu, Alexander; Lohela, Terhi J.; Gabrysch, Sabine; Okyere, Eunice; ten Asbroek, Augustinus H. A.; Hill, Zelee; Agyemang, Charlotte Tawiah; Owusu-Agyei, Seth; Kirkwood, Betty R.

    2013-01-01

    To assess the structural capacity for, and quality of, immediate and essential newborn care (ENC) in health facilities in rural Ghana, and to link this with demand for facility deliveries and admissions. Health facility assessment survey and population-based surveillance data. Seven districts in

  3. [The guideline Oral Health Care for dependent residents in long term care facilities, 2007: dire necessity!

    NARCIS (Netherlands)

    Putten, GJ van der; Visschere, L De; Obbergen, J. van; Schols, J.G.J.H.; Baat, C. de

    2008-01-01

    The oral health status of residents in Dutch nursing homes is rather poor, especially of those depending on caregivers for their oral health care. Moreover, when care dependency is rising, the provision of good oral health care becomes more difficult. With more elderly people still having (parts of)

  4. Nutrition screening for seniors in health care facilities: a survey of health professionals.

    Science.gov (United States)

    Villalon, Lita; Laporte, Manon; Carrier, Natalie

    2011-01-01

    Several studies show that malnutrition is prevalent in health care facilities, especially among elderly patients and nursing home residents. Although validated screening tools exist, little evidence exists on the feasibility of implementing nutrition screening in health care facilities. We examined New Brunswick health care professionals' perceptions of and practices involving nutrition screening in elderly clients, as well as barriers to screening. A survey was conducted with questionnaires intended for physicians, nurses, and dietitians. Participants were 457 health care professionals (physicians, 34.6%; nurses, 50.3%; dietitians, 15.1%). Perceptions of nutrition screening varied. For example, most nurses (94.7%) and dietitians (98.5%) indicated that screening was important/very important, while only 63.5% of physicians indicated this. Screening methods also differed among professionals and few used a screening tool. Several barriers to implementing nutrition screening were reported, such as lack of time, lack of professional resources, and clients' short stays. These findings will help professionals address the feasibility of implementing standardized screening tools in health care facilities. A more consistent and systematic approach for detecting populations at high nutritional risk may result.

  5. Performance assessment for a hypothetical low-level waste disposal facility

    Energy Technology Data Exchange (ETDEWEB)

    Smith, C.S.; Rohe, M.J.; Ritter, P.D. [and others

    1997-01-01

    Disposing of low-level waste (LLW) is a concern for many states throughout the United States. A common disposal method is below-grade concrete vaults. Performance assessment analyses make predictions of contaminant release, transport, ingestion, inhalation, or other routes of exposure, and the resulting doses for various disposal methods such as the below-grade concrete vaults. Numerous assumptions are required to simplify the processes associated with the disposal facility to make predictions feasible. In general, these assumptions are made conservatively so as to underestimate the performance of the facility. The objective of this report is to describe the methodology used in conducting a performance assessment for a hypothetical waste facility located in the northeastern United States using real data as much as possible. This report consists of the following: (a) a description of the disposal facility and site, (b) methods used to analyze performance of the facility, (c) the results of the analysis, and (d) the conclusions of this study.

  6. Hospitalization and Mortality Rates in Long-Term Care Facilities: Does For-Profit Status Matter?

    Science.gov (United States)

    Tanuseputro, Peter; Chalifoux, Mathieu; Bennett, Carol; Gruneir, Andrea; Bronskill, Susan E; Walker, Peter; Manuel, Douglas

    2015-10-01

    To establish if proprietary status (ie, for-profit or not-for-profit) is associated with mortality and hospitalizations among publicly funded long-term care (nursing) homes. We conducted a retrospective cohort study of new admissions in 640 publicly funded long-term care facilities in Ontario, Canada (384 for-profit, 256 not-for-profit). A population-based cohort of 53,739 incident admissions into long-term care facilities between January 1, 2010, and March 1, 2012, was observed. We measured adjusted rates of hospital admissions and mortality, per 1000 person-years (PY) of follow-up, among for-profit and not-for-profit facilities at 3, 6, and 12 months postadmission. Rates were measured postadmission and until discharge or death, whichever came first. One year after admission and before discharge, 11.7% of residents died and 25.7% had at least one hospitalization. After 12 months of follow-up, residents in for-profit facilities had a hospitalization rate of 462 per 1000 PY versus 358 per 1000 PY in not-for-profit facilities. During this period, the crude mortality rate in for-profit facilities was 208 per 1000 PY versus 185 per 1000 PY in not-for-profit facilities. At 3, 6, and 1 year after admission, for-profit facilities had an adjusted hazard ratio of 1.36 (95% confidence interval [CI] 1.28-1.43), 1.33 (95% CI 1.27-1.39), and 1.25 (95% CI 1.21-1.30) for hospitalizations and hazards of 1.20 (95% CI 1.11-1.29), 1.16 (95% CI 1.09-1.24), and 1.10 (95% CI 1.05-1.16) for mortality, respectively. Publicly funded for-profit facilities have significantly higher rates of both mortality and hospital admissions. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  7. Perspectives of older people living in long-term care facilities and of their family members toward advance care planning discussions: a systematic review and thematic synthesis

    Directory of Open Access Journals (Sweden)

    Mignani V

    2017-03-01

    Full Text Available Veronica Mignani,1 Francesca Ingravallo,1 Elena Mariani,2 Rabih Chattat2 1Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio, Bologna, Italy; 2Department of Psychology, University of Bologna, Viale Berti Pichat, Bologna, Italy Objective: We aimed to search and synthesize qualitative studies exploring the perspectives of older people living in long-term care facilities and of their family members about advance care planning (ACP discussions. Methods: The enhancing transparency in reporting the synthesis of qualitative research (ENTREQ framework was used to guide the review and report its results. PubMed, CINAHL, and PsycINFO were searched for studies published between January 2000 and November 2015. All included studies were assessed for comprehensiveness of reporting, and a thematic synthesis of their results was performed. Results: The nine included studies differed in terms of qualitative method used, comprehensiveness of reporting, and geographical origin. The thematic synthesis led to the identification of four main themes: 1 plans already made; 2 end-of-life care and decision-making; 3 opinions and attitudes toward ACP; and 4 how, when, about what, and with whom to do ACP. Conclusion: Despite their willingness to be involved in a shared decision-making process, older residents and their families still have little experience with ACP. Practical implications: In view of implementing ACP for elders living in long-term care facilities, it would be important to rethink ACP and also to incorporate their nonmedical preferences, according to their own priorities. Keywords: advance care planning, frail elderly, caregivers, residential facilities, qualitative research

  8. Violence towards health care workers in a Public Health Care Facility in Italy: a repeated cross-sectional study

    Directory of Open Access Journals (Sweden)

    Magnavita Nicola

    2012-05-01

    Full Text Available Abstract Background Violence at work is one of the major concerns in health care activities. The aim of this study was to identify the prevalence of physical and non-physical violence in a general health care facility in Italy and to assess the relationship between violence and psychosocial factors, thereby providing a basis for appropriate intervention. Methods All health care workers from a public health care facility were invited to complete a questionnaire containing questions on workplace violence. Three questionnaire-based cross-sectional surveys were conducted. The response rate was 75 % in 2005, 71 % in 2007, and 94 % in 2009. The 2009 questionnaire contained the VIF (Violent Incident Form for reporting violent incidents, the DCS (demand/control/support model for job strain, the Colquitt 20 item questionnaire for perceived organizational justice, and the GHQ-12 General Health Questionnaire for the assessment of mental health. Results One out of ten workers reported physical assault, and one out of three exposure to non-physical violence in the workplace in the previous year. Nurses and physicians were the most exposed occupational categories, whereas the psychiatric and emergency departments were the services at greatest risk of violence. Workers exposed to non-physical violence were subject to high job strain, low support, low perceived organizational justice, and high psychological distress. Conclusion Our study shows that health care workers in an Italian local health care facility are exposed to violence. Workplace violence was associated with high demand and psychological disorders, while job control, social support and organizational justice were protective factors.

  9. Reducing the treatment of asymptomatic bacteriuria in seniors in a long-term care facility.

    Science.gov (United States)

    Leduc, Andrée

    2014-10-01

    Cases of asymptomatic bacteriuria (ASB) in elderly people are often treated with antibiotics, but current guidelines recommend that bacteriuria in seniors not be treated unless it is associated with a urinary tract infection (UTI). Stanford Place Care Campus is a 182-bed complex-care facility in Parksville, B.C., catering primarily to seniors. To increase the accuracy of the clinical diagnosis of UTIs and reduce the treatment of ASB in this facility, the author developed a self-learning package and a clinical pathway to help nurses and other care providers better assess, manage and monitor residents with suspected UTIs. She also provided education sessions for the nursing and support staff. In the year after the new clinical pathway was introduced, the number of treated UTIs decreased, as did the percentage of treated UTIs that had been inadequately assessed (i.e., diagnosed solely on the basis of a dipstick urinalysis).

  10. Barriers to provision of dental care in long-term care facilities: the confrontation with ageing and death.

    Science.gov (United States)

    Nitschke, Ina; Ilgner, Alexander; Müller, Frauke

    2005-09-01

    The aim of the study was to reveal barriers to providing dental care for residents in long-term care (LTC) facilities. Participants were selected randomly from the dentist register in Berlin and Saxony, Germany. The sample consisted of 60 self-employed and 60 employed dentists, a further 60 dentists worked in their own dental practice but also part-time in an LTC facility. In semi-structured interviews a questionnaire with 36 statements concerning working conditions, administration and cost, insecurity concerning treatment decisions as well as confrontation with ageing and death was employed. Subsequently, the study participants were asked to rank the four dimensions concerning their impact on the decision against providing dental care in an LTC facility. The random sample was representative in age and gender for the dental register in Berlin and Saxony. Fifty-six per cent of the participants (63% of the men and 51% of the women; 52% of the self-employed, 60% of the employed and 56% of the consultant dentists) indicated unfavourable working conditions as biggest obstacle in providing dental care in an LTC-facility. Thirty-two per cent of participants rated administration and cost, 7% the insecurity in treatment decisions as major hindrance. Only 5% of the participants rated the confrontation with age and death as substantial barrier. There were no age and gender differences. Dentists in Berlin seemed more concerned about administration and cost of a consultancy activity and less secure in their therapy decisions than the colleagues from Saxony (p confrontation with ageing and death (not significant), employed dentist showed the least secure in their treatment decisions (p > 0.001). It can be concluded that the awareness of infra-structural and financial aspects in providing dental care in LTC facilities should be raised with health politicians and that these aspects should be considered when inaugurating or re-structuring the consultancy services to LTC facilities

  11. Our Lady of Lourdes Care Facility, Kilcummin Village, Killarney, Kerry.

    LENUS (Irish Health Repository)

    Thirion, P

    2001-03-02

    Two meta-analyses were conducted to quantify the benefit of combining alpha-IFN to 5FU in advanced colorectal cancer in terms of tumour response and survival. Analyses were based on a total of 3254 individual patient data provided by principal investigators of each trial. The meta-analysis of 5FU +\\/- LV vs. 5FU +\\/- LV + alpha-IFN combined 12 trials and 1766 patients. The meta-analysis failed to show any statistically significant difference between the two treatment groups in terms of tumour response or survival. Overall tumour response rates were 25% for patients receiving no alpha-IFN vs. 24% for patients receiving alpha-IFN (relative risk, RR = 1.02), and median survivals were 11.4 months for patients receiving no alpha-IFN vs. 11.5 months for patients receiving alpha-IFN (hazard ratio, HR = 0.95). The meta-analysis of 5FU + LV vs. 5FU + alpha-IFN combined 7 trials, and 1488 patients. This meta-analysis showed an advantage for 5FU + LV over 5FU + alpha-IFN which was statistically significant in terms of tumour response (23% vs. 18%; RR = 1.26;P = 0.042), and of a borderline significance for overall survival (HR = 1.11;P = 0.066). Metastases confined to the liver and primary rectal tumours were independent favourable prognostic factors for tumour response, whereas good performance status, metastases confined to the liver or confined to the lung, and primary tumour in the rectum were independent favourable prognostic factors for survival. We conclude that alpha-IFN does not increase the efficacy of 5FU or of 5FU + LV, and that 5FU + alpha-IFN is significantly inferior to 5FU + LV, for patients with advanced colorectal cancer.

  12. Perspectives of older people living in long-term care facilities and of their family members toward advance care planning discussions: a systematic review and thematic synthesis.

    Science.gov (United States)

    Mignani, Veronica; Ingravallo, Francesca; Mariani, Elena; Chattat, Rabih

    2017-01-01

    We aimed to search and synthesize qualitative studies exploring the perspectives of older people living in long-term care facilities and of their family members about advance care planning (ACP) discussions. The enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) framework was used to guide the review and report its results. PubMed, CINAHL, and PsycINFO were searched for studies published between January 2000 and November 2015. All included studies were assessed for comprehensiveness of reporting, and a thematic synthesis of their results was performed. The nine included studies differed in terms of qualitative method used, comprehensiveness of reporting, and geographical origin. The thematic synthesis led to the identification of four main themes: 1) plans already made; 2) end-of-life care and decision-making; 3) opinions and attitudes toward ACP; and 4) how, when, about what, and with whom to do ACP. Despite their willingness to be involved in a shared decision-making process, older residents and their families still have little experience with ACP. In view of implementing ACP for elders living in long-term care facilities, it would be important to rethink ACP and also to incorporate their nonmedical preferences, according to their own priorities.

  13. Implementation of 'Goals of Patient Care' medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial.

    Science.gov (United States)

    Martin, Ruth S; Hayes, Barbara J; Hutchinson, Anastasia; Yates, Paul; Lim, Wen Kwang

    2017-03-10

    Systematic reviews demonstrate that advance care planning (ACP) has many positive effects for residents of aged care facilities, including decreased hospitalisation. The proposed Residential Aged Care Facility (RACF) 'Goals of Patient Care' (GOPC) form incorporates a resident's prior advance care plan into medical treatment orders. Where none exists, it captures residents' preferences. This documentation helps guide healthcare decisions made at times of acute clinical deterioration. This is a mixed methods study. An unblinded cluster randomised controlled trial is proposed in three pairs of RACFs. In the intervention arm, GOPC forms will be completed by a doctor incorporating advance care plans or wishes. In the control arm, residents will have usual care which may include an advance care plan. The primary hypothesis is that the GOPC form is superior to standard ACP alone and will lead to decreased hospitalisation due to clearer documentation of residents' medical treatment plans. The primary outcome will be an analysis of the effect of the GOPC medical treatment orders on emergency department attendances and hospital admissions at 6 months. Secondary outcome measurements will include change in hospitalisation rates at 3 and 12 months, length of stay and external mortality rates among others. Qualitative interviews, 12 months post GOPC implementation, will be used for process evaluation of the GOPC and to evaluate staff perceptions of the form's usefulness for improving communication and medical decision-making at a time of deterioration. The results will be disseminated in peer review journals and research conferences. This robust randomised controlled trial will provide high-quality data about the influence of medical treatment orders that incorporate ACP or preferences adding to the current gap in knowledge and evidence in this area. ACTRN12615000298516, Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  14. Culturally Competent Palliative and Hospice Care Training for Ethnically Diverse Staff in Long-Term Care Facilities.

    Science.gov (United States)

    Kataoka-Yahiro, Merle R; McFarlane, Sandra; Koijane, Jeannette; Li, Dongmei

    2017-05-01

    Between 2013 and 2030, older adults 65 years and older of racial/ethnic populations in the U.S. is projected to increase by 123% in comparison to the Whites (Non-Hispanics). To meet this demand, training of ethnically diverse health staff in long-term care facilities in palliative and hospice care is imperative. The purpose of this study was to evaluate a palliative and hospice care training of staff in two nursing homes in Hawaii - (a) to evaluate knowledge and confidence over three time periods, and (b) to compare staff and family caregiver satisfaction at end of program. The educational frameworks were based on cultural and communication theories. Fifty-two ethnically diverse staff, a majority being Asian (89%), participated in a 10-week module training and one 4 hour communication skills workshop. Staff evaluation included knowledge and confidence surveys, pre- and post-test knowledge tests, and FAMCARE-2 satisfaction instrument. There were nine Asian (89%) and Pacific Islander (11%) family caregivers who completed the FAMCARE-2 satisfaction instrument. The overall staff knowledge and confidence results were promising. The staff rated overall satisfaction of palliative care services lower than the family caregivers. Implications for future research, practice, and education with palliative and hospice care training of ethnically diverse nursing home staff is to include patient and family caregiver satisfaction of palliative and hospice care services, evaluation of effectiveness of cross-cultural communication theories in palliative and hospice care staff training, and support from administration for mentorship and development of these services in long term care facilities.

  15. Effects of person-centered care on residents and staff in aged-care facilities: a systematic review.

    Science.gov (United States)

    Brownie, Sonya; Nancarrow, Susan

    2013-01-01

    Several residential aged-care facilities have replaced the institutional model of care to one that accepts person-centered care as the guiding standard of practice. This culture change is impacting the provision of aged-care services around the world. This systematic review evaluates the evidence for an impact of person-centered interventions on aged-care residents and nursing staff. We searched Medline, Cinahl, Academic Search Premier, Scopus, Proquest, and Expanded Academic ASAP databases for studies published between January 1995 and October 2012, using subject headings and free-text search terms (in UK and US English spelling) including person-centered care, patient-centered care, resident-oriented care, Eden Alternative, Green House model, Wellspring model, long-term care, and nursing homes. The search identified 323 potentially relevant articles. Once duplicates were removed, 146 were screened for inclusion in this review; 21 were assessed for methodological quality, resulting in nine articles (seven studies) that met our inclusion criteria. There was only one randomized, controlled trial. The majority of studies were quasi-experimental pre-post test designs, with a control group (n = 4). The studies in this review incorporated a range of different outcome measures (ie, dependent variables) to evaluate the impact of person-centered interventions on aged-care residents and staff. One person-centered intervention, ie, the Eden Alternative, was associated with significant improvements in residents' levels of boredom and helplessness. In contrast, facility-specific person-centered interventions were found to impact nurses' sense of job satisfaction and their capacity to meet the individual needs of residents in a positive way. Two studies found that person-centered care was actually associated with an increased risk of falls. The findings from this review need to be interpreted cautiously due to limitations in study designs and the potential for confounding bias

  16. Clinical audit of intra-partum care at secondary health facilities in Nigeria.

    Science.gov (United States)

    Osungbade, K O; Oginni, S A; Olumide, E A A; Owoaje, E T

    2010-06-01

    Intra-partum care has a significant influence on birth outcomes. Gap however exists between evidence and practice. This study documented pattern of intra-partum monitoring among birth attendants in public secondary healthcare facilities and related findings to quality of care provided. Intra-partum monitoring records of vaginal examination, fetal heart and blood pressure were reviewed. Research assistants extracted information and documented same in appropriate section of Safe Motherhood Needs Assessment forms. Monitoring records were categorized into optimal and sub-optimal care. Proportions were calculated for parturients who received either optimal or sub-optimal care. Chi-square test of statistics was used to explore differences. Level of significance was p labour progressed. Intra-partum care provided by birth attendants was generally sub-optimal and use of the monitoring records to influence birth outcome is doubtful. Improvement in record keeping practices and skills in intra-partum monitoring for decision making, are suggested.

  17. Job role quality and intention to leave current facility and to leave profession of direct care workers in Japanese residential facilities for elderly.

    Science.gov (United States)

    Nakanishi, Miharu; Imai, Hisato

    2012-01-01

    The aim of the present study is to examine job role quality relating to intention to leave current facility and to leave profession among direct care workers in residential facilities for elderly in Japan. Direct care workers completed a paper questionnaire on October 2009. From 746 facilities in three prefectures (Tokyo, Shizuoka, and Yamagata) 6428 direct care workers with complete data were included in the analyses. The Job Role Quality (JRQ) scale was translated into Japanese language to assess job role quality. Hierarchical multiple regression analysis showed that intention to leave current facility was primarily associated with job role quality: poor skill discretion, high job demand, and poor relationship with supervisor. Intention to leave profession was primarily associated with poor skill discretion. The results of the present study imply the strategies to direct care worker retention for each facility and policy efforts. Each facility can implement specific strategies such as enhanced variety of work and opportunity for use of skills, adequate job allocation, and improvement of supervisor-employee relationship in work place. Policy efforts should enhance broader career opportunities in care working such as advanced specialization and authorized medical practice. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  18. Public trust in health care : a performance indicator?

    NARCIS (Netherlands)

    Schee, Evelien van der; Groenewegen, Peter P.; Friele, Ronald D.

    2006-01-01

    Purpose – If public trust in health care is to be used as a performance indicator for health care systems, its measurement has to be sensitive to changes in the health care system. For this purpose, this study has monitored public trust in health care in The Netherlands over an eight-year period,

  19. An Examination of Care Practices of Pregnant Women Incarcerated in Jail Facilities in the United States.

    Science.gov (United States)

    Kelsey, C M; Medel, Nickole; Mullins, Carson; Dallaire, Danielle; Forestell, Catherine

    2017-06-01

    The number of incarcerated women in the United States has been steadily increasing over the last 30 years. An estimated 6-10% of these women are pregnant at intake. Previous studies on the health needs and care of pregnant incarcerated women have focused mainly on prison settings. Therefore, we examined the pregnancy-related accommodations and health care provided for regional jail populations. The present study is a quantitative survey (administered through phone or email to employees of predominately jail medical facilities) of common practices and policies employed across 53 jail facilities in the United States as a function of geographic region (North vs. South; West vs. Central vs. East). We examined provision of pregnancy screening, special diets, and drug rehabilitation and prohibition of shackling. Strikingly, across all aspects of the care of pregnant incarcerated women there are areas to be improved upon. Notably, only 37.7% of facilities pregnancy test all women upon entry, 45.7% put opioid addicted women through withdrawal protocol, and 56.7% of facilities use restraints on women hours after having a baby. In this first study to examine practices in regional jails nationwide, we found evidence that standards of care guidelines to improve health and well-being of pregnant incarcerated women, set by agencies such as American College of Obstetricians and Gynecologists, are not being followed in many facilities. Because not following these guidelines could pose major health risks to the mother and developing fetus, better policies, better enforcement of policies, and better common practices are needed to improve the health and welfare of pregnant incarcerated women.

  20. A revised approach to performance measurement for health-care estates.

    Science.gov (United States)

    May, Daryl; Price, Ilfryn

    2009-11-01

    The purpose of the research was to show how lean asset thinking can be applied to UK health-care facilities using different measures to compare the estates contribution to the business of health-care providers. The challenge to conventional wisdom matches that posed by 'Lean Production' to 'Mass Manufacturing'. Data envelope analysis examined the income generated and patient-occupied area as outputs from the gross area of a NHS Trust's estate. The approach yielded strategic comparisons that conventional facilities management measures of cost per square metre hide. The annual cost of an excess estate is conservatively estimated at pound 600,000,000 (in England alone). Further research to understand the causes of the excess is needed. Meanwhile the research illustrates the power of an alternative way of assessing facilities performance. The authors are not aware of the lean asset perspective previously being applied to health-care facilities. The research shows the underlying fallacy of relying on cost per square metre as the primary measure of asset performance. The results and discussion will be particularly useful to senior estates and facilities managers wishing to use new measures to define strategic estates targets.

  1. Comprehensive Medication Reviews in Long-term Care Facilities: History of Process Implementation and 2015 Results.

    Science.gov (United States)

    O'Shea, Terrence E; Zarowitz, Barbara J; Erwin, W Gary

    2017-01-01

    Since 2013, Part D sponsors have been required to offer comprehensive medication reviews (CMRs) to all beneficiaries enrolled in their medication therapy management (MTM) programs at least annually, including those in long-term care (LTC) settings. Since that time, MTM providers have found that accessing and completing CMRs with beneficiaries is frequently prohibitively complex, since the process often requires a live, face-to-face interactive interview where the beneficiary resides. However, with the migration of the CMR completion rate from a star ratings display measure to an active measure, coupled with the new CMR completion rate cutpoints for 2016, accessing this population for CMR completion has heightened importance. Our proprietary consultant pharmacist (CP) software was programmed in 2012 to produce a cover letter, medication action plan, and personal medication list per CMS standardized format specifications. Using this system, CPs were trained to perform and document CMRs and the interactive interviews. MTM-eligible Part D beneficiaries, identified by several contracted clients as residing in LTC serviced by Omnicare, were provided CMRs and summaries written in CMS standardized format by CPs. Residents with cognitive impairment were identified using 3 data elements in the Minimum Data Set (MDS). In 2015, 7,935 MTM-eligible beneficiaries were identified as receiving medications from an Omnicare pharmacy. After excluding those who were disenrolled by their prescription drug plans, discharged from the LTC facility, or resided in a LTC facility no longer serviced by Omnicare, 5,593 residents were available for CMR completion. Of these, only 3% refused the CMR offer, and 5,392 CMRs (96%) were completed successfully. Thirty-nine percent of residents had cognitive impairment per MDS assessments; in those instances, CMRs were conducted with someone other than the beneficiary. Based on the CMRs and interactive interviews, 7,527 drug therapy problem

  2. Newborn care practices at home and in health facilities in 4 regions of Ethiopia

    Science.gov (United States)

    2013-01-01

    Background Ethiopia is one of the ten countries with the highest number of neonatal deaths globally, and only 1 in 10 women deliver with a skilled attendant. Promotion of essential newborn care practices is one strategy for improving newborn health outcomes that can be delivered in communities as well as facilities. This article describes newborn care practices reported by recently-delivered women (RDWs) in four regions of Ethiopia. Methods We conducted a household survey with two-stage cluster sampling to assess newborn care practices among women who delivered a live baby in the period 1 to 7 months prior to data collection. Results The majority of women made one antenatal care (ANC) visit to a health facility, although less than half made four or more visits and women were most likely to deliver their babies at home. About one-fifth of RDWs in this survey had contact with Health Extension Workers (HEWS) during ANC, but nurse/midwives were the most common providers, and few women had postnatal contact with any health provider. Common beneficial newborn care practices included exclusive breastfeeding (87.6%), wrapping the baby before delivery of the placenta (82.3%), and dry cord care (65.2%). Practices contrary to WHO recommendations that were reported in this population of recent mothers include bathing during the first 24 hours of life (74.7%), application of butter and other substances to the cord (19.9%), and discarding of colostrum milk (44.5%). The results suggest that there are not large differences for most essential newborn care indicators between facility and home deliveries, with the exception of delayed bathing and skin-to-skin care. Conclusions Improving newborn care and newborn health outcomes in Ethiopia will likely require a multifaceted approach. Given low facility delivery rates, community-based promotion of preventive newborn care practices, which has been effective in other settings, is an important strategy. For this strategy to be

  3. Performance of simulated flexible integrated gasification polygeneration facilities. Part A: A technical-energetic assessment

    NARCIS (Netherlands)

    Meerman, J.C.; Ramírez Ramírez, C.A.; Turkenburg, W.C.; Faaij, A.P.C.

    2011-01-01

    This article investigates technical possibilities and performances of flexible integrated gasification polygeneration (IG-PG) facilities equipped with CO2 capture for the near future. These facilities can produce electricity during peak hours, while switching to the production of chemicals during

  4. Newfoundland and Labrador: 80/20 staffing model pilot in a long-term care facility.

    Science.gov (United States)

    Stuckless, Trudy; Power, Margaret

    2012-03-01

    This project, based in Newfoundland and Labrador's Central Regional Health Authority, is the first application of an 80/20 staffing model to a long-term care facility in Canada. The model allows nurse participants to spend 20% of their paid time pursuing a professional development activity instead of providing direct patient care. Newfoundland and Labrador has the highest aging demographic in Canada owing, in part, to the out-migration of younger adults. Recruiting and retaining nurses to work in long-term care in the province is difficult; at the same time, the increasing acuity of long-term care residents and their complex care needs mean that nurses must assume greater leadership roles in these facilities. This project set out to increase capacity for registered nurse (RN) leadership, training and support and to enhance the profile of long-term care as a place to work. Six RNs and one licensed practical nurse (LPN) participated and engaged in a range of professional development activities. Several of the participants are now pursuing further nursing educational activities. Central Health plans to continue a 90/10 model for one RN and one LPN per semester, with the timeframe to be determined. The model will be evaluated and, if it is deemed successful, the feasibility of implementing it in other sites throughout the region will be explored.

  5. Compliance with infection prevention and control in oral health-care facilities: a global perspective.

    Science.gov (United States)

    Oosthuysen, Jeanné; Potgieter, Elsa; Fossey, Annabel

    2014-12-01

    Many publications are available on the topic of compliance with infection prevention and control in oral health-care facilities all over the world. The approaches of developing and developed countries show wide variation, but the principles of infection prevention and control are the same globally. This study is a systematic review and global perspective of the available literature on infection prevention and control in oral health-care facilities. Nine focus areas on compliance with infection-control measures were investigated: knowledge of infectious occupational hazards; personal hygiene and care of hands; correct application of personal protective equipment; use of environmental barriers and disposable items; sterilisation (recirculation) of instruments and handpieces; disinfection (surfaces) and housekeeping; management of waste disposal; quality control of dental unit waterlines, biofilms and water; and some special considerations. Various international studies from developed countries have reported highly scientific evidence-based information. In developed countries, the resources for infection prevention and control are freely available, which is not the case in developing countries. The studies in developing countries also indicate serious shortcomings with regard to infection prevention and control knowledge and education in oral health-care facilities. This review highlights the fact that availability of resources will always be a challenge, but more so in developing countries. This presents unique challenges and the opportunity for innovative thinking to promote infection prevention and control. © 2014 FDI World Dental Federation.

  6. Post-Acute Care Facility as a Discharge Destination for Patients in Need of Palliative Care in Brazil.

    Science.gov (United States)

    Soares, Luiz Guilherme L; Japiassu, André M; Gomes, Lucia C; Pereira, Rogéria

    2018-02-01

    Patients with complex palliative care needs can experience delayed discharge, which causes an inappropriate occupancy of hospital beds. Post-acute care facilities (PACFs) have emerged as an alternative discharge destination for some of these patients. The aim of this study was to investigate the frequency of admissions and characteristics of palliative care patients discharged from hospitals to a PACF. We conducted a retrospective analysis of PACF admissions between 2014 and 2016 that were linked to hospital discharge reports and electronic health records, to gather information about hospital-to-PACF transitions. In total, 205 consecutive patients were discharged from 6 different hospitals to our PACF. Palliative care patients were involved in 32% (n = 67) of these discharges. The most common conditions were terminal cancer (n = 42, 63%), advanced dementia (n = 17, 25%), and stroke (n = 5, 8%). During acute hospital stays, patients with cancer had significant shorter lengths of stay (13 vs 99 days, P = .004), a lower use of intensive care services (2% vs 64%, P care. Further studies are necessary to understand the trajectory of posthospitalized patients with life-limiting illnesses and what factors influence their decision to choose a PACF as a discharge destination and place of death. We advocate that palliative care should be integrated into the portfolio of post-acute services.

  7. Joint Integration Test Facility (JITF) Engineering II Performance Measurement Plans

    National Research Council Canada - National Science Library

    Boucher, Joanne

    2001-01-01

    ..., effectiveness, and accountability in federal programs and spending. The plan establishes six separate performance measurements, which correlate directly to customer satisfaction, Intelligence Mission Application (IMA...

  8. Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda

    Directory of Open Access Journals (Sweden)

    Gertrude Namazzi

    2015-03-01

    Full Text Available Background: In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities. Objective: This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. Design: This health system strengthening study, part of the Uganda Newborn Study (UNEST, aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening. Results: Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with

  9. Experimental Breeder Reactor II (EBR-II) Fuel-Performance Test Facility (FPTF)

    Energy Technology Data Exchange (ETDEWEB)

    Pardini, J.A.; Brubaker, R.C.; Veith, D.J.; Giorgis, G.C.; Walker, D.E.; Seim, O.S.

    1982-01-01

    The Fuel-Performance Test Facility (FPTF) is the latest in a series of special EBR-II instrumented in-core test facilities. A flow control valve in the facility is programmed to vary the coolant flow, and thus the temperature, in an experimental-irradiation subassembly beneath it and coupled to it. In this way, thermal transients can be simulated in that subassembly without changing the temperatures in surrounding subassemblies. The FPTF also monitors sodium flow and temperature, and detects delayed neutrons in the sodium effluent from the experimental-irradiation subassembly beneath it. This facility also has an acoustical detector (high-temperature microphone) for detecting sodium boiling.

  10. Importance of employee vaccination against influenza in preventing cases in long-term care facilities.

    Science.gov (United States)

    Wendelboe, Aaron M; Avery, Catherine; Andrade, Bernardo; Baumbach, Joan; Landen, Michael G

    2011-10-01

    Employees of long-term care facilities (LTCFs) who have contact with residents should be vaccinated against influenza annually to reduce influenza incidence among residents. This investigation estimated the magnitude of the benefit of this recommendation. The New Mexico Department of Health implemented active surveillance in all of its 75 LTCFs during influenza seasons 2006-2007 and 2007-2008. Information about the number of laboratory-confirmed cases of influenza and the proportion vaccinated of both residents and direct-care employees in each facility was collected monthly. LTCFs reporting at least 1 case of influenza (defined alternately by laboratory confirmation or symptoms of influenza-like illness [ILI]) among residents were compared with LTCFs reporting no cases of influenza. Regression modeling was used to obtain adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the association between employee vaccination coverage and the occurrence of influenza outbreaks. Covariates included vaccination coverage among residents, the staff-to-resident ratio, and the proportion of filled beds. Seventeen influenza outbreaks were reported during this 2-year period of surveillance. Eleven of these were laboratory confirmed (n = 21 residents) and 6 were defined by ILI (n = 40 residents). Mean influenza vaccination coverage among direct-care employees was 51% in facilities reporting outbreaks and 60% in facilities not reporting outbreaks (P = .12). Increased vaccination coverage among direct-care employees was associated with fewer reported outbreaks of laboratory-confirmed influenza (aOR, 0.97 [95% CI, 0.95-0.99]) and ILI (aOR, 0.98 [95% CI, 0.96-1.00]). High vaccination coverage among direct-care employees helps to prevent influenza in LTCFs.

  11. How best practices are copied, transferred, or translated between health care facilities: A conceptual framework.

    Science.gov (United States)

    Guzman, Gustavo; Fitzgerald, Janna Anneke; Fulop, Liz; Hayes, Kathryn; Poropat, Arthur; Avery, Mark; Campbell, Steve; Fisher, Ron; Gapp, Rod; Herington, Carmel; McPhail, Ruth; Vecchio, Nerina

    2015-01-01

    In spite of significant investment in quality programs and activities, there is a persistent struggle to achieve quality outcomes and performance improvements within the constraints and support of sociopolitical parsimonies. Equally, such constraints have intensified the need to better understand the best practice methods for achieving quality improvements in health care organizations over time.This study proposes a conceptual framework to assist with strategies for the copying, transferring, and/or translation of best practice between different health care facilities. Applying a deductive logic, the conceptual framework was developed by blending selected theoretical lenses drawn from the knowledge management and organizational learning literatures. The proposed framework highlighted that (a) major constraints need to be addressed to turn best practices into everyday practices and (b) double-loop learning is an adequate learning mode to copy and to transfer best practices and deuteron learning mode is a more suitable learning mode for translating best practice. We also found that, in complex organizations, copying, transferring, and translating new knowledge is more difficult than in smaller, less complex organizations. We also posit that knowledge translation cannot happen without transfer and copy, and transfer cannot happen without copy of best practices. Hence, an integration of all three learning processes is required for knowledge translation (copy best practice-transfer knowledge about best practice-translation of best practice into new context). In addition, the higher the level of complexity of the organization, the more best practice is tacit oriented and, in this case, the higher the level of K&L capabilities are required to successfully copy, transfer, and/or translate best practices between organizations. The approach provides a framework for assessing organizational context and capabilities to guide copy/transfer/translation of best practices. A

  12. Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South AfricaExperiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa

    Directory of Open Access Journals (Sweden)

    Dudu G. Sokhela

    2013-07-01

    Full Text Available Background: Comprehensive Primary Health Care (PHC, based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans.Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients’ experiences led to satisfaction or dissatisfaction with the Fast Queue service.Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed.Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources

  13. Facility Delivery, Postnatal Care and Neonatal Deaths in India: Nationally-Representative Case-Control Studies

    Science.gov (United States)

    Fadel, Shaza A.; Ram, Usha; Morris, Shaun K.; Begum, Rehana; Shet, Anita; Jotkar, Raju; Jha, Prabhat

    2015-01-01

    Objective Clinical studies demonstrate the efficacy of interventions to reduce neonatal deaths, but there are fewer studies of their real-life effectiveness. In India, women often seek facility delivery after complications arise, rather than to avoid complications. Our objective was to quantify the association of facility delivery and postnatal checkups with neonatal mortality while examining the “reverse causality” in which the mothers deliver at a health facility due to adverse perinatal events. Methods We conducted nationally representative case-control studies of about 300,000 live births and 4,000 neonatal deaths to examine the effect of, place of delivery and postnatal checkup on neonatal mortality. We compared neonatal deaths to all live births and to a subset of live births reporting excessive bleeding or obstructed labour that were more comparable to cases in seeking care. Findings In the larger study of 2004–8 births, facility delivery without postnatal checkup was associated with an increased odds of neonatal death (Odds ratio = 2.5; 99% CI 2.2–2.9), especially for early versus late neonatal deaths. However, use of more comparable controls showed marked attenuation (Odds ratio = 0.5; 0.4–0.5). Facility delivery with postnatal checkup was associated with reduced odds of neonatal death. Excess risks were attenuated in the earlier study of 2001–4 births. Conclusion The combined effect of facility deliveries with postnatal checks ups is substantially higher than just facility delivery alone. Evaluation of the real-life effectiveness of interventions to reduce child and maternal deaths need to consider reverse causality. If these associations are causal, facility delivery with postnatal check up could avoid about 1/3 of all neonatal deaths in India (~100,000/year). PMID:26479476

  14. Health Care Expenditures After Initiating Long-term Services and Supports in the Community Versus in a Nursing Facility.

    Science.gov (United States)

    Newcomer, Robert J; Ko, Michelle; Kang, Taewoon; Harrington, Charlene; Hulett, Denis; Bindman, Andrew B

    2016-03-01

    Individuals who receive long-term services and supports (LTSS) are among the most costly participants in the Medicare and Medicaid programs. To compare health care expenditures among users of Medicaid home and community-based services (HCBS) versus those using extended nursing facility care. Retrospective cohort analysis of California dually eligible adult Medicaid and Medicare beneficiaries who initiated Medicaid LTSS, identified as HCBS or extended nursing facility care, in 2006 or 2007. Propensity score matching for demographic, health, and functional characteristics resulted in a subsample of 34,660 users who initiated Medicaid HCBS versus extended nursing facility use. Those with developmental disabilities or in managed care plans were excluded. Average monthly adjusted acute, postacute, long-term, and total Medicare and Medicaid expenditures for the 12 months following initiation of either HCBS or extended nursing facility care. Those initiating extended nursing facility care had, on average, $2919 higher adjusted total health care expenditures per month compared with those who initiated HCBS. The difference was primarily attributable to spending on LTSS $2855. On average, the monthly LTSS expenditures were higher for Medicare $1501 and for Medicaid $1344 when LTSS was provided in a nursing facility rather than in the community. The higher cost of delivering LTSS in a nursing facility rather than in the community was not offset by lower acute and postacute spending. Medicare and Medicaid contribute similar amounts to the LTSS cost difference and both could benefit financially by redirecting care from institutions to the community.

  15. Carbapenem-resistant Escherichia coli harboring Klebsiella pneumoniae carbapenemase beta-lactamases associated with long-term care facilities.

    Science.gov (United States)

    Urban, Carl; Bradford, Patricia A; Tuckman, Margareta; Segal-Maurer, Sorana; Wehbeh, Wehbeh; Grenner, Louise; Colon-Urban, Rita; Mariano, Noriel; Rahal, James J

    2008-06-01

    Nine carbapenem-resistant Escherichia coli isolates harboring Klebsiella pneumoniae carbapenemase (KPC)-2 or KPC-3 enzymes were identified in patients residing in 7 distinct long-term care facilities. Cefotaxime-hydrolyzing (CTX-M)-type beta-lactamases were also documented in 3 isolates. The identification of these enzymes in patients staying in long-term care facilities should be of great concern to all components of health care systems.

  16. Development of a Risk-adjustment Model for the Inpatient Rehabilitation Facility Discharge Self-care Functional Status Quality Measure.

    Science.gov (United States)

    Deutsch, Anne; Pardasaney, Poonam; Iriondo-Perez, Jeniffer; Ingber, Melvin J; Porter, Kristie A; McMullen, Tara

    2017-07-01

    Functional status measures are important patient-centered indicators of inpatient rehabilitation facility (IRF) quality of care. We developed a risk-adjusted self-care functional status measure for the IRF Quality Reporting Program. This paper describes the development and performance of the measure's risk-adjustment model. Our sample included IRF Medicare fee-for-service patients from the Centers for Medicare & Medicaid Services' 2008-2010 Post-Acute Care Payment Reform Demonstration. Data sources included the Continuity Assessment Record and Evaluation Item Set, IRF-Patient Assessment Instrument, and Medicare claims. Self-care scores were based on 7 Continuity Assessment Record and Evaluation items. The model was developed using discharge self-care score as the dependent variable, and generalized linear modeling with generalized estimation equation to account for patient characteristics and clustering within IRFs. Patient demographics, clinical characteristics at IRF admission, and clinical characteristics related to the recent hospitalization were tested as risk adjusters. A total of 4769 patient stays from 38 IRFs were included. Approximately 57% of the sample was female; 38.4%, 75-84 years; and 31.0%, 65-74 years. The final model, containing 77 risk adjusters, explained 53.7% of variance in discharge self-care scores (P<0.0001). Admission self-care function was the strongest predictor, followed by admission cognitive function and IRF primary diagnosis group. The range of expected and observed scores overlapped very well, with little bias across the range of predicted self-care functioning. Our risk-adjustment model demonstrated strong validity for predicting discharge self-care scores. Although the model needs validation with national data, it represents an important first step in evaluation of IRF functional outcomes.

  17. EURO-CARES: European Roadmap for a Sample Return Curation Facility and Planetary Protection Implications.

    Science.gov (United States)

    Brucato, John Robert

    2016-07-01

    A mature European planetary exploration program and evolving sample return mission plans gathers the interest of a wider scientific community. The interest is generated from studying extraterrestrial samples in the laborato-ry providing new opportunities to address fundamental issues on the origin and evolution of the Solar System, on the primordial cosmochemistry, and on the nature of the building blocks of terrestrial planets and on the origin of life. Major space agencies are currently planning for missions that will collect samples from a variety of Solar Sys-tem environments, from primitive (carbonaceous) small bodies, from the Moon, Mars and its moons and, final-ly, from icy moons of the outer planets. A dedicated sample return curation facility is seen as an essential re-quirement for the receiving, assessment, characterization and secure preservation of the collected extraterrestrial samples and potentially their safe distribution to the scientific community. EURO-CARES is a European Commission study funded under the Horizon-2020 program. The strategic objec-tive of EURO-CARES is to create a roadmap for the implementation of a European Extraterrestrial Sample Cu-ration Facility. The facility has to provide safe storage and handling of extraterrestrial samples and has to enable the preliminary characterization in order to achieve the required effectiveness and collaborative outcomes for the whole international scientific community. For example, samples returned from Mars could pose a threat on the Earth's biosphere if any living extraterrestrial organism are present in the samples. Thus planetary protection is an essential aspect of all Mars sample return missions that will affect the retrival and transport from the point of return, sample handling, infrastructure methodology and management of a future curation facility. Analysis of the state of the art of Planetary Protection technology shows there are considerable possibilities to define and develop

  18. Cost of delivering health care services at primary health facilities in Ghana.

    Science.gov (United States)

    Dalaba, Maxwell Ayindenaba; Welaga, Paul; Matsubara, Chieko

    2017-11-17

    There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs) and Community-based Health Planning and Services (CHPS) in Ghana. The study was cross-sectional and quantitative data was collected from the health provider perspective. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs) from the Upper West region of Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Data were captured and analysed using Microsoft excel. Costs of delivery health services were estimated. In addition, unit costs such as cost per Outpatient Department (OPD) attendance were estimated. The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC). The cost per OPD attendance was higher at CHPS (US$8.79) than at HCs (US$5.16). The average Internally Generated Funds (IGF) recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. At all the facilities, IGFs were greatly lower than costs of running the health facilities. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS) reimbursement was the main source of revenue accounting for over 90% total IGF. The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. However, more similar studies involving large numbers of primary health facilities in

  19. Cost of delivering health care services at primary health facilities in Ghana

    Directory of Open Access Journals (Sweden)

    Maxwell Ayindenaba Dalaba

    2017-11-01

    Full Text Available Abstract Background There is limited knowledge on the cost of delivering health services at primary health care facilities in Ghana which is posing a challenge in resource allocations. This study therefore estimated the cost of providing health care in primary health care facilities such as Health Centres (HCs and Community-based Health Planning and Services (CHPS in Ghana. Methods The study was cross-sectional and quantitative data was collected from the health provider perspective. Data was collected between July and August, 2016 at nine primary health facilities (six CHPS and three HCs from the Upper West region of Ghana. All health related costs for the year 2015 and revenue generated for the period were collected. Data were captured and analysed using Microsoft excel. Costs of delivery health services were estimated. In addition, unit costs such as cost per Outpatient Department (OPD attendance were estimated. Results The average annual cost of delivering health services through CHPS and HCs was US$10,923 and US$44,638 respectively. Personnel cost accounted for the largest proportion of cost (61% for CHPS and 59% for HC. The cost per OPD attendance was higher at CHPS (US$8.79 than at HCs (US$5.16. The average Internally Generated Funds (IGF recorded for the period at CHPS and HCs were US$2327 and US$ 15,795 respectively. At all the facilities, IGFs were greatly lower than costs of running the health facilities. Also, at both the CHPS and HCs, the National Health Insurance Scheme (NHIS reimbursement was the main source of revenue accounting for over 90% total IGF. Conclusions The average annual cost of delivering primary health services through CHPS and HCs is US$10,923 and US$44,638 respectively and personnel cost accounts for the major cost. The government should be guided by these findings in their financial planning, decision making and resource allocation in order to improve primary health care in the country. However, more similar

  20. Influenza and pneumococcal vaccination in long term care facilities in two regions of Quebec

    Science.gov (United States)

    De Wals, Philippe; Carbonneau, Michel; Payette, Hélène; Niyonsenga, Théophile

    1996-01-01

    OBJECTIVES: To evaluate the use of influenza and pneumococcal vaccines in long term care facilities. DESIGN: Cross-sectional survey in a random sample of 30 facilities in two regions of Quebec. Information was collected from the general manager or the chief of nursing, all consultant physicians and a random sample of 20 residents in each facility. RESULTS: Twenty-nine centres agreed to participate. The mean influenza vaccination rate was 70%, and was not influenced by differences in the types of facilities or the organization of the programs for immunization. The main obstacle to influenza vaccination reported by physicians was nonacceptance by a significant proportion of residents. Of the residents who did not initially request influenza vaccine, only 64% accepted vaccination when it was offered. The vast majority of residents were satisfied with the information they had received and the respect shown for their freedom of choice. Forty per cent of residents were unfit to provide a valid consent and the vaccination rate was 76% in this group. Only one-third of the physicians regularly obtained authorization from a relative or the legal guardian before prescribing vaccination for incompetent residents. None of the facilities studied had an effective program for pneumococcal vaccination, only 43% of the physicians reported any use of pneumococcal vaccine and 98% of residents had never heard of the vaccine. CONCLUSIONS: The national objective of 95% coverage with influenza vaccine will be difficult to achieve in long term care facilities, mainly because a minority of residents are not likely to be convinced of the benefit of immunization. Much remains to be done to promote and administer pneumococcal vaccine in this setting. PMID:22514453

  1. Fluoroquinolone-resistant Escherichia coli carriage in long-term care facility.

    Science.gov (United States)

    Maslow, Joel N; Lee, Betsy; Lautenbach, Ebbing

    2005-06-01

    We conducted a cross-sectional study to determine the prevalence of, and risk factors for, colonization with fluoroquinolone (FQ)-resistant Escherichia coli in residents in a long-term care facility. FQ-resistant E. coli were identified from rectal swabs for 25 (51%) of 49 participants at study entry. On multivariable analyses, prior FQ use was the only independent risk factor for FQ-resistant E. coli carriage and was consistent for FQ exposures in the previous 3, 6, 9, or 12 months. Pulsed-field gel electrophoresis of FQ-resistant E. coli identified clonal spread of 1 strain among 16 residents. Loss (6 residents) or acquisition (7 residents) of FQ-resistant E. coli was documented and was associated with de novo colonization with genetically distinct strains. Unlike the case in the hospital setting, FQ-resistant E. coli carriage in long-term care facilities is associated with clonal spread.

  2. A collaborative assessment of workload and patient care needs in four rehabilitation facilities.

    Science.gov (United States)

    Flynn, E; Heinzer, M M; Radwanski, M

    1999-01-01

    This article describes the process used by nurse executives at four freestanding rehabilitation facilities to implement and validate an interactive patient classification system. The research process involved defining critical indicators, measuring workloads by level of staff, and validating the number of care hours for the levels of patient classification. The database enabled the four consortium members to share their knowledge, resources, and costs of implementing a patient classification system, and it provides a benchmark of rehabilitation services. The study data are being used in making staffing decisions, preparing and defending budgets, and identifying the cost of care by disability classification.

  3. Distribution of radon concentrations in child-care facilities in South Korea.

    Science.gov (United States)

    Lee, Cheol-Min; Kwon, Myung-Hee; Kang, Dae-Ryong; Park, Tae-Hyun; Park, Si-Hyun; Kwak, Jung-Eun

    2017-02-01

    This study was conducted to provide fundamental data on the distribution of radon concentrations in child day-care facilities in South Korea and to help establish radon mitigation strategies. For this study, 230 child-care centers were randomly chosen from all child-care centers nationwide, and alpha track detectors were used to examine cumulative radon exposure concentrations from January to May 2015. The mean radon concentration measured in Korean child-care centers is approximately 52 Bq m(-3), about one-third of the upper limit of 148 Bq m(-3), which is recommended by South Korea's Indoor Air Quality Control in Public Use Facilities, etc. Act and the U.S. Environmental Protection Agency (EPA). Furthermore, this concentration is about 50% lower than 102 Bq m(-3), which is the measured concentration of radon in houses nationwide from December 2013 to February 2014. Our results indicate that the amount of ventilation, as a major determining factor for indoor radon concentrations, is strongly correlated with the fluctuation of indoor radon concentrations in Korean child-care centers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Part 1: Evidence-based facility design using Transforming Care at the Bedside principles.

    Science.gov (United States)

    Devine, Deborah A; Wenger, Barb; Krugman, Mary; Zwink, Jennifer E; Shiskowsky, Kaycee; Hagman, Jan; Limon, Shelly; Sanders, Carolyn; Reeves, Catherine

    2015-02-01

    An academic hospital used Transforming Care at the Bedside (TCAB) principles as the framework for generating evidence-based recommendations for the design of an expansion of the current hospital. The interdisciplinary team used the table of evidence-based data to advocate for a patient- and family-centered, safe, and positive work environment. A nurse project manager acted as liaison between the TCAB design team, architects, and facilities and design consultants. Part 2 of this series describes project evaluation outcomes.

  5. Distribution of Trauma Care Facilities in Oman in Relation to High-Incidence Road Traffic Injury Sites: Pilot study

    Directory of Open Access Journals (Sweden)

    Sara M. Al-Kindi

    2018-01-01

    Full Text Available Objectives: Road traffic injuries (RTIs are considered a major public health problem worldwide. In Oman, high numbers of RTIs and RTI-related deaths are frequently registered. This study aimed to evaluate the distribution of trauma care facilities in Oman with regards to their proximity to RTI-prevalent areas. Methods: This descriptive pilot study analysed RTI data recorded in the national Royal Oman Police registry from January to December 2014. The distribution of trauma care facilities was analysed by calculating distances between areas of peak RTI incidence and the closest trauma centre using Google Earth and Google Maps software (Google Inc., Googleplex, Mountain View, California, USA. Results: A total of 32 trauma care facilities were identified. Four facilities (12.5% were categorised as class V trauma centres. Of the facilities in Muscat, 42.9% were ranked as class IV or V. There were no class IV or V facilities in Musandam, Al-Wusta or Al-Buraimi. General surgery, orthopaedic surgery and neurosurgery services were available in 68.8%, 59.3% and 12.5% of the centres, respectively. Emergency services were available in 75.0% of the facilities. Intensive care units were available in 11 facilities, with four located in Muscat. The mean distance between a RTI hotspot and the nearest trauma care facility was 34.7 km; however, the mean distance to the nearest class IV or V facility was 83.3 km. Conclusion: The distribution and quality of trauma care facilities in Oman needs modification. It is recommended that certain centres upgrade their levels of trauma care in order to reduce RTI-associated morbidity and mortality in Oman.

  6. Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa

    Directory of Open Access Journals (Sweden)

    Dudu G. Sokhela

    2013-01-01

    Full Text Available Background: Comprehensive Primary Health Care (PHC, based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients’ experiences led to satisfaction or dissatisfaction with the Fast Queue service.Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed.Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources

  7. Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa.

    Science.gov (United States)

    Sokhela, Dudu G; Makhanya, Nonhlanhla J; Sibiya, Nokuthula M; Nokes, Kathleen M

    2013-07-05

    Comprehensive Primary Health Care (PHC), based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients' experiences led to satisfaction or dissatisfaction with the Fast Queue service. A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed. Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources. Effective health communication strategies contribute to positive

  8. The gap in human resources to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico.

    Science.gov (United States)

    Alcalde-Rabanal, Jacqueline Elizabeth; Nigenda, Gustavo; Bärnighausen, Till; Velasco-Mondragón, Héctor Eduardo; Darney, Blair Grant

    2017-08-03

    The purpose of this study was to estimate the gap between the available and the ideal supply of human resources (physicians, nurses, and health promoters) to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico. We conducted a cross-sectional observational study using a convenience sample. We selected 20 primary health facilities in urban and rural areas in 10 states of Mexico. We calculated the available and the ideal supply of human resources in these facilities using estimates of time available, used, and required to deliver health prevention and promotion services. We performed descriptive statistics and bivariate hypothesis testing using Wilcoxon and Friedman tests. Finally, we conducted a sensitivity analysis to test whether the non-normal distribution of our time variables biased estimation of available and ideal supply of human resources. The comparison between available and ideal supply for urban and rural primary health care facilities reveals a low supply of physicians. On average, primary health care facilities are lacking five physicians when they were estimated with time used and nine if they were estimated with time required (P human resources in primary health facilities.

  9. Staff attitudes and reactions towards residents' masturbation in Spanish long-term care facilities.

    Science.gov (United States)

    Villar, Feliciano; Serrat, Rodrigo; Celdrán, Montserrat; Fabà, Josep

    2016-03-01

    To explore staff attitudes and reactions towards masturbation in long-term care facilities. Staff attitudes and reactions towards the expression of sexuality in long-term care facilities may be influenced by the nature of the sexual behaviour being expressed. Staff attitudes towards masturbation, a common sexual behaviour in such settings, have gone largely unexplored so far. An exploratory, descriptive, qualitative research design. Fifty-three staff members working in five different long-term care facilities participated in the study. They were asked about what they would think, how they would react, and what possible reactions they might expect from workmates if they entered a room and found a resident masturbating. The majority of participants considered that masturbation was acceptable and avoiding interference was by far the most common reaction, although other reactions also arose. When asked about reactions attributed to workmates, mentions to reprimanding the resident and gossiping/joking about the issue were more frequent than acceptance. The discrepancy between professionals' own reported attitudes and those attributed to workmates suggests the existence of widespread negative reactions towards sexual activity in later life. In the light of these results, we underline the necessity of developing explicit policies regarding sexual issues. Formal training offered to staff would also help to recognise and preserve resident's sexual rights and needs. © 2016 John Wiley & Sons Ltd.

  10. Regional health care planning: a methodology to cluster facilities using community utilization patterns.

    Science.gov (United States)

    Delamater, Paul L; Shortridge, Ashton M; Messina, Joseph P

    2013-08-22

    Community-based health care planning and regulation necessitates grouping facilities and areal units into regions of similar health care use. Limited research has explored the methodologies used in creating these regions. We offer a new methodology that clusters facilities based on similarities in patient utilization patterns and geographic location. Our case study focused on Hospital Groups in Michigan, the allocation units used for predicting future inpatient hospital bed demand in the state's Bed Need Methodology. The scientific, practical, and political concerns that were considered throughout the formulation and development of the methodology are detailed. The clustering methodology employs a 2-step K-means + Ward's clustering algorithm to group hospitals. The final number of clusters is selected using a heuristic that integrates both a statistical-based measure of cluster fit and characteristics of the resulting Hospital Groups. Using recent hospital utilization data, the clustering methodology identified 33 Hospital Groups in Michigan. Despite being developed within the politically charged climate of Certificate of Need regulation, we have provided an objective, replicable, and sustainable methodology to create Hospital Groups. Because the methodology is built upon theoretically sound principles of clustering analysis and health care service utilization, it is highly transferable across applications and suitable for grouping facilities or areal units.

  11. Education and process change to improve skin health in a residential aged care facility.

    Science.gov (United States)

    Price, Kay; Kennedy, Kate J; Rando, Tabatha L; Dyer, Anthony R; Boylan, Jo

    2017-12-01

    We report on an intervention and evaluation in relation to changes in staff knowledge, time spent on healing and wound prevention and proportion of wounds in the facilities before and after. A rapid review of recent peer-reviewed literature (2006-2016) found 14 education-based intervention articles and provided the background and context for this intervention. A cohort of 164 nurses and personal care workers and 261 residents at two aged care-approved facilities contributed to this intervention on the effect of education, mentoring and practice change on staff knowledge and wound prevalence between 2015 and 2016. There was a significant decrease in pressure injury prevalence and an increase in the early identification of potential wounds between phase 1 and 3 across the two facilities. Overall, registered nurses and enrolled nurses showed significant increase in mean knowledge scores. There was a reorganisation of time spent on various wound care and prevention strategies that better represented education and knowledge. Wound management or prevention education alone is not enough; this study, using an educational intervention in conjunction with resident engagement, practice change, mentorship, onsite champions for healthy skin and product choice suggestions, supported by an organisation that focuses on a healthy ageing approach, showed improvement across two residential sites. © 2017 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  12. [Regulation of sexual expression in residential aged care facilities: A professional point of view].

    Science.gov (United States)

    Villar, Feliciano; Fabà, Josep; Celdrán, Montserrat; Serrat, Rodrigo

    2014-01-01

    The purpose of this study is to determine the opinion of professionals working in residential aged care facilities on the regulation of sexuality in these settings. Fifty-three professionals from five residential aged care facilities located in the metropolitan area of Barcelona answered several questions regarding the advisability of establishing measures for the regulation of sexuality in RACFs, the elements that could contribute to this, and the aspects that such regulations should consider. Around 50% of the participants recognized the advisability of having some type of measures for sexuality regulation in residential aged care facilities. According to their responses this should be developed taking into account professional opinions, but also the points of view of the residents and their relatives. The most frequently mentioned regulations were those that ensured that any kind of sexually charged situation occurred in a private environment. The development of strategies are suggested to distinguish those people with dementia that are competent to consent to sexual acts from those who are not. The opinion of professionals working in RACFs regarding the advisability of establishing measures for sexuality regulation seems to be considerably divided. Thus, whilst around 50% of them recognize their potential usefulness, the other half consider them unnecessary or even counterproductive for the sexual freedom of residents. Associating regulation with prohibition and sexuality with sexual activity was not uncommon among the responses of the participants. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

  13. Legionnaires' disease in a newly constructed long-term care facility.

    Science.gov (United States)

    Stout, J E; Brennen, C; Muder, R R

    2000-12-01

    To determine whether a newly-constructed long-term care facility would become colonized with Legionella and whether Legionnaires' disease would occur in residents of this new facility. Prospective environmental surveillance of the hospital's water distribution system for the presence of Legionella pneumophila during construction. Utilization of diagnostic tests for Legionnaires' disease in cases of nosocomial pneumonia. The Pittsburgh VA Health Care System, Aspinwall Division, a two-building 400-bed complex. Six patients who acquired Legionnaires' disease while in the facility. Installation of copper-silver ionization systems. Isolation of L. pneumophila from potable water and the occurrence of Legionnaires' disease. L. pneumophila serogroup 1 was recovered from the water distribution system within 1 month of operation; 74% (61/82) of distal sites were positive during construction. In the first 2 years of occupancy, six cases of legionellosis were diagnosed. Both clinical isolates of L. pneumophila were identical to environmental isolates by pulsed field gel electrophoresis (PFGE). Copper-silver ionization systems were installed to control Legionella in the water system. We conclude that long-term care residents are at risk for acquiring nosocomial Legionnaires' disease in the presence of a colonized water system, even in a newly constructed building.

  14. Rural–Urban Differences in End-of-Life Nursing Home Care: Facility and Environmental Factors

    Science.gov (United States)

    Temkin-Greener, Helena; Zheng, Nan Tracy; Mukamel, Dana B.

    2012-01-01

    Purpose of the study: This study examines urban–rural differences in end-of-life (EOL) quality of care provided to nursing home (NH) residents. Data and Methods: We constructed 3 risk-adjusted EOL quality measures (QMs) for long-term decedent residents: in-hospital death, hospice referral before death, and presence of severe pain. We used CY2005-2007 100% Minimum Data Set, Medicare beneficiary file, and inpatient and hospice claims. Logistic regression models were estimated to predict the probability of each outcome conditional on decedents’ risk factors. For each facility, QMs were calculated as the difference between the actual and the expected risk-adjusted outcome rates. We fit multivariate linear regression models, with fixed state effects, for each QM to assess the association with urban–rural location. Results: We found urban–rural differences for in-hospital death and hospice QMs, but not for pain. Compared with NHs located in urban areas, facilities in smaller towns and in isolated rural areas have significantly (p small towns, they are not statistically significant between facilities located in small towns and isolated rural areas. Implications: This study provides empirical evidence for urban–rural differences in EOL quality of care using a national sample of NHs. Identifying differences is a necessary first step toward improving care for dying NH residents and for bridging the urban–rural gap. PMID:22230492

  15. Life in institutional care: the voices of children in a residential facility in Botswana.

    Science.gov (United States)

    Morantz, Gillian; Heymann, Jody

    2010-01-01

    As a result of the HIV/AIDS pandemic, there are now more than 12 million orphans in sub-Saharan Africa. The majority of these children have been absorbed into their extended families. A minority of AIDS orphans and other vulnerable children are living in residential care facilities. Although concerns have been raised regarding the care received in such facilities, very little is known about children's perspectives on their own experiences residing in these institutions. As part of an ongoing initiative to better understand the impact of HIV/AIDS in Southern Africa and what can be done to address needs, one-on-one interviews were conducted with the children and youth residents, and graduates of a residential care facility in Botswana. The children report on the importance of having uninterrupted access to food, shelter and schooling and a sense of belonging. However, they also reveal a profound ambivalence towards their paid caregivers, and the other children residents. They describe being separated from siblings, missing their families and feeling disconnected from the community at large. Their narratives offer insight into ways in which we can better meet their complex needs. Policy implications are discussed.

  16. Covenants with Weak Swords: ISO 14001 and Facilities' Environmental Performance

    Science.gov (United States)

    Potoski, Matthew; Prakash, Aseem

    2005-01-01

    Voluntary environmental programs are codes of progressive environmental conduct that firms pledge to adopt. This paper investigates whether ISO 14001, a voluntary program with a weak sword--a weak monitoring and sanctioning mechanism--can mitigate shirking and improve participants' environmental performance. Sponsored by the International…

  17. A comparative analysis of dementia inpatient characteristics: results from a nationwide survey of different care facilities in Japan.

    Science.gov (United States)

    Yoshimura, Atsuko; Lebowitz, Adam; Bun, Shogyoku; Aiba, Miyuki; Ikejima, Chiaki; Asada, Takashi

    2016-01-01

    In Japan, the number of dementia patients admitted to hospitals and other care facilities has been increasing and their hospital stays prolonged. Until now, there has been no study examining the differences between patients in psychiatric hospitals and other care facilities. Here we attempt a comparative analysis of characteristics of dementia patients in psychiatric hospitals and other types of facilities based on a nationwide survey. A nationwide, cross-sectional survey was conducted in 2009-2011. Questionnaires were sent to randomly selected facilities and asked about each facility's status as of September 2009 and about individuals with dementia residing in each facility during the 2008 fiscal year. The portion about individuals consisted of items to assess eligibility for the Long-Term Care Insurance programme. Based on data from 6121 patients residing in seven different types of facilities, features of dementia patients in psychiatric hospitals and differences among facilities were analyzed. There was a significant difference in average age, activities of daily living level, and dementia severity level among the seven types of facilities. The average age in all types of facilities, except for psychiatric hospitals, was higher than the national average life expectancy of 82.59 years. The results of the study revealed that in psychiatric hospitals the proportion of men, those aged dementia, and those with frontotemporal dementia was significantly greater than in other types of facilities. In other Long-Term Care Insurance care facilities, dementia patients >80 years and women accounted for 80% of all patients. Result showed that dementia patients in psychiatric hospitals had a higher proportion of men, younger age groups, and severe dementia than other types of facilities. These features contrast markedly with status of dementia patients in other Long-Term Care Insurance care facilities. In order to facilitate dementia patients' early discharge from psychiatric

  18. An Experiment to Analyze Performance of Virtual Private Network Approach to Information Exchange between Health Facilities

    Directory of Open Access Journals (Sweden)

    Siphael BETUEL

    2017-06-01

    Full Text Available In developing countries, Tanzania in particular, studies and reports have depicted that there is a strong desire and need for seamless information exchange across health care providing facilities. A limited study conducted in few public and private hospitals has also revealed the same. On the other hand, the eHealth community has failed to effectively take advantage of the advances in technologies to make that desire come true. One potential technology is Virtual Private Network (VPN for which it has been noticed that there is a misconception and lack of innovative initiatives that slow down its uptake in eHealth. This article presents a technical assessment of the VPN technology in Tanzanian context. Primarily, the assessment focused on practicability of the best VPN practices and the perceived user experience performance when VPN is in use. It was observed that the response time dropped significantly as expected. The increase in response time and computer memory utilization is due to security mechanisms that are involved in VPN, the stronger security is used the more performance decreases. However, the increase in response time and computer memory utilization is very small in such a way that users will not be able to notice.

  19. A probability metric for identifying high-performing facilities: an application for pay-for-performance programs.

    Science.gov (United States)

    Shwartz, Michael; Peköz, Erol A; Burgess, James F; Christiansen, Cindy L; Rosen, Amy K; Berlowitz, Dan

    2014-12-01

    Two approaches are commonly used for identifying high-performing facilities on a performance measure: one, that the facility is in a top quantile (eg, quintile or quartile); and two, that a confidence interval is below (or above) the average of the measure for all facilities. This type of yes/no designation often does not do well in distinguishing high-performing from average-performing facilities. To illustrate an alternative continuous-valued metric for profiling facilities--the probability a facility is in a top quantile--and show the implications of using this metric for profiling and pay-for-performance. We created a composite measure of quality from fiscal year 2007 data based on 28 quality indicators from 112 Veterans Health Administration nursing homes. A Bayesian hierarchical multivariate normal-binomial model was used to estimate shrunken rates of the 28 quality indicators, which were combined into a composite measure using opportunity-based weights. Rates were estimated using Markov Chain Monte Carlo methods as implemented in WinBUGS. The probability metric was calculated from the simulation replications. Our probability metric allowed better discrimination of high performers than the point or interval estimate of the composite score. In a pay-for-performance program, a smaller top quantile (eg, a quintile) resulted in more resources being allocated to the highest performers, whereas a larger top quantile (eg, being above the median) distinguished less among high performers and allocated more resources to average performers. The probability metric has potential but needs to be evaluated by stakeholders in different types of delivery systems.

  20. Development and performances of a high statistics PMT test facility

    Directory of Open Access Journals (Sweden)

    Mollo Carlos Maximiliano

    2016-01-01

    Full Text Available Since almost a century photomultipliers have been the main sensors for photon detection in nuclear and astro-particle physics experiments. In recent years the search for cosmic neutrinos gave birth to enormous size experiments (Antares, Kamiokande, Super-Kamiokande, etc. and even kilometric scale experiments as ICECUBE and the future KM3NeT. A very large volume neutrino telescope like KM3NeT requires several hundreds of thousands photomultipliers. The performance of the telescope strictly depends on the performance of each PMT. For this reason, it is mandatory to measure the characteristics of each single sensor. The characterization of a PMT normally requires more than 8 hours mostly due to the darkening step. This means that it is not feasible to measure the parameters of each PMT of a neutrino telescope without a system able to test more than one PMT simultaneously. For this application, we have designed, developed and realized a system able to measure the main characteristics of 62 3-inch photomultipliers simultaneously. Two measurement sessions per day are possible. In this work, we describe the design constraints and how they have been satisfied. Finally, we show the performance of the system and the first results coming from the test of few thousand tested PMTs.

  1. Quality of care and its determinants in longer term mental health facilities across Europe; a cross-sectional analysis

    NARCIS (Netherlands)

    Killaspy, Helen; Cardoso, Graca; White, Sarah; Wright, Christine; Caldas de Almeida, Jose Miguel; Turton, Penny; Taylor, Tatiana L.; Schuetzwohl, Matthias; Schuster, Mirjam; Cervilla, Jorge A.; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Adamowski, Tomasz; Ploumpidis, Dimitris; Gonidakis, Fragiskos; King, Michael

    2016-01-01

    Background: The Quality Indicator for Rehabilitative Care (QuIRC) is an international, standardised quality tool for the evaluation of mental health facilities that provide longer term care. Completed by the service manager, it comprises 145 items that assess seven domains of care: living

  2. Current Status and Performance Tests of Korea Heat Load Test Facility KoHLT-EB

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sukkwon; Jin, Hyunggon; Shin, Kyuin; Choi, Boguen; Lee, Eohwak; Yoon, Jaesung; Lee, Dongwon [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of); Kim, Duckhoi; Cho, Seungyon [National Fusion Research Institute, Daejeon (Korea, Republic of)

    2013-05-15

    A commissioning test has been scheduled to establish the installation and preliminary performance experiments of the copper hypervapotron mockups. And a qualification test will be performed to evaluate the CuCrZr duct liner in the ITER neutral beam injection facility and the ITER first wall small-scale mockups of the semi-prototype, at up to 1.5 and 5 MW/m{sup 2} high heat flux. Also, this system will be used to test other PFCs for ITER and materials for tokamak reactors. Korean high heat flux test facility(KoHLT-EB; Korea Heat Load Test facility - Electron Beam) by using an electron beam system has been constructed in KAERI to perform the qualification test for ITER blanket FW semi-prototype mockups, hypervapotron cooling devices in fusion devices, and other ITER plasma facing components. The commissioning and performance tests with the supplier of e-gun system have been performed on November 2012. The high heat flux test for hypervapotron cooling device and calorimetry were performed to measure the surface heat flux, the temperature profile and cooling performance. Korean high heat flux test facility for the plasma facing components of nuclear fusion machines will be constructed to evaluate the performance of each component. This facility for the plasma facing materials will be equipped with an electron beam system with a 60 kV acceleration gun.

  3. The effects of refurbishment on residents' quality of life and wellbeing in two Swedish residential care facilities.

    Science.gov (United States)

    Falk, Hanna; Wijk, Helle; Persson, Lars-Olof

    2009-09-01

    This study was conducted to follow a refurbishment aimed at enhancing the supportiveness of the physical environment in two Swedish residential care facilities. Significant differences between intervention and equivalent reference groups were found for quality of life (p=0.007) and wellbeing (p=0.02, 0.01) indicating a deterioration for the intervention group. These results suggest that residential care facilities residents are more frail and sensitive to change than has been assumed. This needs to be considered when facilities accommodating the elderly need refurbishment. It also indicates that interior design features alone have little importance for the care climate in nursing homes.

  4. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis.

    Science.gov (United States)

    Shakibazadeh, Elham; Namadian, Masoumeh; Bohren, Meghan A; Vogel, Joshua P; Rashidian, Arash; Pileggi, Vicky Nogueira; Madeira, Sofia; Leathersich, Sebastian; Tunçalp, Ӧzge; Oladapo, Olufemi T; Souza, João Paulo; Gülmezoglu, Ahmet Metin

    2017-11-08

    What constitutes respectful maternity care (RMC) operationally in research and program implementation is often variable. To develop a conceptualization of RMC. Key databases including PubMed, CINAHL, EMBASE, Global Health Library; grey literature and reference lists of relevant studies. Primary qualitative studies focusing on care occurring during labour, childbirth and/or immediate postpartum in health facilities without any restrictions on locations or publication date. A combined inductive and deductive approach was used to synthesize data; the GRADE CERQual was used to assess the level of confidence in review findings. Sixty-seven studies from 32 countries met our inclusion criteria. Twelve domains of RMC were synthesized: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women's dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing equitable maternity care; engaging with effective communication; respecting women's choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care. Globally, women's perspectives of what constitutes RMC are quite consistent. This review presents an evidence-based typology of RMC in health facilities globally, and demonstrates that the concept is broader than a reduction of disrespectful care or mistreatment of women during childbirth. Innovative approaches should be developed and tested to integrate RMC as a routine component of quality maternal and newborn care programs. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  5. Variation in Hospice Services by Location of Care: Nursing Home Versus Assisted Living Facility Versus Home.

    Science.gov (United States)

    Unroe, Kathleen T; Bernard, Brittany; Stump, Timothy E; Tu, Wanzhu; Callahan, Christopher M

    2017-07-01

    To describe differences in hospice services for patients living at home, in nursing homes or in assisted living facilities, including the overall number and duration of visits by different hospice care providers across varying lengths of stay. Retrospective cohort study using hospice patient electronic medical record data. Large, national hospice provider. Data from 32,605 hospice patients who received routine hospice care from 2009 to 2014 were analyzed. Descriptive statistics were calculated for utilization measures for each type of provider and by location of care. Frequency and duration of service contacts were standardized to a 1 week period and pairwise comparisons were used to detect differences in care provided between the three settings. Minimal differences were found in overall intensity of service contacts across settings, however, the mix of services were different for patients living at home versus nursing home versus assisted living facility. Overall, more nurse care was provided at the beginning and end of the hospice episode; intensity of aide care services was higher in the middle portion of the hospice episode. Nearly 43% of the sample had hospice stays less than 2 weeks and up to 20% had stays greater than 6 months. There are significant differences between characteristics of hospice patients in different settings, as well as the mix of services they receive. Medicare hospice payment methodology was revised starting in 2016. While the new payment structure is in greater alignment with the U shape distribution of services, it will be important to evaluate the impact of the new payment methodology on length of stay and mix of services by different providers across settings of care. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  6. 7 CFR 353.9 - Standards for accreditation of non-government facilities to perform laboratory seed health...

    Science.gov (United States)

    2010-01-01

    ... facilities to perform laboratory seed health testing and seed crop phytosanitary inspection. 353.9 Section...-government facilities to perform laboratory seed health testing and seed crop phytosanitary inspection. (a... facility may apply to be accredited to perform laboratory seed health testing or seed crop phytosanitary...

  7. Health Facilities

    Science.gov (United States)

    Health facilities are places that provide health care. They include hospitals, clinics, outpatient care centers, and specialized care centers, such as birthing centers and psychiatric care centers. When you ...

  8. Association between continuing education and job satisfaction of nurses employed in long-term care facilities.

    Science.gov (United States)

    Robertson, E M; Higgins, L; Rozmus, C; Robinson, J P

    1999-01-01

    The purpose of this descriptive, correlational study was to investigate the relationship between continuing education and job satisfaction among RNs and licensed practical nurses (LPNs) employed in long-term care facilities. Herzberg's Motivational-Hygiene Theory was used as a framework to guide the design of the study. The Professional Educational Activities Scale and the McCloskey/Mueller Satisfaction Scale were completed by 110 nurses employed in long-term care facilities. No difference was found between type of employment status (full-time versus part-time) on the level of professional educational activities. However, RNs participated in more continuing education activities than LPNs. Nurses who reported higher family incomes also had greater participation in educational activities. Registered nurses reported greater job satisfaction than LPNs. No significant difference was found between the degree of job satisfaction for Black and White nurses. The results of this study indicated nurses who participated in more continuing education activities scored higher on the job satisfaction scale. As the elderly population increases, a critical need exists for nurses to be knowledgeable about current research-based information, including the economic and psychosocial effects of illness in later life. To provide the most effective care for the elderly population, nurses in long-term care must be knowledgeable about the complexity and specific characteristics of chronic illnesses. Continuing education activities are an important way to access this information.

  9. Families' perceptions of end-of-life care in Veterans Affairs versus non-Veterans Affairs facilities.

    Science.gov (United States)

    Lu, Hien; Trancik, Emily; Bailey, F Amos; Ritchie, Christine; Rosenfeld, Kenneth; Shreve, Scott; Furman, Christian; Smith, Dawn; Wolff, Catherine; Casarett, David

    2010-08-01

    The Veterans Affairs (VA) has made significant investments in care for veterans. However, it is not known whether these investments have produced improvements in end-of-life care in the VA compared to other settings. Therefore, the goal of this study was to compare families' perceptions of end-of-life care among patients who died in VA and non-VA facilities. Retrospective 32-item telephone surveys were conducted with family members of patients who died in VA and non-VA facilities. Five Veterans Affairs medical centers and their affiliated nursing homes and outpatient clinics. Patients were eligible if they received any care from a participating VA facility in the last month of life and if they died in an inpatient setting. One family member per patient completed the survey. In bivariate analysis, patients who died in VA facilities (n = 520) had higher mean satisfaction scores compared to those who died in non-VA facilities (n = 89; 59 versus 51; rank sum test p = 0.002). After adjusting for medical center, the overall score was still significantly higher for those dying in the VA (beta = 0.07; confidence interval [CI] = 0.02-0.11; p = 0.004), as was the domain measuring care around the time of death (beta = 0.11; CI = 0.04-0.17; p = 0.001). Families of patients who died in VA facilities rated care as being better than did families of those who died in non-VA facilities. These results provide preliminary evidence that the VA's investment in end-of-life care has contributed to improvements in care in VA facilities compared to non-VA facilities.

  10. Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa.

    Science.gov (United States)

    Bergh, Anne-Marie; Kerber, Kate; Abwao, Stella; de-Graft Johnson, Joseph; Aliganyira, Patrick; Davy, Karen; Gamache, Nathalie; Kante, Modibo; Ligowe, Reuben; Luhanga, Richard; Mukarugwiro, Béata; Ngabo, Fidèle; Rawlins, Barbara; Sayinzoga, Felix; Sengendo, Naamala Hanifah; Sylla, Mariam; Taylor, Rachel; van Rooyen, Elise; Zoungrana, Jeremie

    2014-07-08

    Some countries have undertaken programs that included scaling up kangaroo mother care. The aim of this study was to systematically evaluate the implementation status of facility-based kangaroo mother care services in four African countries: Malawi, Mali, Rwanda and Uganda. A cross-sectional, mixed-method research design was used. Stakeholders provided background information at national meetings and in individual interviews. Facilities were assessed by means of a standardized tool previously applied in other settings, employing semi-structured key-informant interviews and observations in 39 health care facilities in the four countries. Each facility received a score out of a total of 30 according to six stages of implementation progress. Across the four countries 95 per cent of health facilities assessed demonstrated some evidence of kangaroo mother care practice. Institutions that fared better had a longer history of kangaroo mother care implementation or had been developed as centres of excellence or had strong leaders championing the implementation process. Variation existed in the quality of implementation between facilities and across countries. Important factors identified in implementation are: training and orientation; supportive supervision; integrating kangaroo mother care into quality improvement; continuity of care; high-level buy in and support for kangaroo mother care implementation; and client-oriented care. The integration of kangaroo mother care into routine newborn care services should be part of all maternal and newborn care initiatives and packages. Engaging ministries of health and other implementing partners from the outset may promote buy in and assist with the mobilization of resources for scaling up kangaroo mother care services. Mechanisms for monitoring these services should be integrated into existing health management information systems.

  11. Development and Validation of an Index to Measure the Quality of Facility-Based Labor and Delivery Care Processes in Sub-Saharan Africa.

    Directory of Open Access Journals (Sweden)

    Vandana Tripathi

    Full Text Available High quality care is crucial in ensuring that women and newborns receive interventions that may prevent and treat birth-related complications. As facility deliveries increase in developing countries, there are concerns about service quality. Observation is the gold standard for clinical quality assessment, but existing observation-based measures of obstetric quality of care are lengthy and difficult to administer. There is a lack of consensus on quality indicators for routine intrapartum and immediate postpartum care, including essential newborn care. This study identified key dimensions of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC in facility deliveries and developed a quality assessment measure representing these dimensions.Global maternal and neonatal care experts identified key dimensions of QoPIIPC through a modified Delphi process. Experts also rated indicators of these dimensions from a comprehensive delivery observation checklist used in quality surveys in sub-Saharan African countries. Potential QoPIIPC indices were developed from combinations of highly-rated indicators. Face, content, and criterion validation of these indices was conducted using data from observations of 1,145 deliveries in Kenya, Madagascar, and Tanzania (including Zanzibar. A best-performing index was selected, composed of 20 indicators of intrapartum/immediate postpartum care, including essential newborn care. This index represented most dimensions of QoPIIPC and effectively discriminated between poorly and well-performed deliveries.As facility deliveries increase and the global community pays greater attention to the role of care quality in achieving further maternal and newborn mortality reduction, the QoPIIPC index may be a valuable measure. This index complements and addresses gaps in currently used quality assessment tools. Further evaluation of index usability and reliability is needed. The availability of a streamlined

  12. Development and Validation of an Index to Measure the Quality of Facility-Based Labor and Delivery Care Processes in Sub-Saharan Africa.

    Science.gov (United States)

    Tripathi, Vandana; Stanton, Cynthia; Strobino, Donna; Bartlett, Linda

    2015-01-01

    High quality care is crucial in ensuring that women and newborns receive interventions that may prevent and treat birth-related complications. As facility deliveries increase in developing countries, there are concerns about service quality. Observation is the gold standard for clinical quality assessment, but existing observation-based measures of obstetric quality of care are lengthy and difficult to administer. There is a lack of consensus on quality indicators for routine intrapartum and immediate postpartum care, including essential newborn care. This study identified key dimensions of the quality of the process of intrapartum and immediate postpartum care (QoPIIPC) in facility deliveries and developed a quality assessment measure representing these dimensions. Global maternal and neonatal care experts identified key dimensions of QoPIIPC through a modified Delphi process. Experts also rated indicators of these dimensions from a comprehensive delivery observation checklist used in quality surveys in sub-Saharan African countries. Potential QoPIIPC indices were developed from combinations of highly-rated indicators. Face, content, and criterion validation of these indices was conducted using data from observations of 1,145 deliveries in Kenya, Madagascar, and Tanzania (including Zanzibar). A best-performing index was selected, composed of 20 indicators of intrapartum/immediate postpartum care, including essential newborn care. This index represented most dimensions of QoPIIPC and effectively discriminated between poorly and well-performed deliveries. As facility deliveries increase and the global community pays greater attention to the role of care quality in achieving further maternal and newborn mortality reduction, the QoPIIPC index may be a valuable measure. This index complements and addresses gaps in currently used quality assessment tools. Further evaluation of index usability and reliability is needed. The availability of a streamlined, comprehensive

  13. The lived experiences and social support needs of first-time mothers at health care facilities in the City of Tshwane, South Africa

    Directory of Open Access Journals (Sweden)

    Mmajapi E.T. Masala-Chokwe

    2017-02-01

    Full Text Available Background: Social support refers to the assistance people receive from others, and it is divided into four types of support. Given the increasing mortality and morbidity rates of mothers and neonates postpartum, this study intended to determine whether the social support needs of the first-time mothers were met after early discharge from health care facilities.Objectives: The objective of the study was to explore the lived experiences and social support needs of the first-time mothers after an early discharge from health care facilities in the City of Tshwane, Gauteng.Method: A qualitative explorative study was conducted to explore the lived experiences and social support needs of the first-time mothers. The population were first-time mothers who had a vaginal delivery and were discharged within 6–12 hours of delivery from health care facilities. Purposive sampling was performed and 14 semi-structured interviews were conducted, with those mothers who came for the prescribed three postnatal check-ups at the three health care facilities identified according to maternity services provided. Saturation of data for the three health care facilities was reached at the 14th interview. Data analysis was performed using the hermeneutic interpretive approach.Results: Almost all participants had completed grades 11 or 12, but most were unemployed. The needs identified included the need for social support, lack of confidence, knowledge and skill to care for themselves and their newborn babies after early discharge.Conclusion: There is need to identify alternative types of social support for the first-time mothers, to ensure a normal adjustment to motherhood.

  14. The lived experiences and social support needs of first-time mothers at health care facilities in the City of Tshwane, South Africa.

    Science.gov (United States)

    Masala-Chokwe, Mmajapi E T; Ramukumba, Tendani S

    2017-09-22

    Social support refers to the assistance people receive from others, and it is divided into four types of support. Given the increasing mortality and morbidity rates of mothers and neonates postpartum, this study intended to determine whether the social support needs of the first-time mothers were met after early discharge from health care facilities. The objective of the study was to explore the lived experiences and social support needs of the first-time mothers after an early discharge from health care facilities in the City of Tshwane, Gauteng. A qualitative explorative study was conducted to explore the lived experiences and social support needs of the first-time mothers. The population were first-time mothers who had a vaginal delivery and were discharged within 6-12 hours of delivery from health care facilities. Purposive sampling was performed and 14 semi-structured interviews were conducted, with those mothers who came for the prescribed three postnatal check-ups at the three health care facilities identified according to maternity services provided. Saturation of data for the three health care facilities was reached at the 14th interview. Data analysis was performed using the hermeneutic interpretive approach. Almost all participants had completed grades 11 or 12, but most were unemployed. The needs identified included the need for social support, lack of confidence, knowledge and skill to care for themselves and their newborn babies after early discharge. There is need to identify alternative types of social support for the first-time mothers, to ensure a normal adjustment to motherhood.

  15. Evidence-based practices to increase hand hygiene compliance in health care facilities: An integrated review.

    Science.gov (United States)

    Neo, Jun Rong Jeffrey; Sagha-Zadeh, Rana; Vielemeyer, Ole; Franklin, Ella

    2016-06-01

    Hand hygiene (HH) in health care facilities is a key component to reduce pathogen transmission and nosocomial infections. However, most HH interventions (HHI) have not been sustainable. This review aims to provide a comprehensive summary of recently published evidence-based HHI designed to improve HH compliance (HHC) that will enable health care providers to make informed choices when allocating limited resources to improve HHC and patient safety. The Medline electronic database (using PubMed) was used to identify relevant studies. English language articles that included hand hygiene interventions and related terms combined with health care environments or related terms were included. Seventy-three studies that met the inclusion criteria were summarized. Interventions were categorized as improving awareness with education, facility design, and planning, unit-level protocols and procedures, hospital-wide programs, and multimodal interventions. Past successful HHIs may not be as effective when applied to other health care environments. HH education should be interactive and engaging. Electronic monitoring and reminders should be implemented in phases to ensure cost-effectiveness. To create hospitalwide programs that engage end users, policy makers should draw expertise from interdisciplinary fields. Before implementing the various components of multimodal interventions, health care practitioners should identify and examine HH difficulties unique to their organizations. Future research should seek to achieve the following: replicate successful HHI in other health care environments, develop reliable HHC monitoring tools, understand caregiver-patient-family interactions, examine ways (eg, hospital leadership, financial support, and strategies from public health and infection prevention initiatives) to sustain HHC, and use simulated lab environments to refine study designs. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc

  16. The Proposal of Key Performance Indicators in Facility Management and Determination the Weights of Significance

    Science.gov (United States)

    Rimbalová, Jarmila; Vilčeková, Silvia

    2013-11-01

    The practice of facilities management is rapidly evolving with the increasing interest in the discourse of sustainable development. The industry and its market are forecasted to develop to include non-core functions, activities traditionally not associated with this profession, but which are increasingly being addressed by facilities managers. The scale of growth in the built environment and the consequential growth of the facility management sector is anticipated to be enormous. Key Performance Indicators (KPI) are measure that provides essential information about performance of facility services delivery. In selecting KPI, it is critical to limit them to those factors that are essential to the organization reaching its goals. It is also important to keep the number of KPI small just to keep everyone's attention focused on achieving the same KPIs. This paper deals with the determination of weights of KPI of FM in terms of the design and use of sustainable buildings.

  17. Results of the RAMI analyses performed for the IFMIF accelerator facility in the engineering design phase

    Energy Technology Data Exchange (ETDEWEB)

    Bargalló, Enric, E-mail: enric.bargallo@esss.se [Fusion Energy Engineering Laboratory (FEEL), Technical University of Catalonia (UPC) Barcelona-Tech, Barcelona (Spain); Arroyo, Jose Manuel [Laboratorio Nacional de Fusión por Confinamiento Magnético – CIEMAT, Madrid (Spain); Abal, Javier; Dies, Javier; De Blas, Alfredo; Tapia, Carlos [Fusion Energy Engineering Laboratory (FEEL), Technical University of Catalonia (UPC) Barcelona-Tech, Barcelona (Spain); Moya, Joaquin; Ibarra, Angel [Laboratorio Nacional de Fusión por Confinamiento Magnético – CIEMAT, Madrid (Spain)

    2015-10-15

    Highlights: • RAMI methodology used for IFMIF accelerator facility is presented. • Availability analyses and results are shown. • Main accelerator design changes are proposed. • Consequences and conclusions of the RAMI analyses are described. - Abstract: This paper presents a summary of the RAMI (Reliability Availability Maintainability Inspectability) analyses done for the IFMIF (International Fusion Materials Irradiation Facility) Accelerator facility in the Engineering Design Phase. The methodology followed, the analyses performed, the results obtained and the conclusions drawn are described. Moreover, the consequences of the incorporation of the RAMI studies in the IFMIF design are presented and the main outcomes of these analyses are shown.

  18. Impacts of natural hazards on primary health care facilities of iran: a 10-year retrospective survey.

    Science.gov (United States)

    Ardalan, Ali; Mowafi, Hani; Khoshsabeghe, Homa Yousefi

    2013-06-28

    Public health facilities in Iran are exposed to a wide range of natural hazards. This article presents the first survey of the impacts of such natural hazards on primary health care (PHC) centers in Iran from 2001 to 2011. A retrospective survey was conducted in 25 out of 30 provinces of Iran. Archival reports at provincial public health departments were cross-referenced with key informant interviews. During a 10-year period, 119 natural hazard events were recorded that led to physical damage and/or functional failure in 1,401 health centers, 127 deaths and injury or illness in 644 health staff. Earthquakes accounted for the most physical damage and all health-worker deaths. However, there was an increasing trend of impacts due to hydro-meteorological hazards. Iran's health system needs to establish a registry to track the impact of natural hazards on health facilities, conduct regular hazard and vulnerability assessments and increase mitigation and preparedness measures. Disaster, primary health care, facility, Iran, natural hazard Corresponding author: Ali Ardalan MD, PhD. Iran's National Institute of Health Research, Tehran University of Medical Sciences. Harvard Humanitarian Initiative. Email: aardalan@tums.ac.ir.

  19. Post abortion care quality status in health facilities of Guraghe zone, Ethiopia.

    Science.gov (United States)

    Tesfaye, Gezahegn; Oljira, Lemessa

    2013-07-23

    Unsafe abortion in the developing world accounts for 13% of all maternal deaths. Ethiopia is one of the developing countries with the highest maternal mortality ratio (673 per 100,000 live births) in the world. Unsafe abortion was estimated to account for 32% of all maternal deaths in Ethiopia. To assess post abortion care quality status in health facilities of Guraghe zone. A facility based cross-sectional study design with both quantitative and qualitative methods was conducted. Patient interview, direct service observation, provider self administered questionnaire and inventory of equipment and supplies were used for the assessment. Six health centers, two hospitals and 422 post-abortion patients were included in the study. Patient-provider interaction was generally satisfactory from the patient's perspective. The majority of the respondents (93.5%) said that they were treated with politeness and respect. More than half 226(56.5%) of the clients have received post abortion family planning. Overall, 83.5% of the patients were satisfied with the services. Those who said waiting time was long were less satisfied and unemployed women were more satisfied than others. The study has revealed several improvements as well as problems in the provision of post-abortion care service in the studied health facilities.

  20. Health behavior associated with influenza vaccination among healthcare workers in long-term-care facilities.

    Science.gov (United States)

    Manuel, D G; Henry, B; Hockin, J; Naus, M

    2002-10-01

    To investigate the health behavior associated with influenza vaccination among healthcare workers (HCWs) in long-term-care facilities. A cross-sectional, self-administered survey of HCWs, augmented with focus groups to further examine attitudes toward influenza vaccination. Two long-term-care facilities participated in the survey. The focus groups were held at one of the two facilities. All HCWs were invited to participate in the survey and all nonmanagerial staff members were invited to participate in the focus groups. The response rate for the survey was 58% (231 of 401). Vaccinated HCWs had a more positive attitude toward influenza vaccination and a greater belief that the vaccine is effective. This was not accompanied by differences in vaccine knowledge or values of potential preventive outcomes. Nonvaccinated respondents were more likely to believe that other preventive measures, such as washing hands, taking vitamins and supplements, eating a nutritious diet, exercising, and taking homeopathic or naturopathic medications, were more effective than vaccination. Additional findings from the focus groups suggest that HCWs believe that the main purpose of influenza vaccination programs is to protect residents' health at the expense, potential harm, and burden of responsibility of the staff. This study identifies challenges to and opportunities for improving vaccination rates among HCWs. A message that emphasizes the health benefits of vaccination to staff members, such as including vaccination as part of a staff "wellness" program, may improve the credibility of influenza immunization programs and coverage rates.

  1. Robotic Seals as Therapeutic Tools in an Aged Care Facility: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Melanie Birks

    2016-01-01

    Full Text Available Robots, including robotic seals, have been used as an alternative to therapies such as animal assisted therapy in the promotion of health and social wellbeing of older people in aged care facilities. There is limited research available that evaluates the effectiveness of robot therapies in these settings. The aim of this study was to identify, explore, and describe the impact of the use of Paro robotic seals in an aged care facility in a regional Australian city. A qualitative, descriptive, exploratory design was employed. Data were gathered through interviews with the three recreational therapists employed at the facility who were also asked to maintain logs of their interactions with the Paro and residents. Data were transcribed and thematically analysed. Three major themes were identified from the analyses of these data: “a therapeutic tool that’s not for everybody,” “every interaction is powerful,” and “keeping the momentum.” Findings support the use of Paro as a therapeutic tool, revealing improvement in emotional state, reduction of challenging behaviours, and improvement in social interactions of residents. The potential benefits justify the investment in Paro, with clear evidence that these tools can have a positive impact that warrants further exploration.

  2. Interprofessional education in aged-care facilities: Tensions and opportunities among undergraduate health student cohorts.

    Science.gov (United States)

    Annear, Michael; Walker, Kim; Lucas, Peter; Lo, Amanda; Robinson, Andrew

    2016-09-01

    This article examines the reflective discourses of medical, nursing, and paramedic students participating in interprofessional education (IPE) activities in the context of aged-care clinical placements. The intent of the research is to explore how students engage with their interprofessional colleagues in an IPE assessment and care planning activity and elucidate how students configure their role as learners within the context of a non-traditional aged-care training environment. Research participants included cohorts of volunteer medical (n = 61), nursing (n = 46), and paramedic (n = 20) students who were on clinical placements at two large teaching aged-care facilities in Tasmania, Australia, over a period of 18 months. A total of 39 facilitated focus group discussions were undertaken with cohorts of undergraduate student volunteers from three health professions between February 2013 and October 2014. Thematic analysis of focus group transcripts was assisted by NVIVO software and verified through secondary coding and member checking procedures. With an acceptable level of agreement across two independent coders, four themes were identified from student focus group transcripts that described the IPE relations and perceptions of the aged-care environment. Emergent themes included reinforcement of professional hierarchies, IPE in aged care perceived as mundane and extraneous, opportunities for reciprocal teaching and learning, and understanding interprofessional roles. While not all students can be engaged with IPE activities in aged care, our evidence suggests that within 1 week of clinical placements there is a possibility to develop reciprocal professional relations, affirm a positive identity within a collaborative healthcare team, and support the health of vulnerable older adults with complex care needs. These important clinical learnings support aged-care-based IPE as a potentially powerful context for undergraduate learning in the 21st Century.

  3. First regulatory inspections measuring adherence to Good Pharmacy Practices in the public sector in Uganda: a cross-sectional comparison of performance between supervised and unsupervised facilities.

    Science.gov (United States)

    Trap, Birna; Kikule, Kate; Vialle-Valentin, Catherine; Musoke, Richard; Lajul, Grace Otto; Hoppenworth, Kim; Konradsen, Dorthe

    2016-01-01

    perform better than unsupervised facilities, substantiating the value of supporting supervision interventions in GPP areas that need strengthening. None compliant indicators can be improved through practices and behavioral changes; some require infrastructure investments. We conclude that regular NDA inspections of public sector pharmacies in conjunction with interventions to improve GPP adherence can revolutionize patient care in Uganda.

  4. 76 FR 9503 - Medicare and Medicaid Programs; Requirements for Long-Term Care (LTC) Facilities; Notice of...

    Science.gov (United States)

    2011-02-18

    ..., written notification of an impending facility closure. For informational purposes, LTC ombudsmen are... the use of language translators in hospitals, health literacy and its impact on health care outcomes...

  5. New signal functions to measure the ability of health facilities to provide routine and emergency newborn care.

    Directory of Open Access Journals (Sweden)

    Sabine Gabrysch

    Full Text Available Based upon an expert survey and consensus method, Sabine Gabrysch and colleagues recommend new signal functions to monitor and track facilities' provision of routine and emergency newborn care.

  6. Hospital Ownership of a Postacute Care Facility Influences Discharge Destinations After Emergent Surgery.

    Science.gov (United States)

    Abdelsattar, Zaid M; Gonzalez, Andrew A; Hendren, Samantha; Regenbogen, Scott E; Wong, Sandra L

    2016-08-01

    The aim of the study was to identify hospital characteristics associated with variation in patient disposition after emergent surgery. Colon resections in elderly patients are often done in emergent settings. Although these operations are known to be riskier, there are limited data regarding postoperative discharge destination. We evaluated Medicare beneficiaries who underwent emergent colectomy between 2008 and 2010. Using hierarchical logistic regression, we estimated patient and hospital-level risk-adjusted rates of nonhome discharges. Hospitals were stratified into quintiles based on their nonhome discharge rates. Generalized linear models were used to identify hospital structural characteristics associated with nonhome discharges (comparing discharge to skilled nursing facilities vs home with/without home health services). Of the 122,604 patients surviving to discharge after emergent colectomy at 3012 hospitals, 46.7% were discharged to a nonhome destination. There was a wide variation in risk and reliability-adjusted nonhome discharge rates across hospitals (15% to 80%). Patients at hospitals in the highest quintile of nonhome discharge rates were more likely to have longer hospitalizations (15.1 vs 13.2; P hospital ownership of a skilled nursing facility (P discharges. Nearly half of Medicare beneficiaries are discharged to a nonhome destination after emergent colectomy. Hospital ownership of a skilled nursing facility and low nurse-to-patient ratios are highly associated with nonhome discharges. This may signify the underlying financial incentives to preferentially utilize postacute care facilities under the traditional fee-for-service payment model.

  7. The Association Between Characteristics of Care Environments and Apathy in Residents With Dementia in Long-term Care Facilities.

    Science.gov (United States)

    Jao, Ying-Ling; Algase, Donna L; Specht, Janet K; Williams, Kristine

    2015-06-01

    Apathy is highly prevalent in dementia but often overlooked. Environment-based interventions have demonstrated positive impact on apathy, yet, influential environmental components are largely understudied. This study examined the relationship between care environments and apathy in long-term care residents with dementia. This study was exploratory and employed a descriptive and repeated observation design. A sample of 40 was selected from a parent study with 185 participants from 28 facilities. Three videos from each participant were coded to measure apathy and environmental stimulation. Data on ambiance, crowding, staff familiarity, light, and sounds were extracted from the parent study. Generalized linear mixed models were used for analysis. The clarity and strength of environmental stimulation were significantly associated with a lower apathy level. An increase of 1 point on stimulation clarity and strength corresponded to a decrease of 1.3 and 1.9 points on apathy score, respectively (p dementia. Findings suggest that care environments that contain clear and sufficient environmental stimulation are significantly associated with lower resident apathy levels. Findings will guide environmental design and interventions for dementia care. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Newborn Care in the Home and Health Facility: Formative Findings for Intervention Research in Cambodia

    Directory of Open Access Journals (Sweden)

    Alessandra N. Bazzano

    2016-12-01

    Full Text Available Global coverage and scale up of interventions to reduce newborn mortality remains low, though progress has been achieved in improving newborn survival in many low-income settings. An important factor in the success of newborn health interventions, and moving to scale, is appropriate design of community-based programs and strategies for local implementation. We report the results of formative research undertaken to inform the design of a newborn health intervention in Cambodia. Information was gathered on newborn care practices over a period of three months using multiple qualitative methods of data collection in the primary health facility and home setting. Analysis of the data indicated important gaps, both at home and facility level, between recommended newborn care practices and those typical in the study area. The results of this formative research have informed strategies for behavior change and improving referral of sick infants in the subsequent implementation study. Collection and dissemination of data on newborn care practices from settings such as these can contribute to efforts to advance survival, growth and development of newborns for intervention research, and for future newborn health programming.

  9. Participative Facility Planning for Obstetrical and Neonatal Care Processes: Beginning of Life Process

    Directory of Open Access Journals (Sweden)

    Jori Reijula

    2016-01-01

    Full Text Available Introduction. Old hospitals may promote inefficient patient care processes and safety. A new, functionally planned hospital presents a chance to create an environment that supports streamlined, patient-centered healthcare processes and adapts to users’ needs. This study depicts the phases of a facility planning project for pregnant women and newborn care processes (beginning of life process at Turku University Hospital. Materials and Methods. Project design reports and meeting documents were utilized to assess the beginning of life process as well as the work processes of the Women’s and Children’s Hospital. Results. The main elements of the facility design (FD project included rigorous preparation for the FD phase, functional planning throughout the FD process, and setting key values: (1 family-centered care, (2 Lean thinking and Lean tools as the framework for the FD process, (3 safety, and (4 cooperation. Conclusions. A well-prepared FD project with sufficient insight into functional planning, Lean thinking, and user-centricity seemed to facilitate the actual FD process. Although challenges occurred, the key values were not forgone and were successfully incorporated into the new hospital building.

  10. Managing the wandering behaviour of people living in a residential aged care facility.

    Science.gov (United States)

    Hodgkinson, Brent; Koch, Susan; Nay, Rhonda; Lewis, Matthew

    2007-12-01

    Background  Wandering behaviour is frequently seen in older people with cognitive impairment. The prevalence of patients exhibiting wandering behaviour has been estimated to be 11.6% on traditional units and 52.7% on Alzheimer's units. Wandering is one of the core behavioural characteristics that impact on familial carers and is likely to influence the decision to place a family member in an aged care environment. Considering the possible risks associated with wandering behaviour, the successful identification and management of wandering is essential. Wandering is also a problem for caregivers in the institutionalised setting, in terms of containment, usually being addressed by securing the environment. There has been some research conducted to assist in the understanding and management of wandering behaviour; however, the findings have been diverse resulting in a level of confusion about the best approaches to take. Objectives  This review aims to present the best available evidence on the management of wandering in older adults who reside in an aged care facility (both high and low care). Search strategy  An extensive search of keywords contained in the title and abstract, and relevant MeSH headings and descriptor terms was performed on the following databases: MEDLINE, CINAHL, PsychINFO, AGELINE, Cochrane Library, Embase, APAIS Health, Current Contents, Dare, Dissertation Abstracts, Personal Communication, Social Science Index. Selection criteria  Papers were selected if they focused on the treatment of wandering in an institutional setting. Some studies were not specifically examining wanderers over the age of 65 years as per the protocol requirements, but were included as it was felt that their findings could be applied to this age group. Data collection and analysis  Study design and quality were tabulated and relative risks, odds ratios, mean differences and associated 95% confidence intervals were calculated from individual comparative studies

  11. Using Simulation to Develop Care Models for Rapid Response and Code Teams at a Satellite Facility.

    Science.gov (United States)

    Rule, Amy R L; Snider, Julie; Marshall, Cheryl; Kramer, Kathleen; Geis, Gary L; Tegtmeyer, Ken; Gosdin, Craig H

    2017-12-01

    Our institution recently completed an expansion of an acute care inpatient unit within a satellite hospital that does not include an on-site ICU or PICU. Because of expected increases in volume and acuity, new care models for Rapid Response Teams (RRTs) and Code Blue Teams were necessary. Using simulation-based training, our objectives were to define the optimal roles and responsibilities for team members (including ICU physicians via telemedicine), refine the staffing of RRTs and code Teams, and identify latent safety threats (LSTs) before opening the expanded inpatient unit. The laboratory-based intervention consisted of 8 scenarios anticipated to occur at the new campus, with each simulation followed by an iterative debriefing process and a 30-minute safety talk delivered within 4-hour interprofessional sessions. In situ sessions were delivered after construction and before patients were admitted. A total of 175 clinicians completed a 4-hour course in 17 sessions. Over 60 clinicians participated during 2 in situ sessions before the opening of the unit. Eleven team-level knowledge deficits, 19 LSTs, and 25 system-level issues were identified, which directly informed changes and refinements in care models at the bedside and via telemedicine consultation. Simulation-based training can assist in developing staffing models, refining the RRT and code processes, and identify LSTs in a new pediatric acute care unit. This training model could be used as a template for other facilities looking to expand pediatric acute care at outlying smaller, more resource-limited facilities to evaluate new teams and environments before patient exposure. Copyright © 2017 by the American Academy of Pediatrics.

  12. Social and cultural dimensions of hygiene in Cambodian health care facilities.

    Science.gov (United States)

    Hancart-Petitet, Pascale; Dumas, Céline; Faurand-Tournaire, Anne-Laure; Desclaux, Alice; Vong, Sirenda

    2011-02-07

    The frequency of bloodborne pathogen healthcare-associated infections is thought to be high in developing Southeast Asian countries. The underlying social-cultural logics contributing to the risks of transmission are rarely studied. This report provides some insights on the social and cultural factors that shape hygiene practices in Cambodian health care settings. We conducted qualitative surveys in various public and private health facilities in Phnom Penh, the capital city and in provinces. We observed and interviewed 319 participants, health care workers and patients, regarding hygiene practices and social relationships amongst the health care staff and with patients. We also examined the local perceptions of hygiene, their impact on the relationships between the health care staff and patients, and perceptions of transmission risks. Data collection stem from face to face semi-structured and open-ended interviews and focus group discussions with various health care staffs (i.e. cleaners, nurses, midwives and medical doctors) and with patients who attended the study health facilities. Overall responses and observations indicated that hygiene practices were burdened by the lack of adequate materials and equipment. In addition, many other factors were identified to influence and distort hygiene practices which include (1) informal and formal social rapports in hospitals, (2) major infection control roles played by the cleaners in absence of professional acknowledgment. Moreover, hygiene practices are commonly seen as an unessential matter to be devoted to low-ranking staff. Our anthropological findings illustrate the importance of comprehensive understanding of hygiene practices; they need to be considered when designing interventions to improve infection control practices in a Cambodian medical setting.

  13. Social and cultural dimensions of hygiene in Cambodian health care facilities

    Directory of Open Access Journals (Sweden)

    Faurand-Tournaire Anne-Laure

    2011-02-01

    Full Text Available Abstract Background The frequency of bloodborne pathogen healthcare-associated infections is thought to be high in developing Southeast Asian Countries. The underlying social-cultural logics contributing to the risks of transmission are rarely studied. This report provides some insights on the social and cultural factors that shape hygiene practices in Cambodian health care settings. Methods We conducted qualitative surveys in various public and private health facilities in Phnom Penh, the capital city and in provinces. We observed and interviewed 319 participants, health care workers and patients, regarding hygiene practices and social relationships amongst the health care staff and with patients. We also examined the local perceptions of hygiene, their impact on the relationships between the health care staff and patients, and perceptions of transmission risks. Data collection stem from face to face semi-structured and open-ended interviews and focus group discussions with various health care staffs (i.e. cleaners, nurses, midwives and medical doctors and with patients who attended the study health facilities. Results Overall responses and observations indicated that hygiene practices were burdened by the lack of adequate materials and equipements. In addition, many other factors were identified to influence and distort hygiene practices which include (1 informal and formal social rapports in hospitals, (2 major infection control roles played by the cleaners in absence of professional acknowledgment. Moreover, hygiene practices are commonly seen as an unessential matter to be devoted to low-ranking staff. Conclusion Our anthropological findings illustrate the importance of comprehensive understanding of hygiene practices; they need to be considered when designing interventions to improve infection control practices in a Cambodian medical setting.

  14. Impact of Facilities on Academic Performance of Students with Special Needs in Mainstreamed Public Schools in Southwestern Nigeria

    Science.gov (United States)

    Fareo, Dorcas Oluremi; Ojo, Olakunbi Olubukola

    2013-01-01

    Facilities have a great impact on academic performances of students, and inadequate facilities translate to poor performance. The study examined the availability and convenience of the facilities that were provided to students with special educational needs in mainstreamed schools. It ascertained the qualifications of teachers teaching in…

  15. Variability in glycosylated hemoglobin values in diabetic patients living in long-term care facilities.

    Science.gov (United States)

    Meyers, Roberta M; Broton, Jay C; Woo-Rippe, Kathleen W; Lindquist, Sara A; Cen, Ye-Ying

    2007-10-01

    The objectives of this study were to determine the prevalence of diabetes and mean A1C of patients in long-term care facilities (LTCFs); to determine differences in A1C values based on patient characteristics; and to examine the self-reported practices of providers regarding diabetes management goals. Twelve-month retrospective review of patient charts; survey of physicians and nurse practitioners providing care to these patients. Nursing facility practice of an urban teaching hospital. Participants included 168 diabetic patients living in 20 nursing facilities and 18 physician and nurse practitioners in one practice providing care to these patients. The prevalence of diabetes was 21.6% (168 of 778 patients). Mean A1C was 7.1% +/- 1.2%for 135 patients who had AIC values measured during the study interval. A1C varied by age, with patients younger than 65 having higher A1C values than patients older than 65. Higher A1C values were associated with insulin use, frequent glucose monitoring, and attending a diabetes clinic. Although a survey of providers identified modifying A1C target ranges for LTCF compared with ambulatory patients, they did not reach consensus on the actual target A1C. No association between provider perception of either patient health status or patient life expectancy and A1C values was found. Relatively low A1C values were obtainable in LTCF patients without diabetes specialty clinic use. Providers identified modifying target A1C values for LTCF patients, but achieved relatively low A1C values and did not agree on a target A1C value for LTCF patients.

  16. Culture-independent analysis of bacterial diversity in a child-care facility

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    Tin Sara

    2007-04-01

    Full Text Available Abstract Background Child-care facilities appear to provide daily opportunities for exposure and transmission of bacteria and viruses. However, almost nothing is known about the diversity of microbial contamination in daycare facilities or its public health implications. Recent culture-independent molecular studies of bacterial diversity in indoor environments have revealed an astonishing diversity of microorganisms, including opportunistic pathogens and many uncultured bacteria. In this study, we used culture and culture-independent methods to determine the viability and diversity of bacteria in a child-care center over a six-month period. Results We sampled surface contamination on toys and furniture using sterile cotton swabs in four daycare classrooms. Bacteria were isolated on nutrient and blood agar plates, and 16S rRNA gene sequences were obtained from unique (one of a kind colony morphologies for species identification. We also extracted DNA directly from nine representative swab samples taken over the course of the study from both toy and furniture surfaces, and used "universal" 16S rRNA gene bacterial primers to create PCR-based clone libraries. The rRNA gene clones were sequenced, and the sequences were compared with related sequences in GenBank and subjected to phylogenetic analyses to determine their evolutionary relationships. Culturing methods identified viable bacteria on all toys and furniture surfaces sampled in the study. Bacillus spp. were the most commonly cultured bacteria, followed by Staphylococcus spp., and Microbacterium spp. Culture-independent methods based on 16S rRNA gene sequencing, on the other hand, revealed an entirely new dimension of microbial diversity, including an estimated 190 bacterial species from 15 bacterial divisions. Sequence comparisons and phylogenetic analyses determined that the clone libraries were dominated by a diverse set of sequences related to Pseudomonas spp., as well as uncultured

  17. How gender is born in a diagnostic child-care facility

    Directory of Open Access Journals (Sweden)

    Jana Benešová

    2014-11-01

    Full Text Available The article is a summary of the main findings concerning (reconstruction of the gender identities of children placed in a contemporary diagnostic child-care facility in the Czech Republic. The research setting has the fictitious name DDÚ Archa. The author of the arcticle is summarizing the interim results from her Ph.D. dissertation project. The goal is to catch processes which have been neglected so far by the Czech professional community, and which may become potential disciplinary tools in the hands of professionals in a wide range of helping professions, including social and special pedagogy.

  18. Medication Reconciliation in Long-Term Care and Assisted Living Facilities: Opportunity for Pharmacists to Minimize Risks Associated with Transitions of Care.

    Science.gov (United States)

    Gooen, Linda G

    2017-05-01

    The transitions of care process involves pharmacists and other members of the health care team who are in a position to collect, review, and analyze medications lists to help improve health care outcomes. Medication reconciliation is a complex process, especially when providing care to elderly population due to increased medication use, the movement of the patient from one health care setting to another, the number of acute and chronic illnesses, and the intervention of multiple health care providers in different facilities. The use of electronic health records can provide many benefits. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. An assessment of equity in the distribution of non-financial health care inputs across public primary health care facilities in Tanzania.

    Science.gov (United States)

    Kuwawenaruwa, August; Borghi, Josephine; Remme, Michelle; Mtei, Gemini

    2017-07-11

    There is limited evidence on how health care inputs are distributed from the sub-national level down to health facilities and their potential influence on promoting health equity. To address this gap, this paper assesses equity in the distribution of health care inputs across public primary health facilities at the district level in Tanzania. This is a quantitative assessment of equity in the distribution of health care inputs (staff, drugs, medical supplies and equipment) from district to facility level. The study was carried out in three districts (Kinondoni, Singida Rural and Manyoni district) in Tanzania. These districts were selected because they were implementing primary care reforms. We administered 729 exit surveys with patients seeking out-patient care; and health facility surveys at 69 facilities in early 2014. A total of seventeen indices of input availability were constructed with the collected data. The distribution of inputs was considered in relation to (i) the wealth of patients accessing the facilities, which was taken as a proxy for the wealth of the population in the catchment area; and (ii) facility distance from the district headquarters. We assessed equity in the distribution of inputs through the use of equity ratios, concentration indices and curves. We found a significant pro-rich distribution of clinical staff and nurses per 1000 population. Facilities with the poorest patients (most remote facilities) have fewer staff per 1000 population than those with the least poor patients (least remote facilities): 0.6 staff per 1000 among the poorest, compared to 0.9 among the least poor; 0.7 staff per 1000 among the most remote facilities compared to 0.9 among the least remote. The negative concentration index for support staff suggests a pro-poor distribution of this cadre but the 45 degree dominated the concentration curve. The distribution of vaccines, antibiotics, anti-diarrhoeal, anti-malarials and medical supplies was approximately

  20. [Determinant factors encouraging work motivation: a study of care staff working in health services facilities for elderly people].

    Science.gov (United States)

    Hotta, Kazushi; Okuno, Junko; Tomura, Sigeo; Yanagi, Hisako

    2009-12-01

    Work motivation among care workers influences the quality of care for facility residents. The purpose of this study was to identify related factors in care staff. Sixty hundred and seven care staff working at 25 health services facilities for elderly people participated in this study. We applied a theoretically derived model of specific relationships among work motivation, jobsatisfaction, profession identity, job competence, interprofessional working and profession image. These factor relationships were then tested using a structural equation modeling technique. Profession identity, job competence and the profession image of caring were shown to have direct influences on work motivation. In addition, job satisfaction, inter professional working, profession images of nursing and rehabilitation responsibilities were shown to have indirect influences. These data suggest that improving profession identity, job competence and the profession image of caring are important to enhance work motivation of care staff.

  1. Surgical Human Resources According to Types of Health Care Facility: An Assessment in Low- and Middle-Income Countries.

    Science.gov (United States)

    Sheik Ali, Shirwa; Jaffry, Zahra; Cherian, Meena N; Kunjumen, Teena; Nkwowane, Annette M; Leather, Andrew J M; Von Muhlenbrock, Hernan Montenegro; Kelley, Edward; Campbell, James

    2017-11-01

    A robust health care system providing safe surgical care to a population can only be achieved in conjunction with access to competent surgical personnel. It has been reported that 5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed. This study aims to fill the existing gap in evidence by quantifying shortfalls in trained personnel delivering safe surgical and anaesthetic care in low- and middle-income countries (LMICs) according to the type of health care facility. We conducted secondary analysis of 1323 health facilities, in 35 low- and middle-income countries using facility-based cross-sectional data from the World Health Organization Situational Analysis Tool to Assess Emergency and Essential Surgical Care. The majority of surgical and anaesthetic care in LMICs was provided by general doctors (range 13.8-41.1%; mean 27.1%). Non-physicians made up a significant proportion of the surgical workforce in LMICs. 26.76% of the surgical and anaesthetic workforce was provided by clinical medical officers and nurses. Private/NGO/mission hospitals, large, well-resourced institutions had the highest proportion of surgeons compared to any other type of health care facility at 27.92%. This compares to figures of 18.2 and 19.96% of surgeons at health centres and subdistrict/community hospitals, respectively, representing the lowest level of health facility. We highlight the significant proportion of non-physicians delivering surgical and anaesthetic care in LMICs and illustrate wide variations according to the type of health care facility.

  2. Investing in Post-Acute Care Transitions: Electronic Information Exchange Between Hospitals and Long-Term Care Facilities.

    Science.gov (United States)

    Cross, Dori A; Adler-Milstein, Julia

    2017-01-01

    Electronic health information exchange (HIE) is expected to help improve care transitions from hospitals to long-term care (LTC) facilities. We know little about the prevalence of hospital LTC HIE in the United States and what contextual factors may motivate or constrain this activity. Cross-sectional analysis of U.S. acute-care hospitals responding to the 2014 AHA IT Supplement survey and with available readmissions data (n = 1,991). We conducted multivariate logistic regression to explore the relationship between hospital LTC HIE and selected IT and policy characteristics. Over half of the hospitals in our study (57.2%) reported engaging in some form of HIE with LTC providers: 33.9% send-only, 0.5% receive-only, and 22.8% send and receive. Hospitals that engaged in some form of LTC HIE were more likely than those that did not engage to have attested to meaningful use (odds ratio [OR], 1.87; P = .01 for stage 1 and OR, 2.05; P value, those leading these organizations have new incentives to pursue collaborative relationships. Hospitals appear to be investing in electronic information exchange with LTCs as part of a general strategy to adopt EHRs and engage in HIE, but also potentially to strengthen ties to LTC providers and to reduce readmissions. To achieve widespread connectivity, continued focus on adoption of related health IT infrastructure and greater emphasis on aligning incentives for hospital-LTC care transitions would be valuable. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  3. A qualitative study exploring issues related to medication management in residential aged care facilities.

    Science.gov (United States)

    Ahmad Nizaruddin, Mariani; Omar, Marhanis-Salihah; Mhd-Ali, Adliah; Makmor-Bakry, Mohd

    2017-01-01

    Globally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs). A total of 11 stakeholders comprising health care providers, administrators, caretakers and residents were recruited from a list of registered government, nongovernmental organization and private RACFs in Malaysia from September 2016 to April 2017. An exploratory qualitative study adhering to Consolidated Criteria for Reporting Qualitative Studies was conducted. In-depth interview was conducted with consent of all participants, and the interviews were audio recorded for later verbatim transcription. Observational analysis was also conducted in a noninterfering manner. Three themes, namely medication use process, personnel handling medications and culture, emerged in this study. Medication use process highlighted an unclaimed liability for residents' medication by the RACFs, whereas personnel handling medications were found to lack sufficient training in medication management. Culture of the organization did affect the medication safety and quality improvement. The empowerment of the residents in their medication management was limited. There were unclear roles and responsibility of who manages the medication in the nongovernment-funded RACFs, although they were well structured in the private nursing homes. There are important issues related to medication management in RACFs which require a need to establish policy and guidelines.

  4. Patients Are Not Given Quality-Of-Care Data About Skilled Nursing Facilities When Discharged From Hospitals.

    Science.gov (United States)

    Tyler, Denise A; Gadbois, Emily A; McHugh, John P; Shield, Renée R; Winblad, Ulrika; Mor, Vincent

    2017-08-01

    Hospitals are now being held at least partly accountable for Medicare patients' care after discharge, as a result of regulations and incentives imposed by the Affordable Care Act. However, little is known about how patients select a postacute care facility. We used a multiple case study approach to explore both how patients requiring postacute care decide which skilled nursing facility to select and the role of hospital staff members in this decision. We interviewed 138 staff members of sixteen hospitals and twenty-five skilled nursing facilities and 98 patients in fourteen of the skilled nursing facilities. Most patients described receiving only lists of skilled nursing facilities from hospital staff members, while staff members reported not sharing data about facilities' quality with patients because they believed that patient choice regulations precluded them from doing so. Consequently, patients' choices were rarely based on readily available quality data. Proposed changes to the Medicare conditions of participation for hospitals that pertain to discharge planning could rectify this problem. In addition, less strict interpretations of choice requirements would give hospitals flexibility in the discharge planning process and allow them to refer patients to higher-quality facilities. Project HOPE—The People-to-People Health Foundation, Inc.

  5. Using Value Stream Mapping to improve quality of care in low-resource facility settings.

    Science.gov (United States)

    Ramaswamy, Rohit; Rothschild, Claire; Alabi, Funmi; Wachira, Eric; Muigai, Faith; Pearson, Nick

    2017-11-01

    Jacaranda Health (JH) is a Kenya-based organization that attempts to provide affordable, high-quality maternal and newborn healthcare through a chain of private health facilities in Nairobi. JH needed to adopted quality improvement as an organization-wide strategy to optimize effectiveness and efficiency. Value Stream Mapping, a Lean Management tool, was used to engage staff in prioritizing opportunities to improve clinical outcomes and patient-centered quality of care. Implementation was accomplished through a five-step process: (i) leadership engagement and commitment; (ii) staff training; (iii) team formation; (iv) process walkthrough; and (v) construction and validation. The Value Stream Map allowed the organization to come together and develop an end-to-end view of the process of care at JH and to select improvement opportunities for the entire system. The Value Stream Map is a simple visual tool that allows organizations to engage staff at all levels to gain commitment around quality improvement efforts.

  6. Older peoples' experiences of living in a residential aged care facility in Australia.

    Science.gov (United States)

    Walker, Helen; Paliadelis, Penelope

    2016-09-01

    The objectives of the study were to investigate the lived experience of older people in residential aged care facilities (RACFs) in Australia, to explore their perceptions of their lives in RACFs and how care might be improved. This qualitative study used a phenomenological approach to explore the lived experience of older persons in RACFs across two Australian states. In-depth interviews regarding independence, dignity, autonomy, communication and relationships were conducted with 18 participants. The interviews were audiotaped, transcribed and thematically analysed. Three themes emerged reflecting the reality of RACF life for these participants: (i) loss of autonomy, dignity and control; (ii) valuing important relationships; and (iii) resigned acceptance. Older people were not included in decision-making and found it difficult to maintain their autonomy and dignity, and forge meaningful relationships. They traded their independence and dignity for the safety and assistance they needed; however, they accepted this trade-off with stoicism and remained positive. © 2016 AJA Inc.

  7. Capital Ideas for Facilities Management.

    Science.gov (United States)

    Golding, Stephen T.; Gordon, Janet; Gravina, Arthur

    2001-01-01

    Asserting that just like chief financial officers, higher education facilities specialists must maximize the long-term performance of assets under their care, describes strategies for strategic facilities management. Discusses three main approaches to facilities management (insourcing, cosourcing, and outsourcing) and where boards of trustees fit…

  8. Expert care of the performing artist.

    Science.gov (United States)

    Bird, Howard; Macdonald, Ian

    2013-04-01

    Compared to elite athletes, elite performers, especially musicians and dancers, invariably lack expert medical backup even though their needs are just as great as the sportspeople. In some countries, this is now being realised and addressed. It is hoped that a new MSc in Performing Arts Medicine, recently introduced in the UK, will go some way towards correcting this, and its syllabus has provided the catalyst for this themed issue.

  9. A student-led demonstration project on fall prevention in a long-term care facility.

    Science.gov (United States)

    Bonner, Alice; MacCulloch, Patricia; Gardner, Terri; Chase, Chantel W

    2007-01-01

    Falls are a frequent and serious problem facing people aged 65 and older. The incidence of falls increases with greater numbers of intrinsic and extrinsic risk factors and can be reduced by risk modification and targeted interventions. Falls account for 70% of accidental deaths in persons aged 75 and older. Mortality due to falls is significantly higher for older adults living in extended care facilities versus those living in the community. Our objective was to evaluate the effectiveness of a fall prevention training program in a long-term care setting. A single-group repeated-measure design was used, guided by the Precede-Proceed framework. A comprehensive review of the literature and a concept analysis guided the development of testing and educational materials for all nursing and ancillary facility staff. Preliminary testing provided baseline data on knowledge related to fall prevention. Pre- and posttests, a fall prevention newsletter, and informational brochures were distributed to nursing staff and ancillary personnel at training sessions. Certified nursing assistant (CNA) champions were identified and given peer leadership training. "Quick Tips" fall prevention badges were also distributed to staff. Graduate students led interdisciplinary environmental rounds weekly, and new falls were reviewed on a daily basis by the interdisciplinary team. A 60-day posttest evaluated retention of fall prevention knowledge. Fall rates at baseline and for 2 months after the intervention were compared. Preliminary survey data revealed fall prevention learning opportunities, with a pretest mean score of 86.78%. Qualitative data were coded and revealed specific learning gaps in intrinsic, extrinsic, and organizational causes of falls. The 60-day posttest mean score was 90.69%; a paired t test (t score = -1.050; P = .057) suggested that learning may have taken place; however, differences in scores did not reach statistical significance. The fall rate before training was 16

  10. Hospice Care in Assisted Living Facilities Versus at Home: Results of a Multisite Cohort Study.

    Science.gov (United States)

    Dougherty, Meredith; Harris, Pamela S; Teno, Joan; Corcoran, Amy M; Douglas, Cindy; Nelson, Jackie; Way, Deborah; Harrold, Joan E; Casarett, David J

    2015-06-01

    To compare residents of assisted living facilities receiving hospice with people receiving hospice care at home. Electronic health record-based retrospective cohort study. Nonprofit hospices in the Coalition of Hospices Organized to Investigate Comparative Effectiveness network. Individuals admitted to hospice between January 1, 2008, and May 15, 2012 (N = 85,581; 7,451 (8.7%) assisted living facility, 78,130 (91.3%) home). Hospice length of stay, use of opioids for pain, and site of death. The assisted living population was more likely than the home hospice population to have a diagnosis of dementia (23.5% vs 4.7%; odds ratio (OR) = 13.3, 95% confidence interval (CI) = 12.3-14.4; P < .001) and enroll in hospice closer to death (median length of stay 24 vs 29 days). Assisted living residents were less likely to receive opioids for pain (18.1% vs 39.7%; OR = 0.33, 95% CI = 0.29-0.39, P < .001) and less likely to die in an inpatient hospice unit (9.3% vs 16.1%; OR = 0.53, 95% CI = 0.49-0.58, P < .001) or a hospital (1.3% vs 7.6%; OR = 0.16, 95% CI = 0.13-0.19, P < .001). Three are several differences between residents of assisted living receiving hospice care and individuals living at home receiving hospice care. A better understanding of these differences could allow hospices to develop guidelines for better coordination of end-of-life care for the assisted living population. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

  11. Staff Knowledge, Awareness, Perceptions, and Beliefs About Infection Prevention in Pediatric Long-term Care Facilities.

    Science.gov (United States)

    Løyland, Borghild; Wilmont, Sibyl; Hessels, Amanda J; Larson, Elaine

    2016-01-01

    The burden of healthcare-associated infection worldwide is considerable, and there is a need to improve surveillance and infection control practices such as hand hygiene. The aims of this study were to explore direct care providers' knowledge about infection prevention and hand hygiene, their attitudes regarding their own and others' hand hygiene practices, and their ideas and advice for improving infection prevention efforts. This exploratory study included interviews with direct care providers in three pediatric long-term care facilities. Two trained nurse interviewers conducted semistructured interviews using an interview guide with open-ended questions. Two other nurse researchers independently transcribed the audio recordings and conducted a thematic analysis using a strategy adapted from the systematic text condensation approach. From 31 interviews, four major thematic categories with subthemes emerged from the analysis: (a) hand hygiene products; (b) knowledge, awareness, perceptions, and beliefs; (c) barriers to infection prevention practices; and (d) suggested improvements. There was confusion regarding hand hygiene recommendations, use of soap or sanitizer, and isolation precaution policies. There was a robust "us" and "them" mentality between professionals. One essential driver of staff behavior change is having expectations that are meaningful to staff, and many staff members stated that they wanted more in-person staff meetings with education and hands-on, practical advice. Workflow patterns and/or the physical environment need to be carefully evaluated to identify systems and methods to minimize cross-contamination. Further studies need to evaluate if personal sized containers of hand sanitizer (e.g., for the pocket, attached to a belt or lanyard) would facilitate improvement of hand hygiene in these facilities.

  12. Comparison of postarthroplasty functional outcomes in skilled nursing facilities among Medicare and Managed Care beneficiaries

    Directory of Open Access Journals (Sweden)

    Brandon A. Haghverdian, BSc

    2017-12-01

    Full Text Available Background: After home health care, the skilled nursing facility (SNF is the most commonly used postacute care modality, among Medicare beneficiaries, after total joint arthroplasty. Prior studies demonstrated that a loss in postsurgical ambulatory gains is incurred in the interval between hospital discharge and arrival at the SNF. The aim of this present study is to determine the consequences of that loss in function, as well as compare SNF-related outcomes in patients with Medicare vs Managed Care (MC insurance. Methods: We conducted a retrospective analysis of 80 patients (54 Medicare and 26 MC who attended an SNF after hospitalization for total joint arthroplasty. Outcomes from physical therapy records were abstracted from each patient's SNF file. Results: There was an approximately 40% drop-off in gait achievements between hospital discharge and SNF admission. This decline in ambulation was significantly greater in Medicare patients (Medicare: 94.6 ± 123.2 ft, MC: 40.0 ± 48.9 ft, P = .034. Larger reductions in gait achievements between hospital discharge and SNF admission were significantly correlated with longer SNF lengths of stay and poorer gait achievements by SNF discharge. Patients with MC insurance made significant improvements in gait training at the SNF beyond that which was acquired at the hospital, whereas Medicare patients did not (PMedicare = .28, PMC = .003. Conclusions: Large losses in motor function between hospital discharge and SNF admission were associated with poor functional outcomes and longer stays at the SNF. These effects were more pronounced in Medicare patients than those with MC insurance. Keywords: Total joint arthroplasty, Skilled nursing facility, Medicare, Managed Care, Physical therapy

  13. Psychometric properties of the Balance Computerized Adaptive Test in residents in long-term care facilities.

    Science.gov (United States)

    Lu, Wen-Shian; Lien, Bella Ya-Hui; Hsieh, Ching-Ling

    2015-01-01

    To validate the psychometric properties and efficiency of the Balance Computerized Adaptive Testing (Balance CAT) when applied to residents in long-term care (LTC) facilities. A cohort study was conducted in central Taiwan. The Balance CAT, the Berg Balance Scale (BBS), and the Barthel Index (BI) were administered to each participant with the ability to follow simple instructions by a trained rater in two days. The Pearson's correlation coefficient (r) was used to determine the concurrent validity of the Balance CAT. ANOVA and post hoc analysis were employed to investigate the discriminative ability of the Balance CAT. The paired t test was used to validate the efficiency. A total of 120 participants completed assessments of the Balance CAT, the BBS, and the Barthel Index (BI). The Pearson's r between the scores of the Balance CAT and the BBS was 0.90. Groups with different levels of dependence had significantly different mean scores of the Balance CAT. The mean IRT reliability of the Balance CAT scores was 0.93. The mean administration time of the Balance CAT was about 28% of that of the BBS, and the mean number of items used in the Balance CAT was 3.4. The Balance CAT had excellent concurrent and discriminative validity, reliability, and efficiency in residents of LTC facilities. These results indicate that the Balance CAT is a sound and practical measure for assessing the balance function of residents of LTC facilities. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Clinical significance of methicillin-resistant Staphylococcus aureus colonization in residents in community long-term-care facilities in Spain.

    Science.gov (United States)

    Manzur, A; De Gopegui, E Ruiz; Dominguez, M; Mariscal, D; Gavalda, L; Perez, J L; Segura, F; Pujol, M

    2012-03-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in Spanish hospitals and community long-term-care facilities (LTCFs). This longitudinal study was performed in community LTCFs to determine whether MRSA colonization is associated with MRSA infections and overall mortality. Nasal and decubitus ulcer cultures were performed every 6 months for an 18-month period on 178 MRSA-colonized residents (86 490 patient-days) and 196 non-MRSA carriers (97 470 patient-days). Fourteen residents developed MRSA infections and 10 of these were skin and soft tissue infections. Two patients with respiratory infections required hospitalization. The incidence rate of MRSA infection was 0·12/1000 patient-days in MRSA carriers and 0·05/1000 patient-days in non-carriers (P=0·46). No difference in MRSA infection rate was found according to the duration of MRSA colonization (P=0·69). The mortality rate was 20·8% in colonized residents and 16·8% in non-carriers; four residents with MRSA infection died. Overall mortality was statistically similar in both cohorts. Our results suggest that despite a high prevalence of MRSA colonization in LTCFs, MRSA infections are neither frequent nor severe while colonized residents remain at the facility. The epidemiological impact of an MRSA reservoir is more relevant than the clinical impact of this colonization for an individual resident and supports current recommendations to control MRSA spread in community LTCFs.

  15. Understanding health care provider barriers to hospital affiliated medical fitness center facility referral: a questionnaire survey and semi structured interviews.

    Science.gov (United States)

    Smock, Carissa; Alemagno, Sonia

    2017-08-03

    The purpose of this study is to understand health care provider barriers to referring patients to Medical Fitness Center Facilities within an affiliated teaching hospital system using referral of diabetic services as an example. The aims of this study include: (1) to assess health care providers' awareness and use of facilities, (2) to determine barriers to referring patients to facilities, (3) identify current and needed resources and/or changes to increase referral to facilities. A 20-item electronic survey and requests for semi-structured interviews were administered to hospital system directors and managers (n = 51). Directors and managers instructed physicians and staff to complete the survey and interviews as applicable. Perceived barriers, knowledge, utilization, and referral of patients to Medical Fitness Center Facilities were collected and examined. Descriptive statistics were generated regarding practice characteristics, provider characteristics, and referral. Of the health care providers surveyed and interviewed (n = 25) 40% indicated verbally suggesting use of facilities, 24% provided a flyer about the facilities. No respondents indicated that they directly referred patients to the facilities. However, 16% referred patients to other locations for physical activity - including their own department's management and prevention services. 20% do not refer to Medical Fitness Center Facilities or any other lifestyle programs/locations. Lack of time (92%) and lack of standard guidelines and operating procedures (88%) are barriers to referral. All respondents indicated a strong ability to refer patients to Medical Fitness Center Facilities if given education about referral programs available as well as standard clinical guidelines and protocol for delivery. The results of this study indicate that, although few healthcare providers are currently referring patients to Medical Fitness Center Facilities, health care providers with an affiliated Medical Fitness

  16. End-of-Life Care and Discussions in Japanese Geriatric Health Service Facilities: A Nationwide Survey of Managing Directors' Viewpoints.

    Science.gov (United States)

    Kanoh, Asako; Kizawa, Yoshiyuki; Tsuneto, Satoru; Yokoya, Shoji

    2018-01-01

    Geriatric health service facilities (GHSFs) play important roles as intermediate care facilities for elderly individuals temporarily when they need rehabilitation before returning home. However, the number of residents spending their end-of-life (EOL) period in such facilities is increasing. To improve the quality of EOL care, end-of-life discussions (EOLDs) are recommended by some guidelines and studies. This study aimed to clarify the current practice of EOL care and EOLDs in GHSFs in Japan. We conducted a nationwide cross-sectional survey by mailing questionnaires about EOL care and EOLDs to 3437 GHSF managing directors. The questionnaire was developed through a literature review and discussion among the researchers and experts. Descriptive statistics summarized the data. We also analyzed the factors related to GHSFs conducting EOLDs using Fisher exact tests. The response rate was 20.7% (713 of 3437). Among the respondents, 75.2% (536 of 713) of GHSFs provided EOL care and 73.1% (521 of 713) conducted EOLDs. The most common reasons for difficulties in providing EOL care included the lack of EOL education for nurses and care workers, and their fear about caring for dying residents. End-of-life discussions were mostly initiated after the deterioration of a resident's condition and were conducted with families by physicians. Statistically significant factors of GHSFs conducting EOLDs included providing EOL education for nurses and care workers, availability of private room for critically ill residents, emergency on-call doctors, and EOL care. Adequate practical staff education programs for EOL care including EOLDs may be crucial for quality of end-of-life care in aged care facilities.

  17. Quality of tuberculosis care in six health facilities of Afar Region, Ethiopia.

    Science.gov (United States)

    Girma, Anteneh; H/Mariam, Damen; Deribe, Kebede

    2010-07-01

    Quality tuberculosis care plays an important role in the status of tuberculosis (TB) control, treatment completion and adherence. Nonetheless, very little is known about the quality of TB care in public health facilities in Ethiopia. In this study we assessed the quality of TB care delivery in Afar Region of Ethiopia. A descriptive cross sectional health institution based survey with both semi-structured and structured questionnaires was employed. A mix of complementary techniques was administered Data were collected between 5th February and 10th March 2007 from six health institutions. Records were reviewed for 270 patients, exit interviews were made for 209 patients, six providers were interviewed & 49 patients were observed Data was collected by trained nurses and analyzed using SPSS 11.0 statistical software. The study had showed that delivery of materials, drugs and supplies for tuberculosis control activities were fairly good. Staffing qualities were poor and patterns of supervision were weak. A relatively higher proportion of patients were dissatisfied with the appropriateness and adequacy of working hours (63.6%) and waiting time (70.3%). Statistically significant correlation was observed between process quality and output quality (clients' satisfaction) parameters (p .001). Continues quality improvement mechanisms to improve the different aspects of the programme and adherence to the National Tuberculosis and Leprosy Control Program guideline could be important interventions to enhance the quality of care delivery. An expanded community-based study to better guide quality DOTS program in pastoralist communities is crucial.

  18. Job Satisfactions of Nurses and Physicians Working in the Same Health Care Facility in Turkey

    Directory of Open Access Journals (Sweden)

    Züleyha Alper

    2011-01-01

    Full Text Available Background: Job satisfaction is defined as the degree to which employees like or enjoy their jobs and the degreeof satisfaction is based on the importance placed upon this reward and benefit.Objective: Aim of this study was to determine the job satisfaction levels of nurses and physicians working in thesame health care facility, analyze the factors that may affect job satisfaction levels. This study was conducted asa descriptive study and was carried out in one Medical Care Center Northwestern Region of Turkey, Bursa.Results:A job satisfaction scale developed by researchers according to literature review. The scale contained 36items related to measure job satisfaction levels of the participants. Data were collected from 65 nurses and 15physicians. Motivation of nurses is significantly higher than physicians. There is no affect of nurses’ educationlevels on general job satisfaction levels (p>0.05. No significant association was found between gender andmotivation (p>0.05. Payments and organization–related factors affect job satisfaction among nurses andphysicians.Conclusion:This scale yielded significant results in all subgroups except for satisfaction with patient treatment,care services and age. Seniority in the profession and age correlates with general job satisfaction level. Futurestudies need to focus on if job dissatisfaction affects health care workers to quit their jobs, differences amonggenders and profession.

  19. Noroviruses associated with acute gastroenteritis in a children's day care facility in Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Gallimore C.I.

    2004-01-01

    Full Text Available Noroviruses (Norwalk-like viruses are an important cause of gastroenteritis worldwide. They are the most common cause of outbreaks of gastroenteritis in the adult population and occur in nursing homes for the elderly, geriatric wards, medical wards, and in hotel and restaurant settings. Food-borne outbreaks have also occurred following consumption of contaminated oysters. This study describes the application of a reverse transcription-polymerase chain reaction (RT-PCR assay using random primers (PdN6 and specific Ni and E3 primers, directed at a small region of the RNA-dependent RNA polymerase-coding region of the norovirus genome, and DNA sequencing for the detection and preliminary characterisation of noroviruses in outbreaks of gastroenteritis in children in Brazil. The outbreak samples were collected from children <5 years of age at the Bertha Lutz children's day care facility at Oswaldo Cruz Foundation (Fiocruz, Rio de Janeiro, that occurred between 1996 and 1998, where no pathogen had been identified. At the Bertha Lutz day care center facility, only Fiocruz's employee children are provided for, and they come from different social, economic and cultural backgrounds. Three distinct genogroup II strains were detected in three outbreaks in 1997/98 and were most closely related to genotypes GII-3 (Mexico virus and GII-4 (Grimsby virus, both of which have been detected in paediatric and adult outbreaks of gastroenteritis worldwide.

  20. Norovirus genotype diversity associated with gastroenteritis outbreaks in aged-care facilities.

    Science.gov (United States)

    Bruggink, L D; Dunbar, N L; Marshall, J A

    2015-10-01

    Noroviruses are a major cause of gastroenteritis. Vaccine strategies against norovirus are currently under consideration but depend on a detailed knowledge of the capsid genotypes. This study examined the incidence of norovirus outbreaks in residential aged-care facilities in Victoria, Australia over one year (2013) and documented the (capsid) norovirus genotypes associated with these outbreaks. It was found that 65·0% of 206 outbreaks tested were associated with norovirus infection, thereby showing norovirus to be the major cause of viral gastroenteritis in residential aged-care facilities. Fifteen capsid (open reading frame 2) genotypes were identified as follows: GI.2 (0·9%), GI.3 (1·8%), GI.4 (3·7%), GI.6 (0·9%), GI.7 (0·9%), GI.8 (0·9%), GII.1 (0·9%), GII.2 (0·9%), GII.3 (1·8%), GII.4 (2009-like) (0·9%), GII.4 (2012) (48·6%), GII.4 (2012-like) (16·5%), GII.4 (unknown) (9·2%), GII.5 (2·8%), GII.6 (0·9%), GII.7 (0·9%), GII.13 (6·4%) and an as yet unclassified GII genotype (0·9%). Although GII.4 was the most common norovirus capsid genotype detected, the great diversity of norovirus genotypes in the elderly indicates vaccination strategies for this demographic are not straightforward.

  1. Privacy and senior willingness to adopt smart home information technology in residential care facilities.

    Science.gov (United States)

    Courtney, K L

    2008-01-01

    With large predicted increases of the older adult (65 years and older) population, researchers have been exploring the use of smart home information technologies (IT) in residential care (RC) facilities to enhance resident quality of life and safety. Older adults' perceptions of privacy can inhibit their acceptance and subsequent adoption of smart home IT. This qualitative study, guided by principles of grounded theory research, investigated the relationship between privacy, living environment and willingness of older adults living in residential care facilities to adopt smart home IT through focus groups and individual interviews. The findings from this study indicate that privacy can be a barrier for older adults' adoption of smart home IT; however their own perception of their need for the technology may override their privacy concerns. Privacy concerns, as a barrier to technology adoption, can be influenced by both individual-level and community-level factors. Further exploration of the factors influencing older adults' perceptions of smart home IT need is necessary.

  2. Does training on performance based financing make a difference in performance and quality of health care delivery? Health care provider's perspective in Rungwe Tanzania.

    Science.gov (United States)

    Manongi, Rachel; Mushi, Declare; Kessy, Joachim; Salome, Saria; Njau, Bernard

    2014-04-04

    In recent years, Performance Based Financing (PBF); a form of result based financing, has attracted a global attention in health systems in developing countries. PBF promotes autonomous health facilities, motivates and introduces financial incentives to motivate health facilities and health workers to attain pre-determined targets. To achieve this, the Tanzanian government through the Christian Social Services Commission initiated a PBF pilot project in Rungwe district, Mbeya region. Kilimanjaro Christian Medical Center was given the role of training health workers on PBF principles in Rungwe. The aim of this study was to explore health care providers' perception on a three years training on PBF principles in a PBF pilot project at Rungwe District in Mbeya, Tanzania. This was an explorative qualitative study, which took place at Rungwe PBF pilot area in October 2012. Twenty six (26) participants were purposively selected. Six took part in- depth interviews (IDIs) and twenty (20) in the group discussions. Both the IDIs and the GDs explored the perceived benefit and challenges of implementing PBF in their workplace. Data were manually analyzed using content analysis approach. Overall informants had positive perspectives on PBF training. Most of the health facilities were able to implement some of the PBF concepts in their work places after the training, such as developing job descriptions for their staff, creating quarterly business plans for their facilities, costing for their services and entering service agreement with the government, improved record keeping, customer care and involving community as partners in running their facilities. The most common principle of paying individual performance bonuses was mentioned as a major challenge due to inadequate funding and poor design of Rungwe PBF pilot project. Despite poor design and inadequate funding, our findings have shown some promising results after PBF training in the study area. The findings have highlighted

  3. Does training on performance based financing make a difference in performance and quality of health care delivery? Health care provider’s perspective in Rungwe Tanzania

    Science.gov (United States)

    2014-01-01

    Background In recent years, Performance Based Financing (PBF); a form of result based financing, has attracted a global attention in health systems in developing countries. PBF promotes autonomous health facilities, motivates and introduces financial incentives to motivate health facilities and health workers to attain pre-determined targets. To achieve this, the Tanzanian government through the Christian Social Services Commission initiated a PBF pilot project in Rungwe district, Mbeya region. Kilimanjaro Christian Medical Center was given the role of training health workers on PBF principles in Rungwe. The aim of this study was to explore health care providers’ perception on a three years training on PBF principles in a PBF pilot project at Rungwe District in Mbeya, Tanzania. Methods This was an explorative qualitative study, which took place at Rungwe PBF pilot area in October 2012. Twenty six (26) participants were purposively selected. Six took part in- depth interviews (IDIs) and twenty (20) in the group discussions. Both the IDIs and the GDs explored the perceived benefit and challenges of implementing PBF in their workplace. Data were manually analyzed using content analysis approach. Results Overall informants had positive perspectives on PBF training. Most of the health facilities were able to implement some of the PBF concepts in their work places after the training, such as developing job descriptions for their staff, creating quarterly business plans for their facilities, costing for their services and entering service agreement with the government, improved record keeping, customer care and involving community as partners in running their facilities. The most common principle of paying individual performance bonuses was mentioned as a major challenge due to inadequate funding and poor design of Rungwe PBF pilot project. Conclusion Despite poor design and inadequate funding, our findings have shown some promising results after PBF training in the

  4. Is Accessibility to Dental Care Facilities in Rural Areas Associated with Number of Teeth in Elderly Residents?

    Directory of Open Access Journals (Sweden)

    Tsuyoshi Hamano

    2017-03-01

    Full Text Available Given that public transportation networks are less developed in rural than in urban areas, a lack of accessibility to dental care facilities could be a barrier to routine dental checkups. Thus, we hypothesized that the distance to the dental care facilities is a risk factor for tooth loss. The aim of this study was to test whether there is an association between the distance to dental care facilities, estimated by geographic information systems, and number of teeth, assessed by an oral examination, among elderly residents of a rural area in Japan. Data were collected in 2016 from a cross-sectional study conducted in Shimane prefecture, Japan. After excluding participants with missing data (n = 21, we analyzed data from 710 participants. Of them, 40.6% were male and the mean (standard deviation age was 67.4 (7.4 years. Further, 68.0% (n = 483 had at least 20 teeth. We found that the distance to dental care facilities was significantly associated with the number of teeth (less than 20 (odds ratio = 1.07, 95% confidence interval = 1.01–1.12 after adjustment for potential confounders. This result suggested that individuals without easy access to dental care facilities may be important targets for dental care.

  5. Is Accessibility to Dental Care Facilities in Rural Areas Associated with Number of Teeth in Elderly Residents?

    Science.gov (United States)

    Hamano, Tsuyoshi; Takeda, Miwako; Tominaga, Kazumichi; Sundquist, Kristina; Nabika, Toru

    2017-03-21

    Given that public transportation networks are less developed in rural than in urban areas, a lack of accessibility to dental care facilities could be a barrier to routine dental checkups. Thus, we hypothesized that the distance to the dental care facilities is a risk factor for tooth loss. The aim of this study was to test whether there is an association between the distance to dental care facilities, estimated by geographic information systems, and number of teeth, assessed by an oral examination, among elderly residents of a rural area in Japan. Data were collected in 2016 from a cross-sectional study conducted in Shimane prefecture, Japan. After excluding participants with missing data (n = 21), we analyzed data from 710 participants. Of them, 40.6% were male and the mean (standard deviation) age was 67.4 (7.4) years. Further, 68.0% (n = 483) had at least 20 teeth. We found that the distance to dental care facilities was significantly associated with the number of teeth (less than 20) (odds ratio = 1.07, 95% confidence interval = 1.01-1.12) after adjustment for potential confounders. This result suggested that individuals without easy access to dental care facilities may be important targets for dental care.

  6. Hand-hygiene practices and observed barriers in pediatric long-term care facilities in the New York metropolitan area.

    Science.gov (United States)

    Løyland, Borghild; Wilmont, Sibyl; Cohen, Bevin; Larson, Elaine

    2016-02-01

    To describe hand-hygiene practices in pediatric long-term care (pLTC) facilities and to identify observed barriers to, and potential solutions for, improved infection prevention. Observational study using (i) the World Health Organization's '5 Moments for Hand Hygiene' validated observation tool to record indications for hand hygiene and adherence; and (ii) individual logs of subjective impressions of behavioral and/or systemic barriers witnessed during direct observation. Staff in three pLTC facilities (284 beds total) were observed by two trained nurses 1 day a week for 3 weeks in February and March 2015. Direct providers of health, therapeutic and rehabilitative care, and other staff responsible for social and academic activities for children with complex, chronic medical conditions. Hand-hygiene indications, adherence and barriers. Hand hygiene was performed for 40% of the 847 indications observed and recorded. Adherence increased at one site and decreased in the other two sites during the study period. Adherence appeared to be influenced by individuals' knowledge, attitudes, beliefs and work setting. Poor hand-hygiene adherence was observed overall. Specific barriers were identified, which suggest a contextual approach to the interpretation of results indicated in this uniquely challenging setting. We offer some practical suggestions for overcoming those barriers or mitigating their effect. Ultimately, an adaptation of the '5 Moments for Hand Hygiene' may be necessary to improve infection prevention in pLTC. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  7. Exercise for falls and fracture prevention in long term care facilities: a systematic review and meta-analysis.

    Science.gov (United States)

    Silva, Raimunda B; Eslick, Guy D; Duque, Gustavo

    2013-09-01

    The overall effect of exercise on falls and fracture prevention in long term care facilities remains controversial. In this study, we aimed to analyze the impact and the characteristics of the most effective physical exercise regime to prevent falls and fractures in this particular setting. Our search looked for randomized controlled trials published in English language between January 1974 and June 2012 in electronic databases including MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, Allied and Complementary Medicine, and Occupational Therapy Seeker that specifically tested the effect of exercise on falls and/or fractures in long term care residents. Two investigators independently extracted data and assessed study quality. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was applied throughout the systematic review and meta-analysis. Twelve studies were selected that included 1292 participants. Most of the participants were women (68%) with a mean age of 83.9 ± 9 years. The intervention period was between 3 and 24 months, and the most commonly performed intervention were balance and resistance training exercises. Meta-analysis showed that exercise has a preventive effect on falls (risk ratio [RR] = 0.77, 95% confidence interval [CI], 0.64-0.92; I(2) = 72.18, P exercises (RR = 0.71, 95% CI, 0.55-0.90; I(2) = 72.07, P exercise did not show any effect on fracture prevention (RR = 0.57, 95% CI, 0.21-1.57; I(2) = 48.805). Combined, frequent and long-term exercise programs are effective to prevent falls in long term care facilities. No effect of exercise on fracture prevention was observed in this population. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  8. Critical Care Performance in a Simulated Military Aircraft Cabin Environment

    Science.gov (United States)

    2007-01-01

    significantly contribute cognitive performance in this study with the exception of Critical Care Time 14, Defibrillates 1st time. The regression for CRRT 14 with...this study with the exception of Critical Care Time 14, Defibrillates 1 t time. The regression for CRRT 14 with altitude and noise as was

  9. Child Care Services Guide. Performance Objectives. Criterion Measures. Home Economics.

    Science.gov (United States)

    Duval County School Board, Jacksonville, FL.

    Several intermediate performance objectives and corresponding criterion measures are listed for each of 14 terminal objectives for a high school child care services course. This course is designed to provide opportunities for exploring a broad range of child care, guidance, and service occupations. Major concepts include characteristics of…

  10. Performance analysis of online health care system | Kohli ...

    African Journals Online (AJOL)

    This paper deals with selection of appropriate indexing techniques applied on MySQL database for a health care system and its related performance issues. The proposed Smart Card based Online Health Care System deals with frequent data storage, exchange and retrieval of data from the database servers. Speed and ...

  11. Factors Associated With Early Readmission Among Patients Discharged to Post-Acute Care Facilities.

    Science.gov (United States)

    Horney, Carolyn; Capp, Roberta; Boxer, Rebecca; Burke, Robert E

    2017-06-01

    Over a quarter of Medicare patients admitted to the hospital are discharged to post-acute care (PAC) facilities, but face high rates of readmission. Timing of readmission may be an important factor in identifying both risk for and preventability of future readmissions. This study aims to define factors associated with readmission within the first week of discharge to PAC facilities following hospitalization. This was a secondary analysis of the 2011 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for California, Massachusetts, and Florida. The primary outcome was all-cause readmission within 7 days after hospital discharge, compared to readmission on days 8-30, for patients aged 65 and older who were discharged from the hospital to a PAC facility. Predictor variables included patient, index hospitalization, and hospital characteristics; multivariable logistic regression was used to identify significant predictors of readmission within 7 days. There were 81,173 hospital readmissions from PAC facilities in the first 30 days after hospital discharge. Patients readmitted within the first week were older, white, urban, had fewer comorbid illnesses, had a higher number of previous hospital admissions, and less commonly had Medicare as a payer. Longer index hospital length of stay (LOS) was associated with decreased risk of early readmission (OR 0.74; 95% CI 0.70-0.74 for LOS 4-7 days and 0.60; 95% CI 0.56-0.64 for LOS ≥8 days). Shorter length of index hospital stay is associated with earlier readmission and suggests that for this comorbid, older population, a shorter hospital stay may be detrimental. Readmission after 1 week is associated with increased chronic disease burden, suggesting they may be associated with factors that are less modifiable. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  12. The Aged Residential Care Healthcare Utilization Study (ARCHUS): a multidisciplinary, cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities.

    Science.gov (United States)

    Connolly, Martin J; Boyd, Michal; Broad, Joanna B; Kerse, Ngaire; Lumley, Thomas; Whitehead, Noeline; Foster, Susan

    2015-01-01

    To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities. Cluster randomized controlled trial. RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control. A total of 1998 residents of 18 intervention facilities and 18 control facilities. A facility-based complex intervention of 9 months' duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria. Primary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up was for a total of 14 months. The intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85-1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76-1.61; P = .62). This multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging. Australian and New Zealand Clinical Trials Registry (ACTRN12611000187943). Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  13. Critical Care Organizations: Business of Critical Care and Value/Performance Building.

    Science.gov (United States)

    Leung, Sharon; Gregg, Sara R; Coopersmith, Craig M; Layon, A Joseph; Oropello, John; Brown, Daniel R; Pastores, Stephen M; Kvetan, Vladimir

    2018-01-01

    New, value-based regulations and reimbursement structures are creating historic care management challenges, thinning the margins and threatening the viability of hospitals and health systems. The Society of Critical Care Medicine convened a taskforce of Academic Leaders in Critical Care Medicine on February 22, 2016, during the 45th Critical Care Congress to develop a toolkit drawing on the experience of successful leaders of critical care organizations in North America for advancing critical care organizations (Appendix 1). The goal of this article was to provide a roadmap and call attention to key factors that adult critical care medicine leadership in both academic and nonacademic setting should consider when planning for value-based care. Relevant medical literature was accessed through a literature search. Material published by federal health agencies and other specialty organizations was also reviewed. Collaboratively and iteratively, taskforce members corresponded by electronic mail and held monthly conference calls to finalize this report. The business and value/performance critical care organization building section comprised of leaders of critical care organizations with expertise in critical care administration, healthcare management, and clinical practice. Two phases of critical care organizations care integration are described: "horizontal," within the system and regionalization of care as an initial phase, and "vertical," with a post-ICU and postacute care continuum as a succeeding phase. The tools required for the clinical and financial transformation are provided, including the essential prerequisites of forming a critical care organization; the manner in which a critical care organization can help manage transformational domains is considered. Lastly, how to achieve organizational health system support for critical care organization implementation is discussed. A critical care organization that incorporates functional clinical horizontal and

  14. Role of health care professionals in multidisciplinary pain treatment facilities in Canada

    Science.gov (United States)

    Peng, Philip; Stinson, Jennifer N; Choiniere, Manon; Dion, Dominique; Intrater, Howard; LeFort, Sandra; Lynch, Mary; Ong, May; Rashiq, Saifee; Tkachuk, Gregg; Veillette, Yves

    2008-01-01

    PURPOSE: To examine the role of health care professionals in multidisciplinary pain treatment facilities (MPTF) for the treatment of chronic pain across Canada. METHODS: MPTF were defined as clinics that advertised specialized multidisciplinary services for the diagnosis and management of chronic pain, and had staff from a minimum of three different health care disciplines (including at least one medical specialty) available and integrated within the facility. Administrative leaders at eligible MPTF were asked to complete a detailed questionnaire on their infrastructure as well as clinical, research, teaching and administrative activities. RESULTS: A total of 102 MPTF returned the questionnaires. General practitioners, anesthesiologists and physiatrists were the most common types of physicians integrated in the MPTF (56%, 51% and 32%, respectively). Physiotherapists, psychologists and nurses were the most common nonphysician professionals working within these MPTF (75%, 68% and 57%, respectively), but 33% to 56% of them were part-time staff. Only 77% of the MPTF held regular interdisciplinary meetings to discuss patient management, and 32% were staffed with either a psychologist or psychiatrist. The three most frequent services provided by physiotherapists were patient assessment, individual physiotherapy or exercise, and transcutaneous electrical nerve stimulation. The three most common services provided by psychologists were individual counselling, cognitive behavioural therapy and psychodynamic therapy. The major roles of nurses were patient assessment, assisting in interventional procedures and patient education. CONCLUSION: Different health care professionals play a variety of important roles in MPTF in Canada. However, few of them are involved on a full-time basis and the extent to which pain is assessed and treated in a truly multidisciplinary manner is questionable. PMID:19225605

  15. Relationship between professional antenatal care and facility delivery: an assessment of Colombia.

    Science.gov (United States)

    Trujillo, Juan C; Carrillo, Bladimir; Iglesias, Wilman J

    2014-07-01

    The determinants of maternal and child health have been the recurrent topics of study in developing countries. Using the Demographic and Health Survey (2010) of Colombia, this study aimed to identify the determinants for professional antenatal care and institutional delivery, taking into account the interdependence of these two decisions, which we consider using a bivariate probit model. This study found that when certain factors affecting both the decision to seek prenatal care and giving birth in a hospital are neglected, the results of the estimates are inefficient. Estimates show that the effects of education, parity, regional location and economic status on institutional delivery tend to be underestimated in a univariate probit model. The results indicate that economic status, level of education, parity and medical-insurance affiliation influenced the joint likelihood of accessing professional antenatal care and delivering in a health facility. An important finding is that mothers with a higher level of education are 9 percentage points more likely to access these two health services compared with mothers who are illiterate. Another observed finding is the regional disparities. The evidence indicates that mothers in the Pacific Region, the poorest region of Colombia, are 6 percentage points less likely to access such services. Thus, the results indicate that the Colombian health policy should emphasize increasing the level of schooling of mothers and establish health facilities in the poorest regions of the country to ensure that women in need are provided with social health insurance. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

  16. Prevention of influenza and pneumococcal pneumonia in Canadian long-term care facilities: how are we doing?

    Science.gov (United States)

    Stevenson, C G; McArthur, M A; Naus, M; Abraham, E; McGeer, A J

    2001-05-15

    Influenza and pneumococcal pneumonia are serious health problems among elderly people and a major cause of death in long-term care facilities. We describe the results of serial surveys of vaccination coverage and influenza outbreak management in Canadian long-term care facilities over the last decade. Cross-sectional surveys consisting of questionnaires mailed to all Canadian residential long-term care facilities for elderly people in 1991 and to a random sample of respondents in 1995 and 1999. The response rates were 83% (430/515) in 1995 and 75% (380/506) in 1999. In 1999 the mean reported rates of influenza vaccination were 83% among residents and 35% among staff, and the mean rate of pneumococcal vaccination among residents was 71%; all 3 rates were significantly higher than those in 1991. The rates were also higher in facilities with an infection control practitioner than in those without such an individual (88% v. 82% for influenza vaccination among residents [p influenza vaccination among staff [p = 0.008] and 75% v. 63% for pneumococcal vaccination among residents [p vaccination on admission to the facility was associated with higher influenza and pneumococcal vaccination rates among residents (p = 0.04 and p influenza vaccination rates among residents and staff reported lower rates of influenza outbreaks (p = 0.08 and 0.03 respectively). Despite recommendations from the National Advisory Committee on Immunization, only 50% of the facilities had policies for amantadine prophylaxis during influenza A outbreaks. Amantadine was judged effective in controlling 76% of the influenza A outbreaks and was discontinued because of side effects in 3% of the residents. Influenza and pneumococcal vaccination rates among residents and staff in Canadian long-term care facilities have increased over the last decade but remain suboptimal. Vaccination of residents and staff against influenza is associated with a reduced risk of influenza outbreaks. Amantadine is effective in

  17. Layout Improvement Study to Reduce Staff Walking Distance in a Large Health Care Facility: How to Not Walk an Extra 4740 Miles.

    Science.gov (United States)

    Ley-Chavez, Adriana; Hmar-Lagroun, Tatiana; Douglas-Ntagha, Pamela; Cumbo, Charlotte L

    2016-01-01

    Inefficient facility layouts have been found to be a challenge in health care, with excessive walking adding to the demands of staff and creating delays, which can impact the quality of care. Minimizing unnecessary transportation during care delivery improves efficiency, reduces delays, and frees up resources for use on value-added activities. This article presents a methodology and application of facility design to improve responsiveness and efficiency at a large hospital. The approach described provides the opportunity to improve existing layouts in facilities in which the floor plan is already defined, but there is some flexibility to relocate key areas. The existing physical constraints and work flows are studied and taken into consideration, and the volume of traffic flow throughout the facility guides the decision of where to relocate areas for maximum efficiency. Details on the steps followed and general recommendations to perform the necessary process and data analyses are provided. We achieved a 34.8% reduction in distance walked (4740 miles saved per year) and a 30% reduction in floors traveled in elevators (344 931 floors, which translate to 842 hours spent using elevators) by relocating 4 areas in which frequently used resources are housed.

  18. Association Between Remoteness to a Health Care Facility and Incidence of Ambulance Calls in Rural Areas of Japan.

    Science.gov (United States)

    Kashima, Saori; Inoue, Kazuo; Matsumoto, Masatoshi; Eboshida, Akira; Takeuchi, Keisuke

    2015-01-01

    Whether traffic remoteness from health care service in rural areas influences usage of ambulance service has not been well investigated. This study aimed to evaluate the relation between remoteness to health care facilities and incidence of ambulance calls in rural areas of Japan. We analyzed 155 rural communities of Hiroshima. Data were obtained on all ambulance dispatches from 2010 to 2012. Driving time was calculated from each community to the closest primary/secondary and tertiary health care facility (equivalent to tertiary emergency care centers). We estimated the incidence rate and the incidence rate ratio (IRR) of ambulance calls for each 10-minute increase in the driving time, using generalized log-linear regression models, and evaluated the effect among each specific subgroup of emergency level and season. During the study period, the median incidence rate was 436 per 10 000 people in targeted communities. When driving time to the closest primary/secondary facility increased by an increment of 10 minutes, there was a significant increase in the IRR of ambulance calls, especially during colder seasons (IRR: 1.29 [95% confidence interval: 1.11-1.49]), and this relation was also obtained for most emergency levels. In comparison, there was no such increase in IRRs observed for driving time to a tertiary facility. This study indicated a positive association between remoteness to primary/secondary medical facilities and the frequency of ambulance calls. The remoteness to a primary/secondary health care may induce an increase in ambulance calls, particularly during cold seasons.

  19. [Hygiene provisions for the processing of food in nurseries and child care facilities. Approaching problems in practical experience].

    Science.gov (United States)

    Bosche, H; Schmeisser, N

    2008-11-01

    In Germany more than 2 million children under the age of six attend child care institutions. Among the duties, these institutions have to provide meals to the children. Several food-borne viruses pose a particular threat to infants. In accordance with the new European Law on Food Hygiene nurseries and child care facilities are business premises as they process and dispense food. Law requires guarding all stages of food acquisition, storage, preparation and dispersal against health hazards. Furthermore, facilities are legally required to provide risk control and to ensure that food issued by their kitchen does not pose a health hazard upon consumption. Overall, child care facilities are given by far a more comprehensive responsibility under the new European Law. This article introduces a hygiene manual for child care facilities in accordance with the EU Law on Hygiene, which was field tested in more than 70 child care facilities during the course of the extensive organisational process. The manual supplies easy-tohandle instructions and form sheets for documentation and hence assists in realising legal provisions.

  20. Source term model evaluations for the low-level waste facility performance assessment

    Energy Technology Data Exchange (ETDEWEB)

    Yim, M.S.; Su, S.I. [North Carolina State Univ., Raleigh, NC (United States)

    1995-12-31

    The estimation of release of radionuclides from various waste forms to the bottom boundary of the waste disposal facility (source term) is one of the most important aspects of LLW facility performance assessment. In this work, several currently used source term models are comparatively evaluated for the release of carbon-14 based on a test case problem. The models compared include PRESTO-EPA-CPG, IMPACTS, DUST and NEFTRAN-II. Major differences in assumptions and approaches between the models are described and key parameters are identified through sensitivity analysis. The source term results from different models are compared and other concerns or suggestions are discussed.

  1. Radiological performance assessment for the E-Area Vaults Disposal Facility

    Energy Technology Data Exchange (ETDEWEB)

    Cook, J.R.

    2000-04-11

    This report is the first revision to ``Radiological Performance Assessment for the E-Area Vaults Disposal Facility, Revision 0'', which was issued in April 1994 and received conditional DOE approval in September 1994. The title of this report has been changed to conform to the current name of the facility. The revision incorporates improved groundwater modeling methodology, which includes a large data base of site specific geotechnical data, and special Analyses on disposal of cement-based wasteforms and naval wastes, issued after publication of Revision 0.

  2. A record review of reported musculoskeletal pain in an Ontario long term care facility

    Directory of Open Access Journals (Sweden)

    Humphreys B Kim

    2006-03-01

    Full Text Available Abstract Background Musculoskeletal (MSK pain is one of the leading causes of chronic health problems in people over 65 years of age. Studies suggest that a high prevalence of older adults suffer from MSK pain (65% to 80% and back pain (36% to 40%. The objectives of this study were: 1. To investigate the period prevalence of MSK pain and associated subgroups in residents of a long-term care (LTC facility. 2. To describe clinical features associated with back pain in this population. 3. To identify associations between variables such as age, gender, cognitive status, ambulatory status, analgesic use, osteoporosis and osteoarthritis with back pain in a long-term care facility. Methods A retrospective chart review was conducted using a purposive sampling approach of residents' clinical charts from a LTC home in Toronto, Canada. All medical records for LTC residents from January 2003 until March 2005 were eligible for review. However, facility admissions of less than 6 months were excluded from the study to allow for an adequate time period for patient medical assessments and pain reporting/charting to have been completed. Clinical data was abstracted on a standardized form. Variables were chosen based on the literature and their suggested association with back pain and analyzed via multivariate logistic regression. Results 140 (56% charts were selected and reviewed. Sixty-nine percent of the selected residents were female with an average age of 83.7 years (51–101. Residents in the sample had a period pain prevalence of 64% (n = 89 with a 40% prevalence (n = 55 of MSK pain. Of those with a charted report of pain, 6% (n = 5 had head pain, 2% (n = 2 neck pain, 21% (n = 19 back pain, 33% (n = 29 extremity pain and 38% (n = 34 had non-descriptive/unidentified pain complaint. A multivariate logistic regression analysis revealed that osteoporosis was the only significant association with back pain from the variables studied (P = 0.001. Conclusion

  3. Caregiver fear of falling and functional ability among seniors residing in long-term care facilities.

    Science.gov (United States)

    Fitzgerald, Theresa G Dever; Hadjistavropoulos, Thomas; MacNab, Ying C

    2009-01-01

    Consistent with fear-avoidance models of falling and pain, past research has demonstrated that, among adults living in the community, excessive fear of falling and fear of pain result in activity restriction and predict functional outcomes including falls (possibly because self-imposed activity restriction, due to fear of pain or falling, can lead to muscular decline and deconditioning). Among seniors with dementia, who rely on others for their care, decisions concerning activity restrictions are made by caregivers. As such, caregivers' fear about the possibility of care recipient falls and pain is important to examine. In this investigation of patients with dementia, our goal was to conduct a longitudinal investigation of the relationship between professional caregivers' fears (about the possibility that care recipients will experience falls and pain) with long-term care (LTC) resident functional ability and falls. For the purposes of our 3-month longitudinal study, nurses' and special care aides' fears that specific residents might experience pain and falls were examined. Resident functional ability was assessed, based on an established and well-validated caregiver-administered questionnaire, both before and after the 3-month period. Falls and fall-related injuries sustained by residents were recorded. After controlling for physical risk factors for falling and functional ability at the beginning of the study, caregiver fears that residents might experience pain or falls were found to be predictive of restraint/restriction use. In turn, the use of restraints/restrictions was found to be predictive of future functional ability of residents with dementia (after controlling for functional ability at the beginning of the study) and injurious falls (after controlling for physical risk factors for falling). This is the first study to apply a modified fear-avoidance model of falls and pain to seniors with dementia who reside in LTC facilities. Our results demonstrate

  4. Small-scale, homelike facilities in dementia care: a process evaluation into the experiences of family caregivers and nursing staff.

    Science.gov (United States)

    Verbeek, Hilde; Zwakhalen, Sandra M G; van Rossum, Erik; Kempen, Gertrudis I J M; Hamers, Jan P H

    2012-01-01

    Current developments in institutional dementia care aim at the downsizing of facilities and increasing their homelike appearance. Small-scale living facilities are an example of this movement, in which a small group of residents (usually six to eight) live together in a homelike environment. Residents are encouraged to participate in normal daily activities and nursing staff is part of the household with integrated tasks. Despite the increase of these facilities, little is known about experiences of family caregivers of residents and nursing staff. To gain an in-depth insight into the experiences of family caregivers and nursing staff with small-scale living facilities. A process evaluation was conducted alongside the final measurement of an effectiveness study, using a cross-sectional, descriptive design. Two types of institutional dementia care in the Netherlands: small-scale living facilities and regular wards in nursing homes. In total, 130 family caregivers and 309 nursing staff workers in both care settings participated in a survey questionnaire. Additional in-depth interviews were conducted with a random selection of 24 participants in small-scale living facilities: 13 family caregivers and 11 nursing staff workers. Survey questions for family caregivers focused on care service delivery; questions for nursing staff were related to skills. The interviews especially related to positive and negative aspects of small-scale living facilities and skills for nursing staff. Both family caregivers and staff mainly reported positive experiences with small-scale living facilities, especially the personal attention that nursing staff provides to residents, their involvement with residents and the emphasis on autonomy in daily life. Barriers mainly related to nursing staff working alone during a large part of the day. Family caregivers in small-scale living facilities were more satisfied with the care facility and nursing staff than those in regular wards. The findings

  5. Money for Research, Not for Energy Bills: Finding Energy and Cost Savings in High Performance Computer Facility Designs

    Energy Technology Data Exchange (ETDEWEB)

    Drewmark Communications; Sartor, Dale; Wilson, Mark

    2010-07-01

    High-performance computing facilities in the United States consume an enormous amount of electricity, cutting into research budgets and challenging public- and private-sector efforts to reduce energy consumption and meet environmental goals. However, these facilities can greatly reduce their energy demand through energy-efficient design of the facility itself. Using a case study of a facility under design, this article discusses strategies and technologies that can be used to help achieve energy reductions.

  6. Physicians' professionalism at primary care facilities from patients' perspective: The importance of doctors' communication skills.

    Science.gov (United States)

    Sari, Merry Indah; Prabandari, Yayi Suryo; Claramita, Mora

    2016-01-01

    Professionalism is the core duty of a doctor to be responsible to the society. Doctors' professionalism depicts an internalization of values and mastery of professionals' standards as an important part in shaping the trust between doctors and patients. Professionalism consists of various attributes in which current literature focused more on the perspective of the health professionals. Doctors' professionalism may influence patients' satisfaction, and therefore, it is important to know from the patients' perspectives what was expected of medical doctors' professionalism. This study was conducted to determine the attributes of physician professionalism from the patient's perspective. This was a qualitative research using a phenomenology study design. In-depth interviews were conducted with 18 patients with hypertension and diabetes who had been treated for at least 1 year in primary care facilities in the city of Yogyakarta, Indonesia. The results of the interview were transcribed, encoded, and then classified into categories. Communication skills were considered as the top priority of medical doctors' attributes of professionalism in the perspectives of the patients. This study revealed that communication skill is the most important aspects of professionalism which greatly affected in the process of health care provided by the primary care doctors. Doctor-patient communication skills should be intensively trained during both basic and postgraduate medical education.

  7. Biannular Airbreathing Nozzle Rig (BANR) facility checkout and plug nozzle performance test data

    Science.gov (United States)

    Cummings, Chase B.

    2010-09-01

    The motivation for development of a supersonic business jet (SSBJ) platform lies in its ability to create a paradigm shift in the speed and reach of commercial, private, and government travel. A full understanding of the performance capabilities of exhaust nozzle configurations intended for use in potential SSBJ propulsion systems is critical to the design of an aircraft of this type. Purdue University's newly operational Biannular Airbreathing Nozzle Rig (BANR) is a highly capable facility devoted to the testing of subscale nozzles of this type. The high accuracy, six-axis force measurement system and complementary mass flowrate measurement capabilities of the BANR facility make it rather ideally suited for exhaust nozzle performance appraisal. Detailed accounts pertaining to methods utilized in the proper checkout of these diagnostic capabilities are contained herein. Efforts to quantify uncertainties associated with critical BANR test measurements are recounted, as well. Results of a second hot-fire test campaign of a subscale Gulfstream Aerospace Corporation (GAC) axisymmetric, shrouded plug nozzle are presented. Determined test article performance parameters (nozzle thrust efficiencies and discharge coefficients) are compared to those of a previous test campaign and numerical simulations of the experimental set-up. Recently acquired data is compared to published findings pertaining to plug nozzle experiments of similar scale and operating range. Suggestions relating to the future advancement and improvement of the BANR facility are provided. Lessons learned with regards to test operations and calibration procedures are divulged in an attempt to aid future facility users, as well.

  8. When doctors come to prison – a pilot project for better HIV care in correctional facilities

    Directory of Open Access Journals (Sweden)

    I Vaz Pinto

    2012-11-01

    Full Text Available Recent rearrangements in national policies regarding follow-up of HIV-infected inmates have determined that hospitals closest to the prison facility be responsible for their care. Our HIV Unit and the two prison facilities in the area have established a clinical protocol whereby a clinical team goes to the prisons for blood collecting and visits instead of having the inmates transported to the hospital. The purpose of the protocol, from a clinical point of view, was to: (i promote adherence to blood tests and clinical visits; (ii promote adherence to antiretroviral (ARV therapy; (iii facilitate ARV administration by promoting once-daily-dosing. This retrospective review looks back at the first year of protocol implementation between the HIV Unit of HPP Cascais Hospital and the prisons of Tires and Linhó. The purpose of this study is to characterize the demographics of our inmate population; assess the number of inmates on ARV and describe the regimens as PI- or NNRTI-based and as once- or twice-daily dosed; evaluate ARV efficacy by HIV viral load undetectability; and assess opportunity for ARV switch from twice- to once-daily dosing. From April 2011 until June 2012 a total of 53 inmates were included in this protocol. The majority of patients were female (55% as one of the prisons is mainly for female inmates. The median age is 36 years (from 23–59. The average time of follow-up was 11 months (15 months maximum. From the total of 53 patients under study, 40 are currently under care, the other 13 having been released or transferred to other prison facilities. The majority of these patients are on ARV therapy (83%. By the end of follow-up time 88% of patients were on a once-daily dosed regimen; these are PI-based in 69% and NNRTI-based in 31%. At their last evaluation, 32/33 patients on therapy had undetectable HIV viremia (97%. As a conclusion, we assess that this protocol implementation has benefitted all parts: patients assure regular

  9. Thermodynamic Performance Indicators for Offshore Oil and Gas Processing: Application to Four North Sea Facilities

    DEFF Research Database (Denmark)

    Voldsund, Mari; Nguyen, Tuong-Van; Elmegaard, Brian

    2014-01-01

    achievable potential, they should evaluate the use of theoretical potential, and they should evaluate the total use of energy resources. The performance indicators are tested on four North Sea facilities, and the results are discussed. We recommend the use of a set of indicators for a thorough evaluation......Well-defined performance indicators can motivate optimal operation of offshore oil and gas platforms. We evaluate several thermodynamic performance indicators presented in the literature according to three criteria: Thermodynamic performance indicators should evaluate the use of technically...... of oil and gas platforms—the best-available-technology efficiency on an exergy basis, a task exergy efficiency, and the specific exergy destruction....

  10. Design, construction and performance of the current lead test facility CuLTKa

    Science.gov (United States)

    Richter, T.; Bobien, S.; Fietz, W. H.; Heiduk, M.; Heller, R.; Hollik, M.; Lange, C.; Lietzow, R.; Rohr, P.

    2017-09-01

    The Karlsruhe Institute of Technology (KIT) has a longtime experience in the development of High Temperature Superconductor (HTS) Current Leads (CLs) for high currents leading to several contracts with national and international partners. Within these contracts series production and cold acceptance tests of such CLs were required. The cold test of a large number of CLs requires the availability of a flexible facility which allows fast and reproducible testing. With the Current Lead Test Facility Karlsruhe (CuLTKa) a versatile and flexible test bed for CLs was designed and constructed. The facility consists of five cryostats including two test boxes and is directly connected by a transfer line to a refrigerator with a capacity of 2 kW at 4.4 K. The refrigerator supplies supercritical helium at two different temperature levels simultaneously. Each of the two test cryostats can be equipped with a pair of CLs which is short-circuited at the low temperature level via a superconducting bus bar. For current tests a power supply can provide DC currents up to 30 kA. If required, the facility design offers the potential of withstanding high voltages of up to 50 kV on the test objects. The commissioning of the facility started in July 2014. In total a series of acceptance tests of the CLs for the Japanese JT-60SA will be carried out until second half of 2017 to qualify six CLs with a current of 26 kA and 20 CLs with a current of 20 kA. In the meantime, six CLs@26 kA and 16 CLs@20 kA have been tested in CuLTKa which demonstrates the very effective operation of the facility. This paper describes the setup of the facility from cryogenic, electrical and process control point of view and will highlight the design of particular technical aspects. Furthermore, an overview of the performance during the commissioning phase will be given.

  11. Development of boron concentration analysis system and techniques for testing performance of BNCT facility

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hee Dong; Kim, Chang Shuk; Byun, Soo Hyun; Lee, Jae Yun; Sun, Gwang Min; Kim, Suk Kwon [Seoul National University, (Korea)

    2000-04-01

    I. Objectives and Necessity of the Project. Development of a boron concentration analysis system used for BNCT. Development of test techniques for BNCT facility. II. Contents and Scopes of the Project. (1) Design of a boron concentration analysis system at HANARO. (2) Component machining and instruments purchase, performance test. (3) Calculation and measurement of diffracted polychromatic beam quality. (4) Test procedures for boron concentration analysis system and BNCT facility. III. Result of the Project (1) Diffracted neutron beam quality for boron concentration analysis. (neutron flux: 1.2 * 10{sup 8} n/cm{sup 2}s, Cd-ratio : 1,600) (2) Components and instruments of the boron concentration analysis system. (3) Diffracted neutron spectrum and flux. (4) Test procedures for boron concentration analysis system and BNCT facility. 69 refs., 44 figs., 14 tabs. (Author)

  12. 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.

  13. Poor knowledge – predictor of nonadherence to universal precautions for blood borne pathogens at first level care facilities in Pakistan

    Directory of Open Access Journals (Sweden)

    Chandir Subhash

    2007-07-01

    Full Text Available Abstract Background We conducted an assessment of knowledge about blood borne pathogens (BBP and use of universal precautions at first level care facilities (FLCF in two districts of Pakistan. Methods We conducted a cross-sectional survey and selected three different types of FLCFs ; public, general practitioners and unqualified practitioners through stratified random sampling technique. At each facility, we interviewed a prescriber, a dispenser, and a housekeeper for knowledge of BBPs transmission and preventive practices, risk perception, and use of universal precautions. We performed multiple linear regression to assess the effect of knowledge score (11 items on the practice of universal precautions score (4 items- use of gloves, gown, needle recapping, and HBV vaccination. Results We interviewed 239 subjects. Most of the participants 128 (53% were recruited from general practitioners clinics and 166 (69.5% of them were dispensers. Mean (SD knowledge score was 3.8 (2.3 with median of 4. MBBS prescribers had the highest knowledge score while the housekeepers had the lowest. Mean universal precautions use score was 2.7 ± 2.1. Knowledge about mode of transmission and the work experience alone, significantly predicted universal precaution use in multiple linear regression model (adR2 = 0.093. Conclusion Knowledge about mode of transmission of blood borne pathogens is very low. Use of universal precautions can improve with increase in knowledge.

  14. Staff Member Reactions to Same-Gender, Resident-to-Resident Sexual Behavior Within Long-Term Care Facilities.

    Science.gov (United States)

    Ahrendt, Andrew; Sprankle, Eric; Kuka, Alex; McPherson, Keagan

    2017-01-01

    The current study assesses ageism and heterosexism relating to older adult sexual activity within long-term care facilities. To assess caregiver reactions, 153 residential care facility staff members read one of three vignettes. Each vignette described a scenario in which a staff member walks in on two residents (male/female, male/male, or female/female) engaging in sexual activity. Although no main effects were discovered for vignette type, exploratory analyses revealed that the facility where participants were employed was significantly related to their ratings of approval. Furthermore, an interaction effect between vignette and facility types was also discovered for caregivers' approval of sexual activity among residents. Additionally, a strong overall approval rating of older adult sexuality was reported by staff members. The results of this study warrant that further research is necessary regarding older adults' perception of caregiver bias, as well as further investigation of caregivers' perceptions of older adults' sexual activity.

  15. Health Insurance Portability and Accountability Act (HIPAA) legislation and its implication on speech privacy design in health care facilities

    Science.gov (United States)

    Tocci, Gregory C.; Storch, Christopher A.

    2005-09-01

    The Health Insurance Portability and Accountability Act (HIPAA) of 1996 (104th Congress, H.R. 3103, January 3, 1986), among many things, individual patient records and information be protected from unnecessary issue. This responsibility is assigned to the U.S. Department of Health and Human Services (HHS) which has issued a Privacy Rule most recently dated August 2002 with a revision being proposed in 2005 to strengthen penalties for inappropriate breaches of patient privacy. Despite this, speech privacy, in many instances in health care facilities need not be guaranteed by the facility. Nevertheless, the regulation implies that due regard be given to speech privacy in both facility design and operation. This presentation will explore the practical aspects of implementing speech privacy in health care facilities and make recommendations for certain specific speech privacy situations.

  16. E AREA LOW LEVEL WASTE FACILITY DOE 435.1 PERFORMANCE ASSESSMENT

    Energy Technology Data Exchange (ETDEWEB)

    Wilhite, E

    2008-03-31

    This Performance Assessment for the Savannah River Site E-Area Low-Level Waste Facility was prepared to meet requirements of Chapter IV of the Department of Energy Order 435.1-1. The Order specifies that a Performance Assessment should provide reasonable assurance that a low-level waste disposal facility will comply with the performance objectives of the Order. The Order also requires assessments of impacts to water resources and to hypothetical inadvertent intruders for purposes of establishing limits on radionuclides that may be disposed near-surface. According to the Order, calculations of potential doses and releases from the facility should address a 1,000-year period after facility closure. The point of compliance for the performance measures relevant to the all pathways and air pathway performance objective, as well as to the impact on water resources assessment requirement, must correspond to the point of highest projected dose or concentration beyond a 100-m buffer zone surrounding the disposed waste following the assumed end of active institutional controls 100 years after facility closure. During the operational and institutional control periods, the point of compliance for the all pathways and air pathway performance measures is the SRS boundary. However, for the water resources impact assessment, the point of compliance remains the point of highest projected dose or concentration beyond a 100-m buffer zone surrounding the disposed waste during the operational and institutional control periods. For performance measures relevant to radon and inadvertent intruders, the points of compliance are the disposal facility surface for all time periods and the disposal facility after the assumed loss of active institutional controls 100 years after facility closure, respectively. The E-Area Low-Level Waste Facility is located in the central region of the SRS known as the General Separations Area. It is an elbow-shaped, cleared area, which curves to the northwest

  17. Near-Field Hydrology Data Package for the Integrated Disposal Facility 2005 Performance Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Meyer, Philip D.; Saripalli, Prasad; Freedman, Vicky L.

    2004-06-25

    CH2MHill Hanford Group, Inc. (CHG) is designing and assessing the performance of an Integrated Disposal Facility (IDF) to receive immobilized low-activity waste (ILAW), Low-Level and Mixed Low-Level Wastes (LLW/MLLW), and the Waste Treatment Plant (WTP) melters used to vitrify the ILAW. The IDF Performance Assessment (PA) assesses the performance of the disposal facility to provide a reasonable expectation that the disposal of the waste is protective of the general public, groundwater resources, air resources, surface water resources, and inadvertent intruders. The PA requires prediction of contaminant migration from the facilities, which is expected to occur primarily via the movement of water through the facilities and the consequent transport of dissolved contaminants in the pore water of the vadose zone. Pacific Northwest National Laboratory (PNNL) assists CHG in its performance assessment activities. One of PNNL’s tasks is to provide estimates of the physical, hydraulic, and transport properties of the materials comprising the disposal facilities and the disturbed region around them. These materials are referred to as the near-field materials. Their properties are expressed as parameters of constitutive models used in simulations of subsurface flow and transport. In addition to the best-estimate parameter values, information on uncertainty in the parameter values and estimates of the changes in parameter values over time are required to complete the PA. These parameter estimates and information were previously presented in a report prepared for the 2001 ILAW PA. This report updates the parameter estimates for the 2005 IDF PA using additional information and data collected since publication of the earlier report.

  18. Disrespectful intrapartum care during facility-based delivery in sub-Saharan Africa: A qualitative systematic review and thematic synthesis of women's perceptions and experiences.

    Science.gov (United States)

    Bradley, Susan; McCourt, Christine; Rayment, Juliet; Parmar, Divya

    2016-11-01

    The psycho-social elements of labour and delivery are central to any woman's birth experience, but international efforts to reduce maternal mortality in low-income contexts have neglected these aspects and focused on technological birth. In many contexts, maternity care is seen as dehumanised and disrespectful, which can have a negative impact on utilisation of services. We undertook a systematic review and meta-synthesis of the growing literature on women's experiences of facility-based delivery in sub-Saharan Africa to examine the drivers of disrespectful intrapartum care. Using PRISMA guidelines, databases were searched from 1990 to 06 May 2015, and 25 original studies were included for thematic synthesis. Analytical themes, that were theoretically informed and cognisant of the cultural and social context in which the dynamics of disrespectful care occur, enabled a fresh interpretation of the factors driving midwives' behaviour. A conceptual framework was developed to show how macro-, meso- and micro-level drivers of disrespectful care interact. The synthesis revealed a prevailing model of maternity care that is institution-centred, rather than woman-centred. Women's experiences illuminate midwives' efforts to maintain power and control by situating birth as a medical event and to secure status by focusing on the technical elements of care, including controlling bodies and knowledge. Midwives and women are caught between medical and social models of birth. Global policies encouraging facility-based delivery are forcing women to swap the psycho-emotional care they would receive from traditional midwives for the technical care that professional midwives are currently offering. Any action to change the current performance and dynamic of birth relies on the participation of midwives, but their voices are largely missing from the discourse. Future research should explore their perceptions of the value and practice of interpersonal aspects of maternity care and the

  19. Transitioning from caregiver to visitor in a long-term care facility: the experience of caregivers of people with dementia.

    Science.gov (United States)

    Crawford, K; Digby, R; Bloomer, M; Tan, H; Williams, A

    2015-01-01

    Transitioning from the primary caregiver to the visitor in a long-term care facility may be challenging for the caregiver; they are required to surrender their caring duties to the medical and nursing staff. The aim of this study was to explore the experiences of caregivers during their transition from day-to-day caregiver of a person with dementia to a visitor in a long-term care facility. This study utilised a qualitative descriptive design. Twenty caregivers of people with dementia were recruited from the one Aged Rehabilitation and Geriatric Evaluation and Management facility, located in Victoria, Australia. Semi-structured interviews were used to explore the caregiver's experiences. Interviews were analysed using thematic analysis. The interview data revealed that the participants were undergoing similar experiences. The findings revealed that it was difficult for the caregiver to transition to their new role of visitor; negative reactions of grief, loss of motivation and loneliness were also coupled with positive feelings of relief and the reassurance that their relative or friend would be well cared for and safe within the long-term care facility. The findings offer insight into the experiences felt by caregivers when their relative or friend with dementia is admitted to hospital. Implications of this study include the need to improve the transition process for the caregiver by allowing them to be involved in the decision-making process, keeping them informed of care decisions, and importantly, providing emotional support to help the caregiver positively adapt to this transition.

  20. Radiological performance assessment for the Z-Area Saltstone Disposal Facility

    Energy Technology Data Exchange (ETDEWEB)

    Cook, J.R.; Fowler, J.R. [Westinghouse Savannah River Co., Aiken, SC (United States)

    1992-12-18

    This radiological performance assessment (RPA) for the Savannah River Site (SRS) Saltstone Disposal Facility (SDF) was prepared in accordance with the requirements of Chapter III of the US Department of Energy Order 5820.2A. The Order specifies that an RPA should provide reasonable assurance that a low-level waste (LLW) disposal facility will comply with the performance objectives of the Order. The performance objectives require that: (1) exposures of the general public to radioactivity in the waste or released from the waste will not result in an effective dose equivalent of 25 mrem per year; (2) releases to the atmosphere will meet the requirements of 40 CFR 61; (3) inadvertent intruders will not be committed to an excess of an effective dose equivalent of 100 mrem per year from chronic exposure, or 500 mrem from a single acute exposure; and (4) groundwater resources will be protected in accordance with Federal, State and local requirements.

  1. Evaluating the Effect of a Clostridium difficile Infection Prevention Initiative in Veterans Health Administration Long-Term Care Facilities.

    Science.gov (United States)

    Singh, Maninder B; Evans, Martin E; Simbartl, Loretta A; Kralovic, Stephen M; Roselle, Gary A

    2018-03-01

    We evaluated rates of clinically confirmed long-term-care facility-onset Clostridium difficile infections from April 2014 through December 2016 in 132 Veterans Affairs facilities after the implementation of a prevention initiative. The quarterly pooled rate decreased 36.1% from the baseline (P<.0009 for trend) by the end of the analysis period. Infect Control Hosp Epidemiol 2018;39:343-345.

  2. An exploration of the experiences of older persons in an economically deprived residential care facility / Shabangu T.R.

    OpenAIRE

    Shabangu, Tankiso Richard.

    2011-01-01

    The older person’s component of the population has increased rapidly in recent years due to developments in medicine, technology and other areas of life. Growing older implies a gradual decline in the physical, mental and social functioning of an individual. Older people consequently have to rely on others for assistance, and, in some instances, they are looked after in residential care facilities. These facilities should be sensitive to older person’s culture, religion, ethnic...

  3. Performance Assessment for the Idaho National Laboratory Remote-Handled Low-Level Waste Disposal Facility

    Energy Technology Data Exchange (ETDEWEB)

    Annette L. Schafer; A. Jeffrey Sondrup; Arthur S. Rood

    2012-05-01

    This performance assessment for the Remote-Handled Low-Level Radioactive Waste Disposal Facility at the Idaho National Laboratory documents the projected radiological dose impacts associated with the disposal of low-level radioactive waste at the facility. This assessment evaluates compliance with the applicable radiological criteria of the U.S. Department of Energy and the U.S. Environmental Protection Agency for protection of the public and the environment. The calculations involve modeling transport of radionuclides from buried waste to surface soil and subsurface media, and eventually to members of the public via air, groundwater, and food chain pathways. Projections of doses are calculated for both offsite receptors and individuals who inadvertently intrude into the waste after site closure. The results of the calculations are used to evaluate the future performance of the low-level radioactive waste disposal facility and to provide input for establishment of waste acceptance criteria. In addition, one-factor-at-a-time, Monte Carlo, and rank correlation analyses are included for sensitivity and uncertainty analysis. The comparison of the performance assessment results to the applicable performance objectives provides reasonable expectation that the performance objectives will be met

  4. Changes in the relationship between nursing home financial performance and quality of care under public reporting.

    Science.gov (United States)

    Park, Jeongyoung; Werner, Rachel M

    2011-07-01

    The relationship between financial performance and quality of care in nursing homes is not well defined and prior work has been mixed. The recent focus on improving the quality of nursing homes through market-based incentives such as public reporting may have changed this relationship, as public reporting provides nursing homes with increased incentives to engage in quality-based competition. If quality improvement activities require substantial production costs, nursing home profitability may become a more important predictor of quality under public reporting. This study explores the relationship between financial performance and quality of care and test whether this relationship changes under public reporting. Using a 10-year (fiscal years 1997-2006) panel data set of 9444 skilled nursing facilities in the US, this study employs a facility fixed-effects with and without instrumental variables approach to test the effect of finances on quality improvement and correct for potential endogeneity. The results show that better financial performance, as reflected by the 1-year lagged total profit margin, is modestly associated with higher quality but only after public reporting is initiated. These findings have important policy implications as federal and state governments use market-based incentives to increase demand for high-quality care and induce providers to compete based on quality. Copyright © 2010 John Wiley & Sons, Ltd.

  5. Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

    Directory of Open Access Journals (Sweden)

    Yamada Yukari

    2006-01-01

    Full Text Available Abstract Background The prevalence and risk factors of potentially inappropriate medication use among the elderly patients have been studied in various countries, but because of the difficulty of obtaining data on patient characteristics and medications they have not been studied in Japan. Methods We conducted a retrospective cross-sectional study in 17 Japanese long-term care (LTC facilities by collecting data from the comprehensive MDS assessment forms for 1669 patients aged 65 years and over who were assessed between January and July of 2002. Potentially inappropriate medications were identified on the basis of the 2003 Beers criteria. Results The patients in the sample were similar in terms of demographic characteristics to those in the national survey. Our study revealed that 356 (21.1% of the patients were treated with potentially inappropriate medication independent of disease or condition. The most commonly inappropriately prescribed medication was ticlopidine, which had been prescribed for 107 patients (6.3%. There were 300 (18.0% patients treated with at least 1 inappropriate medication dependent on the disease or condition. The highest prevalence of inappropriate medication use dependent on the disease or condition was found in patients with chronic constipation. Multiple logistic regression analysis revealed psychotropic drug use (OR = 1.511, medication cost of per day (OR = 1.173, number of medications (OR = 1.140, and age (OR = 0.981 as factors related to inappropriate medication use independent of disease or condition. Neither patient characteristics nor facility characteristics emerged as predictors of inappropriate prescription. Conclusion The prevalence and predictors of inappropriate medication use in Japanese LTC facilities were similar to those in other countries.

  6. Observations on managing an outbreak of influenza A infection in an aged care facility.

    Science.gov (United States)

    McCall, Bradley J; Mohr, Christine M; Jarvinen, Kari A J

    2007-12-01

    Influenza outbreaks in aged care facilities (ACFs) can be associated with high morbidity and mortality. National guidance includes the use of antiviral medication for residents and staff and other measures to prevent serious health outcomes. An outbreak of influenza in an ACF was reported to the Brisbane Southside Population Health Unit (BSPHU) on 10 August 2007. The BSPHU assisted the ACF and local general practitioners in the provision of oseltamivir to staff and residents on 11 August 2007. The onset of illness in the last case was 13 August 2007. Antiviral prophylaxis was ceased and the outbreak declared over on 22 August 2007. This paper describes some of the practical issues encountered in the public health response in this setting. Vaccination of ACF residents and staff remains the key preventive strategy for the future.

  7. Outcomes of a geriatric rehabilitation program in a long-term care facility.

    Science.gov (United States)

    McCusker, J; Mundt, D J; Stoddard, A M; Cole, E; Whitbourne, S K; Simmons, J E

    1989-11-01

    This study investigated outcomes of geriatric rehabilitation and predictors of success among 81 consecutive admissions to a 40-bed rehabilitation unit in a long-term care facility. Predictors measured at admission included sociodemographic variables, functional status (both current and prior to illness), social contact, and self-motivation. In all, 62 patients (77%) successfully completed the rehabilitation program; 76% of the successes were discharged home. Failure to discharge successfully rehabilitated subjects was mainly due to placement problems and patient and family preference. Both of the success groups showed significant improvement in functional status (Barthel Index), while failures had poorer initial functional status, and showed no improvement on average. At six-month follow-up, functional status (measured by the Sickness Impact Profile) was similar in the two success groups. No predictors other than functional status were associated with rehabilitation success. Among the successes, better functional status at six months was predicted by aspects of self-motivation.

  8. Computer usage among nurses in rural health-care facilities in South Africa: obstacles and challenges.

    Science.gov (United States)

    Asah, Flora

    2013-04-01

    This study discusses factors inhibiting computer usage for work-related tasks among computer-literate professional nurses within rural healthcare facilities in South Africa. In the past two decades computer literacy courses have not been part of the nursing curricula. Computer courses are offered by the State Information Technology Agency. Despite this, there seems to be limited use of computers by professional nurses in the rural context. Focus group interviews held with 40 professional nurses from three government hospitals in northern KwaZulu-Natal. Contributing factors were found to be lack of information technology infrastructure, restricted access to computers and deficits in regard to the technical and nursing management support. The physical location of computers within the health-care facilities and lack of relevant software emerged as specific obstacles to usage. Provision of continuous and active support from nursing management could positively influence computer usage among professional nurses. A closer integration of information technology and computer literacy skills into existing nursing curricula would foster a positive attitude towards computer usage through early exposure. Responses indicated that change of mindset may be needed on the part of nursing management so that they begin to actively promote ready access to computers as a means of creating greater professionalism and collegiality. © 2011 Blackwell Publishing Ltd.

  9. Hypertension management in the oldest old: Findings from a large long-term care facility.

    Science.gov (United States)

    Schwinn, Susan; McKay, Robin; Dinkel, Shirley; Mansfield, Bobbe; Da Cunha, Brooke Faria; Cummins, Savanna; Brunin, Krystal

    2017-03-01

    The purpose of this quality improvement project was to evaluate hypertension (HTN) management in patients 80 years of age and older who reside in a large, long-term care (LTC) facility. A retrospective chart audit was conducted on 75 charts of patients 80 years of age and older and who had a diagnosis of HTN. Using the 2011 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Expert Consensus Document on Management of Hypertension in the Elderly as a guide, blood pressure readings, significant comorbidities, and antihypertensive medication utilization were analyzed. LTC residents in this sample were often not treated according to expert recommendations. Specifically, analysis revealed overtreatment of uncomplicated HTN and undertreatment of those with comorbid conditions. Additionally, those with diabetes mellitus and chronic kidney disease were infrequently prescribed ace inhibitors/angiotensin receptor blockers, as recommended. Utilizing evidence-based practice (EBP) guidelines affords the best avenue for providing safe and effective treatment of HTN. While expert recommendations are available, researchers seldom recruit frail elders in LTC facilities into treatment investigations. In the absence of population-specific EBP guidelines, nurse practitioners must rely on expert opinion and diagnostic reasoning to individualize HTN treatment to this unique and vulnerable population. ©2016 American Association of Nurse Practitioners.

  10. Psycho-social factors affecting elders' maltreatment in long-term care facilities.

    Science.gov (United States)

    Natan, M Ben; Lowenstein, A; Eisikovits, Z

    2010-03-01

    To examine and analyse major variables affecting maltreatment of elderly nursing home residents. The study was based on two theoretical paradigms: the theoretical model for predicting causes of maltreatment of elderly residents developed by Pillemer, and the Theory of Reasoned Action developed by Ajzen & Fishbein. The study employed a correlational quantitative method. The research population consisted of the staff of 22 nursing homes in Israel. Six hundred questionnaires were distributed in these facilities and 510 were completed and returned (85%). In addition, 24 questionnaires were distributed among directors of the facilities and 22 were returned (91.6%). Slightly more than half of the staff sampled reported abuse of elderly residents over the past year, as manifested in one or more of types of maltreatment. The total number of various types of maltreatment reported was 513. About two-thirds of the cases were incidents of neglect. Seventy per cent of respondents reported that they had been present at incidents in which another staff member abused an elderly resident in one or more types of maltreatment, and in such situations mental abuse and mental neglect were the most prevalent forms of maltreatment. This is the first study to examine elder maltreatment in the long-term care population of Israel. The research findings produce an expanded and improved research model investigating elder maltreatment in long-term nursing homes.

  11. An outbreak of norovirus infection in a long-term care facility in Brazil

    Directory of Open Access Journals (Sweden)

    Fernando Gatti de Menezes

    2010-12-01

    Full Text Available Objective: To describe a norovirus outbreak in a Brazilian longtermcare facility from July 8 to 29, 2005. Methods: In thefirst 48 to 72 hours after onset of symptoms in inpatients andemployees, the main infection control strategies were staffeducation, emphasis on hand washing, implementing contactprecautions up to 48-72 hours after resolution of symptoms,complete cleaning of the rooms and exclusion of symptomaticemployees from work until 48-72 hours after resolution of theirsymptoms. Epidemiological and clinical characteristics of thenorovirus infections were described based on chart review.Results: The incidence among inpatients and employees was41.3% and 16.25%, respectively. The main symptom was diarrhea,affecting 100% of inpatients and employees. Forty-four percent ofspecimens were positive by RIDASCREEN® Norovirus analyses,and identified as norovirus genogroup GII. Seventy percent ofinpatients were women and their age range was 51-98 years.Inpatients had in average two comorbid conditions – 87.3% withcardiovascular or chronic pulmonary condition and 47.6% withdementia. There was not relapse or death. Conclusions: The earlyinfection-control measures associated to surveillance are requiredto keep long-term care facilities free of noroviruses and to protectthose who are most vulnerable.

  12. Efficiency performance of China's health care delivery system.

    Science.gov (United States)

    Zhang, Luyu; Cheng, Gang; Song, Suhang; Yuan, Beibei; Zhu, Weiming; He, Li; Ma, Xiaochen; Meng, Qingyue

    2017-07-01

    Improving efficiency performance of the health care delivery system has been on the agenda for the health system reform that China initiated in 2009. This study examines the changes in efficiency performance and determinants of efficiency after the reform to provide evidence to assess the progress of the reform from the perspective of efficiency. Descriptive analysis, Data Envelopment Analysis, the Malmquist Index, and multilevel regressions are used with data from multiple sources, including the World Bank, the China Health Statistical Yearbook, and routine reports. The results indicate that over the last decade, health outcomes compared with health investment were relatively higher in China than in most other countries worldwide, and the trend was stable. The overall efficiency and total factor productivity increased after the reform, indicating that the reform was likely to have had a positive impact on the efficiency performance of the health care delivery system. However, the health care delivery structure showed low system efficiency, mainly attributed to the weakened primary health care system. Strengthening the primary health care system is central to enhancing the future performance of China's health care delivery system. Copyright © 2017 John Wiley & Sons, Ltd.

  13. Nurses' perceptions of the impact of the aged care reform on services for residents in multi-purpose services and residential aged care facilities in rural Australia.

    Science.gov (United States)

    Henderson, Julie; Willis, Eileen; Xiao, Lily; Toffoli, Luisa; Verrall, Claire

    2016-12-01

    To understand nurses' perceptions of the impact of the aged care reform on care and services for residents in multi-purpose services (MPS) and residential aged care facilities (RACF) in rural South Australia. An interpretative study using semi-structured interviews. Participants comprised registered and enrolled nurses working with aged care residents in rural South Australia. Eleven nurses were interviewed, of these seven worked in MPS and four in RACF. Data were analysed for similarities and differences in participants' experiences of care delivery between MPS and RACF. Common issues were identified relating to funding and resource shortfalls, staffing levels, skill mix and knowledge deficits. Funding and staffing shortfalls in MPS were related by participants to the lower priority given to aged care in allocating resources within MPS. Nurses in these services identified limited specialist knowledge of aged care and care deficits around basic nursing care. Nurses in RACF identified funding and staffing shortfalls arising from empty beds due to the introduction of the accommodation payment. Dependence upon care workers was associated with care deficits in complex care such as pain management, medication review and wound care. Further research is needed into the impact of recent reforms on the capacity to deliver quality aged care in rural regions. © 2016 AJA Inc.

  14. Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses

    OpenAIRE

    Joachim Rapin; Danielle D’Amour; Carl-Ardy Dubois

    2015-01-01

    The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2...

  15. High rates of hospital admission among older residents in assisted living facilities: opportunities for intervention and impact on acute care.

    Science.gov (United States)

    Hogan, David B; Amuah, Joseph E; Strain, Laurel A; Wodchis, Walter P; Soo, Andrea; Eliasziw, Misha; Gruneir, Andrea; Hagen, Brad; Teare, Gary; Maxwell, Colleen J

    2014-01-01

    Little is known about health or service use outcomes for residents of Canadian assisted living facilities. Our objectives were to estimate the incidence of admission to hospital over 1 year for residents of designated (i.e., publicly funded) assisted living (DAL) facilities in Alberta, to compare this rate with the rate among residents of long-term care facilities, and to identify individual and facility predictors of hospital admission for DAL residents. Participants were 1066 DAL residents (mean age ± standard deviation 84.9 ± 7.3 years) and 976 longterm care residents (85.4 ± 7.6 years) from the Alberta Continuing Care Epidemiological Studies (ACCES). Research nurses completed a standardized comprehensive assessment for each resident and interviewed family caregivers at baseline (2006 to 2008) and 1 year later. We used standardized interviews with administrators to generate facility- level data. We determined hospital admissions through linkage with the Alberta Inpatient Discharge Abstract Database. We used multivariable Cox proportional hazards models to identify predictors of hospital admission. The cumulative annual incidence of hospital admission was 38.9% (95% confidence interval [CI] 35.9%- 41.9%) for DAL residents and 13.7% (95% CI 11.5%-15.8%) for long-term care residents. The risk of hospital admission was significantly greater for DAL residents with greater health instability, fatigue, medication use (11 or more medications), and 2 or more hospital admissions in the preceding year. The risk of hospital admission was also significantly higher for residents from DAL facilities with a smaller number of spaces, no licensed practical and/ or registered nurses on site (or on site less than 24 hours a day, 7 days a week), no chain affiliation, and from select health regions. The incidence of hospital admission was about 3 times higher among DAL residents than among long-term care residents, and the risk of hospital admission was associated with a number of

  16. Do Danes enjoy a high performing chronic care system

    DEFF Research Database (Denmark)

    Juul, Annegrete; Olejaz, Maria; Rudkjøbing, Andreas

    2012-01-01

    The trends in population health in Denmark are similar to those in most Western European countries. Major health issues include, among others, the high prevalence of chronic illnesses and lifestyle related risk factors such as obesity, tobacco, physical inactivity and alcohol. This has pressed...... the health system towards a model of provision of care based on the management of chronic care conditions. While the Chronic Care Model was introduced in 2005, the Danish health system does not fulfil the ten key preconditions that would characterise a high-performing chronic care system. As revealed...... in a recent report, the fragmented structure of the Danish health system poses challenges in providing effectively coordinated care to patients with chronic diseases....

  17. 'We just do the dirty work': dealing with incontinence, courtesy stigma and the low occupational status of carework in long-term aged care facilities.

    Science.gov (United States)

    Ostaszkiewicz, Joan; O'Connell, Beverly; Dunning, Trisha

    2016-09-01

    To systematically examine, describe and explain how continence care was determined, delivered and communicated in Australian long aged care facilities. Incontinence is a highly stigmatising condition that affects a disproportionally large number of people living in long-term aged care facilities. Its day-to-day management is mainly undertaken by careworkers. We conducted a Grounded theory study to explore how continence care was determined, delivered and communicated in long-term aged care facilities. This paper presents one finding, i.e. how careworkers in long-term aged care facilities deal with the stigma, devaluation and the aesthetically unpleasant aspects of their work. Grounded theory. Eighty-eight hours of field observations in two long-term aged care facilities in Australia. In addition, in-depth interviews with 18 nurses and careworkers who had experience of providing, supervising or assessment of continence care in any long-term aged care facility in Australia. Occupational exposure to incontinence contributes to the low occupational status of carework in long-term aged care facilities, and continence care is a symbolic marker for inequalities within the facility, the nursing profession and society at large. Careworkers' affective and behavioural responses are characterised by: (1) accommodating the context; (2) dissociating oneself; (3) distancing oneself and (4) attempting to elevate one's role status. The theory extends current understandings about the links between incontinence, continence care, courtesy stigma, emotional labour and the low occupational status of carework in long-term aged care facilities. This study provides insights into the ways in which tacit beliefs and values about incontinence, cleanliness and contamination may affect the social organisation and delivery of care in long-term aged care facilities. Nurse leaders should challenge the stigma and devaluation of carework and careworkers, and reframe carework as 'dignity work'.

  18. Using geographical information systems for defining the accessibility to health care facilities in Jeddah City, Saudi Arabia.

    Science.gov (United States)

    Murad, Abdulkader A

    2014-12-01

    Spatial data play an important role in the planning of health care facilities and their allocation. Today, geographical information systems (GIS) provide useful techniques for capturing, maintaining and analysing health care spatial data; indeed health geoinformatics is an emerging discipline that uses innovative geospatial technology to investigate health issues. The purpose of this paper is to define how GIS can be used for assessing the level of accessibility to health care. The paper identifies the advantages of using GIS in health care planning and covers GIS-based international accessibility with a focus on GIS applications for health care facilities in Jeddah city, Saudi Arabia. A geodatabase that includes location of health services, road networks, health care demand and population districts was created using ArcGIS software. The geodatabase produced is based on collected data and covers issues, such as defining the spatial distribution of health care facilities, evaluating health demand types and modelling health service areas based on analysis of driving-time and straight-line distances.

  19. Using geographical information systems for defining the accessibility to health care facilities in Jeddah City, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Abdulkader A. Murad

    2014-12-01

    Full Text Available Spatial data play an important role in the planning of health care facilities and their allocation. Today, geographical information systems (GIS provide useful techniques for capturing, maintaining and analysing health care spatial data; indeed health geoinformatics is an emerging discipline that uses innovative geospatial technology to investigate health issues. The purpose of this paper is to define how GIS can be used for assessing the level of accessibility to health care. The paper identifies the advantages of using GIS in health care planning and covers GIS-based international accessibility with a focus on GIS applications for health care facilities in Jeddah city, Saudi Arabia. A geodatabase that includes location of health services, road networks, health care demand and population districts was created using ArcGIS software. The geodatabase produced is based on collected data and covers issues, such as defining the spatial distribution of health care facilities, evaluating health demand types and modelling health service areas based on analysis of driving-time and straight-line distances.

  20. A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana

    Science.gov (United States)

    Ahiabu, Mary-Anne; Tersbøl, Britt P; Biritwum, Richard; Bygbjerg, Ib C; Magnussen, Pascal

    2016-01-01

    Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis and logistic regression was used to explore for predictors of antibiotic prescription. Average number of medicines prescribed per encounter was 4.01, and 59.9% of prescriptions had antibiotics whilst 24.2% had injections. In total, 79.2% and 88.1% of prescribed medicines were generics and from the national essential medicine list, respectively. In the multivariate analysis, health facility type (odds ratio [OR] = 2.05; 95% confidence interval [CI]: 1.42, 2.95), patient age (OR = 0.97; 95% CI: 0.97, 0.98), number of medicines on a prescription (OR = 1.85; 95% CI: 1.63, 2.10) and ‘no malaria drug’ on prescription (OR = 5.05; 95% CI: 2.08, 12.25) were associated with an antibiotic prescription. A diagnosis of upper respiratory tract infection was positively associated with antibiotic use. The level of antibiotic use varied depending on the health facility type and was generally high compared with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health

  1. Trajectory of cause of death among brought dead neonates in tertiary care public facilities of Pakistan: A multicenter study.

    Science.gov (United States)

    Mustufa, Muhammad Ayaz; Sheikh, Munir Ahmed; Taseer, Ijaz-Ul-Haque; Raza, Syed Jamal; Arshad, Muhammad Sohail; Akhter, Tasleem; Arain, Ghazala Mohyuddin; Habibullah, Sultana; Safdar, Sohail; Firdous, Rukhsana; Adnan, Muhammad

    2017-02-01

    Considering the fact that Pakistan is amongst the countries with very high neonatal mortality rates, we conducted a research study to determine the possible causes and characteristics of neonates presenting dead to the emergency department of tertiary public health care facilities of Pakistan using verbal autopsies. A descriptive case series study was conducted in emergency department/pediatrics ward/neonatal ward/nursery unit of ten tertiary care public health facilities, situated in seven major cities of Pakistan from November, 2011 to June, 2013. Precoded verbal autopsy proforma was used to collect information regarding cause of death, family narratives and other associated risks accountable for pathway to mortality. We identified 431 neonates presenting dead to the emergency department (238 males and 193 females). Sepsis (26.7%), birth asphyxia (18.8%) and persistent pulmonary arrest (17.2%) were main primary causes of brought death. Around 72% brought dead neonates were referred from doctors/health care facilities and more than 28% caregivers mentioned that they were not informed about the diagnosis/ailment of their deceased newborn. Findings of our study suggest that infectious disease remains the main primary cause of neonatal mortality. Underweight in newborns (64%) was estimated as a leading associated risk. Delays in referrals to respective health care facility enlightened the concern of sub-standard prerequisites of neonatal care that could be one of the major contributing risk factor of high mortality rates.

  2. Práticas de cuidados produzidas no serviço de residências terapêuticas: percorrendo os trilhos de retorno à sociedade Las prácticas de cuidados ofrecidos en el servicio de residencias terapéuticas: recorriendo los caminos de retorno a la sociedad Health-care practices performed at assisted living facilities: pursuing the paths back to society

    Directory of Open Access Journals (Sweden)

    Hudson Pires de Oliveira Santos Junior

    2009-12-01

    service. Data collection was performed using an observation form, field journal, and a semi-structured interview script, which was conducted with 10 professionals working at the facilities. It was found that the care provided at the facility was humanized and valued the uniqueness of the individuals living there, as well as their values and beliefs, seeking to (reestablish the individuals' social relationships and encourage them towards self-care. It is observed that this form of care has been achieving (resocialization and valuing the lives of those experiencing psychic distress.

  3. DOE High Performance Computing Operational Review (HPCOR): Enabling Data-Driven Scientific Discovery at HPC Facilities

    Energy Technology Data Exchange (ETDEWEB)

    Gerber, Richard; Allcock, William; Beggio, Chris; Campbell, Stuart; Cherry, Andrew; Cholia, Shreyas; Dart, Eli; England, Clay; Fahey, Tim; Foertter, Fernanda; Goldstone, Robin; Hick, Jason; Karelitz, David; Kelly, Kaki; Monroe, Laura; Prabhat,; Skinner, David; White, Julia

    2014-10-17

    U.S. Department of Energy (DOE) High Performance Computing (HPC) facilities are on the verge of a paradigm shift in the way they deliver systems and services to science and engineering teams. Research projects are producing a wide variety of data at unprecedented scale and level of complexity, with community-specific services that are part of the data collection and analysis workflow. On June 18-19, 2014 representatives from six DOE HPC centers met in Oakland, CA at the DOE High Performance Operational Review (HPCOR) to discuss how they can best provide facilities and services to enable large-scale data-driven scientific discovery at the DOE national laboratories. The report contains findings from that review.

  4. [The Computer Competency of Nurses in Long-Term Care Facilities and Related Factors].

    Science.gov (United States)

    Chang, Ya-Ping; Kuo, Huai-Ting; Li, I-Chuan

    2016-12-01

    It is important for nurses who work in long-term care facilities (LTCFs) to have an adequate level of computer competency due to the multidisciplinary and comprehensive nature of long-term care services. Thus, it is important to understand the current computer competency of nursing staff in LTCFs and the factors that relate to this competency. To explore the computer competency of LTCF nurses and to identify the demographic and computer-usage characteristics that relate significantly to computer competency in the LTCF environment. A cross-sectional research design and a self-report questionnaire were used to collect data from 185 nurses working at LTCFs in Taipei. The results found that the variables of the frequency of computer use (β = .33), age (β = -.30), type(s) of the software used at work (β = .28), hours of on-the-job training (β = -.14), prior work experience at other LTCFs (β = -.14), and Internet use at home (β = .12) explain 58.0% of the variance in the computer competency of participants. The results of the present study suggest that the following measures may help increase the computer competency of LTCF nurses. (1) Nurses should be encouraged to use electronic nursing records rather than handwritten records. (2) On-the-job training programs should emphasize participant competency in the Excel software package in order to maintain efficient and good-quality of LTC services after implementing of the LTC insurance policy.

  5. Pt-Decorated Magnetic Nanozymes for Facile and Sensitive Point-of-Care Bioassay.

    Science.gov (United States)

    Kim, Min Su; Kweon, Soon Ho; Cho, Seongyeon; An, Seong Soo A; Kim, Moon Il; Doh, Junsang; Lee, Jinwoo

    2017-10-11

    Development of facile and sensitive bioassays is important for many point-of-care applications. In this study, we fulfilled such demand by synthesizing Pt-decorated magnetic nanozymes and developing a bioassay based on unique properties of the newly synthesized nanozymes. Fe3O4-Pt/core-shell nanoparticles (MPt/CS NPs) with various compositions were synthesized and characterized. Fe3O4 NP itself is a good nanozyme with catalytic activity superior to that of natural enzymes, but catalytic activity can be further improved by incorporating Pt to the outer layers of the Fe3O4 NPs and building heterogeneous nanostructures. Magnetic properties of MPt/CS NPs enable magnetic enrichment of liquid samples, whereas catalytic properties of MPt/CS NPs allow signal amplification by enzyme-like reactions. By integrating MPt/CS NPs in lateral flow immunoassay strips, one of the widely used point-of-care bioassay devices, and harnessing magnetic and enzyme-like properties of MPt/CS NPs, an increase in sensitivity of two orders of magnitude was achieved compared to the sensitivity of conventional lateral flow immunoassay based on Au nanoparticles.

  6. Medication Administration Errors in an Adult Emergency Department of a Tertiary Health Care Facility in Ghana.

    Science.gov (United States)

    Acheampong, Franklin; Tetteh, Ashalley Raymond; Anto, Berko Panyin

    2016-12-01

    This study determined the incidence, types, clinical significance, and potential causes of medication administration errors (MAEs) at the emergency department (ED) of a tertiary health care facility in Ghana. This study used a cross-sectional nonparticipant observational technique. Study participants (nurses) were observed preparing and administering medication at the ED of a 2000-bed tertiary care hospital in Accra, Ghana. The observations were then compared with patients' medication charts, and identified errors were clarified with staff for possible causes. Of the 1332 observations made, involving 338 patients and 49 nurses, 362 had errors, representing 27.2%. However, the error rate excluding "lack of drug availability" fell to 12.8%. Without wrong time error, the error rate was 22.8%. The 2 most frequent error types were omission (n = 281, 77.6%) and wrong time (n = 58, 16%) errors. Omission error was mainly due to unavailability of medicine, 48.9% (n = 177). Although only one of the errors was potentially fatal, 26.7% were definitely clinically severe. The common themes that dominated the probable causes of MAEs were unavailability, staff factors, patient factors, prescription, and communication problems. This study gives credence to similar studies in different settings that MAEs occur frequently in the ED of hospitals. Most of the errors identified were not potentially fatal; however, preventive strategies need to be used to make life-saving processes such as drug administration in such specialized units error-free.

  7. The Association between Suicide Screening Practices and Attempts Requiring Emergency Care in Juvenile Justice Facilities.

    Science.gov (United States)

    Gallagher, Catherine A.; Dobrin, Adam

    2005-01-01

    Objective: To provide a national description of suicide screening practices in juvenile residential facilities and to examine their association with whether facilities experience a suicide attempt. Method: Multivariate modeling with data from the 2000 Juvenile Residential Facility Census (n = 3690 facilities). Results: Controlling for facility…

  8. Availability of emergency obstetric care (EmOC) among public and private health facilities in rural northwest Bangladesh.

    Science.gov (United States)

    Sikder, Shegufta S; Labrique, Alain B; Ali, Hasmot; Hanif, Abu A M; Klemm, Rolf D W; Mehra, Sucheta; West, Keith P; Christian, Parul

    2015-01-31

    Although safe motherhood strategies recommend that women seek timely care from health facilities for obstetric complications, few studies have described facility availability of emergency obstetric care (EmOC). We sought to describe and compare availability and readiness to provide EmOC among public and private health facilities commonly visited for pregnancy-related complications in two districts of northwest Bangladesh. We also described aspects of financial and geographic access to healthcare and key constraints to EmOC provision. Using data from a large population-based community trial, we identified and surveyed the 14 health facilities (7 public, 7 private) most frequently visited for obstetric complications and near misses as reported by women. Availability of EmOC was based on provision of medical services, assessed through clinician interviews and record review. Levels of EmOC availability were defined as basic or comprehensive. Readiness for EmOC provision was based on scores in four categories: staffing, equipment, laboratory capacity, and medicines. Readiness scores were calculated using unweighted averages. Costs of C-section procedures and geographic locations of facilities were described. Textual analysis was used to identify key constraints. The seven surveyed private facilities offered comprehensive EmOC compared to four of the seven public facilities. With 100% representing full readiness, mean EmOC readiness was 81% (range: 63%-91%) among surveyed private facilities compared to 67% (range: 48%-91%) in public facilities (p = 0.040). Surveyed public clinics had low scores on staffing and laboratory capacity (69%; 50%). The mean cost of the C-section procedure in private clinics was $77 (standard deviation: $16) and free in public facilities. The public sub-district facilities were the only facilities located in rural areas, with none providing comprehensive EmOC. Shortages in specialized staff were listed as the main barrier to EmOC provision in

  9. Performance-enhancing sports supplements: role in critical care.

    Science.gov (United States)

    Weitzel, Lindsay-Rae B; Sandoval, Paul A; Mayles, W Jonathan; Wischmeyer, Paul E

    2009-10-01

    Many performance-enhancing supplements and/or drugs are increasing in popularity among professional and amateur athletes alike. Although the uncontrolled use of these agents can pose health risks in the general population, their clearly demonstrated benefits could prove helpful to the critically ill population in whom preservation and restoration of lean body mass and neuromuscular function are crucial. Post-intensive care unit weakness not only impairs post-intensive care unit quality of life but also correlates with intensive care unit mortality. This review covers a number of the agents known to enhance athletic performance, and their possible role in preservation of muscle function and prevention/treatment of post-intensive care unit weakness in critically ill patients. These agents include testosterone analogues, growth hormone, branched chain amino acid, glutamine, arginine, creatine, and beta-hydryoxy-beta-methylbutyrate. Three of the safest and most effective agents in enhancing athletic performance in this group are creatine, branched-chain amino acid, and beta-hydryoxy-beta-methylbutyrate. However, these agents have received very little study in the recovering critically ill patient suffering from post-intensive care unit weakness. More placebo-controlled studies are needed in this area to determine efficacy and optimal dosing. It is very possible that, under the supervision of a physician, many of these agents may prove beneficial in the prevention and treatment of post-intensive care unit weakness.

  10. Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey.

    Science.gov (United States)

    Peck, Robert; Mghamba, Janneth; Vanobberghen, Fiona; Kavishe, Bazil; Rugarabamu, Vivian; Smeeth, Liam; Hayes, Richard; Grosskurth, Heiner; Kapiga, Saidi

    2014-05-01

    Historically, health facilities in sub-Saharan Africa have mainly managed acute, infectious diseases. Few data exist for the preparedness of African health facilities to handle the growing epidemic of chronic, noncommunicable diseases (NCDs). We assessed the burden of NCDs in health facilities in northwestern Tanzania and investigated the strengths of the health system and areas for improvement with regard to primary care management of selected NCDs. Between November, 2012, and May, 2013, we undertook a cross-sectional survey of a representative sample of 24 public and not-for profit health facilities in urban and rural Tanzania (four hospitals, eight health centres, and 12 dispensaries). We did structured interviews of facility managers, inspected resources, and administered self-completed questionnaires to 335 health-care workers. We focused on hypertension, diabetes, and HIV (for comparison). Our key study outcomes related to service provision, availability of guidelines and supplies, management and training systems, and preparedness of human resources. Of adult outpatient visits to hospitals, 58% were for chronic diseases compared with 20% at health centres, and 13% at dispensaries. In many facilities, guidelines, diagnostic equipment, and fi rst-line drug therapy for the primary care of NCDs were inadequate, and management, training, and reporting systems were weak. Services for HIV accounted for most chronic disease visits and seemed stronger than did services for NCDs. Ten (42%) facilities had guidelines for HIV whereas three (13%) facilities did for NCDs. 261 (78%) health workers showed fair knowledge of HIV, whereas 198 (59%) did for hypertension and 187 (56%) did for diabetes. Generally, health systems were weaker in lower-level facilities. Front-line health-care workers (such as non-medical-doctor clinicians and nurses) did not have knowledge and experience of NCDs. For example, only 74 (49%) of 150 nurses had at least fair knowledge of diabetes care

  11. Environmental performances of different configurations of a material recovery facility in a life cycle perspective.

    Science.gov (United States)

    Ardolino, Filomena; Berto, Chiara; Arena, Umberto

    2017-10-01

    The study evaluated the environmental performances of an integrated material recovery facility (MRF) able to treat 32kt/y of unsorted mixed waste, made of residuals from household source separation and separate collection. The facility includes a mechanical sorting platform for the production of a solid recovered fuel (SRF) utilized in an external waste-to-energy plant, bio-cells for tunnel composting of organic fraction, and a sanitary landfill for the safe disposal of ultimate waste. All the MRF sub-units have been analysed in depth in order to acquire reliable data for a life cycle assessment study, focused on the environmental performances of different configurations of the facility. The study investigated a "past" configuration, including just mechanical sorting, landfilling and biogas combustion in a gas engine, and the "present" one, which includes also a composting unit. Two possible "future" configurations, having a gasifier inside the MRF battery limits, have been also analysed, assessing the performances of two fluidized bed reactors of different size, able to gasify only the residues generated by the sorting platform or the whole amount of produced SRF, respectively. The analysis evaluated the contributions of each unit in the different configurations and allowed a reliable assessment of the technological evolution of the facility. The results quantified the positive effect of the inclusion of an aerobic treatment of the waste organic fraction. The SRF gasification in situ appears to improve the MRF environmental performances in all the impact categories, with the exclusion of that of global warming. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. The role of civil society in strengthening intercultural maternal health care in local health facilities: Puno, Peru.

    Science.gov (United States)

    Samuel, Jeannie

    2016-01-01

    Peru's Ministry of Health has made efforts to increase the cultural inclusiveness of maternal health services. In 2005, the Ministry adopted an intercultural birthing policy (IBP) that authorizes and encourages the use of culturally acceptable birthing practices in government-run health facilities. However, studies suggest that indigenous women may receive inconsistent benefits from these kinds of policies. This article examines whether a grassroots accountability initiative based on citizen monitoring of local health facilities by indigenous women can help to promote the objectives of the IBP and improve intercultural maternal health care. Findings are drawn from a larger qualitative research study completed in 2015 that included fieldwork done between 2010 and 2011. Semi-structured interviews were conducted with 23 women working as citizen monitors in local health facilities in Puno and 30 key informants, including frontline health workers, health officials, and civil society actors in Puno and Lima, and human rights lawyers from the Defensoría del Pueblo Office in Puno. Monitors confirmed from their own personal experiences in the 1990s and early 2000s that respect for intercultural aspects of maternal health care, including traditional indigenous birthing practices, were not readily accepted in publicly funded health facilities. It was also common for indigenous women to face discrimination when seeking health service provided by the state. Although the government's adoption of the IBP in 2005 was a positive step, considerable efforts are still needed to ensure high-quality, culturally appropriate maternal health care is consistently available in local health facilities. Despite important progress in the past two decades, policies aimed at improving intercultural maternal health care are unevenly implemented in local health facilities. Civil society, in particular indigenous women themselves, can play an important role in holding the state accountable for

  13. The role of civil society in strengthening intercultural maternal health care in local health facilities: Puno, Peru

    Science.gov (United States)

    Samuel, Jeannie

    2016-01-01

    Background and objective Peru's Ministry of Health has made efforts to increase the cultural inclusiveness of maternal health services. In 2005, the Ministry adopted an intercultural birthing policy (IBP) that authorizes and encourages the use of culturally acceptable birthing practices in government-run health facilities. However, studies suggest that indigenous women may receive inconsistent benefits from these kinds of policies. This article examines whether a grassroots accountability initiative based on citizen monitoring of local health facilities by indigenous women can help to promote the objectives of the IBP and improve intercultural maternal health care. Design Findings are drawn from a larger qualitative research study completed in 2015 that included fieldwork done between 2010 and 2011. Semi-structured interviews were conducted with 23 women working as citizen monitors in local health facilities in Puno and 30 key informants, including frontline health workers, health officials, and civil society actors in Puno and Lima, and human rights lawyers from the Defensoría del Pueblo Office in Puno. Results Monitors confirmed from their own personal experiences in the 1990s and early 2000s that respect for intercultural aspects of maternal health care, including traditional indigenous birthing practices, were not readily accepted in publicly funded health facilities. It was also common for indigenous women to face discrimination when seeking health service provided by the state. Although the government's adoption of the IBP in 2005 was a positive step, considerable efforts are still needed to ensure high-quality, culturally appropriate maternal health care is consistently available in local health facilities. Conclusions Despite important progress in the past two decades, policies aimed at improving intercultural maternal health care are unevenly implemented in local health facilities. Civil society, in particular indigenous women themselves, can play an

  14. Using organizational and clinical performance data to increase the value of mental health care.

    Science.gov (United States)

    Schmidt, Eric M; Krahn, Dean D; McGuire, Marsden H; Tavakoli, Sara; Wright, David M; Solares, Hugo E; Lemke, Sonne; Trafton, Jodie

    2017-02-01

    U.S. health systems, policy makers, and patients increasingly demand high-value care that improves health outcomes at lower cost. This study describes the initial design and analysis of the Mental Health Management System (MHMS), a performance data and quality improvement tool used by the Veterans Health Administration (VHA) to increase the value of its mental health care. The MHMS evaluates access to and quality of mental health care, organizational structure and efficiency, implementation of innovative treatment options, and, in collaboration with management, resource needs for delivering care. Performance on 31 measures was calculated for all U.S. VHA facilities (N = 139). Pearson correlations revealed that better access to care was significantly associated with fewer mental health provider staffing vacancies (r = -.24) and higher staff-to-patient ratios for psychiatrists (r = .19) and other outpatient mental health providers (r = .27). Higher staff-to-patient ratios were significantly associated with higher performance on a number of patient and provider satisfaction measures (range of r = .18-.51) and continuity of care measures (range of r = .26-.43). Relationships observed between organizational and clinical performance measures suggest that the MHMS is a robust informatics and quality improvement tool that can serve as a model for health systems planning to adopt a value perspective. Future research should expand the MHMS framework to measure patient and health systems costs and psychosocial outcomes, as well as evaluate whether quality improvement solutions implemented as a result of using organizational information leads to higher-value mental health care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  15. Perspectives of older people living in long-term care facilities and of their family members toward advance care planning discussions: a systematic review and thematic synthesis

    OpenAIRE

    Mignani V; Ingravallo F; Mariani E; Chattat R

    2017-01-01

    Veronica Mignani,1 Francesca Ingravallo,1 Elena Mariani,2 Rabih Chattat2 1Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio, Bologna, Italy; 2Department of Psychology, University of Bologna, Viale Berti Pichat, Bologna, Italy Objective: We aimed to search and synthesize qualitative studies exploring the perspectives of older people living in long-term care facilities and of their family members about advance care planning (ACP) discussions. Methods: The enhanci...

  16. Manager traits and quality-of-care performance in hospitals.

    Science.gov (United States)

    Aij, Kjeld Harald; Aernoudts, René L M C; Joosten, Gepke

    2015-07-06

    This paper aims to assess the impact of the leadership traits of chief executive officers (CEOs) on hospital performance in the USA. The effectiveness and efficiency of the CEO is of critical importance to the performance of any organization, including hospitals. Management systems and manager behaviours (traits) are of crucial importance to any organization because of their connection with organizational performance. To identify key factors associated with the quality of care delivered by hospitals, the authors gathered perceptions of manager traits from chief executive officers (CEOs) and followers in three groups of US hospitals delivering different levels of quality of care performance. Three high- and three low-performing hospitals were selected from the top and bottom 20th percentiles, respectively, using a national hospital ranking system based on standard quality of care performance measures. Three lean hospitals delivering intermediate performance were also selected. A survey was used to gather perceptions of manager traits (providing a modern or lean management system inclination) from CEOs and their followers in the three groups, which were compared. Four traits were found to be significantly different (alpha performing hospitals. The different perceptions between these two hospital groups were all held by followers in the low-performing hospitals and not the CEOs, and all had a modern management inclination. No differences were found between lean (intermediate-) and high-performing hospitals, or between high- and low-performing hospitals. These findings support a need for hospital managers to acquire appropriate traits to achieve lean transformation, support a benefit of measuring manager traits to assess progress towards lean transformation and lend weight to improved quality of care that can be delivered by hospitals adopting a lean system of management.

  17. Economic evaluation of oseltamivir phosphate for postexposure prophylaxis of influenza in long-term care facilities.

    Science.gov (United States)

    Risebrough, Nancy A; Bowles, Susan K; Simor, Andrew E; McGeer, Alison; Oh, Paul I

    2005-03-01

    To compare the cost-effectiveness of oseltamivir postexposure prophylaxis during influenza A outbreaks with that of amantadine postexposure prophylaxis or no postexposure prophylaxis in long-term care facilities (LTCFs). Cost-effectiveness analysis based on decision analytic model from a government-payer perspective. A Canadian LTCF, with high staff vaccination, at the beginning of influenza season. Elderly, influenza-vaccinated patients living in a Canadian LTCF. Incremental costs (or savings) per influenza-like illness case avoided compared with usual care. From a government-payer perspective, this analysis showed that oseltamivir was a dominant strategy because it was associated with the fewest influenza-like illness cases, with cost savings of $1,249 per 100 patients in 2001 Canadian dollars compared with amantadine and $3,357 per 100 patients compared with no prophylaxis. Costs for amantadine dose calculation and hospitalization for adverse events contributed to amantadine being a more-expensive prophylaxis strategy than oseltamivir. Both prophylaxis strategies were more cost-effective than no prophylaxis. Despite high influenza vaccination rates, influenza outbreaks continue to emerge in LTCFs, necessitating cost-effective measures to further limit the spread of influenza and related complications. Although amantadine has a lower acquisition cost than oseltamivir, it is associated with more adverse events, lower efficacy, and individualized dosing requirements, leading to higher overall costs and more influenza-like illness cases than oseltamivir. Therefore the use of oseltamivir postexposure prophylaxis is more cost-effective than the current standard of care with amantadine prophylaxis or no prophylaxis.

  18. Medication incident reporting in residential aged care facilities: Limitations and risks to residents’ safety

    Directory of Open Access Journals (Sweden)

    Tariq Amina

    2012-11-01

    Full Text Available Abstract Background Medication incident reporting (MIR is a key safety critical care process in residential aged care facilities (RACFs. Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a design MIR artefacts that facilitate identification of the root causes of medication incidents, b integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.

  19. Prevalence of physical and verbal aggressive behaviours and associated factors among older adults in long-term care facilities

    OpenAIRE

    Desrosiers Johanne; Azizah Ginette M; Verreault René; Voyer Philippe; Champoux Nathalie; Bédard Annick

    2005-01-01

    Abstract Background Verbal and physical aggressive behaviours are among the most disturbing and distressing behaviours displayed by older patients in long-term care facilities. Aggressive behaviour (AB) is often the reason for using physical or chemical restraints with nursing home residents and is a major concern for caregivers. AB is associated with increased health care costs due to staff turnover and absenteeism. Methods The goals of this secondary analysis of a cross-sectional study are ...

  20. Do service innovations influence the adoption of electronic health records in long-term care organizations? Results from the U.S. National Survey of Residential Care Facilities.

    Science.gov (United States)

    Bhuyan, Soumitra S; Zhu, He; Chandak, Aastha; Kim, Jungyoon; Stimpson, Jim P

    2014-12-01

    Healthcare organizations including residential care facilities (RCFs) are diversifying their services to meet market demands. Service innovations have been linked to the changes in the way that healthcare organizations organize their work. The objective of this study is to explore the relationship between organizational service innovations and Electronic Health Record (EHR) adoption in the RCFs. We used the data from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention. The outcome was whether an RCF adopted EHR or not, and the predictors were the organizational service innovations including provision of skilled nursing care and medication review. We also added facility characteristics as control variables. Weighted multivariate logistic regressions were used to estimate the relationship between service innovation factors and EHR adoption in the RCFs. In 2010, about 17.4% of the RCFs were estimated to use EHR. Multivariate analysis showed that RCFs employing service innovations were more likely to adopt EHR. The residential care facilities that provide skilled nursing services to their residents are more likely (OR: 1.42; 95% CI: 1.09-1.87) to adopt EHR. Similarly, RCFs with a provision of medication review were also more likely to adopt EHR (OR: 1.40; 95% CI: 1.00-1.95). Among the control variables, facility size, chain affiliation, ownership type, and Medicaid certification were significantly associated with EHR adoption. Our findings suggest that service innovations may drive EHR adoption in the RCFs in the United States. This can be viewed as a strategic attempt by RCFs to engage in a new business arrangement with hospitals and other health care organizations, where quality of care and interoperability of patients' records might play a vital role under the current healthcare reform. Future research could examine the relationship between service innovations and use of different EHR functionality in

  1. Practice and Perceived Importance of Advance Care Planning and Difficulties in Providing Palliative Care in Geriatric Health Service Facilities in Japan: A Nationwide Survey.

    Science.gov (United States)

    Yokoya, Shoji; Kizawa, Yoshiyuki; Maeno, Takami

    2018-03-01

    The provision of end-of-life (EOL) care by geriatric health service facilities (GHSFs) in Japan is increasing. Advance care planning (ACP) is one of the most important issues to provide quality EOL care. This study aimed to clarify the practice and perceived importance of ACP and the difficulties in providing palliative care in GHSFs. A self-report questionnaire was mailed to head nurses at 3437 GHSFs nationwide. We asked participants about their practices regarding ACP, their recognition of its importance, and their difficulties in providing palliative care. We also analyzed the relationship between these factors and EOL care education. Among 844 respondents (24.5% response rate), approximately 69% to 81% of head nurses confirmed that GHSF residents and their families understood disease conditions and goals of care. There was a large discrepancy between the actual practice of ACP components and the recognition of their importance (eg, asking residents about existing advance directive [AD; 27.5% practiced it, while 79.6% considered it important]; recommending completion of an AD [18.1% vs 68.4%], and asking for designation of a health-care proxy [30.4% vs 76.8%]). The EOL care education was provided at 517 facilities (61.3%). Head nurses working at EOL care education-providing GHSFs practiced ACP significantly more frequently and had significantly fewer difficulties in providing palliative care. A large discrepancy was found between GHSF nurses' practice of ACP and their recognition of its importance. Providing EOL care education in GHSFs may increase ACP practices and enhance respect for resident's preferences concerning EOL care.

  2. Intention to Use Long-Term Care Facilities: Differences beween Korean Pre-elderly and Korean Baby-boomers.

    Science.gov (United States)

    Hong, Michin; Hong, Seunghye; Kim, Mee Hye; Yi, Eun Hye

    2016-12-01

    With the rapidly increasing number of older adults, dealing with long-term care (LTC) needs becomes an emerging issue in South Korea. This study aims to examine factors affecting the intention to use longtermcare facilities with two groups of young-old adults: (1) Korean pre-elderly (KPE) and (2) Korean babyboomers (KBB). Guided by Andersen's behavioral model of health service use and prior research, predisposing characters, enabling resources, need factors, availabilities of informal care and self-care activities were used as predictors. In the final analyses, 803 KPE and 966 KBB were included. The results of logistic regression analyses showed different findings in two groups. Age, education, spouse's physicalhealth, and self-care activities for relationship with family and friends are significantly associated with intention to use LTC facilities among KPE. However, income, physical health of respondents, and relationship satisfaction with children are significantly related to intention of use LTC facilities in the group of KBB. This study suggests different LTC needs between KPE and KBB. Health care professionals and policy makers need to consider such differences to provide quality LTC care for them.

  3. Carbapenem-resistant Enterobacteriaceae carriers in acute care hospitals and postacute-care facilities: The effect of organizational culture on staff attitudes, knowledge, practices, and infection acquisition rates.

    Science.gov (United States)

    Fedorowsky, Rina; Peles-Bortz, Anat; Masarwa, Samira; Liberman, Dvora; Rubinovitch, Bina; Lipkin, Valentina

    2015-09-01

    Carbapenem-resistant Enterobacteriaceae (CRE) carriers are frequently transferred between acute care hospitals (ACHs) and postacute-care facilities (PACFs). Compliance of health care workers with infection prevention guidelines in both care settings may be influenced by the institution's organizational culture. To assess the association between organizational culture and health care workers' attitudes, knowledge, practices, and CRE acquisition rate and to identify differences between different care settings and health care workers' sectors. Cross-sectional descriptive design. Self-administered questionnaires were distributed to a sample of 420 health care workers from 1 ACH and 1 PACF belonging to the same health maintenance organization located in central Israel. The organizational culture factor known as staff engagement was positively correlated with infection prevention attitudes and compliance with contact precaution protocols and negatively correlated with CRE acquisition rate. In the 2 care settings, health care workers' attitudes, knowledge, and practices were found to be similar, but CRE acquisition rate was lower in PACFs. Compliance with contact precaution protocols by physicians was lower than compliance reported by other health care workers. Auxiliary staff reported lower knowledge. In a setting of endemic CRE where a multifaceted intervention is already being implemented, organizational culture variables can predict health care workers' attitudes, knowledge, and practices and in turn can affect CRE acquisition rates. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Preparedness of lower-level health facilities and the associated factors for the outpatient primary care of hypertension: Evidence from Tanzanian national survey.

    Science.gov (United States)

    Bintabara, Deogratius; Mpondo, Bonaventura C T

    2018-01-01

    Sub-Saharan Africa is experiencing a rapid rise in the burden of non-communicable diseases in both urban and rural areas. Data on health system preparedness to manage hypertension and other non-communicable diseases remains scarce. This study aimed to assess the preparedness of lower-level health facilities for outpatient primary care of hypertension in Tanzania. This study used data from the 2014-2015 Tanzania Service Provision Assessment survey. The facility was considered as prepared for the outpatient primary care of hypertension if reported at least half (≥50%) of the items listed from each of the three domains (staff training and guideline, basic diagnostic equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Data were analyzed using Stata 14. An unadjusted logistic regression model was used to assess the association between outcome and explanatory variables. All variables with a P value primary care of hypertension. About 9% and 42% of the assessed facilities reported to have at least one trained staff and guidelines for hypertension respectively. In multivariate analysis, private facilities [AOR = 2.7, 95% CI; 1.2-6.1], urban location [AOR = 2.2, 95% CI; 1.2-4.2], health centers [AOR = 5.2, 95% CI; 3.1-8.7] and the performance of routine management meetings [AOR = 2.6, 95% CI; 1.1-5.9] were significantly associated with preparedness for the outpatient primary care of hypertension. The primary healthcare system in Tanzania is not adequately equipped to cope with the increasing burden of hypertension and other non-communicable diseases. Rural location, public ownership, and absence of routine management meetings were associated with being not prepared. There is a need to strengthen the primary healthcare system in Tanzania for better management of chronic diseases and curb their rising impact on health outcomes.

  5. Relationship between national mental health expenditure and quality of care in longer-term psychiatric and social care facilities in Europe: cross-sectional study.

    Science.gov (United States)

    Salisbury, Tatiana Taylor; Killaspy, Helen; King, Michael

    2017-07-01

    Background It is not known whether increased mental health expenditure is associated with better outcomes. Aims To estimate the association between national mental health expenditure and (a) quality of longer-term mental healthcare, (b) service users' ratings of that care in eight European countries. Method National mental health expenditure (per cent of health budget spent on mental health) was calculated from international sources. Multilevel models were developed to assess associations with quality of care and service user experiences of care using ratings of 171 facility managers and 1429 service users. Results Significant positive associations were found between mental health spend and (a) six of seven quality of care domains; and (b) service user autonomy and experiences of care. Conclusions Greater national mental health expenditure was associated with higher quality of care and better service user experience. © The Royal College of Psychiatrists 2017.

  6. Developing the Family Involvement Questionnaire-Long-Term Care: A Measure of Familial Involvement in the Lives of Residents at Long-Term Care Facilities.

    Science.gov (United States)

    Fast, Christopher T; Houlihan, Daniel; Buchanan, Jeffrey A

    2018-01-03

    Existing measures designed to assess family involvement in the lives of older adults residing in long-term care facilities are basic, using visitation frequency as the prominent gauge of involvement in a situation specific fashion. The purpose of this study was to design and validate a measure of family involvement that could be used to gauge more aspects of family involvement than visitation alone and be useful in a variety of settings for both researchers and long-term care facility administrators. Long-term facility staff were asked to assist in creating a 40-item questionnaire that used 4-point Likert scales to measure various aspects of family involvement. The finalized Family Involvement Questionnaire-Long-Term Care (FIQ-LTC) was distributed to the family members of older adults residing in long-term care facilities around the country. A total of 410 participants responded. Researchers found that the FIQ-LTC was highly reliable (α = .965). Results also indicated that a significant correlation between distance and overall involvement (r = -.121, p = .015) was no longer significant (r = .17, p = .740) when the effect of a question asking the frequency of visitation was controlled for. These results indicate that existing measures that use visitation frequency as the sole measure of involvement are insufficient. The newly developed FIQ-LTC can serve as a more complete measure of family involvement.

  7. The Impact of a Direct Care Training Program on the Self-Efficacy of Newly Hired Direct Care Employees at State Mental Health Facilities

    Science.gov (United States)

    Lewis, Marcus Wayne

    2012-01-01

    Self-efficacy has been shown to be an important element in the success of individuals in a variety of different settings. This research examined the impact of a two week new employee orientation training program on the general and social self-efficacy of newly hired direct care employees at state mental health facilities. The research showed that…

  8. Learning opportunities in a residential aged care facility: the role of supported placements for first-year nursing students.

    Science.gov (United States)

    Lea, Emma; Marlow, Annette; Bramble, Marguerite; Andrews, Sharon; Crisp, Elaine; Eccleston, Claire; Mason, Ron; Robinson, Andrew

    2014-07-01

    The residential aged care sector is reportedly a less attractive career choice for nursing students than other sectors. Research shows that students are often fearful of working with residents with dementia when they are inadequately supported on clinical placements by aged care staff. Thirty first-year nursing students attended a 2-week placement in one of two Tasmanian aged care facilities as part of the Wicking Dementia Research and Education Centre Teaching Aged Care Facilities Program, which aims to provide students with a quality aged care placement focusing on dementia palliation. Placement experience and dementia knowledge were evaluated through preplacement and postplacement questionnaires and weekly feedback meetings with mentors and students. Students had more positive attitudes related to aged care and higher dementia knowledge at the end of placement. Students described their interactions with residents with dementia and thought that the placement had increased their capacity to provide quality care to these residents. The findings indicate that residential aged care placements can be productive learning environments for novice nursing students. Copyright 2014, SLACK Incorporated.

  9. Risk factors for fecal colonization with multiple distinct strains of Escherichia coli among long-term care facility residents.

    Science.gov (United States)

    Lautenbach, Ebbing; Tolomeo, Pam; Black, Nicole; Maslow, Joel N

    2009-05-01

    Of 49 long-term care facility residents, 21 (43%) were colonized with 2 or more distinct strains of Escherichia coli. There were no significant risk factors for colonization with multiple strains of E. coli. These results suggest that future efforts to efficiently identify the diversity of colonizing strains will be challenging.

  10. Knowledge of Staff Members of Residential Care Facilities for Individuals with Intellectual Disability on Medication Administration via Enteral Feeding Tube

    Science.gov (United States)

    Joos, E.; Mehuys, E.; Van Bocxlaer, J.; Remon, J. P.; Van Winckel, M.; Boussery, K.

    2016-01-01

    Background: Guidelines for the safe administration of drugs through enteral feeding tube (EFT) are an important tool to minimise the risk of errors. This study aimed to investigate knowledge of these guidelines among staff of residential care facilities (RCF) for people with ID. Method: Knowledge was assessed using a 13-item self-administered…

  11. Using silver yoga exercises to promote physical and mental health of elders with dementia in long-term care facilities.

    Science.gov (United States)

    Fan, Jue-Ting; Chen, Kuei-Min

    2011-10-01

    This study aimed to test the effects of yoga exercises on the physical and mental health of elderly people with dementia living in long-term care facilities. A quasi-experimental, pretest-post-test design was used. A convenience sample of 68 residents in long-term care facilities in southern Taiwan, aged 60 years and above with mild to moderate dementia, was selected. An experimental group of 33 elders participated in a 12-week yoga training program of three 55-minute sessions a week; a control group of 35 elders maintained their usual daily activities. Data were collected before and after completing the 12-week study. Measurements included body composition, cardiopulmonary functions, body flexibility, muscle strength and endurance, balance, joints motion, depression, and problem behaviors. The yoga-trained participants had better physical and mental health than those who did not participate, including lowered blood pressure, reduced respiration rate, strengthened cardiopulmonary fitness, enhanced body flexibility, improved muscle strength and endurance, improved balance, and increased joints motion (all p values Yoga exercise has positive benefits for both the physical and mental health of elders with dementia living in long-term care facilities. It is recommended that yoga be included as one of the routine activities in these long-term care facilities.

  12. Patterns of antimicrobial use for respiratory tract infections in older residents of long-term care facilities

    Science.gov (United States)

    OBJECTIVE: To describe patterns of antimicrobial use for respiratory tract infections (RTIs) among elderly residents of long-term care facilities (LTCFs). DESIGN: Data from a prospective, randomized, controlled study conducted from April 1998 through August 2001 to investigate the effect of vitamin ...

  13. Impact of Infection Prevention and Control Initiatives on Acute Respiratory Infections in a Pediatric Long-Term Care Facility.

    Science.gov (United States)

    Murray, Meghan T; Jackson, Olivia; Cohen, Bevin; Hutcheon, Gordon; Saiman, Lisa; Larson, Elaine; Neu, Natalie

    2016-07-01

    We evaluated the collective impact of several infection prevention and control initiatives aimed at reducing acute respiratory infections (ARIs) in a pediatric long-term care facility. ARIs did not decrease overall, though the proportion of infections associated with outbreaks and average number of cases per outbreak decreased. Influenza rates decreased significantly. Infect Control Hosp Epidemiol 2016;37:859-862.

  14. 42 CFR 476.88 - Examination of the operations and records of health care facilities and practitioners.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Examination of the operations and records of health care facilities and practitioners. 476.88 Section 476.88 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS UTILIZATION...

  15. A Videotape-Based Training Method for Improving the Detection of Depression in Residents of Long-Term Care Facilities

    Science.gov (United States)

    Wood, Stacey; Cummings, Jeffrey L.; Schnelle, Betha; Stephens, Mary

    2002-01-01

    Purpose: This article reviews the effectiveness of a new training program for improving nursing staffs' detection of depression within long-term care facilities. The course was designed to increase recognition of the Minimal Data Set (MDS) Mood Trigger items, to be brief, and to rely on images rather than didactics. Design and Methods: This study…

  16. Does Accreditation Matter? School Readiness Rates for Accredited versus Nonaccredited Child Care Facilities in Florida's Voluntary Pre-Kindergarten Program

    Science.gov (United States)

    Winterbottom, Christian; Piasta, Shayne B.

    2015-01-01

    Accreditation is a widely accepted indicator of quality in early education and includes many of the components cited in broad conceptualizations of quality. The purpose of this study was to examine whether kindergarten readiness rates differed between Florida child care facilities that were and were not accredited by any relevant national…

  17. Evaluation of the Color Me Healthy Program in Influencing Nutrition and Physical Activity in Mississippi Preschool Child Care Facilities

    Science.gov (United States)

    Huye, Holly F.; Bankston, Sarah; Speed, Donna; Molaison, Elaine F.

    2014-01-01

    Purpose/Objectives: The purpose of this research was to determine the level of implementation and perceived value in creating knowledge and behavior change from the Color Me Healthy (CMH) training program in child care centers, family day carehomes, or Head Start facilities throughout Mississippi. Methods: A two-phase survey was used to initially…

  18. Imaging Facilities' Adherence to PI-RADS v2 Minimum Technical Standards for the Performance of Prostate MRI.

    Science.gov (United States)

    Esses, Steven J; Taneja, Samir S; Rosenkrantz, Andrew B

    2018-02-01

    This study aimed to assess variability in imaging facilities' adherence to the minimum technical standards for prostate magnetic resonance imaging acquisition established by Prostate Imaging-Reporting and Data System (PI-RADS) version 2 (v2). A total of 107 prostate magnetic resonance imaging examinations performed at 107 unique imaging facilities after the release of PI-RADS v2 and that were referred to a tertiary care center for secondary interpretation were included. Image sets, DICOM headers, and outside reports were reviewed to assess adherence to 21 selected PI-RADS v2 minimum technical standards. Hardware arrangements were 23.1%, 1.5T without endorectal coil; 7.7%, 1.5T with endorectal coil; 63.5%, 3T without endorectal coil; and 5.8%, 3T with endorectal coil. Adherence to minimum standards was lowest on T2 weighted imaging (T2WI) for frequency resolution ≤0.4 mm (16.8%) and phase resolution ≤0.7 mm (48.6%), lowest on diffusion-weighted imaging (DWI) for field of view (FOV) 120-220 mm (30.0%), and lowest on dynamic contrast-enhanced (DCE) imaging for slice thickness 3 mm (33.3%) and temporal resolution value (≥1400 s/mm 2 ) images were included in 58.0% (calculated in 25.9%). Adherence to T2WI phase resolution and DWI inter-slice gap were greater (P  .05) for any parameter between examinations performed with and without an endorectal coil. Adherence was greater for examinations performed at teaching facilities for T2WI slice thickness and DCE temporal resolution (P  .05). Facilities' adherence to PI-RADS v2 minimum technical standards was variable, being particularly poor for T2WI frequency resolution and DCE temporal resolution. The standards warrant greater community education. Certain technical standards may be too stringent, and revisions should be considered. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  19. NUMERICAL FLOW AND TRANSPORT SIMULATIONS SUPPORTING THE SALTSTONE FACILITY PERFORMANCE ASSESSMENT

    Energy Technology Data Exchange (ETDEWEB)

    Flach, G.

    2009-02-28

    The Saltstone Disposal Facility Performance Assessment (PA) is being revised to incorporate requirements of Section 3116 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 (NDAA), and updated data and understanding of vault performance since the 1992 PA (Cook and Fowler 1992) and related Special Analyses. A hybrid approach was chosen for modeling contaminant transport from vaults and future disposal cells to exposure points. A higher resolution, largely deterministic, analysis is performed on a best-estimate Base Case scenario using the PORFLOW numerical analysis code. a few additional sensitivity cases are simulated to examine alternative scenarios and parameter settings. Stochastic analysis is performed on a simpler representation of the SDF system using the GoldSim code to estimate uncertainty and sensitivity about the Base Case. This report describes development of PORFLOW models supporting the SDF PA, and presents sample results to illustrate model behaviors and define impacts relative to key facility performance objectives. The SDF PA document, when issued, should be consulted for a comprehensive presentation of results.

  20. Factors affecting the performance of maternal health care providers in Armenia

    Directory of Open Access Journals (Sweden)

    Voltero Lauren

    2004-06-01

    variables such as the facility type (antenatal care and whether observation was on simulated vs. real patients (postpartum care also had a role in observed performance. Conclusion This study concludes that the antenatal and postpartum care performance of health providers in Armenia is strongly associated with having the practical knowledge and skills to use everyday tools of the trade and with receiving recognition for their work, as well as having performance feedback. The paper recognized several limitations and expects further studies will illuminate this important topic further.

  1. ECHO: health care performance assessment in several European health systems.

    Science.gov (United States)

    Bernal-Delgado, E; Christiansen, T; Bloor, K; Mateus, C; Yazbeck, A M; Munck, J; Bremner, J

    2015-02-01

    Strengthening health-care effectiveness, increasing accessibility and improving resilience are key goals in the upcoming European Union health-care agenda. European Collaboration for Health-Care Optimization (ECHO), an international research project on health-care performance assessment funded by the seventh framework programme, has provided evidence and methodology to allow the attainment of those goals. This article aims at describing ECHO, analysing its main instruments and discussing some of the ECHO policy implications. Using patient-level administrative data, a series of observational studies (ecological and cross-section with associated time-series analyses) were conducted to analyze population and patients' exposure to health care. Operationally, several performance dimensions such as health-care inequalities, quality, safety and efficiency were analyzed using a set of validated indicators. The main instruments in ECHO were: (i) building a homogeneous data infrastructure; (ii) constructing coding crosswalks to allow comparisons between countries; (iii) making geographical units of analysis comparable; and (iv) allowing comparisons through the use of common benchmarks. ECHO has provided some innovations in international comparisons of health-care performance, mainly derived from the massive pooling of patient-level data and thus: (i) has expanded the usual approach based on average figures, providing insight into within and across country variation at various meaningful policy levels, (ii) the important effort made on data homogenization has increased comparability, increasing stakeholders' reliance on data and improving the acceptance of findings and (iii) has been able to provide more flexible and reliable benchmarking, allowing stakeholders to make critical use of the evidence. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  2. The Life of the Elderly in Residential Care Facilities - A Study of Autonomy and Life Situation of Elderly People in the Context of the Political Organisation of the Facilities

    DEFF Research Database (Denmark)

    Skjødt, Ulla

    Abstract: Bridging the gap – in Public Health Nursing September 19th and 20th 2016 Organised by: Global Network of Public Health Nursing The Life of the Elderly in Residential Care Facilities - A Study of Autonomy and Life Situation of Elderly People in the Context of the Political Organisation...... of the Facilities Keywords: vulnerable elderly people, impaired elderly people, residential care facility, autonomy of elderly, political organisation of help, New Public Management, market-orientation, welfare state. Aim: To examine how autonomy of the elderly in residential care facilities is practiced and how...... as mutually informing each other. Empirical material is generated by participant observation studies and interviews in residential care facilities as well as policy documents concerning the arrangement of public help to impaired elderly people are analysed. Results: Analysis of the empirical material...

  3. Independent Review of Siesmic Performance Assessments for the Plutonium Facility PF-4

    Energy Technology Data Exchange (ETDEWEB)

    Whittaker, Andrew [State Univ. of New York (SUNY), Buffalo, NY (United States); Goen, Lawrence Kenneth [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Kennedy, Robert [RPK Structural Mechanics, San Diego, CA (United States); McDonald, Brian [Exponent, Los Angeles, CA (United States); Morgan, Troy [Exponent, Los Angeles, CA (United States); Wyllie, Loring [Degenkolb Engineers, San Francisco, CA (United States)

    2015-11-25

    The Plutonium Facility, designated PF-4, is located in Technical Area 55 at the Los Alamos National Laboratory (LANL). The facility is a one-story rectangular structure above a complete basement; the building was constructed of cast-in-place reinforced concrete, with small interior frames of structural steel. The plan dimensions of the building are 265’×284’. The overall height of the building varies between 39’-0” at the north and south ends, and 40’-6” at the center ridge. The programmatic work performed in the building is vital to our national security and its functions and storage purposes are not replicated elsewhere in the United States Department of Energy (DOE).

  4. Secondary Waste Cementitious Waste Form Data Package for the Integrated Disposal Facility Performance Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Cantrell, Kirk J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Westsik, Joseph H. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Serne, R Jeffrey [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Um, Wooyong [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Cozzi, Alex D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-05-16

    A review of the most up-to-date and relevant data currently available was conducted to develop a set of recommended values for use in the Integrated Disposal Facility (IDF) performance assessment (PA) to model contaminant release from a cementitious waste form for aqueous wastes treated at the Hanford Effluent Treatment Facility (ETF). This data package relies primarily upon recent data collected on Cast Stone formulations fabricated with simulants of low-activity waste (LAW) and liquid secondary wastes expected to be produced at Hanford. These data were supplemented, when necessary, with data developed for saltstone (a similar grout waste form used at the Savannah River Site). Work is currently underway to collect data on cementitious waste forms that are similar to Cast Stone and saltstone but are tailored to the characteristics of ETF-treated liquid secondary wastes. Recommended values for key parameters to conduct PA modeling of contaminant release from ETF-treated liquid waste are provided.

  5. Facilities and procedures used for the performance testing of DOE personnel dosimetry systems

    Energy Technology Data Exchange (ETDEWEB)

    Roberson, P.L.; Fox, R.A.; Hogan, R.T.; Holbrook, K.L.; Hooker, C.D.; Yoder, R.C.

    1983-04-01

    Radiological calibration facilities for personnel dosimeter testing were developed at the Pacific Northwest Laboratory (PNL) for the Department of Energy (DOE) to provide a capability for evaluating the performance of DOE personnel dosimetry systems. This report includes the testing methodology used. The informational presented here meets requirements specified in draft ANSI N13.11 for the testing laboratory. The capabilities of these facilities include sealed source irradiations for /sup 137/Cs, several beta-particle emitters, /sup 252/Cf, and machine-generated x-ray beams. The x-ray beam capabilities include filtered techniques maintained by the National Bureau of Standards (NBS) and K-fluorescent techniques. The calibration techniques, dosimeter irradiation procedures, and dose-equivalent calculation methods follow techniques specified by draft ANSI N13.11 where appropriate.

  6. [Delinquent adolescents: health problems and health care guidelines for juvenile correctional facilities].

    Science.gov (United States)

    Oliván Gonzalvo, G

    2002-10-01

    The aim of this article was to provide an update that would serve to increase knowledge of health problems among juvenile delinquents before and during incarceration in juvenile correctional centers. Recommendations are made for the care of mental and physical health and for the health education of these teenagers that could be useful for health professionals providing health care to these teenagers while in custody as well as for those seeing them in the ambulatory setting. From the literature consulted, 63 % of studies have been performed in the United States, 24 % in Western Europe (Spain, United Kingdom, Holland, Belgium, Sweden, Finland), 8 % in Australia and 5 % in Canada. These studies show no appreciable qualitative differences in the health problems most frequently presented by these teenagers and there is agreement that the areas that should be prioritized are the provision of preventive and/or therapeutic dental care, as well as programs for psychiatric care, immunization, infectious diseases and health education. Failure to identify the health requirements of these teenagers and to provide early interventions can not only adversely effect their quality of life and their future physical, emotional and intellectual development but can also make their rehabilitation and reintegration into society more difficult.

  7. Use of a geographic information system to assess accessibility to health facilities providing emergency obstetric and newborn care in Bangladesh.

    Science.gov (United States)

    Chowdhury, Mahbub E; Biswas, Taposh K; Rahman, Monjur; Pasha, Kamal; Hossain, Mollah A

    2017-08-01

    To use a geographic information system (GIS) to determine accessibility to health facilities for emergency obstetric and newborn care (EmONC) and compare coverage with that stipulated by UN guidelines (5 EmONC facilities per 500 000 individuals, ≥1 comprehensive). A cross-sectional study was undertaken of all public facilities providing EmONC in 24 districts of Bangladesh from March to October 2012. Accessibility to each facility was assessed by applying GIS to estimate the proportion of catchment population (comprehensive 500 000; basic 100 000) able to reach the nearest facility within 2 hours and 1 hour of travel time, respectively, by existing road networks. The minimum number of public facilities providing comprehensive and basic EmONC services (1 and 5 per 500 000 individuals, respectively) was reached in 16 and 3 districts, respectively. However, after applying GIS, in no district did 100% of the catchment population have access to these services. A minimum of 75% and 50% of the population had accessibility to comprehensive services in 11 and 5 districts, respectively. For basic services, accessibility was much lower. Assessing only the number of EmONC facilities does not ensure universal coverage; accessibility should be assessed when planning health systems. © 2017 International Federation of Gynecology and Obstetrics.

  8. Second performance assessment iteration of the Greater Confinement Disposal facility at the Nevada Test Site

    Energy Technology Data Exchange (ETDEWEB)

    Baer, T.A.; Emery, J.N. [GRAM, Inc., Albuquerque, NM (United States); Price, L.L. [Science Applications International Corp., Albuquerque, NM (United States); Olague, N.E. [Sandia National Labs., Albuquerque, NM (United States)

    1994-04-01

    The Greater Confinement Disposal (GCD) facility was established in Area 5 at the Nevada Test Site for containment of waste inappropriate for shallow land burial. Some transuranic (TRU) waste has been disposed of at the GCD facility, and compliance of this disposal system with EPA regulation 40 CFR 191 must be evaluated. We have adopted an iterative approach in which performance assessment results guide site data collection, which in turn influences the parameters and models used in performance assessment. The first iteration was based upon readily available data, and indicated that the GCD facility would likely comply with 40 CFR 191 and that the downward flux of water through the vadose zone (recharge) had a major influence on the results. Very large recharge rates, such as might occur under a cooler, wetter climate, could result in noncompliance. A project was initiated to study recharge in Area 5 by use of three environmental tracers. The recharge rate is so small that the nearest groundwater aquifer will not be contaminated in less than 10,000 years. Thus upward liquid diffusion of radionuclides remained as the sole release pathway. This second assessment iteration refined the upward pathway models and updated the parameter distributions based upon new site information. A new plant uptake model was introduced to the upward diffusion pathway; adsorption and erosion were also incorporated into the model. Several modifications were also made to the gas phase radon transport model. Plutonium solubility and sorption coefficient distributions were changed based upon new information, and on-site measurements were used to update the moisture content distributions. The results of the assessment using these models indicate that the GCD facility is likely to comply with all sections of 40 CFR 191 under undisturbed conditions.

  9. Association Between Remoteness to a Health Care Facility and Incidence of Ambulance Calls in Rural Areas of Japan

    Directory of Open Access Journals (Sweden)

    Saori Kashima

    2015-07-01

    Full Text Available Objectives: Whether traffic remoteness from health care service in rural areas influences usage of ambulance service has not been well investigated. This study aimed to evaluate the relation between remoteness to health care facilities and incidence of ambulance calls in rural areas of Japan. Methods: We analyzed 155 rural communities of Hiroshima. Data were obtained on all ambulance dispatches from 2010 to 2012. Driving time was calculated from each community to the closest primary/secondary and tertiary health care facility (equivalent to tertiary emergency care centers. We estimated the incidence rate and the incidence rate ratio (IRR of ambulance calls for each 10-minute increase in the driving time, using generalized log-linear regression models, and evaluated the effect among each specific subgroup of emergency level and season. Results: During the study period, the median incidence rate was 436 per 10 000 people in targeted communities. When driving time to the closest primary/secondary facility increased by an increment of 10 minutes, there was a significant increase in the IRR of ambulance calls, especially during colder seasons (IRR: 1.29 [95% confidence interval: 1.11-1.49], and this relation was also obtained for most emergency levels. In comparison, there was no such increase in IRRs observed for driving time to a tertiary facility. Conclusion: This study indicated a positive association between remoteness to primary/secondary medical facilities and the frequency of ambulance calls. The remoteness to a primary/secondary health care may induce an increase in ambulance calls, particularly during cold seasons.

  10. Intention of use of long-term care facilities and home support services by Chinese-Canadian family caregivers.

    Science.gov (United States)

    Lai, Daniel W L

    2008-01-01

    One common myth about ethno-cultural minority family caregivers is that they do not use formal services. This study examined the intention of using home support and long-term care facilities by a random sample of 339 Chinese-Canadian family caregivers, using a modified version of the Andersen-Newman service utilization model. Filial piety, caregiving burden, care receivers, and health conditions are the common predictors identified. Filial obligation is most likely manifested through facilitating the care receivers to make use of the services needed, particularly for caregivers who reported a high level of caregiving burden.

  11. Laser performance upgrade for precise ICF experiment in SG-Ⅲ laser facility

    Directory of Open Access Journals (Sweden)

    Wanguo Zheng

    2017-09-01

    Full Text Available The SG-Ⅲ laser facility (SG-Ⅲ is the largest laser driver for inertial confinement fusion (ICF researches in China, which has 48 beamlines and can deliver 180 kJ ultraviolet laser energy in 3 ns. In order to meet the requirements of precise physics experiments, some new functionalities need to be added to SG-Ⅲ and some intrinsic laser performances need upgrade. So at the end of SG-Ⅲ's engineering construction, the 2-year laser performance upgrade project started. This paper will introduce the newly added functionalities and the latest laser performance of SG-Ⅲ. With these function extensions and performance upgrade, SG-Ⅲ is now fully prepared for precise ICF experiments and solidly paves the way towards fusion ignition.

  12. Reduction of femoral fractures in long-term care facilities: the Bavarian fracture prevention study.

    Directory of Open Access Journals (Sweden)

    Clemens Becker

    Full Text Available BACKGROUND: Hip fractures are a major public health burden. In industrialized countries about 20% of all femoral fractures occur in care dependent persons living in nursing care and assisted living facilities. Preventive strategies for these groups are needed as the access to medical services differs from independent home dwelling older persons at risk of osteoporotic fractures. It was the objective of the study to evaluate the effect of a fall and fracture prevention program on the incidence of femoral fracture in nursing homes in Bavaria, Germany. METHODS: In a translational intervention study a fall prevention program was introduced in 256 nursing homes with 13,653 residents. The control group consisted of 893 nursing homes with 31,668 residents. The intervention consisted of staff education on fall and fracture prevention strategies, progressive strength and balance training, and on institutional advice on environmental adaptations. Incident femoral fractures served as outcome measure. RESULTS: In the years before the intervention risk of a femoral fracture did not differ between the intervention group (IG and control group (CG. During the one-year intervention period femoral fracture rates were 33.6 (IG and 41.0/1000 person years (CG, respectively. The adjusted relative risk of a femoral fracture was 0.82 (95% CI 0.72-0.93 in residents exposed to the fall and fracture prevention program compared to residents from CG. CONCLUSIONS: The state-wide dissemination of a multi-factorial fall and fracture prevention program was able to reduce femoral fractures in residents of nursing homes.

  13. Abuse and discrimination towards indigenous people in public health care facilities: experiences from rural Guatemala.

    Science.gov (United States)

    Cerón, Alejandro; Ruano, Ana Lorena; Sánchez, Silvia; Chew, Aiken S; Díaz, Diego; Hernández, Alison; Flores, Walter

    2016-05-13

    Health inequalities disproportionally affect indigenous people in Guatemala. Previous studies have noted that the disadvantageous situation of indigenous people is the result of complex and structural elements such as social exclusion, racism and discrimination. These elements need to be addressed in order to tackle the social determinants of health. This research was part of a larger participatory collaboration between Centro de Estudios para la Equidad y Gobernanza en los Servicios de Salud (CEGSS) and community based organizations aiming to implement social accountability in rural indigenous municipalities of Guatemala. Discrimination while seeking health care services in public facilities was ranked among the top three problems by communities and that should be addressed in the social accountability intervention. This study aimed to understand and categorize the episodes of discrimination as reported by indigenous communities. A participatory approach was used, involving CEGSS's researchers and field staff and community leaders. One focus group in one rural village of 13 different municipalities was implemented. Focus groups were aimed at identifying instances of mistreatment in health care services and documenting the account of those who were affected or who witnessed them. All of the 132 obtained episodes were transcribed and scrutinized using a thematic analysis. Episodes described by participants ranged from indifference to violence (psychological, symbolic, and physical), including coercion, mockery, deception and racism. Different expressions of discrimination and mistreatment associated to poverty, language barriers, gender, ethnicity and social class were narrated by participants. Addressing mistreatment in public health settings will involve tackling the prevalent forms of discrimination, including racism. This will likely require profound, complex and sustained interventions at the programmatic and policy levels beyond the strict realm of public

  14. Medication errors in residential aged care facilities: a distributed cognition analysis of the information exchange process.

    Science.gov (United States)

    Tariq, Amina; Georgiou, Andrew; Westbrook, Johanna

    2013-05-01

    Medication safety is a pressing concern for residential aged care facilities (RACFs). Retrospective studies in RACF settings identify inadequate communication between RACFs, doctors, hospitals and community pharmacies as the major cause of medication errors. Existing literature offers limited insight about the gaps in the existing information exchange process that may lead to medication errors. The aim of this research was to explicate the cognitive distribution that underlies RACF medication ordering and delivery to identify gaps in medication-related information exchange which lead to medication errors in RACFs. The study was undertaken in three RACFs in Sydney, Australia. Data were generated through ethnographic field work over a period of five months (May-September 2011). Triangulated analysis of data primarily focused on examining the transformation and exchange of information between different media across the process. The findings of this study highlight the extensive scope and intense nature of information exchange in RACF medication ordering and delivery. Rather than attributing error to individual care providers, the explication of distributed cognition processes enabled the identification of gaps in three information exchange dimensions which potentially contribute to the occurrence of medication errors namely: (1) design of medication charts which complicates order processing and record keeping (2) lack of coordination mechanisms between participants which results in misalignment of local practices (3) reliance on restricted communication bandwidth channels mainly telephone and fax which complicates the information processing requirements. The study demonstrates how the identification of these gaps enhances understanding of medication errors in RACFs. Application of the theoretical lens of distributed cognition can assist in enhancing our understanding of medication errors in RACFs through identification of gaps in information exchange. Understanding

  15. Evaluation of Antidiabetic Prescriptions from Medical Reimbursement Applications at Banaras Hindu University Health Care Facility

    Directory of Open Access Journals (Sweden)

    Dev Priya

    2015-10-01

    Full Text Available Background: Diabetes is on rapid increase in third world countries undergoing rapid transition in terms of development particularly in India, which is often being referred as Diabetic capital. It is a disease more prevalent at latter part of life of human beings when finances dwindle and social care gets neglected. The medication continues till the whole life on a regular basis. In present study, the objective has been to provide pharmacoeconomic medication to the diabetic pensioners in the backdrop as mentioned in above background.Methods: The data was collected at the medical reimbursement section of pensioners of the University. The data was examined to answer issues of therapeutic decisions in the light of the pharmacoeconomic considerations. In this paper essentially data on choice of prescriptions with the angle of pharmacoeconomic prudence were included. The dichotomy of specialist versus non specialist prescribers at the tertiary center (i.e. medical college hospital was compared. Effort was made to define merit of the prescription based on comprehensive considerations of patient profile, disease profile and therapeutic choice.Results: Total 72 prescriptions were analyzed for the study in which 475 drugs were prescribed to the patients.  Total antidiabetic drugs prescribed to the patients were 169. Out of 72 cases 39 were males and 33 were females with mean age 66.04 ± 5.80 (Mean ± SEM. The average number of drugs per prescription was 6.59 which was very high as per guidelines. Most commonly prescribed antidiabetic drug was Metformin (63.89% followed by Glimepiride (31.95%.Conclusion: This study reflects that there is need to make available the standard therapeutic optionat University Health Care Facility based upon pharmacoeconomic considerations.

  16. Brucellosis is not a major cause of febrile illness in patients at public health care facilities in Binh Thuan Province, Vietnam

    NARCIS (Netherlands)

    Nga, Tran T. T.; de Vries, Peter J.; Abdoel, Theresia H.; Smits, Henk L.

    2006-01-01

    To determine the presence of brucellosis among patients with acute febrile illness at health care facilities in Binh Thuan province, Vietnam. A retrospective seroepidemiological study on serum samples collected at 13 not adjacent health care facilities using the Rose Bengal test as a rapid screening

  17. Epidemiology and resistance patterns in urinary pathogens from long-term care facilities and GP populations.

    LENUS (Irish Health Repository)

    Brabazon, E D

    2012-06-01

    Urinary tract infections (UTIs) are a major source of antimicrobial prescribing in the clinical setting and a potential reservoir for the emergence of resistant organisms. Although studies have been published on resistance rates for urinary pathogens from both hospital and general practitioner (GP) settings, there is little information from Long-Term Care Facilities (LTCFs) in Ireland. This study aimed to document the epidemiology and resistance rates in urinary isolates, in the LTCF and GP setting, from samples submitted to a typical microbiology laboratory. In 2010, there were 963 urinary isolates from LTCFs and 1,169 urinary isolates from GPs, identified from patients 65 years and over, with cytology suggestive of infection. E. coil was the most common causative organism identified. There were significantly higher levels of resistance to ampicillin, co-amoxiclav, ciprofloxacin, nitrofurantoin, trimethoprim, and piperacillin\\/tazobactam in the LTCF population compared to the GP population (e.g. for E. coli, 86%-v-69%; 30%-v- 21%; 58%-v-26%, 10%-v-3%, 68%-v-48%, 10%-v- 4% respectively). Isolates with resistance mechanisms to beta-lactams, were identified in both populations. Results presented in this paper demonstrate significant differences between resistance rates in LTCF and GP populations which suggest that there are implications for empiric antimicrobial prescribing for UTIs in the LTCF setting.

  18. Norovirus Disease in Older Adults Living in Long-Term Care Facilities: Strategies for Management.

    Science.gov (United States)

    Chen, Yingxi; Hall, Aron J; Kirk, Martyn D

    2017-01-01

    Noroviruses are the most common cause of gastroenteritis outbreaks in long-term care facility (LTCFs). This review summarizes the most up-to-date knowledge on norovirus infection in LTCFs with the aim of identifying potential strategies for management. LTCF residents are at greater risk of norovirus infection. Early identification of norovirus infection and prompt initiation of appropriate supportive therapy are required to reduce morbidity and mortality. Measures to prevent outbreaks and reduce the risk of norovirus infection in LTCFs include timely diagnosis and implementation of infection control interventions to limit virus transmission. Current guidelines for prevention and control are based on generic principles of infection control. Real-time reverse transcription-quantitative polymerase chain reaction assays have been the gold standard for the rapid and sensitive detection of noroviruses. With the recent breakthroughs of human norovirus in vitro culture, doors are now opened to evaluate the efficacy of environmental disinfectants and hand hygiene options. Additionally, development of licensed vaccines against noroviruses may provide another important tool for infection prevention among high-risk individuals.

  19. Outbreaks of influenza-like illness in long-term care facilities in Winnipeg, Canada.

    Science.gov (United States)

    Mahmud, Salaheddin M; Thompson, Laura H; Nowicki, Deborah L; Plourde, Pierre J

    2013-11-01

    Outbreaks of influenza-like illness (ILI) are common in long-term care facilities (LTCFs) and result in significant morbidity and mortality among residents. We describe patterns of reported ILI outbreaks in LTCFs in Winnipeg, Canada, and examine LTCF and outbreak characteristics that influence the clinical outcomes of these outbreaks. We analyzed the electronic records of all ILI outbreaks reported by LTCFs in Winnipeg from 2003 to 2011. Outbreak duration, ILI attack rates among staff and residents, and residents' death rates were calculated by presumed viral etiology, staff vaccination rates, type of influenza chemoprophylaxis used, and time to notification to public health. Of a total of 154 reported outbreaks, most (N=80) were attributed to influenza, and these outbreaks tended to have higher attack and death rates among LTCF residents compared with outbreaks caused by other respiratory viruses (12) or those of unknown etiology (62). About 92% of residents and 38% of staff of the average LTCFs were vaccinated. Chemoprophylaxis was used in 57·5% of influenza outbreaks. Regardless of presumed viral etiology, outbreaks reported within 3 days of onset ended sooner and had lower attack and mortality rates among residents. Influenza-like illness outbreaks still occur among highly immunized LTCF residents, so in addition to vaccination of staff and residents, it is important to maintain competent infection control practices. Early identification and notification to public health authorities and possibly early initiation of control measures could improve clinical outcomes of ILI outbreaks. © 2012 John Wiley & Sons Ltd.

  20. [An outbreak of Hemophylus influenzae infection among residents in an insurance care facility for the elderly].

    Science.gov (United States)

    Onouchi, Zenshiro; Yamaki, Tarumi; Matsui, Michinori

    2008-07-01

    To study the epidemics of the hemophilus influenzae (HI) infection in the summer, 2005 among 46 residents in the second floor of our insurance care facility, Mam Cuore. The spreading pattern of HI infection, antibiotic susceptibility and serological identification of HI isolated from sputum culture were investigated, and underlying diseases, functional disorders, body weight, age, sex, ADL- and dementia-scores were compared among patients with the non-symptomatic group, HI infection and severe HI pneumonia groups. Lower ADL and body weight were noted to suffer significantly more HI infection and severe pneumonia. Furthermore, stroke patients tended to suffer more HI infection. Dementia patients suffered significantly more severe pneumonia. Residents of rooms close to the room of original patient showed symptoms earlier than patients in more distant rooms. While the numbers of patients with HI infection were 15 (60%) and 10 (40%) before and after the first isolation of HI, 5 out of 15 patients (33%) and one out of 10 patients (10%) progressed to severe pneumonia, respectively. Although these results did not have statistical significance, they suggests that rapid assessment and therapy of HI infection tended to prevent aggravation. Non-typeable strains were detected and were all beta-lactamase nonproducing ampicillin resistant (BLNAR) without susceptibilities to cefaclor (CCL) and cefdinir (CFDN). Preceding the epidemic, an outbreak of the common cold syndrome was recognized. Assessing elderly patients suspected of the HI infection, and organized management for treatment are essential to improving outcome.